Proceedings, 2023, FENS 2023

Thinness is used to denote low BMI in children and may be a marker of undernutrition. However, despite prevalence rates of up to 10%, thinness in children is highly overlooked in high-income countries, and we have little knowledge about the diet and nutrient status among these children. We investigated if dietary intake and biomarkers of nutrient status, including iron, n-3 LCPUFA and vitamin D, differed in Danish schoolchildren with thinness compared to children with normal and overweight. We also investigated if intakes of important micronutrients were adequate across weight groups. We used cross-sectional data from 815 Danish 8–11-year-old children collected during the period August–November 2011. Measurements included 7-day dietary records, anthropometry and analysis of nutritional biomarkers in fasting blood samples. We defined thinness using the age- and sex-specific IOTF BMI cut-offs. In total, 10.2% of the children had thinness (boys: 8.9%; girls: 11.6%). These children had lower intake of energy, protein and red meat and higher intake of added sugar compared to children with normal and overweight. Thinness was also associated with higher fish intake compared to overweight, but we found no group differences in whole-blood EPA+DHA. Furthermore, thinness was associated with lower intake of iron and zinc than the other groups and lower intake of selenium versus normal weight, but with no group differences in iron biomarkers, serum ferritin or hemoglobin. The proportions of children with adequate intake of zinc and selenium were lower in the thin (56.5% and 50.7%) compared to the normal-weight children (72.5% and 63.9%) (p < 0.05), but the intake of these micronutrients as well as vitamin B12 and calcium were generally high across all weight groups. In contrast, intake of vitamin D and iron were low across groups, and there were no group differences in serum 25(OH)D. Danish children with thinness had different dietary intake than children with normal and overweight, but thin children did not generally have a poorer diet than normal-weight children. We also found comparable nutrient status and intakes of important micronutrients except for iron, zinc and selenium, which were lower in thin children and should be explored further. Full article

Harmonized and standardized collection, processing, and analysis of individual dietary data is essential for nutrition assessment and informed policy decision making. To underpin the harmonization of food consumption data collection methodologies and the development of a common, comprehensive European food consumption database, the European Food Safety Authority (EFSA) supported 36 child and/or adult dietary surveys in 18 EU Member States and four Balkan pre-accession countries through the EU Menu Project. Given the lack of relevant and harmonized research and data on food and nutrition in the Balkan region, CENM-IMR and CAPNUTRA scientists focused their activities on capacity building in nutrition research, particularly on the creation of a contemporary, harmonized research infrastructure (RI) that meets European standards. The EFSA EU Menu methodology has been implemented in the Balkans through the adaptation and use of an innovative, comprehensive tool for the standardized collection of food consumption and dietary intake assessment data, the Diet Assess and Plan (DAP). DAP has the essential features of an RI needed to strengthen public health surveillance, monitoring, evaluation, and nutrition research; this is a unique example of a standardized and harmonized tool for assessing dietary intake, i.e., collecting data on food and nutrition in the Balkan region and beyond. It is a concurrent tool for large-scale nutritional epidemiological studies and represents one of the new technologies for dietary intake assessment. National dietary surveys were conducted from 2017 to 2023 among adults aged 10 to 74 years (in Bosnia and Herzegovina, Montenegro, and Serbia) and children aged three months to nine years (in Montenegro, North Macedonia, and Serbia). The collected data on food consumption are internationally comparable with other European countries under the EU Menu Program. The data collected will be used for dietary and exposure risk assessment, establishment of national nutrient reference values, as a basis for the development of food-based dietary guidelines, a tool to provide evidence and infrastructure for public health nutrition policy decisions, and for tailored pathways to transform the food system in the Balkans towards a more nutrition-sensitive and sustainable system. Full article

Due to the outbreak of the new coronavirus disease, many lifestyle alterations occurred. Changes in eating habits and contributing factors during the COVID-19 pandemic were examined. A cross-sectional anonymous online survey was conducted among students from the Faculty of Medicine, Comenius University in Bratislava, during November–December 2022. The data were statistically analysed using IBM SPSS Statistics, version 25. The study population consisted of 783 students; the mean age was 22.7 ± 2.7 years; 68.1% studied in the Slovak language; 67.0% of respondents were female. Out of these, eating habits did not change for the majority of students in the study sample (53.1%) (Slovaks 52.6% vs. foreigners 54.0%; males 53.0% vs. females 53.1%); consumption of alcoholic beverages did not change compared to pre-pandemic period for 54.3% of students, the rest of students decreased (30.6%) or increased (15.1%) consumption; energy drinks consumption remained unchanged for 69.6% students; coffee intake stayed stable for 48.3%, whereas 43.8% increased their coffee consumption, while 7.8% drank less coffee, without any statistically significant difference between the subgroups. The level of physical activity (frequency, intensity, duration) changed with a significant difference between Slovak and foreign students (p = 0.038), more foreign students decreased their level of physical activity compared to Slovaks (42.3% vs. 33.8%). We also recorded body weight changing during the pandemic, with a statistically significant difference between men and women (p = 0.009); 14.3% of men vs. 22.9% women decreased, while 34.7% of men and 27.3% of women increased their body weight. The results showed some changes in the dietary habits and other lifestyle factors during the pandemic among medical students. Future healthcare providers will play key roles in health promotion and disease prevention, and they should serve as role models for their patients and the general public as well. Full article

Given our current knowledge and insights into the nature of nutrition, a simplistic approach to understanding the role of nutrition in relation to health outcomes appears insufficient as a scientific base for setting nutrition policies. To raise this issue, we performed a scoping review to evaluate the relationship between sugar intake, quality of life (QoL), and well-being in children and adolescents. Sugar was selected as it is an essential part of many different foods and dietary patterns. Its consumption is motivated by various aspects, such as social relationships, economic status, individual habits, and taste preferences. Childhood and adolescence are important periods in the life span influencing individual dietary habits and taste preferences but have been overlooked. We developed a framework and performed a structured literature search for articles published in English between 2001 and 2023 in three databases (Pubmed, Scopus, and Web of Science). This search resulted in 21 full-text eligible papers with highly heterogeneous exposure and outcome measures. Most studies found a negative association between the intake of sugar, sugar-sweetened beverages, or sweets, and various QoL outcomes, including food insecurity, sleep and sleep-related outcomes, and (oral) health-related QoL. This scoping review showed that the inclusion of more varied endpoints than only non-communicable diseases or caries could add more dimensions to the evidence underlying the association between sugar and health. The application of interdisciplinary approaches considering more aspects of sugar intake could give a more holistic view of nutrition when considering dietary recommendations or developing dietary policies, especially for children. Full article

The Serbian National Food Consumption Survey on adults from 10 to 74 years old, including pregnant women and vegetarians, was conducted in compliance with the EFSA EU Menu project support and guidance from 2017 to 2022. Valid data were collected from a total of 3018 participants with 856 adolescents aged 10 to 17 years, 1155 adults aged 18 to 64, 581 elderly subjects aged 65 to 74 years, 145 pregnant women, and 281 persons following a vegetarian diet. Data collection was conducted using a national Survey Pack designed for the project, including the following: a general questionnaire, an age-appropriate Food Propensity Questionnaire, an International Physical Activity Questionnaire, and 24 h dietary recall. The advanced nutritional platform Diet Assess and Plan (DAP) was applied for data storage, processing, and the creation of the final dataset for transfer to EFSA. The Serbian food composition database was used and updated during the project as a resource of food information for all foods and recipes that were consumed by the study cohort. Regardless of age and gender category, the majority (56%) of adults had normal weight according to the Body Mass Index, while 21% were overweight, and 15.5% were underweight. The average daily energy intake was 2178.72 kcal, while overall contributions of carbohydrates, protein, and fat to the total energy intake were 43.37%, 15.47%, and 41.16%, respectively. The proportions of macronutrient intake deviated from the dietary reference values, particularly for fat, which was often too high, where sunflower oil was the major source of fat in diets. Out of the 3018 participants, 98% had breakfast, 99% had lunch, and 95% had dinner, while approx. 80% had snacks between main meals. The highest energy intake was recorded during lunch, 706.5 kcal (32% TE). The survey results provide valuable insight into the nutritional status and dietary habits of adults from 10 to 74 years old living in Serbia. The Serbian food consumption database serves as an evidence platform for decision-making processes in public health nutrition policies and strategies, diet monitoring, exposure risk assessments, and interventions targeting identified nutritional challenges in particular population groups. Harmonized data are part of the EFSA comprehensive food consumption database. Full article

Quality-proven Digital Health Applications (DiGAs) or “apps on prescription” in Germany extend obesity treatment options. This 24-week single-center randomized controlled trial aimed to examine the weight-lowering effect of an evidence-based multimodal weight loss intervention program delivered by a DiGA. Methods: Adults with a body mass index (BMI) between 30.0 and 40.0 kg/m² were randomized. In the first 12 weeks, participants either received the app (ADHOC group) or were asked to maintain their current lifestyle (EXPECT group). In the second 12 weeks, the ADHOC group were invited to continue app use and the EXPECT group started with the app intervention. At three visits (baseline, after 12, and 24 weeks), anthropometric variables were measured and quality of life, app usage, and user acceptance were collected by questionnaires (Euroquol, Technology Acceptance Model 3, System Usability Scale). A total of 168 participants (age: 46.8 ± 11.0 years, BMI: 34.2 ± 2.8 kg/m², 64.3% women) were included. The total adherence rates were 82.7% after 12 weeks and 67.3% after 24 weeks. After 12 weeks, the ADHOC group showed a mean weight loss of 3.2 ± 3.0% and the EXPECT group a mean weight loss of 0.3 ± 2.6% with a statistically significant difference between the groups (p < 0.001, completers analysis). At the 12-week follow-up, the ADHOC group maintained body weight (weight loss after 24 weeks: 3.1 ± 4.5%, completers analysis), whereas the EXPECT group—starting with the app intervention—lost weight. The investigated multimodal intervention program delivered by a DiGA resulted in a significant and clinically meaningful short-term weight loss with weight maintenance for a further three months. Full article

Adherence to the Mediterranean diet (MD) has been shown to promote health and reduce the prevalence of several chronic diseases. However, to date, more and more countries in the Mediterranean basin seem to be moving away from their traditional eating habits, including Italy. Therefore, the aim of this study was to investigate adherence to the MD and the consumption of its food groups in a large sample of Italian adults. After the removal of duplicates, the study sample comprised 10,916 questionnaires, of which 7088 were completed by women (65%) and 3828 by men (35%). The dietary intake of each food group component in the questionnaire was estimated by multiplying the frequency by the portion size. The mean Medi-Lite score was 12 ± 2.5, suggesting a moderate level of MD adherence, with a significantly (p < 0.05) higher level of adherence observed in women and older subjects. The analysis of the consumption of the individual food groups showed a consumption behavior in line with the national dietary recommendations of fruit (342 g/day), pasta (96 g/day), white meat (302 g/week) and fish (296 g/week). On the other hand, a low consumption of vegetables (270 g/day), bread (85 g/day), legumes (233 g/week) and milk and dairy products (187 g/day) emerged. In addition, the consumption of red meat (209 g/week) was observed to be twice as high as the national guidelines. Subgroup analysis showed that women and the elderly consumed significantly (p < 0.001) more fruit, vegetables, and bread and less meat and meat products than did men and younger subjects. Upon a logistic regression analysis adjusted for possible confounding factors, women showed an increased probability (OR 1.34, 95%CI 1.22–1.46; p < 0.001) of being in the highest MD adherence tertile (i.e., Medi-Lite score > 11). Although the sample reported moderate adherence to MD, the consumption of some typically Mediterranean food groups such as vegetables, legumes and bread is still low, while the consumption of red meat is high. Full article

Background and objectives: Regular moderate exercise is considered a protector against chronic inflammatory diseases. Intense exercise causes a significant release of pro-inflammatory cytokines and free radicals depending on exercise intensity and duration. The aim of this study was to investigate the effects of antioxidant supplementation on parameters of immunity and inflammation in athletes. Methods: The study included 14 elite rowers (group 1) and 10 recreational athletes (group 2). All participants were supplemented with 500 mg/day (500 IU SOD) plant-origin superoxide dismutase (GliSODin®) during a 6-week pre-competition microcycle preparation period (rowers, 120 min training/6 days weekly; recreational athletes, 60 minutes training/3 days weekly). Venous blood samples were taken in the morning after a 24-hour resting period. White blood cell (WBC) and its subpopulation count were determined using an AcT Diff Hematology Analyzer (Beckman Coulter, Inc., Brea, CA, USA) and CRP concentration using the biochemistry analyzer Olympus AU400 (Beckman Coulter, Inc., Brea, CA, USA) at the Faculty of Pharmacy, University of Belgrade. Selected cytokines IL-4, IL-6, IL-8, and IL-10 were measured by hs ELISA kits (R&D Systems). All data were analyzed using nonparametric tests (Mann–Whitney U test, Kruskal–Wallis test). Results: WBCs and their subpopulation were all in the reference range in both groups before and after supplementation, without significant differences within and between groups according to tests considering supplementation. In rowers, IL-6 was significantly higher before and after supplementation (p ˂ 0.001, p ˂ 0.001 respectively), CRP was higher before supplementation (p = 0.025), and IL-10 was higher at initial and final testing (p = 0.030, p = 0.040 respectively). In the recreational group, IL-8 and IL-4 were higher at both measuring points (p ˂ 0.001 and p ˂ 0.01 respectively). Observing changes in variables within the groups, there was a significantly decreased level of IL-6 (p = 0.019) and increased level of IL-4 (p = 0.001) in rowers and a higher IL-4 level in the recreational group (p = 0.059) after supplementation. Discussion: The results of this investigation indicate that there are positive effects of Glisodin supplementation on parameters of inflammation (decreased IL-6, increased IL-4), especially in highly trained rowers, who are more prone to exercise-related oxidative stress. More studies including a greater number of participants are necessary to confirm the influence of antioxidant supplementation on immunity and inflammation in athletes. Full article

There is a growing consumer interest and public health mandate to reduce sugar intake, and an increased iimpetus to innovate in the food sector to develop new and more acceptable sweeteners and sweetness enhancers (S&SEs) as low- or non-calorific replacements for sugar. Within the European context, S&SEs are subject to stringent risk assessment and regulatory framework to permit new S&SEs in the European market. There has been a long-standing debate about the role of regulation in facilitating or slowing down innovation processes. The aim of this study is to examine the S&SE regulation and risk governance framework, with a specific focus on the implementation of the precautionary principle to assess its perceived impact on the food industry’s ability to innovate. We conducted six semi-structured interviews with food industry applicants for new and novel S&SE approval. The study results indicate that the legislation is achieving its primary aims of harmonising the approval process, ensuring consumer safety, and contributing to the public health policies of the EU. However, there are several barriers to innovation associated with the regulatory framework, including the application of the precautionary principle and the burden-of-proof requirement facing the industry. The barriers are particularly relevant to small and medium organisations who have limited resources to accommodate these uncertainties. An open dialogue between business operatives and risk assessors would be an important step towards raising this awareness and addressing the uncertainties within the process. Full article

Background and objectives: Food balance sheets (FBSs) provide comprehensive annual information on a country’s food supply, reflecting possible trends in a population’s overall food consumption. However, FBSs essentially refer to agricultural products and primary commodities, rather than foods ready to be consumed. Therefore, FBSs have only limited value for assessing the nutritional adequacy of a country’s food supply. However, certain data transformations could substantially enhance the suitability of FBSs for public health purposes, considering human and planetary health alike. Methods: Schwinglhackl et al. (2019) [1] estimated disability-adjusted life years (DALYs) attributable to the intake of food groups as well as respective theoretical minimum risk exposure levels (TMRELs). These data are translated into respective food supply using ratios of FBS data and respective nationally representative food consumption. Poore and Nemecek (2018) [2] provide data on the environmental impact of 43 agricultural products along the complete supply chain, allowing the analysis of various sustainability parameters for specific products or the entire food supply. Results: The inadequate consumption of nuts or fruits has the highest contribution to food-related DALYs (approx. 20% each), followed by fish and soft drinks (approx. 15% each), and legumes, vegetables, meat, or dairy (approx. 8% each). The average consumption of red meat exceeded the respective TMREL by a factor of 2.6, whereas the consumption of most other food products reached the TMREL only by fraction, e.g., fish and legumes: 20%, respectively, nuts: 26%, and vegetables: 49%. Animal products make up more than 75% of the greenhouse gas emissions attributable to the food sector (red meat: 28%, dairy: 30%, butter: 10%, poultry, fish, and eggs together: 8%). The situation is quite similar when considering freshwater use. Discussion: Despite serious methodological limitations of FBS data, they can provide a valuable basis for defining public health nutrition goals. Clearly, human and planetary health would both benefit from a drastic reduction in meat consumption and a sincere endeavor to replace animal products with plants. Full article

Background: Micronutrient deficiency is also referred as hidden hunger, and it increases the global disease burden. Adolescent girls need nutritional care, and their poor dietary intake leads to micronutrient deficiency and poor maternal outcomes. Therefore, there is an urgent need to assess the micronutrient intake among adolescent girls to plan and promote healthy eating behavior and break the malicious cycle of intergenerational malnutrition. Objective: To assess the micronutrient adequacy and associated factors among school-going adolescent girls. Methodology: A school-based, cross-sectional study was conducted among 300 adolescent girls in the suburban area of Navi Mumbai, Maharashtra, India. A simple random-sampling technique was used to select the study participants. A structured questionnaire was used to assess sociodemographic profiles and other factors. The heights and weights of the participants were measured through a standardized method, and their BMI was calculated. Their dietary intake was assessed by taking 24-h recall for three consecutive days, including the weekend. Nutrient adequacy was assessed as the amount of nutrients per 1000 kcal of the participants’ diet that met the critical nutrient density, and it was compared to the observed nutrient densities of the adolescent girls. The data were analyzed using the SPSS software version 24. Independent t, Pearson’s correlation, and chi-squared tests were used to assess the difference and association between micronutrient densities and different variables. Results: For most micronutrients (iron, calcium, zinc, vitamin A, vitamin D, thiamin, riboflavin, niacin, folic acid, vitamin B12, and vitamin C) the observed density was less than that recommended, meaning intake was inadequate. The mean densities of vitamin A, vitamin B12, iron, calcium, and potassium were significantly (p < 0.05) associated with age, BMI, dietary diversity scores, socioeconomic status, and body image concern. Conclusion: The findings of this study revealed that micronutrient intake inadequacy among adolescent girls is a public health problem in the study area. Therefore, interventions should be planned with a focus on nutrition-sensitive activities to increase diet diversification and nutrition security among adolescent girls. Full article

Background: Front-of-package nutrition labelling (FOPNL) is an important public health tool for promoting healthier food choices. Therefore, the European Commission has committed to proposing harmonised mandatory FOPNL in Europe. A relevant option for this harmonisation is Nutri-Score (NS), which, however, has been subject to some criticism about its alignment with nutritional recommendations. As a result, the Scientific Committee of the NS published two reports in 2022 and 2023, updating the NS algorithm. The aim of our study was to exploit differences between previous (NS2021) and updated (NS2023) algorithm, using foods from Slovenian food supply. Methods: A total of 19,510 branded foods/drinks from the 2020 Slovenian food supply database were profiled using NS2021 and NS2023. We focused on comparing the distribution of each grade and the discriminatory ability between NS2021 and NS2023, while identifying products that were most affected by the NS2023 changes. We also examined changes in alignment with Slovenian nutritional recommendations based on nationally adapted WHO Europe nutrient profile (WHOE). Results: The results show that both NS2021 and NS2023 have good discriminatory ability, with NS2023 being slightly better in 12 sub-categories. Overall, NS2023 was stricter, with E being the most common grade (32%), whereas NS2021 predominantly assigned a grade of D (28%). While the overall proportion of products with grade C remained almost unaffected, there was a notable decrease in “healthier” products graded A or B, from 30% (NS2021) to 23% (NS2023). NS2023 was stricter than NS2021 in almost all main categories, except for beverages and eggs. Alignment with the WHOE profile was moderate (κ = 0.59) for NS2021 and strong (κ = 0.65) for NS2023. Alignment was improved especially for edible oils and emulsions, fruits and vegetables, and snack foods. Discussion: NS2023 was shown to be stricter and more aligned with recommendations than NS2021. The updated NS2023 addressed limitations such as better grading of cooking oils (especially olive oil), higher penalisation of high sugar and salt content, lower grading of beverages with non-nutritive sweeteners, and slight modifications for nuts and cheeses. This study gives first insights into how the update of the NS algorithm works on real-life data and can support policymakers in the implementation of harmonised FOPNL in Europe. Full article

Background: Vegan diets have recently gained popularity in Switzerland and abroad. A method to evaluate the diet quality of the vegan population for research and clinical practice is currently not available. Therefore, the aim of the present study was to develop a diet quality score for vegans (DQS-V) based on the Swiss dietary recommendations for vegans. Methods: The dataset included 52 healthy vegan adults. Dietary intake data were assessed using three-day weighed food records. Body weight and height were measured, and a venous blood sample for the analysis of vitamin and mineral status was collected. Spearman rank correlation coefficients were used due to the presence of not-normally distributed data. Dietary patterns were identified using principal component analysis (PCA). Results: The DQS-V score (mean ± SD) was 48.9 ± 14.7. Most vegans adhered to the recommended portions of vegetables, vitamin C-rich vegetables, fruits, omega 3-rich nuts, fats and oils, and iodised salt. However, the intake of green leafy vegetables, vitamin C-rich fruits, wholegrains, legumes, nuts and seeds, selenium-rich nuts, zero caloric liquid, and calcium-fortified foods was suboptimal. The intake of sweet-, salty-, fried foods and alcohol was higher than reccomended. The DQS-V had a significantly positive correlation with intakes of fibre, polyunsaturated fatty acids, potassium, zinc, and phosphorus (p’s < 0.05) but was negatively correlated with vitamin B12 and niacin intakes (p’s < 0.05). Two dietary patterns were derived from PCA: (1) refined grains and sweets and (2) wholegrains and nuts. The correlation between the DQS-V and the first dietary pattern was negative (−0.41, p = 0.004), but positive for the second dietary pattern (0.37, p = 0.01). The dietary pattern of refined grains and sweets was inversely correlated with the beta-carotene status (−0.41, p = 0.004) and the vitamin C status (r = −0.51, p = 0.0002). Conclusion: The newly developed DQS-V, based on the Swiss dietary recommendations for vegans, provides a single score for estimating the diet quality among vegan adults. Further validation studies examining the correlation of DQS-V with an independent dietary assessment method and with the biomarkers of nutritional intake and status are still needed before the general use of the DQS-V score. Full article

Nutrition, as a science, is facing challenges. While issues regarding obesity, chronic diseases, and sustainability are becoming more pressing, nutrition science is encountering limitations regarding novel insights, trust, and social relevance. In order to move forward, we need to innovate the field and explore new perspectives. Current nutrition research has mainly employed a reductionist approach, which has been very successful in the past. However, reductionism shows limitations when addressing the problems we face today. The addressed weaknesses of reductionism include (1) the questionable assumption that nutrients and calories are exchangeable between foods, (2) the tendency of reductionism to oversimplify reality, which has consequences for complex concepts such as health and nutrition, and (3) the focus on details, which could undermine the aim of nutrition science: creating optimal dietary guidelines for the promotion of health and prevention of disease. Holism offers an alternative perspective that could complement these limitations, on the condition that they are similar enough on an ontological and epistemological level. Holistic approaches to health appear in eastern philosophies (ayurveda), but also in modern western nutrition approaches (dietary patterns). These two holistic approaches can complement reductionism in the following ways: (1) Holistic approaches like ayurveda and dietary patterns provide different nutritional knowledge by considering multiple factors that affect food’s health potential, in addition to only nutrients and calories. Some of these factors include food processing, food matrix/structure, food combinations, food compatibility, and nutrient interaction. (2) Holism can complement the reductionistic tendency to oversimplify reality by including subjective, individual, and holistic aspects of health into nutrition research and embracing the complexity of food-chronic disease relationships. (3) Holism has the potential to improve the practical relevance and comprehensibility of nutrition science. All presented results were based on the existing literature, found in Scopus and PubMed. To conclude, this study explores how holism can complement the limitations of reductionism, and as a result, reduce the overemphasis on reductionism as a research approach, which will hopefully promote progress and inspire the future of nutrition science. Full article

Background and objectives: Diet is a modifiable risk factor of non-communicable diseases. The French dietary guidelines, updated in 2017, provide recommendations for a healthier diet. We aimed to study the association between adherence to these dietary guidelines and mortality in the E3N (Etude Epidémiologique auprès de femmes de l’Education Nationale) French cohort. Methods: We studied 72,585 women included in the E3N prospective cohort, which completed a food frequency questionnaire in 1993. Adherence to French dietary guidelines was estimated using the simplified “Programme National Nutrition Santé—guidelines score 2” (sPNNS-GS2, range: −20.4 to 12.6). We estimated the association between sPNNS-GS2 and all-cause or cause-specific mortality using Cox proportional hazard models, adjusted for age (as time-scale), BMI, physical activity, birth generation, education level, smoking status, menopausal status and recent menopausal hormone therapy use, and total energy intake. Results: During follow-up (1993–2014), we identified 6441 deaths. The mean sPNNS-GS2 was 3.8 (SD 3.0). In the fully adjusted model, we found a non-linear inverse association, with a plateau from the third quartile, between sPNNS-GS2 and all-cause (HRQ4 vs. Q1 [95%CI]: 0.79 [0.73; 0.86]), all cancers (HRQ4 vs. Q1 [95%CI]: 0.79 [0.70; 0.89]) and breast cancer (HRQ4 vs. Q1 [95%CI]: 0.73 [0.58; 0.91]) mortality. We also highlighted a non-linear U-shaped association with lung cancer mortality (HRQ3 vs. Q1 [95%CI]: 0.62 [0.45; 0.87] and HRQ4 vs. Q1 [95%CI]: 0.73 [0.52; 1.02]) and a linear inverse association with cardiovascular disease mortality (HRoneSTD [95%CI]: 0.86 [0.76; 0.97]). We observed no association with colorectal cancer mortality (HRoneSTD [95%CI]: 0.86 [0.70; 1.04]). Discussion: This study on a large prospective cohort following more than 70,000 women for over 20 years suggests that a higher adherence to the French dietary guidelines is associated with a reduced risk of mortality from all-cause cardiovascular diseases, all cancers, breast cancer and lung cancer. These results enable us to confirm the French nutritional recommendations. Finally, the reduced risk observed for various mortality outcomes is an important public health message. Full article

Background: Obesity is prevalent in young people, yet limited research explores young people’s views regarding nutrition, health, and obesity. Objectives: The aim of this study was to explore young people’s views about obesity and factors mitigating this condition. Methods: An online cross-sectional survey was distributed to UK participants aged 12–19. The survey measured views about obesity and its management (Likert scale of 1–5, 14 questions), interest in health and nutrition (Likert scale of 1–5, 2 questions), and nutrition knowledge (scored as “low” or “high” based on a threshold of giving 3 out of 6 correct answers to multiple-choice questions about nutrient sources in diet). Self-reported weight, height, and sociodemographic data were collected. Independence between variables was explored using X² tests. Results: Participants (n = 317, median age of 16, IQR15–18) were equally distributed between the two sexes (54% boys) and were mostly British (72%). Approximately one quarter (22%) had a BMI ≥ 30 kg/m² and most (61%) had a BMI < 25 kg/m². Participants had a high interest in health (median 4, IQR 4–5, 86% agreeing/strongly agreeing) and in the relationship between food, diet, and health (median 5, IQR 4–5, 83% agreeing/strongly agreeing). However, most participants (83%) had low nutrition knowledge. There was a relationship between interest in health (classified as interested/neutral/not interested) and sex (p = 0.02, 81% girls and 90% boys interested), but no relationship with BMI groups (p = 0.5). Over half (59%) agreed that obesity is a medical condition (median 4, IQR 3–4). There was a relationship between this agreement and sex (p < 0.001, 68% girls and 53% boys), but no relationship with BMI (p = 0.9) or nutrition knowledge (p = 0.9). Across the weight management options (including dieting, exercise, surgery, and medication), participants most likely agreed that combining diet and exercise is important to manage obesity (median 4, IQR 4–5, 77% agreeing/strongly agreeing). There was a relationship between this agreement and nutrition knowledge (p = 0.04, 75% among those with low knowledge and 90% among those with high knowledge), but no relationship with sex (p = 0.08) or BMI (p = 0.9). Discussion: In this sample representative of both sexes, obesity was generally recognised as a disease regardless of BMI or nutrition knowledge; however, sex played a role, with boys less likely to agree, despite their greater interest in health than girls. However, the sample’s levels of interest in health (high) and nutrition knowledge (low) were homogenous, which limited further exploration. The influences of socioeconomic status, parental occupation, and family obesity experiences need further exploration. Full article

Background and objectives: Obesity is a state of chronic low-grade inflammation, which may improve with n-3 long-chain polyunsaturated fatty acid (LCPUFA) treatment in populations with low n-3 LCPUFA status. Inflammation reduces iron bioavailability by increasing hepcidin concentrations, leading to iron sequestration in macrophages and reduced intestinal iron absorption. Therefore, the objective of this study was to investigate the effects of n-3 LCPUFA supplementation on inflammatory markers and fractional iron absorption in overweight and obese individuals with chronic low-grade inflammation and a low n-3 LCPUFA status. Methods: In a single group stable iron isotope study, overweight and obese women of African descent (n = 33) with a BMI ≥ 28 kg/m², C-reactive protein (CRP) between 2 and 20 mg/L, Hb ≥ 11 g/dL and n-3 index < 6% were supplemented with ~2 g DHA/EPA daily for 15 weeks. Inflammatory markers, hepcidin, iron status indices and erythrocyte total phospholipid fatty acid composition (% of total fatty acids) were measured at baseline and endpoint. Fractional iron absorption (%) was determined by measuring erythrocyte incorporation of isotopically labelled iron (58Fe) at the baseline and endpoint. Sample analysis is ongoing and the results, including fractional iron absorption, for all participants will be available by the time of the conference. Results: Thirty women completed the study. Their mean BMI at baseline was 36.7 ± 8.08 kg/m²,they had a mean n-3 index of 4.57 ± 0.83%, and median (95% CI) fractional iron absorption (FIA) was 11.8% (7.1–20.1). The n-3 index increased to 6.59 ± 0.82% (p < 0.001)) but there was no change in FIA (9.7% (5.1–15.8), p = 0.962) Inflammatory status at baseline was characterized by a median (IQR) CRP of 4.15 (1.50–7.90) mg/L and alpha-1-glycoprotein of 0.99 (0.76–1.11) g/L and there was no change at endpoint. Median serum ferritin was 28.1 (12.3–71.6) µg/L and soluble transferrin receptor was 5.9 (4.8–7.1) mg/L, resulting in body iron stores of 4.80 (0.85–6.92) mg/kg body weight. Discussion: The overweight and obese women in this study had a low n-3 index and high inflammatory status at baseline. Despite improvement of the n-3 index after 15-week supplementation, inflammatory markers and FIA did not improve at endpoint. To understand whether the improvement of the n-3 index was insufficient or the supplement dose too low requires further investigation. Full article

Diet is an important risk factor for cancer. Several approaches for assessing the nutritional quality of diets have been developed and are associated with cancer risk. However, the evidence is limited for some dietary patterns. This study investigated the associations between five dietary patterns and incident all-cause cancer. This study included 159,631 adults from the UK Biobank cohort who were free from cancer at baseline. All-cause cancer was derived from cancer registry linkage. Dietary intake was evaluated according to five dietary pattern scores: the energy-adjusted Dietary Inflammatory Index (E-DII), the Recommended Food Score (RFS), the Healthy Diet Indicator (HDI), the Mediterranean Diet Score (MDS), and the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND). All dietary scores were categorised into tertiles, and the unhealthiest tertile for each score was used as the reference group. Cox regression was performed to investigate associations between each of the five dietary scores and all-cause cancer incidence, adjusting for sociodemographic (age, sex, ethnicity, deprivation, and income) and lifestyle (smoking status, total sedentary time, and total physical activity) factors, adiposity (BMI), and multimorbidity. After a median follow-up of 7.8 (IQR: 7.3; 10.6) years, 11,978 adults developed cancer. The RFS (HR 0.96 [95% CI 0.94; 0.98]), HDI (HR 0.96 [95% CI 0.94; 0.99]), and E-DII (HR 0.97 [95% CI 0.95; 0.99]) were inversely associated with the risk of all-cause cancer. Compared with the lowest tertile, the risk of all-cause cancer was lower for adults in the healthiest tertile for the RFS (HR 0.92 [95% CI 0.88; 0.96]), HDI (HR 0.93 [95% CI 0.89; 0.97]), and E-DII (HR 0.94 [95% CI 0.90; 0.99]). No associations were found for the MDS and MIND. A lower risk of all-cause cancer was observed with greater adherence to three of the five investigated dietary patterns (RFS, HDI, and E-DII) independent of adiposity and sociodemographic and lifestyle factors. Full article

Background and objectives: Nutritional intake and dysregulation of fatty acid metabolism play a role in the progression of various tumours. The consumption of different fatty acids is difficult to assess accurately by dietary questionnaires. Biomarkers allow objective assessments of intake, storage, and bioavailability. We studied the association between the polyunsaturated fatty acid (PUFA) composition of abdominal subcutaneous adipose tissue (a good indicator of dietary intake over 2–3 years) and all-cause mortality. Methods: In this multicentre AGARIC study, including 203 patients with colorectal cancer (CRC) undergoing curative surgery, samples were harvested from subcutaneous adipose tissue, which were analysed for PUFA composition. Cox proportional hazards models were used to estimate associations between PUFA levels and mortality. Results: After a median follow-up of 45 months, 76 patients died. These patients were more often men (72.4% vs. 57.5%, p = 0.04), diabetic (32.9% vs. 13.4%, p = 0.001), older (median: 74.5 vs. 66.6 years, p = <0.001), and with high alcohol consumption (47.4% vs. 30.7%, p = 0.005) compared to survivors. An increased risk of death was observed with higher levels of eicosadienoic acid (hazard ratio tertile3 vs tertile1 (HRT3vsT1) = 2.12; 95% confidence interval (CI) = 1.01–4.42; p-trend = 0.04), adrenic acid (HRT3vsT1 = 3.52; 95% CI = 1.51–8.17; p-trend = 0.005), and 22:5 n-6 (HRT3vsT1 = 3.50; 95% CI = 1.56–7.87; p-trend = 0.002). Conversely, the risk of death seemed to be lower when higher concentrations of ү-linolenic acid (HRT3vsT1 = 0.52; 95% CI = 0.27–0.99; p-trend = 0.04) and the essential fatty acid α-linolenic acid (HRT3vsT1 = 0.47; 95% CI = 0.24–0.93; p-trend = 0.03) were observed. The estimated δ-6-desaturase & elongase 5 enzyme activity were found to be positively associated with all-cause mortality (HRT3vsT1 = 2.25; 95% CI = 1.03–4.90; p-trend = 0.04). Discussion: The risk of death in CRC patients was increased in those with higher concentrations of certain n-6 PUFAs and lower concentrations of α-linolenic acid in their subcutaneous adipose tissue. These results reflect both dietary habits and altered fatty acid metabolism. Nevertheless, our exploratory results need to be confirmed in larger studies with further exploration of the mechanisms involved. The AGARIC study group: Scherrer Marie-Lorraine (Regional Hospital Centre Metz Thionville), Ayav Ahmet (University hospital of Nancy), Ortega-Deballon Pablo, (University hospital of Dijon), Lakkis Zaher (University hospital of Besançon), Liu David (University hospital Hautepierre of Strasbourg), and Deguelte Sophie (University hospital of Reims). Full article

Background: Colorectal cancer (CRC) is the most commonly diagnosed cancer in Europe and the second most common cause of cancer death. The aim of the MeaTIc study was to determine the impact of three diets associated with different risks of CRC (a meat diet (MBD: high risk), a meat diet with alpha-tocopherol supplementation (MBD-T: medium risk), and a pesco-vegetarian diet (PVD: low risk)) on CRC risk markers and fecal microbiota. Methods: A controlled, randomized, open-label, parallel-group, 12-week dietary intervention was conducted on 113 participants aged 18–50 years. The primary outcome was a change in fecal water (FW) genotoxicity. Secondary outcomes were changes in FW cytotoxicity, bile acids, fecal microbiota, and metabolomic profiles. Results: A total of 103 participants (91%) completed the study. After adjustment for possible confounding factors, a significant increase (p < 0.05) in FW genotoxicity (+43%) was observed only in the MBD group. Regarding FW cytotoxicity, a decrease in cell viability (−7%, p = 0.054) was observed after MBD, while no changes occurred for the other diets. Bile acid analysis showed an increase in total bile acids during MBD-T (+35%) and a decrease during PVD (−2.3%). Upon correlating changes in bile acids with FW genotoxicity and cytotoxicity, a moderate correlation (R = 0.66; p < 0.0001) emerged between changes in total bile acids and changes in FW cytotoxicity. A linear discriminant analysis (LDA) of changes in the gut microbiota revealed no clustering by diet, while metabolomic analysis showed a clear clustering of changes in metabolites. A random forest regression model identified 2-hydroxybutyric acid and cholic acids among the metabolites most correlated with FW genotoxicity (R^2 = 0.84 for the model). Conclusion: These results indicate that MBD can lead to a worsening of CRC markers in a relatively short time. Our findings also suggest that intervention diets had a greater impact on the metabolism of the gut microbiota, and thus, its metabolites, than on its taxonomic composition. A correlation between some metabolites and FW genotoxicity was also found. Full article

Background: The global population is ageing, with predictions that 150 million people will be living with dementia by 2050. Cognitive dysfunction and dementia have significant adverse impacts on quality of life in older adults. Therefore, the identification of modifiable risk factors is a major public health priority. Evidence suggests that certain dietary patterns and/or specific nutrients can contribute to reducing the risk of dementia; however. the evidence is inconsistent. Objectives: The aim of this systematic review with meta-analysis was to investigate the effect of dietary patterns and specific nutrients on cognitive function in older adults. Methods: The bibliographic databases MEDLINE, EMBASE and PyscINFO were used to identify relevant studies. Inclusion criteria included the following: randomised controlled trials (RCT) with specific nutrients or dietary intervention with control groups; duration ≥1 y; and adults ≥50 years. Meta-analyses were performed to calculate standardised mean differences (SMD) for global cognition and specific cognitive domains such as memory. Quality of evidence was evaluated using the GRADE (grading of recommendations, assessment, development, and evaluations) assessment framework. A sensitivity analysis was conducted to assess the impact of studies with a high-risk of bias. Results: A total of 23 studies were identified for inclusion in meta-analyses. Results showed that B-vitamin interventions ≥1 y had a significant beneficial effect on memory (SMD 0.09, 95% CI, 0.02 to 0.16; 13 studies; 7330 participants; moderate certainty); removing the B-vitamin studies (n = 3) at high-risk of bias did not change the overall result. RCTs of vitamin D supplementation improved cognitive function scores (SMD 0.88, 95% CI, 0.08 to 1.67; 4 studies; 4593 participants; very low certainty). No significant cognitive benefits were detected in response to omega-3 supplements; however, the analysis for this outcome was limited by far fewer studies. Discussion: B-vitamins may have specific benefits for the ageing brain. Enhancing the status of these nutrients could contribute to improved cognitive health; however, additional RCTs should target at-risk individuals with sub optimal B-vitamin status. Full article

Background and objectives: Depression is a low mood-based disorder that affects approximately one in six people in the UK. Analyses of the gut in depressed individuals have demonstrated dysbiosis in the normal gut microbial composition. These imbalances have been associated with gut symptoms such as abdominal pain and nausea. This study aims to investigate the relationships between self-reported depression, gastro-intestinal (GI) symptoms and dietary intake. Methods: Participants with self-reported depression and healthy controls were recruited via Prolific. Participants were asked to complete a web-based online survey tool (Qualtrics), which included questions on diet, gut health and mental health. Estimated micronutrient intakes from reported fruit and vegetable intakes (FAVI) were calculated using dietary analysis software (myFood24). Results: In total, 496 adults consented to participate (n = 249 with self-reported life-time diagnosis of depression, n = 247 healthy controls). There was a significant positive correlation between the GI symptom score and the depression score (r = 0.506, p < 0.001) which included reported measures of nausea (r = 0.359) and pain (r = 0.419). FAVI and omega-3 intakes were inversely related to GI symptoms (p = 0.010, p < 0.001, respectively) and depression scores (p < 0.05) and significant mediators of the association between GI symptoms and depression (effect size −0.006, −0.025 respectively). Those with depression were found to have significantly lower intakes of vitamin C, folate, vitamin E and magnesium (p < 0.05), though analysis did not identify any significant mediation effects of micronutrient intake on the relationship between GI symptoms and depression scores. Discussion: Dietary intake has a significant mediation effect on the relationship between GI symptoms and depression. Participants in the depression group consumed significantly lower intakes of some important micronutrients found in FAVI, which suggests that depression and gut symptoms could influence food choices. Further research will be required to identify whether these observations correspond to the changes in the microbiome that have been associated with depression. Full article

Background and objectives: Sleep disorders are bidirectionally linked with eating behaviors and glucose metabolism, and this could be clinically relevant in type 1 diabetes (T1D). We investigated the relationship between dietary habits and sleep quality in T1D. Methods: According to a cross-sectional design, T1D patients, 60 men and 60 women, aged 19–79, using continuous glucose monitoring (CGM) filled-in a 7-day food diary and completed the European Prospective Investigation into Cancer and Nutrition (EPIC) questionnaire on dietary habits and the Pittsburgh Sleep Quality Index (PSQI) questionnaire on sleep quality. Blood glucose values over 6 h after dinner were registered for one week. Differences in dietary habits and blood glucose were compared between the participants with good/bad quality, long/short duration, and long/short onset latency of sleep. Results: Bad sleepers (n = 84) were twice as prevalent as good sleepers (n = 36) and had significantly higher intake of fat than good sleepers, in particular at dinner time (30.7 ± 10.7 vs. 24.0 ± 10.5 g, p = 0.004). Short sleepers had significantly higher usual intake (g/1000 kcal) of coffee and tea (88.7 ± 70.9 vs. 62.0 ± 35.6), alcoholic beverages (46.6 ± 50.4 vs. 28.9 ± 31.5), and carbonated soft beverages (21.0 ± 37.5 vs. 9.3 ± 17.2) (p < 0.05 for all). Compared with the short sleep onset latency participants, the long sleep onset latency participants had significantly higher intake of fat at dinner time (41.8 ± 7.4 vs. 38.1 ± 9.1% total energy, p = 0.029). No differences in post-dinner blood glucose were detected between the participants with bad or good sleep quality. Discussion: Sleep disruption is common in T1D and is associated with unhealthy dietary choices, especially at dinner time, independently of post-dinner blood glucose control. Full article

Background and objectives: Limited evidence exists regarding the influence of glycemic index (GI) in the context of a healthy diet on self-reported health status and sleep. We therefore aimed to investigate the effects of a low- vs. high-GI Mediterranean-style healthy eating pattern (MED-HEP) on subjective well-being and sleep, and whether measures of well-being and sleep were related to glycemia. Methods: The MedGICarb-intervention trial is a 12-week randomized, controlled, parallel multi-center trial (Italy, Sweden and USA). During the intervention, participants consumed an eu-energetic diet profiled as a MED-HEP with either high or low GI. Well-being and sleep were measured by the Medical Outcomes Study 36-Item Short Form Health Survey Version 2 (SF-36v2), Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) at baseline and after the 12-week intervention. Similarly, postprandial glucose was measured from oral glucose tolerance tests, and indices of glycemic variability were calculated from 24 h continuous glucose monitoring. Results: 161 adults with ≥2 features of the metabolic syndrome completed the intervention (53% females, mean age 56 ± 10 y, mean BMI 31 ± 3 kg/m²). Low- vs. high-GI MED-HEP resulted in differential changes between the groups in domains of well-being, driven mostly by improvements in the low-GI group, of which role physical (5.6 AU vs. −2.5 AU, p = 0.022) and vitality (6.9 AU vs. −0.3 AU, p = 0.008) were significant (ANOVA with group, site and sex as fixed factors and age and BMI as covariates). There was no significant difference between the diets for aggregated physical or mental components, or for the other domains of well-being (physical functioning, bodily pain, general health, social functioning, role emotional, mental health) or for sleep quality (PSQI) or daytime sleepiness (ESS). The aggregated physical and mental component, as well as some domains of well-being and sleep quality, were correlated with glycemic measures at baseline (Spearman correlation). Discussion: Low compared to high GI in the context of a MED-HEP resulted in improvements in domains of subjective well-being. No major differences were seen between the groups for indexes of sleep. Full article

Vitamins C and D are known to have immunomodulatory effects. Current recommendations state that plasma 25-hydroxyvitamin D3 should be maintained above 50 nmol/L, although concentrations of 100 nmol/L can enhance health benefits. Concentrations below 25 and 12.5 nmol/L are considered insufficient and deficient, respectively. The typical plasma ascorbate concentration is 50 μmol/L. Vitamin C supplementation can increase plasma concentration to 100–150 μmol/L. Vitamin C insufficiency and deficiency occur at 25 μmol/L and <10 μmol/L, respectively. This study investigates cytokine production by THP-1 monocytes and macrophages, following vitamin C and D treatment at concentrations representing deficiency, insufficiency, sufficiency and following supplementation. Macrophages were differentiated from THP-1 monocytes using PMA. THP-1 cells (monocytes or macrophages) were pre-treated with ascorbate or 25-hydroxyvitamin D3 for 24 h at the aforementioned concentrations, then challenged with lipopolysaccharide for 6 and 24 h. Extracellular concentrations of IL-1β, IL-6, IL-10 and TNF-α were measured using Luminex assays. In THP-1 monocytes, 25-hydroxvitamin D3 and ascorbate, at concentrations representing sufficiency and supplementation, decreased TNF-α, IL-1β and IL-6 at 6 and 24 h. Ascorbate at concentrations of >50 μmol/L also increased IL-10 at both time points. At supplemented concentrations, 25-hydroxvitamin D3 and ascorbate lowered the TNF-α/IL-10 ratio from 39:1 to 31:1 and 17:1, respectively, at 6 h. At 24 h, TNF-α/IL-10 was lowered from 88:1 to 31:1, following 150 μmol/L ascorbate treatment, and from 185:1 to 108:1 following 100 nmol/L 25-hydroxyvitamin D3 treatment. In THP-1 macrophages, pro-inflammatory cytokines were unaffected by 25-hydroxvitamin D3 at 6 h. However, IL-10 concentration increased at concentrations > 50 nmol/L. At 24 h, the inflammatory cytokines decreased as the 25-hydroxyvitamin D3 concentration increased. 25-hydroxvitamin D3 (100 nmol/L) reduced the TNF-α/IL-10 ratio from 88:1 to 64:1 at 6 h and from 105:1 to 35:1 at 24 h. Ascorbate, at concentrations representing sufficiency and supplementation, decreased the inflammatory cytokines at 6 and 24 h. Ascorbate at 150 μmol/L decreased TNF-α/IL-10 from 116:1 to 35:1 at 6 h and from 102:1 to 21:1 at 24 h. These data demonstrate that both 25-hydroxyvitamin D3 and ascorbate decrease the inflammatory burden in THP-1 monocytes and THP-1 derived macrophages. Future work will investigate vitamin interactions and underlying mechanisms. Full article

Background and objectives: Metabolomics is influenced by diet and may inform underlying mechanisms for diseases. We aimed to assess differences in circulating metabolites between people of different habitual dietary groups. Methods: The UK Biobank recruited 500,000 adults aged 40 to 69 years throughout the UK between 2006 and 2010. Plasma samples were collected from almost all participants at recruitment, and metabolomics assays (249 metabolites, 168 directly measured and 81 ratios) were performed using nuclear magnetic resonance (NMR) metabolic profiling in a randomly selected subset of 120,000 participants. Participants were asked to report their ethnicity and consumption of red and processed meat, poultry, fish, dairy and eggs. Based on this information, we defined six diet groups among the White British participants (42,963 regular meat eaters, 44,170 low meat eaters, 1051 poultry eaters, 2290 fish eaters, 1521 vegetarians and 102 vegans) and two diet groups among the British Indians (725 meat eaters and 250 vegetarians). We compared adjusted geometric mean levels of the metabolites by diet group. Results: Significant differences in the levels of many plasma metabolites were observed by diet group, with the biggest differences overall for fatty acids. Compared with regular meat eaters, low meat, poultry and fish eaters all had higher omega-3 and docosahexaenoic acid concentrations, while vegetarians and vegans had substantially lower concentrations of these fatty acids and their ratios to total fatty acids. Vegetarians and vegans had significantly higher ratios of omega-6 to both omega-3 and total fatty acids, as well as higher percentages of monounsaturated fatty acids and linoleic acid to total fatty acids. Of the amino acids, vegetarians and vegans had notably higher concentrations of glycine, but lower concentrations of total and individual branched-chain amino acids compared with regular meat eaters. Higher concentrations of citrate but lower concentrations of creatinine in vegetarians and vegans, higher acetate in vegans, as well as differences in many lipid fractions by diet group were also observed. The observed differences were similar for the White British and the British Indian participants. Discussion: The markedly different plasma metabolic profiles between people of different diet groups may impact on their long-term health. Full article

Background: Cardiovascular disease (CVD) remains the leading cause of death worldwide. Attention in recent years is turning toward the role that apolipoproteins might play as markers of CVD risk. However, to date, evidence regarding the effects of diet on apolipoproteins is still limited. Aim: To compare the effects of the Mediterranean diet (MD) and lacto-ovo vegetarian diet (VD) on anthropometric parameters, lipid profile, inflammatory profile and apolipoprotein levels, in subjects with low-to-moderate CVD risk. Methods: Fifty-two clinically healthy subjects (39 F; mean age: 49.1 ± 12.4 years), followed an MD and a VD for 3 months each. Demographics, risk factors, dietary and lifestyle habits were collected from each subject at the baseline. Anthropometric parameters and blood samples were obtained both at the beginning and at the end of the MD and VD periods. Results: Both MD and VD resulted in significant reductions in body weight, BMI and fat mass. VD led to a significant reduction in LDL (−5%; p = 0.038), while MD led to a significant reduction in plasma triglycerides (−9%; p = 0.018). Both diets led to a reduction in most of the inflammatory parameters, but MD was more effective in reducing IL-10 (−37.2%; p = 0.009) and IL-17 (−49.1%; p = 0.002). As for apolipoproteins, a statistically significant change was observed only for Apo C1 after VD (+24.4%; p = 0.020). MD led to a statistically significant negative correlation between Apo C3 and carbohydrates (R = −0.29; p = 0.039), whereas VD led to a statistically significant negative correlation between Apo D and saturated fats (R = −0.38; p = 0.006). In addition, a statistically significant positive correlation emerged after MD between change in plasma triglycerides and change in Apo C1 (R = 0.32; p = 0.020) and Apo D (R = 0.30; p = 0.031). On the other hand, after VD, a significant positive correlation emerged between change in HDL and Apo D (R = 0.33; p = 0.017). Subgroup analysis revealed positive effects on apolipoprotein levels from both diets, especially in women, individuals with >50 years and those with <3 CVD risk factors. Conclusions: Both diets resulted in improved apolipoprotein levels, especially in certain population subgroups, while also demonstrating different associations with specific dietary nutrients. Full article

Background and objectives: Diet is suggested as a major modifiable risk factor for neurodegenerative diseases, but there is conflicting and inadequate evidence regarding whether adherence to a Mediterranean diet (MD) is associated with lower risks of Alzheimer Disease (AD) and Parkinson Disease (PD). We performed a systematic review of available population-based studies to disentangle the association between MD and risk of AD or PD. Methods: PubMed, MEDLINE, Embase and Scopus were searched for relevant articles published from inception until April 2023. Only observational cohort studies, prospective studies, and case–cohort studies were included to explore the longitudinal association between adherence to an MD and the risk of AD and PD. Studies with adult participants (>18 years old) were included if they explored and reported results on MD, along with other dietary patterns, and examined MD using the following definitions: ‘Medi Score diet’ and ‘alternate Mediterranean diet index (aMED diet)’. Results: A total of three studies (two longitudinal and one case–control) on AD were identified out of 1233 records, and five studies on PD (three longitudinal and two case–control) out of 320 records were identified. For AD, all three studies reported an association between a higher adherence to an MD and a lower risk of AD, with values ranging from 9% (Hazard ratio, 0.91; 95% confidence interval, 0.83–0.98; p = 0.015) to 54% (Hazard ratio = 0.46, 95% CI 0.26, 0.79, p = 0.01). For PD, three out of five studies reported that a higher adherence to MD was associated with a lower risk of PD, with values ranging from 11% (Hazard ratio = 0.89; 95% CI 0.74–1.07) to 46% (Hazard ratio = 0.54; 95% CI 0.30–0.98). Conclusions/Discussion: The overall longitudinal findings suggested that a high adherence to an MD was inversely associated with the risks of AD and PD, and might be beneficial for nutrition strategies and clinical treatment. However, further epidemiological studies are warranted to increase the generalizability of the findings and to better understand the longitudinal associations for efficient prognosis of AD and PD. Full article

Background and objectives: The Mediterranean Diet (MD) has been consistently associated with lower mortality in cohort studies worldwide. Ultra-processed foods (UPF) are increasingly displacing nutritious traditional diets, with alarming health results globally. We examined the combined association of an MD and UPF consumption in relation to all-cause and cardiovascular disease (CVD) mortality in a cohort of Italian adults. Methods: Longitudinal analyses on 22,895 participants of the Moli-sani Study (2005–2010) followed for 12.2 years(median). Food intake was assessed using a 188-item FFQ. UPF was defined following the NOVA classification and calculated as the ratio (weight ratio; %) between UPF (g/d) and total food (g/d). The Mediterranean Diet Score (MDS; range 0–9) was used to assess adherence to MD. Low/High MD adherence (i.e. MDS < 6 or ≥6, respectively) was combined with low/high UPF consumption (i.e. <9.4 or ≥9.4% corresponding to the population’s median intake of UPF) to obtain a 4-level dietary variable reflecting dietary combinations from ‘low MD and high UPF’ to ‘high MD and low UPF’. Results: In multivariable-adjusted analysis controlled for known risk factors, compared to the ‘low MD and high UPF’ combination, taken as reference, the ‘high MD and low UPF’ combination had a significant 24% lower rate of all-cause mortality (Hazard ratio = 0.76; 95% CI 0.67–0.86). Participants reporting both “low MD and low UPF” had a significant but only 15% lower death rate (Hazard ratio = 0.85; 0.77–0.95), while individuals consuming both “high MD and high UPF” had a 4% not significant lower death rate (Hazard ratio = 0.96; 0.80–1.14; p-value for difference across groups < 0.001; p-value for interaction between MD and UPF = 0.47). Similar results were found for CVD mortality, with highest protection observed in the ‘high MD and low UPF’ dietary combination group (Hazard ratio = 0.74; 0.60–0.92) as compared to the reference combination. Discussion and conclusions: The combination of both high adherence to an MD and low UPF intake was associated with lowest all-cause and CVD death rate; the effects of both dietary exposures were additive. Besides the adoption, or maintenance, of an MD, dietary guidelines should also recommend to contextually reduce the dietary share of UPF to maximize Mediterranean diet-related health benefits. Full article

Background: Previous studies have shown that dietary and circulating n-6 polyunsaturated fatty acids (n-6 PUFAs) have beneficial associations with cardiometabolic health in humans. However, some studies showed inconsistent associations between circulating gamma-linolenic acid (GLA, C18:3 n-6), a metabolite of linoleic acid (LA, C18:2 n-6), and cardiometabolic health compared to LA. Therefore, this study aimed to examine the associations of erythrocyte GLA proportions with the presence and incidence of cardiometabolic diseases in Chinese adults. Methods: This prospective study included 3591 participants (40–80 years) from the Guangzhou Nutrition and Health Study, South China. The participants were recruited from 2008 to 2013 and followed up every 3 years. Erythrocyte fatty acids were determined using the baseline samples. Assessments of metabolic syndrome (MetS), carotid intima-media thickness, blood lipids, and questionnaire interviews were conducted at each visit. The associations between erythrocyte GLA and the presence and incidence of MetS, carotid artery plaque (CAP), and coronary heart diseases (CHD) were analyzed using logistic and Cox regression models after adjusting for potential covariates. Results: Among the 3591 participants at baseline, 1155, 941, and 417 had MetS, CAP, and CHD, which were included in the cross-sectional analyses. After a median of a 9-year follow-up, 935/2436, 1172/2203, and 524/2507 participants (case N/total N followed up) developed MetS, CAP, and CHD and were included in the prospective analyses, respectively. Multivariate-adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) of MetS, CAP, and CHD for the quartile (Q) 4 (vs. 1) of GLA were 3.11 (2.50, 3.87), 1.25 (0.99, 1.58), and 1.54 (1.12, 2.13) (all p-trends < 0.05). The corresponding hazard risks (HR) and 95% of the CIs of the 9-year incidences were 1.45 (1.20, 1.75), 1.25 (1.06, 1.48), and 1.40 (1.10, 1.80) (all p-trends < 0.05), respectively. However, LA showed beneficial associations with MetS presence (Q4 vs. Q1, OR: 0.65, 95% CI: 0.53, 0.80) and the 9-year CAP incidence (Q4 vs. Q1, HR: 0.78, 95% CI: 0.66, 0.92) (p-trends < 0.01). Conclusions: Our findings show a detrimental association between erythrocyte GAL and the presence and incidence of MetS, CAP, and CHD in Chinese adults. Experimental studies are needed to confirm the causal relationship. Full article

Background and Objectives. Randomly interesterified (IE) palmitic acid (16:0)- and stearic acid (18:0)-rich fats are commonly used by the food industry for applications such as spreads and bakery products. Previous studies demonstrate that 18:0-rich fats (unlike 16:0-rich) do not increase the total:HDL cholesterol ratio (TC:HDL), but the comparative effects of commercially relevant IE fats rich in 16:0 or 18:0 are unclear. Hypothesis: An IE 16:0-rich fat will have equivalent effects on the TC:HDL when compared with a functionally matched 18:0-rich fat. Methods. A randomised crossover trial (clinicaltrials.gov NCT04418102; funded by the Malaysian Palm Oil Board) in healthy adults aged 35–65 was conducted. IE fats provided 10% energy intake for 6 weeks per arm with a minimum 4-week washout period. IE fats were formulated into hardstocks that were baked into muffins and blended into spreads. Spreads contained either 54% IE palm stearin/kernel (PSK) hardstock (16:0, 49%; 18:0, 5%) blended with 36% rapeseed oil (final spread: 16:0, 32%; 18:0, 4%), or 54% IE fully hydrogenated rapeseed oil/coconut oil/high oleic sunflower oil/sunflower oil hardstock (16:0, 7%; 18:0, 41%) blended with 36% rapeseed oil (final spread: 16:0, 6%; 18:0, 25%). The study was conducted at King’s College London and Maastricht University. Results: A total of 51 eligible volunteers were randomised to the treatment sequence; 47 participants completed the study (24 females/23 males; mean age 52 years, SD 8; mean BMI 25.6, SD 3.0). The TC:HDL did not change following FHS (0.03, 95% CI −0.06, 0.12) or PSK (−0.03, 95% CI −0.11, 0.06) and changes did not differ between groups (0.05, 95% CI −0.08, 0.18). The total, HDL and LDL cholesterol and triglyceride concentrations did not change following PSK or FHS and there were no differences in changes between groups. Discussion: Consuming foods made with commercially relevant IE fat blends rich in 16:0 at 10% of the energy intake is unlikely to have a detrimental effect on the TC:HDL when compared with IE fat blends rich in 18:0. These results provide much-needed evidence of the cardiometabolic health effects of industrially processed fats relevant to oil and fat manufacturers, the food industry, health authorities and healthcare professionals. Full article

Background and objectives: An unhealthy dietary pattern (DP) previously identified in the UK Biobank population was positively associated with incident cardiovascular disease (CVD), type 2 diabetes (T2D) and mortality. Differences in individuals’ metabolic responses to this DP may help identify novel pathways explaining the observed associations. This study aimed to identify metabolomic signatures characterising adherence to the DP and to investigate prospective associations with cardiometabolic and mortality outcomes. Methods: A cohort of n = 102,862 UK Biobank participants was studied, of which n = 28,123 participants with data on the DP of interest (derived from 2 or more 24 h dietary assessments at baseline) and available metabolomic data (n = 119 metabolites) were used to construct a DP-related metabolic signature score (DPMS) reflecting adherence to the previously identified DP. Metabolomic data were obtained from randomly selected EDTA plasma samples collected at baseline using a high-throughput NMR-based profiling platform. A sparse partial least squares (sPLS) model was used to compute the coefficients needed to calculate the DPMS. Multivariable Cox-proportional hazard models were used to investigate prospective associations between the DPMS and CVD, T2D and mortality outcomes in all participants with available metabolomic data. Results: A DPMS consisting of 46 differential metabolites was calculated, characterised by higher plasma levels of creatinine, saturated fatty acids and sphingomyelins, but lower levels of docosahexaenoic acid, omega 3 and 6 fatty acids and linoleic acids. During an average of 12 years of follow-up, 10,236 cases of total CVD, 5675 cases of T2D and 6367 cases of all-cause mortality were observed in the study sample (mean age 56 years; 55% women). We found significantly positive associations between the DPMS and total CVD events (hazard ratio [HR] per z-score increment = 1.16 [95%CI 1.14–1.18]) and between the T2D (HR per z-score increment = 1.24 [95%CI, 1.22–1.26]) and all-cause mortality (HR per z-score increment = 1.13 [95%CI, 1.10–1.15]). Conclusions: A newly identified metabolic signature reflecting higher adherence to an unhealthy dietary pattern was characterised by metabolites that indicated a poor lipid metabolism. This metabolic signature showed stronger associations with cardiometabolic and mortality outcomes than those observed previously with traditional dietary pattern measurements. Keywords: dietary pattern, plasma metabolomics, cardiometabolic outcomes, mortality, cohort study. Full article

Background and objectives: Chronological age (CA) may not accurately reflect the health status of an individual. Rather, biological age (BA) or hypothetical underlying “functional” age has been proposed as a relevant indicator of healthy aging. Diets high in polyphenol-rich foods, such as the Mediterranean diet, were inversely associated with biological aging in several cohorts. However, the nutritional content is only one aspect of overall food health potential, and increasing attention should be paid to non-nutrient food characteristics, such as food processing. Ultra-processed foods (UPFs) are mostly industrial formulations designed to maximize palatability and consumption through a combination of calorie-dense ingredients and chemical additives, and have been consistently associated with the increased risk of premature mortality and diseases. We therefore examined the association of UPF with biological aging. Methods: A cross-sectional analysis of a sub-cohort of 4510 subjects (aged ≥35 years; 52.0% women) enrolled in the Moli-sani Study (2005–2010). Food intake was assessed using a 188-item food frequency questionnaire. UPF was defined according to the Nova classification and calculated as the ratio (%) of UPF (g/d) to total food consumed (g/d), and categorized into sex-specific quintiles. Diet quality was assessed using the Food Standards Agency Nutrient Profiling System (FSAm-NPS) dietary index. A Deep Neural Network approach based on 36 circulating biomarkers was used to compute BA, and the resulting difference (∆age = BA−CA) was tested as a dependent variable in multivariable linear regression analyses including known risk factors. Results: The mean CA (SD) was 55.6 y (±11.6 years), BA 54.8 y (±8.6 years), and ∆age −0.77 (±7.7). In multivariable-adjusted analyses also including the FSAm-NPS dietary index, a higher intake of UPF consumption was directly associated with accelerated biological aging (β = 0.61; 95%CI 0.05 to 1.17 for Q5 vs. Q1). Discussion: High UPF consumption was directly associated with a blood-markers-based measure of biological aging, independent of overall diet quality. These findings suggest that biological aging could be influenced by non-nutrient food characteristics (e.g., altered food matrix, contact materials and neoformed compounds). Longitudinal studies are warranted to examine whether accelerated biological aging could fall on the pathway between UPF consumption and chronic disease onset. Full article

Exposure to persistent organic pollutants (POPs) is suspected to play a role in the occurrence of estrogen receptor-positive breast cancer (ER-positive BC). Our objective was to investigate the association between patterns of dietary exposure to POPs and ER-positive BC risk in the E3N cohort. The study included 67,879 women. The intake of 81 POPs, including dioxins, polychlorinated biphenyls (PCBs), per- and polyfluoroalkyl substances (PFASs), brominated flame retardants (BFRs) and polycyclic aromatic hydrocarbons (PAHs), was estimated using food consumption data, collected through a validated semi-quantitative food frequency questionnaire, and food contamination data, as measured in the second French Total Diet Study. ER-positive BC cases were identified through self-administered questionnaires, from next-of-kin spontaneous reports, or through information from the national cause-of-death registry. Partial least square–Cox regression (PLS–Cox), a supervised dimension reduction method, was used to identify POPs patterns associated with ER-positive BC occurrence. Cox proportional hazard models were then used to estimate hazard ratios (HRs) and their 95% confidence intervals (CIs) for the associations between the PLS–Cox patterns retained and the risk of ER-positive BC, adjusted on potential confounders identified using a directed acyclic graph. The women were followed for a maximum of 21.4 years, and 5,686 developed incident ER-positive BC. Based on POP intake estimates, five patterns were retained. The first pattern was characterized by positive weights for almost all POPs, especially PAHs and some dioxins. The other principal components were characterized by both positive and negative weights. A significant non-linear and non-monotonic association was highlighted between exposure to the first pattern and ER-positive BC risk, and significant positive linear associations were highlighted between exposure to the second, fourth and fifth patterns and ER-positive BC risk. The use of the PLS–Cox method allowed the identification of relevant patterns in POPs explaining, as far as possible, the covariance between the exposures and the outcomes. Identifying such patterns can help to better clarify the pollutants involved in BC occurrence and to estimate their cumulative effect. Full article

Background/objectives: Adolescence is associated with two risk markers of Type 2 Diabetes Mellitus (T2DM): insulin resistance and lateness in chronotype. Hence, negative eating behavior during adolescence may increase the future risk of T2DM. We investigated the prospective relevance of carbohydrates (CHO) from high GI sources consumed in the morning and in the evening during adolescence for HOMA2-IR in young adulthood and the role of chronotypes. Methods: Examinations of subjects were performed at the DONALD study centre. Participants provided at least two 3-day weighed dietary records (median = 7 records) during adolescence and one blood sample in young adulthood. CHO quality was classified as low (<55) and moderate (≥55) according to the Glycemic Index. Chronotype was assessed with the Munich Chronotype Questionnaire and defined as age- and sex-adjusted midpoint of sleep on free days corrected for sleep debt on workdays (MSFsc) using all measurements from adolescence up to young adulthood, applying regression analyses. Earlier and later chronotypes were based on the averaged median values of MSFsc. We used the HOMA2 calculator (University of Oxford) to define HOMA2-IR from fasting insulin and glucose measures. Multivariable regression analyses (including, e.g., age, sex, BMI-SDS, physical activity and energy) assessed the longitudinal associations of interest. Testing for trend calculations were based on median values per tertile. We assessed interactions by chronotype and additionally stratified the data according to chronotype. Results: A total of N = 224 (♀ n = 58%) participants with a median (Q1:Q3) age of 12 (12:13) yrs during adolescence and 22 (18:26) yrs at blood withdrawal were included. Stratified analyses by chronotype were not different and there was no significant interaction (p > 0.05). Only the residual of adolescent CHO consumption in the morning (<11:00 hh:mm) was significantly, inversely associated with adult HOMA2-IR (lsmeans HOMA2-IR T1: 2.96 (2.41–3.55) vs. T3: 1.95 (1.54–2.41), p for trend = 0.01). Discussion: Our data suggest that the consumption of CHO in the morning decreases HOMA2-IR independent of chronotypeThe results presented in this article are part of a research project funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation)-AL 1794/1–2. Full article

Background and objectives: Large improvements in vitamin D status (serum 25-hydroxyvitamin D; S-25(OH)D) have been recorded among the general Finnish population, mainly due to vitamin D fortification policies and supplement use. Vitamin D intake has increased since the beginning of the fortification scheme in 2003 and subsequently by its increment in 2010. Also, vitamin D supplement use has increased over the years. However, whether sufficient vitamin D status lowers the risk of diabetes is unclear. Hence, we investigated the association between the improved vitamin D status in the Finnish adult population and long-term incidence of type 2 diabetes (T2D). Methods: This study evaluated data of Finnish adults aged ≥30 years (n = 3014) in a longitudinal setting (Health 2000/2011 cohort) who did not have T2D at baseline. The S-25(OH)D concentrations from both time points (years 2000 and 2011) were standardized according to the Vitamin D Standardization Program. The survey datasets were linked with incident T2D datasets from the national register for the time period 2000–2019. Associations between vitamin D status, change in S-25(OH)D concentrations and incidence of T2D over the 8-year follow-up period were assessed using logistic and Cox regression models (adjusted for age, sex and blood sampling season, etc.). Results: Over the 8-year follow-up period, 214 T2D incident cases were observed in subjects who participated in both Health 2000 and Health 2011. We observed a borderline significantly lower mean baseline S-25(OH)D concentration among T2D cases (45.4 [SD = 12.3] nmol/L) compared with participants not having T2D (48.1 [SD = 134.6] nmol/L) (p = 0.01). Having a sufficient vitamin D status (S-25(OH)D ≥50 nmol/L) at baseline was associated with lower odds of T2D (adjusted OR 0.94 [95% CI 0.89–0.98]). In participants whose S-25(OH)D concentrations increased over the years, the T2D incidence was lowered (adjusted HR 0.01 [95% CI 0.00–0.01] and 0.82 [95% CI 0.76–0.89] for ∆ ≥50 nmol/L). Discussion: Our preliminary findings indicate a protective effect of increased 25(OH)D (up to 50 nmol/L) against T2D among Finnish adults with an initially low vitamin D status. This study shows that well-designed longitudinal cohorts using standardized methods carry valuable potential to evaluate national nutrition status and to investigate the relationship between nutrition status and chronic diseases. Full article

Background: Bowel habits remain under-studied despite their associations with chronic diseases and their impact on quality of life. We aimed to elucidate the pattern of bowel habits in the UK and investigate gender differences and dietary associations. Methods: A UK population-based survey, “The Big Poo Review,” involving 142,765 participants, was conducted in the ZOE Health Study (LRS/DP-20/21-25809). Respondents completed a 37-item bowel habit questionnaire. Diarrhoea was defined as evacuation >3 times/day or passing Bristol Stool scale (BSS) type 6 or 7 > 25% and constipation was defined as evacuation <3 times/wk or passing BSS type 1 or 2 > 25%. Participants (n = 26,703) who completed a food frequency questionnaire within 5 months of the study were included in the subgroup dietary analysis. Results: Participants were predominantly female (77%) with a mean age of 57.8 years (IQR: 50–67). The most frequently reported bowel pattern was a single daily bowel movement (54%) after breakfast (60%) and BSS type 4 (40%). The mean defecation frequency was 1.7 times/day (SD 0.9), but 0.4% of participants defecated <1 time/wk and 1.4% defecated >4 times/day. Constipation was reported in 21.0% (women 23.3%, men 13.0%; p < 0.001) and diarrhoea in 15.3% (men 17.5%, women 14.7%; p < 0.001). Those with diarrhoea or constipation consumed significantly fewer legumes, nuts, and seeds (12 g and 7 g/day less, respectively), fruits (14 g and 18 g/day less, respectively), and vegetables (14 g and 30 g/day less, respectively) than those without (p < 0.01 for all comparisons). Dairy intake was different between all three groups (constipation 276 g/day; diarrhoea 256 g/day; regular stools 267 g/day; p < 0.001 for all comparisons). Discussion: This survey is the largest study of UK bowel habits to date, highlighting gender and dietary differences in habits. The high prevalence of constipation and diarrhoea underscores the need for focused public health efforts and potential nutrition interventions. Full article

Increased intestinal permeability is linked to low-grade systemic inflammation associated with chronic diseases. Undigested dietary proteins reach the colon, where they are fermented by components of the gut microbiota to produce metabolites shown to increase intestinal permeability in vitro. As evidence for sex differences in the microbiota grows, we hypothesised that the effects of the microbial fermentation of protein would also be sex-dependent. Thus, our objective was to determine whether there were sexual dimorphisms in microbial composition and metabolic output following the fermentation of different proteins using in vitro human gut model systems. Faeces from healthy male (n = 5) and female (n = 5) donors were used to inoculate gut fermentation systems supplemented with non-hydrolysed proteins (0.9 g) derived from whey, fish, milk, soya, mycoprotein, egg or pea. At 0, 8, 24 and 48 h, the microbiota composition was quantified using fluorescence in situ hybridisation coupled with flow cytometry, while bacterial-derived metabolite production was assessed via gas chromatography/mass spectroscopy and an ELISA. Increased protein availability resulted in significant increases in proteolytic Bacteroides spp. (p < 0.01) and Clostridium coccoides (p < 0.01) and significant increases in the production of potentially detrimental metabolites including phenol (p < 0.01), p-cresol (p < 0.01), indole (p = 0.018) and ammonia (p < 0.01), all of which were highly dependent on protein type. Furthermore, we showed higher abundances of Clostridium cluster IX (p = 0.03) and concentrations of p-cresol (p = 0.025) at 24 h in males, while females produced more ammonia (p = 0.02) irrespective of the protein source. The fermentation of mycoprotein resulted in significantly higher abundances of Clostridium cluster IX in males at 8 and 24 h compared to females (p < 0.01). There were also significant interactions between sex, protein source, bacterial populations and bacterial-derived metabolic-end-product concentrations. Our study provides new evidence that the effects of the microbial fermentation of dietary proteins in vitro are highly dependent on the source of the protein and the sex of the donor. Consequently, we suggest that different proteins are likely to have differential impacts on intestinal barrier function in vivo, and these effects may be different in males and females. If corroborated in human studies, our results would have important implications for dietary recommendations to limit chronic diseases. Full article

Background: The microbial metabolites short-chain fatty acids (SCFAs) are proposed to largely contribute to improvements in metabolic health associated with dietary fiber (saccharolytic) fermentation. Nevertheless, towards the distal colon, fermentable carbohydrates become depleted, and gut bacteria switches towards protein (proteolytic) fermentation. This yields a diversity of metabolites like branched-chain fatty acids (BCFAs), often considered detrimental to metabolic health. We previously demonstrated that acute SCFA administration to the distal, but not the proximal colon, led to beneficial alterations in human substrate and energy metabolism. Hence, we hypothesize that a switch from proteolytic to saccharolytic fermentation in the distal colon has the most pronounced metabolic health effects and aimed to identify a complex carbohydrate mixture capable of inducing such a microbial substrate switch. Methods: The TIM-2 model, an in vitro computer-controlled dynamic model, was used to mimic colonic fermentation, simulating amongst others body temperature, luminal pH, microbial metabolite absorption, and peristalsis. TIM-2 was inoculated with standardized pooled microbiota from individuals with overweight/obesity and disturbed glucose homeostasis. After an overnight adaptation period, pre-digested proteins were added to the model to create a high protein background. Subsequently, either separately or in combination, potato fiber, native inulin from chicory, pectin from sugar beet, or no fibers (protein control) were administered. Samples of the lumen and dialysate were taken at various time points and assessed for proximal (0–8 h) and distal (8–24 h) SCFA and BCFA levels. Results: Of all the tested combinations, combining potato fiber and pectin resulted in the highest distal SCFA production (26.3 vs 6.4 mmol) and SCFA:BCFA ratio (13.3 vs 2.2) compared to the protein control. Discussion: The combination of potato fiber and pectin was best able to increase distal SCFA production in pooled microbiota of individuals who were overweight/obese. To assess whether these results translate to improvements in metabolic health, we are currently conducting a 12-week double-blind placebo-controlled randomized study. 44 individuals who are overweight/obese and have a disturbed glucose homeostasis are randomized to supplementation with a potato fiber/pectin mixture or placebo (maltodextrin) while consuming an eucaloric high protein diet (25 E% protein). The primary outcome will be the change in peripheral insulin sensitivity. Full article

Background: Breast milk protein content changes with the phases of lactation, whereas it is relatively static in infant formula (IF). The “early protein hypothesis” posits that higher protein intake in infancy increases insulin and IGF-1 secretion, exacerbating weight gain and increasing the risk of cardiometabolic disease. In addition, the FGF-21 hormone also regulates metabolism by enhancing fat oxidation, energy expenditure, and insulin sensitivity. It is strongly induced by dietary protein restriction in adults and is inversely associated with growth rates in infancy. Here, we examined metabolic hormones in infants fed from 0 to 360 days, either standard or sequential IFs with age-adapted protein content, compared to breast-fed infants. Methods: Infants were randomized into two groups: 1. Standard Regimen-1 (n = 233): Standard IF (SIF = 1.85g protein/100kcal; 0–90 days) + Follow-up formula (FuF = 1.50g protein/100kcal; 90–360 days); 2. Age-adapted Regimen-2 (n = 227): New IF (2.50g protein/100kcal; 0–30 days) + SIF (30–90 days) + FuF (90–360 days). Breast-fed infants (n = 231) served as a reference. Plasma insulin, C-peptide, IGF-1, and FGF-21 were measured at 30, 120, and 360 days by ELISA. Results: Insulin and C-peptide concentrations remained similar in Regimen-1 and -2 across 360 days and were significantly higher (up to +64%) than in breast-fed infants. Moreover, both IF regimens showed similar IGF-1 levels that were significantly higher (up to +26%) than breast-fed infants at 120 and 360 days. At 30 days, FGF21 levels were similar in BF and Regimen-1 but significantly lower in Regimen-2 infants. At 120 days, breast-fed infants showed a striking increase in FGF-21 levels (+42 and +74% higher vs. Regimen-1 and -2, respectively). At 360 days, FGF-21 in the breast-fed group remained significantly higher than Regimen-2 but not Regimen-1. These differences in FGF-21 levels were more prominent in males. Discussion: Overall, IGF-1, insulin, and C-peptide concentrations were similar between both IF regimens and significantly higher than in the breast-fed group. In contrast, FGF-21 levels were generally higher in the latter. Interestingly, the lower protein content of SIF in the first month (Regimen-1) brought FGF-21 levels closer to those observed in breast-fed infants. This study highlights FGF-21 as a possible novel mediator underpinning the early protein hypothesis. Full article

Background and objectives: Journal articles describing randomised controlled trials (RCTs) are not optimally reported, often missing crucial details that ensure transparency and reproducibility. We aimed to estimate the frequency of reproducible and transparent research practices in a sample of recently published nutrition- or diet-related RCTs. Methods: We conducted a meta-research of nutrition- or diet-related RCTs published in journals indexed on Pubmed. We used a validated search strategy to identify eligible RCTs published between June 2021 and June 2022. Two reviewers independently screened the records retrieved by reading the titles and abstracts. Eligibility was confirmed after full text inspection. The data on the general aspects of the included RCT publications (participants, intervention, controls, outcomes, and study design) were extracted into RedCap. Research transparency and reproducibility practices included study registration, statistical analysis plan, data and analyses code sharing, conflicts of interest (CoI), authorship statements (CreditT), and whether the publication was open access. The relative frequencies for all variables were calculated, and comparisons were made between nutritional supplementation RCTs and those with other nutrition- or diet-related interventions. This meta-research is registered in the Open Science Framework (doi: 10.17605/OSF.IO/BF47G). Results: Most RCTs were single-centered (88%) with a parallel design (71%). The participants were most frequently adults (46%) or adults and elderly (23%), with some clinical condition (61%), receiving nutritional supplementation (55%) compared to other active intervention (44%) or placebo (40%). The outcomes most frequently studied were clinical (44%) or nutritional status (7%) and the frequency or severity of diseases (11%). Most RCTs were registered (81%) but did not present a statistical analysis plan (97%), data (51%), or code (97%) sharing statement. CoI statements were present in 98% RCTs, with 75% declaring no CoI. CrediT was identified in 61% RCTs and 85% were not open access publications. The practices of research transparency and reproducibility did not differ between supplementation and other nutrition- or diet-related RCTs. Conclusions: In a random sample of recently published nutrition- or diet-related RCTs, the frequency of practices of transparency and reproducibility related to statistical analysis plan and the availability of materials and code sharing are not satisfactory, while study registration and CoI were reported in most publications. Full article

Diet can influence healthy aging through anti- or proinflammatory effects, partly by modulating the gut microbiome composition. This study investigated the relationships between the Dietary Inflammatory Index (DII), the gut microbiome, and nutritional status in elderly individuals. Methods: This cross-sectional analysis included 114 home-dwelling individuals aged over 70 years. The Energy-adjusted DII (E-DII) was calculated from 3-day food diaries, and blood samples were taken to measure micronutrient status, glucose, and lipid metabolism. Body composition was assessed using bioimpedance, and fecal gut microbiome composition was analyzed through 16S rRNA gene sequencing. The participants were categorized into maintaining an anti-inflammatory diet (AD) and a pro-inflammatory diet (PD) based on the median E-DII score. The associations of E-DII groups with blood markers and microbial diversity and composition were examined using the analysis of covariance, permutational analysis of variance, and multivariate linear models. Results: The AD (n = 57, 76 ± 3.83 years) and PD (n = 57, 75 ± 5.21 years) groups were similar in age but differed in sex distribution, with a higher proportion of females in the AD group (p = 0.02). When compared to the PD group and adjusted for sex, the AD group had a lower body mass index, fat mass, fasting insulin level, HOMA-IR (Homeostasis Model Assessment of Insulin Resistance), fasting triglycerides, and serum uric acid concentration (all p < 0.05), with higher concentrations of high-density lipoprotein, red-blood-cell folate (RBC), and Omega-3 index (all p < 0.05). While the microbial diversity and composition did not differ between the DII groups, folate concentrations were negatively associated with Agathobacter and positively associated with Bacteroides abundance (both q = 0.23). Lower uric acid concentrations were associated with a higher abundance of Bifidobacterium (q = 0.09) and lower abundance of Phocaeicola (q = 0.11). Discussion: The study suggests that following an anti-inflammatory diet is associated with improved nutritional status in the elderly. Dietary blood markers, rather than E-DII, were found to be associated with the gut microbiome, suggesting a potential link between the microbiome and changes in nutritional markers independent of diet. Further studies are needed to explore the causal relationship between dietary inflammatory potential, gut microbiome, and healthy aging. Full article

Background: Estimating the prevalence of the double burden of malnutrition (DBM) remains challenging in Latin America and the Caribbean (LAC), where DBM typologies are heterogeneous and estimates are scattered across the literature. We aimed to comprehensively appraise the evidence and estimate the prevalence of any typology of DBM in LAC. Methods: A systematic search was conducted on PubMed, Embase, Scopus and Web of Science to identify studies on the prevalence of DBM published in English, Spanish, French or Portuguese between 1 January 2000 and 23 January 2023. The primary outcome was any typology of DBM derived from combining levels (individual, household, across the life course) and identified DBM typologies. The data extraction and methodological quality assessment were conducted in duplicate. Random effect meta-analyses of proportions were used to estimate the pooled prevalence, stabilized using the Freeman–Tukey transformation. Heterogeneity was assessed using Cochran’s Q and I2-statistics. PROSPERO-CRD42023406755. Results: In total, 754 records were identified, of which 60 (8%) studies were eligible, with a median 4379 individuals, including 314 DBM estimates. Most studies were nationally representative surveys (68%), had a low risk of bias (70%) and came from South America (53%). In total, 40% of DBM estimates corresponded to the individual level, where the most frequent typologies were ‘overweight + stunting’ among <18 years, and ‘overweight + anemia’ among >18 years. The household level represented 59% of estimates, where ‘adults with overweight + child with stunting’ was the most frequent typology. The pooled prevalence of any typology of DBM was 4% (95% prediction interval: 4–5%). For the individual level, the most contributing typology for <18 year was ‘overweight + anemia’, 3% (2–5%), and for >18 year, ‘overweight + short stature’, 22% (14–30%). The typology of ‘adults with overweight + child with stunting, 9% (8–9%), contributed the most at the household level. The pooled prevalence estimates carried large heterogeneity (I2 > 90%). The preliminary source of heterogeneity was the setting, as Mesoamerica and South America had 5% prevalence of DBM and the Caribbean had 2%. The DBM across individuals’ life course could not be estimated due to the scarcity of estimates. Conclusion: The prevalence of multiple forms of malnutrition in LAC varies between 2 and 5%. Adult with overweight are the most common contributor to DBM across levels and typologies. Substantial progress can be made in curbing the burden of DBM in LAC through strategies addressing overweight within the general population. Full article

Background: The vast majority of populations are facing growth in the proportion of older persons. Hence, there is an interest in identifying factors associated with longer and healthier life in older ages. Lifestyle, including diet, is crucial for healthy life expectancy, but evidence to support more specific dietary guidelines easily implemented in real life is lacking. Whole grains are specific dietary components with unexplored potential in healthy ageing. Methods: Using an illness-death multistate model approach with a priori chosen confounder control, the association between whole-grain intake and expected time as “healthy” and “with disease” during 20 years of follow-up was assessed. Healthy ageing was defined as the absence of cancer, ischemic heart disease, stroke, type 2 diabetes, asthma, chronic obstructive pulmonary disease, and dementia. Results: Based on data from 22,606 men and 25,468 women from the Diet, Cancer and Health cohort withmean follow-up times of 14 to 17 years, respectively, a doubling in whole-grain intake was associated with 0.43 (95% CI: 0.33–0.52) and 0.15 (0.06–0.24) years more lived without disease, for men and women. When comparing extreme quartiles, men with the highest whole-grain intake lived on average one year more without disease than those consuming the least. Furthermore, whole-grain intake was inversely associated with life expectancy with disease. Conclusions: This study suggests that whole grains are associated with healthy ageing and inversely associated with life expectancy with disease after age 50. These findings should encourage guidelines for increased whole-grain intake, especially among those with low intake, to support disease-free good health in the last part of life. Full article

Background and objectives: During pregnancy, n-3 polyunsaturated fatty acid (PUFA) requirements increase in order to supply the needs of the growing and developing fetus. Furthermore, the risk of developing depressive symptoms increases during the perinatal period. n-3 PUFAs have been proposed to mitigate depressive symptoms. Little is known about the n-3 PUFA status of women in Switzerland. The objectives of this study were to assess the n-3 PUFA intake and status in Swiss pregnant women and to explore associations with antenatal depressive symptoms. Methods: This study formed part of the Swiss National Iodine Survey conducted in pregnant women in 2020–2022. We determined the intake of n-3 PUFA using a quantitative food frequency questionnaire and determined n-3 PUFA status by measuring fatty acid composition (% of total fatty acids) in dried blood spots. We assessed antenatal depressive symptoms by using the Edinburgh Postnatal Depression Scale (EPDS). Results: The mean n-3 index (converted to erythrocyte equivalents) in the final sample of 508 pregnant women (mean age 31.6 ± 4.3 years) was 4.59 ± 1.09. The n-3 index was higher in women taking an antenatal supplement containing n-3 PUFA (30%) than in their non-supplemented counterparts (4.93 ± 1.23% vs. 4.46 ± 0.99%, p < 0.001). Furthermore, the n-3 index was significantly higher in women who consumed fish ≥ 1×/week (22%) and 1–3×/month (43%) than in women who consumed fish < 1×/month (34%) (4.95 ± 1.10% and 4.70 ± 1.02% vs. 4.35 ± 1.15%). The median (IQR) EPDS score was 4 (4, 5), and 12% and 6% of women had an EPDS score ≥11 and ≥13, respectively. Eicosapentaenoic acid (EPA) levels correlated negatively with EPDS scores (r = −0.105, p = 0.031), and were associated with lower odds of having an EPDS score ≥ 13, even after adjusting for potential confounders (OR = 0.02 [0.00–0.48]). Discussion: Our results indicate that Swiss pregnant women have a low n-3 PUFA status. Even though the n-3 PUFA status was higher in the women who reported taking a supplement containing n-3 PUFA or consumed fish ≥ 1×/week than in their respective counterparts, the n-3 PUFA status remained low in these groups. The association between the n-3 PUFA EPA and depressive symptoms further highlights the need for public health measures to optimize the n-3 PUFA status in Swiss pregnant women. Full article

Clinical riboflavin deficiency is common in low- and middle-income countries, whilst sub-optimal riboflavin status may be much more prevalent globally than generally recognized, including in high-income countries. Riboflavin biomarkers are rarely assessed in humans, with most studies reliant on dietary intakes only, therefore the health consequences of riboflavin deficiency remain largely uninvestigated. Our previous trials in non-pregnant adults demonstrated that supplemental riboflavin can significantly lower blood pressure (BP), specifically among individuals homozygous (TT genotype) for the common MTHFR C677T polymorphism. Little is known about the role of riboflavin in BP during pregnancy. The aim of this study was to examine the association of riboflavin status with BP, heart rate and risk of hypertension in pregnancy (HIP) at the 12th gestational week. Observational data from healthy Irish pregnant women enrolled in the OptiPREG study were analysed (n = 2236). Riboflavin status was determined using the functional assay erythrocyte glutathione reductase activation coefficient (EGRac), whereby higher values indicate lower riboflavin status. We identified a deficient riboflavin status (EGRac ≥ 1.40) in 31% of participants, despite riboflavin supplement usage reported by the majority (64%). EGRac was a significant determinant of systolic (β = 3.390, p = 0.011) and diastolic (β = 2.875, p = 0.003) BP, following adjustment for gestational age, maternal age, BMI, parity, smoking and MTHFR genotype. Riboflavin deficiency was associated with an almost three-fold greater risk of developing HIP (OR = 2.906, p = 0.041). Within quartiles of riboflavin status, ranging from best (Q1) to poorest status (Q4), there were stepwise increases in heart rate (mean ± SD, bpm; 79.9 ± 10.5 (Q1); 81.1 ± 9.7 (Q2); 81.8 ± 10.9 (Q3); 83.3 ± 11.3 (Q4), p = 0.037), following adjustment for gestational age, maternal age and BMI. The prevalence of HIP increased as riboflavin status deteriorated, with the highest prevalence observed among those with the poorest riboflavin status (4.3% (Q1); 4.9% (Q2); 6.6% (Q3); 8.0% (Q4), p = 0.039). The maintenance of an optimal riboflavin status in pregnancy, through improved diet, fortification and/or supplementation, may improve BP and heart rate, and reduce the risk of HIP. The observational findings presented here require confirmation in randomised trials with riboflavin in pregnancy, including the ongoing OptiPREG RCT. Full article

Introduction: Little is known about the association between the duration of exclusive breastfeeding (EBF) and total breastfeeding. More evidence is needed on the association between EBF and growth in whole birth cohorts. Aims: The aim of this study was to assess whether the duration of EBF is associated with total breastfeeding duration until 12 months of age. The association between EBF duration and weight and length was studied at 6, 8, 10, 12, and 48 months of age. Methods: Health-care registries were used to obtain breastfeeding and anthropometric data on all live-born children in Iceland between 1 January 2009 and 31 December 2014. Kaplan–Meier plots were conducted to assess the survival probability of total breastfeeding duration up to 12 months among infants who either received EBF or were partially breastfed at 3 months and at 5 months. For the same groups, T-tests and two-way analyses of variance, adjusted for sex, residence, birth weight, and birth length, were conducted to estimate differences in anthropometric outcomes from 6 months up to 4 years of age. Results: The total number of participants was 25,793. At 3 months, 59% received EBF and 26% were partially breastfed. At 5 months, 36% received EBF and 40% were partially breastfed. The survival probability for breastfeeding at 12 months was 47% among infants that received EBF for 3 months and 30% among infants that were partially breastfed for 3 months. Among infants that received EBF for 5 months, the survival probability at 12 months was 56%, while it was 37% among infants that were partially breastfed for 5 months. EBF infants were heavier and longer at birth and had a significantly slower growth rate up to 4 years of age, compared to non-EBF infants. Conclusions: A longer duration of EBF increases the likelihood for longer breastfeeding duration up to 12 months and is associated with slower growth up to 4 years. The size of the effect on growth was small and should be evaluated in light of the larger birth size of EBF infants, and former studies show the healthy growth of infants who received EBF for 6 months. Full article

Background: Severe maternal iodine deficiency has profound consequences for the developing brain; however, the impact of mild to moderate deficiency is less clear, and findings from observational studies have been mixed. Aim: The purpose of this study is to assess the relationship between maternal iodine status in early pregnancy and infant neurological development in an Irish maternal–infant cohort. Methods: Maternal–infant dyads of the Improved Pregnancy Outcomes by Early Detection (IMPROvED) and the Cork Nutrition and Development (COMBINE) cohorts (n 456) were followed during pregnancy and from birth to 2 years of age. Participants completed detailed a clinical and questionnaire-based assessments (including Bayley’s Scale of Infant Development (BSID-III) at 24 months; n 295). Maternal urinary iodine concentration (UIC) was quantified at 15 weeks of gestation by the Sandell–Kolthoff (S-K) method, and urinary creatinine (Cr) was quantified by the Jaffe rate method using the RX Monaco Clinical Chemistry Analyser (Randox Laboratories Ltd.). Statistical analysis was performed using IBM SPSS Version 27 (IBM Corp., Armonk, NY, USA). Results: The median (IQR) maternal age at delivery was 32 (5) years, and the median (IQR) BMI at 15 weeks of gestation was 25.1 (5.0) kg/m². Three-quarters completed third-level education, 95% were in a relationship and 7% were smokers. Median (IQR) UIC was 118 (132) µg/L, and 65% had UIC < 150 µg/L. At 24 months, median (IQR) cognitive, language and motor composite scores were 105 (15), 103 (20) and 103 (14), respectively. Cognitive, language and motor developmental delay was indicated in 6.0, 7.8 and 0.4% of children, respectively. Though a slightly higher prevalence of developmental language delay was observed among infants of mothers with UI:Cr < 150 µg/g for language (11 versus 6%) and a combined cognitive/language outcome (10 versus 4%), when adjusted for education, marital status, gestational age and birthweight, UI:Cr was not associated with language delay (aOR (95% CI): 1.7 (0.6, 4.7)). Among non-users of iodine supplements (29% of sample; median (IQR) UIC: 84 (96) µg/L; 75% < 150 µg/L), for every 10 µg/L increase in UIC, we observed a 23% and 19% reduction in odds of cognitive and language delay, respectively (aOR (95% CI): 0.77 (0.71, 0.97), p = 0.029; 0.81 (0.66, 0.99), p = 0.035). Our findings highlight the importance of sufficient iodine status in early pregnancy. Full article

Objective: The interest in vegan nutrition and the number of vegans in Germany are increasing. Especially, young women decide to choose a vegan diet. However, there are concerns whether a vegan diet can ensure nutrient adequacy during pregnancy. Methods: The study investigated the energy and nutrient intake as well as food consumption of vegan (VN; n = 34) and omnivorous (OM; n = 16) pregnant women via a 3-day weighed dietary record at the beginning (week 9–16) and at the end (week 35–38) of pregnancy. Results: Significant differences between VN and OM were found in the intake of vitamin B12, niacin, vitamin K, vitamin C, potassium, magnesium, dietary fibre, salt, cholesterol, saturated, monounsaturated and polyunsaturated fatty acids (PUFA), α-linolenic acid, and linoleic acid at the beginning and end of pregnancy. For all nutrients assessed, the VN participants’ median intake met the harmonised average requirements. However, the VN median intakes (including supplements) did not reach the D-A-CH reference values for pantothenic acid, potassium, iron, and iodine at least at one time point. The OM participants’ median intake (including supplements) did not reach the D-A-CH reference values for vitamin D, potassium, calcium, iron, PUFA, eicosapentaenoic acid (EPA), as well as docosahexaenoic acid (DHA) at least at one time point. Excluding supplementation, both groups failed to reach the reference intakes for the following nutrients for both time periods: vitamin D, folate, iron, iodine, EPA, and DHA. In terms of mean intake (including supplementation), the VN group achieved the D-A-CH reference values for all critical nutrients in a VN pregnancy, except for iodine, while OM did not reach the reference intakes for calcium, iron, EPA, and DHA at one or both time points. Conclusion: Including appropriate supplementation, an adequate intake of critical nutrients appears to be possible in a VN diet during pregnancy. Full article

Circulating food metabolites could improve dietary assessment by complementing more traditional, subjective methods. However, information is lacking on the accuracy of these objective markers during pregnancy and lactation. The objective of this paper was to measure a panel of candidate food intake biomarkers, representing different food groups, during pregnancy, delivery, and lactation and correlate their plasma levels with self-reported food intake. All data was collected within the Swedish birth cohort Nutritional impact on Immunological maturation during Childhood in relation to the Environment (NICE). Plasma samples from the women (gestational week 29, N = 579; delivery, N = 532; and four months postpartum, N = 477) and their infants (delivery, N = 348; and four months, N = 193) were analyzed with untargeted liquid chromatography-mass spectrometry (LC-MS) based metabolomics. Food intake was assessed during pregnancy (gestational week 34) and lactation (one and four months postpartum) using a semi-quantitative food frequency questionnaire. Spearman correlation analyses with plasma levels and reported food intake were adjusted for multiple testing. Acetylcarnitine, choline, indole-3-lactic acid, lutein, pipecolic acid, proline betaine, and 3-carboxy-4-methyl-5-propyl-2-furan-propanoic acid (CMPF) were identified in plasma. Self-reported intake of fruit juice correlated positively with proline betaine during pregnancy (rho = 0.38, p_adj < 0.001), delivery (rho = 0.23, p_adj < 0.001), and postpartum (rho = 0.41, p_adj < 0.001), and also with infant plasma levels at delivery (rho = 0.25, p_adj < 0.001). Lutein correlated with vegetables in general, both during pregnancy (rho=0.31, p_adj<0.001) and delivery (rho = 0.29, p_adj < 0.001). CMPF in plasma from mothers and infants at four months correlated with maternal intake of fatty fish (mother: rho = 0.30, p_adj < 0.001; breastfed infant: rho = 0.26, p_adj = 0.037). No clear associations were obtained for the remaining metabolites. Our study confirms the use of proline betaine as a citrus fruit intake biomarker, primarily in the form of juice, for pregnant and lactating women. Plasma lutein could be useful as a more general fruit and vegetable intake biomarker during pregnancy, and CMPF as a fish intake biomarker during lactation. ClinicalTrials.gov identifier: NCT05809479 Full article

Background and objectives: Eating behaviors are formed during childhood; therefore, parental practices play an important role in shaping them. The objective of this study was to determine the association between mothers’ childhood food experiences (CFE), parental feeding practices (PFP) towards their own children aged 4–10 years, and consumption of fruit and vegetables among children and mothers. Methods: A total of 260 women with at least one child aged 4–10 years participated in a cross-sectional study carried out in 2021–2022. The questionnaire consisted of questions from the Adults’ Memories of Feeding in Childhood (AMOFiC) questionnaire and the Comprehensive Feeding Practices Questionnaire (CFPQ). They contain statements describing similar family situations and feeding practices, with responses ranging from never/disagree (1) to very often/agree (5). The AMOFiC includes the option “I don’t remember”. The consumption of fruit and vegetables was assessed based on the frequency of consumption and number of servings. Descriptive statistics, the Chi2 test, and the Pearson correlation coefficient were used in the statistical analyses. Results: Positive correlations between the frequency of eating and the intake of vegetables (0.532 and 0.485, respectively) and fruits (0.597 and 0.410, respectively) have been found in both mothers and children. Positive correlations were found between CFE and PFP, such as the use of weight control restrictions (r = 0.527) and modeling (r = 0.230), whereas monitoring practices and experiences were not correlated (0.098). Children’s fruit and vegetable intake correlated positively with monitoring (0.396 and 0.287, respectively), modeling (0.278 and 0.286), and involvement (0.205 and 0.156). Their fruit and vegetable intake correlated negatively with food rewarding (−0.167; −0.317), whereas vegetable intake correlated with emotion regulation (−0.283). Mothers’ fruit intake correlated positively with experiencing food restrictions only in childhood (0.229). Conclusions: Mothers’ CFE may induce similar practices when raising their children, including restrictions to control child weight and modeling. PFP such as modeling, monitoring, and involvement promote higher consumption of fruit and vegetables in children; however, using food as a reward and emotion regulation was linked to lower intake. The relationship between mothers’ CFE and PFP confirms the intergenerational transmission of parental food-related practices. Full article

Background and Objectives: School-focused public food procurement and service policies (SPFPs) are increasingly being recognised as interventions that can improve the nutritional quality of food served in schools amidst growing overweight/obesity and persistent micronutrient deficiencies, stunting and wasting in sub-Saharan Africa (SSA). The review aims to investigate the impact of such policies on school food environments and nutritional outcomes of children/adolescents (5–18 y) in SSA and explore challenges and facilitators to implementing effective procurement. Methods: A mixed methods systematic review of studies in SSA published between 2012 and February 2023 was conducted. Studies were included if they reported on a publicly funded school meal (e.g., breakfast, lunch, snack, take home ration) and a nutritional (anthropometric, micronutrient deficiencies, food consumed) or food environment outcome. Quantitative findings were synthesised descriptively. Qualitative evidence was synthesized using an adapted eight-step school food system framework to guide coding (food production, wholesale & trading, transportation & storage, processing & distribution, food preparation, distribution to students, student-stakeholders and community involvement). This framework, along with infrastructure support domains, namely leadership, governance and monitoring/evaluation, guided categorisation of authors’ policy-related recommendations. Results: A total of 33 studies (26 qualitative, 7 quantitative) were included from nine SSA countries. Evidence from the quantitative studies was mixed and did not demonstrate any measurable impact of SPFPs on nutritional outcomes. In total, 53 implementation challenges, particularly in food distribution, food preparation and wholesale & trading, and 37 implementation facilitators, notably student stakeholders, community involvement and processing & distribution, were identified across the school food system. Infrastructure support and policy recommendations from authors span across the school food system, particularly for improving food preparation and engaging students in programming. Discussion: While little evidence on the impact of publicly funded school meal programmes and nutrition outcomes was found (partly explained by inadequate research design to evaluate impact), qualitative evidence suggests that developing or revising SPFPs to include healthy (nutritious and safe) food at all levels of the school food system has much potential. The array of policy action needed to improve implementation of school meal programmes across the school food system calls for action at multiple scales of governance (national/local government), as well as engaging schools and local communities to strengthen stakeholder involvement. Full article

Background and Objective: Periconceptional supplementation with 400 µg/day of folic acid (FA) is recommended for primary prevention of neural tube defects, such as spina bifida. In Canada, where higher-dose prenatal FA supplement use is highly prevalent, there is increasing concern over possible excess maternal FA supplementation. The objective of this study was to assess the association between prenatal FA supplementation and circulating folate forms at <20 gestational weeks (GW) in Canada. Methods: For the EpiBrain Project, a transnational collaboration investigating B-vitamin-related early programming of neurodevelopment, we used data on a subsample of apparently healthy, non-fasting pregnant women from the Alberta Pregnancy Outcomes and Nutrition (APrON) Study (n = 250P). Self-reported FA supplement intake was assessed using a questionnaire. Plasma folate, red blood cell (RBC) folate, and plasma total homocysteine (tHcy) concentrations were measured using LC-MS/MS, and plasma total vitamin B12 (tB12) concentration was measured using an immunoassay. Descriptive statistics are presented as medians (25th percentile and 75th percentile). Results: The median maternal age was 31 (28, 33) years. At 15.4 (13.4, 17.4) GW, the RBC total folate, plasma total folate, and plasma tB12 and tHcy concentrations were 1333 (1027, 1652) nM, 49 (40, 61) nM, 247 (184, 321) pM, and 4.5 (3.8, 5.4) µM, respectively. Most participants reported FA supplement use of 1000 µg/day (45%); about 23% reported >1000 µg/day, 21% reported 400–<1000 µg/day, 8% reported <400 µg/day, and 3% presented no data. FA supplement dose was correlated (Bonferroni-adjusted p < 0.05) with plasma and RBC total folate (Spearman’s ρ = 0.26 and 0.28, respectively), plasma and RBC 5-methyltetrahydrofolate (ρ = 0.20 and 0.24, respectively), and plasma unmetabolized FA (ρ = 0.21). RBC total folate concentration differed among the supplement groups (Kruskal–Wallis test, p < 0.05) and was higher in those supplementing with >1000 µg/day (1259 (885, 18,444) nM; Dunn’s test, p < 0.05) compared to the lower-dose groups. FA supplement dose was not associated with the contribution of each RBC or plasma folate form to total folate. Discussion: These preliminary findings from the APrON cohort indicate that FA supplement use at <20 GW is associated with circulating folate forms. These findings will be compared with data from pregnancy studies in Northern Ireland and Spain for the EpiBrain Project. The EpiBrain Project will provide evidence that can inform health policies and recommendations regarding the use of folate and other B vitamin supplementation during pregnancy. Full article

Background and aim: Adolescence is a nutritionally vulnerable life phase. Poor eating habits formed during adolescence can lead to obesity and diet-related diseases in later years. The adoption of healthy eating habits is of particular importance, not only because of the direct impact on growth and development at this age, but also because of the impact on health in adulthood. A change in dietary habits in adolescence is marked by a higher intake of soft drinks, sweets, and salty snacks, with a decrease in the intake of vegetables, fruits, and milk and dairy products. The aim of this study was to show current trends in the eating habits of Serbian adolescents. Method: This study comprised a secondary analysis of data collected from 11-15-year-old students who participated in two cross-sectional Health Behaviour in School-aged Children Surveys (HBSC), conducted in Serbia in 2018 and 2022. Data on breakfast consumption and the intake of fruit, vegetables, soft drinks, and sweets were analyzed. Results: About two thirds of students (67.7%) in 2022 were eating breakfast every day during the working week, significantly more than in 2018 (58.8%), with no gender differences. The number of students who never eat breakfast during the working week is increasing (7.5% in 2018, 9.9% in 2022), with the highest numbers in the oldest age group. When it comes to the intake of fruit and vegetables, students do not meet the recommendations: in 2022, less than half of the students consumed fruit and vegetables once a day or more (39.6% fruit, 39.7% vegetables), while the frequency of a daily intake of fruits and vegetables decreased with age. The results show a decrease in daily consumption in comparison to 2018. Less than one fifth of students in 2022 consumed soft drinks daily (18.8%), boys more often than girls (21.5% vs. 16.4%), significantly less than in 2018 (22.4%). The consumption of soft drinks increases with age. More than a third of adolescents in 2022 ate sweets once a day or more often (34.8%), girls more often than boys (38.7% vs. 30.3%). This consumption has not changed since 2018. Conclusions: The findings of this study indicate a need for a more intensive nutrition-related health education of adolescents in order to improve their eating habits. Full article

Introduction and Purpose: Athletes, especially in weight-dependent sports, are at higher risk of developing eating disorders (ED). Relative Energy Deficiency in Sport (RED-S) results from a mismatch between energy intake (EI) and exercise, leading to an athlete triad. Material and Methods: Our study includes ten high-performance athletes who came to the Center for Sports Nutrition and Supplementation because of ED. Nutritional and mental status were evaluated individually (physician’s examination, body composition, eating and supplement habits, blood analysis, accelerometer, and three-day diet diary). Results: Nine female and one male athlete with an average age of 17 years are classified as having anorexia nervosa (5), bulimia nervosa (4), or an eating disorder not otherwise specified (1). Female athletes had an average BMI of 18.4 kg/m² and an F% of 19.7. All athletes had RED-S with an average EI of 1660 kcal/day and an energy expenditure of 2300 kcal/day. Representing different sports (swimming, volleyball, tennis, basketball, jazz ballet, and synchronized swimming), 7/10 athletes stopped training and 5/10 needed hospitalization because of ED exacerbation. In 7/9 athletes, there were <6 menses/12 months. An antidepressive drug (SSRIs) was indicated in six athletes. The average serum iron level was low, at 13.5 micromol/L. Carbohydrates, fat, and proteins were present in EI at 42.8%, 35.4%, and 21.8%. Athletes showed an intake deficit of cholesterol, magnesium, biotin, chrome, iron, fiber, folate, iodine, potassium, vitamins D, E, and K, pantothenic acid, and pyridoxine. Conclusion: Early identification of ED is associated with better outcomes. Educating athletes, sports entourages, and especially parents about healthy eating, pathological eating behaviors, and their consequences is crucial. Full article

Background and objectives: TRE is an intermittent fasting (IF) technique adopted for its flexibility, which focuses on the timing of eating rather than on the quantity or quality of caloric intake. Tightly controlled metabolic studies show the beneficial health effects of TRE; however, the impact of TRE in free-living settings is unknown. A community experiment on 148,374 people aimed to explore acceptability, and changes in weight, energy, mood and hunger with TRE. Methods: The BIG IF study (NCT05558423) was carried out using the ZOE Health Study smartphone app. UK users completed a baseline habitual eating phase (1 week) followed by an intervention TRE phase (2 weeks) (eating window (EW) of ≤10 h), with additional IF weeks optional. Users self-reported their weight pre- and post-intervention and logged EW, energy, mood, and hunger daily. A subgroup of engaged users included those who regularly logged and completed questionnaires pre and post-intervention. Mixed-effects growth models examined changes in health metrics over time. Results: Of 246,000 active ZHS users, 148,374 users signed up, 37,545 completed the core intervention period (3 weeks), 36,231 opted for additional weeks, and 27,371 were classified as highly engaged. Of engaged users (n = 27,317), 78% of the participants were female, with a mean (±SD) age of 60 (10) years, BMI of 25.6 (3.02) and baseline EW of 11.3 h (95% CI: 11.2–11.4). Overall, 51% of engaged users reported a small reduction in weight over 2–16 weeks (mean change −1.09 kg (IQR: −0.8, −1.4), which was greater in those with larger EW changes (Q1 0.90 h; −1.07 ± 0.01 kg vs. Q4 3.18 h; −1.14 ± 0.01 kg). Practising TRE over a longer duration was associated with higher reported energy (time x EW coefficient (β): 0.016 ± 0.02), mood (β: 0.008 ± 0.02) and lower hunger (β: −0.016 ± 0.02) (p < 0.01 for all). Interestingly, inconsistencies in EWs were associated with lower energy, mood and higher hunger. Conclusion: In this study, 60% of users were prepared to try TRE, which improved their self-reported health in real-world life conditions. People wanting to practise TRE may benefit more if their EW is long at baseline and should consider consistency and the duration of time required to observe effects. Full article

With ageing, older adults’ (≥65 years) appetite and desire to eat decrease, causing body weight and muscle mass loss, which can affect their physical capabilities. Physical activity (PA) may be an effective strategy to promote appetite in older adults; however, current evidence is insufficient to support recommendations. The objective of this study was to investigate the relationship between PA levels and food intake, appetite, and body composition in 108 healthy older adults (49 males, 59 females; 70 (SD 4) years; body mass index (BMI) 24.3 (SD 2.6) kg/m²). Following data collection, participants were categorised into tertiles (low, medium, high) based on PA level measured using a wrist-worn accelerometer, and on activity energy expenditure (AEE) and total energy expenditure (TEE) assessed through simplified PA diaries recorded for seven consecutive days. Body composition was evaluated using a bioelectrical impedance monitor, energy and nutrient intake using 3-day weighed food diaries, and appetite via the Council on Nutrition Appetite Questionnaire (CNAQ) and 100 mm visual analogue scales used at 30 min intervals over a single day. Weight and BMI were significantly higher in the high-AEE and -TEE groups than the low and medium groups (p < 0.05), while percentage fat mass was significantly greater in the high-AEE and -TEE groups compared to low groups (p < 0.05). There was a trend towards higher energy intake in the high-TEE group compared to the low group (p = 0.084). Protein intake was significantly higher in the high-AEE and -TEE groups compared to the low groups (p < 0.05), whereas fibre intake was significantly higher in the high-PA group than the low group (p = 0.035). Although there were no significant differences in appetite from the CNAQ data, the high-PA group had a higher total area under the curve (0–720 min) for desire to eat food compared to the low-PA group (p = 0.036). This work builds a foundation for intervention studies required to examine whether PA and exercise affect appetite and food intake in older adults. Full article

Background and rationale: Child malnutrition is a major global public health problem highlighted by Sustainable Development Goal 2 (“End hunger”). Whilst current malnutrition treatment programmes in humanitarian and low/middle-income country settings focus on the rapid recovery of weight and fast post-malnutrition growth, evidence from small infants in high-income settings suggests that too fast catch-up growth has a risk of later-life non-communicable disease (NCD). We thus aim to improve severe malnutrition treatment programmes by better understanding the links between infant/child undernutrition and longer-term (adult) cardiometabolic NCD. Our objectives are as follows: 1. explore different patterns of post-malnutrition weight gain/growth; 2. investigate the associations between weight gain/growth during and after malnutrition and NCD risk profile as assessed by adults/in later life; 3. understand how the following may influence the risk of later-life NCD: a. the timing of the malnutrition, b. the severity of malnutrition, and c. different patient management approaches (NB., Jamaica used inpatient-only management; Malawi was hybrid; Ethiopia used outpatient-only care). Methods: We will use already collected data from three cohorts of survivors of child malnutrition: Jamaica were originally treated for malnutrition in 1960–95; Malawi was originally treated in 2006–7; Ethiopia was originally treated in 2014–15 We will carry out the following steps: 1. pool data from our three cohorts, identifying and grouping common variables; 2. generate new exposure variables of “post-malnutrition growth” (since there is no one standard definition of this, we will use six different alternatives defining growth in slightly different ways); 3. summarise NCD outcome variables already available in the datasets (e.g., BP, body composition, fasting glucose, and other blood markers of NCD risk); 4. use regression analysis to explore the association between early-life post-malnutrition growth and later-life NCD/NCD risk. We hypothesise that faster post-malnutrition growth is associated with greater NCD risk. Results: The preliminary results from Jamaica and Malawi suggest that for children who grew the fastest, post-malnutrition have associated cardiometabolic NCD risk later in life. Conclusions: Even though our cohorts are in low- and middle-income countries, there are lessons to be learned for other countries undergoing nutrition transition and disadvantaged/vulnerable populations in high-income countries. Full article

Background and aim: Many countries have committed themselves to substantially reducing greenhouse gas emissions (GHGEs) to address climate change. Due to the large share of emissions coming from food production, shifting to a more plant-based diet is desirable, but an uncontrolled shift may compromise its nutritional adequacy and health-promoting properties. This study aimed to develop a climate-friendly, nutritionally adequate, health-promoting, and culturally acceptable food basket for 18–29-year-old Belgian adult omnivores, pescatarians, vegetarians, and vegans. Methods: A database was created, including 418 foods from Belgian supermarkets, with each item’s price, nutritional composition, GHGE values, and the observed intake values from national dietary surveys were included. Linear programming was applied using the least deviation from the observed intake for each food group as the goal function. Dietary recommended values of the Superior Health Council of Belgium and the maximum desired GHGEs, as suggested by the Intergovernmental Panel on Climate Change (1.6 kg CO₂eq/day), were applied as constraints. For the omnivores, the optimized diets matched the Belgian food-based dietary guidelines. Results: The observed diets did not meet the Belgian dietary recommendations on some nutrients. Though reducing the GHGEs, solely switching to a nutritionally adequate diet was not sufficient to bring the GHGEs below the daily threshold value of 1.6 kg CO₂eq. For all dietary patterns, it was possible to calculate a culturally acceptable and nutritionally adequate diet, meeting the desired GHGE limit. Compared to the observed diet, the climate-friendly omnivorous diet contained less red meat, dairy products, and sweetened beverages but more bread, vegetables, and fruits. Conclusion: The optimized diets may support sustainable nutrition by providing nutritionally adequate food choices that can sustain people’s physical well-being. There is a strong need for people to switch towards a more plant-based diet without the necessity to omit all animal-based products. Full article

Background and objectives: Current dietary patterns are the leading cause of morbidity and mortality worldwide, in addition to significantly contributing to natural resource scarcity, environmental degradation, and biodiversity loss. The general adoption of healthy diets with a low environmental impact is timely. While dietary screeners have been used widely to assess the nutritional adequacy of diets, no simple tool that considers both human and environmental dimensions has been developed. Methods: We developed REFRESH (Rapid Evaluation FoR an Environmentally Sustainable and Healthy diet), a 10-item screener that briefly assesses the dietary environmental sustainability and healthiness at once by evaluating habitual consumption of key food groups for a healthy and environmentally sustainable diet. The scoring criteria are based on the EAT-Lancet Commission, FAO, and WHO recommendations. Overall, REFRESH score ranges from 0 to 10 points, with 0 being the lowest and 10 being the highest for adopting an environmentally sustainable healthy diet. Subsequently, we conducted a validation study to evaluate the reliability and validity of REFRESH. In this study, 100 participants were asked to complete the screener’s questionnaire. The results were then compared with a 7-day food record completed in the following week. The questionnaire’s reliability was evaluated by comparing reported servings in both dietary assessments. Additionally, we evaluated the capacity of REFRESH´s scoring system to capture dietary quality and environmental impact. Results: Preliminary validation study results indicated a mean REFRESH score of 5.73 points (range: 1–8) among the participants. Comparing the REFRESH data to the food records, we found a good correlation among both dietary tools. However, we identified that participants tended to slightly overestimate their consumption of legumes, fruits, and vegetables while underestimating their consumption of highly processed foods. The diet of participants who scored higher included a larger proportion of whole plant-based foods. This pattern led to a higher intake of fiber, a lower intake of saturated fats, and a 20% lower environmental impact. Discussion: REFRESH is a valid instrument for rapid estimation of healthy and environmentally sustainable diets and, thus, can be useful for research and clinical practice. The availability of such a validated screener is crucial for promoting environmentally sustainable healthy dietary changes in the general population. Full article

Background: There is a need for uniform communication on healthy and sustainable food choices. Several front-of-pack labels exist with the purpose of informing consumers. Nutri-Score has been introduced in Europe, aiming to help the public make more nutritionally sound choices. However, its potential to also aid consumers in making environmentally sustainable food choices has not yet been studied. Objective: to determine the extent to which the Nutri-Score algorithm is capable of discriminating foods based on their environmental impact. Methods: Nutri-Scores were calculated for foods in the Dutch food composition database. The environmental impact was assessed using lifecycle assessments. Correlations between Nutri-Scores and environmental impact indicators (greenhouse gas (GHG) emission, land use, water consumption, fresh and marine-water eutrophication, and acidification) were assessed. Correlation estimates were obtained for the main food groups. Results: Final Nutri-Scores (FNSs) and environmental impacts were calculated for 1853 foods, with FNSs ranging from −15 to −1 (most favorable) and 19 to 40 (least favorable). The FNSs for “Meat and poultry”, “Cold cut meats”, and “Fish” showed inverse correlations with environmental impacts (r = −0.07 to −0.36), whereas FNSs for “Cheese” and “Dairy” showed positive correlations (r = 0.24 to 0.59). The FNSs for “Fats and oils”, “Bread”, and “Fruit” had the highest correlations. The FNS for “Fats and oils” showed moderate correlations with GHG emissions (r = 0.66), marine-water eutrophication (r = 0.59), and acidification (r = 0.50). The FNS for “Bread” showed moderate correlations with land use (r = 0.62), freshwater eutrophication (r = 0.58), marine-water eutrophication (r = 0.58), and acidification (r = 0.52). Similarly, the FNS for “Fruit” showed moderate correlations with acidification (r = 0.72), marine-water eutrophication (r = 0.55), and land use (r = 0.52). Conclusion: For Meat and poultry, Cold cut meats and Fish, a higher FNS, indicating a less healthy food choice, correlated with lower environmental impacts. On the contrary, especially for the food groups Cheese, Dairy, Fruits, Bread, and Fats and oils, a higher FNS, indicating a healthier food choice, was correlated with higher environmental impacts. Therefore, depending on the food group, healthier food choices according to the Nutri-Score can potentially guide consumers toward more environmentally sustainable food choices. Though trade-offs exist, the use of Nutri-Score may be beneficial for both human and planetary health. Full article

Introduction: Ultra-processed plant-based foods, such as plant-based burgers, have gained popularity and are perceived by consumers as a healthier and more environmentally sustainable alternative to animal-based foods. However, evidence regarding their nutritional profile and environmental sustainability is still evolving. Purpose: To contribute to the understanding of the nutrient profile of ultra-processed plant-based foods in the out-of-home environment. Methods: Cities in four WHO European Member States were selected for study in a convenience sample across the regions of Amsterdam, Copenhagen, Lisbon, and London. Plant-based burgers available at selected out-of-home sites were randomly sampled. In total 41 plant-based burgers were lab-analyzed for their energy, macronutrients, amino-acids and minerals content per 100 g and per serving size. Descriptive data were used to summarize the nutritional composition per 100 g and serving size. The content per serving was compared to the appropriate reference values. Results: The median energy content was 234 kcal/100 g (IQR = 50). Median macronutrient composition was 20.8 g/100 g (IQR = 5.7) carbohydrates and 3.5 g/100 g (IQR = 1.8) dietary fibre. Protein content was 8.9 g/100 g (IQR = 3.7) with low protein quality. The median total fat content was 12.0 g/100 g (IQR = 4.2), including 0.08 g (IQR = 0.05) TFA and 2.2 g (IQR = 2.3) SFA. The median sodium content was 389 mg/100 g (IQR = 113), equivalent to 2.7 g salt. When compared with reference values, the median serving of plant-based burgers (280 g) provided 31% of energy intake and contributed 17–28% of carbohydrates, 42% of dietary fibre, 40% of protein, and 48% of total fat including 26% of SFA. The burgers had low-quality protein. One serving provided 15–20% of the reference values for calcium, potassium, and magnesium, while higher contributions were found for zinc (30%), manganese (38%), phosphorus (51%), and iron (67%). Conclusion: Ultra-processed plant-based foods, such as plant-based burgers, provide protein, dietary fibre, and essential minerals. They also contain high levels of energy, sodium, and fatty acids. Despite their potential as a source of protein, the quality of protein in plant-based burgers is low. The multifaceted nutritional profile of plant-based burgers highlights the need for manufacturers to implement improvements to better support healthy dietary habits. These improvements should include reducing salt and fatty acids while also enhancing protein quality. Full article

Background and objectives: Bolivia has experienced increased meat production and consumption in the past years, particularly due to importance of an emerging market, namely China, and a strong culinary tradition in which meat is the centrepiece of the meals. Bolivian animal protein production system is one of the most inefficient methods used worldwide from an environmental perspective. As climate change accelerates, it is important to identify potential drivers of a dietary shift towards more sustainable foods in countries like Bolivia, which are already facing the consequences of the climate-related disruptions in the food chain and will be further affected in the coming years. A dietary shift toward more plant-based diets seems to be the most sensible societal change to empower individuals to act in response to climate change. Our objective is to explore the effects of intention on dietary shift, as well as attitudes towards social, economic, and environmental sustainability on the perception that plant-based foods facilitate a sustainable healthy dietary transition. Methods: We conducted a cross-sectional study, using online questionnaire filled in by a sample of voluntary respondents. Attitudinal data were obtained via seven-point Likert scales. Linear regression in agreement with the statement “plant-based foods facilitate a sustainable healthy dietary transition” was the dependent variable (mean 5.2 ± 1.7), and the attitudes towards social, economic, and environmental sustainability and intention to undergo a dietary shift were the independent variables; we controlled for sex and age. Data were analysed using SPSS v.28, and a p-value < 0.005 was considered significant. Results: In total, 303 people filled in the questionnaire, of whom 62 did not give consent to use their data, 18 provided straight line answers, and 90 provided inconsistent answers with regard to controlling variables. Therefore, 132 respondents’ responses were used, of whom 59% were women, with an average age of 25 y (±13), and 93% lived in the city of Cochabamba. After controlling for sex and age, significant positive associations were found for the intention to change their current diet and the statement that policies should promote social equity and progressive taxation, while a negative association was found with regard to the perception that policies should prioritise the wellbeing of people and the planet above those of the industry. Conclusion: the perception that plant-based diets can facilitate sustainable healthy dietary transitions in Bolivia mainly depended on how sustainability aspects were assessed by the respondents. Full article

Background and Objectives: In the current era of overshooting both planetary boundaries and social limits, the question arises as to whether the 1948 definition of health (DoH) from the WHO is fit for purpose. As healthy and sustainable diets (HSDs) are among the key societal and planetary challenges in the 21st century, this report focused on the DoH in European policy aimed at realizing HSDs. Methods: The viability of the European DoH of eight European high-income countries was evaluated in a comparative mixed-methods approach, combining a literature review with qualitative and quantitative policy analyses. In addition, national policy documents were analysed in order to define national DoHs and get insight into their operationalizations. To evaluate policies on HSDs, sustainability was uniquely conceptualised as being interrelated to human health, planetary health, and the food system. Results: The operationalizations of the European and national DoHs appear to not be in line with the 1948 WHO DoH. Vastly holistic definitions of sustainability as described in scientific literature are currently absent in European policy, and science-policy gaps are found at several levels. In the DoHs, we identified an anthropocentric bias, with economic growth as the ultimate goal of health policies. HSDs appear to be promoted primarily to address these policy goals, instead of being a health goal on their own. This unravels the lack of intrinsic value of sustainability in European health and sustainability policy. Moreover, the potential of the food system to simultaneously benefit human and planetary health is not acknowledged in national health policies. Discussion: In conclusion, the current European DoH appears to not be viable to face 21st century challenges. In order to improve this, the food systems perspective in policy can be used as the unifying concept for both human and planetary health. European policy could benefit from the implementation of a focus on resilience, combined with acknowledging the interrelations between human health, planetary health, and the food system in the eye of sustainability. The insights provided in this report can be used for effective policy-making to improve health, food systems thinking, and as policy guidance towards the realization of HSDs, especially in the European context. Full article

Background and objectives: Dietary changes are necessary to improve population health and meet environmental sustainability targets. The present study aimed to analyse the impact of in-store promotional activities implemented in major UK supermarkets on purchases of healthier and more sustainable foods. Methods: Three natural experiments examined the impact of promotional activities on (a) no-added-sugar (NAS) plant-based milk (in 200 stores over 3 weeks), (b) products targeted during a ‘Veganuary’ event (in 96 stores over 4 weeks), and (c) seasonal fruit (in 100 non-randomised intervention and 100 matched control stores over 16 weeks). Data were provided on store-level product sales, in units sold and monetary value (GBP), aggregated weekly. The predominant socioeconomic position (SEP) of the store population was provided by the retailer. The primary analyses used interrupted time series and multivariable hierarchical mixed-effects models. Results: Sales of both promotion-targeted and overall NAS plant-based milks during the promotional period increased (targeted food: +126 units, 95% CI: 105, 148; overall: +307 units, 95% CI: 264, 349). The increase was greater in stores with predominately low SEP shoppers. During Veganuary, sales increased for plant-based foods on promotion (+60 units, 95% CI: 37, 84), but not for the sales of plant-based foods overall (dairy alternatives: −1131 units, 95% CI: −5821, 3559; meat alternatives: 1403 units, 95% CI: −749, 3554). There was no evidence of a change in the weekly sales of promoted seasonal fruit products (assessed via ratio change in units sold: 0.01, 95% CI: 0.00–0.01), and overall fruit category sales slightly decreased in intervention stores relative to the control (ratio change in units sold: −0.01, 95% CI: −0.01, –0.00). None of the promotional activities resulted in the continued purchase of promoted products after the intervention period was over. Conclusion: Promotional activity (including prominent positioning and price promotions) related to healthier or more sustainable food products can have a short-term impact on what food consumers purchase. But interventions are short-lived and effects on behaviour are not sustained, suggesting these have limited value in the long-term goal to achieve healthier and more sustainable purchasing patterns. Keywords: sustainable diet; promotions; supermarkets; purchases Full article

Background and objectives: Increasing evidence suggests that complex measures of exposure accounting for the relative presence of healthy and unhealthy food outlets are more strongly associated with dietary pattern that absolute measures of the food environment, although evidence is limited by the cross-sectional design of existing studies. This study examined the long-term associations between absolute and relative measures of neighbourhood food environment and diet quality in Luxembourg. Methods: We used data of 566 adults participating in both waves of the population-based ORISCAV-LUX study (Wave 1: 2007–2009, Wave 2: 2016–2017). Diet quality was estimated in both waves using the Diet Quality Index-International (DQI-I), assessed with a 174-item food frequency questionnaire. Exposure to healthy and less healthy food outlets was computed within a 1000 m street network buffer around the participants’ home address using both absolute (density, spatial access) and relative (proportion) GIS-based measurements. We used linear mixed models adjusted on individual-level covariates and neighbourhood socioeconomic status to estimate associations between cumulative exposure and change in local retail food environment and DQI-I, and tested modification by neighbourhood socioeconomic status. Results: There was a significant decrease in DQI over 10 years from 62.4 to 60.9 (p < 0.0001). Less healthy food outlets increased by +56% over the 10-year. The results showed a 56% increase in less-healthy food outlets over the period. In an adjusted mixed-effects linear regression, high (vs. low) cumulative exposure to less-healthy food outlets is associated with lower DQI-I, when examining spatial access (β = −1.25, 95% CI: −2.29, −0.22) and proportions (β = −1.24, 95% CI: −2.15, −0.33). Stratification shows these associations to be significant only among urban residents. There was no association between change in exposure to less-healthy food outlets and DQI-I. Among rural residents, increased exposure to healthy food outlets over time was associated with worsened DQI-I when examining absolute measurements (density and spatial access). This unexpected result brings into question the ability of absolute measurements to fully capture the healthiness of food environments. Neighborhood socioeconomic status did not moderate the above associations. Discussion: Our results suggest that the relative contribution of unhealthy food outlets in the neighbourhood may play a role in the deterioration of the quality of the population’s diet over time, and should be given special attention by public authorities. Full article

Background: Research on the consumer acceptance of alternative meats will aid our understanding of how to increase their consumption and demand. There are limited data on this in the Asian context, particularly comparing various alternative meat products within a singular study. Objective: In a multi-ethnic Asian population, the demographics and attitudes of individuals towards consuming plant-based meat alternatives, cultured meat, and insect-based products were examined. Methods: Adult Singapore residents (n = 1224) were recruited from the Multi-Ethnic Cohort Phase 2 study to participate in an online survey. Demographic information, dietary habits, and attitudes towards livestock products and alternative meats were obtained. Key demographic and attitudinal factors of consumption intent and participants’ willingness to pay were identified using hierarchical ordinal regression. Results: Consumption intent for plant-based meat alternatives was the highest, followed by cultured meat, and then insect-based products. The strongest barrier to consumption intent was the perception of un-naturalness, found mostly towards cultured meat, followed by insect-based products, and then plant-based meat. Familiarity with the products and being male were associated with greater willingness to consume all three types of alternative meats. Attitudinal factors such as environmental sustainability, distrust in biotechnology, food neophobia, and animal welfare influenced the consumption intent of plant-based meat, cultured meat, and insect-based products, respectively. Participants were more willing to pay a higher price for alternative meats if they were concerned about the use of chemicals in animal products. Conclusion: Common and unique factors towards consuming the various alternative meats were identified. Our findings suggest that different communication strategies may be needed to promote the consumption and acceptance of different types of alternative meats. Full article

Background: The growing consumption of ultra-processed foods (UPFs) among vegetarians and vegans may occur at the expense of the health and environmental benefits of plant-based diets. Objectives: This study aimed to investigate the associations of UPFs in plant-based diets with all-cause mortality and environmental impact. Methods: Analyses were based on 35,030 participants (20–70 years; 74% females) from the EPIC-NL cohort who were followed up from 1993 to 1997 through 2014. The Plant-Based Diet Index (PDI) and UPF consumption (g/2000 kcal) were calculated using a validated FFQ. Based on a median split of the PDI and UPF consumption, four dietary categories were created (e.g., high PDI score/low UPF consumption). Cox proportional hazard and multiple linear regression models were used to estimate associations with all-cause mortality risk, greenhouse gas (GHG) emissions, and blue water consumption. Results: Among diets high in plant-based foods, higher UPF consumption tended to be associated with a 5% (HR: 1.05, CI: 0.95, 1.16) increased all-cause mortality risk and was statistically significantly associated with 1.3% (95% CI: 0.7, 1.9) higher GHG emissions and a 2.5% (95% CI: −3.1, −1.3) lower blue water consumption compared to lower UPF consumption. Diets lower in plant-based foods were associated with a 15% (HR: 1.15, CI: 1.05, 1.26) and 24% (HR: 1.24, CI: 1.13, 1.36) increased mortality risk, 11.7% (95% CI: 11.4, 12.3) and 12.5% (95% CI: 11.9, 13.0) higher GHG emissions, and 8.8% (95% CI: −9.4, −8.2) and 11.3% (95% CI: −12.6, −10.7) lower blue water consumption for low and high UPF consumers, respectively, compared with diets high in plant-based foods and low in UPF. Discussion: UPF consumption did not counteract the health and (reduced) environmental impacts of adhering to a more plant-based diet, although special concern needs to be given to the high blue water consumption of specific plant foods. Future research should clarify whether this also holds for current settings in which populations consume higher amounts and different types of (plant-based) UPFs. Full article

Rationale: An adequate amount of good-quality protein (P) is essential to remain fit and healthy at an older age. Animal-based proteins (ABPs) are of high quality and provide nearly 60% of the P intake in older adults. It is unclear if an adequate P intake can be achieved when ABPs are replaced by vegetarian (Veg) or plant-based (Plant) alternatives. Methods: A simulation study was performed based on dietary intake data from the Dutch National food consumption (DNFC) 2019–2021 (n = 607, age ≥ 65 years). In five scenarios, animal protein intake was replaced by vegetable protein. The scenario diets included vegetarian, flexitarian (two levels), pescatarian and vegan. Protein quality was measured by the Meal Protein Quality Score (MPQS), a score that ranges from 0–100 and takes into account protein digestibility, body-weight based amino acid requirements, and time window of complementation. Results: Total P and MPQS remained stable over all non-vegan plant-based scenarios, but showed a large decrease in the vegan scenario. Conclusions: shifting to a fully vegan diet severely compromises total protein intake and protein quality in older adults, whereas shifting to a vegetarian or flexitarian diet does not. Full article

Background and objectives: There is a compelling need for a more sustainable food system because of climate change and contemporary Western diets, which pose a threat to human and planetary health. The food system is a social–ecological system, consisting of both biophysical and social sub-systems which are interlinked. This implies that changes in one sub-system can lead to synergies and trade-offs elsewhere. To identify such synergies and tradeoffs, researchers are integrating work from a range of disciplines in optimization models. This has resulted in models that are unique but have a similar overarching aim: ‘to create a sustainable food system by understanding the implications of food system choices’. However, the results of these models may differ. Therefore, the aim of this paper was to understand the differences and complementarity of two optimization models to grasp the complexity of the food system. Methods: we compared the Circular Food System (CiFoS) model with the Sustainable, Healthy, Acceptable, Realistic, and Preferable diets (SHARP) model. CiFoS is a biophysical optimization model that aims to produce a healthy diet for a growing population within planetary boundaries. SHARP is a benchmarking model that optimizes current diets for health and sustainability for consumers. Both models propose a healthy and sustainable diet. While CiFoS is detailed on how environmental impacts are calculated, SHARP has a finer grid on the consumption aspects. Results: based on previously modelled scenarios that showed different results in diet composition, we identified that these differences could be explained by fundamental characteristics of the model (e.g., environmental impact calculations or the consideration of distance to the current diet), data input and scenario settings. Besides, the models work complementary regarding the time scale (i.e., solutions for the upcoming years versus upcoming decades), geographic scale and an individual versus population approach. Conclusion: Optimization models may be used for the same goal, e.g., finding an optimal diet, but the nuance chosen will lead to different outcomes. The outcomes of such models are complementary and can therefore be used in conjunction to inform policy or other food system stakeholders. Full article

Background: The EAT-Lancet Commission proposed a global reference diet to promote healthy diets within planetary boundaries. Recently, the Planetary Health Diet Index (PHDI) was proposed to evaluate the adherence to the EAT-Lancet diet, and it has been validated among European adolescents. However, studies evaluating the associations between the PHDI with health outcomes among adolescents are lacking. Thus, our aim was to assess the association between adherence to the EAT-Lancet diet—through the PHDI score—and cardiovascular health among European adolescents. Methods: Data from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study were used. Usual dietary intake was assessed using two 24 h dietary recalls, and adherence to the EAT-Lancet diet was assessed using the PHDI, a 16-component index that ranges from 0 to 150 points. Cardiovascular health was assessed through the seven-component Ideal Cardiovascular Health (ICH) score, the seven components of which are as follows: never smoked, eutrophic body mass index, moderate to vigorous physical activity, healthy dietary pattern, low blood pressure, low fasting plasma glucose, and low total cholesterol. Total ICH scores were categorized into ideal (5–7) and non-ideal (0–4). Logistic regression models were fitted to evaluate the association between the PHDI and ICH, and the model was adjusted for potential confounders, including age, sex, socioeconomic disadvantage/vulnerability score, and total energy intake. Results: A 10-point increase in the PHDI was associated with a lower probability of a non-ideal ICH status (OR 0.84, [95% CI: 0.75, 0.94]) among European adolescents in the adjusted model. Furthermore, a 10-point increase in the PHDI was associated with a lower probability of high blood pressure (OR: 0.87 [0.79, 0.96]) and a lower probability of high blood cholesterol (OR: 0.88 [0.78, 0.99]). Discussion: In the HELENA study, we found that higher adherence to the EAT-Lancet reference diet was positively associated with better cardiovascular health among European adolescents. Furthermore, adolescents with a higher PHDI were less likely to have high blood pressure and cholesterol. Full article

Background: An increasing number of novel protein sources have been developed in recent years, seeking approval to access the European Union (EU) food market. Consequently, the protein quality of these foods and food ingredients could become more relevant to the nutritional status and health of the EU population. Objectives: To provide an overview of the protein quality of novel foods assessed by EFSA and to identify the potential for further advancements of the methodological approach followed during the safety assessment. Methods: A search was carried out using the EFSA library portal to identify all the EFSA scientific opinions published under the EU regulatory frameworks for novel foods (NF) (Regulation (EC) 258/97; Regulation (EU) 2015/2283). Outputs addressing novel foods having 5 g of protein/100 g of NF for solids and 2.5 g/100 mL for liquids (FAO, 2013) or more were included in the study. Data extraction comprised information on the identity of the NF, protein content, digestibility, and anticipated protein intake. Results: Since 2004, 45 EFSA scientific opinions on the safety of novel proteins and their sources have been published [2004–2013: 9 and 2014–2023: 36]. The products comprised whole foods with substantial protein content, protein concentrates, and protein hydrolysates, with 45% being plant-derived, 29% animal-derived, and 11% of fungal origin. The intended uses were mainly as ingredients in foods (67%) and/or food supplements (56%). A high variability was noted regarding the approaches followed by applicants to assess protein quality. An increasing trend for the use of the Digestible Indispensable Amino Acid Score (DIAAS) was noted. The major challenges identified in the protein quality assessment of novel sources were related to the use of appropriate nitrogen-to-protein conversion factors for each NF, the robustness and validity of digestibility assessment methods, and its approach. Discussion: These findings indicate that there may be an opportunity to harmonize further the principles and methodologies used in NFs protein quality assessment within the EU food regulatory environment. This will allow accommodating recent trends in human protein nutrition whilst ensuring foods entering the EU market will not be nutritionally disadvantageous for consumers. Full article

Several studies have focused on reducing the glycemic and insulinemic responses of starchy foods to lower the risks for major non-communicable diseases. A promising approach to limit the starch accessibility to alpha-amylase in cereals is by preserving the integrity of the cells where the starch is encapsulated. This protective effect is effective in flour, but it is lost when coarse semolina, rich in intact cells, is used to produce bread. It was hypothesized that long mixing times increased the cell wall porosity and, in turn, the digestive enzyme penetration. Moreover, food structure plays a key role in digestion and oral processing. The use of coarse semolina, however, reduced the cohesiveness of the breadcrumbs, increasing the disintegration and, in turn, the starch accessibility. Different bread structures can even be obtained by playing with water absorption in the dough. To investigate the effect of cell wall integrity, dough mixing times, and different bread textures on starch digestibility, six durum wheat bread samples were prepared using coarse semolina (CS, >1000 µm) or 20% gluten in substitution of CS, 70% water (optimum water absorption) or 55% water (low water absorption) and with different mixing times (5 or 45 min). The textural properties were evaluated by a texture profile analysis (TPA) and in vitro digestibility was assessed according to the Englyst’s method. The bread sample produced with the addition of 20% gluten, low hydration (55%), and 5 min of dough mixing, was the least digestible at the end of intestinal digestion. This could be explained by the preservation of cell wall integrity, the effect of the gluten network being able to hamper the enzyme, and the presence of a cohesive crumb texture, due to the gluten addition and the low hydration. However, there is no information on the effect of such bread characteristics on oral processing and glucose and insulin release in humans. For this reason, we are now evaluating in healthy volunteers the oral processing and glycemic and insulinemic responses of the developed bread compared to a standard bread made with fine semolina to confirm the results found in vitro. Full article

Background and objectives: Malting is a germination process that alters the composition of cereal grains and can impact the digestion of various nutrients included in whole-grain cereals. This can have a further impact on the composition of dietary fiber fractions fermented by the gut microbiota. We investigated the impact of malting with barley (Hordeum vulgare) and wheat (Triticum aestivum) grains on gut microbial metabolites during in vitro colonic fermentation in a model of human gut. Methods: Raw and malted barley and wheat grains went through in vitro gastric and intestinal digestions and a 24 h in vitro colonic fermentation mimicking human intestinal activities. Metabolite analysis was performed using nontargeted gas chromatography-mass spectrometry (GC-MS) optimized for the analysis of in vitro gut fermentation samples. Results: Multiple metabolites, including amino acids and their derivates (e.g., leucine and γ-aminobutyric acid), biogenic amines (e.g., tyramine, histamine, and putrescine), sugars and their derivates (e.g., fructose and galactinol), fatty acids and associated metabolites (e.g., glycerol and 2-aminoethanol), and energy metabolism-associated compounds (e.g., lactic acid) from raw and malted cereals were identified. The metabolite profiles differed significantly between cereal species and between raw and malted grains. Furthermore, the metabolite profiles changed during the fermentation. At 0 h, there was less variation between the metabolite profiles of raw cereals than malted cereals. At 24 h, the difference between malted barley and wheat was even more pronounced, but raw barley and wheat differed more from each other than at 0 h. Malting increased the initial sugar and sugar derivative levels in the cereals, as expected. However, levels of most amino acids and their derivates were significantly increased after the 24 h in vitro colonic fermentation. Discussion: The malting of cereal grains seems to influence the metabolites produced by the gut microbiota during colonic fermentation. Understanding how cereals and different processing methods affect gut microbial metabolism can help shed light on their microbial fermentation-mediated health impacts. The optimized GC-MS method used in this study was able to differentiate the different sample types and is thus an excellent tool for monitoring gut microbial metabolite profiles. Full article

Hemp seed oil, obtained via the cold pressing of hemp seeds, is widely represented on the market. The objective of this study was to evaluate the fatty acid (FA) composition of hemp seed oil by means of nutritional quality indices. The FA profiles (37 FA) of 20 hemp seed oils marketed in several European countries were obtained using GC-FID and used for the calculation of lipid quality indices. As expected, considering the same plant source, FA profiles and the corresponding quality indices showed great similarity. Polyunsaturated to saturated FA ratio (PUFA/SFA) (6.8 ± 0.5) is used to assess the impact of diet on cardiovascular health (CVH) as PUFA can depress low-density lipoprotein cholesterol (LDL-C) and lower serum cholesterol levels, as opposed to SFA. Therefore, the higher PUFA/SFA ratio, the more positive the effect. Compared with this ratio, the hypocholesterolemic/hypercholesterolemic index (HH) (12.7 ± 0.8) may more accurately reflect the effect of FA composition on CVH. The index of atherogenicity (IA) (0.08 ± 0.005) is characterized by the main classes of SFA (which are pro-atherogenic, with the exception of C18:0) and unsaturated FA (which are anti-atherogenic). Therefore, foods with a lower IA can reduce the levels of total cholesterol and LDL- C in blood plasma. The index of thrombogenicity (IT) (0.11 ± 0.01) indicates the tendency of FA to form clots in blood vessels and provides the relationship between the pro-thrombogenic FA (C12:0, C14:0 and C16:0) and the anti-thrombogenic FA (MUFA, omega-3 and omega-6 FA). Thus, foods with a lower IT are beneficial for CVH. The unsaturation index (UI) (183.8 ± 5.1) represents the degree of unsaturation in lipids. Hemp oil showed advantages over sunflower and olive oils regarding PUFA/SFA (5.1 and 0.5, respectively) and IT (0.23 and 0.24), along with comparable IA (0.08 and 0.14), and substantially higher HH than olive oil (6.8). High UI indicates that unsaturated fatty acids abundantly present in hemp oil could easily undergo thermal degradation. Quality indices should be regarded as a valuable foundation for the valorization of hemp seed oil in nutritional recommendations. Full article

Quinoa (Chenopodium quinoa Willd.) is a pseudocereal originally grown in the Andean region of South America. Due to its nutritional and functional properties, as well as its tolerance to harsh environments, quinoa has garnered increased attention in recent decades, with its production expanding to Europe and Asia. Polyphenols are secondary by-products of plants, exhibit positive impacts on health, including anti-mutagenic and antioxidant activities, which protect against oxidative-induced stress. This study focused on investigating changes in antioxidant capacity and phenolic compounds in white and red quinoa varieties during lactic acid fermentation with Lactobacillus plantarum 299v^®. Throughout fermentation, pH and lactic acid formation were monitored every two hours until the pH dropped below 4.6. Samples before and after fermentation were analyzed for antioxidant capacities using 2,2-diphenyl-1-pic-ylhydrazyl (DPPH) and ferric ion-reducing antioxidant power assay (FRAP). The total polyphenol content (TPC) was measured using the Folin–Ciocalteu method, and the polyphenol profile was identified and quantified by UPLC-MS-UV. The findings revealed that fermentation led to a significant increase (p < 0.001) in TPC from 4.03 to 7.68 mgGAE/100 g and from 4.35 to 7.96 mgGAE/100 g for the white and red quinoa varieties respectively. Fermentation showed a significantly positive impact on the iron-reducing antioxidant capacity of quinoa (p < 0.05). Red quinoa had higher antioxidant levels than the white variety, with a similar trend observed in the DPPH assay. After fermentation, the antioxidant capacity in white and red quinoa increased from 7.90 ± 0.03 to 10.48 ± 0.11 (mgTE/100 g) and from 8.78 ± 0.06 to 11.75 ± 0.10 (mgTE/100 g), respectively. Furthermore, fermentation significantly (p < 0.001) increased the content of polyphenols with high antioxidant power such as epi-catechin, catechin, 4-Hydroxybenzoic acid, vanillic acid, chlorogenic acid, rutin and quercetin in both red and white varieties. In conclusion, lactic fermentation proved to be effective for increasing the phenolic content and antioxidant capacities of both quinoa varieties. Full article

Background and objectives: Nutrients of concern (i.e., salt, sugars, and total fat/saturated fat) are associated with noncommunicable diseases (NCD); their intakes in adults across the EU are, on average, above the recommended intake. Reformulation policies for healthier food and beverage products are an NCD Best Buy to tackle unhealthy diets and could lead to lower intakes of these nutrients. However, regular monitoring of such policies and of food environments is lacking; good quality and representative data about the food offer in supermarkets are difficult or expensive to obtain. Aiming to support public monitoring of the nutritional quality of the food offer, the JRC developed a web-based tool to host data on branded food products across Europe. Methods: FABLE hosts data on branded food and beverage products across Europe collected within three public-funded projects, EUREMO, JANPA and Best-ReMaP. The aligned food product nomenclature makes for more effective data analysis. The FABLE design will allow for the addition of future data collection efforts. Results: FABLE’s dynamic dashboard will enable users to explore, interact with and visualize data on the nutritional content of branded food and beverage products across Europe. Several food categories are covered, such as bread and bread products, breakfast cereals, soft drinks, and dairy products. FABLE allows for (1) country comparisons for specific nutrients and food groups, (2) deep dives into each country/food category-specific nutrient of concern, and (3) the possibility of making time comparisons on the progress of the nutritional quality of the food offer. Discussion: Currently, there is no publicly available systematic approach to collecting and accessing data to continuously monitor food offer across Europe. FABLE aims to close this gap by making data collected on branded food and beverages through EU-funded projects publicly available for researchers, policymakers and the public. Users will be able to interact with, explore and easily visualize data. This will allow for the public monitoring of the food supply across the EU, which can incentivize reformulation efforts and lead to an improved food offer, making healthier choices more available to consumers. Full article

Background and objectives: Blenderized tube meals, with the proper preparation and application, can increase the nutritional variety of hospital nutrition, decrease the financial burden on the hospital system, and complement commercial enteral nutrition administration. As this type of diet is used mainly in fragile populations of patients, whose recovery depends largely on adequate nutritional intake, this study aimed to determine levels of certain elements in blenderized tube hospital meals and to compare the theoretical and obtained analytical values of those meals. Methods: Samples of 29 various freshly prepared meals based on meat (n = 13), dairy (n = 9), fruit (n = 3), and soups (n = 4) were collected in the Clinical Hospital Center Rijeka, Croatia. Those meals in different combinations make 14 daily menus consisting of three meals per day. Meals were prepared according to standard methods of thermal food processing and were blended with a mixer. Water remained after cooking was added to each meal until the proper consistency for tube feeding was achieved. The theoretical composition for each meal was calculated using the National Food Composition Database. Levels of macro-elements (Na, Mg, K, Ca) and trace (Fe) elements were determined with inductively coupled plasma mass spectrometry (ICP-MS) using Agilent 7500cx. Results: With the exception of Fe, theoretical values for all elements were from 1.3 to 2.4-fold lower in comparison to levels obtained by ICP-MS analysis. Benefits of meal consumption in term of essential elements were evaluated using the EFSA nutrient reference values. It was found that irrespective of the approach used, each of the 14 daily menus met the dietary reference values (DRV) for all elements except for Fe. Discussion: Due to the potentially insufficient intake of some microelements, one of which is Fe, dietitians and healthcare professionals should pay attention to meal composition when planning daily menus for tube-fed patients. For Na, intake should be reduced to prevent the development of chronic non-communicable diseases. Further studies should be conducted to determine if the national food composition database needs to be revised for micronutrient content. Full article

Background and objectives: Excessive sodium intake is a major public health issue. Despite the large use of sodium-based additives, their contribution to sodium content is unknown. This work aims to study the association between the use of sodium-based additives and the sodium content of foods sold by a market-leading Portuguese food retail company. Methods: White-label pre-packaged foods and fresh products were included in this study. The salt content of pre-packaged foods was supplied by the company and converted to sodium. The sodium content of non-industrially packaged foods was estimated through food composition tables. Foods were categorized based on the World Health Organization sodium benchmarks. The sodium-based additives on the label’s ingredient list were identified according to Regulation (EU) No. 1129/2011 and counted. Non-parametric tests (n > 5) were used to test the median sodium content (mg/100 g) (minimum, maximum) according to the use of sodium-based additives. Results: A rising sodium content was observed from 0 [56.7 mg (0, 39880)] to ≥ 3 additives [520 mg (60, 2080)] (n = 2451, p < 0.001). A total of 12 categories and 13 subcategories were analyzed. The use of sodium-based additives was associated with higher sodium content for the following categories (a) and subcategories (b): Confectionary (a) (p < 0.001), Chocolates/candies (b) (p < 0.001), Savory snacks (a) (p < 0.001), Salted biscuits (b) (p = 0.027), Fresh (a) and Processed meat/fish (a) (p < 0.001), Processed fruit/vegetables/legumes (a) (p < 0.001), Canned vegetables/legumes (b) (p < 0.001), Ices (a) (p = 0.006), Ready meals (a) (p = 0.030), Composite ready meals (b) (p = 0.001), Cookies (b) (p = 0.007), Cakes (b) (p = 0.022). The use of sodium-based additives was associated with lower sodium content for Beverages (a) (p = 0.002), Fish (heat treated) (b) (p = 0.020), and Pastries (b) (p = 0.045). Non-significant differences were observed for 4 categories and 5 subcategories. Discussion: A positive association between the use of sodium-based additives and the sodium content was observed. Inconsistent results were found across categories, suggesting the need for a deeper analysis of the foods included in each category or subcategory. Full article

The edible parts of artichokes (Cynara scolymus L.) are usually preserved in brine due to the short harvest season; however, this is less preferred by both retail sales and the catering sector since the high amount of salt is harmful to health. Freezing is an alternative method in terms of providing longer shelf life. The final quality of frozen foods can vary with the rate of freezing and the structure, size and distribution of ice crystals formed during the freezing process. The formed ice crystals directly affect the cellular structure and thus resilience of the overall tissue. The aim of this study was to compare the effects of three different freezing methods, i.e., static, air-blast and individual quick freezing (IQF), on the quality characteristics of globe artichokes. In this context, globe artichokes were frozen until reaching a center temperature of −20 °C, then thawed at 4 °C to analyze the amount of ascorbic acid, total phenolic content, antioxidant capacity (with DPPH and ABTS method), color difference value, texture and microstructure. The findings showed that a moderate quick-freezing method or air-blast resulted in the most-conserved DPPH antioxidant capacity result. While the total phenolic content and hardness values were the lowest in static frozen samples, the ascorbic acid was found to be highest in this method. No significant difference was evidenced in the color difference values of the samples (ΔE = 7.9–8.4). When the microstructures were examined, larger ice crystals were formed in the static frozen artichoke samples, followed by the air-blast and IQF processes. It can be concluded that smaller and homogeneously dispersed ice crystals in the artichoke samples frozen by IQF could better preserve the cellular structure. Full article

Iron (Fe) deficiency is a leading cause of anemia among Indian adolescent girls. Supplementation and fortification alone may not effectively reduce the risk of iron deficiency anemia. Therefore, sustainable food-based synergies and processing techniques must be developed to enhance mineral bio-accessibility (BAC) and bio-availability from naturally iron-rich foods. Traditional processing techniques that reduce antinutrient content and enhance mineral BAC have the potential to further enhance mineral bioavailability. This study quantifies the impact of traditional processing on Fe content and BAC in Fe-rich foods. It also quantifies the BAC of contaminant Fe from cooking in iron utensils. Three seeds were roasted and boiled in iron and non-iron utensils, and germinated. Three green leafy vegetables (GLVs) were roasted and blanched. Iron content was assessed using ICP-AES and the BAC was determined using dialyzability assay. Statistical analysis was conducted using MINITAB software, and Tukey’s test was used to determine the difference between the means. The Fe content in raw seeds ranged from 5.6 to 6.6 mg/100 g, and GLVs contained 36–77 mg Fe/100 g (d.b). Processing significantly increased Fe content in seeds (p < 0.05), with a maximum increase of 68–258% in samples boiled in an Fe pan. Among the GLVs, only blanching led to a significant reduction (~65%) in Fe content. The BAC of Fe from seeds increased after roasting (46.6–63.6%) and germination (7.9–68%). In GLVs, the maximum increase in Fe BAC was obtained in blanched samples (102–203%). No notable difference in Fe BAC was observed between the seed samples processed in utensils made of Fe and non-Fe materials. The Fe content and its BAC in food are significantly impacted by processing. Iron utensils may increase Fe content, but the contaminant-Fe BAC is limited. Roasting might release Fe from the protein–Fe–phytate complex due to thermal treatment, while germination mobilizes antinutrients, which may improve Fe bioavailability. Blanching works favorably in case of GLVs which may be due to alterations in the soluble and insoluble dietary fiber ratio. These findings suggest that incorporating such processing techniques can be beneficial while formulating products with high Fe bioavailability to combat anemia. Full article

Background: Curcuminoids are secondary plant metabolites found in turmeric and many dietary supplements. They usually consist of a mixture of curcumin (CUR), demethoxycurcumin (dCUR) and bisdemethoxycurcumin (bdCUR). CUR, the main curcuminoid, has been intensely investigated for its putative effects against, e.g., inflammation, oxidative stress and cancer. However, CUR displays very poor bioavailability. We have previously shown that, when brought by turmeric, dCUR and bdCUR, which can also exert health effects, display greater in vitro bioaccessibility than CUR (PMID: 37073511). However, their bioavailability relative to that of CUR has not been thoroughly investigated. Objective: We aimed to compare the bioavailability of dCUR and bdCUR to that of CUR in a meta-analysis of clinical trials in healthy humans and to compare their in vitro bioaccessibility and enterocyte uptake efficiency. Methods and Results: Studies published until 2022 were searched for using Medline and Scopus. The included studies were randomized trials that measured the bioavailability of CUR, dCUR and bdCUR in healthy participants. Estimates were calculated using a random-effects model. Fifteen trials were included in the study, representing a total of 50 interventions, i.e., each trial investigated several curcuminoid formulations, in 762 participants. The relative bioavailabilities were calculated using the inverse variance method. dCUR was 2.32 (95% CI:1.70, 3.13) times more bioavailable than CUR, while bdCUR was 2.57 (95% CI: 1.58, 4.16) times more bioavailable than CUR, with some heterogeneity across the formulations used. Using an in vitro gastro-intestinal digestion model with pure curcuminoids, we showed that dCUR solubilization efficiency was 4.8 and 5.3 times higher than that of CUR and bdCUR, respectively (p < 0.001), while its micellization efficiency was 10.3 and 5.1 times higher than that of CUR and bdCUR, respectively (p < 0.001). Conclusions: bdCUR and dCUR display greater bioavailability in humans compared to CUR. A subgroup analysis by formulation is undergoing investigation and will be presented. For dCUR, this difference is partly explained by higher in vitro bioaccessibility. Uptake efficiency measurements of pure curcuminoids and of curcuminoids from in vitro digestion fluids are undergoing investigation and will be presented. bdCUR and dCUR might therefore represent relevant alternatives to CUR for the systematic delivery of curcuminoids. Full article

Introduction: The health benefits of eating fruits have been well established. Fruit juice is the product of the extraction or pressing of the natural liquid contained in fruits. The glycemic index (GI) is a tool developed to systematically classify carbohydrate-containing foods according to the time-integrated effects on postprandial glycemic responses. This study aimed to determine the effects of consuming a mixed commercial fruit juice (containing apples, oranges, grapes, and pomegranates) fortified either with two probiotic strains (Lacticaseibacillus casei Shirota and Lacticaseibacillus rhamnosus GG), or with vitamin D3, or with n-3 polyunsaturated fatty acids (PUFA), or with a combination of all of the aforementioned biofunctional ingredients versus the same control fruit juice without biofunctional ingredients on the postprandial glycemic and insulinemic responses. Methods: Eleven healthy, normal-weight volunteers (25—2 years; five females; BMI = 23 ± 1 kg/m²) participated in this randomized, double-blind, crossover clinical trial and were randomly assigned to receive five types of fruit juices (the fruit juice control, fruit juice with 50 μg vitamin D3, fruit juice with 8.33 g n-3 PUFA, fruit juice with 10⁸ cfu/mL probiotics, and fruit juice with vitamin D3, n-3 PUFA, and probiotics, all tested once) and D-glucose as a reference drink, which was tested two times. They all contained 50 g available carbohydrates, and the fruit juices were administered at different weeks in a random sequence according to the recommended glycemic index methodology. Capillary blood glucose and salivary insulin samples were collected at the baseline and for 180 min post consumption. Results: All the fruit juices provided low GI values (control: 54; vitamin D3: 52; n-3: 51; probiotics: 50; vitamin D3-n-3 PUFA-probiotics combination: 52, on the glucose scale). All the fruit juice types provided lower peak glucose values, smaller mean glycemic and insulinemic responses, and were more pleasurable than glucose was. Discussion: All the fruit juice types, regardless of the added biofunctional ingredients, attenuated the postprandial glycemic responses, which may offer advantages for glycemic control. Full article

Betaine (BET) is a natural substance found in a variety of foods. BET is also a popular ingredient in dietary supplements. Athletes and physically active people are among those most interested in supplementing BET, because of its beneficial effect on health and, hypothetically, sports performance. The aim of this study was to evaluate the effect of 3-week BET supplementation on Crossfit performance, muscular power, cytokines, and hormones concentrations in Crossfit-training males. The secondary aim was to compare two different BET doses (2.5 g/d and 5.0 g/d). The study was designed in a double-blinded randomized cross-over fashion. Forty-three participants completed the entire study. Crossfit performance was measured using the Fight Gone Bad (FGB) workout and muscle power was evaluated in a 30 s WAnT. Body composition was determined by air-displacement plethysmography. Blood was drawn in the morning of each of the four study meetings, when fasted. Total FGB improved with BET by 8.7 ± 13.6% (p < 0.001), but no significant changes were observed with the placebo (−0.4 ± 10.0%, p = 0.128). No changes were observed in WAnT and body composition with BET. After BET supplementation, testosterone concentrations increased by 7.0 ± 15.4% (p = 0.046) (no change with the placebo: 1.5 ± 19.6%, p = 0.884) but no effect was observed for concentrations of insulin-like growth factor or cortisol. Our results show that BET supplementation significantly decreased homocysteine concentration (from 17.1 ± 4.0 μmol/L before BET to 15.6 ± 3.5 μmol/L after BET, p = 0.009, η² = 0.164), but had no effect on cytokines concentrations (IL-1β, IL-6, and TNF-α). There was no significant interaction with BET dose for any measured outcome. In conclusion, 3-week BET supplementation may improve Crossfit performance, increase testosterone concentrations, and decrease homocysteine concentrations in training males. However, BET had no influence on anaerobic muscular power, body composition, and inflammatory status in our population. The application of our results might refer to males who want to improve their Crossfit performance, and also to populations with decreased testosterone levels, e.g., older males. However, further studies should determine the effect of BET in different populations. Key words: Wingate; Fight Gone Bad; body composition; betaine. Full article

Background/Objectives: Sleep disturbances are considered a major public health issue due to their negative impact on overall health and the economy. There is an increasing interest in plant bioactive compounds as natural alternatives to common pharmaceutical treatment options for improving sleep quality. The green tea amino acid, L-theanine (L-THE), has been shown to induce relaxation, reduce stress, anxiety, and depressive symptoms by influencing the several neurotransmitters associated with the sleep–wake cycle. Therefore, the aim of this systematic literature review was to evaluate the effects of L-THE consumption on sleep quality in humans. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines, systematic literature searches were conducted in six electronic databases (PsycINFO, CINAHL, Web of Science, Medline, Scopus, and Cochrane Central Register of Controlled Trials). This systematic literature review was pre-registered with the international prospective register of systematic reviews PROSPERO (CRD42022304635). Results/Discussion: In total, eleven journal articles were identified that met the inclusion criteria where L-THE supplementation (alone or in combination with other bioactives) was compared to the supplementation of a placebo (or comparator) for the treatment of sleep disturbances. The duration of treatments varied from one day to eight weeks. The majority of the included studies were conducted in adults (n = 373) while two studies were completed in children (n = 107). Improvements in several sleep parameters were observed including sleep onset latency (7), total sleeping time (2), sleep duration (2), sleep efficiency (2), overall sleep quality (5), daytime dysfunction (2), early awakenings (1), morning sleepiness (3), the use of sleep medication (1), and sleep disturbances (4) (All p’s < 0.05). The findings indicate that L-THE (50–655 mg) may be effective at improving sleep quality either as an individual supplement or in combination with other bioactives. Furthermore, the treatment of sleep disturbances with L-THE at doses higher than 655 mg may not be beneficial and may be detrimental to overall sleep quality. Conclusion: The findings of this systematic literature review indicate promising effects on the use of L-THE in the management of sleep disturbances and highlight the need for further studies to determine if there is an optimal concentration of L-THE for improving sleep. Full article

Introduction: In the last few years, several studies have described the beneficial effects of the supplementation of diets with certain probiotic strains and different obesity-related disturbances, including metabolic syndrome. New research lines aim to characterize and understand the strain-specific mechanisms of action and their effects on the host’s health. The use of animal models is necessary to understand how probiotics interact with the gut microbiota and exert beneficial activities, which would allow us gain insight into potential new strategies against obesity-related diseases. Objective: we aim to characterize the effects of a novel probiotic strain of Latilactobacillus sakei (L. sakei) in two different animal models with adiposity excess. Methods: Caenorhabditis elegans was used as a starting in vivo model to analyse how the probiotics affect fat accumulation, oxidative stress, senescence, and lifespan when exposed to high-glucose conditions. Then, the effects of L. sakei oral administration (10⁹ CFU/day) were evaluated in diet-induced obese (DIO) Wistar rats, and biochemical, transcriptomic, metagenomics, and metabolomics analyses were performed. Results: Supplementation with L. sakei in C. elegans counteracted the deleterious effects of glucose by reducing fat accumulation, enhancing the oxidative stress response, and extending lifespan by directly regulating the carbohydrate- and lipid metabolism-related genes acox-1, maoc-1, and daf-16. Following the same trend, DIO rats supplemented with L. sakei showed lower proportions of mesenteric and subcutaneous fat, improved glucose tolerance, and an ameliorated inflammatory marker profile, partly by regulating the expression levels of key metabolic genes like adiponectin, leptin, and Acox1. The oral administration of L. sakei modulated faecal microbiota composition and induced the production of novel plasma metabolites. Conclusions: our results unveil new strain-specific mechanisms of action through which L. sakei exerts health-promoting effects in C. elegans and DIO adiposity models, as well as further describe how these probiotics could potentially be useful for the prevention and treatment of metabolic syndrome-related diseases. Full article

Introduction: The purpose of this study was to test the hypothesis that a preload including orange fruit juice (FJ) enriched with 50 μg of vitamin D3, 8.33 g of n-3 PUFA, and 108 cfu/mL of Lacticaseibacillus casei Shirota and Lacticaseibacillus rhamnosus GG probiotics, consumed as a snack before a meal, would (a) have greater short-term effects on satiety, as measured by the subsequent ad libitum meal intake, and (b) induce greater satiety, as assessed using visual analogue scales (VAS), in normal-weight and overweight healthy individuals compared to the same orange FJ without any fortification. Methods: Forty-six healthy individuals (normal weight: n = 24, 25 ± 1 years, BMI: 21 ± 1 kg/m²; overweight: n = 22, 28 ± 2 years, BMI: 27 ± 1 kg/m²) participated in this randomized, double-blind, within-subject crossover study. The participants consumed a standardized breakfast after 12 h of fasting. Two hours later, they were given 50 g of available carbohydrates from the two preloads (enriched orange FJ or control FJ) in random order, with a one-week washout period, and three hours later, they were offered an ad libitum lunch. The participants rated their hunger, desire to eat, perceived fullness, thirst, preoccupation with food, and pleasure of eating on visual analogue scales (VAS) at the baseline and at 15–30 min intervals up to 7 h of the intervention. Results: A statistical analysis of the results showed that when the individuals consumed the preload that included the FJ enriched with biofunctional ingredients, they had lower feeling of hunger, desire to eat, and preoccupation with food, and a higher perceived fullness at all time points between the preload and the meal. Additionally, the overweight individuals had a lower total energy intake at the meal and a lower energy intake 24 h post intervention day, as well as lower protein and fat intakes, compared to the normal-weight individuals. Discussion: Since the macronutrient contents of both preloads were similar, the satiating power of the enriched FJ indicates that the added ingredients (vitamin D3, n-3, and probiotics) have biofunctional properties that induce fullness and reduce the total energy intake, particularly in overweight individuals. The addition of enriched FJ to a snack seems to promote satiety besides providing valuable nutrients, and it may be an effective strategy for body weight control. Full article

The food industry offers innovative approaches in accordance with the changing demands of consumers. Developing functional formulations that may have positive effects on human health in addition to the nutritional feature of food has become a very popular approach. Chestnut (Castanea sativa Mill.) has many ways of being consumed, and one of them is candied chestnuts. Candied chestnuts, which are one of the gastronomic products, is offered on the market as whole or broken. Broken candied chestnuts, which have less economic value than whole candied chestnuts, are consumed directly or with a chocolate coating. There are no examples of fruit-coated candied chestnut production. The objective of this research was to produce an alternative and functional new food product by coating broken chestnut candies with pomegranate juice concentrate. Within the scope of the research, four different formulations of fruit-coated candied chestnuts were produced: candied chestnuts coated with solely pomegranate juice concentrate (I), pomegranate juice concentrate coated candied chestnuts with copigment agent (II), riboflavin fortified pomegranate juice concentrate coated candied chestnuts (III), and candied chestnuts coated with riboflavin-fortified and copigment agent added pomegranate juice concentrate (IV). Pomegranate peel phenolic extract as a copigment agent was obtained via microwave-assisted extraction followed by evaporation. The added amount of copigment agent was decided by determining the total phenolic content of the obtained extract (23.1 mg GAE/g) and the total monomeric anthocyanin content of the pomegranate juice (62.7 mg cyn-3-glu/kg). Riboflavin was added to the coating material at a ratio of 50 mg/product to meet the daily intake of individuals. The products were finally packed via aluminum polyethylene (ALPE) packages and stored for two months at 4 °C. Texture, color, total phenolic content, anthocyanin content and antioxidant capacity analyses were performed each 15 days of the 60-day storage period. This study was financially supported with a fund from The Scientific and Technological Research Council of Türkiye (TUBITAK-BIDEB 2209-A). Full article

Background: Inorganic nitrate found in beetroot and green leafy vegetables has been demonstrated to reduce cardiovascular disease risk factors, including reducing blood pressure (BP) and the stiffness of blood vessels by increasing levels of nitric oxide (NO). The most beneficial effects of inorganic nitrate have been observed in young, healthy populations, whereas its impact on at-risk populations, such as postmenopausal women, is currently unknown. Objective: the primary aim of the trial is to evaluate the effectiveness of nitrate-rich beetroot juice in enhancing microvascular blood flow and cognitive function in postmenopausal women. Methods: We conducted a double-blind, three-armed, randomised, and controlled crossover trial with 24 postmenopausal women (aged 45 or older and having not had a period for over one year). The interventions were beetroot juice (BJ), nitrate-depleted BJ (NDJB), or NDBJ supplemented with potassium nitrate (0.4 g) to concurrently test if betalains, as well as nitrate, play a role in the vascular and cognitive effects. Cognitive tasks (episodic memory: Rey auditory verbal learning test; executive function: Stroop task, digit span backward and forward) and microvascular function (Laser Doppler Imaging (LDI) with iontophoresis; endothelium-independent and -dependent) were measured in participants before and 2.5 h after ingestion of the intervention. In addition, BP was measured in triplicate every 15 min from the baseline for 2.5 h. Results: The baseline characteristics of the participants recruited to date are as follows (mean and standard deviation)—age (years): 60 ± 5, BMI (kg/ m²): 23.8 ± 3.1, systolic BP (mmHg): 120 ± 14, and diastolic BP (mmHg): 75 ± 8. Early results indicated no significant difference between the groups with respect to SBP or DBP. A statistical analysis of the full data set, including endothelium-dependent and -independent microvascular function and cognitive tests, will be presented. Discussion: the results of this trial will help shed further light on the impact of dietary nitrate and the phytochemicals present in beetroot on human vascular and cognitive function. Full article

Background and objectives: A health-promoting lifestyle during pregnancy is beneficial for both the mother and the child, but an increase in physical activity, eating a healthy diet and achieving the recommended weight gain require high motivation. Health apps may serve as efficient tools for supporting a health-promoting lifestyle during pregnancy. Although the market for health apps is thriving, the scientific validity of these apps has rarely been studied. The objective of this study was to characterise health app use among pregnant women and to investigate whether the frequency of health app use leads to a change in gestational weight, diet quality and physical activity. Methods: Pregnant women were recruited through social media announcements. Participants were asked to record their lifestyle habits in a health app from early pregnancy to delivery. Online questionnaires were used to assess their diet quality and physical activity with validated indices and self-reported weight in early (<28 gestational weeks) and late (34–36 gestational weeks) pregnancy. Physical activity was categorised into light (<5 MET h/wk), moderate (5–30 MET h/wk) and high physical activity (>30 MET h/wk). Results: Altogether, 1038 participants were enrolled in the study. Of them, 37% (386/1038) used the app at least once, whilst 63% did not use the app. The median (IQR) duration of app use was 4.7 (1.1–15.6) weeks and the median (IQR) number of recordings was 59 (19–294). App users were categorised as frequent (use ≥ 4.7 weeks, 19%) and occasional app users (<4.7 weeks, 19%). No differences were seen between the groups with regard to their change in weight or diet quality score. The proportion of women with a moderate or high activity level decreased in all groups, but this was less in frequent (OR 0.61, 95% CI 0.40–0.94, p = 0.025) and occasional app users (OR 0.55, 95% CI 0.32–0.97, p = 0.04) compared to non-users (time × group interaction, p = 0.036). Discussion: The results demonstrate extensive variations in app use, but the benefits of app use may arise from the maintenance of physical activity. This intervention into the typically observed decrease in physical activity over the course of pregnancy may lower the risk of pregnancy complications, including gestational diabetes. Full article

Research on meal patterns, including both combinations of foods and meals, has increased in recent years. Advanced statistical techniques are required to identify these patterns. Despite this, no study has assessed whether applying different statistical approaches to the same data gives rise to different outcomes. The objective was to identify meal patterns using different methods and compare the resulting meal patterns that were identified. This study is a secondary analysis of data from NHANES 2017-2018. A small number of generic meals were identified that were representative of the larger number of actual meals consumed with regard to their food group and nutrient content, using a previously established method. Combinations of these generic meals consumed (meal patterns) were identified using three different statistical approaches: partitioning around the medoids clustering, principal component analysis (PCA), and latent class analysis (LCA). For clustering and PCA the input data were the % total energy intake from each of the generic meals and five binary variables indicating consumption or non-consumption of five meal types (breakfast, lunch, dinner, snacks, and beverages). For LCA the input data were five categorical variables for each of the five meal types giving the specific generic meal consumed at each meal type and five binary variables that were the same as those used in clustering and PCA. The number of meal patterns identified were 26 by clustering, 18 by PCA, and 17 by LCA. Meal patterns in which individuals skipped certain meal types were only observed using clustering and LCA, but not PCA. There was only one meal pattern that was identical between when comparing clustering patterns with LCA patterns, i.e., the generic meals consumed at all five meal types were the same. No other identical patterns were identified. For all comparisons (clustering v. PCA, clustering v. LCA, and PCA v. LCA), there were two meal patterns in each in which identical generic meals were consumed in four of the five meal types. Different approaches to meal pattern analysis gave rise to the differing number of meal patterns; similar identification of meal skipping between clustering and LCA, but not PCA; and differences in the content of the meal patterns. Caution is required when comparing meal patterns identified using differing statistical approaches. Full article

Background and objectives: Pooling datasets for nutritional epidemiological purposes are becoming more common because of their several advantages. Here, we described our step-by-step dietary data harmonization process applied within the PROMED-COG pooled cohorts study aiming to evaluate the effect of nutrition on neurocognitive ageing. Methods: This is a collaborative project that includes data from four Italian population studies recruited during the 1992–2023 period: BEST; Pro.V.A; ILSA; and NutBrain. Retrospective nutritional data harmonization was performed considering three main nutritional exposures such as body composition (weight and circumference), undernutrition (by combining phenotypic and etiologic criteria), and dietary habits (through food frequency questionnaires). In particular, the challenge was the harmonization procedure for dietary habits that required several steps: (i) access to documentation from the original studies, (ii) discussion with the researchers responsible for each dataset; (iii) exploration of each dataset before the final harmonization; (iv) agreement on portion size and food frequency standardization, and food classification for healthy dietary pattern computation; (v) name, definition, and categorization of the harmonized common variable and the original variables, for each study; (vi) development and application of the algorithm to obtain the harmonized variables from the original ones; and (vii) final pooled dataset preparation. Results: The pooled sample included 9326 adults aged 40–101 years, of which 52% were women. The main issues encountered were due to the heterogeneity of dietary assessment methods across studies: type of instrument (unstructured dietary questionnaires for ILSA and Pro.V.A. vs. structured FFQ for the BEST and NutBrain); data collection time frame (1992–1997 in ILSA, Pro.V.A., and BEST and 2019–2023 in NutBRain); and the period used for diet reporting (last week for ILSA and Pro.V.A., last 12 months for BEST and NutBrain). On the other hand, there were similar characteristics regarding the administration method of data collection (by trained interviewers), comparability of the food composition database used for nutrient profiling, community-dwelling setting, and geographical area (Italy), fostering the comparison across studies. Conclusion: the pooled dataset represents a harmonization standard procedure that may be useful to advance future epidemiologic research with different applications and, specifically within the PROMED-COG, to draw valid and solid conclusions about the nutrition–neurocognitive ageing relation in the general population. Full article

Background: The rapid production of gas during the colonic fermentation of highly soluble fermentable fibres may cause unpleasant gastrointestinal symptoms. In vivo feeding studies are often used to assess symptomatic response to fibres; however, in vitro fermentation studies are quicker, cheaper, and more reproducible. The aim of this study was to validate an in vitro colonic fermentation model of gas production against in vivo experiences of symptoms following inulin consumption. Methods: Healthy volunteers (n = 21, 18–65 y/o, M/F) provided a stool sample used to inoculate an in vitro colonic fermentation model. Fermentation bottles containing faecal slurry, a fermentation medium, and a fibre substrate (inulin) were incubated at 37 °C for 24 h in a shaking water bath. The total gas production (mL) over 24 h (minus control) was measured. Each stool donor added 15 g inulin to a low-fibre diet and recorded experiences of gastrointestinal symptoms for 48h. In vitro gas production and in vivo symptom experience were compared for each donor following tertile classification. Low in vitro gas production was classed as <45mL (<1st quartile of dataset), medium as 45–78 mL (1st quartile–3rd quartile), and high as >78 mL (>3rd quartile). In vivo symptom response was classed as low if symptoms were mild and/or short-lived (<1 h duration); medium if moderate and/or prolonged (1 h); and high when abdominal pain or multiple prolonged (3 h) symptoms occurred. Results: In vitro gas production was high in six cases (29%); medium in ten (48%); and low in five (24%). Symptom experience was high in seven cases (33%); medium in five (24%); and low in nine (43%). The same classification occurred in 57% of cases and classification into adjacent categories occurred in 43%; no complete misclassification occurred. Agreement between the methods was fair: weighted kappa = 0.378 (p < 0.01). Discussion: The level of agreement between the in vitro model of gas production and in vivo symptom reports, and the absence of any cases of complete misclassification, is promising. This simple in vitro batch-fermentation model may be used in future to screen fibres for their potential impact on gastrointestinal symptoms. This will help develop strategies to increase fibre consumption generally and optimise their use in food reformulation. Full article

Background and objectives: Proteins have an integral role in almost all biological processes and may be influenced by environmental factors, such as diet. We aimed to assess differences in circulating proteins between people of different habitual dietary groups, which may provide novel information in understanding biological functions and disease aetiology. Methods: The UK Biobank recruited adults aged 40 to 69 years throughout the UK in 2006–2010. The relative concentrations of 1463 plasma proteins were quantified using Olink Proximity Extension Assay on samples from ~54,000 participants. Participants were also asked to report their ethnicity and consumption of red and processed meat, poultry, fish, dairy and eggs. From this information, we identified six diet groups among the white British participants (23,116 regular meat eaters, 23,323 low meat eaters, 484 poultry eaters, 1074 fish eaters, 722 vegetarians, and 54 vegans), and two diet groups among the British Indian participants (390 meat eaters and 163 vegetarians). We used multivariable-adjusted linear regressions to assess differences in protein concentrations by diet groups. Results: We observed significant differences in many plasma proteins (p < 0.00008 after correction for multiple testing, 683 proteins in white British participants), with many proteins showing a gradient effect in magnitude of differences across diet groups. Of the biggest differences, compared with white British regular meat eaters, the other white British diet groups had higher concentrations of FGF21 (e.g., +0.40 units in vegetarians on a standardised scale), GUCA2A (+0.33), FOLR1 (+0.32), IGFBP2 (+0.31), FGF23 (+0.31) and DSG2 (+0.30), but lower concentrations of HAVCR1 (-0.38), CDHR2 (−0.26) and ACP5 (−0.24); concentrations of CD99L2 were lower in low meat, poultry and fish eaters (−0.16), but higher in vegetarians (+0.24). The observed differences were generally similar in direction for the white British and British Indian participants. The proteins identified are involved in a range of different biological processes, particularly in gastrointestinal tract function, as well as kidney, liver and muscle functions, and cell growth and cell adhesion, among other processes. Discussion: The substantial differences in plasma proteomic profiles between people of different diet groups indicate differences in cellular activities and may relate to differences in future disease risk. Full article

Investigating diet-related disease in India’s ageing population is challenging due to poor dietary assessment infrastructure and limited capacity for nutritional analyses. We developed a semi-quantitative Food Frequency Questionnaire (FFQ) to capture dietary intake among older Indian adults. Nutrient analysis of FFQ data requires linkage to a nutrient database preferably based on local food composition. However, the Indian Food Composition Tables (IFCT) provided only partial coverage for FFQ items, nutrient data for cooked foods were unavailable, and some important nutrients were missing, e.g., iodine and vitamin B12. The objective was to develop a nutrient database maximising the IFCT to allow for the analysis of FFQ data. The development of the nutrient database involved: (1) the creation of a core dataset within the Nutritics (2019) software platform comprising analytical data for matched foods in the IFCT reference database; (2) the selection of suitable matches for additional foods/beverages consumed in the FFQ informed by local dietetic expertise; (3) the import of nutrient profiles for additional foods/beverages from international food composition tables (UK, USA, and Singapore) to provide full coverage for all FFQ items; (4) the filling of nutrient data gaps in the core IFCT dataset to ensure all foods/beverages have a value for each nutrient; and (5) the generation of a conversion file for food frequencies to daily intakes (in servings and grams) to facilitate FFQ linkage with the nutrient database. The complete nutrient database provides full coverage of FFQ raw and cooked food/beverages and has the capability to analyse 53 nutrients. Overall, 53% of the FFQ items were matched to the IFCT, whilst 28% were matched from the UK (GB21-0), 15% from the USA (FNDDS), and 4% from the Singapore food tables. All FFQ items matched to the IFCT had missing nutrients mapped from matches in other databases, with GB21-0 being the first preference. For cooked FFQ items matched to the IFCT (n = 21), an appropriate cooking method was applied using established nutrient retention factors. The bespoke nutrient database developed through the integration of nutritional expertise and dietary assessment software will allow for the nutrient analysis of FFQ data. The next step is to automate the nutrient analysis process from computer-assisted FFQ data collection in Wave 2 of LASI-DAD. Full article

Recently, industrial (ultra) processing of foods and its possible adverse effects on health have been widely debated in scientific literature and media. There is not much known about consumers’ attitudes toward the (ultra) processing of foods. Therefore, a survey was distributed (n = 463) and interviews (n = 11) were conducted with Dutch adult consumers to evaluate consumers’ attitudes and associations towards industrial food processing and to assess opinions about communications on food processing and health. The results showed that 51% of the consumers had a neutral attitude, 23% had a positive attitude, and 26% had a negative attitude towards food processing. Most respondents (75%) were not familiar with the term ultra-processed foods, especially those with a neutral attitude compared to those with a positive or negative attitude (p < 0.001). The survey showed that 69% of the respondents thought food processing had a (slightly) negative health effect, 17% did not know, and 9% indicated (slightly) positive health effects. Associations with industrial processing were as follows: additives, artificial, not fresh, low nutritional value, and unnatural, but also food safety, and convenience. All three attitude groups (negative, neutral, and positive) indicated both positive and negative associations. Respondents of the survey who were indicated to be (slightly) related to food/nutrition by profession (n = 159) more frequently had a positive attitude towards food processing (p = 0.008). Furthermore, many interviewees indicated that communication on food is scattered and chaotic. There is a need for clear and understandable information from a central source, especially for those with negative attitudes. In addition, 77% of the survey respondents with a negative attitude towards food processing indicated that they would like to have more information about nutrition and food (processing). In conclusion, most Dutch consumers in this study population have a neutral and nuanced attitude towards industrial food processing. Those with a background or connection with food via profession showed a more positive attitude, which may indicate a need for clear communication and education about nutrition, ingredients, and food processing. Full article

Background and objectives: Globally, about 70% of the adult population is lactase non-persistent (LNP), lacking the enzyme required for lactose digestion. The main consequence of intolerance is withholding nutrient-rich dairy foods, while the literature shows that many LNPers are able to consume ≤12 g of lactose, comparable to 250 mL of milk, without experiencing gastrointestinal discomfort. Repetitive consumption of lactose may improve intolerance symptoms even further via colonic adaptation. This study aimed to assess the effects of daily consumption of incremental lactose doses on microbiota composition and function, and intolerance symptoms. Methods: Twenty-five healthy adults of Asian origin (age 22–44 yrs, BMI 19–28 kg/m²), carrying the LNP genotype and avoiding lactose in their habitual diet, were included in this 12-week single-blinded intervention trial. Participants consumed lactose twice daily, with doses being gradually increased from 3 to 6 g, to finally 12 g twice daily, each dose being provided for 4 consecutive weeks. Before and after the 12-week intervention, participants underwent a 25 g lactose challenge hydrogen breath test (HBT) and handed in stool samples. Daily gastrointestinal symptoms and acute intolerance symptoms during the HBT were recorded. Results: There was a significant increase in Bifidobacterium after 12 weeks of lactose consumption (p = 0.009), accompanied by a two-fold increase (p < 0.001) in fecal β-galactosidase activity. There was a 1.5-fold decrease (AUC; p = 0.01) in expired hydrogen during the second compared to the baseline HBT. There was a non-significant decrease in total symptom score (p = 0.09) during this second HBT, which was already relatively low during the baseline HBT. Daily consumption of lactose was generally well tolerated, with mild to no gastrointestinal complaints reported during the intervention. Discussion: Repetitive consumption of incremental doses of lactose increases lactose tolerance in LNP individuals via colonic adaptation, most likely through increasing the relative abundance of lactose-fermenting Bifidobacterium. Repetitive lactose consumption is well tolerated and able to reduce expired hydrogen during a 25 g lactose HBT. Here, we show that regular and incremental exposure to lactose in LNP individuals leads to colonic adaptation without any increase in gastrointestinal symptoms. This lifts the necessity to remove dairy foods completely from the diet. Full article

Background and objectives: Despite the current food labelling legislation, there is room for marketing departments in the food industry to seduce consumers with misleading labelling, for example by using pictures of fresh fruits or vegetables that are only present in tiny amounts in the product, or by using terms such as ‘no added sugar’, ‘natural’, ‘healthy’ or ‘fresh’, misleading portion sizes and fun characters for kids. Consumers need help in making the actual healthy choice. So, what needs to be done and by whom? Methods: Several studies were carried out: Semi-structured interviews (n = 7) with food experts on roles and responsibilities of different parties and possible solutions. Based on an inventory of misleading food labels, a categorization was made together with the help of food experts. The eight defined categories were evaluated in quantitative (n = 1117) and qualitative (n = 26) consumer studies. A selection of legislative measures against misleading labelling that are already available in other countries were evaluated in 12 semi-structured interviews with representatives from the food industry. Results and Discussion: Consumers indicated that the top three categories of most misleading labelling were (1) the suggestion of product qualities that are not present or are only present in tiny amounts; (2) blurring of unhealthy ingredients; and (3) incorrect use of nutrition claims. Misleading labelling was mostly found on cookies, bars and non-alcoholic drinks. In general, the representatives of the food industry agreed on the need for legislation to prevent blurring of unhealthy nutrients and incorrect use of nutrition claims. Suggesting product qualities that are not present or are present in tiny amounts was of a lower priority according to the interviewees. It was indicated that there is a tension between the marketing and quality roles within a food company. With respect to roles and responsibilities, there was an agreement that the food producers were responsible for what is on their packages, the government is responsible for the legislation and the consumers are responsible for their own food choices. However, everyone doubts whether the consumers understand enough to be able make healthier choices. Full article

Malnutrition still affects the population in low-income countries. In Burkina Faso, the estimated prevalence of anemia is high among preschool-aged children and women of childbearing age (83.4% and 53%, respectively in 2014). As part of the MERIEM fortification project, a survey was carried out in 2022 in Ouagadougou to describe dietary practices and women’s knowledge. The aim of this work is to assess the association between exposure to nutrition sensitization campaigns and women’s knowledge of nutrition. A cross-sectional survey conducted in Ouagadougou in March 2022 involved 794 randomly selected women. Socio-economic data were collected, and knowledge scores on breastfeeding (BF; max 9), complementary feeding practices (IYCF; max 8) and nutritional status (NS; max 7) of young children, the feeding practices of pregnant (PW; max 4) and breastfeeding women (BW; max 4), and fortified products (FP; max 18) and vitamins and minerals (VM; max 13) were calculated. Exposure to nutrition sensitizations was categorized as low, moderate, or high. Linear regression models (performed with R software version 4.3.0) were used to analyze the association between knowledge scores and household wealth quintiles, as well as the association between knowledge scores and sensitization scores from the MERIEM project, adjusted for wealth quintiles. Mean scores measured in the sample are 4.7, 2.9, 2.6, 1.4, 1.8, 2.7, and 3.1 for BF, IYCF, NS, PW, BW, FP, and VM, respectively. Knowledge scores increased significantly (p < 0.001) with socio-economic status, except for NS, PW, and BW scores. In total, 78.0% of women had a low level of awareness and only 6.3% had a high level. Exposure to nutrition awareness campaigns increases all women’s knowledge, but not for breastfeeding. This is probably due to the wide promotion of breastfeeding practices among the population, particularly in health centers. The MERIEM-specific project’s awareness-raising activities are overall not associated with knowledge scores. However, there was a significant association with IYCD and VM scores (p < 0.05). Knowledge of diet and nutrition is overall low in Burkina Faso. Raising awareness seems to have a positive effect on knowledge levels and can be a lever in the fight against malnutrition. Further research is needed to determine whether improved knowledge scores translate into improved practices. Full article

Background and objectives: Changing dietary patterns into sustainable healthy diets is urgent. So far, few behavior change interventions have addressed all dimensions of dietary sustainability (i.e., nutrition and health, economic, socio-cultural, and environmental) at once. Cutting-edge methodologies, such as eHealth, could be an appealing way to implement such interventions. This pilot study aimed to assess the acceptability and effectiveness of an app-based behavior change intervention, promoting the adoption of a sustainable healthy diet. Methods: Twelve participants were enrolled in a one-year n-of-1 clinical trial (2-week baseline + 22-week intervention + 24-week follow-up). The intervention consisted of push notifications (educational, motivational, or recipes) through an app, as well as scheduled individualized online feedback sessions. The consumption of 10 key food groups for a healthy diet with a low environmental impact was monitored daily on fifteen weekly bursts spread throughout the study by means of an app-based validated questionnaire. Other key aspects for a sustainable diet (e.g., socio-economic or food waste) and the acceptability of the intervention were assessed qualitatively through three interviews. Results: Throughout the study, dietary patterns of 10 out of 12 participants were more aligned with an environmentally sustainable healthy diet. Two of the participants did not modify their diet substantially. The consumption of fruits and vegetables, legumes, and whole grains increased over time, while that of red and processed meat decreased. Diverse results were observed for dairy products and ultraprocessed foods. Over time, half of the participants reported an increased concern for the socioeconomic dimension of dietary sustainability, and 70% reported an increased concern about food waste. Participants provided positive feedback on the text messages they received, the utility of the individual online feedback sessions, and the adequacy of the frequency of response and the ease with which the app-based dietary questionnaire is answered. Conclusions: This pilot study implemented through eHealth technology was effective for changing eating behaviors towards a sustainable healthy diet. The methodology and materials developed can be useful in designing future large-scale interventions. Full article

Background and objectives: Russian military aggression in Ukraine has exposed children to extremely high levels of acute and chronic stressors that are incomparable to stress levels in peaceful countries. Such stressors can impact children’s eating behavior, for example, by altering the psychological climate within families. We aimed to determine the prevalence of war-induced, stress-related disruptions in the eating behavior of Ukrainian children. Methods: We used a cross-sectional survey to determine stress-related disordered eating behavior among school-aged children under conditions of stress caused by the war in Ukraine. A total of 5162 parents or guardians used an electronic questionnaire to report changes in the children’s eating behavior (EB) in various stressful conditions, including being in close proximity to the combat zone, residing in occupied or peaceful territories, displacement from homes, abroad, and other. 311 (6%) of participants did not report the age of the child or reported on behalf of a child who was younger than 5 years or older than 17 years, and were thus excluded. Thus, the final sample included 4854 (94%) parents. Results: of the guardians, 63% reported changes in children’s EBs during the war, with the highest frequency observed among 5 to 10-year-olds. The most common EB changes observed during wartime included food cravings (38%), food fussiness (37%), aversion to certain foods (29%), and decreased appetite (24%). 40% of the reported EB changes were long-term, lasting over a month and related to altered attitudes towards food. Food insecurity, residing in occupied territories, and displacement emerged as the most influential determinants of EB changes. Discussion: The findings underscore a significant and robust association between various war-related exposures and an increased risk of frequent eating behavior changes. As healthy eating behaviors are learned during childhood and have been shown to track into adulthood, the identified disruptions in eating behavior may have significant long-term consequences for the physical and mental health of the Ukrainian children. More research is needed to determine whether the intensity of the identified changes in children’s eating habits is linked to the severity of the stressors. Full article

Background and objectives: The declining trend of the adherence to Mediterranean Diet (MD) and shift toward Western-type dietary patterns involve different age groups across the world, including young generations. University students are particularly involved in this process as university life exposes them to the risk of developing unhealthy dietary behaviors and diet-related chronic diseases in later life. In this context, the present cross-sectional study was aimed at investigating the level of adherence to the MD and its association with sociodemographic and anthropometric variables, and lifestyle-related factors, including the adoption of sustainable dietary behaviors, in two national representative samples of university students (18–24 years) living in Italy (IT) and in the United States (US). Methods: The adherence to the MD and sustainability of dietary behaviors were assessed by applying the KIDMED questionnaires and the Sustainable-HEalthy-Diet (SHED) Index, respectively. Both instruments provide a total score. In addition, the SHED Index includes six sub-scores (i.e., Healthy Eating, Sustainable Eating, Place of Purchase of Fruits and Vegetables, Prepared Meals, Water, and Soda). Results: The final samples consisted of 1434 and 1485 Italian and American students, respectively. Most of the participants had an average adherence to the MD (IT: 55%; US: 47%). In both populations, meeting physical activity recommendations, having a high SHED Index score, mainly consuming plant-based foods, being prone to purchase and eat healthy and sustainable dishes, and regularly attending the university canteen were the most powerful predictors of having a high adherence to the MD. Discussion: In this connection, a major promotion of the MD as a sustainable dietary pattern may be an effective strategy for its revitalization. Considering the positive influence that university canteen attendance has on students’ eating habits, campuses and university dining services represent a unique opportunity to build a supportive environment that educates students about the effects of their actions and fosters human and planetary health. Full article

Eating Behaviour Traits (EBTs) are psychological constructs developed to explain patterns of eating behaviour, including factors that motivate people to (over or under) eat. There is a need to align and clarify their unique contributions and harmonise the understanding they offer for human eating behaviour. Therefore, the current study examined whether 18 commonly cited EBTs could be explained by underlying, latent factors (domains of eating behaviour). An exploratory factor analysis (EFA) was used to identify latent factors, and these factors were validated using a confirmatory factor analysis (CFA). A total of 1279 participants including the general public and members of a weight management programme were included in the analysis (957 females, 317 males, 3 others, 2 prefer not to say), with a mean age of 54 years (median = 57 years, SD = 12.03) and a mean BMI of 31.93 kg/m² (median = 30.86, SD = 6.00). The participants completed 8 questionnaires which included 18 commonly cited EBTs and the dataset was split at random with a 70/30 ratio to conduct the EFA (n = 893) and CFA (n = 383). The results supported a four-factor model which indicated that EBTs can be organised into four domains: reactive, restricted, emotional, and homeostatic eating. The four-factor model also significantly predicted self-reported BMI, weight change and perceived stress. Future research should test whether this factor structure is replicated in more diverse populations, and including other EBTs, to advance these domains of eating as a unifying framework for studying individual differences in human eating behaviour. Full article

Background and objectives: Mindful eating (ME) is defined as non-judgmental awareness of the physical and emotional sensations experienced while eating. An association between ME and healthier eating behaviors has been suggested. However, there are only few observational studies available. The aim of this cross-sectional study was to investigate the association between ME levels and food consumption, in particular, diet quality, food groups, and ultra-processed food consumption, in a general population sample. Methods: In 2022, 2069 participants of the NutriNet-Santé Study completed the Mind-Eat scale, a validated questionnaire assessing ME as a whole and its six dimensions. Participants also completed at least three 24 h dietary records. Adherence to the French dietary guidelines was assessed via the French National Nutrition and Health Program Guideline Score (PNNS-GS2). The degree of food processing was assessed using the NOVA classification. Logistic and linear regressions were used to analyze associations between ME as the exposure (score from 1 to 5), and diet quality, food groups, and ultra-processed food consumption as outcomes, stratified by sex, and considering sociodemographic and lifestyle covariates. Results: Men and women with a higher ME score showed better adherence to dietary guidelines (men: β = 1.05, 95%CI: 0.53, 1.58; women: β = 0.74, 95%CI: 0.40, 1.09), and a lower consumption of ultra-processed food (men: β = −0.02, 95%CI: −0.04, −0.01; women: β = −0.02, 95%CI: −0.03, −0.01). They also consumed fewer dairy products and meat, and more non-salted oleaginous foods. In addition, women with higher levels of ME consumed more fats and eggs, and fewer processed meat and chocolate based-products, while men consumed more vegetables, whole-grain products, and starches, and less seafood. Regarding macronutrients, individuals with higher levels of ME consumed less protein overall and animal protein, but more plant-based protein. In addition, women with higher ME levels consumed more added fats and omega 3, and less total energy and simple and added carbohydrates, while men consumed more fibers and plant-based lipids. Discussion: ME was associated with a healthier overall diet. These findings suggest that ME could be helpful in the promotion of healthy eating behaviors. Further studies on the dimensions of ME are needed. Full article

Background and objectives: Numerous studies link ultra-processed food (UPF) intake to adverse health outcomes. However, data on the relationship between UPF intake and overall dietary quality are scarce. Therefore, the present analysis aimed to explore possible differences in dietary intake between people with a high UPF intake and those with a low one. Methods: A cross-sectional study was conducted between 12/2022 and 4/2023, in which 113 adults (49.56% females, from 18 to 65 years of age) participated. Dietary habits were evaluated in terms of energy, macronutrients, food variety, and UPF intake using 24 h recalls. Food classification as UPFs was based on their processing using the NOVA system. Self-reported demographic and anthropometric characteristics of the participants were also noted. For the present analysis, participants were grouped into those with a lower (LUPFI) and those with a higher UPF intake (HUPFI), using the median (Mdn) value as a cut-off. Differences between groups were examined, using the chi-square test for qualitative variables, and the independent samples t and Mann–Whitney tests for quantitative parametric and non-parametric variables, respectively. The level of statistical significance was set at 5%. Results: The two groups did not statistically significantly differ in age (p = 0.649) and BMI (p = 0.252). Regarding dietary intake, the LUPFΙ group consumed less energy (Mdn 1686 vs. 2117 kcal, p = 0.009), more protein (18.1 ± 4.2 vs. 15.7 ± 3.9%, p < 0.001), fewer carbohydrates from UPF (11.3 ± 6.9 vs. 26.3 ± 10.0%, p < 0.001), less fat from UPFs (Mdn 6.4 vs. 24.2%, p < 0.001), more food variety (Mdn 11.0 vs. 9.0 foods, p = 0.009), less variety of UPFs (Mdn 3.0 vs. 4.0 foods, p < 0.001), less total and UPF sweet desserts (Mdn 0.0 vs. 1.0, p = 0.022 and p = 0.033, respectively), and less UPF cheese (Mdn 0.0 vs. 0.5, p < 0.001). Discussion: These preliminary results show that higher UPF consumption is associated with a higher energy intake and poorer diet quality, although it does not necessarily translate into worse choices across all food groups. Further research is needed to verify the present findings and to explore the relationship between UPFs and overall dietary intake more thoroughly, as well as to identify those UPFs that actually contribute to a poorer dietary quality. Full article

Background and objectives: Research about exercise addiction, perfectionism and orthorexia within endurance sports is emerging. Endurance sports athletes might have a higher risk of exercise addiction and eating disorders. Cycling is a popular endurance sport, but research in this population is lacking. The present study aimed to explore the relationship between exercise addiction, perfectionism, and orthorexia within cycling. Methods: A cross-sectional survey was applied, including validated questionnaires assessing the cognitions, behaviors, and feelings related to an extreme focus on healthy eating (Eating Habits Questionnaire; EHQ), compulsion to exercise (CET-A Questionnaire), and perfectionistic tendencies (Multidimensional Perfectionism Questionnaire). Demographic information such as age, training hours, gender, and competition level were also collected. Results: Sixty-one male (n = 5; 8.2%) and female (54; 88.5%) cyclists with a mean age of 32 ± 7 years completed the survey. Higher scores in orthorexia were significantly associated with higher exercise addiction (β = 0.41; p < 0.001) and total perfectionism scores (β = 0.38; p < 0.01). Higher orthorexia was also associated with higher scores for self-oriented perfectionism (β = 0.34, p < 0.05) and higher weight control (β = 0.39, p < 0.01). Higher EHQ-Knowledge was associated with higher self-oriented (β = 0.33, p < 0.05) and other-oriented perfectionism (β = 0.30, p < 0.05) and higher EHQ-Problems and EHQ-Feelings were associated with higher weight control (β = 0.39, p < 0.01 and β = 0.41, p < 0.01 respectively). Cyclists who trained 16–20 h per week had significantly lower scores on total perfectionism and socially prescribed perfectionism than those who trained 6–10 h per week (p < 0.05). No other significant effects of training hours on exercise addiction or orthorexia were observed. Discussion: The potential risk of an individual developing orthorexia may be significantly predicted by high levels of exercise addiction and perfectionism within the cycling population. The high levels of self-oriented perfectionism observed highlight a potential predisposition or susceptibility within certain populations to the adoption of maladaptive behaviours in relation to diet. Further research is needed to explore the role of perfectionism and exercise addiction as risk factors for orthorexia in amateur and professional cyclists. Full article

The nutritional quality of our diet depends on a number of repeated choices we make throughout the day. Understanding consumer behaviour in its full complexity and real-life context is essential for ensuring a sustainable food system that provides nutritious diets to nearly 10 billion people by 2050. Food consumer science, a multidisciplinary field, aims to comprehend how consumers engage with, desire, obtain, utilise, and dispose of food to meet their physiological, psychological, and social needs. However, the field’s fragmented nature and narrow focus on isolated product choices have hindered progress in understanding food consumption patterns and their relationships to lifestyles. To address these challenges, fostering greater connectivity and collaboration among scientists from diverse disciplines and regions is crucial. This presentation explores data proliferation and system thinking’s potential for significant advancements in the field. While the incorporation of technologies like neuroimaging, physiological measures, virtual reality, and machine learning holds promise, the complexity of the field and the lack of integration present legitimate concerns and obstacles. This presentation highlights food consumer science’s indispensable role in health and sustainability transitions, emphasising the importance of ensuring that the data we produce are Findable, Accessible, Interoperable, and Reusable (FAIR). It showcases approaches to improve data sharing in consumer science, demonstrating progress in harmonising measures, ensuring cross-cultural comparability, and addressing biases in data collection and analysis. Furthermore, we explore the opportunities and challenges associated with establishing research infrastructure in food consumer science, specifically highlighting the EU Horizon 2020-project COMFOCUS as a starting point. Full article

Background and objectives: To determine whether location of residence in the German urban food environment is associated with habitual dietary intake (energy, macronutrient and food groups) and body mass index (standard deviation score of BMI, BMI-SDS) in children and adolescents (6–18 years). Methods: For the cross-sectional analyses of DONALD study data, we grouped participants according to their geocoded residence in the north or south of Dortmund, following available socio-economic neighborhood indices. We applied robust multi-level mixed effects regression models using residence as predictor and (1) BMI-SDS or (2) dietary data (daily intake of energy (kcal), macronutrients (energy percentage) or food groups (g/1000 kcal)) as outcome. Analysis was carried out on 935 3-day weighed dietary records, collected annually from 292 participants (1267 anthropometric measurements from 360 participants) between 2014 and 2019. Models were adjusted for age, sex and household socioeconomic status (SES, derived from household education and occupation data). Results: We observed that 52 (14.4 %) participants reside in the north and 308 (85.6 %) in the south of Dortmund. In the fully adjusted models, residence in the south was associated with lower BMI-SDS (β = −0.42, p = 0.02), lower intake of sugar-sweetened beverages (β = −48.24, p = 0.04) and higher intake of vegetables (β = 11.69, p = 0.03). No significant association was found for intakes of macronutrients or other food groups (meat and fish, fruit, dairy, grains, sweets). Discussion: Our results suggest that place of residence may play a role in explaining variation in dietary intake, beyond the SES of the household. This indicates that dietary intake may at least in part be impacted by factors beyond individual-level indicators. Further research is required to identify more specific pathways of location of residence on nutrition and quantify the food environment in different city areas across socio-economic background variables. Full article

Background and objectives: French public fundings allow NGOs to organise actions (cooking workshops including a dietician and a cooking chef) among elderly people to prevent malnutrition and loss of autonomy. Although similar interventions have already been evaluated in terms of change in knowledge and food habits, little is known about how the social roles and expectations of the participants impact the effects of the actions implemented. Methods: Following their participation in cooking workshops, 42 semi-structured interviews with various participants, including elderly people aged 60 and older, were conducted in five French regions. For 24 participants, a second interview was conducted 2–3 months later. The interviews aimed to understand their representations and practices towards health, cooking and eating, social position, life events, expectations and the effects of their participation in the cooking workshops. Results: The social roles of the participants were overall strongly linked to the effects of participation. The feeding role and domestic work of the female participants lead them to look for new recipes when participating in such workshops and to use the recipes afterwards. For some participants who cook on a daily basis, expectations were also related to reinforcing dietetic knowledge, to check whether it was up-to-date and if they were sometimes looking for moral validation of their behaviour from the dietician. These participants, who had the ability to adapt their cooking practices according to the dietetic advice provided, were all from a higher social position. Others, men and women, who had recently experienced an illness and/or hospitalisation, expected to hear some advice they had previously received. The minority of participants, mostly men, declared not knowing how to cook and saw an interest in learning this skill at some determining point in their life cycle. Finally, the decision of participating in such workshops meets the need of being part of a group, to feel less lonely and a sense of well-being that resulted from this group experience. Discussion: By highlighting three dominant approaches of the participants (cooking/dietetic knowledge/being part of a collective activity), depending on their social roles at some point in their lifecourse, these results can help in refining the design and intensifying the effects of preventive actions in the elderly. Full article

Background and objective: Systemic autoimmune diseases, viral infections (COVID-19) and obesity/metabolic syndrome (MS) are all characterized by a chronic inflammatory state with some putative shared physiopathological features. Biological age and HRQoL approaches have been applied as human health and aging indices. The objective of the METAINFLAMATION study was to analyze the differences and/or similarities between subjects with systemic lupus erythematosus (SLE), long-COVID and obesity/metabolic syndrome, which are all recognized inflammatory conditions, and to compare metabolic age and HRQoL depending on weight status in those patients. Methods: A total of 232 participants (≥18 years) were recruited whose anthropometric data were collected (height, weight, bioelectrical impedance analysis, waist circumference, hip circumference and blood pressure). The patients answered different questionnaires related to socio-demographic data, metabolic history, lifestyle (physical activity, sleep habits and nutrition) and HRQoL. Metabolic age and HRQoL (SF-12) were assessed with validated tools. Differences and interactions among the three types of diseases and body mass index (BMI) as stratified by p50 were studied using a 3 × 2 (diseases × adiposity) factorial ANOVA design and with appropriate post hoc contrasts. Results: The analyses revealed significant differences in biological age (p < 0.001) between each disease and BMI (high vs. low). Interestingly, the type of disease and BMI showed an interaction concerning biological age (p < 0.05). Regarding HRQoL, significant differences (p < 0.01) were found between each pro-inflammatory condition and between both BMI groups for the PCS (Physical Component Summary), while only the MCS (Mental Component Summary) showed statistical differences among diseases (p < 0.001) but not for BMI (p = 0.42). Additionally, the PCS evidenced a statistically significant modification of the effect (p < 0.01) depending on the type of disease as conditioned by the BMI (high vs. low) but not for the MCS (p = 0.13). Discussion. Featuring precision indices such as biological age and HRQoL in patients with SLE, long-COVID, and obesity/metabolic syndrome and interactions with ponderal status enables better monitoring of these inflammatory diseases. Metabolic individualization and the early prevention of associated complications can be achieved by using validated biomarkers and scores, seeking the personalization of therapeutic management with clinical precision. Full article

Background and objectives: A concept of personalized eating originates from personalized nutrition, where dietary advice is tailored to an individual. In personalized nutrition solutions, dietary advice is more and more based on clinical biomarkers, genetics, and the gut microbiome. However, there is evidence that tailored dietary advice based only on personal dietary data is effective in facilitating changes in dietary intakes. Thus, the aim is to create a personalized eating solution: a prototype of data platform recommends foods by linking individual’s dietary data with product information via specified rules. Methods: The data platform is integrated with an external global food product database and a user interface (UI), and the system structure is: (1) a personal profile, (2) a rules engine with functionality for setting tags and filtering rules, and (3) a knowledge database (food product database). The food product database is integrated via an open API (application programming interface) with the platform, and is utilized to retrieve product information for the filtering rules. When using the platform for the first time, a user must enter demographic data and information about specific dietary criteria and personal preferences. With the permission from the user, the data platform may also retrieve data for the personal profile from other integrated services, including wearable devices. Food recommendations are generated by filtering the product information based on the personal profile and food groups selected by the user. The user can access the food recommendations via a web-based UI. The platform also includes an API, which allows the recommendations to be integrated to existing wellness applications and devices. Results and Discussion: The personalized eating solution suitability for use by consumers and ecommerce services will be tested in 2023. A strength is that the solution considers personal preferences to motivate users, such as values related to the consumption of ethic and sustainable products. However, the food recommendation rules rely on formal information about products in the external food database. In the future, the solution could be used for research, commercial, and healthcare purposes in facilitating dietary changes to promote health and wellbeing. Full article

Background and objectives: Several factors may account for food behavior, including common genetic variation. Robust evidence shows that specific single-nucleotide polymorphisms (SNPs) are involved in palatability phenotypes. Considering the limited knowledge of these associations in the context of admixed groups, like the Brazilian population, we aimed to investigate associations of SNPs in the TAS1R and TAS2R taste receptor gene families with diet quality. Methods: A sample of 901 individuals ≥ 12 years old from the general population, categorized into age groups (adolescents, adults, and elderly), was interviewed in the Health Survey of Sao Paulo (ISA-Capital). Data on socioeconomic, demographic, and health characteristics were collected, including dietary information from two 24 h recalls in two nonconsecutive days and blood samples. The 24 h recalls were analyzed using the Revised Brazilian Healthy Eating Index (BHEI-R), comprising 12 components referring to food groups, nutrients, and calories from saturated fats, alcohol, and added sugar. Blood samples were genotyped for 255 SNPs in the TAS2R gene family (related to bitterness) and 73 SNPs in the TAS1R (related to sweetness and umaminess). BHEI-R was normally inversed transformed (invBHEIR). After data cleaning and quality control procedures, genotype and phenotype data of 637 individuals were made available for association analysis with invBHEI-R using linear models adjusted for age, age2, age × sex, sex, BMI, and the two first principal components of ancestry. Genetic taste scores (GTSs) were derived from the significant SNPs of each gene family and tested for associations. Analysis was performed with the software R version 4.0.2 using a significance level of 0.05. Results: There were 31 SNPs of TAS2R genes and four SNPs of TAS1R genes significantly associated with BHEI-R (p < 0.05). GTSs were positively associated, and their use increased the model’s performance, especially with TAS2R SNPs (r² rose from 0.135 to 0.188). Conversely, the estimated effect of the TAS1R score on BHEI-R was 2.02 higher than the TAS2R one. Discussion: Our results show potential genetic influences on diet quality by applying genetic taste scores. Unraveling associations between SNPs and food intake might help guide public policies towards healthier food behavior considering genetic differences, i.e., personalized nutrition. Full article

Good vascular function is one of the key determinants of a healthy heart and preserved neurofunction in advanced age. Previous studies demonstrated vasculoprotective effects of flavonoids, but also inter-individual variability in their action. Several factors have been identified as key determinants of this inter-individual variability, which include sex, age, ethnicity, body mass index, health status, gut microbiome, and genetic factors. Of these, genetic factors are the least studied. The aim of this study was to identify genes that are associated with the vascular health effects of flavonoids and whose polymorphisms could explain inter-individual variability in response to intake of these plant food bioactives. Applying predetermined literature search criteria, we identified five human intervention studies reporting positive effects of flavonoids on vascular function together with global genomic changes analyzed using microarray techniques. Genes involved in vascular dysfunction were identified from genome-wide association studies (GWAS), followed by integrative analyses, functional analyses, and literature search, to identify priority candidate genes for future nutrigenetic studies in flavonoids and vascular health. By extracting data from the eligible human intervention studies, we obtained five sets of differentially expressed genes (DEGs) with n = 1693; 717; 554; 2231; and 1401 genes, or a total number of 5807 genes. The number of identified URs varied across the studies, from 227 to 1407 i.e., n = 227; 503; 508; 1407, and 993. Searching of the GWAS Catalog revealed 493 genes associated with vascular dysfunction. Further, an integrative analysis of transcriptomic data with GWAS genes identified 106 candidate DEGs and 42 candidate URs. By means of subsequent functional analyses and literature search, as well as additional integrative analyses, we identified the 20 top priority candidate genes: ALDH2, APOE, CAPZA1, CYP11B2, GNA13, IL6, IRF5, LDLR, LPL, LSP1, MKNK1, MMP3, MTHFR, MYO6, NCR3, PPARG, SARM1, TCF20, TCF7L2, and TNF. Interrogation of the Variation Viewer and PharmGKB databases identified variants with the highest frequencies and those with pharmacological relevance in the human population. These genes provide important leads to design future nutrigenetic studies for the development of precise nutrition. Full article

Background: In the field of precision nutrition, predicting high-dimensional metabolic response to diet and identifying groups of differential responders are two highly desirable steps towards developing tailored dietary strategies. However, proper data analysis tools are currently lacking, especially for complex settings such as crossover studies. Current methods of analysis often rely on matrix or tensor decompositions, which are well suited for identifying differential responders but lacking in predictive power, or on dynamical systems modelling, which may be used for prediction but typically requires detailed mechanistic knowledge of the system under study. Objectives: To remedy these shortcomings, we aimed to explore dynamic mode decomposition (DMD), which is a recent, data driven method for deriving low-rank linear dynamical systems from high dimensional data. Methods: To allow integration of complex data from several dietary inputs to the metabolic system, we combine parametric DMD (pDMD) with DMD with control (DMDc). The resulting method allows (i) to predict the postprandial metabolic response of a new diet given only the metabolic baseline and dietary input, and (ii) to identify inter-individual differences in metabolic regulation, useful in determining metabotypes, i.e., metabolic phenotypes in dynamic data. To our knowledge, this is the first time DMD has been applied to metabolomics data. Results: pDMDc enabled a data-driven construction of low-dimensional dynamical models, able to capture the underlying dynamics of the metabolome after three dietary challenges. We demonstrate the utility and accuracy of the model in a crossover study setting on both measured and simulated data. Using simulated data, metabolic response to a new diet was accurately predicted having trained on four diets, with an average cosine similarity score of 0.6 (SD = 0.27). In measured data, we identified previously published metabolic groups with 100% overlap. Discussion: Accurate predictions via pDMDc require data from several dietary exposures with large variation, which can be costly to collect to confirm the efficacy of the method. A possible remedy is to share data among individuals using the mixed-effects framework. Employing pDMDc paves the way towards using control theory to approach PN by estimating the optimal input given a target metabolite trajectory. Full article

This work focused on the effect of combustion on the yield, composition, and strength of food-grade bio- alkali from lignocellulosic agro-waste. Seven lignocellulosic types of agro-waste, including plantain stalk, plantain peel (green and ripe), empty palm bunch, palm fiber, coconut fiber, and cocoa pod were sun-dried and combusted using two methods: open-air combustion (OAC) and muffle furnace combustion (MFC). Ash and potash yield from the two methods of combustion were determined using simple proportion calculations. A two-stage hydrothermal extraction process was carried out on the ash using a deionized water ratio of 1:10 for food-grade bio-alkali, and the leachates were evaluated for pH, alkalinity, and metallic ion contents using standard analytical methods. The data obtained were statistically analyzed via a two-way ANOVA. The OAC samples had a higher ash content range (8.24–18.6%) compared to MFC samples (7.37–9.89%). Potash yield (%) is both biomass and combustion-method dependent, with MFC having a higher average yield (3.05%) than OAC (2.35%). The pH of the leachates for all samples ranged from 10.3 to 12.0. All the agro-waste exhibited a similar pattern in the order of magnitude of the metals of which they were composed (K > Mg > Ca > Zn > Na). For the minerals, PO4 was highest (193.1 g/L) in plantain stalk, and KOH and K₂CO₃ were least (10.0 g/L) in coconut fiber, while the highest alkalinity was obtained in ripe plantain peel (62.1 mg/L). The yield and quality of bio-alkali produced were influenced by the combustion method and source of biomass. The bio-alkali from the different biomass types tested can be used as sources of food-grade emulsifiers due to their high nature of alkalinity. This signifies zero waste and is also a boost to the circular economy. The average alkalinity studied under MFC was 33.6 mg/L and for OAC was 27.3 mg/L, suggesting that MFC is a more promising approach. Worthy of exploration is the significant high content (19.3 mg/L) of chlorine in plantain stalk. Full article

Between 702 and 828 million people around the world were affected by hunger in 2021. The prevalence of undernourishment relentlessly continues to affect the world, and particularly Sub-Saharan Africa (23.2% in 2021). Exacerbated inequalities across and within countries are undermining the nutritional adequacy and affordability of diets and threatening vulnerable groups including children under five years of age and women of reproductive age. This research presents a diet optimization approach where the objective is to evaluate the nutritional adequacy and affordability of diets across 4 African countries, namely Ethiopia, Kenya, South Africa and Uganda. The targeted population includes dyads of women of reproductive age and their children between 6 and 24 months. The mathematical programming approach allows for the theoretically contrasting of optimal outcomes of the model with data from food consumption surveys in primary and secondary cities of each country. Based on the observed food intake patterns and the nutrient deficiencies, these outcomes propose new diets modifying food intake (organized in food groups) in order to achieve nutritional adequacy while minimizing food intake changes, or, if applicable, the outcomes indicate which nutrient recommendations are unattainable under the current model setup. On average, our results show that nutritional adequacy can be attained by increasing the intake of legumes, vegetables and fruits, while reducing the intake of cereals. We include a discussion on the assessment of diet affordability and show the practical implications of evaluating healthier diets’ viability. Conclusions include paths for future research on diet optimization modelling and its implications as a means of support for designing future dietary guidelines. Full article

Fruits constitute a dietary source of many essential nutrients and other bioactive substituents. Unfavorable trends in the consumption of fruits can be addressed with increased promotion and also using nutrition and health claims because an important segment of consumers is sensitive to health-related communications. The regulation on the use of nutrition and health claims only allows the use of claims when the product is a relevant source of the nutrient referred to. Food composition databases (FCDBs) offer such data, but it should be highlighted that, in practice, the composition of fruits can vary notably due to the variety, agricultural practices, soils, and climatic conditions. The objective of the present study was to investigate data on the nutritional composition of selected widely available apple varieties in Europe for health promotion purposes. We focused on samples available to consumers at the end of the season (winter). The comparison of existing data from FCDBs with new nutritional composition data from laboratory analyses for health promotion purposes was performed for four studied apple varieties (Golden Delicious, Gala, Idared, and Braeburn). The amount of vitamin C in the observed samples varied up to 15.3 mg, and the dietary fibres varied from 3.3 to 5.5 g in 100 g of apple in laboratory testing. Only the Braeburn variety contained a sufficient amount of vitamin C for the use of nutrition and health claims, while the content of dietary fibre was sufficient for all varieties. The data from laboratory testing differed from the data from FCDBs, which are not specific to the variety. The findings indicate a moderate acceptability of data on nutritional composition from FCBDs for the use of nutrition and health claims for apples, especially when the content of nutrients is on the borderline of the conditions for the use of claims, as in the case with vitamin C. Consequently, additional research on the variability of vitamin C in apples is needed, especially in relation to the variety and storage conditions/duration. The amendment of FCDBs with composition data at the level of fruit variety would present an important aspect for the nutrition and health promotion of fruits. Full article

Background and Objectives: Diet is an important modifiable cancer risk factor. Studies show that adherence to dietary guidelines reduces cancer risk and that adherence is affected by the complexity of dietary actions and the awareness of their effect. Intervention on complex nutrition issues requires clear nutrition messages to the public. To improve adherence for cancer prevention purposes, this research describes a method to provide tailored dietary recommendations by prioritizing dietary advice from the guideline, based on diet–disease relationships revealed by disease risk models. In addition, we developed the method as a risk calculator framework to provide the interoperability between risk models and guidelines. The framework is integrated into our cancer prevention app to facilitate risk communication and guideline adherence. Methods: We propose a simple and intuitive method to define and align cancer risk models and dietary guidelines using object-oriented programming paradigms, which can encapsulate the relationship between dietary advice, cancer risk, and lifestyle variables. The effect of each action can be simulated by applying modified dietary variables into the probability model to calculate an expected risk change. An interactive intervention is then designed to enhance understanding and promote the adoption of dietary actions. It consists of three steps: selecting dietary actions ranked by their preventive effect on cancer risk, modifying selected variables to desired values, and visualizing the simulated changes in cancer risk with dietary actions by humanoid pictogram. Results: We demonstrate the mapping of actions to the corresponding variables for a chosen cancer risk prediction model while ranking them according to their preventive effect. We further show that our method can easily be adapted to any dietary guideline. We implemented more than 10 cancer risk models covering common cancer types and integrated them into the system. Moreover, it is simple to add other cancer risk models to support the prevention of additional cancer types. As a key feature of a web-based application, the practical use of the method allows for the delivery of personalized action suggestions and notifications based on the user’s lifestyle factors. An usability testing was carried out between August and October 2023 with 9 participants using the guideline made by German Nutrition Society (DGE). The test proved the intervention’s effectiveness. Discussion: On the frontier of nutrition science and preventive medicine, our work is the first approach that combines risk models and dietary guidelines into a comprehensive digital health intervention system. It informs the user about the most impactful dietary behaviors, promotes adherence to dietary guidelines, and, accordingly, facilitates cancer risk reduction. Full article

Background and objectives: The use of dietary supplements is extremely common among cancer patients. It is estimated that 20–90% of cancer patients use some form of dietary supplement. Most often, they are “self-selected” supplements or selected from unverified Internet sources, without consulting a specialist. Components in such supplements can interact with the applied therapy and impact cancer patients’ treatment. The aim of this study was to examine the frequency and type of supplementation used by cancer patients. Methods: A cross-sectional observational study was conducted on 52 cancer patients (mean age: 58 years) by using a study-specific questionnaire, conducted between February and July 2022 at the University Clinical Hospital Mostar, Bosnia and Herzegovina. Results: More than half of the respondents (62%) use some dietary or herbal supplements daily. The most common dietary supplements were probiotics (22%), B complex vitamins (22%), and vitamin D (22%). Patients (46.8%) used supplements based on their own or their family–friend’s recommendation, and 90% of them started to use supplementation during therapy. The main reason for use, as stated by 71.8% of the respondents, was to support immunity. Approximately 56.2% of them said that they had noticed a positive effect on their health. It is concerning that 78.8% of patients did not research the possible side effects and risks of taking supplements during therapy. Conclusions: Doctors, nutritionists, and nurses should improve communication with patients by giving them reliable information and evidence-based recommendations about dietary supplements and complementary therapy in general. During consultations, professionals should offer assistance and discuss potential benefits and risks with the patient in order to achieve a mutually informed decision on dietary supplement use. Full article

Background and objective: Providing a population with quality and safe food is one of the main public health problems worldwide. The aim of the present study was to assess the food safety knowledge, attitudes and self-reported food handling practices among a Bulgarian young population. Methods: A cross-sectional survey was conducted among 60 young people from the Pleven region, Bulgaria, aged 20–29. A pre-tested structured questionnaire was used to collect data on the purchase, storage, preparation, culinary processing and serving of food in a home environment, and also on the demographic profile of the respondents. IBM SPSS v.25 software was applied with a level of statistical significance set at p < 0.05. Results: This study showed that a high proportion of the participants had good levels of knowledge and practices for culinary processing of food—73.9%, food preparation—68.7% and food serving—67.2%. More than half of the participants (59.5–58%) gave correct answers about buying and storing food at home. The highest score was established for the shelf life of products—0.8; rapid cooling of animal foods—0.74; washing fresh fruits and vegetables before consumption—0.94; keeping dishes and utensils in the kitchen clean—0.89; adequate heat treatment of food and quality of drinking water—0.75. A lower percentage of correct answers was found about buying organic food and eating in front of a computer and a mobile device—0.38–0.42. Discussion: The outcome of the survey showed that knowledge, attitude and practice among young people to ensure quality and safe food were at a good level. For young people, educational programs can be developed related to the purchase of organic foods and the optimization of the digital health and food safety interaction. Full article

Background: Vitamin D deficiency increases cardio-metabolic risk through different mechanisms: activation of proinflammatory cytokines and mediation of endothelial dysfunction, insulin resistance, accelerated atherosclerosis, etc. Objectives: To study and analyze the cardiovascular (cardio-metabolic) risk in people with different levels of vitamin D. Methods: Laboratory and questionnaire data from 264 adults, mean age 41.19 years, were analyzed. The studied indicators were compared between people with deficiency and normal vitamin D levels, as well as between persons with normal and excessive BMI. Variation and correlation (Spearman’s coefficient) were used. Results: It was established that vitamin D deficiency is related to some risk factors and cases of CVD. CVDs are significantly more common in people with vitamin D deficiency (15.9%) compared to 7.1% for those with a sufficiency of vitamin D and high blood pressure (36.4% compared to 27.4%). Overweight and obesity were found in 70.5% and 48.6% of those surveyed, respectively. Diabetes is present in 11.8% of people with vitamin D deficiency, compared to 4.3% in people with vitamin D sufficiency. Survey data show that people with vitamin D deficiency have more often followed a diet in the last year (74.1% compared to 55.7%), most often low-calorie (17.0%), followed by protein (Dukan) (8.0%), low-carbohydrate (4.5%), and starvation (4.5%). Diet is a modifiable risk factor in the prevention of CVD, but the “weight cycle” effect increases the risk of developing and maintaining cardio-metabolic risk and diseases. In persons with an excessive BMI, there has been a significantly more frequent change in weight in the last year: 59.4% compared to 30.6% in the control group (p < 0.001). Weight gain was 5.53 kg versus 2.43 kg and was associated with an increased risk of CVD regardless of BMI. Discussion: The study shows that there is an increased cardiovascular risk in people with vitamin D deficiency, which increases if combined with an excessive BMI. Diet and weight variation are important triggers for the occurrence and development of CVD in various BMI and metabolic disorders. Full article

Background and objectives: Electrical pulse stimulation (EPS) is widely used to investigate the mechanisms behind the beneficial effects of physical activity in in vitro studies. The aim of our study was to develop a cheap, stable EPS system and protocol capable of causing C2C12 mouse myoblasts cells to contract. Method: The EPS system consists of a control unit, a WEP PS305D power supply unit, and a FY6800 signal generator. The control unit is a circuit board developed by us that connects the power supply unit with the signal generator. The control unit consists of two pairs of electrodes that can be connected to a six-well plate equipped with a manually mounted platinum wire. The stability of the system was evaluated using a Hantek 6022BE oscilloscope to measure ninety minutes of electrical pulse stimulation of C2C12 mouse myotubes. A protocol was established for cell culture and EPS parameters. The contraction of the myotubes was confirmed under a Leica DMi1 inverted microscope. Results: Our custom system is very accurate and has a wide range of EPS parameter adjustment options. The results show that the system is stable over ninety minutes of EPS with variable parameters. The EPS protocol was also optimized. Discussion: To date, only a few custom EPS systems have been described. Our system is relatively cheap, easy to build, and stable, and so could serve as an alternative to commercially available systems. Full article

Introduction: Dietary habits and healthy lifestyles are crucial factors impacting cardiometabolic health and quality of life. Precision nutrition has emerged as a valuable tool to monitor the multiple factors participating in metabolic wellbeing and to examine the possible interactions between diet and health. One such approach involves the use of dimensional reduction methods, which aim to classify subjects into distinct nutritional subgroups or dietotypes based on differential dietary intakes and health outcomes. Methods and Results: A multidimensional exploratory analysis using carefully collected dietary data (Validated FFQ/72 h Recall questionnaires) as well as anthropometric and biochemical determinations from the DIETARY DEAL pilot-study was conducted to define specific dietary profiles. A factorial analysis design was performed, which allowed to identify four distinct clustering factors, characterized as factor 1, or a proto-omnivorous food profile (F1p-O); factor 2, or a pro-vegetarian plant-based diet (F2p-V); factor 3, or a pro-Mediterranean pattern (F3p-M); and factor 4, or a pro-health pescatarian dietary regime (F4p-P). Statistical differences concerning food group consumption (g/d) were found. Thus, F1p-O evidenced higher consumption of fruits, fatty fish, and white and red meat; F2p-V was richer in vegetables, fruits, pulses, and whole grains; F3p-M had olive oil as the most representative food/ingredient; and F4p-P elicited consumption of healthy foods such a vegetables and fatty fish and the avoidance of refined grains, red meats, whole dairy, and ultra-processed solids. After adjusting for potential confounders and energy using the residual method, F1p-O showed a direct relationship with fat-free mass (β = +4.4; p < 0.001), and skeletal muscle mass (β = +2.6; p < 0.001), while the association with F2p-V was the opposite in such somatic markers (β = −2.3; p < 0.001; β = −3.1; p < 0.001; respectively). F3p-M was inversely linked with IL-6 and zinc (β = −0.9; p < 0.05; β = −5.3; p < 0.05, respectively), and F4p-P was coupled with selenium intake in age- and sex-adjusted models (β = +5.6; p < 0.05). Conclusions: Our findings suggest that proto-omnivorous dietary patterns are positively associated with lean mass components, while plant-based diets showed opposite trends. Mediterranean dietary patterns prompted a possible association with anti-inflammatory profiles. These results highlight the potential utility of dimensional reduction methods in understanding the occurrence of qualitative clustered dietotypes relating diet with health outcomes for prescribing precision nutrition. Full article

Celiac disease (CD) is a chronic, multifactorial and autoimmune-based disease. Genetically predisposed individuals respond to gluten by triggering an immune response resulting in various gastrointestinal and extra intestinal symptoms. The only treatment for the disease is a strict, lifelong gluten-free diet (GFD). The GFD aims at physical health, but at the same time, it has an enormous influence on the quality of life of people with CD, especially on a social level. People with CD have problems eating out and attending events and celebrations. Therefore, it is believed that generalized knowledge and awareness of the disease in the general population could improve their situation. To this end, various nutritional education programs have been designed and are being implemented in order to raise awareness of celiac condition among the general population. Interventions have been designed to be carried out in: (a) schools, with primary school children learning about celiac disease through games and experiments, (b) workshops in catering schools, (c) workshops in the context of science fairs for secondary school children. Early results show that participants are increasing their knowledge of GFD, and the interventions are effective in bringing the diseases closer to the general population. It is necessary to treat the disease from a broad approach, beyond physical wellbeing. Social well-being must also be sought, as it is an important and forgotten factor of the quality of life of these people. Full article

Despite positive associations between micronutrient intake, status, and health outcomes, many randomized controlled trials (RCT) of vitamins are null. Standards to establish causality in biological systems include the Bradford Hill criteria, the experimental component of which relies on and promotes RCT-centred approaches. Such criteria may need adaptations to the specificities of nutrition science. Our objective, as part of a broader FENS initiative to improve the science of nutrition, was to conduct a case study to assess the Bradford Hill criteria (BHC) applied to clinical studies of vitamin D and cardiovascular disease endpoints and evaluate strengths and pitfalls for this approach. We conducted a systematic review of the recent literature on CVD and vitamin D supplementation, including both RCT, cohort studies (CT), or systematic reviews within Medline, Web of Science, and Cochrane libraries. Studies had to be conducted in adults, including hard CVD-relevant endpoints with a minimum sample size of n = 500 for RCT and n = 10,000 for CT. CT had to utilize quality-assured, analytical methods for serum 25-hydroxyvitamin D assessment and include verified clinical outcomes. We also evaluated and proposed plausible biochemical and physiological mechanisms for vitamin D and CVD. We graded the evidence according to BHC for the establishment of causality in biological systems and the identification of strengths and pitfalls of this approach. The search yielded 4170 papers, and 31 met the predefined criteria. The criteria “strength of association”, “consistency”, “temporality”, “biological gradient”, “plausibility”, “experiment”, “specificity”, “analogy”, and “coherence” were analyzed and appraised. While the logical framework of the BHC is perceived as useful, its direct applicability to the nutritional context is partly open to interpretation and could be further specified. The Bradford Hill criteria for establishing causality need adaptation for the nutritional context and to the advances in biological and social sciences in the last decades. Insights gained and methodological paradigms identified may have broad application to nutrition science. Full article

Background and objectives: The high obesity prevalence remains a significant global and local health concern. Digital technologies, including electronic health (e-health) and mobile health (m-health), are being increasingly utilised to prevent and address people’s excess weight. Nutrition professionals’ experiences with digital tools in local practices is a relatively unresearched area. The aim of this small study was to explore the utilisation of e-health and m-health by locally registered nutrition and dietetic professionals for weight prevention and management. Methods: An adapted, anonymised questionnaire was disseminated via social media between November 2021 and January 2022 following ethical approval. Twenty-four questions— (twenty-three close-ended and one open-ended) were included and covered: demographics, the challenges experienced and their personal attitudes on e-health and m-health. The data were statistically analysed using SPSS (IBM, version 23), where descriptive statistics and chi-squared tests were utilised. Results: The sample respondents (n = 20) were mainly female (85.0%, n = 17), with half in the 25–34 age category (50.0%, n = 10). A total of 90.0% (n = 18) used technologies in practice, with e-health technologies being preferred. Novel technologies were mainly used for informational or educational purposes (95.0%, n = 19) and to communicate with clients (85.0%, n = 17). Video conferencing (89.5%, n = 17) and educational websites (84.2%, n = 16) were the most popular tools. A total of 90.0% (n = 18) believed that these technologies could support weight management through behaviour change support (100.0%, n = 20) or provide updated information on healthy and sustainable eating (95.0%, n = 19). A total of 95.0% (n = 19) wanted to receive training/further training in digital technologies. The main personal challenge experienced was a difficulty in utilising these technologies (65.0%, n = 13). The main reasons for using digital health were to improve their clients’ nutrition knowledge (85.0%, n = 17) and engagement with the self-management of weight and for overall health (80.0%, n = 16). Discussion: The results of this small study suggest an overall interest, but with further training needs. More research on e-health and m-health is recommended as part of an overall strategy to reduce the obesity prevalence in Malta. Full article

Background and objectives: Diet is a leading modifiable factor for the development of non-communicable diseases. The effective use of dietary interventions and advice should be an integral part of clinical care and medical doctors should be the most reliable and trusted source of nutrition information. The adequacy of nutrition training in medical education remains an issue of concern and most graduating medical students rate their nutrition competency as inadequate. There is no minimum standard of compulsory hours designated for nutrition in Bulgarian medical universities, nutrition classes are elective, and total assigned academic hours vary from 15 to 30. The aim of the current survey was to assess the self-perceived confidence in nutrition knowledge and skills of medical interns, obtained during medical training. Methods: A cross-sectional survey was conducted in February–March 2023. A total of 15 survey questions were formulated to assess the comprehensive medical training, nutrition knowledge and practical skills in dietary assessment, and preparedness to provide nutrition guidelines and dietary counselling. A five-point Likert scale was applied to assess the level of confidence. Results and discussion: A total of 53 interns responded to the survey with a response rate of 44%. Most participants were well confident about the diet-non-communicable disease relationship (64%), body composition and chronic diseases (76%), and the effect of diet on type-2-diabetes (68%), but fewer were familiar with food-drug interactions (8%) and were not prepared to provide food-based dietary guidelines to patients (12%). The interns were confident when interpreting laboratory nutrition tests (68%) and were ready to use anthropometric measurements (60%). About one-third of interns fully agreed that evaluation of nutritional status (36%) and dietary intake (28%) should be a part of every patient’s routine examination and 28% thought that nutrition counselling was not a part of their duties. Only 12% of the respondents were confident in their capacity to provide nutritional consultations. The strengthening of the medical curriculum with more mandatory nutrition classes will benefit physicians’ capacity in diet therapy counselling. Full article

Background and objectives: New technologies provide the opportunity to understand the complex systemic background of multidimensional diseases and allow for a personalised approach. Continuous glucose monitoring (CGM) sensors and their broad use have been key in the discovery of the metabolic heterogeneity surrounding many disorders such as diabetes type II, and have placed the scientific community a step closer to determining which factors contribute to their complications and evolution. However, gathering data extending beyond glucose levels linked to lifestyle factors, such as nutrition, physical activity, sleep quality, and stress, poses a significant challenge in terms of representation, considering the substantial amount of data involved. To comprehend the relationship between these variables in a practical manner that empowers individuals to make choices enhancing their quality of life, there is a need for new graphics. These graphics would enable the observation of the overall framework in a contextualised manner and assist in establishing clear visual goals. Methods: This article introduces glycaemic matrix and metabolic segmentation, a new method for representing and evaluating functional profiles by combining glucose and lifestyle data. Results: In this early-phase trial, the potential of this approach to represent the complete glycaemic spectrum within its context and adapt to a diverse range of objectives is demonstrated. Discussion: We propose a promising tool to finally be able to cluster metabolic types through artificial intelligence (AI) and adapt clinical interventions to metabolic heterogeneity. This research is private research conducted under Glucovibes company R&D initiatives. Full article

Background and objectives: Low-grade inflammation, a hallmark of metabolic disorders, originates in tissues as a consequence of metabolic dysfunction before it progresses to systemic manifestation. The early detection of low-grade inflammation in blood, therefore, is difficult. Here, we set out to develop a postprandial composite biomarker as an early indicator of low-grade inflammation to evaluate the effects of nutritional interventions. Methods: A postprandial composite biomarker was constructed with elastic net regression based on four blood cytokine responses to a mixed-meal challenge test in human reference groups (‘healthy’: 20–29 years, BMI < 25 kg/m²; ‘compromised’: 50–59 years, BMI > 25 kg/m²). The biomarker response was evaluated in three RCT studies with overweight adults and included two studies focusing on energy restriction (ER) and a whole-grain wheat intervention. In one ER study, an extended postprandial composite biomarker was constructed based on a total of twelve inflammatory and vascular markers. Results: A postprandial composite biomarker based on four blood cytokine responses to the mixed-meal challenge test could discriminate between the ‘healthy’ and ‘compromised’ reference groups. The whole-grain wheat intervention showed a significant reduction in the postprandial composite biomarker. No effects of caloric restriction, irrespective of quality of the diet, were observed on the biomarker. The extended postprandial composite biomarker reduced significantly in the persons within the 20% ER intervention group and did not change in the persons in the weight maintenance arm. The reduction correlated with body fat distribution, in particular, the ratio between subcutaneous and internal fat depots. Discussion: Composite biomarkers based on postprandial blood-based cytokine levels are well capable of discriminating low-grade inflammation between ‘compromised’ and ‘healthy’ metabolic phenotypes, which was not possible using fasting blood-based cytokine levels. Although the ability of the four-cytokine-based postprandial composite biomarker of low-grade inflammation to capture the effects of caloric restriction was limited, this biomarker could show the effects of a whole-grain wheat intervention. While whole-grain wheat reduced the secretion of cytokine mediators, an extended version of the composite biomarker indicated that 20% ER only reduced vascular inflammation, suggesting different underlying mechanisms. Full article

Background and Objectives: Taurine is a marker of fish and seafood intake. It is also suggested that its increased excretion in the urine is inversely associated with mortality from cardiovascular diseases. This study aimed to assess taurine concentration in Polish postmenopausal women’s urine and whether higher urinary taurine excretion is associated with higher fish intake in the aimed population. Methods: Thirty-three postmenopausal women, with an average BMI of 26.7 kg/m², were asked for three days to record their dietary information concerning fish (including shellfish) intake, and twenty-four-hour urinary taurine excretion was measured using the high-performance liquid chromatography (HPLC) method. Anthropometric parameters were also evaluated. All data are presented as mean ± standard error of the mean. Results: The study population was divided into two groups according to the median taurine/creatinine ratio (Tau/Cr), with the cut-off value of 46.8 µmol/mmol. A significantly lower (p < 0001) concentration of taurine in the 24 h urine samples was observed in the group with a low Tau/Cr ratio (231.3 ± 35.5 µmol/day) in comparison to the high Tau/Cr ratio group (612.7 ± 48.8 µmol/day). Postmenopausal women with a higher Tau/Cr ratio daily consumed more fish (60.2 ± 11.9 g) and eggs (25.0 ± 4.5 g) compared to the group with a low Tau/Cr ratio (16.2 ± 5.3 g vs. 11.1 ± 4.6 g, respectively). Discussion: higher 24 h urinary Tau/Cr ratio can be related to higher fish intake in Polish postmenopausal women. Full article

Background: Parents’ own dietary habits have an impact on the diet quality and health of their children. Yet, the relationship between parental self-perceived health consciousness and health in preschool-aged children is not known. Thus, the aim was to study the relation of self-perceived dietary behavior of parents with their pre-school aged children’s dietary quality and body adiposity. Methods: Parents of 2–6-year-old children (n = 738) were recruited from child health clinics across Finland. Parents were divided into health-conscious (HC, n = 396) and non-health-conscious (non-HC, n = 342) according to a self-perceived report of following a healthy diet. Semi-structured questionnaires on parental views on their child’s diet were collected. Children’s diet quality was evaluated with the Children’s Index of Diet Quality (CIDQ). Anthropometrics of the children were recorded during the child’s health clinic visit. BMI was converted to a BMI standard deviation score (BMI-SDS) and categorized according to the Finnish growth reference curves as well as the categories of the International Task Force (IOTF). Results: Children of HC parents had better diet quality compared to children of non-HC parents (11.4 ± 2.6 vs. 10.6 ± 2.6, p = 0.01). They also presented lower BMI-SDS values compared to children of non-HC parents (−0.02 ± 1.12 vs. 0.19 ± 1.09 p = 0.015). Categories of BMI-SDS according to the Finnish growth charts did not differ between the children of HC and non-HC parents. Yet, the categories of BMI-SDS according to cut-offs defined by the IOTF differed significantly between the HC and non-HC parents: the number of children with underweight was 44 (13.6%), normal weight 233 (72.1%), overweight 30 (9.3%) and obese 16 (5.0%), while the number of children of HC parents who were underweight was 69 (18.6%), normal weight 255 (68.7%), overweight 44 (11.9%) and obese 3 (0.8%). Conclusion: Parental self-perceived health consciousness in terms of healthy eating is related to adiposity and diet quality in children. Self-perceived healthy eating in parents could be one factor to consider when monitoring a child’s health in health clinics. Full article

Dancers are considered aesthetic athletes due to the great emphasis directed towards maintaining svelte figures with the aim of enhancing the aesthetic of performance. Ballerinas are consistently found 10–12% below their ideal body weight and are susceptible to the female athlete triad. Still, while the dietary intake of several sports populations has been extensively studied worldwide, in the dance arts data are limited. The aim of this study was to assess the dietary intake of adult female dancers on a small Mediterranean island. All dance schools in Gozo (n = 7) were invited to participate via email. A 4 day food and beverage diary recorded between Thursday and Sunday was used to assess the dietary intake of eligible students and teachers of dance schools. A self-reported questionnaire was used to assess demographic data and exercise energy expenditure, adapted from the ‘International Physical Activity Questionnaire’. Participants’ energy and macronutrient intakes were compared to the recommended dietary allowances (RDA) using the one sample t-test. The paired samples t-test was used to determine any significant differences in dietary intake between weekdays and the weekend. Of a potential 25 eligible participants, 14 engaged in the study yielding a 56% response rate. The majority of participants were recreational dancers (n = 11). The mean energy intake was 1306 kcal/day with 34.7% derived from fat. The mean carbohydrate and protein intakes were 2.4 g/kg bodyweight and 1.1 g/kg bodyweight, respectively. The mean total energy expenditure was 2034 kcal/day. The daily mean energy, carbohydrate and protein intakes were lower than the RDA, while mean fat intake was higher. There was no evidence of a significant difference in dietary intake between weekdays and the weekend (p = 0.309 carbohydrates, p = 0.596 fat, p = 0.956 protein). Professional dancers failed to meet energy, carbohydrates and protein recommendations for athletic populations, whereas, recreational dancers were likely to consume sufficient energy, carbohydrate and protein intakes. Dietary fat recommendations were met by half of the participants and exceeded by the rest. This study was the first to assess the dietary intake of a dance population in the Maltese Islands. Further research in a larger cohort of local dancers is merited. Full article

Background and objectives: Chemosensory function declines with the progression of age and can potentially impact adherence to a healthy diet. A loss of taste perception could induce higher sodium intake and increase the risk of cardiovascular diseases. The aim of this study was to determine whether there is a decrease in olfactory and gustatory function and to analyze the possible association with nutritional status and dietary sodium intake in older nursing home residents. Methods: This study included 123 participants aged 65 years and older (average age of 80.7 ± 5.8 years, 76.5% females) and 70 adults aged 18–64 years (average age of 43.8 ± 8.1 years, 77.2% females) for a comparison of chemosensory function. Olfactory function was determined by the European Test of Olfactory Capabilities (ETOC) and salty taste perception by the rapid detection threshold method. Nutritional status was evaluated by the Mini Nutritional Assessment-Short Form (MNA-SF^®). Sodium intake was determined by 24 h recall collected on two non-consecutive days. Results: The results show that olfactory function in the elderly participants (17.3 ± 8.8, 65% hyposmic) was significantly impaired compared to that in the younger population (29.3 ± 2.9, 15% hyposmic) (p < 0.0001). The salty taste recognition threshold in the elderly population (48.8 ± 30.1) was significantly higher compared to that in the younger population (13.7 ± 10.7) (p < 0.001). The MNA^® result for elderly participants was, on average, 13.7 ± 10.7, which indicated normal nutritional status; 22.8% of participants were at risk of malnutrition; and 1.6% were malnourished. This study established significant association between a higher salty taste threshold and intake of sodium (p < 0.02), but there was no significant impact of the loss of olfactory perception on sodium intake. There was no significant association between the loss of gustatory or olfactory function and the nutritional status of elderly people. Discussion: This study showed that chemosensory function declines in older nursing home residents and nutritional status does not appear to be related to this, but it could have a potentially negative impact on health as it is associated with higher sodium intake. Full article

Background: The national cardiovascular program includes medical, nursing, and dietetic interventions, which lack evaluation. Therefore, this study aims to evaluate the accomplishment of diabetes and hypertension targets in users of the national cardiovascular program in the Ñuble region between 2018 and 2020. Methods: A cross-sectional study was carried out on users enrolled in the national cardiovascular health program with T2D and/or HTA in the Ñuble region between 2018 and 2020. To evaluate the association between target goals (glycosylated hemoglobin (HbA1c) and blood pressure) and sociodemographic variables, linear and logistic regression were used. Results: More than 16,000 users were included. Men had higher HbA1c levels than women. Meanwhile, for age, people older than 65 years had lower HbA1c levels; a similar tendency was observed when comparing people older than 80 years. When the comparison was performed for rurality, people living in rural areas had higher HbA1c levels, and these levels were higher among people living in Itata province. This tendency was slightly different among HTA people; men continued to exhibit higher levels of Systolic Blood Pressure (SBP) through the years, older people had higher levels of SBP, and people living in rural areas had lower levels compared to people living in urban areas. Conclusion: The present study allows us to deliver the first results regarding the operation of the national cardiovascular health program in the Ñuble region, which allows us to determine if the goals of achievement for T2D and HTA have decreased in the period 2018–2020. Full article

Background and objectives: Although testicular cancer is considered the paradigm of highly curable malignancy, treatment-induced adverse effects and potential impairment of gonadal function may cause non-negligible long-term health repercussions, including metabolic disturbances and cardiovascular sequelae. This observational, cross-sectional study recruited a sample of testicular germ cell tumor survivors (TGCTSs) attending routine follow-up care, with the aim to investigate the relationship between the Omega-3 Index, a promising cardiometabolic risk-assessment biomarker, and complete blood cell (CBC) count-derived systemic inflammation indexes. Methods: Erythrocyte membrane fatty acid (FA) profiling was performed by gas chromatography with flame ionization detection. The Omega-3 index (OI3) was computed by summarizing eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) expressed as a percentage of total FAs. Inflammatory indexes, including NLR (neutrophil-to-lymphocyte ratio), SII (systemic immune-inflammation index (platelet count × NLR)), SIRI (systemic inflammatory response index (monocyte count × NLR)), and AISI (aggregate index of systemic inflammation (monocyte count × SII)) were determined using routinely obtained hematological parameters. Results: In the analyzed cohort (n = 92, age $\bar{\mathrm{x}}$ = 35.89 ± 8.67 years), the mean value of O3I was 4.41 ± 0.92%, where 53.26% of men were allocated the high-risk group (O3I < 4%) and the rest were in the moderate cardiovascular hazard category (4% ≤ O3I < 8%). The O3I correlated inversely with the NLR, SII, and AISI (r = −0.234, −0.241, and −0.249, respectively, all p < 0.01). A negative association was determined between the total content of polyunsaturated fatty acids and SIRI (r = −0.221, p < 0.05). The NLR and AISI were statistically significantly lower in the subgroup of patients with O3I ≥ 4% (p < 0.05). Discussion: Blood cell count-based inflammatory indexes may contribute to a more efficient risk stratification of TGCTS in relation to cardiometabolic disorders. Further large-scale research and long-term intervention trials are warranted to investigate the clinical significance of an increased intake of anti-inflammatory long-chain omega-3 polyunsaturated FA via dietary sources and/or supplementation in modulating the inflammatory process and reducing the morbidity burden in this patient population. Full article

Colorectal cancer (CRC) incidence can be reduced through various modifiable lifestyle factors, including diet and physical activity. Awareness of the risk factors for CRC can encourage individuals to follow cancer prevention recommendations and reduce their risk of developing the disease. The aim of this study was to assess the awareness of the role of diet in CRC development in Malta. The researcher specifically designed a questionnaire that was used to assess knowledge of CRC risk and awareness of dietary factors that affect CRC development. This research tool was validated through a pilot study and ethically approved. Convenience sampling was used to recruit Maltese adults from eight different public places around Malta over a period of three months. The questionnaires were distributed by the researcher, and participants filled in the questionnaire in the presence of the researcher. Data were analyzed statistically using the Chi-squared test, the Kruskal–Wallis test, and the Spearman correlation coefficient. Sample participants (n = 150) were mostly female, well-educated, and employed. Less than half (44%) of the participants were aware that CRC risk can be reduced, but when asked about the link between diet and CRC, 83% of the participants acknowledged that diet affects CRC risk. However, there was poor awareness of how specific dietary factors, including alcohol, calcium supplements, dairy products, processed meat, and fiber, may affect CRC risk. Participants performed better in closed-ended questions than in open-ended ones. They also performed well in questions that asked about sources of fiber, whole grains, and processed meat, although 47.3% of participants failed to recognize bacon as processed meat. Participants were aware that diet affects CRC development, but awareness of the association with specific food groups and nutrients was poor. Public health strategies should be targeted towards raising awareness of cancer prevention recommendations, especially in younger generations. Despite its limited sample size, this pilot study is the first to investigate awareness of this association in Malta, thus paving the way for a study looking at a representative sample of the Maltese population. Full article

Background and objectives: Osteosarcopenic obesity/adiposity (OSO/OSA) syndrome describes the concurrent deterioration of bone, muscle, and adipose tissue. The objective of this review was to evaluate human studies addressing serum biomarkers in relation to OSA. Methods: A search in the PubMed, Scopus, and Web of Science databases was conducted to examine relevant articles published from their inception to the end of March 2023, using the MeSH strings in the search strategy. Only studies published in English and conducted in humans (≥18 years) without chronic diseases (cancers, kidney/liver disease) or pregnancy were used. Book chapters, abstracts only, and studies in which participants did not have all three body composition components measured to identify OSA or in which the body composition components could not be related to the independent/exposure variables were excluded. Results: A total of n = 943 articles were retrieved from all three databases. After removing duplicates and articles unrelated to the topic, only n = 4 studies conducted in South Korea and China met the inclusion criteria. Three studies were cross-sectional while one was retrospective. Of the biomarkers, only serum 25(OH)D and ferritin were studied, showing strong relations with OSA. Discussion: Overall, lower serum vitamin D (<20 ng/mL) and higher serum ferritin were associated with a higher prevalence of OSA. Further research is needed to develop biomarkers for each tissue that, in combination, may indicate the existing impairments and presence of OSA. Full article

Context and Objectives: There is an urgent need for a dietary shift towards an increased consumption of plant protein foods. However, some nutritional and sensory challenges are associated with whole-meal grains and pulses. Fermentation is a promising technology for reducing anti-nutrients, increasing protein digestibility, and reducing starch digestibility in plant-based matrices. This study aimed to evaluate the impact of different fermentation conditions using different bacteria on the nutritional composition of grains and pulses. Methods: Milled wheat, buckwheat, and chickpeas were fermented using different bacteria or combinations of bacteria, i.e., Lactobacillus delbrueckii + Streptococcus thermophilus (Vega), Lacticaseibacillus rhamnosus (Lrham), Leuconostoc pseudomesenteroides (Lpseu), Weissella confusa alone (Wcon) or combined with Lactococcus lactis (Wcon + Lac), or Pediococcus pentosaceus (Wcon + Pen), for 24 or 48 h. Protein hydrolysis and protein and starch digestibility were measured using the O-phtaldialdehyde and Infogest methods, respectively. Starch digestibility was evaluated using the Englyst method. Dietary fibers (DF) were quantified. Results: In buckwheat, all fermentation conditions increased protein hydrolysis, especially Vega. In chickpeas, Lrham and Wcon, alone and in combination, increased protein hydrolysis. In wheat, fermentation did not increase protein hydrolysis. Protein digestibility increased only with Wcon + Pen in buckwheat. For chickpeas and wheat, fermentation did not increase protein hydrolysis, and it was lowest with Lpseu in both cases. Lpseu, Wcon + Lac, and Wcon + Pen led to increased DF in buckwheat, especially soluble high-molecular-weight (HMW) buckwheat (dextran formation). In chickpeas, no increase in DF content was observed due to the hydrolysis of oligosaccharides, but soluble HMW DF increased with Lpseu, Wcon + Lac, and Wcon + Pen (dextran formation). No significant change was observed for wheat DF. The starch hydrolysis index (HI) increased with Lrham over 48 h and Lpseu over 24 h but decreased with Wcon + Lac over 24 h in buckwheat. In chickpeas, HI was reduced in all conditions, the lowest values being with Wcon + Pen and Wcon + Lac. In wheat, HI increased with Lrham over 48 h and decreased with Wcon + Pen. Conclusions: The impact of the fermentation conditions tested differed depending on the grains. Some conditions improved the nutritional characteristics of these grains. These results show promising effects concerning the nutritional quality of grains, which need to be confirmed in finished products. Full article

Non-communicable diseases are a major health burden worldwide, and they all share diet as common risk factor. In this context, understanding the complexity of eating behaviours can be useful both at the individual and population level for prevention and treatment. Foremost, there is a need for reliable and simple tools to assess eating behaviours, both for public health research and clinical practice. The aim of this study was to validate in Romanian and test by comparison two internationally popular questionnaires of eating behaviour: The Dutch Eating Behavior Questionnaire (DEBQ), which assesses emotional, external and restricted eating styles, and The Eating Motivation Survey (TEMS), short form, which investigates 15 determinants of food intake (taste, habits, need and hunger, health, convenience, pleasure, tradition, considerations related to the origin of food, social, price, appearance, weight control, social norms and social image). Methods: We tested (with the consent of the authors of the original questionnaires) the psychometric properties of the Romanian versions of DEBQ and TEMS on an adult general population and explored associations of eating behaviour with weight status with both questionnaires. Our study showed factor loads similar to the original version of the questionnaire for DEBQ and a very good internal validity (Cronbach's alpha fidelity coefficient greater than 0.8) for both DEBQ and TEMS. Emotional eating in DEBQ and items related to emotional eating in TEMS showed the strongest correlation with weight, but for all scales of DEBQ, there were further information given by TEMS. This study enables the use of the DEBQ and TEMS in Romania for the adult population. We also consider that the two questionnaires could be used together for developing more adequate strategies to reduce the burden of nutrition-related diseases. Full article

Background. Recent evidence suggests that the gut microbiota (GM) in Behçet’s syndrome patients (BS) has low diversity and a peculiar layout. Diet is known to influence the GM, but to date no study has investigated its effect on these patients. Aim. To evaluate the effect of a lacto-ovo vegetarian diet (VD) and a Mediterranean diet supplemented with 2 g/die of oral butyrate (MD-Bt) in comparison with a Mediterranean diet (MD) on the GM in BS. Methods. Forty-four (27F; mean age: 46.9 ± 11.2 years) BS patients were randomly assigned to follow a VD, MD-Bt, or MD for 3 months each and then crossed over. Stool samples were collected from the participants at the beginning and at the end of each intervention phase. Samples were analyzed through 16S rRNA amplicon sequencing on an Illumina MiSeq platform. Results. Regarding alpha diversity, a decreasing trend after a VD (Shannon index: p = 0.069; observed species: p = 0.08) and an increasing trend after a MD (Shannon index: p = 0.084; observed species: p = 0.079) were observed. Regarding beta diversity, no significant separation was found between the sample groups either over time or between different interventions. Phylum-level taxonomic analysis showed a significant increase in Bacteroidetes (+2.6%; p = 0.049) following the MD and a significant reduction in Proteobacteria (−0.2%; p = 0.035) following the MD-Bt. At the family level, we observed a significant increase in Bacteroidaceae (+2%; p = 0.05) and Porphyromonadaceae (+0.3%; p = 0.004) after the MD, a significant reduction in Porphyromonadaceae (−0.4%; p = 0.05) and Rikenellaceae (−0.7%; p = 0.03) after the VD, and a significant reduction in Rikenellaceae (−0.2%; p = 0.008) and Turicibacteraceae (−0.02%; p = 0.04) after the MD-Bt. In addition, there was a significant increase in the genus Bacteroides (+2%; p = 0.05) and Parabacteroides (−0.2%; p = 0.004) after the MD. On the other hand, the MD-Bt, led to a significant increase in Clostridium (+1%; p = 0.05) and a significant reduction in Oscillospira (−0.6%; p = 0.011) and Turicibacter (−1.9%; p = 0.04). Conclusions. The MD appeared to have an overall better impact on the GM modulation of BS in terms of higher diversity and potentially beneficial compositional changes. Full article

Maintaining and reducing weight are considered as important features in reducing mortality and morbidity caused by metabolic-associated diseases. Increasing evidence from in vivo mechanistic and clinical studies has shown that the gut microbiota is interacting with the host's physiological function in regulating energy intake and body weight. A prebiotic is a substrate that is selectively utilized by host microorganisms conferring a health benefit. Numerous clinical studies showed multifaceted benefits of prebiotic chicory inulin-type fructans (ITFs) on gut and metabolic health. The present systematic review and meta-analysis aimed to synthesize the totality of evidence through pooled estimates of ITF supplementation in supporting weight management on both healthy and diseased subjects. A systematic search for eligible articles was performed in databases (EMBASE, MEDLINE (PubMed), Web of Science) without a language restriction. Two reviewers independently extracted data from eligible articles. We chose primary (body weight) and secondary (BMI, total fat mass, body fat percentage and waist circumference) outcomes as weight management parameters. The baseline-corrected mean difference (MD) was used to synthesize the pooled effect size by employing a random-effects model using the inverse variance method. A sub-group analysis based on dose, duration, health status and ITF-type was also conducted. A total of 31 randomized controlled trials with 40 arms (n = 1309 participants) were included in this review. A significant reduction was observed on body weight (MD: −1.03 kg, 95% CI: −1.42 to −0.64, p < 0.0001), BMI (MD: −0.39 kg/m², 95% CI: −0.58 to −0.21, p = 0.0001), fat mass (MD: −0.45 kg, 95% CI: −0.71 to −0.2, p = 0.0023), and waist circumference (MD: −0.99 cm, 95% CI: −1.61 to −0.37, p = 0.003) following ITF supplementation. For body fat percentage, a significant effect was observed following subgroup analysis on an intervention that lasted for more than 8 weeks (MD: −0.78 percent, 95% CI: −1.17 to −0.39, p < 0.01). The present meta-analysis of randomized controlled trials provides further evidence to support that ITF supplementation could help benefit weight management by reducing body weight, BMI, fat mass, waist circumference, and to a certain extent on body fat percentage. Full article

Background and objectives: The guidelines provided by the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) aim to reduce the risk of developing cancers worldwide. The WCRF/AICR advises cancer survivors to follow the same recommendations for cancer primary prevention. These recommendations have been operationalized into a quantitative index based on a total of seven or eight healthy lifestyles; the points-based system allows for scoring a full point and, in some cases, partially meeting a recommendation. Evidence of the usefulness of the WCRF/AICR recommendations in populations different from those in the US is scarce. The aim of the present study was to assess whether compliance with the 2018 WCRF/AICR recommendations for cancer prevention is related to all-cause mortality among cancer survivors recruited in the Moli-sani Study cohort in Italy (2005–2010). Methods: A longitudinal analysis of 786 participants (59.7% women) with a history of cancer at study entry were analyzed. The 2018 WCRF/AICR score included seven components: body weight, physical activity, plant-based foods, fast foods, red and processed meat, sugar-sweetened beverages, and alcohol; the optional breastfeeding component was excluded. The final score ranged between 0 and 7 points, with higher values reflecting greater alignment with the WCRF/AICR recommendations. Multivariable Cox proportional hazard models adjusted to account for sociodemographic factors and major health conditions were fitted for estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality. Results: The sample consisted of cancer survivors with an average age (SD) of 62.7 years old (11.7). Over a median follow-up of 11.8 years, a total of 220 deaths were registered. The median WCRF/AICR score was 4.6 ± SD 0.9. In multivariable-adjusted analyses, the risk of mortality was lower for participants who scored >5 points (HR = 0.54; 0.37–0.78; p value = 0.0010) compared to those who scored 0–4 points. Each one-point increment in the WCRF/AICR score was associated with a 22% decreased risk of all-cause mortality (HR = 0.78; 0.66–0.90; p value = 0.0012). Discussion: Higher compliance with the WCRF/AICR recommendations regarding diet, physical activity, and body weight was associated with lower all-cause mortality risk among cancer survivors. These findings suggest that cancer survivors should be encouraged to increase their adherence to the WCRF/AICR recommendations. Full article

Metabolic syndrome (MetS) is associated with an increased risk of cardiovascular disease and type 2 diabetes mellitus by an estimated two- and five-fold, respectively. Nutrition intervention could help to prevent the progression of MetS and associated pathologies with age, but the precise dietary components and related factors are not well understood. Therefore, the aim of this study was to evaluate the role of nutrition-related factors in MetS as well as the progression of MetS and its components over a 7-year follow-up period in older adults. This investigation involved the secondary analysis of data from the North–South of Ireland Trinity-Ulster-Department of Agriculture (TUDA) study of community-dwelling older adults (≥60 y), which were sampled at baseline (2008–2012; n = 5186) and follow-up (2015–2018; n = 953). Participants were deemed to have MetS if they met at least three of the following criteria: waist circumference (≥102 cm for males, ≥88 cm for females); HDL cholesterol (<1.0 mmol/L for males, <1.3 mmol/L for females); triglycerides (≥1.7 mmol/L); blood pressure (systolic ≥ 130 and/or diastolic ≥ 85 mmHg); and HbA1c (≥39 mmol/mol). The prevalence of MetS increased with advancing age (67% at baseline vs. 74% at follow-up). The factors at baseline that were predictive of a higher MetS risk at follow-up included waist circumference (OR 1.04, 95% CI 1.00–1.08; p = 0.038) and triglycerides (OR 1.77, 95% CI 1.21–2.59; p = 0.003). In a detailed dietary analysis conducted at the follow-up time point, higher protein intake (g/kg body weight) was associated with a lower risk of MetS (OR 0.06, 95% CI 0.02–0.20; p < 0.001), abdominal obesity (OR 0.10, 95% CI 0.02–0.51; p = 0.006), and hypertension (OR 0.022, 95% CI 0.00–0.80; p = 0.037), and a higher MUFA intake (g/day) was associated with a lower risk of MetS (OR 0.88, 95% CI 0.78–1.00; p = 0.030). No other dietary factors were significantly associated with MetS. In terms of protein quality, participants with MetS compared to those without consumed fewer high-quality protein foods (p = 0.009) and consumed more low-quality protein foods (p < 0.001). Dietary intervention along with other strategies focusing on potentially modifiable risk factors may delay the progression of MetS in older adults. Efforts to enhance the quantity and quality of protein intake may be warranted to reduce MetS in certain at-risk groups. Full article

Background: Exogenous compounds with antioxidant activity mainly include plant compounds such as polyphenols, β-carotene, lycopene, vitamin C and vitamin E. Culinary processing significantly affects the organoleptic characteristics and nutritional value of food. However, little is known about the effect of cooking processing on the antioxidant activity of foods. Objectives: This study aimed to investigate whether cooking processes affect the antioxidant activity of foods and whether there are differences in antioxidant activity between different foods. Materials and methods: Raw materials were used to prepare raw and cooked soups. Four model raw and four cooked soups (tomato, cucumber, cauliflower, vegetable) were prepared according to recipes given in Polish food composition tables, each in triplicate. Samples were lyophilized and extracted with the following solvents: methanol/water (90:10 vol.) and acetone/water/acetic acid (70:29.5:0.5 vol.). Antioxidant activity was determined by an electrochemical method using the e-BQC analyzer, Bioquochem, Spain, and expressed in µC, and by the FRAP spectrophotometric method according to Benzie and Strain, in which values were expressed in mM/100g dry weight. The Kolmogorov–Smirnov and Wilcoxon tests were used for intergroup comparisons and the Spearman test was used for correlations. Results: Antioxidant activity measured by the electrochemical method was found to be higher in acetone extracts compared to methanol extracts (p < 0.05) in terms of Q1 (fast-acting antioxidants), Q2 (slow-acting antioxidants) and QT (total charge) parameters. No significant differences were found by FRAP between methanolic and acetone extracts (p = 0.057). In acetone extracts, higher antioxidant activity was found in cooked soups compared to raw soups for tomato, cucumber and cauliflower soups. In both methanolic and acetone extracts, the antioxidant activity determined by the electrochemical method (parameter Q1) correlated with the FRAP method: 0.92 and 0.63, respectively. No correlation was found between the FRAP method and parameter Q2 of the electrochemical method in either extract. Discussion: The model soups had different antioxidant activities, but it was higher for boiled soups, which may be related to the better availability of antioxidants after cooking. The methanol extraction method allows the extraction of compounds that similarly affect the antioxidant activity determined by the electrochemical and FRAP methods. Full article

Introduction: Dietary and physical activity interventions have beneficials health effects for people with type 2 diabetes (T2D). Although the effects of such interventions on long-term changes in glucose levels are well studied in a controlled setting, little is known about the acute effects of lifestyle interventions in a real-life setting and on an individual level. Quantifying the effects of lifestyle on metrics of continuously measured glucose and how these differ between individuals may allow for personalized lifestyle advice for people with T2D. Methods: Forty people with T2D were included in this study. Participants wore a continuous glucose monitor (CGM) for 11 periods of 4 days, of which 3 were control periods (habitual everyday life) and 8 were intervention periods (2× low carbohydrate diet, 2× Mediterranean diet, 2× walking after each meal, and 2× hourly exercise bouts of 5 minutes (‘active day’)). The CGM metrics used in the ambulatory glucose profile, an internationally recognized standard for interpreting glucose control, were calculated. We used a random effects model to quantify the effect of the four lifestyle interventions on CGM metrics with the participants as a random effect. Results: On overage, a low carbohydrate diet, walking after a meal, and an active day resulted in improved CGM metrics, including a lower mean glucose (−0.70, −0.34, and −0.25 mmol/L, respectively) and SD (−0.22, −0.05, and −0.02) and higher time in range (6.9, 3.5, and 3.2%, respectively), the latter being the average percentage of time per day spend in the target glucose range (3.9–10.0 mmol/L). Only the low carbohydrate diet had a positive effect on the coefficient of variation (−1.48), a measure of glucose variability. Also, the magnitude of the effects varied between the interventions. Surprisingly, the Mediterranean diet had adverse effects on all the calculated CGM metrics. Our next step is to investigate inter-individual variation in these intervention effects. Discussion: The low carbohydrate diet, walking after a meal, and active day intervention showed positive, but differential, effects on CGM metrics within 4 days, while the Mediterranean diet showed negative effects. Further analysis on inter-individual variation can be used for personalized lifestyle recommendations, for instance targeted at avoiding high glucose peaks, or reducing variability in glucose levels. Full article

The inadequate intake of essential micronutrients remains a huge public health issue that carries significant social, economic, and health consequences. Although deficiencies in iron, vitamin A, and iodine are well-documented, there is growing recognition of deficiencies in folate, vitamin B12, zinc, calcium, and other micronutrients among disadvantaged populations. A national shopping basket (also known as a food basket or food basket survey) is a list of foods and beverages that represent the typical dietary requirements of a population in a given country. The items in the food basket are chosen based on their frequency of consumption, nutritional value, and availability in the market. This study was designed to assess the intake of certain micronutrients using the food items of a moderate-cost shopping basket in Serbia. The structure of a moderate-cost shopping basket for a family of three in Serbia is published on a monthly basis by the Ministry of Trade, Tourism and Telecommunications. The food list includes 73 food items categorized into nine groups, such as cereals, vegetables, fruits, meats, fish, fats and oils, dairy products, non-alcoholic beverages, and miscellaneous other foods. The food composition database CapNUTRA was used for the calculation of the iron, vitamin A, iodine, folate, and zinc content in all food items in the basket. The monthly quantities, intended for a family of three, of each food item were characterized by their micronutrient contents and the values were summed to derive an estimate of the average intake. When comparing the obtained estimates with the recommended daily intakes, it was noticed that the requirements were met for iron and zinc, but, when it came to vitamin A, the intake was around 20% lower than the recommended value. The iodine and folate intake would be higher than is recommended in the Serbian population, based on such an assessment. The evaluation of nutrient intake using a national shopping basket is one way to estimate the adequacy of a population’s diet and essential nutrient supply. However, it is important to note that this approach has some limitations and may not capture the full complexity of an individual’s dietary intake. Full article

Diabetes is a metabolic disease characterized by changes in carbohydrate and lipid metabolism. In turn, prolonged hyperglycemia may lead to increased oxidative stress and changes in the status of elements, including iron. Both ginkgo biloba extract (GBE) and zinc (Zn) may play a role in glycemic control. In this study, the effect of these ingredients both individually and in combination on the parameters of iron metabolism in diabetic rats was assessed. The experiment was carried out on male Wistar rats. The control group fed a standard diet (AIN-93M) was created, and in the rest of the rats diabetes was induced by feeding a high-fat diet and streptozotocin injection. Then, diabetic rats were divided into four groups: diabetic control, diabetic supplemented with Zn, diabetic supplemented with GBE, and diabetic supplemented with Zn and GBE. The doses of these supplements were 150 mg/kg diet for Zn and 0.8% for GBE, respectively. Rats were fed the diets for 6 weeks. During the autopsy, internal organs (liver, kidneys, spleen, pancreas, testis and heart) were collected. The content of Fe in tissues was determined by the AAS method followed by microwave digestion. Moreover, the serum ferritin concentration was measured. The significance of differences between the groups was analyzed by one-way analysis of variance and Tuckey’s post-hoc test. The induction of diabetes resulted in a significant increase in Fe content in the pancreas and liver, as well as serum ferritin levels. Zn supplementation had no effect on the parameters studied. However, it was found that GBE alone and in combination with Zn significantly normalized the parameters studied in diabetic rats. In conclusion, GBE supplementation significantly improved the parameters of Fe metabolism, probably due to the fact that the extract contains compounds showing the ability to chelate iron ions. Full article

Iron and folic acid deficiency are common among women of childbearing age and in pregnant women. Poor iron and folate status in women is associated with an increased risk of anemia and disorders in the fetus development during pregnancy. The reason for the deficit of these micronutrients is improper nutrition and their low bioavailability. Incorrect eating habits before pregnancy are often continued during pregnancy. The aim of this study was to determine the intake of iron and folate with diet and supplements in non-pregnant and pregnant women in each trimester. The study was conducted on 50 non-pregnant women (NPW), 50 pregnant women in the first trimester (PW_1), 50 women in the second trimester (PW_2), and 44 women in the third trimester (PW_3), aged 19–42 years. We used a validated questionnaire and a 24 h recall nutrition interview. The results were analyzed using the computer software package Aliant. The BMI index was calculated (pre-pregnancy BMI in PW groups). Statistical analysis of the results was performed using Statistica 13.3. It was found that the average BMI was 23.5 kg/m² and was comparable between groups. The energy intake was significantly lower in the PW_2 group (1118 kcal) and markedly higher in the PW_3 group (1925 kcal). The intake of iron and folate from the diet was below RDA in all groups, and was significantly lower in the PW_1 group (27.4% RDA for iron and 23.7% RDA for folate) and markedly higher in the NPW group (55.5% RDA for iron and 66.3% RDA for folate). Only the use of supplementation resulted in an adequate intake of iron and folates, wherein the iron supplements were used by 14% of NPW, 46% of PW_1, 40% of PW_2, and 5% of PW_3, and folate supplements were as follows: 36%, 68%, 58%, and 23%, respectively, in the analyzed groups. In conclusion, the supply of iron and folates from the diet in non-pregnant and pregnant women is low (below 50% RDA in PW in each trimester and between 50 and 60% RDA in NPW). With such a low supply of these micronutrients, supplementation seems necessary for women. Full article

Background and objectives: Inflammatory bowel disease is a chronic condition with no cure. However, there are a range of treatment options. Pharmacological approaches are usually the first step in treatment, and they are effective for many patients; however, for some, side effects are evident, and effectiveness can reduce overtime. Research on advanced delivery systems, new drugs and the therapeutic benefits of nutraceuticals such as curcumin have been previously investigated with promising results for IBD treatment, although they present their own unique challenges including poor bioavailability. The poor bioavailability of hydrophobic agents including curcumin is partly attributed to poor solubility and inadequate concentrations at target tissues. Therefore, the aim of the present work was to develop a novel pH-sensitive drug and nutraceutical delivery system featuring microspheres embedded in a hydrogel. Methods: Polylactic acid–polyethylene glycol microspheres loaded with dexamethasone (0.8 wt%) and curcumin (0.8 wt%) were synthesised using an emulsion solvent evaporation method. pH-sensitive polyethylene glycol dimethacrylate-co-acrylic acid hydrogels (46.6% and 33.3%, respectively) were synthesised with water (20%) by UV-photopolymerisation. The dexamethasone and curcumin microspheres were embedded into the hydrogels. Hydrogels and microspheres were characterised separately to understand their properties. Results: The encapsulation efficiency of the dexamethasone and curcumin microspheres was promising with higher encapsulation efficiency achieved for the curcumin microspheres (29% and 92%, respectively). Swelling studies demonstrated the equilibrium water content (EWC), the ability of the hydrogel to uptake its surrounding solution, with differences observed in response to changes in pH. In pH 6.8, hydrogels took up more of the surrounding solution compared to pH 2.2 (EWC% after 24 h = 69% and 56%, respectively). Gel fraction studies showed that the efficiency of the network formed during photopolymerisation (96%). Discussion: This targeted drug and nutraceutical delivery system may have the potential to play a role for IBD treatment with the combined impact of the microspheres in the hydrogel to be established. Dexamethasone and curcumin were encapsulated into microspheres which aid their solubility. The hydrogel component may help achieve a targeted delivery system, owing to the changes observed in response to different pH levels, as would be observed along the gastrointestinal tract. Full article

Parental feeding practices are a source of childhood food experiences (CFE), which can influence behavior in youth and later in adulthood. This study aimed to assess the relationship between CFE related to restrictions, restrained eating, and restricting selected food intake in adulthood. A total of 435 young adults participated in this cross-sectional study carried out in 2020–2021. The questionnaire included questions on feeding practices related to restrictions, restrained eating from the Polish version of the Dutch Eating Behaviour Questionnaire (scales from 1—never to 5—very often), and restricting the intake of sugar and highly processed, high-fat, and high-sugar products (yes/no). Scores for “Restriction for health” (four statements), “Restriction for weight” (eight statements), and “Restrained eating” (nine statements) were calculated by summing the individual scores and counting the mean value. The degree of fit of the scales was satisfactory (Cronbach’s alpha: 0.709, 0.833, and 0.899, respectively). Descriptive statistics and Pearson correlation coefficient (p < 0.01) were used in the statistical analysis. The score for “Restriction for health” was 2.8 (mean value), for “Restriction for weight”, it was 1.9, and for “Restrained eating”, it was 2.5. CFE related to the use of restrictions (for health and weight) were positively interrelated (r = 0.508). A relationship between experiences of “Restriction for weight” and restrained eating in adulthood was found (r = 0.294). About one-fifth of people (22.5%) did not restrict their food intake. Most people limited their sugar intake (57.7%), followed by high-sugar products (44.6%), highly processed foods (38.9%), and high-fat products (37.0%). Adults who restricted food scored higher on “Restriction for weight” (2.0 vs. 1.7) and “Restrained eating” (2.8 vs. 1.8) compared to non-restricting ones. Restrained eating and only CFE of “Restriction for weight” correlated with the restricted consumption of highly processed foods (0.300; 0.118, respectively), sugar (0.380; 0.171), high-sugar foods (0.338; 0.144), and high-fat foods (0.463; 0.161). Experiencing restrictions for weight control in childhood correlates with restrained eating in adulthood. Restrained eating in adulthood is a stronger predictor of restricting sugar and high-fat and sugar-rich foods, as well as highly processed foods, than CFE among young adults. Full article

Salicylates are naturally present in plants. In medicine, acetylsalicylic acid (aspirin) is widely used as an analgesic, antipyretic, and anti-inflammatory agent and also as a preventive medicine for preeclampsia in pregnancy. The main sources of salicylates are vegetables, herbs, and spices. It is observed that salicylates present in a diet rich in vegetables and herbs are largely responsible for the positive effects of these foods on human health. Therefore, the aim of this study was to determine the total salicylate intake in pregnant and non-pregnant women. This study was conducted on 105 non-pregnant women (NPW) and 98 pregnant women (PW) aged 19–42 years old. PW were at 11–12 weeks of gestation. We used a validated questionnaire and a 24 h recall nutrition interview. The results were analyzed using the original database on salicylate content in food and the computer software package Aliant. The BMI index was calculated. A statistical analysis of the results was performed using Statistica 13.3. It was found that in PW, the total intake of salicylates was significantly lower than in NPW as follows: 421.11 ± 51.19 µg/day and 539.32 ± 43.20 µg/day, respectively. PW did not use supplements with salicylates nor aspirin, while 4.4% of NPW used supplements with salicylates, and 15% occasionally used aspirin. The main food sources of salicylates in women were as follows: spices, vegetables and fruits, and cereal products. However, PW used a significantly lower number of spices (especially hot spices) than NPW. In the NPW group, a good source of salicylates was alcohol (beer and wine), while PW did not drink alcohol at all. The energy intake in both groups was not markedly different and was 1612.81 ± 314.07 kcal/day in PW and 1552.40 ± 321.18 kcal/day in NPW. The average BMI of 22.8 kg/m² was comparable between groups. In conclusion, the intake of natural salicylates decreased in pregnancy, which may be associated with the lower beneficial effect of these bioactive substances on health in pregnant women, e.g., increasing the risk of preeclampsia. Full article