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Updating evidence-based nutrient guidance is challenging. One set of recommendations for which a robust evidence base is essential is the DRIs. In the past 10 y, DRI values for 4 essential nutrients have been re-evaluated in 2 groups: vitamin D and calcium, and sodium and potassium. To support the work of the committees tasked with evaluating the available evidence, the federal agencies that sponsor the DRI reviews contracted with the Agency for Healthcare Research and Quality to perform systematic reviews on predefined questions for these nutrient groups. Our aims were to tabulate the studies included in these systematic reviews and then, within the context of prespecified outcomes, summarize the totality of the available evidence and identify areas for consideration to maximize the value of the end products for future DRI committees. For the outcomes of interest, the available studies did not tend to report age data consistent with the current DRI categories. For some life stage categories, particularly pregnancy and lactation, there is a dearth of data. A wide range of study interventions were used, making it challenging to combine data to accurately derive or re-evaluate DRI values. There is also an under-representation of data on race/ethnicity and overweight/obesity, which is of concern, given the shifting demographic in the US and Canadian populations. Moving forward, it may be advantageous to develop a process to prospectively target research funding for studies designed to generate data that will most closely support re-evaluation of DRI values.

OBJECTIVES: To evaluate the impact of a family-based weight management intervention for children with overweight/obesity on parental nutrient biomarker concentrations and cardiometabolic risk factors (CMRF). METHODS: Secondary analysis from a randomized-controlled, parallel-arm clinical trial. Families were recruited from a largely Hispanic population and assigned to either Standard Care (SC; American Academy of Pediatrics overweight/obesity recommendations) or Standard Care + Enhanced Program (SC + EP; eight skill-building cores, subsequent monthly support sessions, targeted diet/physical activity strategies). Nutrient biomarkers (plasma carotenoids and fat soluble vitamins; red blood cell [RBC] fatty acid profiles) and CMRF (BMI, blood pressure, plasma glucose, insulin, lipid profile, inflammatory markers and adipokine concentrations) were measured in archived samples collected from the parents at baseline and at the end of the 1-year intervention. RESULTS: Parents of children in both groups (SC = 106; SC + EP = 99) had significantly lower total SFA (−3%) and trans fatty acid (−14%), and higher MUFA (2%), PUFAn-6 (2%), PUFAn-3 (7%) and beta-carotene (20%) concentrations, indicative of decreased partially-hydrogenated fat and increased vegetable oil, fish and fruit/vegetable intake, respectively. In both groups, there were significant reductions in inflammatory markers (hsCRP [−21%], TNFα [−19%] and IL-6 [−19%]), but not in BMI, blood pressure or lipid profile. Parents with children assigned to the SC + EP group had additional improvements in serum insulin (−6%) and leptin (−1.3%) concentrations. Using multiple linear regression models adjusted for sex, age, group, baseline BMI, and baseline CMRF values, improvements in circulating inflammatory and glucose metabolism markers, and adipokine concentrations were associated with higher carotenoid and PUFAn-3 (specifically 20:5n-3), and lower SFA and trans fatty acid concentrations, at the end of the 1-year intervention. CONCLUSIONS: These results suggest that a family-based childhood obesity intervention can spill over to parents, resulting in apparent healthier dietary shifts that are associated with modest improvements in some CMRF. FUNDING SOURCES: NIH, NIDDK, USDA.

OBJECTIVES: Understanding individual-level drivers of food intake is critical when personalizing dietary guidance. One likely driver is taste perception; yet, limited data relate perception of all 5 tastes (sweet, salt, sour, bitter, umami) to dietary patterns (DPs). Our aim was to determine whether a multivariable measure of taste perception, taste perception profiles, was associated with adherence to empirically derived DPs. METHODS: Participants were 367 community-dwelling adults with metabolic syndrome from PREDIMED-Plus, Valencia (55–75 years; 55% female). Six taste perception profiles were derived from 5 taste perception scores via a data-driven clustering approach: Low All (23%), High Bitter (16%), High Umami (17%), Low Bitter & Umami (20%), High All But Bitter (13%) and High All But Umami (11%). DPs were derived via principal component analysis using food groupings tabulated from food frequency questionnaires. Generalized linear models were used to examine relations between taste perception profiles and DP adherence, adjusting for confounders. RESULTS: Three DPs were identified, explaining 25% of total variance: a high fruit, vegetable and whole grain DP (Fruit/Veg), a high fat, sugar and refined grain DP (Fat/Sug) and a high alcohol, salt and processed meat DP (Alch/Salt). Adherence to the DPs differed by profile. Across all profiles, High Bitter and Low All individuals were most likely to follow the Alch/Salt DP (44% and 39% in highest tertial of adherence, respectively; P = 0.03), while those with High All But Bitter and High Umami tended to follow the Fat/Sug DP (42% and 39% in highest tertial, respectively; P = 0.08). Compared to Low All individuals, after adjusting for age, sex, physical activity, diabetes and BMI, those with Low Bitter & Umami adhered less to the Alch/Salt DP (β [95% CI] = −0.3 [−0.6, −0.03]) while those with High Umami adhered more to the Fat/Sug DP (0.4 [0.1, 0.8]). CONCLUSIONS: Among older adults with metabolic syndrome, taste perception profiles were differentially associated with adherence to empirically derived DPs, suggesting the benefit of using taste perception profiles when customizing risk reduction dietary guidance. FUNDING SOURCES: ARS/USDA, HNRCA Cassidy Student Research Award, Spanish Ministry of Health (Instituto de Salud Carlos III; SAF2016–80532-R), CIBEROBN (06/03/0035) and Generalitat Valenciana (PROMETEO 17/2017).

Dietary modification has been the cornerstone of cardiovascular disease (CVD) prevention since the middle of the last century when the American Heart Association (AHA) first issued recommendations. For the vast majority of that time the focus has been on saturated fat, with or without concomitant guidance for total or unsaturated fat. Over the past few years there has been a renewed debate about the relation between dietary saturated fat and CVD risk, prompted by a series of systematic reviews that have come to what appears to be different conclusions. This triggered a robust discourse about this controversy in the media that in turn has led to confusion in the general public. The genesis of the different conclusions among the systematic reviews has been identified in several studies on the basis of isocaloric substitution analyses. When the data were analyzed on the basis of polyunsaturated fat replacing saturated fat, there was a positive relation between dietary saturated fat and CVD. When the data were analyzed on the basis of carbohydrate replacing saturated fat, there was a null relation between dietary saturated fat and CVD. When the substitution macronutrient was not taken into consideration, the differential effects of the macronutrient substitution went unrecognized and the relations judged as null. The lack of distinction among substituted macronutrients accounted for much of what appeared to be discrepancies. Dietary guidance consistent with replacing foods high in saturated fat with foods high in unsaturated fat, first recommended more than 50 y ago, remains appropriate to this day.

BACKGROUND: Inverse associations have been reported between serum 25-hydroxyvitamin D [25(OH)D] and circulating cholesterol concentrations in observational studies. Postulated mechanisms include reduced bioavailability of intestinal cholesterol and alterations in endogenous cholesterol synthesis. OBJECTIVE: To explore the effect of daily supplementation with 4000 IU/d vitamin D(3) for 24 wk on surrogate biomarkers of cholesterol absorption (campesterol and β-sitosterol) and endogenous synthesis (lathosterol and desmosterol). METHODS: Ancillary study of The Vitamin D for Established Type 2 Diabetes (DDM2) trial. Patients with established type 2 diabetes (N = 127, 25–75 y, BMI 23–42 kg/m(2)) were randomly assigned to receive either 4000 IU vitamin D(3) or placebo daily for 24 wk. Of participants without changes in cholesterol-lowering medications (n = 114), plasma surrogate cholesterol absorption and endogenous synthesis biomarker concentrations were measured and merged with available measures of serum LDL cholesterol and HDL cholesterol concentrations. RESULTS: At week 24, vitamin D(3) supplementation significantly increased 25(OH)D concentrations (+21.5 ± 13.4 ng/mL) but not insulin secretion rates (primary outcome of the parent study) as reported previously. In this ancillary study there was no significant effect of vitamin D(3) supplementation on serum cholesterol profile or surrogate biomarkers of cholesterol absorption and endogenous synthesis. Compared with participants not treated with cholesterol-lowering medications, those who were treated exhibited a greater reduction in plasma campesterol concentrations in the vitamin D(3) but not placebo group (P-interaction = 0.011). Analyzing the data on the basis of cholesterol absorption status (hypo- versus hyperabsorbers) or cholesterol synthesis status (hypo- versus hypersynthesizers) did not alter these results. CONCLUSIONS: Vitamin D(3) supplementation for 24 wk had no significant effect on surrogate biomarkers of cholesterol absorption or endogenous synthesis, consistent with the lack of effect on serum cholesterol profile. Vitamin D(3) supplementation resulted in greater reduction in campesterol concentrations in participants not using compared with those using cholesterol-lowering medications. Further studies are required. This trial was registered at clinicaltrials.gov as NCT01736865.

OBJECTIVES: In humans, perception for each taste (sweet, salt, sour, bitter and umami) has been independently related to food preferences and intake. Yet, the collective influence of perception of all 5 tastes on diet and cardiometabolic health remains unexplored. Therefore, our objective was to investigate the relations between a collective measure of taste perception – “taste perception profiles” – and adiposity. METHODS: We analyzed baseline data of 367 older adults (55–75 years; 55% female) with metabolic syndrome (MetS) participating in the PREDIMED-Plus Valencia trial. Taste perception was assessed for sweet, salt, sour, bitter and umami using sucrose, NaCl, citric acid, phenylthiocarbamide and monopotassium L-glutamate, respectively, and evaluated on a 0–5 scale. Taste perception profiles were derived from perception scores using predictive modeling and k-means clustering (KCA). Multivariable linear regression was used to evaluate the relations between taste perception profiles and BMI, body weight (BW) and waist circumference (WC), after adjustment for confounders. RESULTS: KCA identified 7 taste perception profiles: Low All (n = 79), High Umami (n = 61), High Bitter (n = 49), High Bitter & Umami (n = 44), High Sweet, Salt & Sour (n = 51), High All But Bitter (n = 49) and High All But Umami (n = 34). After adjusting for age, sex, physical activity, smoking, diabetes, medication use and energy intake, BMI, BW and WC were highest for the Low All profile (adjusted means: 33.4 kg/m(2), 87.5 kg and 108.4 cm; reference). Comparatively, mean BMI and BW were lower for High Bitter (–1.9 kg/m(2); –5.4 kg), High Bitter & Umami (–1.7; –4.7), High Sweet, Salt & Sour (–1.3; –4.6) and High All But Bitter (–1.7; –5.0) profiles; and WC was lower for High Bitter & Umami (–3.4 cm) and High All But Bitter (–4.9) profiles (all P

Background Developing dietary strategies to prevent excess weight gain during childhood is critical to stem the current obesity epidemic and associated adverse cardiometabolic consequences. Objectives We aimed to assess how participation in a family-based weight-management intervention affected nutrient biomarkers and cardiometabolic risk factors (CMRFs) in children (7–12 y old; n = 321) with baseline BMI z score (BMIz) ≥85th percentile. Methods This was a secondary analysis from a randomized-controlled, parallel-arm clinical trial. Families of children, recruited from a largely Hispanic population, were assigned to Standard Care (SC; American Academy of Pediatrics overweight/obesity recommendations), or SC + Enhanced Program (SC + EP; 8 skill-building cores, monthly support sessions, targeted diet/physical activity strategies). Nutrient biomarkers (plasma carotenoids, fat-soluble vitamins, RBC fatty acid profiles, desaturase indexes) and CMRFs were measured in archived blood samples collected at baseline and the end of the 1-y intervention. Results Children in both groups had significantly lower trans fatty acid and higher pentadecylic acid (15:0), PUFA n–3, and β-carotene concentrations, indicative of decreased hydrogenated fat and increased dairy, vegetable oil, fish, and fruit/vegetable intake, respectively. Similar changes were seen in de novo lipogenesis and desaturase indexes, as well as CMRFs (BMIz, lipid profile, inflammation, adipokines, liver enzymes) in both groups. Using multiple logistic regression, increase in carotenoids and decrease in endogenously synthesized SFA, MUFA, PUFA n–6, and desaturase indexes were associated with improvements in BMIz, blood pressure, lipid profile, glucose metabolism, inflammatory biomarkers, adipokines, and liver enzymes. Trans fatty acids were associated with improvements in BMIz, glucose metabolism, and leptin, with less favorable effects on inflammatory markers and adiponectin. Conclusions Providing targeted family-based behavioral counseling, as part of SC, can help overweight/obese children adopt healthier eating patterns that are associated with modest improvements in BMIz and several CMRFs. Limited additional benefit was observed with SC + EP. These results provide critical data to design subsequent interventions to increase the impact of family-based obesity prevention programs. This trial was registered at clinicaltrials.gov as NCT00851201.

Dietary modification has been the cornerstone of cardiovascular disease (CVD) prevention since the middle of the last century when the American Heart Association (AHA) first issued recommendations. For the vast majority of that time the focus has been on saturated fat, with or without concomitant guidance for total or unsaturated fat. Over the past few years there has been a renewed debate about the relation between dietary saturated fat and CVD risk, prompted by a series of systematic reviews that have come to what appears to be different conclusions. This triggered a robust discourse about this controversy in the media that in turn has led to confusion in the general public. The genesis of the different conclusions among the systematic reviews has been identified in several studies on the basis of isocaloric substitution analyses. When the data were analyzed on the basis of polyunsaturated fat replacing saturated fat, there was a positive relation between dietary saturated fat and CVD. When the data were analyzed on the basis of carbohydrate replacing saturated fat, there was a null relation between dietary saturated fat and CVD. When the substitution macronutrient was not taken into consideration, the differential effects of the macronutrient substitution went unrecognized and the relations judged as null. The lack of distinction among substituted macronutrients accounted for much of what appeared to be discrepancies. Dietary guidance consistent with replacing foods high in saturated fat with foods high in unsaturated fat, first recommended more than 50 y ago, remains appropriate to this day.

OBJECTIVES: To determine the impact of two isocaloric diets containing (38% ,15% and 47% energy from fat, protein and carbohydrate, respectively): Western diet (WD) rich in saturated fat, refined carbohydrate, low in fiber and high in cholesterol, and a heart healthy diet (HHD) rich in unsaturated fat, unrefined carbohydrate, fruits/vegetables, high in fiber and low in cholesterol, on the composition and function of the gut microbiome METHODS: Thirty-Ossabaw pigs were fed WD or HHD diets with half within each group therapeutically treated with statin (atorvastatin [Lipitor]). The fecal microbiome was analyzed one and six months after dietary intervention by 16S rRNA sequencing and metagenomic function was empirically inferred RESULTS: Genus diversity was transiently affected with a reduced Shannon Diversity index one month after feeding the WD or HHD (FDR P

OBJECTIVES: To investigate the association between taste perception for sweet, salt, sour, bitter and umami and food category intakes. We hypothesized that greater taste perception will be inversely associated with the amount consumed. METHODS: A cross-sectional baseline analysis was performed on community-dwelling overweight adults with metabolic syndrome (N = 367, 55–75y) from the PREDIMED-PLUS Trial, University of Valencia Center, Spain. Taste perception was determined by challenging subjects with standard solutions of sweet, salt, sour, bitter and umami (400 mM sucrose, 200 mM NaCl, 34 mM citric acid, 5.6 mM phenylthiocarbamide (PTC), 200 mM monopotassium glutamate, respectively) and evaluated on a 0–5 scale. Outcomes included intake (servings/week) of food categories derived from a validated food frequency questionnaire: fruit (citrus/non-citrus/nuts), vegetables (cruciferous/non-cruciferous), protein (eggs/fish[fresh/shell/canned]/meat[processed/unprocessed]), grains (legumes/refined/whole), dairy (regular/low- & no-fat) and oils (extra virgin olive (EVOO)/olive/vegetable). Multivariable linear regression models were used to assess associations of perception for each taste and consumption of each food category (untransformed or transformed, for normality). RESULTS: After controlling for age, sex, diabetes, smoking, physical activity and energy intake, sweet was inversely associated with vegetables (β = −1.1; 95% CI = [−2.0, −0.2]), particularly non-cruciferous (β = −1.0; P = 0.02), and citrus fruit (β = −0.5; P

OBJECTIVES: Limited data are available on the prospective relationship between beverage consumption and plasma lipid and lipoprotein concentrations in population-based studies. Two major sources of sugar in the US diet are sugar-sweetened beverages (SSB; sodas and fruit drinks) and 100% fruit juices (FJ). Low-calorie sweetened beverages (LCSB) are common replacements for SSB and FJ. METHODS: Fasting plasma triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) concentrations were measured at up to 5 exams in the Framingham Heart Study offspring and up to 2 exams in generation 3 cohorts (1998–2005; N = 6730). Consumption of SSB, FJ, and LCSB were estimated from food frequency questionnaires and intakes were categorized. Mixed-effect linear regression models were used to examine changes in lipid concentrations, and Cox proportional hazard models were used to estimate hazard ratios (HR) for incident dyslipidemia, adjusting for potential confounding factors. Results were statistically significant at a Bonferroni-corrected P-value 1 serving/day) vs. low intake category (

OBJECTIVES: To prospectively examine the association between low density lipoprotein cholesterol (LDL-C) concentrations and intracerebral hemorrhage (ICH) risk, and test the association in a meta-analysis combining the present data with previous studies. METHODS: The current cohort study included 96,043 participants (mean age 51.3 y), free of stroke, myocardial infarction, and cancer at baseline (2006). Serum LDL-C concentrations were assessed in 2006, 2008, 2010 and 2012. Cumulative average LDL-C concentrations were calculated from all available LDL-C data during that period. Incident ICH was confirmed by review of medical records. RESULTS: We identified 753 incident ICH cases during 9 years of follow-up. The ICH risk was similar among participants with LDL concentrations of 70–99 mg/dL and those with LDL-C concentrations ≥100 mg/dL. In contrast, participants with LDL-C concentrations less than 70 mg/dL had a significantly higher risk of developing ICH than those with LDL-C concentrations of 70–99 mg/dL –adjusted HR 1.65 (95%CI, 1.32 to 2.05) for LDL-C concentrations of 50–69 mg/dL and 2.69 (95%CI, 2.03 to 3.57) for LDL-C concentrations of

Background Current cardiovascular risk reduction guidance focuses on shifts in dietary patterns, rather than single foods or nutrients. Experimental studies are needed to identify the mechanisms by which food-based diets affect the development and progression of atherosclerosis. Objectives The aim of this study was to investigate the effect of 2 food-based dietary patterns and statin therapy on the transcriptome of the left anterior descending coronary artery of the Ossabaw pig. Methods Pigs were randomly assigned to 1 of 4 groups and fed isocaloric diets for 6 mo; Heart Healthy–style diet (HHD) (high in unsaturated fat, unrefined grain, fruits/vegetables) or Western-style diet (WD) (high in saturated fat, cholesterol, refined grain), with or without atorvastatin. A 2-factor edge R analysis was used to determine differential gene expression in the left anterior descending coronary artery. Results Relative to the HHD, the WD resulted in the differential expression of 143 genes, of which 139 genes were upregulated and 4 genes were downregulated (all log fold change ≥0.6, false discovery rate

Serving as a cornerstone of dietary policy in the United States, the Dietary Guidelines for Americans (DGAs) provide an important foundation for understanding the programs and policies that influence public health practice. In this chapter, we review the emergence and development of the guidelines beginning with their evolution from the Dietary Goals for Americans and moving through various iterations from 1980 until the current era in 2015. Topics include concrete reporting on recommendations, evolving principles of a healthy diet, and a discussion of controversies borne by industry lobbying groups and government mandates.

Background Although there is interest in popular diets such as vegan and vegetarian, Paleo, and other "whole food" diets, existing cohort studies lack data for these subgroups. The use of electronic data capture and Web-based surveys in nutrition research may be valuable for future studies by allowing targeting of specific dietary subgroups. Objective The aim was to perform a Feasibility Survey (FS) to assess the practicality of Web-based research methods to gather data and to maximize response rates among followers of popular diets. Methods The FS was an open, voluntary, 15-min survey conducted over 8 wk in the summer of 2015. Recruitment targeted self-identified followers of popular diets from a convenience sample, offering no incentives, via social media and e-newsletters shared by recruitment partners. Feasibility was assessed by number of responses, survey completion rate, distribution of diets, geographic location, and willingness to participate in future research. Results A total of 14,003 surveys were initiated; 13,787 individuals consented, and 9726 completed the survey (71% of consented). The numbers of unique visitors to the questionnaire site, view rate, and participation rate were not captured. Among respondents with complete demographic data, 83% were female and 93% were white. Diet designations were collapsed into the following groups: whole-food, plant-based (25%); vegan and raw vegan (19%); Paleo (14%); try to eat healthy (11%); vegetarian and pescatarian (9%); whole food (8%); Weston A Price (5%); and low-carbohydrate (low-carb) (4%). Forced-response, multiple-choice questions produced the highest response rates (0-2% selected "prefer not to answer"). The percentage who were willing to complete future online questionnaires was 86%, diet recall was 93%, and food diary was 75%; the percentages willing to provide a finger-stick blood sample, venipuncture blood sample, urine sample, and stool sample were 60%, 44%, 58%, and 42%, respectively. Conclusions This survey suggests that recruiting followers of popular diets is feasible with the use of Web-based methods. The unbalanced sample with respect to sex and race/ethnicity could be corrected with specific recruitment strategies using targeted online marketing techniques.