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The fashionable gluten-free diet—wear with caution
Claire L Jansson-Knodell, Alberto Rubio-Tapia
doi : 10.1093/ajcn/nqaa371
The American Journal of Clinical Nutrition, Volume 113, Issue 3, March 2021, Pages 491–492
Olympic gold medalist in swimming Dana Vollmer, the current men's world top-ranked tennis player Novak Djokovic, 6-time Olympian Nordic combined skier Todd Lodwick, and National Football League quarterback Drew Brees are just a few examples of world-class athletes who have adopted and touted the benefits of the gluten-free diet (GFD). Riding the wave of these athlete and other celebrity endorsements, the diet has become extremely popular. In addition, the expanding gluten-free product market is making it more accessible to the general public. Although initially designed for those with celiac disease, dermatitis herpetiformis, and wheat allergy, the GFD is followed by many without celiac disease or...
Weight and mortality: why body composition matters
Andrew O Odegaard, JoAnn E Manson
doi : 10.1093/ajcn/nqaa409
The American Journal of Clinical Nutrition, Volume 113, Issue 3, March 2021, Pages 493–494
BMI (kg/m2) is a nonspecific metric of body size that does not inform on body composition or the distribution of adipose tissue in an individual or a population. Yet, as a proxy for adiposity and the most widely used metric to define population levels of obesity, BMI has significant epidemiologic utility in predicting chronic disease and mortality risk across populations (1). In obesity-related research, it is seemingly a rite of passage for investigators to report on the prediction of mortality risk according to readily accessible BMI values within the population under study (2). This is primarily motivated by the...
Dairy foods and the risk of type 2 diabetes: getting the “fats” straight?
Benoît Lamarche
doi : 10.1093/ajcn/nqaa376
The American Journal of Clinical Nutrition, Volume 113, Issue 3, March 2021, Pages 495–496
According to the World Health Organization, more than 400 million people worldwide suffer from diabetes, with numbers having increased steadily over the last 40 years (1). Often a direct consequence of obesity, type 2 diabetes (T2D) and its comorbidities can be effectively managed and prevented through healthy lifestyles, including healthy eating. According to the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) in the United States, a healthy diet for the management of diabetes is based on variety and should include, among other foods, low- or non-fat milk, yogurt, and cheese, as opposed to higher-fat dairy foods, to limit the intake...
“Instead of what,” and repeated 4-year interval change regarding red meat and T2D: increasing causal inference in nutritional epidemiology through methodological advances
Christopher Gardner
doi : 10.1093/ajcn/nqaa385
The American Journal of Clinical Nutrition, Volume 113, Issue 3, March 2021, Pages 497–498
Recommendations to limit consumption of red meat, particularly processed red meat, have been made by many national and global health organizations due to associations with chronic diseases such as heart disease and cancer (1, 2). Many of these recommendations have been in place for decades. Reports of associations of red meat consumption with type 2 diabetes (T2D) have been more limited (3). The evidence base for these recommendations comes from a variety of lines of evidence, including long-term observational epidemiological studies with clinical outcomes of morbidity and mortality, short-term randomized controlled trials (RCTs) examining physiological response to dietary factors such...
Dietary prevention of breast cancer in high-risk women: role of carotenoids
Anne McTiernan
doi : 10.1093/ajcn/nqaa399
The American Journal of Clinical Nutrition, Volume 113, Issue 3, March 2021, Pages 499–500
Worldwide, >2 million women are diagnosed with breast cancer each year (1). Among women with high-risk germline variants, lifetime risk of breast cancer development can approach 70% (2). Women with high breast density on mammographic imaging also have a higher lifetime risk for breast cancer (3). For women at elevated breast cancer risk, prevention strategies have focused on intensive screening for early disease, chemoprevention, and prophylactic surgery (4–6). Lifestyle factors, including diet, have been linked to breast cancer etiology, but few studies have provided data specific to high-risk women. Meta-analyses and pooled analyses have found...
Malnutrition in patients with heart failure
Khursheed N Jeejeebhoy
doi : 10.1093/ajcn/nqaa406
The American Journal of Clinical Nutrition, Volume 113, Issue 3, March 2021, Pages 501–502
Patients with heart failure have significant loss of weight and wasting, especially in the terminal stages of this condition. The question is the extent to which these changes are related to an inability to consume and utilize nutrients, in contrast to cachexia, wherein similar body changes occur as a result of excessive cytokine production as opposed to a deficiency of nutrients (1). Furthermore, true cachexia does not respond to specialized nutritional interventions. The distinction between these 2 conditions is critical, both from a clinical and research perspective, since pathophysiologies and therapies differ substantially. When presented with an underweight patient, or group of research...
Nutrigenomics: lessons learned and future perspectives
Lorraine Brennan, Baukje de Roos
doi : 10.1093/ajcn/nqaa366
The American Journal of Clinical Nutrition, Volume 113, Issue 3, March 2021, Pages 503–516
The omics technologies of metabolomics, transcriptomics, proteomics, and metagenomics are playing an increasingly important role in nutrition science. With the emergence of the concept of precision nutrition and the need to understand individual responses to dietary interventions, it is an opportune time to examine the impact of these tools to date in human nutrition studies. Advances in our mechanistic understanding of dietary interventions were realized through incorporation of metabolomics, proteomics, and, more recently, metagenomics. A common observation across the studies was the low intra-individual variability of the omics measurements and the high inter-individual variation. Harnessing this data for use in the development of precision nutrition will be important. Metabolomics in particular has played a key role in the development of biomarkers of food intake in an effort to enhance the accuracy of dietary assessments. Further work is needed to realize the full potential of such biomarkers and to demonstrate integration with current strategies, with the goal of overcoming the well-established limitations of self-reported approaches. Although many of the nutrigenomic studies performed to date were labelled as proof-of-concept or pilot studies, there is ample evidence to support the use of these technologies in nutrition science. Incorporating omic technologies from the start of study designs will ensure that studies are sufficiently powered for such data. Furthermore, multi-disciplinary collaborations are likely to become even more important to aid analyses and interpretation of the data.
Persistent confusion in nutrition and obesity research about the validity of classic nonparametric tests in the presence of heteroscedasticity: evidence of the problem and valid alternatives
Cynthia M Kroeger, Keisuke Ejima, Bridget A Hannon, Tanya M Halliday, Bryan McComb ...
doi : 10.1093/ajcn/nqaa357
The American Journal of Clinical Nutrition, Volume 113, Issue 3, March 2021, Pages 517–524
The use of classic nonparametric tests (cNPTs), such as the Kruskal–Wallis and Mann–Whitney U tests, in the presence of unequal variance for between-group comparisons of means and medians may lead to marked increases in the rate of falsely rejecting null hypotheses and decreases in statistical power. Yet, this practice remains prevalent in the scientific literature, including nutrition and obesity literature. Some nutrition and obesity studies use a cNPT in the presence of unequal variance (i.e., heteroscedasticity), sometimes because of the mistaken rationale that the test corrects for heteroscedasticity. Herein, we discuss misconceptions of using cNPTs in the presence of heteroscedasticity. We then discuss assumptions, purposes, and limitations of 3 common tests used to test for mean differences between multiple groups, including 2 parametric tests: Fisher's ANOVA and Welch's ANOVA; and 1 cNPT: the Kruskal–Wallis test. To document the impact of heteroscedasticity on the validity of these tests under conditions similar to those used in nutrition and obesity research, we conducted simple simulations and assessed type I error rates (i.e., false positives, defined as incorrectly rejecting the null hypothesis). We demonstrate that type I error rates for Fisher's ANOVA, which does not account for heteroscedasticity, and Kruskal–Wallis, which tests for differences in distributions rather than means, deviated from the expected significance level. Greater deviation from the expected type I error rate was observed as the heterogeneity increased, especially in the presence of an imbalanced sample size. We provide brief tutorial guidance for authors, editors, and reviewers to identify appropriate statistical tests when test assumptions are violated, with a particular focus on cNPTs.
Circulating carotenoids and breast cancer among high-risk individuals
Cheng Peng, Chi Gao, Donghao Lu, Bernard A Rosner, Oana Zeleznik ...
doi : 10.1093/ajcn/nqaa316
The American Journal of Clinical Nutrition, Volume 113, Issue 3, March 2021, Pages 525–533
Carotenoids represent 1 of few modifiable factors to reduce breast cancer risk. Elucidation of interactions between circulating carotenoids and genetic predispositions or mammographic density (MD) may help inform more effective primary preventive strategies in high-risk populations.
The impact of diets rich in low-fat or full-fat dairy on glucose tolerance and its determinants: a randomized controlled trial
Kelsey A Schmidt, Gail Cromer, Maggie S Burhans, Jessica N Kuzma, Derek K Hagman ...
doi : 10.1093/ajcn/nqaa301
The American Journal of Clinical Nutrition, Volume 113, Issue 3, March 2021, Pages 534–547
Dairy foods, particularly yogurt, and plasma biomarkers of dairy fat intake are consistently inversely associated with incident type 2 diabetes. Yet, few trials assessing the impact of dairy on glucose homeostasis include fermented or full-fat dairy foods.
Dietary protein intake does not modulate daily myofibrillar protein synthesis rates or loss of muscle mass and function during short-term immobilization in young men: a randomized controlled trial
Sean Paul Kilroe, Jonathan Fulford, Sarah Jackman, Andrew Holwerda, Annemie Gijsen ...
doi : 10.1093/ajcn/nqaa136
The American Journal of Clinical Nutrition, Volume 113, Issue 3, March 2021, Pages 548–561
Short-term (<1 wk) muscle disuse lowers daily myofibrillar protein synthesis (MyoPS) rates resulting in muscle mass loss. The understanding of how daily dietary protein intake influences such muscle deconditioning requires further investigation.
Formal maternal employment is associated with lower odds of exclusive breastfeeding by 14 weeks postpartum: a cross-sectional survey in Naivasha, Kenya
S B Ickes, V M Oddo, H K Sanders, R Nduati, D M Denno ...
doi : 10.1093/ajcn/nqaa351
The American Journal of Clinical Nutrition, Volume 113, Issue 3, March 2021, Pages 562–573
In many low- and middle-income countries, improvements in exclusive breastfeeding (EBF) have stalled, delaying reductions in child mortality. Maternal employment is a potential barrier to EBF.
Postdischarge interventions for children hospitalized with severe acute malnutrition: a systematic review and meta-analysis
Christie C A Noble, Jonathan P Sturgeon, Mutsa Bwakura-Dangarembizi, Paul Kelly, Beatrice Amadi ...
doi : 10.1093/ajcn/nqaa359
The American Journal of Clinical Nutrition, Volume 113, Issue 3, March 2021, Pages 574–585
Children hospitalized with severe acute malnutrition (SAM) have poor long-term outcomes following discharge, with high rates of mortality, morbidity, and impaired neurodevelopment. There is currently minimal guidance on how to support children with SAM following discharge from inpatient treatment.
Neurodevelopment and growth until 6.5 years of infants who consumed a low-energy, low-protein formula supplemented with bovine milk fat globule membranes: a randomized controlled trial
Niklas Timby, Marie Adamsson, Erik Domell?f, Tove Grip, Olle Hernell ...
doi : 10.1093/ajcn/nqaa354
The American Journal of Clinical Nutrition, Volume 113, Issue 3, March 2021, Pages 586–592
We previously reported results from a randomized controlled trial in which we found that Swedish infants consuming an experimental low-energy, low-protein formula (EF) supplemented with bovine milk fat globule membranes (MFGMs) until 6 mo of age had several positive outcomes, including better performance in the cognitive domain of Bayley Scales of Infant and Toddler Development 3rd Edition at 12 mo of age, and higher plasma cholesterol concentrations during the intervention, than infants consuming standard formula (SF).
Food insecurity is associated with magnetic resonance–determined nonalcoholic fatty liver and liver fibrosis in low-income, middle-aged adults with and without HIV
Javier A Tamargo, Kenneth E Sherman, Adriana Campa, Sabrina S Martinez, Tan Li ...
doi : 10.1093/ajcn/nqaa362
The American Journal of Clinical Nutrition, Volume 113, Issue 3, March 2021, Pages 593–601
Nonalcoholic fatty liver disease (NAFLD) is the most prevalent liver disease in the United States. Food-insecure individuals often depend on low-cost, energy-dense but nutritionally poor foods, resulting in obesity and chronic diseases related to NAFLD.
Maternal gut microbiota reflecting poor diet quality is associated with spontaneous preterm birth in a prospective cohort study
Victoria Gershuni, Yun Li, Michal Elovitz, Hongzhe Li, Gary D Wu ...
doi : 10.1093/ajcn/nqaa361
The American Journal of Clinical Nutrition, Volume 113, Issue 3, March 2021, Pages 602–611
A processed diet, high in fat and low in fiber, is associated with differences in the gut microbiota and adverse health outcomes in humans; however, little is known about the diet–microbiota relation and its impact on pregnancy. Spontaneous preterm birth (SPTB), a pregnancy outcome with serious short- and long-term consequences, occurs more frequently in black and in obese women in the United States.
Replacing the consumption of red meat with other major dietary protein sources and risk of type 2 diabetes mellitus: a prospective cohort study
Anne Mette L Würtz, Marianne U Jakobsen, Monica L Bertoia, Tao Hou, Erik B Schmidt ...
doi : 10.1093/ajcn/nqaa284
The American Journal of Clinical Nutrition, Volume 113, Issue 3, March 2021, Pages 612–621
Greater consumption of red meat has been associated with a higher risk of type 2 diabetes mellitus (T2DM). A decreased intake of red meat and simultaneous increased intake of other high-protein foods may be associated with a lower risk of T2DM. These analyses of specific food replacements for red meat may provide more accurate dietary advice.
Genetic, lifestyle, and health-related characteristics of adults without celiac disease who follow a gluten-free diet: a population-based study of 124,447 participants
Thomas J Littlejohns, Amanda Y Chong, Naomi E Allen, Matthew Arnold, Kathryn E Bradbury ...
doi : 10.1093/ajcn/nqaa291
The American Journal of Clinical Nutrition, Volume 113, Issue 3, March 2021, Pages 622–629
The number of gluten-free diet followers without celiac disease (CD) is increasing. However, little is known about the characteristics of these individuals.
Magnesium intake is associated with a reduced risk of incident liver cancer, based on an analysis of the NIH-American Association of Retired Persons (NIH-AARP) Diet and Health Study prospective cohort
Shailja C Shah, Xiangzhu Zhu, Qi Dai, Richard M Peek, Jr, Martha J Shrubsole
doi : 10.1093/ajcn/nqaa326
The American Journal of Clinical Nutrition, Volume 113, Issue 3, March 2021, Pages 630–638
Liver cancer incidence and mortality are escalating globally. Magnesium intake has been studied extensively in nonmalignant liver pathology, but the association between dietary intake of magnesium and primary liver malignancy has not been previously evaluated.
Relation of body fat mass and fat-free mass to total mortality: results from 7 prospective cohort studies
Anja M Sedlmeier, Sebastian E Baumeister, Andrea Weber, Beate Fischer, Barbara Thorand ...
doi : 10.1093/ajcn/nqaa339
The American Journal of Clinical Nutrition, Volume 113, Issue 3, March 2021, Pages 639–646
Fat mass and fat-free mass may play independent roles in mortality risk but available studies on body composition have yielded inconsistent results.
Long-term dietary intake from infancy to late adolescence is associated with gut microbiota composition in young adulthood
Kolade Oluwagbemigun, Aoife N O'Donovan, Kirsten Berding, Katriona Lyons, Ute Alexy ...
doi : 10.1093/ajcn/nqaa340
The American Journal of Clinical Nutrition, Volume 113, Issue 3, March 2021, Pages 647–656
Gut microbiota composition as influenced by long-term diet may be associated with the risk of adult chronic diseases. Thus, establishing the relation of long-term diet, particularly starting from early life, with adult microbiota composition would be an important research advance.
Sugar-sweetened beverage (SSB) consumption is associated with lower quality of the non-SSB diet in US adolescents and young adults
Alex M Doherty, Allison M Lacko, Barry M Popkin
doi : 10.1093/ajcn/nqaa342
The American Journal of Clinical Nutrition, Volume 113, Issue 3, March 2021, Pages 657–664
Since 2003–4, the United States has seen large declines in sugar-sweetened beverage (SSB) intake overall, especially among non-Hispanic white (NHW) subpopulations. However, obesity prevalence has not shown comparable declines in the 2 highest SSB-consuming groups, adolescents and young adults. Little is understood about the quality of the diet excluding SSBs (non-SSB diet).
Risk factors for postdischarge mortality following hospitalization for severe acute malnutrition in Zimbabwe and Zambia
Mutsa Bwakura-Dangarembizi, Cherlynn Dumbura, Beatrice Amadi, Deophine Ngosa, Florence D Majo ...
doi : 10.1093/ajcn/nqaa346
The American Journal of Clinical Nutrition, Volume 113, Issue 3, March 2021, Pages 665–674
Children discharged from hospital following management of complicated severe acute malnutrition (SAM) have a high risk of mortality, especially HIV-positive children. Few studies have examined mortality in the antiretroviral therapy (ART) era.
Healthful dietary patterns and risk of end-stage kidney disease: the Singapore Chinese Health Study
Ting-Ting Geng, Tazeen H Jafar, Nithya Neelakantan, Jian-Min Yuan, Rob M van Dam ...
doi : 10.1093/ajcn/nqaa348
The American Journal of Clinical Nutrition, Volume 113, Issue 3, March 2021, Pages 675–683
Although adherence to healthful dietary patterns has been associated with a lower risk of kidney function decline in Western populations, evidence in Asian populations remains scanty.
Long-term diet quality is associated with gut microbiome diversity and composition among urban Chinese adults
Danxia Yu, Sang M Nguyen, Yaohua Yang, Wanghong Xu, Hui Cai ...
doi : 10.1093/ajcn/nqaa350
The American Journal of Clinical Nutrition, Volume 113, Issue 3, March 2021, Pages 684–694
Few population-based studies have evaluated the influence of long-term diet on the gut microbiome, and data among Asian populations are lacking.
The impact of malnutrition on short-term morbidity and mortality in ambulatory patients with heart failure
Shirley Sze, Pierpaolo Pellicori, Jufen Zhang, Joan Weston, Andrew L Clark
doi : 10.1093/ajcn/nqaa311
The American Journal of Clinical Nutrition, Volume 113, Issue 3, March 2021, Pages 695–705
Malnutrition is common in patients with chronic heart failure (CHF) and is associated with adverse outcomes, but it is uncertain how malnutrition should best be evaluated.
Risk of metabolic syndrome and metabolic phenotypes in relation to biomarker-calibrated estimates of energy and protein intakes: an investigation from the Women's Health Initiative
Alexi Vasbinder, Lesley F Tinker, Marian L Neuhouser, Mary Pettinger, Lauren Hale ...
doi : 10.1093/ajcn/nqaa334
The American Journal of Clinical Nutrition, Volume 113, Issue 3, March 2021, Pages 706–715
Metabolic syndrome (MetS) is associated with increased mortality independent of BMI, resulting in discordant metabolic phenotypes, such as metabolically healthy obese and metabolically unhealthy normal-weight individuals. Studies investigating dietary intake in MetS have reported mixed results, due in part to the limitations of self-reported measures.
Effect of food variety on intake of a meal: a systematic review and meta-analysis
Rochelle Embling, Aimee E Pink, Jennifer Gatzemeier, Menna Price, Michelle D Lee ...
doi : 10.1093/ajcn/nqaa352
The American Journal of Clinical Nutrition, Volume 113, Issue 3, March 2021, Pages 716–741
Many studies have shown that food variety—the presence of multiple foods and/or sensory characteristics within and across meals—increases intake. However, studies report mixed findings, and effect size remains unclear.
Associations of lifestyle risk factors with overweight or obesity among adolescents: a multicountry analysis
Sabera Sultana, Md Mizanur Rahman, Byron Sigel, Masahiro Hashizume
doi : 10.1093/ajcn/nqaa337
The American Journal of Clinical Nutrition, Volume 113, Issue 3, March 2021, Pages 742–750
About 35% of the global burden of disease has roots in adolescence. Health in adolescence is an important determinant of health in adulthood.
Reward-related gustatory and psychometric predictors of weight loss following bariatric surgery: a multicenter cohort study
Gabriela Ribeiro, Marta Camacho, Ana B Fernandes, Gonçalo Cotovio, Sandra Torres ...
doi : 10.1093/ajcn/nqaa349
The American Journal of Clinical Nutrition, Volume 113, Issue 3, March 2021, Pages 751–761
Reward sensitivity has been proposed as a potential mediator of outcomes for bariatric surgery.
Calendar of Events
doi : 10.1093/ajcn/nqab041
The American Journal of Clinical Nutrition, Volume 113, Issue 3, March 2021, Page 762
Due to the ongoing COVID-19 pandemic, events around the world are being postponed or moved online. For the most current information on events listed below, please visit the meeting's website.
