Search Results (58)

Background: Celiac disease (CeD) requires lifelong adherence to a gluten-free diet (GFD). However, there is evidence that a GFD may lead to an unhealthy cardiometabolic risk profile and potentially increase the risk of cardiovascular disease in some patients. Incorporating plant-based foods (primarily derived from plants) into a GFD may offer a solution to improve cardiometabolic health. Thus, this study aimed to identify the attitudes toward and barriers to adopting a more plant-dominant diet among Danish patients with CeD. Methods: A cross-sectional survey was distributed to 2861 members of the Danish Celiac Society. Data from 959 patients with confirmed CeD were included. Results: Most participants (58.5%) reported adapting their diet after diagnosis by combining gluten-free products with plant-based foods, while 31.2% relied solely on gluten-free replacements. Dietary adaptation was primarily shaped by the limited availability of gluten-free plant-based foods (64%), taste/texture (55%), and cost (51%). More than half of the patients (56.8%) considered ‘eating more plant-based foods’, with ‘health’ being the primary motivator (70%), followed by ‘climate’ (50%) and ‘taste’ (36%). However, several barriers to a more plant-dominant diet were identified. Most notably, ‘taste and texture’ (71%), ‘limited availability of gluten-free plant-based foods’ (68%), ‘nutritional concerns’ (56%), and ‘cost’ (54%) were reported as barriers. Conclusions: Most Danish patients with CeD were generally positive about increasing their intake of plant-based foods; however, barriers to such dietary changes remain. Ongoing follow-up, practical guidance from dietitians, and accessible evidence-based resources may help patients maintain a nutritionally balanced, plant-dominant GFD that supports long-term health. Full article

Objective: To assess the relationship between adherence to various plant-based diets, as measured by overall, healthy, and unhealthy plant-based diet indices (PDI, hPDI, uPDI), and ovarian cancer risk. Methods: We obtained data on 1031 cases of ovarian cancer and 2411 controls from a case-control study conducted in Italy. PDI, hPDI, and uPDI were calculated using data from a validated food frequency questionnaire. We used logistic regression to calculate the odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) of ovarian cancer for PDI, hPDI, and uPDI, adjusting for several possible confounders. Results: PDI and hPDI were inversely related to ovarian cancer risk (OR = 0.70 for the fourth compared to the first quartile, 95% CI: 0.55–0.89, and OR = 0.67, 95% CI: 0.53–0.84, respectively). On the other hand, a higher uPDI was related to a higher risk of ovarian cancer (OR = 1.78, 95% CI: 1.40–2.28). The estimates for a 5-point increment in the indices were 0.88 (95% CI: 0.81–0.95) for PDI, 0.90 (95% CI: 0.83–0.96) for hPDI, and 1.15 (95% CI: 1.07–1.23) for uPDI. Consistent associations for the three indices were observed across strata of age, family history of breast/ovarian cancer, educational level, parity, oral contraceptives use, and menopausal status. Conclusions: Plant-based diets favorably influence ovarian cancer risk; plant-based diets characterized by a high intake of unhealthy plant foods are linked to an increased risk. Promoting diets rich in healthy plant foods could support the reduction of ovarian cancer risk. Full article

Background/Objectives: The global prevalence of overweight and obesity among young adults has doubled since 1975, primarily due to unhealthy dietary habits and sedentary lifestyles. Understanding dietary patterns (DPs) in this population is essential for designing effective prevention strategies. This study aimed to characterize the dietary patterns and diet quality of university students and to examine their physical activity and associated health risks. Methods: A convenience sample of 136 participants (77.9% females, 22.1% males) was recruited. Data on clinical history, lifestyle behaviors, and physical activity were collected using a structured questionnaire. Dietary intake was assessed using a food frequency questionnaire and three 24-h dietary recalls. Intake was analyzed by food groups, total energy, and macronutrient and fiber composition. Principal component analysis was applied to identify DPs. Results: Three major DPs were identified: Ultra-Processed Foods, Variety Foods, and Traditional Mixed Mexican. Overall, participants showed low consumption of fiber, legumes, and nuts, coupled with high intake of animal-based foods. The mean daily energy intake was 2278 kcal for men and 2008 kcal for women. Although participants demonstrated higher adherence to the Traditional Mixed Mexican pattern, a strong tendency toward the Ultra-Processed Foods pattern was observed, which is linked to an increased risk of chronic diseases and poor nutritional outcomes. Conclusions: The findings highlight the urgent need for targeted dietary interventions among university students. Strategies should emphasize increased intake of fiber-rich plant foods, moderation of protein consumption, and reduction in refined carbohydrates and added sugars to promote healthier dietary habits and prevent chronic disease development. Full article

Background: Plant-based diets are recommended in guidelines for the prevention of cancer and cardiometabolic diseases, which remain major causes of death in breast cancer survivors (BCS). Since not all plant foods are healthy, we calculated the plant-based dietary index (PDI), healthy (hPDI) and unhealthy (uPDI), and their associations with cardiometabolic targets in BCS. Methods: Baseline dietary and cardiometabolic data were derived from 492 (median age 51, IQR 46–59) female BCS participating in a multicentric lifestyle trial conducted in Italy. Dietary data were collected with 7-day food records. PDI, hPDI, and uPDI were calculated by assigning positive scores to all plant foods, healthy plant foods or less healthy plant foods, respectively, as defined by the literature (scores ranged from 18 to 90). Using logistic or multinomial regression models, we estimated the odds ratios (OR) and the corresponding 95% confidence intervals (CI) between PDIs and cardiometabolic risk factors. Results: The OR of being obese (BMI ≥ 30 Kg/m²) was 0.47 (95%CI: 0.29–0.77), 0.37 (95%CI: 0.22–0.61) and 1.38 (95%CI: 0.83–2.28) with higher PDI, hPDI and uPDI, respectively. The OR of having a large waist circumference (≥88 cm) was 0.64 (95%CI: 0.42–1.00) with higher hPDI. The OR for hypercholesterolemia (≥200 mg/dL) was 1.80 (95%CI: 1.16–2.78) with higher uPDI. The ORs of hypertriglyceridemia (≥150 mg/dL) and metabolic syndrome were 0.38 (95%CI: 0.20–0.71) and 0.59 (95%CI: 0.35–0.97), respectively, with higher PDI. No other significant association was observed. Conclusions: Maintaining cardiometabolic risk factors within normal ranges is clinically relevant in BCS, and this may be more likely when a plant-based diet is consumed, especially if low in unhealthy plant foods. Full article

Background/Objectives: The aging population is associated with an increased incidence of dementia, which deteriorates the quality of life of adults, leading to an elevated socioeconomic burden. This review aimed to extensively examine which dietary patterns favorably influence cognitive outcomes based on prospective cohort studies of adults. Methods: A literature search was performed in the PubMed^®/MEDLINE^® database up to 30 October 2024. Results: One hundred and eighteen publications were included. In a comparison of high and low categories, the Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) diet increased cognitive function and reduced the risk of cognitive impairment. The Mediterranean (MED) diet improved cognitive function but showed no beneficial effects on cognitive impairment or dementia. The Dietary Approaches to Stop Hypertension (DASH) diet lowered the risk of cognitive impairment but showed no alteration in either cognitive function or dementia. The Healthy Eating Index (HEI) did not alter cognitive function, cognitive impairment, or dementia. The healthy plant-based dietary index (hPDI) decreased the risk of cognitive impairment and dementia, whereas the unhealthy plant-based dietary index (uPDI) elevated the risk of cognitive impairment. The Western dietary pattern (WDP) decreased cognitive function. Conclusions: The MIND diet and hPDI appeared to be effective, while the WDP appeared to be detrimental for cognitive health. Further prospective cohort studies of healthy and unhealthy dietary patterns are required to confirm the association between diverse diets and cognitive health. Full article

Background: Frailty is known to elevate the risk of all-cause mortality and shorten life expectancy. Although the effects of diet on health are well documented, the specific interaction between diet quality and frailty remains unexplored. This research aims to examine the combined effects of various diet quality scores and frailty on all-cause mortality and life expectancy among middle-aged and older adults. Methods: A total of 151,628 participants were sourced from the UK Biobank for analysis. Frailty phenotype (FP) and frailty index (FI), as two different approaches, were used to assess frailty status. Diet quality was evaluated through seven diet quality scores: the Alternate Healthy Eating Index (AHEI), Dietary Approaches to Stop Hypertension (DASH) score, Mediterranean diet (MED) score, Dietary Inflammatory Index (DII), and three plant-based diet indices (overall PDI, healthful PDI, and unhealthful PDI). Cox proportional hazards models were applied to calculate adjusted hazard ratios (HRs) for overall mortality and predict life expectancy differences. Results: Over a median follow-up period of 12.2 years, 8231 deaths were identified. After accounting for potential confounding factors, frail individuals in the unhealthier tertile of diet scores exhibited markedly elevated mortality risks, ranging from 1.99 to 2.07 based on the frailty index and 2.79 to 3.06 based on the frailty phenotype, compared to their robust counterparts in the healthier tertile. Regardless of frailty categories, a healthier diet was associated with longer life expectancy and with lower mortality risk in a dose–response relationship. Conclusions: The healthier tertile of diet scores was found to mitigate the detrimental effects of frailty, emphasizing diet quality as a modifiable factor in promoting healthier aging. Evidence suggests that it is never too late to adopt healthier dietary habits for significant health benefits. Full article

Objective: The aim of this systematic review was to compare the impact of various dietary patterns on cancer mortality, recurrence, remission, quality of life, and prostate-specific antigen (PSA) in non-metastatic prostate cancer patients. Methods: Ovid Medline, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus databaseswere searched from inception to March 2024. Dietary interventions or observational studies investigating dietary patterns in men with non-metastatic prostate cancer with at least one primary outcome related to mortality, recurrence, remission, quality of life or PSA/PSA doubling time were included. Two independent reviewers conducted article selection, data extraction, and quality assessment. Results: Sixteen eligible articles were included. Adherence to a Mediterranean dietary pattern was linked to lower overall mortality and increased quality of life and adherence to a Prudent diet was associated with both lower overall and cancer-specific mortality risk. A plant-based dietary pattern is associated with increased quality of life. Contrastingly, a Western diet was associated with a higher cancer-specific mortality and overall mortality and high-inflammatory, hyperinsulinaemic, and insulin-resistant diets with increased recurrence. Conclusions: Despite the heterogeneity and inconsistencies of PCa literature, there is fair evidence that suggests unprocessed foods with healthier dietary patterns of Mediterranean and prudent diets confer a beneficial effect on overall and cancer-specific mortality, recurrence, and quality of life whereas, a more Western and unhealthier diet generates the opposite. The increased risk of bias prevents conclusive interpretation of these results and, hence, detracts from its clinical implementation. Future research should focus on increasing sample sizes and robustness and standardisation in study design. Full article

Background/Objectives: Recent research indicates a global transition from healthy and balanced diets to unhealthy Westernized dietary patterns (WDPs). This transition is linked to increased rates of non-communicable diseases (NCDs), e.g., obesity, type 2 diabetes, and cardiovascular diseases, often preceded by metabolic syndrome (MetS). Therefore, the objective of this study was to develop a diet quality index, termed Westernized Diet Index (WDI), to assess adherence to WDPs and its association with main cardiometabolic health issues, for which MetS and its components were chosen as representatives of NCDs. Methods: The development of the WDI was driven by a semi-systematic and comprehensive examination of the literature (n = 491 articles) that evaluated the influence of WDP components on health outcomes. The scoring algorithm involved multiple steps, assigning scores based on study design, sample size, and the direction of food effects on health outcomes. Results: The final developed index encompassed 30 food groups/items. It was revealed that soft drinks, processed foods, red meat, sodium, and hydrogenated fats had the most detrimental effects on health, significantly influencing the index’s coefficients. In contrast, dietary fiber, plant-based metabolites, vitamins, minerals, nuts/seeds, and fish had the most substantial beneficial impacts. Conclusions: The WDI aligns with the existing literature on the importance of specific food items and with other validated diet quality indices, e.g., the Dietary Inflammatory Index (DII) and Alternate Healthy Eating Index (AHEI). Thus, the WDI can provide evidence for clinicians and researchers in formulating evidence-based dietary guidelines as well as strategies for the prevention and treatment of diet-related health issues. However, further validation is proposed to verify the WDI’s capability across different contexts. Full article

Background/Objectives: Plant-based diets are associated with reduced chronic disease risk, though regional variations persist. In Zhejiang, China, where plant-based food intake is high, this study aimed to explore the association between plant-based diets and metabolic syndrome (MetS) in adults aged 35–75. Methods: This cross-sectional study utilized data from the 2024 Zhejiang Nutrition and Health Survey (ZJNHS). Three plant-based diet indices were calculated: the overall plant-based diet index (PDI), healthy plant-based diet index (hPDI), and unhealthy plant-based diet index (uPDI). Multivariate logistic regression models evaluated associations between diet index quintiles and MetS and its components. Results: Among the 4695 participants included in the study, 23.9% (n = 1122) had MetS. After adjusting for demographic and lifestyle factors, individuals in the highest uPDI quintile showed a significantly higher MetS risk compared to the lowest quintile (OR = 1.37, 95% CI: 1.08–1.73, p-trend = 0.013). Subgroup analyses revealed significant gender interaction (p for interaction < 0.001), with women exhibiting elevated MetS risk (OR = 1.03, 95% CI: 1.01–1.04, p < 0.001). For MetS components, the highest uPDI quintile was associated with increased risks of abdominal obesity (OR = 1.32, 95% CI: 1.05–1.66; p-trend = 0.032), elevated blood pressure (OR = 1.41, 95% CI: 1.12–1.78; p-trend = 0.003), and elevated fasting glucose (OR = 1.27, 95% CI: 1.01–1.59; p-trend = 0.037). Conclusions: Unhealthy plant-based foods are associated with increased MetS risk, particularly in women. Reducing intake of such foods, considering sex differences, and implementing precision nutrition interventions are essential. Full article

Background/Objectives: Evidence suggests that plant-based dietary patterns are beneficial for cardiometabolic health. However, it is unclear whether the quality of plant-based dietary patterns is differentially associated with cardiometabolic health. This study aimed to examine the association between three plant-based diet quality indices and cardiometabolic health among Australian adults. Methods: Data on 4877 adults (mean 45.1 years) from the cross-sectional Australian Health Survey 2011–2013 were used. Three plant-based diet quality indices (overall, healthful, and unhealthful) were derived from two 24 h dietary recalls. Anthropometric measures and blood pressure were assessed by trained interviewers. High-risk waist circumference was classified as ≥80 cm in females and ≥80 cm in males. Hypertension was defined as >140/90 mmHg. Fasting blood samples were used to estimate lipid profiles and diabetes status (based on plasma glucose or HbA1c). Multivariate logistic regression analyses were used to investigate the association between plant-based diet indices and cardiometabolic markers. Results: The healthy plant-based diet index was associated with lower odds of a high-risk waist circumference (OR 0.98; 95%CI 0.96–0.99), and the unhealthy plant-based diet index was associated with increased odds of having hypertension (OR 1.02; 95%CI 1.00–1.04). No other significant associations were identified between the plant-based diet quality indices and cardiometabolic outcomes. Conclusions: There was some evidence that the quality of plant-based dietary patterns was differentially associated with cardiometabolic health, with healthier plant-based dietary patterns associated with lower odds of a high-risk waist circumference, and less healthy plant-based dietary patterns associated with increased odds of hypertension. These findings support the consideration of the quality of plant foods consumed, and the need for targeted advice for optimising cardiometabolic health among adults. Full article

Background/Objectives: Dietary patterns rich in plant-based foods during pregnancy have been associated with neurodevelopmental outcomes in offspring. However, not all components of these diets are healthy, and the impact of their quality on behavioral outcomes remains unexplored. Therefore, this study aimed to examine the association between healthy and unhealthy plant-based diets and offspring behavioral problems at the age of four. Methods: This research involved 201 mother–child pairs from the ECLIPSES study. Maternal diet during pregnancy was assessed using a validated food frequency questionnaire, from which the healthy plant-based diet index (hPDI) was calculated, emphasizing the consumption of fruits, vegetables, legumes and nuts, along with the unhealthy plant-based diet index (uPDI), highlighting the intake of sugary drinks and refined grains. Children’s behavior was evaluated using the Child Behavior Checklist 1.5-5. Multivariable logistic regression analyses were conducted to estimated odds ratios (ORs) and their 95% confidence intervals (CIs). Results: Greater adherence to the uPDI during pregnancy was associated with higher odds for externalizing problems, including attention-deficit/hyperactivity problems (OR = 1.08; 95%CI from 1.01 to 1.16) and oppositional defiant behavior (OR = 1.09; 95%CI from 1.00 to 1.19) in offspring, particularly girls. Higher adherence to the hPDI was not associated with children’s behavior. Conclusions: The consumption of unhealthy components of a plant-based dietary pattern during gestation has been associated with adverse behavioral outcomes in children at age four. These findings underscore the importance of discerning between the healthy and unhealthy components of plant-based diets when assessing their impact on child development. Full article

Background: While unhealthy dietary trends, such as elevated confectionery consumption and decreased fruit intake, have been documented in adults, the longitudinal patterns of food consumption during childhood remain inadequately characterized. This study aimed to describe national trends in food group intakes among children and adolescents in Japan. Methods: Data on participants aged 1–19 years in the National Health and Nutrition Survey from 2001 to 2019 (n = 37,072) were used in this study. A 1-day, semi-weighed, household-based dietary record was used to assess dietary intake. Results: Decreasing trends in the intakes of animal-based foods, potatoes and starches, sugars and sweeteners, fruits (annual percentage change [APC] range: −5.04 to −0.62), algae, fish and shellfish (APC range: −3.22 to −2.02), eggs, milks, fats and oils, and confectionery were observed, while intakes of meats (APC range: 1.02 to 1.92) and beverages (APC range: 1.36 to 2.51) increased. Consumption of plant-based foods, cereals, legumes, nuts and seeds, vegetables, and mushrooms was mostly unchanged, whereas variable intakes of seasonings and spices were observed. Conclusions: This study showed that the intakes of many food groups (e.g., fruits, fish and shellfish, and milk) decreased among children and adolescents, but some increased (e.g., meats and beverages) or remained stable (e.g., cereals and vegetables). Further evidence is needed to enable policymakers to set target interventions to improve children’s diets. Full article

Background/Objectives: Plant-based diets are associated with human and planetary health. However, the overall quality of these diets may depend on the proportion of ultra-processed foods (UPFs). This study investigates the association between UPF consumption and plant-based diet quality in Australian adults. Methods: Analysis was conducted on 9111 participants (aged ≥ 19 years) from the National Nutrition and Physical Activity Survey 2011–2012. Food items reported from a 24 h recall were classified using the NOVA system, and the contribution of UPFs to total energy intake was calculated. Plant-based diet quality was examined using the overall plant-based diet index (PDI), healthy PDI (hPDI), and unhealthy PDI (uPDI). Multiple linear regression models were used to examine the association between the UPF intake and PDI, hPDI, uPDI, and their score components. Results: The proportion of energy from UPFs was positively associated with the uPDI (β = 0.80; 95% CI 0.72, 0.89) and negatively associated with the PDI (β = −0.13; 95% CI: −0.22, −0.04) and the hPDI (β = −0.65; 95% CI: −0.73, −0.57). All score components of the PDI, hPDI and uPDI, except whole grains, legumes and fruit juices, significantly contributed to these associations. The sugars and syrups group contributed most to the positive association between UPFs and the uPDI (β = 6.47; 95% CI: 6.07, 6.87) and the negative association of UPFs and the hPDI (β = −6.47; 95% CI: −6.07, −6.87). Conclusions: Higher consumption of UPFs was associated with a lower plant-based diet quality. These findings have implications for the design of dietary interventions that encourage the consumption of minimally processed plant-based foods. Full article

Background: Environmental and cardiometabolic impacts of adherence to plant-based dietary patterns with different quality are unclear. Objectives: To investigate the associations between adherence to the overall, healthy, and unhealthy plant-based dietary patterns, as assessed by the plant-based diet index (PDI), healthy PDI (hPDI), and unhealthy PDI (uPDI), respectively, and risk of myocardial infarction (MI), type 2 diabetes (T2D), stroke, and all-cause mortality and greenhouse gas (GHG) emissions. Methods: Data from adults (N = 14,652 for cardiometabolic diseases and 15,318 for all-cause mortality) in the China Health and Nutrition Survey (1997–2015 wave) were analyzed. PDI, hPDI, and uPDI scores were calculated with dietary intake data. The total GHG emissions were calculated by summing the amount of emissions from all food groups included in the index. Cox proportional hazard regression models and linear regression models were used for statistical analysis. Results: Greater adherence to an unhealthy plant-based dietary pattern, as reflected by higher uPDI scores, was positively associated with risk of MI (Q5 vs. Q1: HR = 5.90; 95% CI: 2.59–13.48), T2D (Q5 vs. Q1: HR = 2.18; 95% CI: 1.75–2.73), stroke (Q5 vs. Q1: HR = 5.96; 95% CI: 2.86–12.42) and all-cause mortality (Q5 vs. Q1: HR = 6.87; 95% CI: 4.70–10.03). PDI scores were inversely associated with the risk of MI, T2D, and all-cause mortality, and hPDI scores were inversely and positively associated with the risk of T2D and stroke, respectively. All scores were inversely associated with GHG emissions (all p-trends < 0.001). Conclusions: Long-term adherence to unhealthy plant-based dietary patterns guided by higher uPDI scores may be a risk factor for new-onset cardiometabolic diseases and all-cause death in Chinese adults. Food-based dietary guidelines, clinicians, and dietitians should consider the quality of plant-based dietary patterns prior to making recommendations for both healthy individuals and those with elevated cardiometabolic disease risk. Full article

Objectives: The potential of a plant-based diet (PD) to mitigate the adverse effects of long-term air pollution exposure on chronic obstructive pulmonary disease (COPD) remains uncertain. This study aims to explore both the independent and synergistic impacts of air pollution components and PD on COPD risk. Methods: Annual concentrations of air pollutants, including particulate matter (PM_2.5, PM_2.5–10, and PM₁₀), as well as nitrogen oxides (NO_X) and nitrogen dioxide (NO₂), were estimated using a land-use regression model. We calculated the plant-based diet index (PDI), healthy plant-based diet index (hPDI), and unhealthy plant-based diet index (uPDI) by evaluating scores of 17 food categories. Cox regression was performed to evaluate their individual and combined effects on COPD risk. Results: This prospective cohort study included 162,741 participants. Every standard deviation increase in PM_2.5, NO₂, and NO_X exposure was associated with an increased risk of COPD, with an adjusted HR (95% CI) of 1.049 (1.019, 1.079), 1.065 (1.034, 1.096), and 1.063 (1.035, 1.092), respectively. Compared with low-quality hPDI, moderate- and high-quality hPDI were associated with a lower risk of COPD with an adjusted HR (95% CI) of 0.884 (0.827, 0.946) and 0.758 (0.697, 0.825), respectively. For the combined effects, with the level of hPDI increasing, the joint effects of hPDI with PM_2.5, NO₂, and NO_X showed a gradually increasing negative impact on COPD risk (p-interaction = 0.001, 0.005, and 0.005, respectively). Conclusions: Exposure to PM_2.5, NO₂, and NO_x may elevate the risk of chronic obstructive pulmonary disease (COPD), whereas adherence to a high-quality hPDI could potentially counteract this association. Future research should explore the underlying biological mechanisms, assess the long-term effects of diet, and evaluate the effectiveness of dietary modifications in diverse populations to inform targeted prevention policies. Full article