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Perspective: Opportunities and Challenges of Technology Tools in Dietary and Activity Assessment: Bridging Stakeholder Viewpoints
Sai Krupa Das, Akari J Miki, Caroline M Blanchard, Edward Sazonov, Cheryl H Gilhooly, Sujit Dey, Colton B Wolk, Chor San H Khoo, James O Hill, Robin P Shook
doi : 10.1093/advances/nmab103
Advances in Nutrition, Volume 13, Issue 1, January 2022, Pages 1–15
The science and tools of measuring energy intake and output in humans have rapidly advanced in the last decade. Engineered devices such as wearables and sensors, software applications, and Web-based tools are now ubiquitous in both research and consumer environments. The assessment of energy expenditure in particular has progressed from reliance on self-report instruments to advanced technologies requiring collaboration across multiple disciplines, from optics to accelerometry. In contrast, assessing energy intake still heavily relies on self-report mechanisms. Although these tools have improved, moving from paper-based to online reporting, considerable room for refinement remains in existing tools, and great opportunities exist for novel, transformational tools, including those using spectroscopy and chemo-sensing. This report reviews the state of the science, and the opportunities and challenges in existing and emerging technologies, from the perspectives of 3 key stakeholders: researchers, users, and developers. Each stakeholder approaches these tools with unique requirements: researchers are concerned with validity, accuracy, data detail and abundance, and ethical use; users with ease of use and privacy; and developers with high adherence and utilization, intellectual property, licensing rights, and monetization. Cross-cutting concerns include frequent updating and integration of the food and nutrient databases on which assessments rely, improving accessibility and reducing disparities in use, and maintaining reliable technical assistance. These contextual challenges are discussed in terms of opportunities and further steps in the direction of personalized health.
Perspective: The High-Folate–Low-Vitamin B-12 Interaction Is a Novel Cause of Vitamin B-12 Depletion with a Specific Etiology—A Hypothesis
Jacob Selhub, Joshua W Miller, Aron M Troen, Joel B Mason, Paul F Jacques
doi : 10.1093/advances/nmab106
Advances in Nutrition, Volume 13, Issue 1, January 2022, Pages 16–33
Vitamin B-12 is a water-soluble vitamin that plays important roles in intermediary metabolism. Vitamin B-12 deficiency has many identifiable causes, including autoimmune and other gastrointestinal malabsorption disorders, dietary deficiency, and congenital defects in genes that are involved in vitamin B-12 trafficking and functions. Another putative cause of vitamin B-12 deficiency is the high-folate–low vitamin B-12 interaction, first suspected as the cause for observed relapse and exacerbation of the neurological symptoms in patients with pernicious anemia who were prescribed high oral doses of folic acid. We propose that this interaction is real and represents a novel cause of vitamin B-12 depletion with specific etiology. We hypothesize that excessive intake of folic acid depletes serum holotranscobalamin (holoTC), thereby decreasing active vitamin B-12 in the circulation and limiting its availability for tissues. This effect is specific for holoTC and does not affect holohaptocorrin, the inert form of serum vitamin B-12. Depletion of holoTC by folic acid in individuals with already low vitamin B-12 status further compromises the availability of vitamin B-12 coenzymes to their respective enzymes, and consequently a more pronounced state of biochemical deficiency. This hypothesis is drawn from evidence of observational and intervention studies of vitamin B-12–deficient patients and epidemiological cohorts. The evidence also suggests that, in a depleted state, vitamin B-12 is diverted to the hematopoietic system or the kidney. This most likely reflects a selective response of tissues expressing folate receptors with high affinity for unmetabolized folic acid (UMFA; e.g., hematopoietic progenitors and renal tubules) compared with those tissues (e.g., liver) that only express the reduced folate carrier, which is universally expressed but has poor affinity for UMFA. The biochemical and physiological mechanisms underlying this interaction require elucidation to clarify its potential public health significance.
Perspective: Creatine, a Conditionally Essential Nutrient: Building the Case
Sergej M Ostojic, Scott C Forbes
doi : 10.1093/advances/nmab111
Advances in Nutrition, Volume 13, Issue 1, January 2022, Pages 34–37
Creatine is a major component of energy metabolism that is abundant in human skeletal muscle, brain, and heart. Either synthesized internally or provided via an omnivorous diet, creatine is required for normal growth, development, and health. Recent advances in creatine nutrition and physiology suggest that the quantity of creatine the body naturally synthesizes is not sufficient to meet human needs. As a result, humans have to obtain enough creatine from the diet, which nominates creatine as an essential nutrient in certain circumstances. In this article, we summarize arguments that creatine should be considered a conditionally essential nutrient for humans and propose several questions that should be addressed in future research.
Perspective: Unpacking the Wicked Challenges for Alternative Proteins in the United States: Can Highly Processed Plant-Based and Cell-Cultured Food and Beverage Products Support Healthy and Sustainable Diets and Food Systems?
Vivica I Kraak
doi : 10.1093/advances/nmab113
Advances in Nutrition, Volume 13, Issue 1, January 2022, Pages 38–47
Over the past decade, a plethora of alternative protein (AP) products has entered the US food system as plant-based food and beverage products. These AP products, which include plant-based meat and dairy alternatives and cell-cultured meat and seafood products, are being developed for the marketplace to simulate the appearance, texture, taste, and flavor and nutritional profiles of animal products. The new generation of AP plant-based and cell-cultured food and beverage products are part of a market-driven narrative that has embraced technology to address future human health, environmental, ethical, and planetary health challenges. This perspective article synthesizes evidence about the benefits of adopting minimally processed plant-based diets that support sustainable food systems and human and planetary health. Thereafter, it examines 4 wicked challenges related to AP products in the US context that include 1) a confusing marketing landscape for the public; 2) diverse views and varying acceptance among consumers about the health and environmental benefits of these products; 3) inadequate education and labeling provided by federal agencies to enable consumers to understand how these may support healthy sustainable diets; and 4) slow federal policy and regulatory actions to address the range of AP products and provide industry guidance. The article concludes with suggested policies and actions for government agencies and food system actors to address these challenges. Future research and actions are needed to balance the human health, equity, animal welfare, and economic viability goals and to clarify how AP products may support safe, healthy, sustainable diets and food systems.
Evaluating Concordance of Bodies of Evidence from Randomized Controlled Trials, Dietary Intake, and Biomarkers of Intake in Cohort Studies: A Meta-Epidemiological Study
Jessica Beyerbach, Julia Stadelmaier, Georg Hoffmann, Sara Balduzzi, Nils Bröckelmann, Lukas Schwingshackl
doi : 10.1093/advances/nmab095
Advances in Nutrition, Volume 13, Issue 1, January 2022, Pages 48–65
We aimed to identify and compare empirical data to determine the concordance of diet–disease effect estimates of bodies of evidence (BoE) from randomized controlled trials (RCTs), dietary intake, and biomarkers of dietary intake in cohort studies (CSs). The Cochrane Database of Systematic Reviews and MEDLINE were searched for systematic reviews (SRs) of RCTs and SRs of CSs that investigated both dietary intake and biomarkers of intake published between 1 January 2010 and 31 December 2019. For matched diet–disease associations, the concordance between results from the 3 different BoE was analyzed using 2 definitions: qualitative (e.g., 95% CI within a predefined range) and quantitative (test hypothesis on the z score). Moreover, the differences in the results coming from BoERCTs, BoECSs dietary intake, and BoECSs biomarkers were synthesized to get a pooled ratio of risk ratio (RRR) across all eligible diet–disease associations, so as to compare the 3 BoE. Overall, 49 diet–disease associations derived from 41 SRs were identified and included in the analysis. Twenty-four percent, 10%, and 39% of the diet–disease associations were qualitatively concordant comparing BoERCTs with BoECSs dietary intake, BoERCTs with BoECSs biomarkers, and comparing both BoE from CSs, respectively; 88%, 69%, and 90% of the diet–disease associations were quantitatively concordant comparing BoERCTs with BoECSs dietary intake, BoERCTs with BoECSs biomarkers, and comparing both BoE from CSs, respectively. The pooled RRRs comparing effects from BoERCTs with effects from BoECSs dietary intake were 1.09 (95% CI: 1.06, 1.13) and 1.18 (95% CI: 1.10, 1.25) compared with BoECSs biomarkers. Comparing both BoE from CSs, the difference in the results was also small (RRR: 0.92; 95% CI: 0.88, 0.96). Our findings suggest that BoE from RCTs and CSs are often quantitatively concordant. Prospective SRs in nutrition research should include, whenever possible, BoE from RCTs and CSs on dietary intake and biomarkers of intake to provide the whole picture for an investigated diet–disease association.
Zinc as a Neuroprotective Nutrient for COVID-19–Related Neuropsychiatric Manifestations: A Literature Review
Guido Cereda, Valentina Ciappolino, Andrea Boscutti, Filippo Cantù, Paolo Enrico, Lucio Oldani, Giuseppe Delvecchio, Paolo Brambilla
doi : 10.1093/advances/nmab110
Advances in Nutrition, Volume 13, Issue 1, January 2022, Pages 66–79
The outbreak of the pandemic associated with Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) led researchers to find new potential treatments, including nonpharmacological molecules such as zinc (Zn2+). Specifically, the use of Zn2+ as a therapy for SARS-CoV-2 infection is based on several findings: 1) the possible role of the anti-inflammatory activity of Zn2+ on the aberrant inflammatory response triggered by COronaVIrus Disease 19 (COVID-19), 2) properties of Zn2+ in modulating the competitive balance between the host and the invading pathogens, and 3) the antiviral activity of Zn2+ on a number of pathogens, including coronaviruses. Furthermore, Zn2+ has been found to play a central role in regulating brain functioning and many disorders have been associated with Zn2+ deficiency, including neurodegenerative diseases, psychiatric disorders, and brain injuries. Within this context, we carried out a narrative review to provide an overview of the evidence relating to the effects of Zn2+ on the immune and nervous systems, and the therapeutic use of such micronutrients in both neurological and infective disorders, with the final goal of elucidating the possible use of Zn2+ as a preventive or therapeutic intervention in COVID-19. Overall, the results from the available evidence showed that, owing to its neuroprotective properties, Zn2+ supplementation could be effective not only on COVID?19–related symptoms but also on virus replication, as well as on COVID-19–related inflammation and neurological damage. However, further clinical trials evaluating the efficacy of Zn2+ as a nonpharmacological treatment of COVID-19 are required to achieve an overall improvement in outcome and prognosis.
The Potential Impact of Climate Change on the Micronutrient-Rich Food Supply
Richard D Semba, Sufia Askari, Sarah Gibson, Martin W Bloem, Klaus Kraemer
doi : 10.1093/advances/nmab104
Advances in Nutrition, Volume 13, Issue 1, January 2022, Pages 80–100
Micronutrient deficiencies are a major cause of morbidity and mortality in low- and middle-income countries worldwide. Climate change, characterized by increasing global surface temperatures and alterations in rainfall, has the capacity to affect the quality and accessibility of micronutrient-rich foods. The goals of this review are to summarize the potential effects of climate change and its consequences on agricultural yield and micronutrient quality, primarily zinc, iron, and vitamin A, of plant foods and upon the availability of animal foods, to discuss the implications for micronutrient deficiencies in the future, and to present possible mitigation and adaptive strategies. In general, the combination of increasing atmospheric carbon dioxide and rising temperature is predicted to reduce the overall yield of major staple crops, fruits, vegetables, and nuts, more than altering their micronutrient content. Crop yield is also reduced by elevated ground-level ozone and increased extreme weather events. Pollinator loss is expected to reduce the yield of many pollinator-dependent crops such as fruits, vegetables, and nuts. Sea-level rise resulting from melting of ice sheets and glaciers is predicted to result in coastal inundation, salt intrusion, and loss of coral reefs and mangrove forests, with an adverse impact upon coastal rice production and coastal fisheries. Global ocean fisheries catch is predicted to decline because of ocean warming and declining oxygen. Freshwater warming is also expected to alter ecosystems and reduce inland fisheries catch. In addition to limiting greenhouse gas production, adaptive strategies include postharvest fortification of foods; micronutrient supplementation; biofortification of staple crops with zinc and iron; plant breeding or genetic approaches to increase zinc, iron, and provitamin A carotenoid content of plant foods; and developing staple crops that are tolerant of abiotic stressors such as elevated carbon dioxide, elevated temperature, and increased soil salinity.
Effects of Dietary Patterns on Biomarkers of Inflammation and Immune Responses: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Liselot Koelman, Caue Egea Rodrigues, Krasimira Aleksandrova
doi : 10.1093/advances/nmab086
Advances in Nutrition, Volume 13, Issue 1, January 2022, Pages 101–115
Altered immune cell phenotype and chronic inflammation are key features shared by various chronic diseases. Evidence from nutritional interventions aimed at alleviating inflammation could be a promising approach for the prevention of adverse health outcomes. We therefore aimed to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to summarize the recent evidence on the effects of dietary patterns on inflammatory and immune-related biomarkers in humans. PubMed, Medline, and Web of Science databases were searched for publications up to October 2020. In total, 22 RCTs were included in the meta-analysis conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Mediterranean diet appeared as the dietary pattern that showed the most prominent reductions of inflammatory biomarkers such as IL-6 [mean difference (MD): –1.07 pg/mL (95% CI: –1.94, –0.20); I2: 96%], IL-1? [MD: –0.46 pg/mL (95% CI: –0.66, –0.25); I2: 0%], and C-reactive protein [MD: –1.00 mg/L (95% CI: –2.02, 0.01); I2: 100%]. No substantial effects were observed for the additional dietary patterns studied in intervention research, including the Dietary Adherence to Stop Hypertension diet, and the vegetarian or vegan diets. Future large-scale multifactorial intervention studies are warranted to allow direct comparison of various dietary patterns in relation to a range of biomarkers reflecting multiple inflammatory and immune-related pathways.
Effects of 100% Orange Juice on Markers of Inflammation and Oxidation in Healthy and At-Risk Adult Populations: A Scoping Review, Systematic Review, and Meta-analysis
Kelly Copeland Cara, Andrew R Beauchesne, Taylor C Wallace, Mei Chung
doi : 10.1093/advances/nmab101
Advances in Nutrition, Volume 13, Issue 1, January 2022, Pages 116–137
One hundred percent orange juice (OJ) has no added sugar, naturally contains flavonoids and ascorbic acid, and can modulate the body's oxidative and inflammatory systems. This scoping review, systematic review, and meta-analysis investigated associations between 100% OJ and markers of inflammation or oxidation in healthy adults and those at risk for chronic diseases. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and scoping review extension. Literature in English was searched to July 2021 in Embase and 4 Ovid platform databases. Clinical and observational studies of any duration were eligible. Cochrane Collaboration tools were used to assess the risk of bias in controlled trials. Strength of evidence was determined using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. The scoping review presents a qualitative synthesis of evidence in summary and results tables. Twenty-one interventional studies (16 controlled trials and 5 before-after studies) conducted in 307 healthy and 327 at-risk participants were included. Six common markers [C-reactive protein (CRP) or high-sensitivity CRP (hs-CRP), IL-6, TNF-?, malondialdehyde (MDA), oxidized LDL (oxLDL), and antioxidant capacity] measured across 16 studies were systematically reviewed, and results were synthesized narratively. Random-effects model meta-analyses were conducted on 10 studies reporting hs-CRP, IL-6, and/or MDA. After consuming 100% OJ, healthy and at-risk participants showed significantly lower IL-6 concentrations (pooled net difference: ?1.51 pg/mL; 95% CI: ?2.31, ?0.70) and lower, but nonsignificant, hs-CRP (pooled net change: ?0.58 mg/L; 95% CI: ?1.22, 0.05) and MDA (crossover trials pooled net difference: ?0.06 ?mol/L; 95% CI: ?0.19, 0.08). Findings suggest that 100% OJ may reduce inflammation, but results should be interpreted with caution due to moderate risk of bias, very low strength of evidence, and the low number of subjects. This study was registered on PROSPERO (https://www.crd.york.ac.uk/prospero/) as CRD42021235438.
Are Processed Tomato Products as Nutritious as Fresh Tomatoes? Scoping Review on the Effects of Industrial Processing on Nutrients and Bioactive Compounds in Tomatoes
Xianli Wu, Liangli Yu, Pamela R Pehrsson
doi : 10.1093/advances/nmab109
Advances in Nutrition, Volume 13, Issue 1, January 2022, Pages 138–151
Tomatoes are the second most consumed vegetable in the United States. In 2017, American people consumed 9.2 kg of tomatoes from a fresh market and 33.2 kg of processed tomato products per capita. One commonly asked question by consumers and the nutrition community is “Are processed tomato products as nutritious as fresh tomatoes?” This review addresses this question by summarizing the current understandings on the effects of industrial processing on the nutrients and bioactive compounds of tomatoes. Twelve original research papers were found to study the effects of different industrial processing methods on the nutrients and/or bioactive compounds in tomato products. The data suggested that different processing methods had different effects on different compounds in tomatoes. However, currently available data are still limited, and the existing data are often inconsistent. The USDA National Nutrient Database for Standard Reference Legacy was utilized to estimate nutrient contents from raw tomatoes and processed tomato products. In addition, several other important factors specifically related to the industrial processing of tomatoes were also discussed. To conclude, there is no simple “yes” or “no” answer to the question “Are processed tomato products as nutritious as fresh tomatoes?” Many factors must be considered when comparing the nutritious value between fresh tomatoes and processed tomato products. At this point, we do not have sufficient data to fully understand all of the factors and their impacts.
Adherence to the Mediterranean Diet, Five-Year Weight Change, and Risk of Overweight and Obesity: A Systematic Review and Dose–Response Meta-Analysis of Prospective Cohort Studies
Keyhan Lotfi, Parvane Saneei, Zahra Hajhashemy, Ahmad Esmaillzadeh
doi : 10.1093/advances/nmab092
Advances in Nutrition, Volume 13, Issue 1, January 2022, Pages 152–166
Findings from earlier studies on the association between adherence to a Mediterranean diet and risk of overweight/obesity were inconsistent. We summarized cohort studies investigating the association between the Mediterranean diet and risk of overweight and/or obesity and weight change in adults. A systematic search of PubMed, Scopus, ISI Web of Science, and Google Scholar was conducted up to May 2021. Prospective cohorts that examined the Mediterranean diet adherence in adults as the exposure, and overweight and/or obesity or weight change as the outcomes, and reported RRs or ? coefficients and 95% CIs as the effect sizes were included. Seven prospective cohort studies were included of which 6 studies (with 244,678 adult participants) reported the risk of overweight and/or obesity, and 4 cohorts (with 436,617 participants) reported the weight change (3 cohorts reported both overweight and/or obesity risk and weight change). Combining 15 effect sizes from 6 cohorts revealed that greater adherence to the Mediterranean diet was significantly associated with a 9% decreased risk of overweight and/or obesity (RR: 0.91; 95% CI: 0.88, 0.94; I2 = 44.7%; PQ-test = 0.031). This association was significant in the case of studies investigating combined overweight and obesity (RR: 0.92; 95% CI: 0.88, 0.96; I2 = 29.4%; PQ-test = 0.166), but not for studies that reported on obesity (RR: 0.68; 95% CI: 0.43, 1.10, I2 = 50.6%, PQ-test = 0.132). Linear dose–response analysis of 6 studies showed a 2% decreased risk of overweight and/or obesity for 1 additional Mediterranean diet score (RR: 0.98; 95% CI: 0.96, 0.99). Each unit increase in the Mediterranean diet score was associated with 0.04 kg less weight gain over 5 y (?0.04 kg; 95% CI: ?0.07, ?0.02 kg; 13 effect sizes from 4 cohorts). In conclusion, Mediterranean diet adherence is inversely associated with risk of overweight and/or obesity as well as 5-y weight gain and thus has practical importance for public health.
The Effects of Prebiotics, Synbiotics, and Short-Chain Fatty Acids on Respiratory Tract Infections and Immune Function: A Systematic Review and Meta-Analysis
Lily M Williams, Isobel L Stoodley, Bronwyn S Berthon, Lisa G Wood
doi : 10.1093/advances/nmab114
Advances in Nutrition, Volume 13, Issue 1, January 2022, Pages 167–192
Prebiotics, synbiotics, and SCFAs have been shown to decrease systemic inflammation and play a protective role in chronic respiratory conditions. However, their effects on infection and immune function are unclear. The objective of this systematic review was to summarize the current evidence for prebiotic, synbiotic, and SCFA supplementation on respiratory tract infections (RTIs) and immune function. The protocol for this systematic review was registered with PROSPERO (National Institute for Health Research, University of York, UK), accessed online at https://www.crd.york.ac.uk/prospero (CRD42019118786). Relevant English-language articles up to May 2021 were identified via online databases: MEDLINE, EMBASE, CINAHL, and Cochrane Library. Included studies (n = 58) examined the effect of prebiotics, synbiotics, or SCFA, delivered orally, on the incidence, severity, or duration of RTIs and/or markers of immune function (e.g., peripheral blood immunophenotyping, NK cell activity). The majority of studies were randomized controlled trials reporting on RTIs in infants and children. The meta-analysis indicated that the numbers of subjects with ?1 RTI were reduced with prebiotic (OR, 0.73; 95% CI: 0.62–0.86; P = 0.0002; n = 17) and synbiotic (OR, 0.75; 95% CI: 0.65–0.87; P = 0.0001; n = 9) supplementation compared to placebo. Further, NK cell activity was increased with synbiotic (standardized mean difference, 0.74; 95% CI: 0.42–1.06; P < 0.0001, n = 3) supplementation. This review provides evidence that prebiotic, specifically oligosaccharide, supplementation may play a protective role in RTIs in infants and children. There is less evidence for this effect in adults. Supplementation with prebiotic and synbiotic treatment may alter immune function by increasing NK cell activity, though effects on immunophenotype were less clear.
Impact of Meal Fatty Acid Composition on Postprandial Lipemia in Metabolically Healthy Adults and Individuals with Cardiovascular Disease Risk Factors: A Systematic Review
Hannah F Neumann, Sarah Egert
doi : 10.1093/advances/nmab096
Advances in Nutrition, Volume 13, Issue 1, January 2022, Pages 193–207
Consuming fat results in postprandial lipemia, which is defined as an increase in blood triglyceride (TG) concentration. According to current knowledge, an excessively elevated postprandial TG concentration increases the risk of cardiovascular disease (CVD). It is well known that meal-dependent (e.g., nutrient composition) as well as meal-independent factors (e.g., age) determine the magnitude of the lipemic response. However, there is conflicting evidence concerning the influence of fatty acid (FA) composition on postprandial TG concentration. The FA composition of a meal depends on the fat source used; for example, butter and coconut oil are rich in SFAs, while olive oil and canola oil have a high content of unsaturated FAs. To investigate the influence of meals prepared with fat sources rich in either SFAs or unsaturated FAs on postprandial lipemia, we carried out a systematic literature search in PubMed, Scopus, and the Cochrane Library. Randomized crossover studies were analyzed and the AUC of postprandial TG concentration served as the primary outcome measure. To examine the influence of health status, we differentiated between metabolically healthy individuals and those with CVD risk factors. In total, 23 studies were included. The results show that, in metabolically healthy adults, the FA composition of a meal is not a relevant determinant of postprandial lipemia. However, in individuals with CVD risk factors, SFA-rich meals (>32 g SFA/meal) often elicited a stronger lipemic response than meals rich in unsaturated FAs. The results suggest that adults with hypertriglyceridemia, an elevated BMI (?30 kg/m2), and/or who are older (>40 y) may benefit from replacing SFA sources with unsaturated FAs. These hypotheses need to be verified by further studies in people with CVD risk factors using standardized postprandial protocols. This review was registered in PROSPERO as CRD42021214508 (https://www.crd.york.ac.uk/prospero/).
Key Findings of the French BioNutriNet Project on Organic Food–Based Diets: Description, Determinants, and Relationships to Health and the Environment
Emmanuelle Kesse-Guyot, Denis Lairon, Benjamin Allès, Louise Seconda, Pauline Rebouillat, Joséphine Brunin, Rodolphe Vidal, Bruno Taupier-Letage, Pilar Galan, Marie-Josèphe Amiot, Sandrine Péneau, Mathilde Touvier, Christine Boizot-Santai, Véronique Ducros, Louis-Georges Soler, Jean-Pierre Cravedi, Laurent Debrauwer, Serge Hercberg, Brigitte Langevin, Philippe Pointereau, Julia Baudry
doi : 10.1093/advances/nmab105
Advances in Nutrition, Volume 13, Issue 1, January 2022, Pages 208–224
Few studies have investigated the relationships between organic food consumption, dietary patterns, monetary diet cost, health, and the environment. To address these issues, a consortium of French epidemiologists, nutritionists, economists, and toxicologists launched the BioNutriNet project in 2013. In 2014, an FFQ documented the usual organic and nonorganic (conventional) food consumption of approximately 35,000 NutriNet-Santé participants. Then, individual organic and conventional food intakes were merged with price, environmental, and pesticide residue data sets, which distinguished between conventional and organic farming methods. Many studies were conducted to characterize organic consumers and their environmental impacts (i.e., greenhouse gas emissions, energy demand, and land use) and organic food consumption impacts on health. We observed that organic consumers had diets that were healthier and richer in plant-based food than nonorganic consumers. Their diets were associated with higher monetary costs, lower environmental impacts, and reduced exposure to certain pesticide residues. Regular consumption of organic food was associated with reduced risks of obesity, type 2 diabetes, postmenopausal breast cancer, and lymphoma. Although several observations have been confirmed by several studies conducted in other countries, our results should be replicated in other cultural settings and coupled with experimental studies to be able to draw causal conclusions. Finally, the main finding of the BioNutriNet project is that while organic food consumption could be associated with positive externalities on human health and the environment, organic-based diets should be accompanied by dietary shifts toward plant-based diets to allow for better planetary and human health.
Targeting the Dietary Na:K Ratio—Considerations for Design of an Intervention Study to Impact Blood Pressure
David J Baer, Andrew Althouse, Mindy Hermann, Janice Johnson, Kevin C Maki, Matti Marklund, Liffert Vogt, Donald Wesson, Virginia A Stallings
doi : 10.1093/advances/nmab099
Advances in Nutrition, Volume 13, Issue 1, January 2022, Pages 225–233
Despite medical, dietary, and lifestyle recommendations and drug advancements, hypertension persists as among the most prevalent noncommunicable diseases in the US population, and control remains elusive. Uncontrolled hypertension may increase the risk of serious illness from various other health challenges, including cardiovascular and renal responses. Adoption of a healthy diet is a consistent core element of lifestyle modifications that are recommended for mitigation of hypertension. The dietary sodium-to-potassium ratio is recognized as having promising potential in the regulation of blood pressure. In fact, the understanding of the relation between this ratio and blood pressure was documented as a key evidence gap in the 2019 National Academies of Sciences, Engineering, and Medicine report that revised recommended intake levels for both sodium and potassium. Although notable animal and human evidence supports this point, fundamental to developing a specific dietary recommendation for a sodium-to-potassium ratio is a well-designed human intervention trial. The successful translatability of such a trial will require careful consideration of study elements, including the study population, duration, blood pressure measurement, and dietary intervention, among other factors. This paper addresses these decision points and serves as supporting documentation for a research group or organization with the interest and means to address this important data gap, which will undoubtedly be foundational for advancing dietary guidance and would inform the next iteration of Dietary Reference Intakes for sodium and potassium.
The Influence of Common Noncommunicable Diseases on Chemosensory Perception and Clinical Implications in Children and Adolescents
Camilla Cattaneo, Chiara Mameli, Enza D'Auria, Gianvincenzo Zuccotti, Ella Pagliarini
doi : 10.1093/advances/nmab100
Advances in Nutrition, Volume 13, Issue 1, January 2022, Pages 234–247
An increased incidence of noninfectious chronic diseases, such as obesity, diabetes, and allergies, has been noted in the last century, especially in the last 2 to 3 generations. Evidence suggested that the interrelation among these chronic conditions in pediatric age (e.g., children and adolescents aged 4–16 y) is complex and still unknown, reinforcing the interest of pediatricians in these diseases. Of interest is the need to better understand the link between these pathologies and sensory perception, since the chemical senses of taste and smell, together with chemesthesis, are reported to have a role in food choices and may provide a novel target for intervention in the treatment of these pathologies. This review aims to explore the current evidence on the link between these chronic conditions and chemosensory perception (i.e., taste and smell). In addition, the putative role that chemosensory perception may have on food choices and eating behavior of children and adolescents affected by these diseases are highlighted. Furthermore, the review addresses the unexplored issues that need to be investigated in this area. The literature data search suggested that no clear relation between taste and smell perception and the aforementioned diseases in young population yet exists. However, some possible trends have been highlighted in the adult population, in whom the duration of disease might have affected the relation. There is a need for further, high-quality, hypothesis-led research, with robust measures of taste and smell functions as the primary outcomes, to strengthen or deny this evidence.
Systematic Review and Meta-Analysis on the Effect of Portion Size and Ingestive Frequency on Energy Intake and Body Weight among Adults in Randomized Controlled Feeding Trials
Kelly A Higgins, Joshua L Hudson, Anna M R Hayes, Ethan Braun, Eunjin Cheon, Sam C Couture, Nilupa S Gunaratna, Erica R Hill, Stephanie R Hunter, Bethany S McGowan, Evan J Reister, Yu Wang, Richard D Mattes
doi : 10.1093/advances/nmab112
Advances in Nutrition, Volume 13, Issue 1, January 2022, Pages 248–268
Energy intake is the product of portion size (PS)—the energy content of an ingestive event—and ingestive frequency (IF)—the number of ingestive events per unit time. An uncompensated alteration in either PS or IF would result in a change in energy intake and body weight if maintained over time. The objective of this meta-analysis was to assess the independent effects of PS and IF on energy intake and body weight among healthy adults in randomized controlled trials (RCTs). A total of 9708 articles were identified in PubMed, Web of Science, Cochrane, and CINAHL databases. The articles were divided among 10 researchers; each article was screened for eligibility by 2–3 independent reviewers. Exclusion criteria included: populations <19 y and >65 y, unhealthy populations (i.e. participants with an acute or chronic disease), assessments <24 h and <4 wk in duration for trials investigating energy intake or body weight, respectively. Controlled feeding trials (i.e. fixed energy intake) that manipulated IF and PS in the same study intervention (IF/PS) were evaluated separately and for the body weight outcome only. Twenty-two studies (IF = 4, PS = 14, IF/PS = 4) met the inclusion criteria. There was an insufficient number of studies to assess the effect of IF, PS, or IF/PS on body weight. There was heterogeneity in the effect sizes among all comparisons (I2 ?75%). Consuming larger portion sizes was associated with higher daily energy intake [295 kcal (202, 388), n = 24; weighted mean differences (WMD) (95% CI), n = comparisons], and increased frequency of ingestive events was associated with higher energy intake [203 kcal (76, 330), n = 10]. Results from RCTs support that larger PS and greater IF are both associated with higher energy consumption. However, there is insufficient information to determine chronic effects on body weight. This protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO) as CRD42018104757.
Chronotype Differences in Energy Intake, Cardiometabolic Risk Parameters, Cancer, and Depression: A Systematic Review with Meta-Analysis of Observational Studies
Sofia Lotti, Giuditta Pagliai, Barbara Colombini, Francesco Sofi, Monica Dinu
doi : 10.1093/advances/nmab115
Advances in Nutrition, Volume 13, Issue 1, January 2022, Pages 269–281
Chronotype is a behavioral manifestation of the internal circadian clock system. It refers to the specific activity-rest preference of an individual over a 24-h period and can be assessed using different methodologies that classify individuals into morning or evening chronotype. In recent years, several studies have suggested a relation between individual chronotype, eating habits, and the risk of developing obesity and other conditions. Our aim was to evaluate the association between chronotype, energy intake, and health status through a meta-analytic approach. A comprehensive search of MEDLINE, Embase, Scopus, Web of Science, and Cochrane Database was conducted. Observational studies that reported a measure of association between chronotype, energy intake, and health indicators were considered eligible. Overall, 39 observational studies (37 cross-sectional studies, 2 prospective cohort studies) were included in the systematic review, with a total of 377,797 subjects. By comparing morning and evening subjects, pooled analyses of cross-sectional studies showed significantly (P < 0.001) higher concentrations of blood glucose [mean difference (MD): 7.82; 95% CI: 3.18, 12.45], glycated hemoglobin (MD: 7.64; 95% CI: 3.08, 12.21), LDL cholesterol (MD: 13.69; 95% CI: 6.84, 20.54), and triglycerides (MD: 12.62; 95% CI: 0.90, 24.35) in evening subjects. Furthermore, an association between evening type and the risk of diabetes (OR: 1.30; 95% CI: 1.20, 1.41), cancer (OR: 1.18; 95% CI: 1.08, 1.30), and depression (OR: 1.86; 95% CI: 1.20, 2.88) was reported. Regarding the other outcomes examined, no significant differences were observed between the groups in terms of energy intake, anthropometric parameters, blood pressure, insulin, total and HDL cholesterol, and hypertension risk. In conclusion, evening chronotype was associated with a worse cardiometabolic risk profile and higher risk of diabetes, cancer, and depression. Further studies are needed to confirm these results and to better elucidate the interplay between chronotype, nutrition, and health status.
Economic Evaluations of Child Nutrition Interventions in Low- and Middle-Income Countries: Systematic Review and Quality Appraisal
Yeji Baek, Zanfina Ademi, Susan Paudel, Jane Fisher, Thach Tran, Lorena Romero, Alice Owen
doi : 10.1093/advances/nmab097
Advances in Nutrition, Volume 13, Issue 1, January 2022, Pages 282–317
Economic evaluation is crucial for cost-effective resource allocation to improve child nutrition in low and middle-income countries (LMICs). However, the quality of published economic evaluations in these settings is not well understood. This systematic review aimed to assess the quality of existing economic evaluations of child nutrition interventions in LMICs and synthesize the study characteristics and economic evidence. We searched 9 electronic databases, including MEDLINE, with the following concepts: economic evaluation, children, nutrition, and LMICs. All types of interventions addressing malnutrition, including stunting, wasting, micronutrient deficiency, and overweight, were identified. We included economic evaluations that examined both costs and effects published in English peer-reviewed journals and used the Drummond checklist for quality appraisal. We present findings through a narrative synthesis. Sixty-nine studies with diverse settings, perspectives, time horizons, and outcome measures were included. Most studies used data from sub-Saharan Africa and South Asia and addressed undernutrition. The mortality rate, intervention effect, intervention coverage, cost, and discount rate were reported as predictors among studies that performed sensitivity analyses. Despite the heterogeneity of included studies and the possibility of publication bias, 81% of included studies concluded that nutrition interventions were cost-effective or cost-beneficial, mostly based on a country's cost-effectiveness thresholds. Regarding quality assessment, the studies published after 2016 met more criteria than studies published before 2016. Most studies had well-stated research questions, forms of economic evaluation, interventions, and conclusions. However, reporting the perspective of the analyses, justification of discount rates, and describing the role of funders and ethics approval were identified as areas needing improvement. The gaps in the quality of reporting could be improved by consolidated guidance on the publication of economic evaluations and the use of appropriate quality appraisal checklists. Strengthening the evidence base for child malnutrition across different regions is necessary to inform cost-effective investment in LMICs. Trial registration: PROSPERO CRD42020194445.
Fructooligosaccharides: From Breast Milk Components to Potential Supplements. A Systematic Review
Valentina De Cosmi, Alessandra Mazzocchi, Carlo Agostoni, Francesco Visioli
doi : 10.1093/advances/nmab102
Advances in Nutrition, Volume 13, Issue 1, January 2022, Pages 318–327
Breast milk is the optimal food choice for infant growth and development. Among breast milk components, fructooligosaccharides (FOSs) are being actively studied because of their role in microbiota development. In particular, 2?-fucosyllactose is being proposed as a potential supplement/nutraceutical or component of infant formula. In this systematic review, we critically summarize the available information on FOSs and we discuss their future use in infant nutrition. We searched the main electronic databases (PubMed, Embase, and Scopus), with a final check in May 2021. Search terms were inserted individually and using the Boolean tools AND and OR. Relevant articles were identified using the following words: (“fructooligosaccharides” OR “FOS”) AND (“human milk” OR “breast milk” OR “donor milk” OR “bank milk”). The search retrieved 1814 articles. After removal of duplicates, we screened 1591 articles based on title, abstract, and exclusive use of the English language. We included articles describing the concentration of FOSs in human milk and assessed the relevant ones. We excluded reviews, studies on animals, and studies exclusively carried out on adults. Also, we excluded studies that have not reported evidence either on FOSs or on galactooligosaccharides from human milk. The resulting publications were reviewed, and 10 studies were included in the systematic review. We conclude that human milk FOSs are, indeed, crucial to infant gut development and their addition to infant formula is safe, well-tolerated, and might provide immune benefits to newborns. However, we would like to underscore the scantiness of human data and the need to avoid the immediate translation of infant research to the commercialization of supplements marketed to adults.
Design Factors for Food Supplementation and Nutrition Education Interventions That Limit Conclusions about Effectiveness for Wasting Prevention: A Scoping Review of Peer-Reviewed Literature
Scott B Ickes, Christina Craig, Rebecca Heidkamp
doi : 10.1093/advances/nmab107
Advances in Nutrition, Volume 13, Issue 1, January 2022, Pages 328–341
We conducted a scoping review to characterize the evidence base for the effectiveness of food supplementation (FS), nutrition education (NE), or FS/NE interventions to prevent wasting among children aged 6 to 59 mo. We aimed to identify gaps in peer-reviewed literature and to develop recommendations for strengthening study designs. We identified 56 unique studies (FS = 21, NE = 19, FS/NE = 16) for which we assessed intervention design factors, implementation context, evaluation methods, and wasting impact. Compared with studies focused on stunting, fewer wasting-focused studies reported weight-for-height z score (WHZ). Midupper arm circumference (MUAC) was more commonly reported in wasting-focused studies (71.4%) than those focused on stunting (36.8%) or wasting and stunting (30.4%). FS studies measured anthropometry (mean, 95% CI) more frequently at every 11.3 (7.8, 14.8) wk than NE interventions at 36.3 (8.8, 62.1) wk (P = 0.036), but not FS/NE interventions at 25.8 (5.6, 49.1) wk (P = 0.138). NE interventions tended to be of longer duration than FS or FS/NE interventions. Only 6 studies followed and measured children after the intervention period ended. Across all studies, 45% reported a significant effect on wasting; these included FS, NE, and FS/NE interventions. The lack of comparability across studies limits conclusions about the effectiveness of specific types of interventions. To build a more unified evidence base for wasting prevention we recommend that future studies 1) report on a consistent set of metrics, including MUAC; 2) attempt to measure change in wasting incidence using more frequent measures; 3) measure wasting prevalence among the general population; 4) follow children postintervention to assess relapse; 5) measure food insecurity and diet quality; and 6) use harmonized protocols across multiple settings. Such efforts to improve study comparability will strengthen the evidence base, may help unite divergent professional communities, and ultimately accelerate progress toward eliminating child undernutrition.
Advances in Nutrition Reviewer Acknowledgments
doi : 10.1093/advances/nmab152
Advances in Nutrition, Volume 13, Issue 1, January 2022, Pages 342–344
Invitation for Nominations and Applications for the 2022 Scientific Achievement Awards, the ASN Class of 2022 Fellows, and Other Honors
doi : 10.1093/advances/nmab144
Advances in Nutrition, Volume 13, Issue 1, January 2022, Pages 345–349
Vitamin K
M Kyla Shea, Sarah L Booth
doi : 10.1093/advances/nmab133
Advances in Nutrition, Volume 13, Issue 1, January 2022, Pages 350–351
Errors in Analyses and Undisclosed Methods Render Meta-Analysis Irreproducible: A Second Comment on “Effects of Flaxseed Interventions on Circulating Inflammatory Biomarkers: A Systematic Review and Meta-Analysis of Randomized Controlled Trials”
Yasaman Jamshidi-Naeini, Rui Li, Stephanie Dickinson, Colby J Vorland, Andrew W Brown
doi : 10.1093/advances/nmab146
Advances in Nutrition, Volume 13, Issue 1, January 2022, Pages 352–354
