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  Subjects -> NUTRITION AND DIETETICS (Total: 201 journals)
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American Journal of Clinical Nutrition
Journal Prestige (SJR): 3.438
Citation Impact (citeScore): 6
Number of Followers: 178  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-9165 - ISSN (Online) 1938-3207
Published by Oxford University Press Homepage  [424 journals]
  • COP27 Climate Change Conference: urgent action needed for Africa and the
           worldWealthy nations must step up support for Africa and vulnerable
           countries in addressing past, present and future impacts of climate change
           

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      Pages: 1457 - 1459
      Abstract: The 2022 report of the Intergovernmental Panel on Climate Change (IPCC) paints a dark picture of the future of life on earth, characterised by ecosystem collapse, species extinction, and climate hazards such as heatwaves and floods (1). These are all linked to physical and mental health problems, with direct and indirect consequences of increased morbidity and mortality. To avoid these catastrophic health effects across all regions of the globe, there is broad agreement—as 231 health journals argued together in 2021—that the rise in global temperature must be limited to less than 1.5°C compared with pre-industrial levels.
      PubDate: Wed, 19 Oct 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac287
      Issue No: Vol. 116, No. 6 (2022)
       
  • Limited alcohol consumption and lower risk of diabetes: can we believe our
           own eyes'

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      Pages: 1460 - 1461
      Abstract: See corresponding article on page 1507.
      PubDate: Mon, 17 Oct 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac258
      Issue No: Vol. 116, No. 6 (2022)
       
  • Can nonfoodreinforcers sustainably compete with food'

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      Pages: 1462 - 1463
      Abstract: See corresponding article on page 1642.
      PubDate: Mon, 17 Oct 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac242
      Issue No: Vol. 116, No. 6 (2022)
       
  • COVID Conversations

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      Pages: 1464 - 1465
      Abstract: See corresponding article on page 1672.
      PubDate: Mon, 17 Oct 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac268
      Issue No: Vol. 116, No. 6 (2022)
       
  • Yet another study stirring the debate on saturated fat

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      Pages: 1466 - 1467
      Abstract: See corresponding article on page 1682.
      PubDate: Fri, 28 Oct 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac270
      Issue No: Vol. 116, No. 6 (2022)
       
  • Is it caffeine' Coffee consumption and future risk of type 2 diabetes
           among women with a history of gestational diabetes

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      Pages: 1468 - 1469
      Abstract: Ministry of Science and Technology10.13039/501100003711National Science and Technology Council10.13039/501100020950National Taiwan University Higher Education Sprout111L7304111L7306110L7418110L881002
      PubDate: Tue, 15 Nov 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac275
      Issue No: Vol. 116, No. 6 (2022)
       
  • A unified definition of whole-grain foods is needed

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      Pages: 1470 - 1471
      Abstract: Whole Grain Council
      PubDate: Wed, 30 Nov 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac271
      Issue No: Vol. 116, No. 6 (2022)
       
  • Unrecognized riboflavin deficiency and evidence for cascading effects on
           vitamin B-6 status

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      Pages: 1472 - 1473
      Abstract: See corresponding article on page 1767.
      PubDate: Thu, 20 Oct 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac269
      Issue No: Vol. 116, No. 6 (2022)
       
  • The omega-3 index in Alzheimer's disease: Ready for prime time'

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      Pages: 1474 - 1475
      Abstract: University of Southern California10.13039/100006034National Institute on Aging10.13039/100000049RF1AG076124R01AG055770R01AG067063R01AG054434R21AG056518P30AG066530Alzheimer's Drug Discovery Foundation10.13039/100002565GC-201711-2014197
      PubDate: Mon, 17 Oct 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac248
      Issue No: Vol. 116, No. 6 (2022)
       
  • Does the concept of “ultra-processed foods” help inform dietary
           guidelines, beyond conventional classification systems' YES

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      Pages: 1476 - 1481
      Abstract: ABSTRACTThe recommendation to prefer unprocessed/minimally processed foods and freshly made meals instead of ultra-processed foods (following the Nova food classification system) is being increasingly adopted in new official dietary guidelines issued by national governments and international health associations. This recommendation is supported by systematic reviews and meta-analyses of nationally representative dietary surveys and long-term cohort studies. These data show that increased intake of ultra-processed foods is associated with poor-quality diets and with increased morbidity and mortality from several chronic diseases. Various attributes of ultra-processed foods acting through known, plausible, or suggested physiologic and behavioral mechanisms relate them to ill health, and it is likely that different combinations of attributes and mechanisms affect different health outcomes. Although more research should be done to identify these mechanisms, existing evidence is sufficient to recommend the avoidance of ultra-processed foods to optimize health and policies to support and make feasible this recommendation.
      PubDate: Tue, 07 Jun 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac122
      Issue No: Vol. 116, No. 6 (2022)
       
  • Does the concept of “ultra-processed foods” help inform dietary
           guidelines, beyond conventional classification systems' NO

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      Pages: 1482 - 1488
      Abstract: ABSTRACTThe Nova classification of ultra-processed foods (UPFs) rests on poorly defined food processes and the presence of food additives from a chemically heterogeneous group, easily leading to misclassification. UPFs are claimed to promote overconsumption of energy and obesity due to high palatability, but little evidence supports effects beyond those that can be accounted for by nutrient composition, energy density, and food matrices. Observational studies link dietary intake of UPFs with obesity, but none have demonstrated independent associations after controlling for likely confounders. A highly cited randomized controlled feeding study that compared a UPF diet with an unprocessed diet showed a rapidly weaning effect on energy intake that can be entirely explained by more conventional and quantifiable dietary factors, including energy density, intrinsic fiber, glycemic load, and added sugar. Clearly, many aspects of food processing can affect health outcomes, but conflating them into the notion of ultra-processing is unnecessary, because the main determinants of chronic disease risk are already captured by existing nutrient profiling systems. In conclusion, the Nova classification adds little to existing nutrient profiling systems; characterizes several healthy, nutrient-dense foods as unhealthy; and is counterproductive to solve the major global food production challenges.
      PubDate: Tue, 07 Jun 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac123
      Issue No: Vol. 116, No. 6 (2022)
       
  • Does the concept of “ultra-processed foods” help inform dietary
           guidelines, beyond conventional classification systems' Debate
           consensus

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      Pages: 1489 - 1491
      Abstract: ABSTRACTThe participants in this debate agree that food processing vitally affects human health, and that the extent of food processing significantly affects diet quality and health outcomes. They disagree on the significance of ultra-processing, as defined within the Nova food classification system. The YES position holds that the concept is well-founded, clear, and supported by a wealth of investigations, as demonstrated by systematic association between ultra-processed food (UPF) intake and various diseases and disorders, and the persistence of these associations with control for critical nutrients. The NO position argues that the concept of UPF is poorly defined; gives rise to misclassification of foods; is without clear mechanisms of action; and that the observed associations with obesity are likely confounded. The YES position argues that the Nova system is therefore crucial to inform dietary guidelines and also public policies designed to reduce production and consumption of UPFs, whereas the NO position argues that the system adds no value to conventional nutrient metrics and existing nutrient profiling systems, pointing instead to the need to develop an evidence-based system to characterize obesogenic foods.
      PubDate: Mon, 17 Oct 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac230
      Issue No: Vol. 116, No. 6 (2022)
       
  • Associations of erythrocyte omega-3 fatty acids with cognition, brain
           imaging and biomarkers in the Alzheimer's disease neuroimaging initiative:
           cross-sectional and longitudinal retrospective analyses

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      Pages: 1492 - 1506
      Abstract: ABSTRACTBackgroundThe association between omega-3 (ω-3) PUFAs and cognition, brain imaging and biomarkers is still not fully established.ObjectivesThe aim was to analyze the cross-sectional and retrospective longitudinal associations between erythrocyte ω-3 index and cognition, brain imaging, and biomarkers among older adults.MethodsA total of 832 Alzheimer's Disease Neuroimaging Initiative 3 (ADNI-3) participants, with a mean (SD) age of 74.0 (7.9) y, 50.8% female, 55.9% cognitively normal, 32.7% with mild cognitive impairment, and 11.4% with Alzheimer disease (AD) were included. A low ω-3 index (%EPA + %DHA) was defined as the lowest quartile (≤3.70%). Cognitive tests [composite score, AD Assessment Scale Cognitive (ADAS-Cog), Wechsler Memory Scale (WMS), Trail Making Test, Category Fluency, Mini-Mental State Examination, Montreal Cognitive Assessment] and brain variables [hippocampal volume, white matter hyperintensities (WMHs), positron emission tomography (PET) amyloid-β (Aβ) and tau] were considered as outcomes in regression models.ResultsLow ω-3 index was not associated with cognition, hippocampal, and WMH volume or brain Aβ and tau after adjustment for demographics, ApoEε4, cardiovascular disease, BMI, and total intracranial volume in the cross-sectional analysis. In the retrospective analysis, low ω-3 index was associated with greater Aβ accumulation (adjusted β = 0.02; 95% CI: 0.01, 0.03; P = 0.003). The composite cognitive score did not differ between groups; however, low ω-3 index was significantly associated with greater WMS-delayed recall cognitive decline (adjusted β = –1.18; 95% CI: –2.16, –0.19; P = 0.019), but unexpectedly lower total ADAS-Cog cognitive decline. Low ω-3 index was cross-sectionally associated with lower WMS performance (adjusted β = –1.81, SE = 0.73, P = 0.014) and higher tau accumulation among ApoE ε4 carriers.ConclusionsLongitudinally, low ω-3 index was associated with greater Aβ accumulation and WMS cognitive decline but unexpectedly with lower total ADAS-Cog cognitive decline. Although no associations were cross-sectionally found in the whole population, low ω-3 index was associated with lower WMS cognition and higher tau accumulation among ApoE ε4 carriers. The Alzheimer's Disease Neuroimaging Initiative (ADNI) is registered at clinicaltrials.gov as NCT00106899.
      PubDate: Mon, 17 Oct 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac236
      Issue No: Vol. 116, No. 6 (2022)
       
  • Moderate alcohol drinking with meals is related to lower incidence of type
           2 diabetes

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      Pages: 1507 - 1514
      Abstract: ABSTRACTBackgroundPrevious studies on alcohol drinking and health largely have ignored the potential impact of the timing of drinking.ObjectivesWe aimed to investigate the joint associations of the timing of alcohol intake with respect to meals (i.e., with meals or outside of meals) and the amount of alcohol consumed with the risk of type 2 diabetes (T2D).MethodsA total of 312,388 current drinkers from the UK Biobank without T2D at baseline were included. Cox proportional hazards models were used to examine the association between the timing of alcohol intake with respect to meals and the risk of T2D.ResultsDuring a median of 10.9 y of follow-up, 8598 incident cases of T2D were documented. After adjustment for covariates and the amount of alcohol consumed, consuming alcohol with meals was significantly associated with a 12% lower risk of T2D (HR: 0.88; 95% CI: 0.83, 0.93) than was consuming alcohol outside of meals. In addition, we found that the timing of alcohol intake with respect to meals significantly modified the relations between the amount of alcohol consumed and risk of T2D (P-interaction = 0.017); the beneficial association of moderate drinking with T2D risk was only observed in participants who consumed alcohol with meals, but not in others. Further analyses on various types of alcoholic beverages indicated that the beneficial associations between alcohol drinking with meals and T2D were mainly driven by wine consumption. Moreover, we found that when consumed together with meals, drinking more wine, rather than other alcoholic beverages, was related to lower concentrations of C-reactive protein.ConclusionsIn current drinkers, moderate drinking of alcohol, especially wine, with meals is associated with a lower risk of T2D.
      PubDate: Mon, 17 Oct 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac207
      Issue No: Vol. 116, No. 6 (2022)
       
  • A red wine intervention does not modify plasma trimethylamine N-oxide but
           is associated with broad shifts in the plasma metabolome and gut
           microbiota composition

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      Pages: 1515 - 1529
      Abstract: ABSTRACTBackgroundGut microbiota profiles are closely related to cardiovascular diseases through mechanisms that include the reported deleterious effects of metabolites, such as trimethylamine N-oxide (TMAO), which have been studied as diagnostic and therapeutic targets. Moderate red wine (RW) consumption is reportedly cardioprotective, possibly by affecting the gut microbiota.ObjectivesTo investigate the effects of RW consumption on the gut microbiota, plasma TMAO, and the plasma metabolome in men with documented coronary artery disease (CAD) using a multiomics assessment in a crossover trial.MethodsWe conducted a randomized, crossover, controlled trial involving 42 men (average age, 60 y) with documented CAD comparing 3-wk RW consumption (250 mL/d, 5 d/wk) with an equal period of alcohol abstention, both preceded by a 2-wk washout period. The gut microbiota was analyzed via 16S rRNA high-throughput sequencing. Plasma TMAO was evaluated by LC-MS/MS. The plasma metabolome of 20 randomly selected participants was evaluated by ultra-high-performance LC-MS/MS. The effect of RW consumption was assessed by individual comparisons using paired tests during the abstention and RW periods.ResultsPlasma TMAO did not differ between RW intervention and alcohol abstention, and TMAO concentrations showed low intraindividual concordance over time, with an intraclass correlation coefficient of 0.049 during the control period. After RW consumption, there was significant remodeling of the gut microbiota, with a difference in β diversity and predominance of Parasutterella, Ruminococcaceae, several Bacteroides species, and Prevotella. Plasma metabolomic analysis revealed significant changes in metabolites after RW consumption, consistent with improved redox homeostasis.ConclusionsModulation of the gut microbiota may contribute to the putative cardiovascular benefits of moderate RW consumption. The low intraindividual concordance of TMAO presents challenges regarding its role as a cardiovascular risk biomarker at the individual level. This study was registered at clinical trials.gov as NCT03232099.
      PubDate: Fri, 07 Oct 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac286
      Issue No: Vol. 116, No. 6 (2022)
       
  • Insulinemic potential of diet and risk of total and subtypes of breast
           cancer among US females

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      Pages: 1530 - 1539
      Abstract: AbstractBackgroundInsulin resistance and hyperinsulinemia play important roles in the progression of multiple chronic disease and conditions. Diet modulates insulin response; however, evidence is limited regarding whether diets with higher insulinemic potential increase the risk of invasive breast cancer.ObjectivesWe aimed to prospectively evaluate the association between a food-based empirical dietary index for hyperinsulinemia (EDIH) and the incidence of invasive breast cancer.MethodsWe prospectively followed 76,686 women from the Nurses’ Health Study (NHS; 1984–2016) and 93,287 women from the Nurses’ Health Study II (NHSII; 1991–2017). Diet was assessed by food-frequency questionnaires every 4 y. The insulinemic potential of diet was evaluated using the previously established EDIH based on circulating C-peptide concentrations. Higher scores indicate higher insulinemic potential of the diet. Covariates included reproductive, hormonal, and anthropometric factors (height and BMI at age 18 y); race; socioeconomic status; total alcohol intake; total caloric intake; and physical activity.ResultsDuring 4,216,106 person-years of follow-up, we documented 10,602 breast cancer cases (6689 NHS, 3913 NHSII). In the pooled multivariable-adjusted analyses, women in the highest, compared with the lowest, EDIH quintile (Q) were at higher breast cancer risk (HRQ5 vs. Q1 = 1.15; 95% CI: 1.07, 1.24; P-trend < 0.01). Although heterogeneity by estrogen receptor (ER) status was nonsignificant, the strongest association between EDIH and breast cancer was observed for ER-negative tumors (HRQ5 vs. Q1 = 1.21; 95% CI: 1.00, 1.46; P-trend = 0.02). Among tumor molecular subtypes, the strongest associations were observed for human epidermal growth factor receptor 2 (HER2)–enriched tumors (HRQ5 vs. Q1 = 1.62; 95% CI: 1.01, 2.61; P-trend = 0.02).ConclusionsA dietary pattern contributing to hyperinsulinemia and insulin resistance was associated with greater breast cancer risk, especially ER-negative and HER2-enriched tumors. Our findings suggest that dietary modifications to reduce insulinemic potential may reduce the risk of breast cancer.
      PubDate: Fri, 30 Sep 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac284
      Issue No: Vol. 116, No. 6 (2022)
       
  • Association of visceral adipose tissue with postoperative outcome in upper
           gastrointestinal cancer: a systematic review and meta-analysis

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      Pages: 1540 - 1552
      Abstract: ABSTRACTBackgroundThere is no consensus on the relation between visceral fat mass and long-term postoperative prognosis in patients with upper gastrointestinal (GI) cancer.ObjectivesThe purpose of this study was to investigate the association of preoperative visceral fat mass with postoperative complications and overall survival (OS) in patients with upper GI cancer.MethodsWe searched MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE (Dialog), the WHO International Clinical Trials Platform Search Portal, and ClinicalTrials.gov and identified observational studies published from inception through 20 July 2022. We conducted a systematic review and random-effects meta-analysis of studies including patients who were surgically treated for upper GI cancer and whose visceral fat mass was assessed on the basis of body composition. We independently assessed the risk of bias and quality of evidence using the Quality In Prognosis Studies and the Grading of Recommendations, Assessment, Development, and Evaluation approach, respectively. The primary outcome was OS. HRs and 95% CIs for OS were pooled.ResultsNinety-one studies (n = 20,583) were included. All studies used computed tomography (CT) to assess the body composition of patients. Twenty-four studies reported the relation between high visceral fat and postoperative outcomes, and their results were synthesized. Compared with low visceral adipose tissue, high visceral adipose tissue assessed by CT may improve OS (HR: 0.69; 95% CI: 0.55, 0.87; I2 = 65%; n = 3407). The risk of bias for OS in each study was moderate or high. The certainty of evidence for OS was very low because of inconsistency in the forest plot, the moderate or high risk of bias, and publication bias.ConclusionsHigh visceral fat may be associated with improved OS after radical resection in patients with upper GI cancer. Further studies are needed to confirm these findings and mitigate the risk.
      PubDate: Tue, 27 Sep 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac273
      Issue No: Vol. 116, No. 6 (2022)
       
  • Periconceptional folate intake influences DNA methylation at birth based
           on dietary source in an analysis of pediatric acute lymphoblastic leukemia
           cases and controls

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      Pages: 1553 - 1564
      Abstract: ABSTRACTBackgroundPericonceptional folate intake is associated with the establishment of DNA methylation in offspring; however, variations in this relation by food sources compared with folic acid supplements are not described. Also, maternal folate intake is associated with decreased risk of pediatric acute lymphoblastic leukemia (ALL), but the mechanism is not known.ObjectivesWe evaluated the relation between periconceptional folate intake by source and DNA methylation at birth in a cohort of pediatric ALL cases and controls in an epigenome-wide association study.MethodsGenome-wide DNA methylation status obtained from archived neonatal blood spots from pediatric ALL cases (n = 189) and controls (n = 205) in the California Childhood Leukemia Study (CCLS) from 1995–2008 was compared with periconceptional folate from total, food, and supplemental sources using multivariable linear regression. Further stratification was performed by income, education, ethnicity, and total folate intake. We evaluated variable DNA methylation response to periconceptional folate by ALL case status through an interaction term.ResultsTwo significant differentially methylated probes (DMPs) were associated with food and supplemental periconceptional folate intake in all subjects (n = 394). The top differentially methylated region at the promoter region of DUSP22(dual specificity phosphatase 22) demonstrated DNA hypermethylation in ALL cases but not in controls in response to total and food folate intake. We further identified 8 interaction term DMPs with variable DNA methylation response to folate intake by ALL case status. Further stratification of the cohort by education and ethnicity revealed a substantially higher number of DMPs associated with supplemental folic acid intake in Hispanic subjects with lower income and educational level.ConclusionsWe identified modest associations between periconceptional folate intake and DNA methylation differing by source, including variation by ALL case status. Hispanic subjects of lower income and education appear uniquely responsive to periconceptional folate supplementation.
      PubDate: Fri, 30 Sep 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac283
      Issue No: Vol. 116, No. 6 (2022)
       
  • One-year longitudinal association between changes in dietary choline or
           betaine intake and cardiometabolic variables in the PREvención con DIeta
           MEDiterránea-Plus (PREDIMED-Plus) trial

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      Pages: 1565 - 1579
      Abstract: ABSTRACTBackgroundCholine and betaine intakes have been related to cardiovascular health.ObjectivesWe aimed to explore the relation between 1-y changes in dietary intake of choline or betaine and 1-y changes in cardiometabolic and renal function traits within the frame of the PREDIMED (PREvención con DIeta MEDiterránea)-Plus trial.MethodsWe used baseline and 1-y follow-up data from 5613 participants (48.2% female and 51.8% male; mean ± SD age: 65.01 ± 4.91 y) to assess cardiometabolic traits, and 3367 participants to assess renal function, of the Spanish PREDIMED-Plus trial. Participants met ≥3 criteria of metabolic syndrome and had overweight or obesity [BMI (in kg/m2) ≥27 and ≤40]. These criteria were similar to those of the PREDIMED parent study. Dietary intakes of choline and betaine were estimated from the FFQ.ResultsThe greatest 1-y increase in dietary choline or betaine intake (quartile 4) was associated with improved serum glucose concentrations (−3.39 and −2.72 mg/dL for choline and betaine, respectively) and HbA1c levels (−0.10% for quartile 4 of either choline or betaine intake increase). Other significant changes associated with the greatest increase in choline or betaine intake were reduced body weight (−2.93 and −2.78 kg, respectively), BMI (−1.05 and −0.99, respectively), waist circumference (−3.37 and −3.26 cm, respectively), total cholesterol (−4.74 and −4.52 mg/dL, respectively), and LDL cholesterol (−4.30 and −4.16 mg/dL, respectively). Urine creatinine was reduced in quartile 4 of 1-y increase in choline or betaine intake (−5.42 and −5.74 mg/dL, respectively).ConclusionsIncreases in dietary choline or betaine intakes were longitudinally related to improvements in cardiometabolic parameters. Markers of renal function were also slightly improved, and they require further investigation.This trial was registered at https://www.isrctn.com/ as ISRCTN89898870.
      PubDate: Fri, 16 Sep 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac255
      Issue No: Vol. 116, No. 6 (2022)
       
  • Bifidobacterium animalis subsp. lactis Bi-07 supports lactose digestion in
           vitro and in randomized, placebo- and lactase-controlled clinical trials

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      Pages: 1580 - 1594
      Abstract: ABSTRACTBackgroundProbiotics may alleviate lactose maldigestion.ObjectivesThe objective was to select a probiotic with high lactase activity and compare it with lactase and placebo in clinical trials.MethodsBacterial cultures were screened for lactase activity in a model of the upper gastrointestinal (GI) tract. Bifidobacterium animalis subsp. lactis Bi-07 (Bi-07) counts were adjusted in subsequent experiments to correspond to 4500 Food Chemicals Codex (FCC) units of lactase, the amount in the European Food Safety Authority (EFSA)-approved health claim. Two crossover clinical trials, Booster Alpha and Booster Omega, were performed in participants with lactose intolerance, where 2 × 1012 CFUs Bi-07, 4662 FCC lactase, or placebo was consumed simultaneously with a lactose challenge, with 1-wk washouts between challenges. The trial designs were identical except for the source of lactose. Breath hydrogen concentration (BHC) was measured to assess the effect of the investigational products on lactose digestion, for which incremental area under the curve (iAUC) was the primary outcome. Peak BHC, cumulative BHC, and GI symptoms were secondary outcomes.ResultsBi-07 was superior to placebo in reducing BHC [iAUC, parts per million (ppm) ∙ h] in both trials (Booster Alpha: geometric least square mean ratio: 0.462; 95% CI: 0.249, 0.859; P = 0.016; Booster Omega: 0.227; 95% CI: 0.095, 0.543; P = 0.001). Lactase was superior to placebo in Booster Alpha (0.190; 95% CI: 0.102, 0.365; P < 0.001) but not Booster Omega (0.493; 95% CI: 0.210, 1.156; P = 0.102). Noninferiority of Bi-07 compared with lactase was observed in Booster Omega (0.460; 95% CI: 0.193, 1.096; P = 0.079; CI upper limit < 1.25 noninferiority margin). Odds of abdominal pain (compared with placebo: 0.32, P = 0.036) and flatulence (compared with placebo: 0.25, P = 0.007) were lower with lactase in Booster Alpha. Increased odds of nausea were seen with Bi-07 (compared with placebo: 4.0, P = 0.005) in Booster Omega.ConclusionsBi-07 has high lactase activity, and in 2 clinical trials, it supported lactose digestion in individuals with lactose intolerance.These trials were registered at clinicaltrials.gov as NCT03659747 (Booster Alpha) and NCT03814668 (Booster Omega).
      PubDate: Fri, 23 Sep 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac264
      Issue No: Vol. 116, No. 6 (2022)
       
  • Homocysteine, folate, and nonalcoholic fatty liver disease: a systematic
           review with meta-analysis and Mendelian randomization investigation

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      Pages: 1595 - 1609
      Abstract: ABSTRACTBackgroundCirculating concentrations of homocysteine and folate are inconsistently associated with the risk of nonalcoholic fatty liver disease (NAFLD) in observational studies.ObjectivesWe conducted a meta-analysis and Mendelian randomization (MR) analyses to examine these associations.MethodsWe performed a meta-analysis of observational studies identified from 3 databases to evaluate the associations of serum homocysteine and folate concentrations with NAFLD from inception to 7 April 2022. We conducted MR analyses to strengthen the causal inference in these associations. Independent single-nucleotide polymorphisms without linkage disequilibrium (r2 < 0.01) that were strongly associated (P < 5 × 10−8) with serum homocysteine (n = 13) and folate (n = 2) concentrations were selected as instrumental variables from 2 meta-analyses of genome-wide association studies (GWASs) of 44,147 and 37,645 individuals of European ancestry, respectively. Data on NAFLD were obtained from a GWAS of 8434 NAFLD cases and 770,180 controls of European ancestry. We further included 4 liver enzymes as secondary outcomes from a GWAS of 361,194 individuals with European descent.ResultsTwenty-two observational studies comprising 30,368 participants were included in the meta-analysis. There was a positive association between serum homocysteine and NAFLD risk (n = 20; OR: 1.96; 95% CI: 1.57, 2.45) and an inverse association between serum folate and NAFLD risk (n = 12; OR: 0.75; 95% CI: 0.58, 0.99). In MR analysis, the ORs of NAFLD were 1.17 (95% CI: 1.01, 1.36) and 0.75 (95% CI: 0.55, 1.02) per 1-SD increment of genetically predicted circulating concentrations of homocysteine and folate, respectively. Each 1-SD increase of genetically predicted circulating homocysteine and folate conferred a change in ALT concentrations of 0.62 U/L (95% CI: 0.20, 1.04) and –0.84 U/L (95% CI: –0.14, –1.54).ConclusionsThis study suggests a potential role of circulating homocysteine and possibly folate in NAFLD, which calls for future clinical exploration of the possibility of lowering homocysteine concentrations to prevent NAFLD. This systematic review was registered at PROSPERO as CRD42021296434.
      PubDate: Fri, 07 Oct 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac285
      Issue No: Vol. 116, No. 6 (2022)
       
  • Obesity- and sex-related metabolism of arginine and nitric oxide in adults

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      Pages: 1610 - 1620
      Abstract: ABSTRACTBackgroundThere is growing interest in the supplementation of arginine (Arg) and citrulline (Cit) in obesity due to their potential anti-obesogenic and anti-inflammatory properties. However, there is no consensus on the metabolic changes in Arg kinetics in obesity.ObjectivesThis exploratory cross-sectional study aimed to investigate the association between obesity, sex, and sex-by-obesity interaction on whole-body Arg kinetics in a large group of human subjects.MethodsWe studied 83 nonobese [BMI (kg/m2) <30] and 80 morbidly obese (BMI >30) middle-aged individuals (40% males) enrolled in the MEDIT (Metabolism of Disease with Isotope Tracers) trial. After body-composition measurement by DXA, we collected arterial(ized) blood samples for amino acid (AA) concentrations, markers of inflammation [high-sensitivity C-reactive protein (hs-CRP)], liver function, and glucose in a postabsorptive state. We administered a pulse of AA stable tracers and measured whole-body production (WBP) of Arg, Cit, ornithine (Orn), phenylalanine, and tyrosine, and calculated their clearance (disposal capacity) and metabolite interconversions [markers for NO and de novo Arg production, systemic Arg hydrolysis, and whole-body protein breakdown (wbPB)]. We measured plasma enrichments by LC-MS/MS and statistics by Fisher's exact test or analysis of (co)variance. Significance was set at P < 0.05.ResultsObese individuals were normoglycemic and characterized by low-grade inflammation (P < 0.0001) and greater wbPB (P = 0.0298). We found lower plasma Cit concentration (P < 0.0001) in the obese group but no differences in the WBP of Arg, Cit, and Orn. Furthermore, we observed overproduction of NO (P < 0.0001) in obesity but lower de novo Arg production (P = 0.0007). The WBP of Arg was lower in females for almost all Arg-related AAs, except for plasma Cit and NO production.ConclusionsAlterations in Arg metabolism are present in morbid obesity. Further studies are needed to investigate if these changes could be related to factors such as increased Arg requirement in obesity or metabolic adaptation.
      PubDate: Tue, 27 Sep 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac277
      Issue No: Vol. 116, No. 6 (2022)
       
  • Nutritionally adequate and environmentally respectful diets are possible
           for different diet groups: an optimized study from the NutriNet-Santé
           cohort

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      Pages: 1621 - 1633
      Abstract: ABSTRACTBackgroundResearch has shown that vegetarian diets have a low environmental impact, but few studies have examined the environmental impacts and nutritional adequacy of these diets together, even though vegetarian diets can lead to nutritional issues.ObjectivesOur objective was to optimize and compare 6 types of diets with varying degrees of plant foods (lacto-, ovolacto-, and pescovegetarian diets and diets with low, medium, and high meat content) under nutritional constraints.MethodsConsumption data in 30,000 participants were derived from the French NutriNet-Santé cohort using an FFQ. Diets were optimized by a nonlinear algorithm minimizing the diet deviation while meeting multiple constraints at both the individual and population levels: nonincrease of the cost and environmental impacts (as partial ReCiPe accounting for greenhouse gas emissions, cumulative energy demand, and land occupation, distinguishing production methods: organic and conventional), under epidemiologic, nutritional (based on nutrient reference values), and acceptability (according to the diet type) constraints.ResultsOptimized diets were successfully identified for each diet type, except that it was impossible to meet the EPA (20:5n–3) + DHA (22:6n–3) requirements in lacto- and ovolactovegetarians. In all cases, meat consumption was redistributed or reduced and the consumption of legumes (including soy-based products), whole grains, and vegetables were increased, whereas some food groups, such as potatoes, fruit juices, and alcoholic beverages, were entirely removed from the diets. The lower environmental impacts (as well as individual indicators) observed for vegetarians could be attained even when nutritional references were reached except for long-chain n–3 (omega-3) fatty acids.ConclusionsA low-meat diet could be considered as a target for the general population in the context of sustainable transitions, although all diets tested can be overall nutritionally adequate (except for n–3 fatty acids) when planned appropriately.This trial was registered at clinicaltrials.gov as NCT03335644.
      PubDate: Fri, 16 Sep 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac253
      Issue No: Vol. 116, No. 6 (2022)
       
  • Chronic aflatoxin exposure during pregnancy is associated with lower fetal
           growth trajectories: a prospective cohort from the Butajira Nutrition,
           Mental Health, and Pregnancy (BUNMAP) Study in rural Ethiopia

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      Pages: 1634 - 1641
      Abstract: AbstractBackgroundAflatoxins are toxic secondary metabolites produced by Aspergillus fungi, which are ubiquitously present in the food supplies of low- and middle-income countries. Studies of maternal aflatoxin exposure and fetal outcomes are mainly focused on size at birth and the effect on intrauterine fetal growth has not been assessed.ObjectivesIn the present study, we examined the association between chronic aflatoxin exposure during pregnancy and fetal growth trajectories in a rural setting in Ethiopia.MethodsIn a prospective cohort study, we enrolled 492 pregnant females, with a singleton pregnancy and before 28 wk of gestation. Serum aflatoxin B1–lysine concentration was measured using LC–tandem MS. Three rounds of ultrasound measurements were conducted to estimate fetal weight at mean ± SD gestational age weeks of 19.1 ± 3.71, 28.5 ± 3.51, and 34.5 ± 2.44. Estimated fetal weight was expressed in centiles using the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) reference. We fitted a multivariable linear mixed-effects model to estimate the rate of fetal growth between aflatoxin-exposed (i.e., aflatoxin B1–lysine concentration above or equal to the limit of detection) and unexposed mothers in the study.ResultsMothers had a mean ± SD age of 26.0 ± 4.58 y. The median (25th, 75th percentile) serum aflatoxin B1–lysine concentration was 12.6 (0.93, 96.9) pg/mg albumin, and aflatoxin exposure was observed in 86.6% of maternal blood samples. Eighty-five percent of the females enrolled provided at least 2 ultrasound measurements for analysis. On average, the aflatoxin-exposed group had a significantly lower change over time in fetal weight-for-gestational-age centile than the unexposed group (ß = –0.92; 95% CI: –1.77, –0.06 centiles/week; P = 0.037).ConclusionsChronic maternal aflatoxin exposure is associated with lower fetal growth over time. Our findings emphasize the importance of nutrition-sensitive strategies to mitigate dietary aflatoxin exposure and adopting food safety measures in low-income settings, in particular during the fetal period of development.
      PubDate: Fri, 30 Sep 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac280
      Issue No: Vol. 116, No. 6 (2022)
       
  • Reducing relative food reinforcement of infants using a music enrichment
           program: a randomized, controlled trial

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      Pages: 1642 - 1653
      Abstract: ABSTRACTBackgroundFood reinforcement or one's motivation to eat may be established early in life; it might not be the food reinforcement per se that drives weight gain, but rather the imbalance between food and nonfood reinforcement.ObjectivesWe implemented a 2-y randomized, controlled trial to assess the effects of a music enrichment program (music, n = 45) compared with an active play date control (control, n = 45) in 9- to 15-mo-old healthy infants who were strongly motivated to eat.MethodsThe 12-mo intensive intervention phase included 4 semesters of Music Together® or a play date program (Winter, Spring, Summer, and Fall), comprised of once per week group meetings, followed by a 12-mo maintenance phase with monthly meetings. Parents were encouraged to listen to the Music Together® program CD or play with the play date group's toy with their infants at home, respectively. We performed a modified intention-to-treat analysis using all randomly assigned, non-excluded subjects for the outcome measures [relative reinforcing value of food (RRVfood), food reinforcement, music reinforcement, and weight-for-length z-score (WLZ)].ResultsThere were significant differential group changes across time for RRVfood (group × month; P = 0.016; Cohen's f2 = 0.034). The music group had significantly greater RRVfood decreases than the control group from baseline to the end of the intensive intervention phase (music change = −0.211; control change = −0.015; P = 0.002; Cohen's D = 0.379). However, these differences were not maintained during months 12–24 (music change = −0.187; control change = −0.143; P = 0.448; D = 0.087). We observed an overall moderation effect by sex for food reinforcement and WLZ. Boys in the music group had a significant attenuation in food reinforcement and WLZ compared with boys in the control group.ConclusionsThis study extends our knowledge in infant eating behavior by providing insight into the role of nonfood alternatives in altering one's motivation to eat. There may be sex differences in altering one's motivation to eat.This trial was registered at clinicaltrials.gov as NCT02936284.
      PubDate: Mon, 17 Oct 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac209
      Issue No: Vol. 116, No. 6 (2022)
       
  • Infant consumption of microRNA miR-375 in human milk lipids is associated
           with protection from atopy

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      Pages: 1654 - 1662
      Abstract: ABSTRACTBackgroundHuman milk is thought to reduce infant atopy risk. The biologic mechanism for this protective effect is not fully understood.ObjectivesWe tested the hypothesis that infant consumption of 4 microRNAs (miR-146b-5p, miR-148b-3p, miR-21–5p, and miR-375–3p) in human milk would be associated with reduced atopy risk.MethodsThe Breast Milk Influence of the Microtranscriptome Profile on Atopy in Children over Time (IMPACT) study involved a cohort of mother-infant dyads who planned to breastfeed beyond 4 mo. Infant consumption of the 4 human milk microRNAs (miRNAs) in the first 6 mo was calculated as the product of milk miRNA concentration and the number of human milk feeds, across 3 lactation stages: early milk (0–4 wk), transitional milk (4–16 wk), and mature milk (16–24 wk). The primary outcome was infant atopy in the first year, defined as atopic dermatitis (AD), food allergies, or wheezing. The final analysis included 432 human milk samples and 7824 wk of longitudinal health data from 163 dyads.ResultsSeventy-three infants developed atopy. Forty-one were diagnosed with AD (25%), 33 developed food allergy (20%), and 10 had wheezing (6%). Eleven developed >1 condition (7%). Infants who did not develop atopy consumed higher concentrations of miR-375–3p (d = 0.18, P = 0.022, adj P = 0.044) and miR-148b-3p (d = 0.23, P = 0.007, adj P = 0.028). The consumption of miR-375–3p (X2 = 5.7, P = 0.017, OR: 0.92, 95% CI: 0.86, 0.99) was associated with reduced atopy risk. Concentrations of miR-375–3p increased throughout lactation (r = 0.46, F = 132.3, P = 8.4 × 10−34) and were inversely associated with maternal body mass (r = –0.11, t = –2.1, P = 0.032).ConclusionsThis study provides evidence that infant consumption of miR-375–3p may reduce atopy risk.
      PubDate: Tue, 27 Sep 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac266
      Issue No: Vol. 116, No. 6 (2022)
       
  • The effects of 9 months of formulated whole-egg or milk powder food
           products as meal or snack replacements on executive function in
           preadolescents: A randomized, placebo-controlled trial

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      Pages: 1663 - 1671
      Abstract: ABSTRACTBackgroundElevated brain choline is associated with better executive functions in preadolescents. Manipulating dietary choline prospectively in preadolescents using egg supplementation could improve executive functions via effects on brain cellular and neurotransmitter functions.ObjectivesWe tested the 9-month impacts of egg supplementation on executive functions. It was hypothesized that preadolescents who consumed meal or snack replacement products containing powder made from whole eggs would have the largest improvements in executive functions after 9 months compared to those consuming similar products with either added milk powder or gelatin as a placebo.MethodsA randomized, parallel-group, double-blinded, placebo-controlled trial design was used. The executive functions of 122 preadolescents (58 females) aged 9–13 were analyzed before and after the 9-month intervention. The primary outcomes were 3 NIH Toolbox-Cognitive Battery measures of executive function: mental flexibility, working memory, and selective attention and inhibitory control. Participants were randomized to consume food products with either: 1) whole egg powder; 2) milk powder; or 3) gelatin as a placebo, all matched on macronutrient content and used as replacements for commonly consumed foods (i.e., waffles, pancakes, macaroni and cheese, ice cream, and brownies). Hypothesis testing used mixed-effects models that included physical activity and sleep scores as covariates.ResultsA statistically significant group × time interaction for selective attention and inhibitory control was found (P = 0.049) for the milk group. This interaction resulted from no change for the placebo group and an improvement in selective attention and inhibitory control performance for the milk group by a T-score of 5.8; the effect size (d) was 0.44 SD units. Other comparisons were statistically insignificant.ConclusionsConsumption of foods with added milk powder as a replacement for snacks or meals for 9 months improves selective attention and inhibitory control in preadolescents. Replacement of foods with added whole egg powder does not impact 9-month changes in preadolescent executive functions. This trial was registered at clinicaltrials.gov as NCT03739424.
      PubDate: Thu, 29 Sep 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac281
      Issue No: Vol. 116, No. 6 (2022)
       
  • Long-term diet and risk of Severe Acute Respiratory Syndrome Coronavirus 2
           (SARS-CoV-2) infection and Coronavirus Disease 2019 (COVID-19) severity

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      Pages: 1672 - 1681
      Abstract: ABSTRACTBackgroundThe role of diet on Coronavirus Disease 2019 (COVID-19) is emerging. We investigated the association between usual diet before the onset of the pandemic and risk and severity of subsequent SARS-CoV-2 infection.MethodsWe included 42,935 participants aged 55–99 y in 2 ongoing cohort studies, the Nurses’ Health Study II and Health Professionals Follow-up Study, who completed a series of COVID-19 surveys in 2020 and 2021. Using data from FFQs before COVID-19, we assessed diet quality using the Alternative Healthy Eating Index (AHEI)-2010, the alternative Mediterranean Diet (AMED) score, an Empirical Dietary Index for Hyperinsulinemia (EDIH), and an Empirical Dietary Inflammatory Pattern (EDIP). We calculated multivariable-adjusted ORs and 95% CIs for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and severity of COVID-19 after controlling for demographic, medical, and lifestyle factors.ResultsAmong 19,754 participants tested for SARS-CoV-2, 1941 participants reported a positive result. Of these, 1327 reported symptoms needing assistance and another 109 were hospitalized. Healthier diets, represented by higher AHEI-2010 and AMED scores and lower EDIH and EDIP scores, were associated with lower likelihood of SARS-CoV-2 infection (quartile 4 compared with quartile 1: OR: 0.80; 95% CI: 0.69, 0.92 for AHEI-2010; OR: 0.78; 95% CI: 0.67, 0.92 for AMED; OR: 1.36; 95% CI: 1.16, 1.57 for EDIH; and OR: 1.13; 95% CI: 0.99, 1.30 for EDIP; all P-trend ≤ 0.01). In the analysis of COVID-19 severity, participants with healthier diet had lower likelihood of severe infection and were less likely to be hospitalized owing to COVID-19. However, associations were no longer significant after controlling for BMI and pre-existing medical conditions.ConclusionsDiet may be an important modifiable risk factor for SARS-CoV-2 infection, as well as for severity of COVID-19. This association is partially mediated by BMI and pre-existing medical conditions.
      PubDate: Tue, 09 Aug 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac219
      Issue No: Vol. 116, No. 6 (2022)
       
  • Saturated fat from dairy sources is associated with lower cardiometabolic
           risk in the Framingham Offspring Study

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      Pages: 1682 - 1692
      Abstract: ABSTRACTBackgroundCurrent dietary guidance recommends limiting intakes of saturated fats, but most fails to consider that saturated fats from different food sources may have different health effects.ObjectivesWe aimed to evaluate the associations of saturated fats from dairy and nondairy sources with measures of body fat, inflammatory biomarkers, lipid concentrations, and lipid particle sizes and concentrations.MethodsThe Framingham Offspring Study is a prospective cohort study. Participants (n = 2391) ≥30 y of age who had dietary records and data on the outcomes of interest were included.ResultsAmong females, those in the highest quintile (compared with the lowest) of dairy-derived saturated fat had lower multivariable-adjusted levels of body fat [BMI (in kg/m2): 26.2 compared with 27.8, P < 0.01; and percentage fat mass: 36.7% compared with 38.0%, P = 0.09) and larger LDL particle sizes. Nondairy saturated fat in females was inversely associated with the triglyceride (TG):HDL ratio (P = 0.03). Among males, intakes of dairy-derived saturated fats were inversely associated with C-reactive protein (P < 0.01), fibrinogen (P < 0.01), TGs (P < 0.01), and the TG:HDL ratio (P < 0.01). HDL cholesterol was 2.8 mg/dL (P = 0.04) higher among males in the highest (compared with the lowest) quintile of saturated fat from dairy sources. Males with the highest intakes of dairy-derived saturated fats had larger HDL and LDL particle sizes (P < 0.01 for both), a higher HDL particle concentration (P < 0.01), and a lower VLDL particle concentration (P < 0.01). There were no statistically significant adverse effects of saturated fats from nondairy sources on any of these outcomes in either males or females.ConclusionsMales with higher intakes of dairy-derived saturated fats had a less atherogenic profile than males with lower intakes of these fats. These effects were weaker in females. Nondairy saturated fats were not associated with these cardiometabolic outcomes.
      PubDate: Fri, 28 Oct 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac224
      Issue No: Vol. 116, No. 6 (2022)
       
  • Habitual coffee consumption and subsequent risk of type 2 diabetes in
           individuals with a history of gestational diabetes – a prospective study
           

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      Pages: 1693 - 1703
      Abstract: ABSTRACTBackgroundFemales with a history of gestational diabetes mellitus (GDM) are at higher risk of developing type 2 diabetes mellitus (T2D) later in life.ObjectiveThis study prospectively examined whether greater habitual coffee consumption was related to a lower risk of T2D among females with a history of GDM.MethodsWe followed 4522 participants with a history of GDM in the NHS II for incident T2D between 1991 and 2017. Demographic, lifestyle factors including diet, and disease outcomes were updated every 2–4 y. Participants reported consumption of caffeinated and decaffeinated coffee on validated FFQs. Fasting blood samples were collected in 2012–2014 from a subset of participants free of diabetes to measure glucose metabolism biomarkers (HbA1c, insulin, C-peptide; n = 518). We used multivariable Cox regression models to calculate adjusted HRs and 95% CIs for the risk of T2D. We estimated the least squares mean of glucose metabolic biomarkers according to coffee consumption.ResultsA total of 979 participants developed T2D. Caffeinated coffee consumption was inversely associated with the risk of T2D. Adjusted HR (95% CI) for ≤1 (nonzero), 2–3, and 4+ cups/d compared with 0 cup/d (reference) was 0.91 (0.78, 1.06), 0.83 (0.69, 1.01), and 0.46 (0.28, 0.76), respectively (P-trend = 0.004). Replacement of 1 serving/d of sugar-sweetened beverage and artificially sweetened beverage with 1 cup/d of caffeinated coffee was associated with a 17% (risk ratio [RR] = 0.83, 95% CI: 0.75, 0.93) and 9% (RR = 0.91, 95% CI: 0.84, 0.99) lower risk of T2D, respectively. Greater caffeinated coffee consumption was associated with lower fasting insulin and C-peptide concentrations (all P-trend <0.05). Decaffeinated coffee intake was not significantly related to T2D but was inversely associated with C-peptide concentrations (P-trend = 0.003).ConclusionsAmong predominantly Caucasian females with a history of GDM, greater consumption of caffeinated coffee was associated with a lower risk of T2D and a more favorable metabolic profile.
      PubDate: Mon, 14 Nov 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac241
      Issue No: Vol. 116, No. 6 (2022)
       
  • Whole-grain food intake among US adults, based on different definitions of
           whole-grain foods, NHANES 2003–2018

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      Pages: 1704 - 1714
      Abstract: ABSTRACTBackgroundWhole-grain (WG) foods are defined by the Dietary Guidelines for Americans (DGA), FDA, AHA, American Association of Cereal Chemists International (AACCI), and Whole Grains Council (WGC) in different ways with diverse focuses on grain components only, whole foods, or nutrient contents.ObjectivesWe aimed to compare estimated WG food intake among US adults using different definitions.MethodsFor each definition, we estimated the mean intake and trends of WG food consumption using survey-weighted 24-h dietary recalls from nationally representative samples of 39,755 US adults aged 20+ y from 8 cycles (2003–2018) of the NHANES. This is an observational study that used deidentified and publicly available datasets.ResultsThe estimated mean consumption of WG foods (ounces equivalents/2000 kcal/d, oz. eq./d) varied by definition. In 2017–2018, the AHA (mean [SEM]: 1.05 [0.07] oz. eq./d) and WGC (0.95 [0.07]) definitions yielded the highest amounts, followed by the DGA (0.81 [0.06]), AACCI (0.73 [0.05]), and FDA (0.53 [0.04]). Using all definitions except for WGC, US adults increased WG food intake from 2003–2004 to 2017–2018 with the largest increase (61.5%) using the AHA (from 0.65 to 1.05 oz. eq./d), followed by DGA (0.50 to 0.81) and AACCI (0.51 to 0.73) definitions. For each definition, the main sources of WG foods consumed by US adults were ready-to-eat cereals, cooked grains and cereals, and breads (including rolls and tortillas). For all definitions except the AHA, non-Hispanic White adults and individuals with college degrees or above consumed higher levels of WG foods than non-Hispanic Blacks and those with lower levels of education.ConclusionsDifferent definitions affect the determination of WG foods, estimated intakes, and associated trends in WG food consumption among US adults. These findings call for a standardized definition of WG foods to guide consumers, industry, and policymakers in promoting WG intake in the US.Clinical Trial Registration: Not Applicable.
      PubDate: Wed, 30 Nov 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac267
      Issue No: Vol. 116, No. 6 (2022)
       
  • Habitual intake of dietary methylglyoxal is associated with less low-grade
           inflammation: the Maastricht Study

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      Pages: 1715 - 1728
      Abstract: ABSTRACTBackgroundDicarbonyls are major reactive precursors of advanced glycation endproducts (AGEs). Dicarbonyls are formed endogenously and also during food processing. Circulating dicarbonyls and AGEs are associated with inflammation and microvascular complications of diabetes, but for dicarbonyls from the diet these associations are currently unknown.ObjectivesWe sought to examine the associations of dietary dicarbonyl intake with low-grade inflammation and microvascular function.MethodsIn 2792 participants (mean ± SD age: 60 ± 8 y; 50% men; 26% type 2 diabetes) of the population-based cohort the Maastricht Study, we estimated the habitual intake of the dicarbonyls methylglyoxal (MGO), glyoxal (GO), and 3-deoxyglucosone (3-DG) by linking FFQ outcome data to our food composition database of the MGO, GO, and 3-DG content of >200 foods. Low-grade inflammation was assessed as six plasma biomarkers, which were compiled in a z score. Microvascular function was assessed as four plasma biomarkers, compiled in a zscore; as diameters and flicker light–induced dilation in retinal microvessels; as heat-induced skin hyperemic response; and as urinary albumin excretion. Cross-sectional associations of dietary dicarbonyls with low-grade inflammation and microvascular function were investigated using linear regression with adjustments for age, sex, potential confounders related to cardiometabolic risk factors, and lifestyle and dietary factors.ResultsFully adjusted analyses revealed that higher intake of MGO was associated with a lower z score for inflammation [standardized β coefficient (STD β): −0.05; 95% CI: −0.09 to −0.01, with strongest inverse associations for hsCRP and TNF-α: both −0.05; −0.10 to −0.01]. In contrast, higher dietary MGO intake was associated with impaired retinal venular dilation after full adjustment (STD β: −0.07; 95% CI: −0.12 to −0.01), but not with the other features of microvascular function. GO and 3-DG intakes were not consistently associated with any of the outcomes.ConclusionHigher habitual intake of MGO was associated with less low-grade inflammation. This novel, presumably beneficial, association is the first observation of an association between MGO intake and health outcomes in humans and warrants further investigation.
      PubDate: Wed, 07 Sep 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac195
      Issue No: Vol. 116, No. 6 (2022)
       
  • Physical activity and individual plasma phospholipid SFAs in pregnancy: a
           longitudinal study in a multiracial/multiethnic cohort in the United
           States

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      Pages: 1729 - 1737
      Abstract: ABSTRACTBackgroundCirculating individual SFAs in pregnant females are critical for maternal and fetal health. However, research on identifying their modifiable factors is limited.ObjectivesWe aimed to examine the associations of total physical activity (PA) and types of PA with circulating individual SFAs during pregnancy in a multiracial/multiethnic cohort of pregnant females in the United States.MethodsThe study included participants in a nested case–control study (n = 321) from the Eunice Kennedy Shriver NICHD Fetal Growth Studies–Singleton Cohort. Sampling weights were applied, so the results represented the entire Fetal Growth Cohort. Plasma phospholipid SFAs were measured at 4 visits [10–14 (visit 1), 15–26 (visit 2), 23–31 (visit 3), and 33–39 (visit 4) weeks of gestation] throughout pregnancy. PA of the previous year at visit 1 and since the previous visit at the subsequent visits was assessed using the validated Pregnancy PA Questionnaire. Time-specific and longitudinal associations were examined using multivariable linear and generalized estimating equation models.ResultsTotal PA (metabolic equivalent of task-h/wk) was positively associated with circulating heptadecanoic acid (17:0) at visit 1 (β × 103: 0.07; 95% CI: 0.02, 0.11) and pentadecanoic acid (15:0) at visit 3 (β × 103: 0.09; 95% CI: 0.03, 0.14) independent of sociodemographic, reproductive, pregnancy, and dietary factors. Across the 4 visits, the positive associations with total PA were consistent for pentadecanoic acid (β × 103: 0.06; 95% CI: 0.02, 0.10) and heptadecanoic acid (β × 103: 0.10; 95% CI: 0.06, 0.14). Out of the 4 PA types (i.e., sports/exercise, household/caregiving, transportation, and occupational PA) considered, the magnitude of positive associations was the largest for sports/exercise PA.ConclusionsOur findings suggest that maternal PA is positively associated with circulating pentadecanoic and heptadecanoic acids. The findings warrant confirmation by future studies.This trial was registered at clinicaltrials.gov as NCT00912132.
      PubDate: Mon, 14 Nov 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac250
      Issue No: Vol. 116, No. 6 (2022)
       
  • Overall diet quality and proinflammatory diet in relation to risk of
           obstructive sleep apnea in 3 prospective US cohorts

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      Pages: 1738 - 1747
      Abstract: ABSTRACTBackgroundInflammation-related mechanisms may be important in the development of obstructive sleep apnea (OSA), and diet plays a crucial role in modulating inflammation. Current epidemiologic evidence for the associations between dietary patterns and OSA risk is limited to cross-sectional studies.ObjectivesWe investigated prospectively the associations of overall diet quality and proinflammatory diet with OSA risk.MethodsWe followed 145,801 participants in the Nurses’ Health Study (NHS) (2002–2012), NHS II (1995–2013), and Health Professionals Follow-up Study (1996–2012). Alternative Healthy Eating Index 2010 (AHEI) and Empirical Dietary Inflammatory Pattern (EDIP) scores were calculated based on validated FFQs administered every 4 y. Cox models were used to estimate HRs and 95% CIs.ResultsWe documented 8856 incident OSA cases during follow-up. In pooled analyses adjusted for potential confounders, higher diet quality (higher AHEI scores) was associated with lower OSA risk (HR comparing the highest with the lowest quintile of AHEI: 0.76; 95% CI: 0.71, 0.82; P-trend < 0.001), and higher dietary inflammatory potential (higher EDIP scores) was associated with significantly increased risk (HR comparing the highest with the lowest quintile of EDIP: 1.94; 95% CI: 1.81, 2.08; P-trend < 0.001). Additional adjustment for metabolic factors attenuated both associations. The association with AHEI score was no longer statistically significant (comparable HR: 0.98; 95% CI: 0.91, 1.05; P-trend = 0.54), whereas the association with EDIP score remained statistically significant (comparable HR: 1.31; 95% CI: 1.22, 1.41; P-trend < 0.001).ConclusionsA healthier diet, particularly one with anti-inflammatory potential, was associated with lower OSA risk.
      PubDate: Fri, 16 Sep 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac257
      Issue No: Vol. 116, No. 6 (2022)
       
  • Greater adherence to the 2019 Canada's Food Guide recommendations on
           healthy food choices reduces the risk of cardiovascular disease in adults:
           a prospective analysis of UK Biobank data

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      Pages: 1748 - 1758
      Abstract: ABSTRACTBackgroundCanada's Food Guide (CFG) was profoundly revised in 2019, but the extent to which adherence to recommendations on healthy food choices reduces the risk of cardiovascular disease (CVD) is unknown.ObjectivesThe aim of this study was to examine how greater adherence to the 2019 CFG's recommendations on healthy food choices influences the risk of incident CVD.MethodsParticipants were a sample of adults without history of CVD, diabetes, or cancer from the UK Biobank prospective cohort study. Usual dietary intakes were estimated by modeling data from repeated Web-based 24-h dietary recalls using the National Cancer Institute multivariate method. Adherence to key CFG recommendations on healthy food choices was assessed using the Healthy Eating Food Index (HEFI)-2019, which has a maximum of 80 points. The CVD outcome was a composite of fatal and nonfatal myocardial infarction and ischemic stroke. Cox regression models adjusted via inverse probability weighting were used to estimate CVD risks. Counterfactual models were used to interpret risks of hypothetical changes in the HEFI-2019 score.ResultsA total of 136,698 participants met the eligibility criteria (55% females; mean age: 57.2 y; range: 40–75 y). During the 11-y follow-up, there were 2843 cases of incident CVD. Compared with no change in the HEFI-2019 score, increasing the HEFI-2019 score of all participants to the 90th percentile of the score distribution (58.1 points) hypothetically reduced the risk of CVD by 24% (RR: 0.76; 95% CI: 0.58, 0.94; absolute risk difference: −0.58%).ConclusionsThese results suggest that greater adherence to the 2019 CFG recommendations on healthy food choices reduces the 11-y risk of CVD in middle-aged and older adults.
      PubDate: Fri, 16 Sep 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac256
      Issue No: Vol. 116, No. 6 (2022)
       
  • Association of omega-3 and omega-6 fatty acid intake with leukocyte
           telomere length in US males

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      Pages: 1759 - 1766
      Abstract: ABSTRACTBackgroundOmega-3 (n–3) and omega-6 (n–6) fatty acids may contribute to oxidative stress and inflammation, which are related to telomere shortening. Evidence supporting an association between intake of n–3 or n–6 fatty acids and leukocyte telomere length (LTL) in males has been limited.ObjectivesWe conducted a cross-sectional study to examine the associations of total or individual n–3 or total n–6 fatty acid intake with LTL in US males.MethodsWe included 2,494 US males with LTL measurement from 4 nested case–control studies within the Health Professionals Follow-Up Study. Individuals with previous histories of cancers, diabetes, and cardiovascular diseases at or before blood collection were excluded. Blood collection was performed between 1993 and 1995, and relevant information including n–3 and n–6 intake was collected in 1994 by questionnaire. The LTL was log-transformed and Z scores of the LTL were calculated for statistical analyses by standardizing the LTL in comparison with the mean within each selected nested case–control study.ResultsWe found that consumption of DHA (22:6n–3) was positively associated with LTL. In the multivariable-adjusted model, compared with individuals who had the lowest intake of DHA (i.e., first quartile group), the percentage differences (95% CIs) of LTL were −3.7 (−13.7, 7.5), 7.0 (−4.3, 19.7), and 8.2 (−3.5, 21.3) for individuals in the second, third, and fourth quartiles of consumption, respectively (P-trend = 0.0498). We did not find significant associations between total n–3 or total n–6 fatty acid intakes and LTL. In addition, we found that males who consumed canned tuna had longer LTL than those who did not; in the multivariable-adjusted model, the percentage difference of LTL was 10.5 (95% CI: 1.3, 20.4) (P = 0.02).ConclusionsOur results suggest that higher intakes of DHA and canned tuna consumption are associated with longer LTL.
      PubDate: Tue, 20 Sep 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac263
      Issue No: Vol. 116, No. 6 (2022)
       
  • Vitamin B-6 and riboflavin, their metabolic interaction, and relationship
           with MTHFR genotype in adults aged 18–102 years

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      Pages: 1767 - 1778
      Abstract: AbstractBackgroundThe generation of the active form of vitamin B-6, pyridoxal 5′-phosphate (PLP), in tissues is dependent upon riboflavin as flavin mononucleotide, but whether this interaction is important for maintaining vitamin B-6 status is unclear.ObjectiveTo investigate vitamin B-6 and riboflavin status, their metabolic interaction, and relationship with methylenetetrahydrofolate reductase (MTHFR) genotype in adulthood.MethodsData from 5612 adults aged 18–102 y were drawn from the Irish National Adult Nutrition Survey (NANS; population-based sample) and the Trinity-Ulster Department of Agriculture (TUDA) and Genovit cohorts (volunteer samples). Plasma PLP and erythrocyte glutathione reductase activation coefficient (EGRac), as a functional indicator of riboflavin, were determined.ResultsOlder (≥65 y) compared with younger (<65 y) adults had significantly lower PLP concentrations (P < 0.001). A stepwise decrease in plasma PLP was observed across riboflavin categories, from optimal (EGRac ≤1.26), to suboptimal (EGRac: 1.27–1.39), to deficient (EGRac ≥1.40) status, an effect most pronounced in older adults (mean ± SEM: 76.4 ± 0.9 vs 65.0 ± 1.1 vs 55.4 ± 1.2 nmol/L; P < 0.001). In individuals with the variant MTHFR 677TT genotype combined with riboflavin deficiency, compared with non-TT (CC/CT) genotype participants with sufficient riboflavin, we observed PLP concentrations of 52.1 ± 2.9 compared with 76.8 ±0.7 nmol/L (P < 0.001). In participants with available dietary data (i.e., NANS cohort, n = 936), PLP was associated with vitamin B-6 intake (nonstandardized regression coefficient β: 2.49; 95% CI 1.75, 3.24; P < 0.001), supplement use (β: 81.72; 95% CI: 66.01, 97.43; P < 0.001), fortified food (β: 12.49; 95% CI: 2.08, 22.91; P = 0.019), and EGRac (β: –65.81; 95% CI: –99.08, –32.54; P < 0.001), along with BMI (β: –1.81; 95% CI: –3.31, –0.30; P = 0.019).ConclusionsThese results are consistent with the known metabolic dependency of PLP on flavin mononucleotide (FMN) and suggest that riboflavin may be the limiting nutrient for maintaining vitamin B-6 status, particularly in individuals with the MTHFR 677TT genotype. Randomized trials are necessary to investigate the PLP response to riboflavin intervention within the dietary range. The TUDA study and the NANS are registered at www.ClinicalTrials.gov as NCT02664584 (27 January 2016) and NCT03374748 (15 December 2017), respectively.Clinical Trial Registry details: Trinity-Ulster-Department of Agriculture (TUDA) study, ClinicalTrials.gov no. NCT02664584 (January 27th 2016); National Adult Nutrition Survey (NANS), ClinicalTrials.gov no. NCT03374748 (December 15th 2017).
      PubDate: Thu, 20 Oct 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac240
      Issue No: Vol. 116, No. 6 (2022)
       
  • Top sources and trends in consumption of total energy and energy from
           solid fats and added sugars among youth aged 2–18 years: United States
           2009–2018

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      Pages: 1779 - 1789
      Abstract: ABSTRACTBackgroundHigh energy intake from non–nutrient-dense sources correlates with poorer diet quality.ObjectivesThe aims were to 1) estimate total energy intake and energy from solid fats and added sugars combined (SoFAS) and identify their top food category sources for ages 2–18 y in 2015–2018 and 2) describe trends over time in 2009–2018.MethodsData were from the NHANES. Pairwise differences were examined using univariate t statistics (2015–2018, n = 5038), and trends by age and over time (2009–2018, n = 14,038) were examined using orthogonal polynomials.ResultsIn 2015–2018, SoFAS contributed a mean (SE) of 30.0% (0.3%) of total energy. Solid fats [16.1% (0.2%)] and added sugars [13.8% (0.2%)] each contributed >10%. The contribution of added sugars increased with age from 11.1% (2–3 y) to 14.4% (14–18 y), and was higher for all other race/Hispanic origins than non-Hispanic Asians. The top 5 sources of energy were sweet bakery products, savory snacks, pizza, other mixed dishes, and unflavored milk, and for SoFAS also included soft drinks, other desserts, candy, and snack bars. Total energy did not change between 2009 and 2018, but energy from SoFAS, and servings of solid fats, and added sugars declined. The contribution of unflavored milk to total energy declined for all ages and most race/Hispanic origins. Fruit drinks (all ages) and soft drinks (9–18 y) remained among top added sugars sources despite declines. The contribution of sweet bakery products to energy from SoFAS increased for most ages and candy and snack bars to energy from added sugars.ConclusionsIn 2015–2018, SoFAS contributed >30% of total energy for ages 2–18 y, which doubled the Dietary Guidelines for Americans’ recommended limit of 15%. The top 5 sources of total energy were similar to those of solid fats, and those of SoFAS similar to those of added sugars. These results may inform public health efforts for improving diet quality.
      PubDate: Tue, 30 Aug 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac238
      Issue No: Vol. 116, No. 6 (2022)
       
  • The impact of almonds and almond processing on gastrointestinal
           physiology, luminal microbiology, and gastrointestinal symptoms: a
           randomized controlled trial and mastication study

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      Pages: 1790 - 1804
      Abstract: ABSTRACTBackgroundAlmonds contain lipid, fiber, and polyphenols and possess physicochemical properties that affect nutrient bioaccessibility, which are hypothesized to affect gut physiology and microbiota.ObjectivesTo investigate the impact of whole almonds and ground almonds (almond flour) on fecal bifidobacteria (primary outcome), gut microbiota composition, and gut transit time.MethodsHealthy adults (n = 87) participated in a parallel, 3-arm randomized controlled trial. Participants received whole almonds (56 g/d), ground almonds (56 g/d), or an isocaloric control in place of habitual snacks for 4 wk. Gut microbiota composition and diversity (16S rRNA gene sequencing), SCFAs (GC), volatile organic compounds (GC-MS), gut transit time (wireless motility capsule), stool output and gut symptoms (7-d diary) were measured at baseline and endpoint. The impact of almond form on particle size distribution (PSD) and predicted lipid release was measured (n = 31).ResultsModified intention-to-treat analysis was performed on 79 participants. There were no significant differences in mean ± SD abundance of fecal bifidobacteria after consumption of whole almonds (8.7% ± 7.7%), ground almonds (7.8% ± 6.9%), or control (13.0% ± 10.2%; q = 0.613). Consumption of almonds (whole and ground pooled) resulted in higher mean ± SD butyrate (24.1 ± 15.0 μmol/g) than control (18.2 ± 9.1 μmol/g; P = 0.046). There was no effect of almonds on gut microbiota at the phylum level or diversity, gut transit time, stool consistency, or gut symptoms. Almond form (whole compared with ground) had no effect on study outcomes. Ground almonds resulted in significantly smaller PSD and higher mean ± SD predicted lipid release (10.4% ± 1.8%) than whole almonds (9.3% ± 2.0%; P = 0.017).ConclusionsAlmond consumption has limited impact on microbiota composition but increases butyrate in adults, suggesting positive alterations to microbiota functionality. Almonds can be incorporated into the diet to increase fiber consumption without gut symptoms.This trial was registered at clinicaltrials.gov as NCT03581812.
      PubDate: Tue, 20 Sep 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac265
      Issue No: Vol. 116, No. 6 (2022)
       
  • Novel lipid emulsion for total parenteral nutrition based on 18-carbon
           n–3 fatty acids elicits a superior immunometabolic phenotype in a murine
           model compared with standard lipid emulsions

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      Pages: 1805 - 1819
      Abstract: ABSTRACTBackgroundWhile lipid emulsions in modern formulations for total parenteral nutrition (TPN) provide essential fatty acids and dense calories, they also promote inflammation and immunometabolic disruptions.ObjectivesWe aimed to develop a novel lipid emulsion for TPN use with superior immunometabolic actions compared with available standard lipid emulsions.MethodsA novel lipid emulsion [Vegaven (VV)] containing 30% of 18-carbon n–3 fatty acids (α-linolenic acid and stearidonic acid) was developed for TPN (VV-TPN) and compared with TPN containing soybean oil-based lipid emulsion (IL-TPN) and fish-oil–based lipid emulsion (OV-TPN). In vivo studies were performed in instrumented male C57BL/6 mice subjected to 7-d TPN prior to analysis of cytokines, indices of whole-body and hepatic glucose metabolism, immune cells, lipid mediators, and mucosal bowel microbiome.ResultsIL-6 to IL-10 ratios were significantly lower in liver and skeletal muscle of VV-TPN mice when compared with IL-TPN or OV-TPN mice. VV-TPN and OV-TPN each increased hepatic insulin receptor abundance and resulted in similar HOMA-IR values, whereas only VV-TPN increased hepatic insulin receptor substrate 2 and maintained normal hepatic glycogen content, effects that were IL-10–dependent and mediated by glucokinase activation. The percentages of IFN-γ– and IL-17–expressing CD4+ T cells were increased in livers of VV-TPN mice, and liver macrophages exhibited primed phenotypes when compared with IL-TPN. This immunomodulation was associated with successful elimination of the microinvasive bacterium Akkermansia muciniphila from the bowel mucosa by VV-TPN as opposed to standard lipid emulsions. Assay of hepatic lipid mediators revealed a distinct profile with VV-TPN, including increases in 9(S)-hydroxy-octadecatrienoic acid. When co-administered with IL-TPN, hydroxy-octadecatrienoic acids mimicked the VV-TPN immunometabolic phenotype.ConclusionsWe here report the unique anti-inflammatory, insulin-sensitizing, and immunity-enhancing properties of a newly developed lipid emulsion designed for TPN use based on 18-carbon n–3 fatty acids.
      PubDate: Tue, 27 Sep 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac272
      Issue No: Vol. 116, No. 6 (2022)
       
  • Unprocessed red meat in the dietary treatment of obesity: a randomized
           controlled trial of beef supplementation during weight maintenance after
           successful weight loss

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      Pages: 1820 - 1830
      Abstract: ABSTRACTBackgroundConsumption of unprocessed red meat in randomized trials has no adverse effects on cardiovascular risk factors and body weight, but its physiological effects during weight loss maintenance are not known.ObjectivesWe sought to investigate the effects of healthy diets that include small or large amounts of red meat on the maintenance of lost weight after successful weight loss, and secondarily on body composition (DXA), resting energy expenditure (REE; indirect calorimetry), and cardiometabolic risk factors.MethodsIn this 5-mo parallel randomized intervention trial, 108 adults with BMI 28–40 kg/m2 (45 males/63 females) underwent an 8-wk rapid weight loss period, and those who lost ≥8% body weight (n = 80) continued to ad libitum weight maintenance diets for 12 wk: a moderate-protein diet with 25 g beef/d (B25, n = 45) or a high-protein diet with 150 g beef/d (B150, n = 35).ResultsIn per protocol analysis (n = 69), mean body weight (−1.2 kg; 95% CI: −2.1, −0.3 kg), mean fat mass (−2.7 kg; 95% CI: −3.4, −2.0 kg), and mean body fat content (−2.6%; 95% CI: −3.1, −2.1%) decreased during the maintenance phase, whereas mean lean mass (1.5 kg; 95% CI: 1.0, 2.0 kg) and mean REE (51 kcal/d; 95% CI: 15, 86 kcal/d) increased, with no differences between groups (all P > 0.05). Results were similar in intention-to-treat analysis with multiple imputation for dropouts (20 from B150 compared with 19 from B25, P = 0.929). Changes in cardiometabolic risk factors were not different between groups, the general pattern being a decrease during weight loss and a return to baseline during weight maintenance (and despite the additional mild reduction in weight and fat mass).ConclusionsHealthy diets consumed ad libitum that contain a little or a lot of unprocessed beef have similar effects on body weight, energy metabolism, and cardiovascular risk factors during the first 3 mo after clinically significant rapid weight loss.
      PubDate: Fri, 28 Oct 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac152
      Issue No: Vol. 116, No. 6 (2022)
       
  • Gut microbiota and acylcarnitine metabolites connect the beneficial
           association between equol and adiposity in adults: a prospective cohort
           study

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      Pages: 1831 - 1841
      Abstract: ABSTRACTBackgroundMany studies have investigated the effects of soy isoflavones on weight control, but few have focused on the role of equol, a gut-derived metabolite of daidzein with greater bioavailability than other soy isoflavones.ObjectivesThis study examined the association of equol production with obesity and explored the mediating roles of equol-related gut microbiota and microbial carnitine metabolites.MethodsThis 6.6-y prospective study included 2958 Chinese adults (2011 females and 947 males) aged 60.6 ± 6.0 y (mean ± SD) at baseline. Urinary equol and isoflavones were measured using HPLC–tandem MS. BMI, percentage fat mass (%FM), and serum triglycerides (TGs) were assessed every 3 y. Metagenomics sequencing and assessment of carnitine metabolites in feces were performed in a subsample of 897 participants.ResultsUrinary equol, but not daidzein and genistein, was independently and inversely associated with the obesity-related indicators of BMI, %FM, and a biomarker (TGs). Equol producers (EPs) had lower odds of adiposity conditions and a reduced risk of 6.6-y obesity progression than non-EPs among total participants. Gut microbial analyses indicated that EPs had higher microbiome species richness (P = 3.42 × 10−5) and significantly different β-diversity of gut microbiota compared with the non-EP group (P = 0.001), with 20 of 162 species differing significantly. EPs (compared with non-EPs) had higher abundances of Alistipes senegalensis and Coprococcus catus but lower abundances of Ruminococcus gnavus (false discovery rate <0.05). Among the 7 determined fecal acylcarnitine metabolites, palmitoylcarnitine, oleylcarnitine 18:1, and stearylcarnitine were inversely associated with EPs but positively correlated with obesity conditions and progression. Path analyses indicated that the beneficial association between equol and obesity might be mediated by gut microbiota and decreased production of 3 acylcarnitines in feces.ConclusionsThis study suggests a beneficial association between equol and obesity, mediated by the gut microbiome and acylcarnitines, in adults.This trial was registered at clinicaltrials.gov as NCT03179657.
      PubDate: Mon, 12 Sep 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac252
      Issue No: Vol. 116, No. 6 (2022)
       
  • The association between TMAO, CMPF, and clinical outcomes in advanced
           chronic kidney disease: results from the European QUALity (EQUAL) Study

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      Pages: 1842 - 1851
      Abstract: ABSTRACTBackgroundTrimethylamine N-oxide (TMAO), a metabolite from red meat and fish consumption, plays a role in promoting cardiovascular events. However, data regarding TMAO and its impact on clinical outcomes are inconclusive, possibly due to its undetermined dietary source.ObjectivesWe hypothesized that circulating TMAO derived from fish intake might cause less harm compared with red meat sources by examining the concomitant level of 3-carboxy-4-methyl-5-propyl-2-furanpropionate (CMPF), a known biomarker of fish intake, and investigated the association between TMAO, CMPF, and outcomes.MethodsPatients were recruited from the European QUALity (EQUAL) Study on treatment in advanced chronic kidney disease among individuals aged ≥65 y whose estimated glomerular filtration rate (eGFR) had dropped for the first time to ≤20 mL/min per 1.73 m2 during the last 6 mo. The association between TMAO, CMPF, and outcomes including all-cause mortality and kidney replacement therapy (KRT) was assessed among 737 patients. Patients were further stratified by median cutoffs of TMAO and CMPF, suggesting high/low red meat and fish intake.ResultsDuring a median of 39 mo of follow-up, 232 patients died. Higher TMAO was independently associated with an increased risk of all-cause mortality (multivariable HR: 1.46; 95% CI: 1.17, 1.83). Higher CMPF was associated with a reduced risk of both all-cause mortality (HR: 0.79; 95% CI: 0.71, 0.89) and KRT (HR: 0.80; 95% CI: 0.71, 0.90), independently of TMAO and other clinically relevant confounders. In comparison to patients with low TMAO and CMPF, patients with low TMAO and high CMPF had reduced risk of all-cause mortality (adjusted HR: 0.49; 95% CI: 0.31, 0.73), whereas those with high TMAO and high CMPF showed no association across adjusted models.ConclusionsHigh CMPF conferred an independent role in health benefits and might even counteract the unfavorable association between TMAO and outcomes. Whether higher circulating CMPF concentrations are due to fish consumption, and/or if CMPF is a protective factor, remains to be verified.
      PubDate: Tue, 27 Sep 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac278
      Issue No: Vol. 116, No. 6 (2022)
       
  • Associations between folic acid supplement use and folate status
           biomarkers in the first and third trimesters of pregnancy in the
           Maternal–Infant Research on Environmental Chemicals (MIREC) Pregnancy
           Cohort Study

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      Pages: 1852 - 1863
      Abstract: ABSTRACTBackgroundAchieving optimal folate status during early gestation reduces the risk of neural tube defects (NTDs). While inadequate folate intake remains a concern, it is becoming increasingly common for individuals to consume higher than recommended doses of folic acid (FA) with minimal additional benefit.ObjectiveHere, we sought to investigate the determinants, including FA supplement dose and use, of plasma total and individual folate vitamer concentrations in the first and third trimesters of pregnancy.MethodsUsing data from the Maternal–Infant Research on Environmental Chemicals (MIREC) Study, a cohort exposed to mandatory FA fortification, we measured plasma total folate and individual folate vitamer [5-methyltetrahydrofolate (5-methylTHF), unmetabolized FA (UMFA), and non-methyl folates (sum of THF, 5-formylTHF, 5,10-methenyl-THF)] concentrations in the first and third trimesters (n = 1,893). Using linear mixed models, we estimated associations between plasma folate concentrations, total daily supplemental FA intake, plasma vitamin B-12 concentrations, and multiple demographic, maternal, and reproductive factors.ResultsAlmost 95% of MIREC study participants met or exceeded the recommended daily supplemental FA intake from supplements (≥400 μg/d), with approximately 25% consuming more than the Tolerable Upper Intake Level (>1000 μg/d). Over 99% of MIREC participants had a plasma total folate status indicative of maximal NTD risk reduction (25.5 nmol/L) regardless of FA supplement dose. UMFA was detected in almost all participants, with higher concentrations associated with higher FA doses. Determinants of adequate FA supplement intake and folate status associated with reduced NTD risk included indicators of higher socioeconomic position, higher maternal age, nulliparity, and lower prepregnancy BMI.ConclusionsIn the context of mandatory FA fortification, our data indicate that higher-than-recommended FA doses are unwarranted, with the exception of individuals at higher risk for NTDs. Ideally, prenatal supplements would contain 400 rather than 1000 µg FA, thereby enabling the consumption of optimal and safe FA doses.
      PubDate: Tue, 18 Oct 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac235
      Issue No: Vol. 116, No. 6 (2022)
       
  • Effects of prenatal nutritional supplements on gestational weight gain in
           low- and middle-income countries: a meta-analysis of individual
           participant data

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      Pages: 1864 - 1876
      Abstract: ABSTRACTBackgroundGestational weight gain (GWG) below or above the Institute of Medicine (IOM) recommendations has been associated with adverse perinatal outcomes. Few studies have examined the effect of prenatal nutrient supplementations on GWG in low- and middle-income countries (LMICs).ObjectivesWe aimed to investigate the effects of multiple micronutrient supplements (MMSs) and small-quantity lipid-based nutrient supplements (LNSs) on GWG in LMICs.MethodsA 2-stage meta-analysis of individual participant data was conducted to examine the effects of MMSs (45,507 women from 14 trials) and small-quantity LNSs (6237 women from 4 trials) on GWG compared with iron and folic acid supplements only. Percentage adequacy of GWG and total weight gain at delivery were calculated according to the IOM 2009 guidelines. Binary outcomes included severely inadequate (percentage adequacy <70%), inadequate (<90%), and excessive (>125%) GWG. Results from individual trials were pooled using fixed-effects inverse-variance models. Heterogeneity was examined using I2, stratified analysis, and meta-regression.ResultsMMSs resulted in a greater percentage adequacy of GWG [weighted mean difference (WMD): 0.86%; 95% CI: 0.28%, 1.44%; P < 0.01] and higher GWG at delivery (WMD: 209 g; 95% CI: 139, 280 g; P < 0.01) than among those in the control arm. Women who received MMSs had a 2.9% reduced risk of severely inadequate GWG (RR: 0.971; 95% CI: 0.956, 0.987; P < 0.01). No association was found between small-quantity LNSs and GWG percentage adequacy (WMD: 1.51%; 95% CI: −0.38%, 3.40%; P = 0.21). Neither MMSs nor small-quantity LNSs were associated with excessive GWG.ConclusionsMaternal MMSs were associated with greater GWG percentage adequacy and total GWG at delivery than was iron and folic acid only. This finding is consistent with previous results on birth outcomes and will inform policy development and local recommendations of switching routine prenatal iron and folic acid supplements to MMSs.
      PubDate: Wed, 21 Sep 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac259
      Issue No: Vol. 116, No. 6 (2022)
       
  • Research gaps and opportunities in precision nutrition: an NIH workshop
           report

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      Pages: 1877 - 1900
      Abstract: ABSTRACTPrecision nutrition is an emerging concept that aims to develop nutrition recommendations tailored to different people's circumstances and biological characteristics. Responses to dietary change and the resulting health outcomes from consuming different diets may vary significantly between people based on interactions between their genetic backgrounds, physiology, microbiome, underlying health status, behaviors, social influences, and environmental exposures. On 11–12 January 2021, the National Institutes of Health convened a workshop entitled “Precision Nutrition: Research Gaps and Opportunities” to bring together experts to discuss the issues involved in better understanding and addressing precision nutrition. The workshop proceeded in 3 parts: part I covered many aspects of genetics and physiology that mediate the links between nutrient intake and health conditions such as cardiovascular disease, Alzheimer disease, and cancer; part II reviewed potential contributors to interindividual variability in dietary exposures and responses such as baseline nutritional status, circadian rhythm/sleep, environmental exposures, sensory properties of food, stress, inflammation, and the social determinants of health; part III presented the need for systems approaches, with new methods and technologies that can facilitate the study and implementation of precision nutrition, and workforce development needed to create a new generation of researchers. The workshop concluded that much research will be needed before more precise nutrition recommendations can be achieved. This includes better understanding and accounting for variables such as age, sex, ethnicity, medical history, genetics, and social and environmental factors. The advent of new methods and technologies and the availability of considerably more data bring tremendous opportunity. However, the field must proceed with appropriate levels of caution and make sure the factors listed above are all considered, and systems approaches and methods are incorporated. It will be important to develop and train an expanded workforce with the goal of reducing health disparities and improving precision nutritional advice for all Americans.
      PubDate: Fri, 02 Sep 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac237
      Issue No: Vol. 116, No. 6 (2022)
       
  • The A, B, C, D's of dietary trials

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      Pages: 1901 - 1902
      Abstract: Dear Editor:
      PubDate: Fri, 28 Oct 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac274
      Issue No: Vol. 116, No. 6 (2022)
       
  • Reply to H Staudacher et al

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      Pages: 1903 - 1904
      Abstract: Endeavour College of Natural Health10.13039/100013817University of Technology Sydney10.13039/501100001775
      PubDate: Fri, 28 Oct 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac276
      Issue No: Vol. 116, No. 6 (2022)
       
  • Correction to: Perumal et al. Impact of scaling up prenatal nutrition
           interventions on human capital outcomes in low- and middle-income
           countries: a modeling analysis

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      Pages: 1904 - 1904
      Abstract: This is a correction to: Perumal et al. Impact of scaling up prenatal nutrition interventions on human capital outcomes in low- and middle-income countries: a modeling analysis. Am J Clin Nutr 2021;114:1708–18.
      PubDate: Tue, 15 Nov 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac282
      Issue No: Vol. 116, No. 6 (2022)
       
  • Correction to: Bettina Hieronimus, Kimber L Stanhope, RE: Current WHO
           recommendation to reduce free sugar intake from all sources to below 10%
           of daily energy intake for supporting overall health is not well supported
           by available evidence. Am J Clin Nutr 2022;116:1187

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      Pages: 1904 - 1904
      Abstract: This is a correction to: Bettina Hieronimus, Kimber L Stanhope, RE: Current WHO recommendation to reduce free sugar intake from all sources to below 10% of daily energy intake for supporting overall health is not well supported by available evidence. Am J Clin Nutr 2022;116:1187.
      PubDate: Wed, 09 Nov 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac289
      Issue No: Vol. 116, No. 6 (2022)
       
  • Correction to: Gardner et al. Effect of a ketogenic diet versus
           Mediterranean diet on glycated hemoglobin in individuals with prediabetes
           and type 2 diabetes mellitus: The interventional Keto-Med randomized
           crossover trial

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      Pages: 1904 - 1904
      Abstract: This is a correction to: Gardner et al. Effect of a ketogenic diet versus Mediterranean diet on glycated hemoglobin in individuals with prediabetes and type 2 diabetes mellitus: The interventional Keto-Med randomized crossover trial. Am J Clin Nutr 2022;116:640–52.
      PubDate: Wed, 09 Nov 2022 00:00:00 GMT
      DOI: 10.1093/ajcn/nqac279
      Issue No: Vol. 116, No. 6 (2022)
       
 
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