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Resumo A alimentação adequada tem profundo impacto na saúde dos idosos, e uma especial atenção deve ser dada ao consumo de açúcares de adição na dieta, que em excesso está associado a pior controle das doenças crônicas nesta fase. O objetivo do estudo foi avaliar a prevalência do consumo de açúcares de adição de idosos da região de Campinas-SP, seus fatores associados e suas principais fontes alimentares. Trata-se de estudo transversal realizado na região de Campinas-SP, com amostra de conveniência de 586 idosos. O consumo foi obtido por meio de dois recordatórios de 24 horas, sendo inadequado se >5% do consumo energético total. Também foi calculada a contribuição dos alimentos em relação ao teor total de açúcares. Considerou-se nível crítico de p5% of total energy consumption were considered inadequate. The contribution of the groups and foods in relation to the total content of sugars was also calculated. A critical level of p

Background Nearly a third of young US children take multivitamin/mineral (MVM) dietary supplements, yet it is unclear how formulations compare with requirements. Objective Describe the number and amounts of micronutrients contained in MVMs for young children and compare suggested amounts on product labels to micronutrient requirements. Design Cross-sectional. Setting All 288 MVMs on the market in the United States in the National Institutes of Health’s Dietary Supplement Label Database in 2018 labeled for children 1 to Main outcome measures Number of MVM products and amounts per day of micronutrients in each product suggested on labels compared with requirements represented by age-appropriate Daily Values (DV). Micronutrients of public health concern identified by the Dietary Guidelines for Americans (DGA) 2015-2020 (DGA 2015) and DGA 2020-2025 (DGA 2020) or those of concern for exceeding the upper tolerable intake levels. Statistical analyses Number of products and percent DV per day provided by each micronutrient in each product. Results The 288 MVMs contained a mean of 10.1 ± 2.27 vitamins and 4.59 ± 2.27 minerals. The most common were, in rank order, vitamins C, A, D, E, B6, B12; zinc, biotin, pantothenic acid, iodine, and folic acid. For micronutrients denoted by the DGA 2015 and DGA 2020 of public health concern, 56% of the 281 products containing vitamin D, 4% of the 144 with calcium, and none of the 60 containing potassium provided at least half of the DV. The upper tolerable intake level was exceeded by 49% of 197 products with folic acid, 17% of 283 with vitamin A, and 14% of 264 with zinc. Most MVMs contained many of 16 other vitamins and minerals identified in national surveys as already abundant in children’s diets. Conclusions A reexamination of the amounts and types of micronutrients in MVMs might consider formulations that better fill critical gaps in intakes and avoid excess.

Methanol is present at high concentrations in unrecorded fruit spirits, placing consumers of these beverages at risk of exposure at high levels. When assessing any health risk it is necessary to consider blood methanol levels (BMLs), reference dose (RfD), and maximum tolerable blood methanol level (MTBML). The aim of our study was to estimate daily methanol intake and related BMLs attributable to drinking unrecorded fruit spirits in the European population using a probabilistic Monte Carlo simulation. Data on the concentration of methanol in unrecorded fruit spirits in European Union member states were collected and the health risk posed by consumption of unrecorded fruit spirits was estimated. We found that drinking unrecorded fruit spirits containing methanol at a concentration higher than 8598.1 mg/litre of pure alcohol (p.a.) or 6382.1 mg/litre of p.a. and also at least 10 g ethanol can result in a methanol intake above the RfD by men and women, respectively. We confirmed that consumption of unrecorded fruit spirits containing methanol does not result in BMLs higher than the MTBML. Further studies are required to assess whether there is any health risk from chronic exposure to methanol above the RfD from unrecorded fruit spirits.

Breast milk is an emerging matrix for vitamin D assessment of breastfed infants and their mothers. It is considered a more reliable indicator of infant intake than the assessment of maternal circulating vitamin D. With the improved sensitivity of mass spectrometry-based technologies, this method principle has been the recent mainstay for the quantitation of various vitamin D metabolites in breast milk for population-based clinical trials. There are still several areas across the total testing process (pre-analytical, analytical and post-analytical) to be defined and harmonised to translate breast milk vitamin D measurement by liquid chromatography-tandem mass spectrometry (LC-MS/MS) from population-based research to routine clinical use and public health applications. Pre-analytically, the determination of the best form of vitamin D to measure in breast milk requires more evidence. Analytically, standardisation of the methods to allow for comparability of results is required. Post analytically, breast milk vitamin D decision limits are needed to turn the individual numerical outputs into clinically meaningful results. This review aims to synthesise the current evidence and utility of measurement of breast milk vitamin D by LC-MS/MS and to lead a future discussion on best practices to allow for its clinical utility beyond its current research-based use.

Background and aims Food processing has been indicated as a factor capable of negatively affecting the global food system, including the profile of consumers’ diets. The objectives of the present study were to provide a description of the consumption of ultra-processed foods (UPFs) in the large population of children, adolescents and adults from eight European countries participating to the I.Family study, and to investigate the association between UPFs intake and nutritional quality of the diet. Methods and results Dietary intake was assessed using a 24-h dietary recall. The quality of the diet was evaluated by the Healthy Dietary Adherence Score (HDAS) using an FFQ. UPFs were classified according to the NOVA classification. Almost half of the daily energy intake of the 7073 participants came from UPFs, and this trend decreased progressively with age. UPFs contributed more than 50 % of the daily intake of total and saturated fat, carbohydrates and about 70 % of sugars intake in children and adolescents. No differences in UPFs consumption were found according to the educational and socio-economic status of the population. Energy intake increased across the quintiles of UPFs intake, while HDAS decreased. The frequency of consumption of fruit and vegetable, fish, and fibre rich foods was low in the fifth quintile of UPFs intake, both in adolescents and in adults. The consumption of foods rich in calories and low in nutritional content, operationally defined as “junk food”, was significantly higher in the fifth quintile. Conclusions In the population of the European I.Family study, UPFs contributed a large proportion of the daily energy intake, especially in children and adolescents. Higher consumption of UPFs was associated with a lower quality of the diet. Registration number for clinical trials ISRCTN62310987.

Background The link between high protein intake during infancy and obesity later in childhood has been much debated, and the association with differing protein sources remains unclear. Objective This study aimed to examine the associations between total protein intake and protein from different sources (ie, nondairy animal, dairy, and plant) reported at age 9 months and development in body mass index (BMI) z scores until age 5 years. Design This study involved a secondary data analysis of the Melbourne InFANT (Infant Feeding, Activity and Nutrition Trial) program, an observational prospective cohort study that was conducted from 2008 to 2013. Participants/setting Participants were children (n = 345) who completed both the 9-month and 5-year follow-up visits within the Melbourne InFANT program. Main outcome measures BMI z score was measured at age 5 years. Statistical analyses performed Linear mixed models with a random effect for clusters of mother’s group and with adjustment for baseline child and maternal covariates were conducted. Results With adjustment for covariates, every 1 g or 1% energy increase in total protein intake at age 9 months was associated with a 0.016-unit (95% CI 0.003 to 0.029) or 0.034-unit (95% CI 0.005 to 0.063) increase in BMI z score at age 5 years, respectively. With respect to protein sources, associations of similar magnitude were found for nondairy animal protein. No evidence of an association with BMI z score was found for dairy (including milk, yogurt, cheese, breast milk, and infant formula) and plant proteins. Conclusions High intakes of total protein, nondairy animal protein, but not dairy or plant proteins, during infancy were associated with higher BMI z score in early childhood. These findings can inform dietary recommendations regarding protein intakes during infancy. Clinical trial registration The InFANT program was registered with Current Controlled Trials (ISRCTN81847050); http://www.isrctn.com/ISRCTN81847050 .

BACKGROUND The content of essential and toxic elements in grilled fish (Atlantic salmon, trout) and in 20 assortments of fish products was examined. The aim of this study was to assess the fulfilment of the demand for Zn, Fe, Mn and Cu based on recommended dietary allowances (RDAs) or adequate intakes (AIs) and to assess the health risk associated with the consumption of Al, Pb and Cd. The risk assessment was based on estimated weekly intake (EWI), hazard index (HI), target risk ratio (THQ) and percentage: provisional tolerable weekly intake (PTWI) for Al, tolerable weekly intake (TWI) for Cd and reference dose lower bound (BMDL) for Pb. RESULTS Taking into account the health benefits, the best source of Fe, Cu and Mn was found to be fish products in cans and jars, 150 g of which covered the daily requirement: Fe 9.39%, Cu 2.91% and Mn 1.21%. Smoked fish covered the RDA for Zn to 5.69%. Moreover, the uptake of toxic elements was as follows: Al 0.45% PTWI: Pb 0.74% BMDL10 and Cd 2.20% TWI. The THQ values for Pb and Cd were significantly lower than 1, whereas for Al it reached as high as 4.0. CONCLUSION The obtained results indicate that there is no risk related to the intake of Pb and Cd with the consumption of the tested fish products. Low consumption of fish by Poles, however, contributes to their small share in covering the demand for microelements, i.e. Zn, Fe, Mn and Cu. © 2021 Society of Chemical Industry.

Background Excessive intake of sugar in young children is a public health concern. Our study objectives were to examine intakes of total, free and added sugar among preschool-aged children and to investigate their associations with body weight, body mass index Z-scores, percent fat mass and waist circumference. Methods The cross-sectional cohort study included preschool-aged children between 1.5 and 5 years of age, enrolled in pilot studies of the Guelph Family Health Study, Guelph, Ontario, from 2014 to 2016. Daily intake of total sugar was determined using a food processor software; daily intakes of free and added sugar, and food sources were determined through manual inspection of 3-day food records. Anthropometric measures were completed by trained research staff. We used linear regression models with generalized estimating equations to estimate associations between sugar intakes and anthropometric measures. Results We included 109 children (55 girls and 54 boys) in 77 families. Mean daily intakes were 86 (standard deviation [SD] 26) g for total sugar, 31 (SD 15) g for free sugar and 26 (SD 13) g for added sugar. Of participants, 80% (n = 87) had intakes of free sugar greater than 5% of their daily energy intake. The most frequent food sources of free and added sugar were bakery products. A weak inverse association between free sugar intake (kcal/1000 kcal) and waist circumference (cm) (β = -0.02, 95% confidence interval -0.04 to -0.0009) was found, but no significant associations were noted between sugar intake and other anthropometric measures. Interpretation Most of the preschool-aged children in this study had free sugar intakes greater than current recommendations; overall, their total, free and added sugar intakes were not associated with the anthropometric measures. This study can be used to inform policy development for sugar intake in young children and apprise early intervention programs.

Background and aims The association between isoflavone (ISF) consumption and cardiovascular disease (CVD) remains controversial because of limited evidence. Carotid atherosclerosis is an established indicator of subclinical CVD. The study aimed to investigate the relationship between dietary ISF intake and subclinical CVD in middle-aged and elderly adults. Methods and results A total of 873 subjects aged 40–70 years without CVD were enrolled in this cross-sectional study. A restricted cubic spline was used to investigate the association between ISF intake and subclinical CVD risk. The odds ratio (OR) and 95% confidence interval of the risk of subclinical CVD for ISF were estimated by two-segmented logistic regression analysis. In Model 2, there was a non-linear association between ISF intake and the risk of subclinical CVD among women (Pnon-linear = 0.002), with an inverse association below the change point. The nadir for the risk of subclinical CVD among women was 7.26 mg/day (energy-adjusted). Below the change point, an increase of 1 mg ISF/day reduced the risk of subclinical CVD by 15%. There was no significant association between ISF intake and subclinical CVD risk above the change point (OR = 1.01 [0.99, 1.04]). ISF intake was not associated with subclinical CVD risk in men (Model 2: Pnon-linear = 0.224). Conclusions Below the change point (7.26 mg/day), women with a higher intake of ISF had a significantly lower risk of subclinical CVD. Encouraging the consumption of ISF-rich foods may help to lower CVD risk in middle-aged and elderly women. Trial registration This study is registered at http://www.chictr.org.cn (ChiCTR 1900022445).

The 2019 Canada’s Food Guide (CFG) emphasizes consumption of plant protein with implications for protein adequacy and nutrient intakes, yet a baseline with which to compare future dietary trends that may result from its adoption is not available. The objectives were to assess usual protein intake, inadequacy, and the contribution of animal- and plant-based foods to intake of protein, nutrients, and energy in Canada. Twenty-four-hour dietary recalls from the 2015 Canadian Community Health Survey – Nutrition were used to assess dietary intake among adults (n = 13 616). The National Cancer Institute method was used to estimate usual protein intake and inadequacy. Population ratios were used to determine the contribution of animal- and plant-based foods to intake of protein, nutrients, and energy. Usual protein intake averaged 79.47 ± 0.70 g/d; inadequacy was highest for females ≥71 y (9.76 ± 2.04%). Top protein contributors were red and processed meat (21.6 ± 0.55%), poultry and eggs (20.1 ± 0.81%), cereals, grains, and breads (19.5 ± 0.31%), and dairy (16.7 ± 0.38%). Dairy contributed most to calcium (53.4 ± 0.61%), vitamin D (38.7 ± 1.01%), but also saturated fat (40.6 ± 0.69%), whereas cereals, grains, and breads contributed most to iron (46.5 ± 0.57%) and vegetables and fruit to potassium (32 ± 0.45%). Given that animal sources contributed overwhelmingly to protein intake in 2015, dietary shifts towards plant protein needed to meet the 2019 CFG recommendations may pose a challenge, particularly for populations most at risk of inadequacy. Novelty: Older adults and females are most at risk of not meeting protein recommendations. Animal sources contribute two-thirds of the protein consumed by Canadian adults.

Given the focus on developing Dietary Reference Intakes (DRIs) based on chronic disease risk reduction and recent research for omega-3 long chain PUFA since the last DRI review, the Canadian Nutrition Society convened a panel of stakeholders for a 1-day workshop in late 2019. Attendees discussed the new NASEM guidelines for establishing DRI values based on chronic disease risk endpoints and the strength of current evidence for EPA and DHA as it relates to the new guidelines. Novelty: Summarizes evidence and expert opinions regarding the potential for reviewing DRI values for EPA and DHA and cardiovascular disease risk and early development.

Little is known about the optimal daily magnesium (Mg) intake for individuals with high levels of physical activity. The aim of this study was to clarify the optimal dietary Mg intake for people with high levels of physical activity in a scoping review. In this review, we searched MEDLINE and Japan Medical Abstracts Society for studies published up to May 31, 2020. We conducted two searches, one for studies using gold standard measurement methods such as the balance method and factorial calculation (Search 1), and the other for studies using estimation from daily food intake (Search 2). We also performed a meta-analysis of studies that compared the Mg intake among physically active people with the Mg intake among controls. After the primary and secondary screening, 31 studies were included in the final review. All of the included studies examined professional or recreational athletes. We found no studies that examined the optimal intake of Mg using gold standard measurement methods. The Mg intake among physically active individuals was below the recommended dietary allowance in most studies. In five studies that conducted meta-analyses, physically active individuals had significantly higher intakes of Mg than controls, although these levels were still below the recommended dietary allowance. The present review revealed that evidence regarding the optimal daily magnesium intake is currently scarce, and further studies are needed.

BackgroundThis is the first study on dietary intakes of infants and young children in the Eastern Mediterranean Region, a region that is currently witnessing the nutrition transition. It aims at characterizing food consumption patterns amongst 0–4 year old children in Lebanon, evaluating their macro- and micronutrient intakes and assessing adherence to dietary recommendations.MethodsBased on a national cross-sectional survey in 2012 (n = 866), the study collected data on sociodemographic and anthropometric characteristics, and one 24-hour dietary recall was administered. Nutrient intakes were compared with reference values: Estimated Average Requirement (EAR), Adequate Intake (AI) and Acceptable Macronutrient Distribution Range (AMDR).ResultsMilk was the highest contributor to energy intake (EI) in infants (95.8 and 56.5% in 0–5.9 months and 6–11.9 months old infants, respectively), while its intake was lower among toddlers and preschoolers (35.4 and 15.1%, respectively). In contrast, intakes of sweets and sweetened beverages were the highest in preschoolers compared to younger children, contributing 18.5% EI in preschoolers. Compared to dietary guidelines, the lowest dietary adherence was found for vegetables (17.8–20.7%) and fruits (14.4–34.3%). Protein intake was within the recommendations for the vast majority of children. Although total fat intake was lower in toddlers and preschoolers compared to infants, more than 40% of toddlers and preschoolers exceeded the AMDR for fat and 87.3% of preschoolers exceeded the upper limit for saturated fat. Only 3.6% of toddlers and 11.5% of preschoolers exceeded the AI level for dietary fiber. Micronutrient intake assessment showed that mean intakes in infants exceeded the AI for all micronutrients, except for vitamin D and magnesium. In toddlers, vitamin D and calcium were below the EAR among 84.7, and 44.6%, respectively. In preschoolers, most of the children (91.9%) had inadequate intakes of vitamin D, and a third had inadequate intakes of folate, calcium and vitamin A.ConclusionsThis study identified priority issues for nutrition intervention in infants and young children in Lebanon. Concerted multi-stakeholder efforts are needed to instill heathier food consumption and nutrient intake patterns early in life.

Limited data are available on the association of dietary calcium intake and ulcerative colitis (UC). We aimed to investigate the relation between dietary calcium intake and UC prevalence in Iranian adults. In this population-based case–control study, diagnosed patients with UC by gastroenterologists that were registered in the Iranian inflammatory bowel disease registry were included as cases. Age and sex-matched healthy controls were selected from Study on the Epidemiology of Psychological, Alimentary Health and Nutrition (SEPAHAN) dataset. Dietary calcium intakes of participants were examined through a validated food frequency questionnaire. We included 327 middle-aged participants (109 cases and 218 controls) in the analysis; 52.1% of them were females. After adjustments for potential confounders, individuals in the third tertile of dietary calcium intake had 92% lower odds of UC, compared to those in the first tertile (OR = 0.08, 95% CI 0.02–0.27). Our analysis based on recommended dietary allowances (RDAs) intake showed that dietary Ca intake deficiency was related to increased odds of UC (OR = 9.5, 95% CI 2.98–30.91). Stratified analysis by gender revealed that these associations were significant in both genders; although the results were stronger in the male population. A Significant decreasing trend was observed for odds of UC in tertiles of dietary calcium intakes, in both males and females. Higher dietary calcium intake was associated with lower UC prevalence in Iranian adults. Inadequate dietary calcium intake was also linked to elevated odds of UC. Further prospective investigations are needed to affirm these findings.

The role of antioxidant intake in cardiovascular disease remains inconclusive. This study evaluates the association between antioxidant intake and the risk of major adverse cardiovascular events (MACE) among older Australian men.794 men aged ≥75 years participated in the 3rd wave of the Concord Health and Ageing in Men Project. Dietary adequacy of antioxidant intake was assessed by comparing participants' intake of vitamins A, E, C and zinc to the Nutrient Reference Values (NRV) for Australia. Attainment of NRVs of antioxidants was categorised into a dichotomised variable 'inadequate' (meeting≤2 of 4 antioxidants) or 'adequate' (meeting≥3 of 4 antioxidants). The usage of antioxidant supplements was assessed. The outcome measure was MACE. The composite MACE endpoint was defined as having one of the following: death, myocardial infarction, ischemic stroke, congestive cardiac failure (CCF), and revascularization during the period of observation. There was no significant association between dietary (HR: 1.03, 95% CI: 0.71, 1.48) or supplemental antioxidant intake (HR: 1.10, 95% CI: 0.75, 1.63) and overall MACE. However, a significant association was observed between inadequate antioxidant intake and CCF (HR: 1.32; 95% CI: 1.16, 1.50). The lowest quartile of zinc intake (11.00 mg/d) was significantly associated with CCF (HR 2.36; 95% CI: 1.04, 5.34). None of the other antioxidants were significantly associated with CCF or other MACE components.Inadequate dietary antioxidant intake, particularly zinc, is associated with increased risk of CCF in older Australian men but not associated with overall MACE.

Context Diets high in plant-based protein have gained popularity due to increasing health concerns regarding consumption of animal products. Though links between intakes of certain protein-rich foods and reproductive disorders have been suggested, the relationship of overall animal and vegetable proteins with reproductive hormones among reproductive-aged women is unknown. Objective To evaluate the associations between the intake of dietary protein with reproductive hormones and sporadic anovulation among reproductive-aged women. Design A prospective cohort study, 2005–2007. Setting University at Buffalo, western New York, United States. Participants A total of 259 premenopausal women (18–44 years) without dietary restrictions. Main Outcome Measure(s) Serum reproductive hormones were determined up to 8 times per cycle for 2 cycles. Protein intake was assessed the day prior to hormone assessment at 4 visits/cycle using 24-hour recalls. Results Overall, 84% of participants met the recommended dietary allowance for total protein set for reproductive-aged women. Neither total nor animal protein intake were associated with reproductive hormones or anovulation. However, vegetable protein intake in the lowest tertile was associated with lower luteal phase progesterone (-18.0%, 95% confidence interval [CI] -30.2, -3.6), higher follicle-stimulating hormone (3.8%, 95% CI 0.2, 7.6), and a higher risk of anovulation (risk ratio [RR] 2.53, 95% CI 1.21, 5.26), compared with the middle tertile. Nuts and seeds were the only protein-rich foods associated with an elevated risk of anovulation (RR 2.12, 95% CI 1.17, 3.85). Conclusions Findings suggest that among women who meet the recommended dietary allowance for total protein, low intake of vegetable, but not animal, protein may disturb normal ovulatory function.

The risk of child vitamin A deficiency (VAD) in low and middle income countries (LMICs) begins during the age range of complementary feeding (6-24 months), when children are fed complementary foods (CFs) deficient in vitamin A. However, pumpkin, a source of provitamin A carotenoids (PVACs) is widely cultivated in LMICs, but underutilized as a complementary food. Moreover, when consumed by humans, PVACs are bioconverted to retinol, the active form of vitamin A used by the body. This study evaluated the potential of pumpkin toward combating VAD by reviewing varieties of pumpkin cultivated in LMICs and their provitamin A carotenoid (PVAC) content; retention of PVACs in pumpkin during processing it as a CF; and the extent to which a CF prepared from pumpkin may meet the dietary reference intakes (DRIs) for vitamin A for children aged 6-24 months old. Pumpkin may combat VAD because the varieties cultivated have high β-carotene content, it is a provitamin A biofortifiable food crop, and 100% retention of PVACs was observed when processed using home cooking methods. Feeding less than 50 g of cooked pumpkin per day meets 100% of the recommended dietary allowance (RDA) and adequate intake (AI) of vitamin A for children 6 to 24 months old. Consumption of pumpkin may be used to complement vitamin A supplementation, fortification, and diversification of CFs with animal source foods. For better yield of pumpkin in LMICs, nutrition sensitive agricultural programmes such as biofortification and agronomic management of pumpkin need to be promoted and supported.

BACKGROUND: Hypertensive pregnancy is associated with increased long-term cardiometabolic disease risk. Assessing dietary intake patterns after hypertensive (HP) versus normotensive pregnancy (NP) may provide insights into the mechanism of this risk. METHODS: This study was a prospective sub-study of the P4 (Postpartum, Physiology, Psychology and Paediatrics) cohort. Women were studied six months after NP versus HP (preeclampsia or gestational hypertension). Dietary energy, macronutrient and micronutrient intake were measured using a three-day food diary (FoodWorks™) and assessed against Australian and New Zealand Nutrient Reference Values to determine nutritional adequacy. Comparisons between breastfeeding and non-breastfeeding women were assessed, and linear regression modelling (using hypertensive status, breastfeeding status, and demographic/pregnancy variables) performed to assess predictors of energy intake. RESULTS: Seventy-four women (60 NP, 14 HP) were included. HP women had higher mean body mass index (p = 0.02) and lower breastfeeding rates (29% HP versus 83% NP, p

Adequate magnesium intakes are associated with lower diabetes, hypertension, and cardiovascular disease (CVD) risk but are low in modern diets. Magnesium DRIs, estimated using standard reference body weights (SRBWs) lower than current mean US adult body weights (BWs), need revision. Magnesium DRIs assume variance at 10% CV, whereas balance study data suggests 20–30% CV. Here, estimated average requirements (EARs), the DRI measure estimating average magnesium requirements for healthy adults, were corrected using 2011–2014 mean US adult BWs. Magnesium EARs (in mg magnesium/d) increased 17% for men (330–350 to 386–409) and 25% for women (255–265 to 319–332). RDAs, the DRI measure meant to cover the magnesium needs of 98% of healthy adults, were calculated using BW-corrected EARs given 3 CV levels: 1) 10% (assumed in 1997 DRIs), 2) 20% (model-derived variance from USDA magnesium studies), and 3) 30% (using USDA plus older human magnesium balance data). BW-corrected magnesium RDAs (in mg magnesium/d) rose from 400–420 and 310–320 for men and women, respectively, to 1) 463–491 and 383–398 (16.5% and 23.5% increases), 2) 540–573 and 447–465 (35.5% and 44.5% increases), and 3) 617–654 and 511–531 (55% and 65.5% increases). These recalculations move magnesium intakes estimated to prevent disease into ranges found in traditional diets and to intake levels shown to lower hypertension, diabetes, and CVD risk. In conclusion, mean BW rises over the last ≥20 y and data-driven estimates of CV indicate that reliable US adult magnesium RDAs are ≥60–235 and 70–210 mg magnesium/d higher for men and women, respectively, than the current 1997 RDAs. US adult BMIs are 25 with actual mean BWs. Adjustments for rising BW are necessary for magnesium DRIs to remain useful tools for defining magnesium intake adequacy/deficiency.

Background and aims Low potassium intake, in addition to high sodium, has been associated with higher risk of hypertension and CVD. The Study assessed habitual potassium intake and sodium/potassium ratio of the Italian adult population from 2008 to 2012 to 2018–2019 based on 24-h urine collection, in the framework of the CUORE Project/MINISAL-GIRCSI/MENO SALE PIU’ SALUTE national surveys. Methods and results Data were from cross-sectional surveys of randomly selected age-and-sex stratified samples of resident persons aged 35–74 years in 10 (out of 20) Italian regions. Urinary electrolyte and creatinine measurements were performed in a central laboratory. Analyses considered 942 men and 916 women, examined in 2008–2012, and 967 men and 1010 women, examined in 2018–2019. In 2008–2012, the age-standardized mean of potassium intake (urinary potassium accounts for 70% of potassium intake) was 3147 mg (95% CI 3086–3208) in men and 2784 mg (2727–2841) in women, whereas in 2018–2019, it was 3043 mg (2968–3118) and 2561 mg (2508–2614) respectively. In 2008–2012, age-adjusted prevalence of persons with an adequate potassium intake (i.e. ≥ 3510 mg/day) was 31% (95% CI 28–34%) for men and 18% (16–21%) for women; in 2018–2019, it was 26% (23–29%) and 12% (10–14%) respectively. The sodium/potassium ratio significantly decreased both in men and women. Conclusions The average daily potassium intake of the Italian general adult population remains lower than the WHO and EFSA recommended level. These results suggest the need of a revision to strengthen initiatives for the promotion of an adequate potassium intake at the population level.

Background Clinical trials have demonstrated magnesium supplements to be effective for prophylactic treatment of migraine. Dietary magnesium intake of many Americans is known to be below nutritional recommendations, but typical magnesium intake from dietary sources in adults with migraine has not previously been evaluated. Objective This study aimed to quantify dietary and total (diet + supplement) magnesium consumption of adults with migraine or severe headache in the United States, and to investigate the relationship between magnesium consumption levels and prevalence of migraine or severe headache. Methods This analysis included cross-sectional data from 3626 participants, 20- to 50-years old in the National Health and Nutrition Examination Survey between 2001 and 2004. Presence of migraine or severe headache in the past 3 months was determined by questionnaire. Individuals responding affirmatively were classified as having migraine, and individuals reporting not experiencing migraine or severe headache were classified as controls. Dietary magnesium intake was determined from a 24-hour recall interview, supplemental magnesium intake was determined from the dietary supplements interview, and total magnesium intake was the sum of dietary and supplement intake. Results Mean dietary consumption of magnesium was below the recommended dietary allowance (RDA) for both migraine (n = 905) and control groups (n = 2721). Attainment of the RDA through a combination of diet and supplements was associated with lower adjusted odds of migraine (odds ratio [OR] = 0.83, 95% confidence intervals [CIs] = 0.70, 0.99, p = 0.035). Magnesium consumption in the highest quartile (Q) was associated with lower odds of migraine than in the lowest Q for both dietary (OR = 0.76, 95% CI = 0.63, 0.92, p = 0.006) and total (OR = 0.78, 95% CI = 0.62, 0.99, p = 0.042) magnesium intake in adjusted models. Conclusion These results suggest inadequate consumption of magnesium intake is associated with migraine in U.S. adults ages 20-50. Further prospective investigations are warranted to evaluate the role of dietary magnesium intake on migraine.

Calcium is an essential element for human health, with key roles in the prevention and therapy of multifactorial conditions. Calcium dietary intake is often insufficient in the general population. The aim of this study was to perform a clinical audit for general practitioners (GPs) to understand the efficacy of training intervention on doctors' awareness about dietary calcium and supplements.General practice outpatients were enrolled (Before Clinical Audit, BCA) from the same sanitary district, and calcium dietary intake was evaluated with a validated questionnaire, also collecting information about the consumption of calcium and vitamin D supplements. Then, a training intervention with a frontal lesson and discussion with GPs involved was performed. After one month of this intervention, a second outpatient enrolment was performed (Post Clinical Audit, PCA) in the same general practices to evaluate differences in nutritional suggestions and supplement prescription by GPs. In BCA, the calcium dietary intake was low, with nobody reaching 1000 mg as suggested by the guidelines. Only 6.6% and 24.5% took calcium and vitamin D supplements, respectively; in the PCA, these percentages increased to 28% and 78% for calcium and vitamin D supplements, respectively (p 0.01 PCA vs BCA). There were no differences in calcium dietary intake between BCA and PCA.Training intervention on GPs was successful to sensitize them regarding calcium intake problems; GPs tended to increase the prescription of supplements but not to suggest changes in dietary habits.

Dietary Reference Intakes for Japanese (DRIs) are revised every five years. In DRIs 2020, major revision has been made on vitamin D (VD). In DRIs, five indices are defined for nutrients; estimated average requirement (EAR), recommended dietary allowance (RDA) and adequate intake (AI) for the prevention of deficiency/insufficiency, tolerable upper intake level (UL) for avoiding excess intake, and tentative dietary goal for preventing life-style related diseases (DG) for the primary prevention of life-style related diseases. For VD, AI has been determined. VD deficiency causes rickets and osteomalacia. VD insufficiency, milder than deficiency, is a risk for various diseases including osteoporotic fracture. Previously, the basis of AI for VD was the prevention of rickets and osteomalacia, but was changed to the median intake of healthy subjects in DRIs 2005. Recent studies have shown, however, that VD deficiency/insufficiency is quite prevalent, and the above basis is considered inadequate. Then in DRIs 2020, AI was defined as the amount necessary for fracture prevention (15 μg/d) minus that possibly produced in Sapporo during winter in the skin by ultraviolet (5 μg/d). UL and AI for infants were revised in DRIs 2015. For the future DRIs, more clinical and epidemiological studies are urgently needed.

The revised version of Canada’s Food Guide, released in January 2019, issued new guidance by combining meat and alternatives with milk and alternatives into a single group called “protein foods” and emphasized selecting plant-based foods from this category more often. Though the changes represent a simple depiction of a healthy plate, the new Food Guide has opened knowledge gaps about protein foods and exposed new concerns about the interpretation and implementation of the Food Guide among vulnerable groups, particularly children and the elderly. To address key knowledge and research gaps, nutrition leaders need to reach a consensus on key messages to best inform the development of tools and resources to support practitioners in translating messages to consumers, including foodservice standards. Among consumers, families with young children are a primary target for these resources as they develop their life-long habits to ensure they have the knowledge and skills to select, prepare, and consume nutrient-rich protein foods. The new Food Guide provides an opportunity to address the existing knowledge gaps, develop tools and resources to support health professionals, and design interventions that will help Canadian families choose, prepare, and eat nutrient-rich protein foods. Novelty An updated Canadian regulatory framework is needed for protein labelling and content/health claims. There are knowledge gaps about protein foods consumption and food literacy needed to optimize nutritional health. Mandatory nutrition policies are needed to safeguard the provision of high-quality protein foods across institutions that serve children and older adults.

Prevalence of micronutrient malnutrition is high in individuals living in long-term care (LTC) homes with many individuals consuming low levels of vitamins B6, D, and E; folate; calcium; magnesium; and zinc. The focus of this research was to identify strategies and challenges encountered during development of micronutrient-dense menus for use in Ontario LTC homes and to examine costs associated with development of a menu with acceptable micronutrients. Semi-structured open-ended interviews were conducted with 13 menu planners (7 dietitians, 6 nutrition managers) in diverse LTC homes in Ontario. Data were thematically analyzed. A 7-day hypothetical menu meeting all nutrient requirements was developed and costed. Analysis of the interview data showed that menus are planned according to the Canada’s Food Guide (2007) and focus placed on Dietary Reference Intakes of protein, fibre, calcium, and sodium. Little focus is placed on micronutrients. Flexibility in foods offered was important to accommodate the small volume of food consumed. Resident preferences were balanced against nutritional requirements. Challenges included planning for diverse populations, managing portion sizes, and balancing the budget. A hypothetical menu planned to contain adequate levels of all micronutrients is 49% higher in food costs than the amount currently provided to Ontario LTC homes.

Background: There has been tremendous progress over the past 25 years to control iodine deficiency disorders (IDDs) through universal salt iodization (USI). In 2019, using the median urinary iodine concentration (MUIC), only 19 countries in the world are classified as iodine deficient; in contrast in 1993, using the total goiter rate (TGR), 113 countries were classified as iodine deficient. However, few analyses have tried to quantify the global health and economic benefits of USI programs, and the shift from TGR to MUIC as the main indicator of IDDs complicates assessment of progress. Methods: We used a novel approach to estimate the impact of USI on IDDs, applying a regression model derived from observational data on the relationship between the TGR and the MUIC from 24 countries. The model was used to generate hypothetical national TGR values for 2019 based on current MUIC data. TGR in 1993 and modeled TGR in 2019 were then compared for 139 countries, and using consequence modeling, the potential health and economic benefits realized between 1993 and 2019 were estimated. Results: Based on this approach, the global prevalence of clinical IDDs (as assessed by the TGR) fell from 13.1% to 3.2%, and 720 million cases of clinical IDDs have been prevented by USI (a reduction of 75.9%). USI has significantly reduced the number of newborns affected by IDDs, with 20.5 million cases prevented annually. The resulting improvement in cognitive development and future earnings suggest a potential global economic benefit of nearly $33 billion. However, 4.8 million newborns will be affected by IDDs in 2019, who will experience life-long productivity losses totaling a net present value of $12.5 billion. Conclusions: The global improvements in iodine status over the past 25 years have resulted in major health and economic benefits, mainly in low- and middle-income countries. Efforts should now focus on sustaining this achievement and expanding USI to reach the continuing large number of infants who remain unprotected from IDDs.

Background Colorectal cancer (CRC) has emerged as a major public health concern. However, little is known about the burden attributable to specific risk factors. The present study aimed to estimate the temporal trends and geographical variation of CRC burden attributable to a diet low in milk in China. Methods Following the general analytic strategy used in the 2017 Global Burden of Disease study, we assessed the age-, sex-, and province-specific mortality and disability-adjusted life-years (DALYs) of CRC caused by a diet low in milk in China from 1990 to 2017. Results In 2017, a diet low in milk contributed 32 032 [95% uncertainty interval (UI) = 11 350-53 806] deaths and 726 710 (95% UI = 256 651-1 218 153) DALYs for CRC with a population attributable fraction of 17.1%. The age-standardised mortality and DALY rates per 100 000 were 1.7 (95% UI = 0.6-2.9) and 36.8 (95% UI = 13.0-61.7), respectively. An upward trend with age in rates of mortality and DALYs was observed. Males had higher age-standardised rates than females. The number of deaths and DALYs increased significantly from 1990 to 2017, whereas the corresponding age-standardised rates showed relatively stable trends. In 2017, Hunan and Liaoning were ranked as the top two provinces in terms of disease burden. Socio-demographic index had a weak correlation with the age-standardised mortality (r = 0.348, P = 0.047). Conclusions The present study shows a substantial increase in the CRC burden attributable to a diet low in milk over the past three decades. Greater priority in CRC prevention should be given to males and the elderly population throughout China, particularly in less-developed provinces.

Adherence to a gluten-free diet (GFD) is the only available treatment for gluten-related disorders, although a GFD may also be followed for discretionary reasons. The main objectives of the present study were to (1) describe and test for differences in key nutrient intakes among Canadians who follow a GFD compared with Canadians with no dietary exclusions and (2) describe additional dietary avoidances adhered to by Canadians who avoid gluten. We conducted a secondary analysis of the cross-sectional 2015 Canadian Community Health Survey-Nutrition Survey, which included a general health survey and 24-h dietary recall (n20 487). Participants were categorised as those who avoid dietary gluten and those who reported no avoidances. Key nutrient intakes were assessed, as a percentage of Dietary Recommended Intakes, including fibre, B vitamins, vitamin D, Ca, Fe, Na and Zn, and compared between the two groups usingttests. Canadians who avoided gluten had significantly lower intakes of folate, vitamin B12, vitamin D, Fe, Na and Ca compared with those who did not avoid any food groups. However, Canadians who reported following a GFD were significantly more likely to use vitamin or mineral supplements in the past 30 d. More than 20 % of those who avoided gluten also avoided dairy products. Findings suggest that following a GFD places Canadians at risk for nutrient inadequacies, particularly folate, Ca and vitamin D. Further research is required to further examine how multiple dietary avoidances among those who avoid gluten may contribute to dietary inadequacies.

Dietary guidelines (DG) have the objective to promote healthy diet and prevent chronic diseases. In order to evaluate if this purpose is being achieved, we systematically reviewed studies that associated adherence to DG with obesity. We identified 2012 articles published in the last 5 years, and 38 remained in the final sample. The majority of studies demonstrated a negative association between adherence to DG and obesity. Studies with positive or no association presented mutual characteristics, such as populations composed only by children or adolescents, and dietary intake or dietary adherence assessed through non-validated or weak methods. Adherence to DG seems to be a protective factor for obesity in adults, but this relationship is not so clear for children and adolescents. To improve the quality of dietary intake results, studies must utilize appropriate methods to answer their questions with less biased estimate of dietary intake.

Background and aims Dietary macronutrient composition plays an important role in the prevention of cardiovascular disease (CVD). This study aimed at assessing the iso-energetic substitution of dietary macronutrients in relation to the incidence of CVD. Materials and results This prospective study was conducted on 5102 individuals of Tehran lipid and glucose study participants, aged 20–70 years who were followed for 5.3 years. A valid and reliable semi-quantitative food frequency questionnaire was used to assess dietary intakes. The hazard ratio of CVD for each 5% of energy from macronutrients at the expense of another macronutrient was calculated using the substitution model. During follow-up, a total of 206 CVD outcomes were identified. Mean age of participants (44.2% men) was 47.0 ± 12 and 45.6 ± 11 for men and women, respectively. Substituting 5% of energy from all types of macronutrients by 5% percentage of energy from combined saturated fatty acids (SFA) and monounsaturated fatty acids (MUFA) was associated with a decrease in the risk of CVD by almost 20%. Higher energy intake from total-, starchy-, and nonstarchy carbohydrates replaced by other macronutrients was not significantly associated with the risk of CVD. Each 5% of energy from animal protein (HR: 1.09 and CI: 1.02–1.16) independently increased the risk of CVD in the adjusted Cox proportional hazard regression analyses. Conclusion Higher percentage of energy from animal protein independently increased the risk of CVD, replacement of SFA and MUFA together with other macronutrients was inversely associated with CVD risk.

Background and aims The association between daily egg intake and dyslipidemia remains a contentious issue. Therefore, our study was aimed to explore the relation of daily egg intake to lipid profile; and whether the association was mediated by body mass index (BMI). Methods and results A total of 39,021 participants (18–79 years) were enrolled from the Henan Rural Cohort Study. Data on egg consumptions and blood lipid indices were collected with standardized processes. Logistic regression and restricted cubic splines were used to estimate the odds ratio (OR) and 95% confidence intervals (95% CI). Mediation analysis using bootstrap was performed to examine the contribution of BMI to daily egg intake and HDL-C. The participants were divided into 3 egg intake groups (＜26.79 g/d, 26.79–62.50 g/d, ＞62.5 g/d). According to our results, comparing with the low daily egg consumption group, medium and high egg intake tertiles were related with increased high-TC (ORmedium = 1.546, 95%CI (1.417,1.688); ORhigh = 1.902,95%CI (1.703, 2.124)), high LDL-C (ORmedium = 1.224, 95%CI (1.121, 1.337); ORhigh = 1.368,95%CI (1.220, 1.534)) and non-HDL-C(ORmedium = 1.486,95%CI(1.358,1.625); ORhigh = 1.715,95%CI (1.499, 1.888)), as well as inversely associated with high-TG (ORmedium = 0.825, 95% CI(0.778, 0.875); ORhigh = 0.778,95%CI(0.718,0.844)) and low HDL-C (ORmedium = 0.914, 95%CI (0.858, 0.973); ORhigh = 0.756,95%CI(0.693,0.825)). Moreover, mediation analysis showed that both of BMI and WC partly mediated the relationship between daily egg intake and HDL-C. Conclusions Our results suggested that the daily egg intake may have a role in effect on lipid profiles, and the effect of daily egg intake on HDL-C may be partly mediated by BMI and WC.

Background: A balanced diet is important for ensuring health and development in childhood. As preschool is the main place of childcare, the meals that they provide have a critical influence on children’s dietary intake. Aim: The objectives of this study were to evaluate the nutrition status of preschool meals and to compare the food and nutrient content in public and private preschool meals. Methods: This was a cross-sectional study of 12 randomly sampled, public and private preschools in Taichung City, Taiwan. The background questionnaires, which included the meal budget and provision status of preschool meals, were completed either by the principals or supervisors of the preschools. The food and nutrition levels of preschool meals were assessed by weighing the actual food provided to the preschool children. In addition, preschool menus were collected to evaluate the meals and food served. Results: Overall, the mean calcium provision of preschools was lower than half the daily dietary reference intake (DRI), and the mean sodium was higher than half the DRI. The mean energy, carbohydrate, protein, fat, iron and vitamins B1, B2 and C supplied by the public preschools were significantly higher than those in the private preschools. In addition, the whole grains, meat, vegetables, fruits, oil and nuts supplied in public preschools were significantly higher than those found in private preschools. Conclusions: The mean energy and macronutrient provision of public preschools were significantly higher than those found in private preschools. Meal quality and nutrient levels offered in public preschools were generally higher than those found in private preschools.

Summary Background & aims Children on long-term tube-feeding often need special treatment for oral feeding transitioning. Rapid tube-weaning programs usually result in short-term reductions in food intake and weight loss. This study examined the long-term effects of a “Graz-model” based weaning program on nutritional status and growth. Methods Children aged 0.5–13.0 years on long-term enteral nutritional support (ENS) participated in a three-week multidisciplinary weaning treatment. Data were collected at baseline, after completing the program, and at six and 12 months. Height/length, weight and BMI z-scores were determined according to the WHO growth standards. Energy and protein intake were assessed and presented as % of recommended daily allowance (RDA) values. Results Study participants (n = 58) were 64% male. Four children did not complete the three-week program due to acute illnesses. Complete weaning (from 100% ENS to 100% oral) was achieved in 22 children and partial weaning (at least 80% reduction of ENS) in 23 children. No demographic or clinical success predictors were identified. Thirty of the 45 weaned children completed the 12-month follow-up. A significant reduction in energy intake was observed at the three-week time-point [mean (SE): 56 (5.8)% versus 80 (4.7)%, p = 0.001]. This was followed by improvements in eating skills leading to energy intake at 12 months which did not significantly differ from baseline (p = 0.392). Mean (SE) baseline protein intake was 187 (13.0) %RDA. No significant difference from baseline were noted at 12 months (p = 0.301). Estimated mean (SD) height-, weight- and BMI z-scores at baseline were −2.11(0.28), −1.48(0.25), −0.13(0.31), respectively. No significant differences in growth data were observed over time. Conclusions Short-term reductions in nutritional intake and body weight observed after an intensive weaning program were reversible, and growth patterns were stable over 12 months. Further follow-up is recommended to ensure continued positive development in these children.

Dietary reference intakes (DRIs) are quantitative, nutrient intake–based standards used for assessing the diets and specific nutrient intakes of healthy individuals and populations and for informing national nutrition policy and nutrition programs. Because nutrition needs vary by age, sex, and physiological state, DRIs are often specified for healthy subgroups within a population. Diet is known to be the leading modifiable risk factor for chronic disease, and the prevalence of chronic disease is growing in all populations globally and across all subgroups, but especially in older adults. It is known that nutrient needs can change in some chronic disease and other clinical states. Disease states and/or disease treatment can cause whole-body or tissue-specific nutrient depletion or excess, resulting in the need for altered nutrient intakes. In other cases, disease-related biochemical dysfunction can result in a requirement for a nonessential nutrient, rendering it as conditionally essential, or result in toxicity for a food component at levels usually tolerated by healthy people, as seen in inborn errors of metabolism. Here we summarize examples from a growing body of literature of disease-altering nutrient requirements, supporting the need to give more consideration to special nutrient requirements in disease states.

Background: A better understanding of nutrient intakes and predicting factors will help in designing more effective programs that address the nutrition requirements of pastoral children. Methods: Dietary diversity score (DDS) and amounts of food items consumed were recorded for 538 children aged 6 to 59 months from August to October 2015. The nutrient contents per 100 grams of foods consumed by children were calculated. Median energy and nutrient intakes of children were calculated and compared with the World Health Organization (WHO) recommended nutrient intakes (RNI). The effects of various factors on the median energy adequacy ratio (EAR) and on nutrient adequacy ratio (NAR) were analyzed using logistic regression. Results: Children had low DDS (2.7) with diets dominated by dairy and cereal preparations. Thus, only a few children received the minimum DDS (11.7%) and minimum acceptable diet (5%). Most of the children had low intakes of energy, vitamins (C, B, A, folic acid), iron, and zinc. Autonomy of mothers in decision-making, nonpastoral incomes, crop cultivation, and keeping diverse livestock species had positive effects on nutrient intakes. Children living in villages closer to markets and those aged 6 to 23 months had better NAR than others. The median EAR was higher for children aged 6 to 23 months, when households possessing more animal species and engaged in crop cultivation compared to others. Conclusion: Study children had lower DDS than WHO standards and intakes of several micronutrients were inadequate. Variables associated with median EAR and NAR point to those in need of improvement.

Background Understanding how nutrient intake in older women compares with recommendations is important. The Academy of Nutrition and Dietetics position statement summarizes the nutrient needs of older adults (aged ≥60 years) based on a systematic review. Objective The objective of this study was to compare nutrient intake of Women's Health Initiative Long Life Study participants to the Dietary Reference Intakes for nutrients reviewed in the Academy of Nutrition and Dietetics position statement. Design The study is a cross-sectional analysis. Participants/setting Participants (n=7,875) were mailed the General Nutrition Assessment Food Frequency Questionnaire during 2012-2013, of whom 77% (n=6,095) completed it, and 5,732 were included in the analytic sample after exclusion for implausible energy intakes. Main outcome measures Mean intake of energy and protein, calcium, fiber, folate, potassium, sodium, vitamins B-12, D, E, and K were described overall and compared with recommendations. Statistical analyses performed Demographic and lifestyle characteristics were summarized using descriptive statistics. The proportion of participants meeting recommendations was computed. Results Mean age of completers was 79±7 years and 53.5% were non-Hispanic white, 30% were non-Hispanic black, and 16.5% were Hispanic/Latina. Only one-third of women consumed ≥21 g/day fiber, whereas fewer met the Recommended Dietary Allowance for calcium (18.6%), vitamin E (16.9%), and vitamin D (1.7%). Just more than half (56%) of participants met the Recommended Dietary Allowance for protein of 0.8 g/kg body weight/day, and just less than half (47.0%) met potassium guidelines. Conclusions These findings suggest older women within the Women’s Health Initiative were generally not achieving recommended intake for several key nutrients highlighted by the Academy of Nutrition and Dietetics position statement. These findings underscore the need to identify effective approaches for improving the nutrient density of dietary intake in older women.

Heart Failure (HF) incidence is increasing steadily worldwide, while prognosis remains poor. Though nutrition is a lifestyle factor implicated in prevention of HF, little is known about the effects of macro- and micronutrients as well as dietary patterns on the progression and treatment of HF. This is reflected in a lack of nutrition recommendations in all major HF scientific guidelines. In this state-of-the-art review, we examine and discuss the implications of evidence contained in existing randomized control trials as well as observational studies covering the topics of sodium restriction, dietary patterns and caloric restriction as well as supplementation of dietary fats and fatty acids, protein and amino acids and micronutrients in the setting of pre-existing HF. Finally, we explore future directions and discuss knowledge gaps regarding nutrition therapies for the treatment of HF.

Background and aims Increased intake of whole/coarse grains was associated with improved blood pressure control, but concurrent metabolism alterations are less clear. We sought to identify metabolomic profiles of blood pressure, and to explore their mediation effects on the coarse grain intake-blood pressure association among young adults free of hypertension. Methods and results Plasma metabolome of 86 participants from the Carbohydrate Alternatives and Metabolic Phenotypes study was characterized by untargeted lipidomics and metabolomics using liquid chromatography–high-resolution mass spectrometry. We identified 24 and 117 metabolites associated with systolic blood pressure (SBP) and diastolic blood pressure (DBP), respectively, using random forest modeling and partial correlation analysis. Moreover, metabolite panels for highly specific prediction of blood pressure (8 metabolites for SBP and 11 metabolites for DBP) were determined using ten-fold cross-validated ridge regression (R2 ≥ 0.70). We also observed an inverse association between metabolite panel of SBP (β ± SE = −0.02 ± 0.01, P = 0.04) or DBP (β ± SE = −0.03 ± 0.01, P = 0.02) and coarse grain intake. Furthermore, we observed significant mediating effects of metabolites, in particular, sphingolipid ceramides, on the association between coarse grain exposure and blood pressure using both bias-corrected bootstrap tests and high-dimensional mediation analysis adapted for large-scale and high-throughput omics data. Conclusions We identified metabolomic profiles specifically associated with blood pressure in young Chinese adults without diagnosed hypertension. The inverse association between coarse grain intake and blood pressure may be mediated by sphingolipid metabolites.

Based on decades of research, there is strong evidence that supports ongoing dietary recommendations to decrease intakes of SFAs and, more recently, to replace SFAs with unsaturated fat, including PUFAs and MUFAs. Epidemiologic research has shown that replacement of SFAs with unsaturated fat, but not refined carbohydrate and added sugars, is associated with a reduction in coronary heart disease events and death. There is much evidence from controlled clinical studies demonstrating that SFAs increase LDL cholesterol, a major causal factor in the development of cardiovascular disease. When each (nonprotein) dietary macronutrient isocalorically replaces SFA, the greatest LDL-cholesterol-lowering effect is seen with PUFA, followed by MUFA, and then total carbohydrate. New research on full-fat dairy products high in saturated fat, particularly fermented dairy foods, demonstrates some benefits for cardiometabolic diseases. However, compared with food sources of unsaturated fats, full-fat dairy products increase LDL cholesterol. Thus, current dietary recommendations to decrease SFA and replace it with unsaturated fat should continue to the basis for healthy food-based dietary patterns.

Background and aim Along with the increasing evidence of the cardioprotective effects of the Mediterranean Diet (MD), the scientific interest and advocacy of dietary variety as a potentially healthy eating habit gradually faded, until its complete oblivion in the latest European cardiovascular prevention guidelines. Our study aims to investigate whether dietary variety adds to the “Mediterranean-ness” of the diet in protecting against coronary heart disease (CHD). Methods and results In this case–control Italian study, data on eating habits were collected from 178 patients with CHD and 155 healthy controls, primarily males, frequency matched for age and gender, using the Food Frequency Questionnaire (FFQ) of the European Prospective Investigation into Cancer and Nutrition. Adherence to MD was estimated from FFQ by the Mediterranean Diet Score (MDS), an index developed by Trichopoulou (2003) ranging from 0 to 9, with higher scores indicating a stricter adherence. Overall dietary variety was computed from FFQ as a count of single food items consumed at least once a month. Associations between MDS or overall dietary variety and coronary status were evaluated by logistic regression models adjusted for BMI, physical activity, smoking, education, and caloric intake; the Odds Ratio (OR) for CHD for each 1.5-point increase in MDS was 0.76 [IC 95% 0.59; 0.98], whereas the OR for CHD for each 15-item increase in dietary variety was 0.62 [IC 95% 0.46; 0.84]. Remarkably, adherence to MD and overall dietary variety were independently associated with a significantly reduced chance of CHD. Conclusion Dietary Mediterranean-ness and overall dietary variety exhibit additive cardioprotective effects.

Background and aims The relationships between dietary protein intake and risk of all-cause, cardiovascular disease (CVD), and cancer mortality are still unclear. We conducted a systematic review with meta-analysis of cohort studies to summarize the evidence. Methods and results We searched PubMed and Web of Science for relevant studies through February 2020. The associations of total, animal, and plant proteins with all-cause, CVD, and cancer mortality were evaluated. Study-specific relative risks (RR) were pooled using the fixed effect model when no significant heterogeneity was detected; otherwise the random effect model was employed. Twelve cohort studies were eligible for the study. Increased total protein showed no clear association with risk of all-cause, CVD, and cancer mortality. In the stratified analysis by protein sources, higher plant protein intake was associated with a reduced risk of all-cause mortality (highest vs lowest intake: RR = 0.92; 95% CI: 0.88, 0.96; each 3% increment of intake: RR = 0.97; 95% CI: 0.94, 0.99), and may be associated with a reduced risk of CVD mortality (highest vs lowest intake: RR = 0.90; 95% CI: 0.80, 1.01; each 3% increment of intake: RR = 0.95; 95% CI: 0.91, 0.99). Moreover, higher intake of animal protein may be associated with an increased risk of CVD mortality (highest vs lowest intake: RR = 1.11; 95% CI: 1.01, 1.22; each 3% increment of intake: RR = 1.02; 95% CI: 0.98, 1.06). Conclusion This study demonstrates that higher plant protein intake is associated with a reduced risk of all-cause and CVD-related mortality. Persons should be encouraged to increase their plant protein intake to potentially decrease their risk of death.

Carbohydrates are the major source of dietary energy, but their role in health and disease remains controversial. Recent epidemiological evidence suggests that the increased consumption of carbohydrates is associated with obesity and increased risk of mortality and dietary trials show that carbohydrate restriction leads to weight loss and improved glycaemic status in obese and diabetic subjects. In contrast, the diets of populations with long and healthy lifespans (e.g. traditional Okinawans from Japan) are high in carbohydrate and low in protein, and several clinical and preclinical studies have linked low-carbohydrate–high-protein diets with increased mortality risk. In this paper we attempt to reconcile these contradictory findings by moving beyond traditional single-nutrient analyses to consider the interactions between nutrients on health outcomes. We do so using the Geometric Framework (GF), a nutritional modelling platform that explicitly considers the main and interactive effects of multiple nutrients on phenotypic characteristics. Analysis of human data by GF shows that weight loss and improved cardio-metabolic outcomes under carbohydrate restriction derive at least in part from reduced caloric intake due to the concomitantly increased proportion of protein in the diet. This is because, as in many animals, a specific appetite for protein is a major driver of food intake in humans. Conversely, dilution of protein in the diet leverages excess food intake through compensatory feeding for protein (‘protein leverage’). When protein is diluted in the diet by readily digestible carbohydrates and fats, as is the case in modern ultra-processed foods, protein leverage results in excess calorie intake, leading to rising levels of obesity and metabolic disease. However, when protein is diluted in the diet by increased quantities of less readily digestible forms of carbohydrate and fibre, energy balance is maintained and health benefits accrue, especially during middle age and early late-life. We argue that other controversies in carbohydrate research can be resolved using the GF methodology in dietary studies.

Background and Aims Great discrepancies exist in results from studies examining the association between dietary patterns and cardiovascular disease (CVD) in different populations. The aim of this study is to examine the relationship between the Australian Dietary Guidelines (ADG) 2013, Mediterranean-DASH diet Intervention for Neurodegenerative Delay (MIND), Paleolithic and Okinawan dietary patterns and CVD respectively. Methods and Results In this cross-sectional secondary analysis of the 2011-12 Australian Health Survey, adults who self-reported physician-diagnosed CVD, completed two multiple-pass 24 hour recalls and had no missing data on all confounders were analysed (weighted n = 5,376; 295 CVD cases). Dietary intake was transformed to represent usual intake by the multiple source method. The score of Healthy Eating Index for Australian Adults (HEIFA-2013) was adopted for ADG 2013, while the scores of MIND, Paleolithic and Okinawan dietary patterns were constructed by separating the intake of each predefined food and nutrient into quintiles. The associations between the dietary patterns (as tertiles of scores) and CVD were examined using binary logistic regression adjusted for significant cardiovascular risk factors. Higher adherence to the Okinawan diet pattern was significantly associated with a reduced prevalence of ischemic heart disease (IHD) (OR per unit increase in dietary pattern score: 0.94, 95%CI: 0.90-0.98). Comparing its extreme tertiles, the OR was 0.49 (95%CI: 0.29-0.82; ptrend Conclusion The findings suggested an inverse association between adherence to Okinawan dietary pattern and prevalence of IHD in Australian adults.

Background Intervention strategies to reduce sodium intake and increase potassium intake may decrease blood pressure; however, most are focused on reducing sodium in processed food globally. Objectives We attempt to fill important gaps in understanding the dynamics of these dietary determinants of hypertension in China. Methods We used data on 29,926 adults aged ≥20 y between 1991 and 2015 from an ongoing cohort, the China Health and Nutrition Survey. We collected detailed diet data with use of weighing methods with 3 consecutive 24-h recalls. With panel data random-effects models, we analyzed factors associated with sodium and potassium intakes and sodium to potassium (Na/K) ratios. Results Sodium intake decreased from 6.3 g/d in 1991 to 4.1 g/d in 2015, still twice the tolerable upper intake recommended by the WHO. Potassium intake was 1.7 g/d in 1991 and 1.5 g/d in 2015, below half that recommended by the WHO. The Na/K ratio decreased from 4.1 (ratios in g) in 1991 to 3.1 in 2015, 5 times the recommendation of the WHO. More than two-thirds (67%) of sodium intake was from salt added during food preparation, with 8.8% from processed foods in 2015, up from 5.0% in 1991. The most at-risk populations lived in China's central region and rural areas, were middle aged, had lower educations, or were farmers. Conclusions Sodium intake is very high across all regions in China. As part of sodium reduction efforts, China should target people living in the central region and adults aged above 60 whose sodium intakes are much higher. Strategies to decrease sodium intake and increase potassium intake should be different from those applied in the Western world where the major source is processed food. Reduced sodium higher potassium salts should become a major policy initiative in China.

This study examined the prevalence of pre-hypertension (PHT) and hypertension (HT) in urban youth, and assessed the effects of sodium intake and obesity on blood pressure (BP) by ethnicity. A convenience sample of 557 multiethnic youth, aged 11–23 years, was recruited from 12 schools and institutions in Edmonton, Alberta, Canada. Participants were divided by self-identified ethnicity into four groups (Indigenous, African and Middle Eastern (AME), Asian, and European). Between October 2013 and March 2014, one-on-one interviews were conducted to collect data on demographics, physical activity, diet, and Body Mass Index (BMI). BP was obtained at two different times during the interview and measured a third time in cases of high variability. The standard deviation scores (SDS) of systolic BP (SBP) and diastolic BP (DBP) were used to estimate associations with sodium intake (per 1000 mg/day). Overall, 18.2% and 5.4% of the participants had PHT and HT, respectively. Indigenous and AME participants showed the highest rates of PHT (23.1%). Indigenous and European participants showed higher rates of HT (8.3% and 5.3%, respectively) than other ethnic groups (AME = 4.4%, Asian = 3.9%). There was a positive association between 1000 mg/day increase in sodium intake and SDS of SBP by 0.041 (95% CI 0.007–0.083; p = 0.04) among pre-hypertensive participants. Over 85% of participants exceeded the recommended dietary sodium intake. Mean BMI and dietary sodium intake were higher among pre-hypertensive participants (4219 mg/day) than normotensive (3475 mg/day). The prevalence of HT varied by ethnicity. High dietary sodium intake was of concern. There is a need for culturally-tailored, population-based interventions to reduce sodium intake.

INTRODUCTION Little is known about the relationship of whole-grain intake with dietary fatty acids intake. The present study aimed to assess the whole-grain intake and its relationships with dietary fatty acids intake among multiethnic schoolchildren in Kuala Lumpur, Malaysia. METHODS This cross-sectional study was conducted among 392 schoolchildren aged 9-11 years, cluster sampled from five randomly selected schools in Kuala Lumpur. Whole-grain and fatty acids intakes were assessed by 3-day, 24-h diet recalls. All whole-grain foods were considered irrespective of the amount of whole grain they contained. RESULTS In total, 55.6% (n = 218) were whole-grain consumers. Mean (SD) daily intake of whole grain in the total sample was 5.13 (9.75) g day-1 . In the whole-grain consumer's only sample, mean (SD) intakes reached 9.23 (11.55) g day-1 . Significant inverse associations were found between whole-grain intake and saturated fatty acid (SAFA) intake (r = -0.357; P