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Funding European Commission (DG-SANCO) , the International Agency for Research on Cancer (IARC) , MRC Early Career Fellowship (MR/M501669/1) ., Background Unhealthy diets, the rise of non-communicable diseases, and the declining health of the planet are highly intertwined, where food production and consumption are major drivers of increases in greenhouse gas emissions, substantial land use, and adverse health such as cancer and mortality. To assess the potential co-benefits from shifting to more sustainable diets, we aimed to investigate the associations of dietary greenhouse gas emissions and land use with all-cause and cause-specific mortality and cancer incidence rates. Methods Using data from 443 991 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) study, a multicentre prospective cohort, we estimated associations between dietary contributions to greenhouse gas emissions and land use and all-cause and cause-specific mortality and incident cancers using Cox proportional hazards regression models. The main exposures were modelled as quartiles. Co-benefits, encompassing the potential effects of alternative diets on all-cause mortality and cancer and potential reductions in greenhouse gas emissions and land use, were estimated with counterfactual attributable fraction intervention models, simulating potential effects of dietary shifts based on the EAT–Lancet reference diet. Findings In the pooled analysis, there was an association between levels of dietary greenhouse gas emissions and allcause mortality (adjusted hazard ratio [HR] 1·13 [95% CI 1·10–1·16]) and between land use and all-cause mortality (1·18 [1·15–1·21]) when comparing the fourth quartile to the first quartile. Similar associations were observed for cause-specific mortality. Associations were also observed between all-cause cancer incidence rates and greenhouse gas emissions, when comparing the fourth quartile to the first quartile (adjusted HR 1·11 [95% CI 1·09–1·14]) and between all-cause cancer incidence rates and land use (1·13 [1·10–1·15]); however, estimates differed by cancer type. Through counterfactual attributable fraction modelling of shifts in levels of adherence to the EAT–Lancet diet, we estimated that up to 19–63% of deaths and up to 10–39% of cancers could be prevented, in a 20-year risk period, by different levels of adherence to the EAT–Lancet reference diet. Additionally, switching from lower adherence to the EAT–Lancet reference diet to higher adherence could potentially reduce food-associated greenhouse gas emissions up to 50% and land use up to 62%. Interpretation Our results indicate that shifts towards universally sustainable diets could lead to co-benefits, such as minimising diet-related greenhouse gas emissions and land use, reducing the environmental footprint, aiding in climate change mitigation, and improving population health., European Commission European Commission Joint Research Centre, World Health Organization, UK Research & Innovation (UKRI) Medical Research Council UK (MRC) MR/M501669/1

BACKGROUND: A healthy diet is recommended for patients with Crohn’s disease (CD) in remission. OBJECTIVE: To evaluate the diet quality of patients with CD. METHODS: Cross-sectional study with patients with CD and clinical remission using the biological agent infliximab. The diet quality was assessed using the Diet Quality Index-Revised (DQI-R). DQI-R was calculated based on 24-hour dietary recalls (24HR), being classified as “inadequate diet” (≤40 points), “diet requiring modifications” (41 to 64 points) and “healthy diet” (≥65 points). Weight, height and waist circumference (WC) of patients were assessed. For comparison between groups, Student’s t-test or Mann-Whitney was used. For correlation between continuous variables, Pearson or Spearman coefficient was used. Values of P

Introduction: Obesity is associated with nonalcoholic fatty liver disease (NAFLD) in children. Our aim was to analyze the association of dietary and sociodemographic factors with NAFLD in obese children and adolescents. Materials and methods: Thirty-three obese patients from 6-16 years of age were included in the present analytic cross-sectional study. Obesity was diagnosed with a body mass index z-score > 2 SD. NAFLD was estimated by liver ultrasound, serum amino transferases, and elastography. The sociodemographic variables were evaluated using validated questionnaires. Diet was estimated through two 24-h recall dietary surveys focused on the quantity of food energy, simple sugars, polyunsaturated fatty acids (PUFAs), and antioxidants. Results: Hepatic steatosis was identified by abdominal ultrasound in 13 patients (39.4%) and the serum alanine aminotransferase level was above the upper reference value in 54.2%. A higher educational level in both parents, greater monthly food expenditure, and a higher socioeconomic level were associated with NAFLD. Overall, simple sugar and saturated fat consumption was above the recommended daily intake, whereas vitamin E and PUFA consumption was below those parameters. Conclusions: NAFLD was identified in one-third of the cases. There was an association between NAFLD and sociodemographic variables. Both groups had an increased intake of simple sugars and a reduced intake of PUFAs. The selective occurrence of NAFLD could be related to a genetic predisposition that has been demonstrated in a Mexican population. Resumen: Introducción y objetivo: La obesidad se asocia con el hígado graso no alcohólico (HGNA) en niños. El objetivo fue explorar la asociación de factores dietéticos y sociodemográficos con el HGNA en niños y adolescentes obesos. Material y métodos: Treinta y tres pacientes obesos de 6-16 años fueron incluidos en este estudio transversal analítico. El diagnóstico de obesidad se realizó con puntuación z del índice de masa corporal > 2 DE. El HGNA se estimó con ultrasonido hepático, aminotransferasas séricas y elastografía. Las variables sociodemográficas se evaluaron con cuestionarios validados. La dieta se estimó mediante dos encuestas dietéticas por recordatorio de 24 horas enfocadas a la cantidad de energía, azúcares simples, ácidos grasos poliinsaturados (PUFAS) y antioxidantes. Resultados: En 13 pacientes (39.4%) se identificó esteatosis hepática por ultrasonido abdominal; 54.2% tuvieron una concentración sérica de alanina aminotransferasa por arriba de la referencia. El nivel educativo superior de ambos padres, el mayor gasto familiar mensual en alimentos y el mayor nivel socioeconómico se asociaron con HGNA. En el grupo total, el consumo de azúcares simples y grasas saturadas fue excesivo y el consumo de vitamina E y PUFAS estuvo por debajo del parámetro. Conclusiones: Se identificó HGNA en un tercio de los casos. Se demostró asociación entre HGNA y variables sociodemográficas. Ambos grupos tuvieron una ingesta aumentada de azúcares simples y disminuida de PUFAs. La ocurrencia selectiva de HGNA se podría relacionar a predisposición genética demostrada en población mexicana.

Resumen: La presencia de malnutrición en pacientes con enfermedad renal crónica (ERC) es elevada, puede agravarse por la infección por SARS-CoV-2.La valoración nutricional se debe adaptar para minimizar contagios, recomendando monitorizar: porcentaje de pérdida de peso, índice de masa corporal (IMC), pérdida de apetito, parámetros analíticos y capacidad funcional mediante dinamometría. Así como valorar la sarcopenia mediante la escala SCARF, y la posibilidad de utilizar los criterios GLIM en aquellos pacientes que el cribado MUST ha dado positivo.Es importante adaptar las recomendaciones nutricionales en ingesta calórica y proteica, al estadio de la ERC y a la fase de infección por SARS-CoV-2. En pacientes hipercatabólicos priorizar preservar estado nutricional (35 kcal/kg peso/día, proteínas hasta 1,5 g/kg/día). El resto de nutrientes se adaptarán a estadio de ERC y valores analíticos.En la etapa postinfección, se recomienda realizar valoración nutricional completa, incluyendo sarcopenia. Los requerimientos energéticos y proteicos en esta fase se adaptarán a la afectación del estado nutricional, con especial atención a la pérdida de masa muscular.Es necesario adaptar las recomendaciones dietéticas a efectos secundarios de la infección por SARS-CoV-2: anorexia, disfagia, disgeusiay diarrea.La anorexia y el hipercatabolismo dificulta el cumplimiento de los requerimientos a través de la alimentación, por lo que se recomienda la utilización de soporte nutricional oral y en las fases severas la nutrición enteral o la parenteral. Abstract: The presence of malnutrition in patients with chronic kidney disease (CKD) is high, it can be made worse by SARS-CoV-2 infection.The nutritional assessment should be adapted to minimize the infection, recommending monitoring: weight loss percentage, body mass index (BMI), loss of appetite, analytical parameters and functional capacity using the dynamometer. As well as the sarcopenia assessment using the SCARF scale, and the possibility of using the GLIM criteria in those patients who have been tested positive by MUST.It is important to adapt the nutritional recommendations in the caloric and protein intake, to the CKD stage and to the SARS-CoV-2 infection stage. In patients with hypercatabolism, to prioritize preserving the nutritional status (35 kcal/kg weight/day, proteins up to 1.5 g/kg/day). The rest of the nutrients will be adapted to CKD stage and the analytical values.In the post-infection stage, a complete nutritional assessment is recommended, including sarcopenia. The energy and protein requirements in this phase will be adapted to the nutritional status, with special attention to the loss of muscle mass.Dietary recommendations need to be tailored to side effects of SARS-CoV-2 infection: anorexia, dysphagia, dysgeusia, and diarrhea.Anorexia and hypercatabolism makes it difficult to meet the requirements through diet, therefore the use of oral nutritional supplements is recommended as well as the enteral or parenteral nutrition in severe phases.

Although antioxidants can act locally to react with an oxidant, oral administration of “antioxidants” is quite useless in treating oxidative stress in tissues. Furthermore, it does not make sense to consider a vitamin as an antioxidant, but vitamin B3 leads to the in vivo formation of compounds that are essential for reducing this stress. A rigorous treatment of the subject indicates that to deal with oxidative stress, the most direct approach is to enhance the innate antioxidant mechanisms. The question is whether this is possible through daily activities. Diets can contain the necessary components for these mechanisms or may induce the expression of the genes involved in them. Another possibility is that pro-oxidant molecules in food increase the sensitivity and power of the detoxification pathways. This option is based on well-known DNA repair mechanisms after exposure to radiation (even from the Sun), or strong evidence of induction of antioxidant capacity after exposure to powerful pro-oxidants such as H2O2. More experimental work is required to test whether some molecules in food can increase the expression of antioxidant enzymes and/or improve antioxidant mechanisms. Identifying effective molecules to achieve such antioxidant power is critical to the food and nutraceutical industries. The potential of diet-based interventions to combat oxidative stress must be viewed from a new perspective.

Age-related hearing loss (ARHL) is a major and increasingly prevalent health problem worldwide, causing disability and social isolation in the people who present it. This impairment is caused by genetic and environmental factors. Nutritional status has been identified as a related risk associated with hearing loss (HL). This scoping review aimed to characterize the links between HL and nutritional status. PubMed, Embase, Cochrane and Scopus databases were searched up to December 2019. Studies examining the relation between nutrition and dietary habits and HL were included. After screening 3510 citations, 22 publications were selected for inclusion in the current review, all of which were published between 2010 and 2019. Diets rich in saturated fats and cholesterol have deleterious effects on hearing that could be prevented by lower consumption. Conversely, greater consumption of fruit and vegetables, and of polyunsaturated fatty acids (omega-3) and anti-oxidants in the form of vitamins A, C, and E, prevent the development of ARHL. The current literature suggests a possible association between nutritional status and hearing loss. More studies are needed to better characterize the clinical consequences of this association. Sí

SUMMARY OBJECTIVE: To gather scientific evidence on the role of diet in inflammatory bowel diseases. METHODS: Integrative review with studies published in the last 10 years in national and international journals. Original studies developed with adult human beings aged ≥18 years were included and articles published before 2010, literature reviews, and those that did not focus on elements that answered the guiding question were excluded. RESULTS: 14 articles were selected that addressed important dietary elements in inflammatory bowel disease such as fermentable carbohydrates and polyols, foods of animal origin, foods rich in omega 3, consumption of fruits and vegetables, use of probiotic supplements, whey proteins and soy. CONCLUSION: The diet, as a potentially modifiable environmental factor, plays an important role in the prevention and treatment of inflammatory bowel diseases. The reduction in the consumption of fermentable carbohydrates and polyols combined with the increase in the consumption of fruits and vegetables as well as the exclusion of products of animal origin such as beef, pork, milk and eggs can help control inflammation and improve the quality of life of patients with inflammatory bowel diseases. The use of probiotics increases food tolerance and, whey and soy proteins, can alter body composition and reduce inflammation. RESUMO OBJETIVO: Reunir evidências científicas sobre o papel da dieta nas doenças inflamatórias intestinais. MÉTODOS: Revisão integrativa com estudos publicados nos últimos 10 anos em periódicos nacionais e internacionais. Foram incluídos estudos originais desenvolvidos com seres humanos adultos com idade ≥18anos e excluídos artigos publicados antes de 2010, revisões de literatura, e os que não apresentassem como foco elementos que respondessem a pergunta norteadora. RESULTADOS: Foram selecionados 14 artigos que abordaram elementos dietéticos importantes na doença inflamatória intestinal como carboidratos e polióis fermentáveis, alimentos de origem animal, alimentos ricos em ômega 3, consumo de frutas e vegetais, uso de suplementos com probióticos, proteínas do soro do leite e soja. CONCLUSÃO: A dieta, como fator ambiental potencialmente modificável desempenha importante papel na prevenção e tratamento das doenças inflamatórias intestinas. A redução no consumo de carboidratos e polióis fermentáveis aliado ao aumento do consumo de frutas e vegetais como também a exclusão de produtos de origem animal como carne bovina, carne suína, leite e ovo podem auxiliar no controle da inflamação e melhoria da qualidade de vida dos pacientes com doenças inflamatórias intestinais. O uso de probióticos aumenta a tolerância alimentar e, proteínas do soro do leite e soja, podem alterar a composição corporal e reduzir a inflamação.

Nutrition education resources are of interest for cancer patients and survivors throughout the cancer continuum. We examined the web-based nutrition information in Spanish for cancer patients and survivors provided by national cancer organizations (NCOs). The Guide to Internet Resources for Cancer and the membership list of the Union for International Cancer Control were searched to identify the NCOs. The International Patients Decisions Aid Standards (IPDAS) was used to describe the quality of the available information. We identified 20 NCOs that provided nutrition information aimed at a general audience on their websites. Web-based resources of nine NCOs were selected for presentation in this review. Website scores ranged between 20 and 24 in the IPDAS scale (maximum score = 31). The selected NCOs offered reliable and safe information. Healthy eating information for cancer patients and management of side-effects was provided by all websites. Information was more limited for cancer survivors. We recommend that NCOs increase the possibilities for personalized recommendations and interaction with the content by including instrumental tools on their websites.

Noncommunicable diseases (NCDs) and mental disorders cooccur in adulthood, which is why their determinants and common risk factors should be addressed at an early age. Therefore, we estimated the association of the major risk factors for NCDs with depression and suicide risk by structural equation modeling considering pathways triggered by social vulnerability or mediated by obesity. This population-based study included 2,515 Brazilian adolescents. The following exposures were the major risk factors for NCDs: substance use behaviors (variable deduced from alcohol, tobacco, and drug use), physical inactivity, and components of unhealthy eating markers (added sugar and saturated fat). Obesity was assessed using the fat mass index. The outcomes were depression and suicide risk. Depression was associated with substance use behaviors (SC = 0.304; p < 0.001), added sugar (SC = 0.094; p = 0.005), and females (SC = 0.310; p < 0.001). Suicide risk was also associated with substance use behaviors (SC = 0.356; p < 0.001), added sugar (SC = 0.100; p = 0.012), and females (SC = 0.207; p < 0.001). In adolescents, these associations may help explain the cluster of NCDs and mental disorders in adulthood. As doenças não transmissíveis (DNT) e transtornos mentais podem ocorrer simultaneamente na vida adulta, razão pela qual seus determinantes e fatores de risco comuns devem ser abordados em idade precoce. Portanto, estimamos a associação entre os principais fatores de risco para DNT e a depressão e risco de suicídio através da modelagem de equações estruturais, considerando os caminhos desencadeados pela vulnerabilidade social ou mediados pela obesidade. Este estudo de base populacional incluiu 2.515 adolescentes brasileiros. As exposições foram os principais fatores de risco para DNT: comportamento de risco viciante (variável latente deduzida a partir do uso de álcool, tabaco e drogas), inatividade física e componentes da dieta não saudável (açúcar de adição e gordura saturada). A obesidade foi avaliada pelo índice de massa gorda. Os desfechos foram depressão e risco de suicídio. Comportamento de risco viciante (CP = 0,304; p < 0,001), açúcar de adição (CP = 0,094; p = 0,005) e sexo feminino (CP = 0,310; p < 0,001) estiveram associados à depressão. Comportamento de risco viciante (CP = 0,356; p < 0,001), açúcar de adição (CP = 0,100; p = 0,012) e sexo feminino (CP = 0,207; p < 0,001) também estiveram associados ao risco de suicídio. Comportamento de risco viciante e açúcar de adição estiveram associados à depressão e ao risco de suicídio em adolescentes, fato este que pode ajudar a explicar o agrupamento de DNT e transtornos mentais na vida adulta. Las enfermedades no comunicables (ENTs) y los desórdenes mentales ocurren en la etapa adulta, un hecho que da impulso para dirigirse a sus determinantes y factores de riesgo comunes a una edad temprana. Por ello estimamos la asociación de los mayores factores de riesgo para ENTs con la depresión y riesgo de suicidio mediante un modelo de ecuación estructural, considerando trayectorias derivadas de la vulnerabilidad social o mediadas por la obesidad. Este estudio basado en población incluyó a 2.515 adolescentes brasileños. Las exposiciones fueron los mayores factores de riesgo para las ENTs: comportamiento en el uso de sustancias (variable latente deducida del alcohol, tabaco y consumo de drogas), inactividad física y componentes de marcadores de consumo de comida insana (azúcar añadido y grasas saturadas). La obesidad fue evaluada usando el índice de masa grasa. Los resultados fueron depresión y riesgo de suicidio. Los comportamientos en el uso de sustancias (CE = 0,304; p < 0,001), azúcar añadido (CE = 0,094; p = 0,005), y sexo femenino (CE = 0,310; p < 0,001) estuvieron asociados con depresión. Comportamientos en el consumo de sustancias (CE = 0,356; p < 0,001) y azúcar añadido (CE = 0,100; p = 0,012) y el sexo femenino (CE = 0,207; p < 0,001) estuvieron también asociados con el riesgo de suicidio. Los comportamientos en el consumo de sustancias y de azúcar añadido, estuvieron asociados con la depresión y el riesgo de suicidio en adolescentes, un hecho que puede ayudar a explicar la concentración de ENTs y desórdenes mentales en la etapa adulta.

The Dietary Inflammatory Index (DII) was developed to estimate the inflammatory power of a dietary pattern. This research aimed to evaluate the association between the IID with sociodemographic, anthropometric and dietary indicators of the elderly in the community. This is a descriptive, probabilistic and retrospective study, with a transversal, quantitative and analytical design, which used secondary data from the research “Food and nutritional situation of the elderly in Palmeira das Missões, RS”. A total of 424 elderly people participated in the study, with a predominance of females (68.4%), aged between 60 and 69 years (49.5%) with a mean of 70.8±7.8 years, presence of a partner (53.8% ), education level below 5 years of schooling (60.1%), with salary income less than two minimum wages (79.7%), presence of excess weight according to BMI (49.1%) , was not a smoker (85.6%), on medication (75.7%) and did not practice physical activity (54.7%). The energy-adjusted IID with the pro-inflammatory profile was more prevalent among the elderly (77.6%). In this group, the consumption of energy (p=0.008), total (p

Objective: To investigate if the diet quality and its components are associated with breast cancer risk. Methods: A case-control study was conducted with 332 women, 114 who were diagnosed with breast cancer, and 218 control individuals. Groups were matched for age, body mass index, and menopausal status. The quality of diet was assessed using Brazilian Healthy Eating Index Revised (BHEI-R) and its components. Food consumption was measured through three 24-h dietary recalls and assessed using the NDS-R software. For statistical analyses, it was performed an adjusted logistic regression, estimation of the Odds Ratio (OR), and 95% confidence interval (95%CI), with a p-value

Altres ajuts: Departament d'Universitats, Recerca i Societat de la Informació de la Generalitat de Catalunya (expedient 2017 SGR 1721) The impact of diet and digestive disorders in flatus composition remains largely unexplored. This is partially due to the lack of standardized sampling collection methods, and the easy atmospheric contamination. This paper describes a method to quantitatively determine the major gases in flatus and their application in a nutritional intervention. We describe how to direct sample flatus into Tedlar bags, and simultaneous analysis by gas chromatography-thermal conductivity detection (GC-TCD). Results are analyzed by univariate hypothesis testing and by multilevel principal component analysis. The reported methodology allows simultaneous determination of the five major gases with root mean measurement errors of 0.8% for oxygen (O), 0.9% for nitrogen (N), 0.14% for carbon dioxide (CO), 0.11% for methane (CH), and 0.26% for hydrogen (H). The atmospheric contamination was limited to 0.86 (95% CI: [0.7-1.0])% for oxygen and 3.4 (95% CI: [1.4-5.3])% for nitrogen. As an illustration, the method has been successfully applied to measure the response to a nutritional intervention in a reduced crossover study in healthy subjects.

Three metabolite patterns have previously shown prospective inverse associations with the risk of aggressive prostate cancer within the European Prospective Investigation into Cancer and Nutrition (EPIC). Here, we investigated dietary and lifestyle correlates of these three prostate cancer-related metabolite patterns, which included: 64 phosphatidylcholines and three hydroxysphingomyelins (Pattern 1), acylcarnitines C18:1 and C18:2, glutamate, ornithine, and taurine (Pattern 2), and 8 lysophosphatidylcholines (Pattern 3). In a two-stage cross-sectional discovery (n = 2524) and validation (n = 518) design containing 3042 men free of cancer in EPIC, we estimated the associations of 24 dietary and lifestyle variables with each pattern and the contributing individual metabolites. Associations statistically significant after both correction for multiple testing (False Discovery Rate = 0.05) in the discovery set and at p < 0.05 in the validation set were considered robust. Intakes of alcohol, total fish products, and its subsets total fish and lean fish were positively associated with Pattern 1. Body mass index (BMI) was positively associated with Pattern 2, which appeared to be driven by a strong positive BMI-glutamate association. Finally, both BMI and fatty fish were inversely associated with Pattern 3. In conclusion, these results indicate associations of fish and its subtypes, alcohol, and BMI with metabolite patterns that are inversely associated with risk of aggressive prostate cancer., Cancer Research UK C8221/A30904 C8221/A29017, World Health Organization, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Danish Cancer Society, Ligue Contre le Cancer (France) Institut Gustave Roussy (France) Mutuelle Generale de l'Education Nationale (France), Institut National de la Sante et de la Recherche Medicale (Inserm), Deutsche Krebshilfe, German Cancer Research Center (DKFZ) (Germany) German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE) (Germany), Federal Ministry of Education & Research (BMBF), Fondazione AIRC per la ricerca sul cancro Compagnia di San Paolo Consiglio Nazionale delle Ricerche (CNR), Netherlands Government Netherlands Government, World Cancer Research Fund International (WCRF), Health Research Fund (FIS)-Instituto de Salud Carlos III (ISCIII) (Spain), Junta de Andalucia, Principality of Asturias, Regional Government of Basque Country (Spain) Regional Government of Murcia (Spain) Regional Government of Navarra (Spain) Catalan Institute of Oncology-ICO (Spain), Swedish Cancer Society Swedish Research Council County Council of Skane (Sweden) County Council of Vasterbotten (Sweden), UK Research & Innovation (UKRI) Medical Research Council UK (MRC) 1000143 MR/N003284/1 MC-UU_12015/1 MC_UU_00006/1 MR/M012190/1

A large number of scientists and health professionals recognize that balanced nutrition is fundamental for a good state of physical health [...]

The population suffering from obesity is rapidly increasing all over the world. Bariatric surgery has shown to be the treatment of choice in patients with severe obesity. A Mediterranean diet has long been acknowledged to be one of the healthiest dietary patterns associated with a lower incidence of many chronic diseases. The aim of the present narrative review is to summarize the existing research on the clinical impact of a Mediterranean diet before and after bariatric surgery, focusing on its effects on weight loss and improvement in comorbidities. Although the current knowledge is limited, this information could add value and emphasize the importance of adopting a Mediterranean diet before and after bariatric surgery.

Gastrointestinal (GI) involvement is an early manifestation in systemic sclerosis (SSc), affecting more than 90% of patients, and severe GI disease is a marker of poor prognosis and mortality. Recent studies have hypothesized that alterations of the intestinal microbiota, known as dysbiosis, may represent 1 of the possible environmental factors influencing SSc disease status. In addition, specific microorganisms may be associated with SSc pathogenesis, progression, and GI manifestations. Therapeutic approaches aiming to modulate the intestinal microbiota have emerged, as alternatives to treat GI symptoms, and dietary interventions, probiotic administration, and fecal microbiota transplantation are potential therapies for SSc patients. However, given the complexity and variability of pathogenesis and clinical manifestations in SSc, these therapies need to be combined with additional interventions that target other disease components. Here, we summarize studies addressing intestinal dysbiosis in SSc and discuss the potential of microbiota modulators to treat SSc-related GI disorders.

In recent decades, traditional eating habits have been replaced by a more globalized diet, rich in saturated fatty acids and simple sugars. Extensive evidence shows that these dietary factors contribute to cognitive health impairment as well as increase the incidence of metabolic diseases such as obesity and diabetes. However, how these nutrients modulate synaptic function and neuroplasticity is poorly understood. We review the Western, ketogenic, and paleolithic diets for their effects on cognition and correlations with synaptic changes, focusing mainly (but not exclusively) on animal model studies aimed at tracing molecular alterations that may contribute to impaired human cognition. We observe that memory and learning deficits mediated by high-fat/high-sugar diets, even over short exposure times, are associated with reduced arborization, widened synaptic cleft, narrowed post-synaptic zone, and decreased activity-dependent synaptic plasticity in the hippocampus, and also observe that these alterations correlate with deregulation of the AMPA-type glutamate ionotropic receptors (AMPARs) that are crucial to neuroplasticity. Furthermore, we explored which diet-mediated mechanisms modulate synaptic AMPARs and whether certain supplements or nutritional interventions could reverse deleterious effects, contributing to improved learning and memory in older people and patients with Alzheimer’s disease. info:eu-repo/semantics/publishedVersion

Un erratum d'aquest article s'ha publicat a Int J Behav Nutr Phys Act. 2022 Nov 23;19(1):140. DOI: 10.1186/s12966-022-01373-2 Background: Few studies have analyzed the associations between impulsivity and dietary patterns. Some of them have shown a cross-sectional inverse relationship between impulsivity and healthy diet scores, whereas others reported a positive association with unhealthy dietary assessments. We aimed to examine longitudinal associations of impulsivity trait with adherence to healthy and unhealthy dietary patterns in older participants at high risk of cardiovascular disease over 3 years of follow-up. Methods: A 3-year prospective cohort analysis within the PREDIMED-Plus-Cognition study conducted in 4 PREDIMED-Plus study centers was performed. The PREDIMED-Plus study aimed to test the beneficial effect of a lifestyle intervention on the primary prevention of cardiovascular disease. The participants with overweight or obesity and metabolic syndrome included in the present study (n = 462; mean age of 65.3 years; 51.5% female) completed both the UPPS-P Impulsive Behavior Scale (range: 0-236 points) and the 143-item Food Frequency Questionnaire at baseline, 1-year and 3-years of follow-up. Ten diet scores assessing healthy and unhealthy dietary patterns were evaluated. Linear mixed models were performed adjusting by several confounders to study the longitudinal associations between impulsivity trait and adherence to dietary pattern scores over 3 years of follow-up (also assessing interactions by sex, age, and intervention group). Results: Impulsivity were negatively associated with adherence to the Healthy Plant-Based [β = -0.92 (95%CI -1.67, -0.16)], Mediterranean [β = -0.43 (95%CI -0.79, -0.07)], Energy-Restricted Mediterranean [β = -0.76 (95%CI -1.16, -0.37)], Alternative Healthy Eating Index [β = -0.88 (95%CI -1.52, -0.23)], Portfolio [β = -0.57 (95%CI -0.91, -0.22)], and DASH [β = -0.50 (95%CI -0.79, -0.22)] diet scores over 3 years of follow-up, whereas impulsivity was positively related with adherence to the unhealthy Western diet [β = 1.59 (95%CI 0.59, 2.58)] over time. An interaction by intervention group was found, with those participants in the intervention group with high impulsivity levels having lower adherence to several healthy dietary patterns. Conclusions: Heightened impulsivity was longitudinally associated with lower adherence to healthy dietary patterns and higher adherence to the Western diet over 3 years of follow-up. Furthermore, nutritional intervention programs should consider impulsivity as a relevant factor for the intervention success. Trial registration: Name of registry: Effect of an energy-restricted Mediterranean diet, physical activity and behavioral intervention on the primary prevention of cardiovascular disease. Trial registration number: ISRCTN 89,898,870. Date of registration: 05/28/2014. This work was supported by the official Spanish Institutions for funding scientific biomedical research, CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN) and Instituto de Salud Carlos III (ISCIII), through the Fondo de Investigación para la Salud (FIS), which is co-funded by the European Regional Development Fund (six coordinated FIS projects leaded by JS-S, including the following projects: PI13/00673, PI13/00492, PI13/00272, PI13/01123, PI13/00462, PI13/00233, PI13/02184, PI13/00728, PI13/01090, PI13/01056, PI14/01722, PI14/00636, PI14/00618, PI14/00696, PI14/01206, PI14/01919, PI14/00853, PI14/01374, PI14/00972, PI14/00728, PI14/01471, PI16/00473, PI16/00662, PI16/01873, PI16/01094, PI16/00501, PI16/00533, PI16/00381, PI16/00366, PI16/01522, PI16/01120, PI17/00764, PI17/01183, PI17/00855, PI17/01347, PI17/00525, PI17/01827, PI17/00532, PI17/00215, PI17/01441, PI17/00508, PI17/01732, PI17/00926, PI19/00957, PI19/00386, PI19/00309, PI19/01032, PI19/00576, PI19/00017, PI19/01226, PI19/00781, PI19/01560, PI19/01332, PI20/01802, PI20/00138, PI20/01532, PI20/00456, PI20/00339, PI20/00557, PI20/00886, PI20/01158); the Especial Action Project entitled: Implementación y evaluación de una intervención intensiva sobre la actividad física Cohorte PREDIMED-Plus grant to JS-S; the Recercaixa (number 2013ACUP00194) grant to JS-S; grants from the Consejería de Salud de la Junta de Andalucía (PI0458/2013, PS0358/2016, PI0137/2018); the PROMETEO/2017/017 and PROMETEO 21/2021 grants from the Generalitat Valenciana, and the grant PID2019-108858RB-I00 funded by AEI 10.13039/501100011033 and by “ERDF A way of making Europe” to DC; the SEMERGEN grant; None of the funding sources took part in the design, collection, analysis, interpretation of the data, or writing the report, or in the decision to submit the manuscript for publication. We thank CERCA Programme/Generalitat de Catalunya for institutional support and partial support was also provided by SLT006/17/00246, funded by the Department of Health of the Generalitat de Catalunya by the calls “Acció instrumental de programes de recerca orientats en l’àmbit de la recerca i la innovació en salut” and “Pla estratègic de recerca i innovació en salut (PERIS)”. This research was also partially funded by EU-H2020 Grants (Eat2beNICE/ H2020-SFS-2016–2, Ref 728018; and PRIME/ H2020-SC1-BHC-2018–2020, Ref: 847879). CG-M receives a predoctoral grant from the University of Rovira i Virgili (2020PMF-PIPF-37); JS-S, senior author of this paper, is partially supported by ICREA under the ICREA Academia program. SKN is supported by a postdoctoral fellowship from the Canadian Institutes of Health Research (CIHR, MFE-171207). JJ holds the Miguel Servet-II contract (CPII19/00015) awarded by the Instituto de Salud Carlos III (co-funded by the European Social Fund “Investing in your future”).

Considering the relevance of health behaviors for chronic diseases prevalence and mortality and the increase in income concentration observed in the world and in Brazil, this study aimed to evaluate the changes in the prevalence and in the educational inequalities of Brazilian adult health behaviors between 2013 and 2019. We analyzed data of 49,025 and 65,803 adults (18-59 years of age) from the Brazilian National Health Survey (PNS), 2013 and 2019. Prevalence of health behaviors (smoking, alcohol intake, diet, physical activity and sedentarism) were estimated for three educational strata, for both surveys. Prevalence ratios (PR) between year of survey and between educational strata were estimated by Poisson regression models. Significant reductions were found in the prevalence of smoking, physical inactivity, sedentarism, insufficient consumption of fruits, and the excessive consumption of sweetened beverages. However, an increase was observed in alcohol consumption and binge drinking; vegetable consumption remained stable. Contrasting the favorable change in some behaviors, inequalities among schooling strata remained very high in 2019, specially for smoking (PR = 2.82; 95%CI: 2.49-3.20), passive smoking (PR = 2.88; 95%CI: 2.56-3.23) and physical inactivity (PR = 2.02; 95%CI: 1.92-2.13). There was a significant increase in the educational inequality regarding physical inactivity (21%), insufficient intake of fruit (8%) and in the frequent consumption of sweetened beverages (32%). The persistence and enlargement of inequalities highlight the behaviors and social segments that should be special targets for policies and programs focused in promoting healthy lifestyles. Dada a relevância dos comportamentos de saúde para a prevalência de doenças crônicas, a mortalidade devida a elas e o aumento da concentração de renda no mundo e no Brasil, este estudo procurou avaliar as mudanças na prevalência dos comportamentos de saúde e sua relação com desigualdades educacionais em adultos brasileiros entre 2013 e 2019. Foram analisados dados de 49.025 e 65.803 adultos (18-59 anos) em Pesquisa Nacional de Saúde (PNS), 2013 e 2019. A prevalência de comportamentos de saúde (tabagismo, ingestão de álcool, dieta, atividade física e sedentarismo) foi estimada para três estratos educacionais em ambas as PNS. As razões de prevalência (RP) entre os anos da pesquisa e os estratos educacionais foram estimadas pelos modelos de regressão de Poisson. Foram encontradas reduções expressivas na prevalência de tabagismo, inatividade física, sedentarismo, consumo insuficiente de frutas e ingestão excessiva de bebidas adoçadas. Observou-se um aumento no consumo de álcool (incluindo o excessivo), ao passo que o consumo de vegetais se manteve estável. Em contraste com a mudança favorável em alguns comportamentos, as desigualdades entre os estratos de escolaridade permaneceram muito altas em 2019, especialmente para tabagismo (RP = 2,82; IC95%: 2,49-3,20), fumo passivo (PR = 2,88; IC95%: 2,56-3,23) e inatividade física (RP = 2,02; IC95%: 1,92-2,13). Houve um aumento expressivo da desigualdade entre os estratos de escolaridade em relação à inatividade física (21%), à ingestão insuficiente de frutas (8%) e ao consumo frequente de bebidas adoçadas (32%). A persistência e o ampliação das desigualdades destacam os comportamentos e segmentos sociais que devem ser alvos especiais de políticas e programas focados na promoção de estilos de vida saudáveis. Teniendo en cuenta la relevancia de los comportamientos de salud para la prevalencia de enfermedades crónicas, la mortalidad por ellas y el aumento de la concentración de la renta en el mundo y en Brasil, este estudio buscó evaluar los cambios en la prevalencia de comportamientos de salud y su relación con las desigualdades educativas en adultos brasileños en el periodo entre 2013 y 2019. Se analizaron 49.025 y 65.803 datos de adultos (18-59 años) de la Encuesta Nacional de Salud (PNS), 2013 y 2019. Se estimó la prevalencia de comportamientos de salud (tabaquismo, consumo de alcohol, dieta, actividad física y sedentarismo) para tres estratos educativos en ambas encuestas. Las razones de prevalencia (RP) entre el año de la encuesta y los estratos educativos se estimaron mediante modelos de regresión de Poisson. Se encontraron reducciones significativas en la prevalencia de tabaquismo, inactividad física, sedentarismo, consumo insuficiente de frutas y consumo excesivo de bebidas azucaradas. Se observó un mayor consumo de alcohol (incluido con exceso), mientras que el consumo de vegetales se mantuvo estable. En contraste con el cambio favorable en algunos comportamientos, las desigualdades entre estratos escolares se mantuvieron muy altas en 2019, especialmente para el tabaquismo (RP = 2,82; IC95%: 2,49-3,20), fumo passivo (RP = 2,88; IC95%: 2,56-3,23), y la inactividad física (RP = 2,02; IC95%: 1,92-2,13). Hubo un aumento significativo de la desigualdad en cuanto a la inactividad física (21%), la ingesta insuficiente de frutas (8%) y el consumo frecuente de bebidas azucaradas (32%). La persistencia y ampliación de las desigualdades ponen de manifiesto comportamientos y segmentos sociales que deben ser destinatarios especiales de políticas y programas orientadas hacia la promoción de estilos de vida saludables.

Endothelial dysfunction tends to be the initial indicator in proinflammatory state and macro- and microvascular complications, such as atherosclerosis and cardiovascular diseases. It has been shown that certain compounds in diet can generate beneficial effects on cardiovascular disease due to its interactions with endothelial cells. Thus, this review is aimed at investigating whether certain polyphenols present in the Mediterranean diet, specifically catechin, quercetin, resveratrol, and urolithin, could exert positive effects on endothelial dysfunction. After analysis of numerous papers, we found that polyphenols aiding endothelial function is beneficial not only for patients with cardiovascular disease, diabetes, or endothelial dysfunction but for all people as it can improve the effects of aging on the endothelia. The additional benefit of these polyphenols on weight loss further improves health and lowers the risk of several diseases, including those caused by endothelial dysfunction. However, it is important to note that the dosages in the majorities of the studies mentioned in this review were of supplemental rather than nutritionally relevant quantities, and therefore, the recommended dosages are difficult to determine.

Background: Metabolomics is a powerful tool for investigating the association between nutrition and health status. Although urine is commonly employed for studying the metabolism and transformation of food components, the use of blood samples could be preferable to gain new insights into the bioavailability of diet-derived compounds and their involvement in health. However, the chemical complexity of blood samples hinders the analysis of this biological fluid considerably, which makes the development of novel and comprehensive analytical methods mandatory. Methods: In this work, we optimized a multi-targeted metabolomics platform for the quantitative and simultaneous analysis of 450 food-derived metabolites by ultra-high performance liquid chromatography coupled to tandem mass spectrometry. To handle the chemical complexity of blood samples, three complementary extraction methods were assayed and compared in terms of recovery, sensitivity, precision and matrix effects with the aim of maximizing metabolomics coverage: protein precipitation, reversed solid-phase extraction, and hybrid protein precipitation with solid-phase extraction-mediated phospholipid removal. Results: After careful optimization of the extraction conditions, protein precipitation enabled the most efficient and high-throughput extraction of the food metabolome in plasma, although solid-phase extraction-based protocols provided complementary performance for the analysis of specific polyphenol classes. The developed method yielded accurate recovery rates with negligible matrix effects, and good linearity, as well as high sensitivity and precision for most of the analyzed metabolites. Conclusions: The multi-targeted metabolomics platform optimized in this work enables the simultaneous detection and quantitation of 450 dietary metabolites in short-run times using small volumes of biological sample, which facilitates its application to epidemiological studies.

Objective: To describe the dietary patterns and occurrence of metabolic disorders in children and adolescents with urolithiasis treatment at a referral hospital in southern Brazil in order to learn the features of urolithiasis in this population to better develop preventive actions. Methods: Descriptive study conducted between 2016 and 2017 in a tertiary care referral hospital. Fourty patients aged 2-19 years old with urolithiasis proven by imaging were included. Clinical and dietary data were obtained through interviews and medical records. For statistical analyses, the chi-squared test was performed. Results: 40 individuals were analyzed. Mean age at diagnosis was 7.2 ± 4 years. 25% were overweight or obese. 95% had metabolic disorders, hypocitraturia being the predominant type. Protein intake was adequate in all participants and carbohydrate intake, in 70% of them; 37.5% had lipid intake above recommended and 65% had low fiber intake. The mean daily sodium intake was 2.64 g (±1.74), with 55% of participants ingesting more than the recommended amount. A total of 52.5% had low potassium intake, with a mean of 4.79 g/day (±2.49). Calcium intake was adequate in 27.5%. No significant differences were identified in relation to mean daily consumption among participants with or without the various metabolic disorders. Conclusion: Pediatric urolithiasis is often accompanied by metabolic disorders; therefore, metabolic evaluation should be part of the diagnostic process and subsequent analysis of these patients' dietary patterns, helping to optimize treatment and prevent recurrences and complications. Resumo Objetivo: Descrever o padrão alimentar e a ocorrência de distúrbios metabólicos em crianças e adolescentes portadoras de urolitíase acompanhadas em hospital de referências no sul do Brasil a fim de conhecer as particularidades da urolitíase nessa população para melhor desenvolver ações de prevenção. Métodos: Estudo observacional descritivo realizado entre 2016 e 2017 em centro de referência em atenção terciária. Foram selecionados 40 pacientes de dois a 19 anos com urolitíase comprovada por exame de imagem. Dados clínicos e alimentares foram obtidos através de prontuário e entrevista. Para análise estatística, utilizou-se o teste qui-quadrado. Resultados: Foram analisados 40 indivíduos, 55% masculinos. Idade média ao diagnóstico 7,2 ± 4 anos; 25% tinham sobrepeso ou obesidade; 95% tinham distúrbios metabólicos, predominou a hipocitratúria. O consumo proteico e de carboidratos foi adequado em 100% e 70% dos participantes, respectivamente, 37,5% apresentaram ingestão de lipídeos acima do recomendado e 65% apresentaram ingestão de fibras alimentares abaixo do recomendado. O consumo diário médio de sódio foi de 2,64 g (± 1,74), com 55% acima do recomendado; 52,5% apresentaram baixa ingestão de potássio com média de 4,79 g/dia (± 2,49). O consumo de cálcio foi adequado em 27,5%. Não foram identificadas diferenças significativas em relação ao consumo médio diário dos nutrientes entre os participantes com ou sem os diversos distúrbios metabólicos. Conclusões: A urolitíase pediátrica é frequentemente acompanhada de distúrbios metabólicos, o que confirma a necessidade de avaliação metabólica adequada ao diagnóstico e análise do padrão alimentar a fim de identificar erros alimentares, aprimorar o tratamento desses distúrbios e prevenir recorrências e complicações.

To estimate the prevalence and distribution of anemia in Mexican women and their association with sociodemographic factors and diet diversity.We analyzed information of women in childbearing age. The Ensanut 100k is a probabilistic survey that overrepresents households with less economic capacity. Anemia was estimated using hemoglobin concentration. We collected sociodemographic and health information, food insecurity, and dietary diversity.34.3% of the women presented anemia, belong to tertile 3 of welfare status is a protective factor for anemia (OR= 0.26, 95%CI 0.16-0.61), and living in a household with food security, as well as high diversity of the diet in rural women (OR= 0.57, 95%CI 0.36-0.92).It is necessary to implement actions of detection and early attention of the anemia in women in childbearing age, identification of its underlying causes, strengthening and reformulation of strategies to prevent it.Estimar la prevalencia y distribución de anemia en mujeres mexicanas y su asociación con factores sociodemográficos y la diversidad de la dieta.Se incluyeron mujeres en edad fértil de la encuesta probabilística Ensanut 100k, que representa a los hogares con menos capacidades económicas. Se estimó la prevalencia de anemia mediante concentración de hemoglobina, con información sociodemográfica, de salud, inseguridad alimentaria y diversidad de la dieta.El 34.3% de las mujeres presentó anemia; los factores protectores para anemia fueron pertenecer al tercil 3 de condición de bienestar (OR=0.26, IC95% 0.16-0.61), alta diversidad de la dieta en áreas rurales (OR=0.57, IC95%0.36-0.92), así como vivir en un hogar con seguridad alimentaria.Es necesario implementar acciones de detección y atención temprana de la anemia en las mujeres de edad fértil, así como identificar las causas subyacentes y fortalecer y reformular estrategias para prevenirla.

Background Consumption of certain foods is associated with long-term weight gains and abdominal fat accumulation in healthy, middle-aged and young, non-obese participants. Whether the same foods might be associated with changes in adiposity in elderly population at high cardiovascular risk is less known. Objective Using yearly repeated measurements of both food habits and adiposity parameters, we aimed to investigate how changes in the consumption of specific foods were associated with concurrent changes in weight or waist circumference (WC) in the PREDIMED trial. Design We followed-up 7009 participants aged 55-70 years at high cardiovascular risk for a median time of 4.8 years. A validated 137-item semi-quantitative Food Frequency Questionnaire was used for dietary assessment with yearly repeated measurements. We longitudinally assessed associations between yearly changes in food consumption (serving/d) and concurrent changes in weight (kg) or WC (cm). Results Yearly increments in weight were observed with increased consumption (kg per each additional increase in 1 serving/d) for refined grains (0.32 kg/serving/d), red meat (0.24), potatoes (0.23), alcoholic beverages (0.18), processed meat (0.15), white bread (0.07) and sweets (0.04); whereas inverse associations were detected for increased consumption of low-fat yogurt (- 0.18), and low-fat milk (- 0.06). Annual WC gain (cm per each additional increase in 1 serving/d) occurred with increased consumption of snacks, fast-foods and pre-prepared dishes (0.28), processed meat (0.18), alcoholic beverages (0.13), and sweets (0.08); whereas increased consumption of vegetables (- 0.23), and nuts (- 0.17), were associated with reductions in WC. Conclusions In this assessment conducted in high-risk subjects using yearly repeated measurements of food habits and adiposity, some ultra-processed foods, refined carbohydrates (including white bread), potatoes, red meats and alcohol were associated with higher weight and WC gain, whereas increases in consumption of low-fat dairy products and plant foods were associated with less gain in weight and WC., The research leading to these results was supported by the official Spanish Institutions for funding scientific biomedical research, CIBER Fisiopatologia de la Obesidad y Nutricion (CIBEROBN) and Instituto de Salud Carlos III (ISCIII), and through specific grants/contracts: the FOLIUM program within the FUTURMed project. Talent for the medicine within the future from the Fundacion Instituto de Investigacion Sanitaria Illes Balears (financed by 2017 annual plan of the sustainable tourism tax and at 50% with charge to the ESF Operational Program 2014-2020 of the Balearic Islands) [JK]; ERC Advanced Research Grant (340918) [MAM-G as PI]. None of the funding sources took part in the design, collection, analysis or interpretation of the data, or in the decision to submit the manuscript for publication.

Background: Obesity phenotypes with different metabolic status have been described previously. We analyzed metabolic phenotypes in obese coronary patients during a 5-year follow-up, and examined the factors influencing this evolution. Methods: The CORDIOPREV study is a randomized, long-term secondary prevention study with two healthy diets: Mediterranean and low-fat. All obese patients were classified as either metabolically healthy obese (MHO) or metabolically unhealthy obese (MUO). We evaluated the changes in the metabolic phenotypes and related variables after 5 years of dietary intervention. Results: Initially, 562 out of the 1002 CORDIOPREV patients were obese. After 5 years, 476 obese patients maintained their clinical and dietary visits, 71.8% of MHO patients changed to unhealthy phenotypes (MHO-Progressors), whereas the MHO patients who maintained healthy phenotypes (MHO-Non-Progressors) lost more in terms of their body mass index (BMI) and had a lower fatty liver index (FLI-score) (p &lt, 0.05). Most of the MUO (92%) patients maintained unhealthy phenotypes (MUO-Non-Responders), but 8% became metabolically healthy (MUO-Responders) after a significant decrease in their BMI and FLI-score, with improvement in all metabolic criteria. No differences were found among dietary groups. Conclusions: A greater loss of weight and liver fat is associated with a lower progression of the MHO phenotype to unhealthy phenotypes. Likewise, a marked improvement in these parameters is associated with regression from MUO to healthy phenotypes.

The results of previous studies of the relationship between serum uric acid (SUA) and the risk of cardiovascular disease (CVD) have been inconsistent due to confounding factors caused by other known cardiovascular risk factors.This study aimed to evaluate the relationship between SUA and incident CVD in middle-aged and elderly Chinese people, who were stratified according to body mass index (BMI).This study recruited 5,721 participants of 40-75 years of age, who were free of CVD at baseline and who underwent follow-up from 2008 to 2017. Participants were categorized in SUA quintiles. Cox proportional hazard and Kaplan-Meier survival analysis were used to compare CVD incidence among the SUA groups. The correlations between SUA and CVD incidence in groups with differing BMI and waist circumference (WC) were also analyzed. A P value0.05 was considered statistically significant.During a mean follow-up period of 7.6 years, CVD incidence increased with SUA (log-rank test p0. 001). Compared with the first quintile, the adjusted hazard ratios (95% confidence interval (CI)) for the development of CVD were 1.08 (0.78-1.65), 1.17 (0.88-1.77), 1.47 (1.12-2.21), and 1.68 (1.28-2.44) for the second to fifth quintiles, respectively. This relationship was clearer in participants with normal BMI and WC. The adjusted hazard ratio for each 100 μmol/L increase in SUA was 1.13 (95% CI: 1.02-1.39) for CVD events.High SUA is an independent risk factor for CVD in middle-aged and elderly northern Chinese people. This effect is maintained even after stratification according to measures of leanness/obesity.Os resultados de estudos anteriores sobre a relação entre ácido úrico sérico (AUS) e o risco de doença cardiovascular (DCV) até agora são inconsistentes devido aos fatores de confusão causados por outros fatores de risco cardiovascular conhecidos.Este estudo tem o objetivo de avaliar a relação entre o AUS e as DCV incidentes em chineses de meia-idade e idosos, que foram estratificados de acordo com o índice de massa corporal (IMC).Recrutamos 5.721 participantes com idades entre 40 e 75 anos que não tinham diagnóstico de DCV na linha de base, e que foram monitorados de 2008 a 2017. Os participantes foram categorizados em quintis de AUS. A regressão de Cox e a análise de sobrevivência de Kaplan-Meier foram utilizadas para comparar a incidência de DCV entre os grupos de AUS. As correlações entre AUS e a incidência de DCV em grupos com IMC e circunferência de cintura (CC) variados também foram analisadas. Um P valor0,05 foi considerado estatisticamente significativo.Durante um período médio de monitoramento de 7,6 anos, a incidência de DCV aumentou com o AUS (teste de Log-rank p0,001). Em comparação com o primeiro quintil, as razões de risco padronizadas (intervalos de confiança de 95%) para p desenvolvimento de DCV foram 1,08 (0,78–1,65), 1,17 (0,88–1,77), 1,47 (1,12–2,21), e 1,68 (1,28–2,44) para o segundo, terceiro, quarto e quinto quintis, respectivamente. Essa relação ficou mais clara em participantes com IMC e CC normais. A razão de risco ajustada para cada aumento de 100 μmol/L de AUS foi de 1,13 (intervalo de confiança de 95%: 1,02–1,39) para eventos de DCV.O AUS alto é um fator de risco de DCV independente em pessoas de meia-idade e idosas do norte da China. Esse efeito é mantido mesmo depois da estratificação de acordo com medidas de magreza/obesidade.

BACKGROUND: Diverticulitis is an acute inflammatory process that affects individuals with diverticular disease. Given the sharp increase in the diagnostic rate of such a pathological process, there was also an increased interest in elucidating the possible causes related to the development of this clinical condition. Among the main factors investigated, diet excels, the object of study of this integrative literature review. METHODS: After searching the virtual health library and PubMed databases, five prospective cohort studies were selected that best answered the guiding question: “Is there a relationship between diet and the incidence of diverticulitis?”. RESULTS: It was observed that the high intake of red meat and the low intake of dietary fiber were the most strongly associated dietary factors with the incidence of this inflammatory process. CONCLUSION: Therefore, it is evident that choosing healthy eating habits can considerably reduce the incidence of diverticulitis and, consequently, potentially more serious complications directly related to it. RESUMO CONTEXTO: A diverticulite é um processo inflamatório agudo que afeta indivíduos com doença diverticular. Diante do acentuado aumento da taxa diagnóstica desse processo patológico, também houve o aumento do interesse em elucidar as possíveis causas relacionadas ao desenvolvimento dessa condição clínica. Entre os principais fatores investigados, destaca-se a dieta; objeto de estudo desta revisão integrativa da literatura. MÉTODOS: Após pesquisa nas bases de dados da biblioteca virtual em saúde e PubMed, foram selecionados cinco estudos de coorte prospectivos que melhor responderam à questão norteadora “Há relação entre dieta e incidência de diverticulite?”. RESULTADOS E CONCLUSÃO: Observou-se que o alto consumo de carnes vermelhas e o baixo consumo de fibra alimentar são os fatores dietéticos mais fortemente associados à incidência desse processo inflamatório. Fica evidente, portanto, que a escolha de hábitos alimentares saudáveis pode reduzir consideravelmente a incidência de diverticulite e, consequentemente, de possíveis complicações mais graves diretamente relacionadas a ela.

Objective: This study aimed to evaluate food labels targeted at children and identify the concomitant presence of claims and high levels of critical nutrients and/or the presence of sweeteners. As a secondary objective, it aimed to list different types of claims and check which marketing strategies are most used. Methods: We collected 409 products, from 8 popular food groups targeted at children, in Brazilian market (i.e., fruit drinks, dairy drinks, sandwich cookies, cakes, breakfast cereals, jellies, corn snacks, and yogurts). The contents of critical nutrients (e.g., sugar, total fat, saturated fat, and trans-fat, and sodium) and presence/absence of sweetener were calculated, considering Pan American Health Organization (PAHO) parameters. Then, we verified the presence and types of claims in these products. Results: Overall, 265 (64.7%) labels presented claims. In three of the eight categories (i.e., breakfast cereals, dairy drinks, and yogurt), all products with claims (50, 34, and 34 products, respectively) had one or more nutrients in harmful concentrations (critical nutrients above PAHO’s nutritional profile and/or presence of sweeteners). In the other categories, only one product (of 63 sandwich cookies and 26 breakfast cereals with claims) and three products (of 22 cakes and 28 jellies with claims) had no nutrient in critical concentration. The presence of claims, like “rich/source” of micronutrient, was predominant in seven of the eight food groups. Conclusion: In the present study, there was a high presence of claims, of different types, in foods targeted at children, which, for the most part, also have excess of at least one critical nutrient, according to PAHO. RESUMO Objetivo: Avaliar rótulos de alimentos direcionados ao público infantil e identificar a presença concomitante de alegações e de altos teores de nutrientes críticos e/ou presença de adoçantes. Como objetivo secundário, listar os diferentes tipos de alegações e verificar quais estratégias de marketing são mais utilizadas. Métodos: Foram coletados 409 produtos provenientes das oito categorias de alimentos mais populares entre crianças brasileiras (bebidas à base de frutas, bebidas lácteas, biscoitos recheados, bolos, cereais matinais, gelatinas, salgadinhos de milho e iogurtes). Foram calculados os teores de nutrientes críticos (açúcares, gorduras totais, saturadas e trans e sódio) e presença/ausência de adoçante, considerando-se os parâmetros da Organização Pan-Americana de Saúde (OPAS). Em seguida, verificamos a presença e os tipos de alegações nesses produtos. Resultados: No total, 265 (64,7%) rótulos apresentaram alegações. Em três das oito categorias (cereais matinais, bebidas lácteas e iogurtes), todos os produtos com alegações (50, 34 e 34 produtos, respectivamente) continham um ou mais nutrientes em concentrações prejudiciais (nutrientes críticos acima do preconizado pela OPAS e/ou presença de edulcorantes). Nas demais categorias, apenas um produto (de 63 biscoitos recheados e 26 cereais matinais com alegação) e três (de 22 bolos e 28 gelatinas com alegação) não apresentavam nutrientes em concentração crítica. A presença de alegações, como “rico” ou “fonte” de micronutriente, foi predominante em sete dos oito grupos de alimentos. Conclusões: Observou-se alta presença de alegações, de diferentes tipos, em alimentos destinados a crianças, que, em sua maioria, também possuem excesso de pelo menos um nutriente crítico, de acordo com a OPAS.

New dietary approaches for the prevention of cognitive impairment are being investigated. However, evidence from dietary interventions is mainly from food and nutrient supplement interventions, with inconsistent results and high heterogeneity between trials. We conducted a comprehensive systematic search of randomized controlled trials (RCTs) published in MEDLINE-PubMed, from January 2018 to July 2021, investigating the impact of dietary counseling, as well as food-based and dietary supplement interventions on cognitive function in adults with or without cognitive impairment. Based on the search strategy, 197 eligible publications were used for data abstraction. Finally, 61 articles were included in the analysis. There was reasonable evidence that dietary patterns, as well as food and dietary supplements improved cognitive domains or measures of brain integrity. The Mediterranean diet showed promising results, whereas the role of the DASH diet was not clear. Healthy food consumption improved cognitive function, although the quality of these studies was relatively low. The role of dietary supplements was mixed, with strong evidence of the benefits of polyphenols and combinations of nutrients, but with low evidence for PUFAs, vitamin D, specific protein, amino acids, and other types of supplements. Further well-designed RCTs are needed to guide the development of dietary approaches for the prevention of cognitive impairment.

Diet is recognised as the main driver of changes in gut microbiota. However, linking habitual dietary intake to microbiome composition and activity remains a challenge, leaving most microbiome studies with little or no dietary information. To fill this knowledge gap, we conducted two consecutive studies (n = 84: a first pilot study (n = 40) to build a web-based, semi-quantitative simplified FFQ (sFFQ) based on three 24-h dietary recalls (24HRs), a second study (n = 44) served to validate the newly developed sFFQ using three 24HRs as reference method and to relate gut microbiome profiling (16S rRNA gene) with the extracted dietary and lifestyle data. Relative validation analysis provided acceptable classification and agreement for 13 out of 24 (54%) food groups and 20 out of 29 nutrients (69%) based on intraclass correlation coefficient, cross-classification, Spearman’s correlation, Wilcoxon test, and Bland–Altman. Microbiome analysis showed that higher diversity was positively associated with age, vaginal birth, and intake of fruit. In contrast, microbial diversity was negatively associated with BMI, processed meats, ready-to-eat meals, sodium, and saturated fat. Our analysis also revealed a correlation between food groups or nutrients and microbial composition. Overall, we provide the first dietary assessment tool to be validated and correlated with microbiome data for population studies.

The PREDIMED-Plus trial was supported by the European Research Council (Advanced Research grant 2014–2019; agreement #340918; granted to M.Á.M.-G.); the official Spanish institutions for funding scientific biomedical research, CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN) and Instituto de Salud Carlos III (ISCIII) through the Fondo de Investigación para la Salud (FIS) which is co-funded by the European Regional Development Fund (coordinated FIS projects led by J.S-S. and J.V., including the following projects: PI13/00673, PI13/00492, PI13/00272, PI13/01123, PI13/00462, PI13/00233, PI13/02184, PI13/00728, PI13/01090, PI13/01056, PI14/01722, PI14/00636, PI14/00618, PI14/00696, PI14/01206, PI14/01919, PI14/00853, PI14/01374, PI14/00972, PI14/00728, PI14/01471, PI16/00473, PI16/00662, PI16/01873, PI16/01094, PI16/00501, PI16/00533, PI16/00381, PI16/00366, PI16/01522, PI16/01120, PI17/00764, PI17/01183, PI17/00855, PI17/01347, PI17/00525, PI17/01827, PI17/00532, PI17/00215, PI17/01441, PI17/00508, PI17/01732, PI17/00926, PI19/00957, PI19/00386, PI19/00309, PI19/01032, PI19/00576, PI19/00017, PI19/01226, PI19/00781, PI19/01560, PI19/01332), and the Especial Action Project “Implementación y evaluación de una intervención intensiva sobre la actividad física Cohorte PREDIMED-Plus” (J.S.-S.); the Recercaixa (grant number 2013ACUP00194) (J.S.-S.). Moreover, J.S-S. gratefully acknowledges the financial support by ICREA under the ICREA Academia program; the SEMERGEN grant; Department of Health of the Government of Navarra (61/2015), the Fundació La Marató de TV (Ref. 201630.10); the AstraZeneca Young Investigators Award in Category of Obesity and T2D 2017 (D.R.); grants from the Consejería de Salud de la Junta de Andalucía (PI0458/2013; PS0358/2016; PI0137/2018), the PROMETEO/2017/017 grant from the Generalitat Valenciana, the SEMERGEN grant; grant of support to research groups 35/2011 (Balearic Islands Government; FEDER funds) (J.A.T.). R.S.-C. acknowledges financial support from the Juan de la Cierva Program Training Grants of the Spanish State Research Agency of the Spanish Ministerio de Ciencia e Innovación y Ministerio de Universidades (FJC2018-038168- I). N.B.-T. acknowledges financial support from the Juan de la Cierva Formación Program Training Grants of the Spanish State Research Agency of the Spanish Ministerio de Ciencia e Innovación y Ministerio de Universidades (FJC2018-036016-I). M.R.B.-L. was supported by “Miguel Servet Type I” program (CP15/00028) from the ISCIII-Madrid (Spain), cofinanced by the Fondo Europeo de Desarrollo Regional-FEDER. S.K.N. acknowledges financial support from the Canadian Institute for Health Research, CIHR Fellowship. J.K. was supported by the ‘FOLIUM’ programme within the FUTURMed project from the Fundación Instituto de Investigación Sanitaria Illes Balears (financed by 2017 annual plan of the sustainable tourism tax and at 50% with charge to the ESF Operational Program 2014–2020 of the Balearic Islands. C.M.-P. was financially supported by a joint grant from the Community of Madrid and the European Social Fund (grant PEJD-2019- POST/SAL-15892). The METHYL-UP project was supported by the Spanish Ministry of Science and Innovation (RTI2018-095569-B-I00, Programa de Proyectos Orientados a los Retos de la Sociedad “Projects Toward Society Challenges Program”)., The association between ultra-processed food (UPF) and risk of cardiometabolic disorders is an ongoing concern. Different food processing-based classification systems have originated discrepancies in the conclusions among studies. To test whether the association between UPF consumption and cardiometabolic markers changes with the classification system, we used baseline data from 5636 participants (48.5% female and 51.5% male, mean age 65.1 4.9) of the PREDIMEDPlus (“PREvention with MEDiterranean DIet”) trial. Subjects presented with overweight or obesity and met at least three metabolic syndrome (MetS) criteria. Food consumption was classified using a 143-item food frequency questionnaire according to four food processing-based classifications: NOVA, International Agency for Research on Cancer (IARC), International Food Information Council (IFIC) and University of North Carolina (UNC). Mean changes in nutritional and cardiometabolic markers were assessed according to quintiles of UPF consumption for each system. The association between UPF consumption and cardiometabolic markers was assessed using linear regression analysis. The concordance of the different classifications was assessed with intra-class correlation coefficients (ICC3, overall = 0.51). The highest UPF consumption was obtained with the IARC classification (45.9%) and the lowest with NOVA (7.9%). Subjects with high UPF consumption showed a poor dietary profile. We detected a direct association between UPF consumption and BMI (p = 0.001) when using the NOVA system, and with systolic (p = 0.018) and diastolic (p = 0.042) blood pressure when using the UNC system. Food classification methodologies markedly influenced the association between UPF consumption and cardiometabolic risk markers., European Research Council (ERC) European Commission #340918, Centro de Investigacion Biomedica en Red-Fisiopatologia de la Obesidad y Nutricion PI16/00473, PI16/00662, PI16/01873, PI16/01094, PI16/00501, PI16/00533, PI16/00381, PI16/00366, PI16/01522, PI16/01120, PI17/00764, PI17/01183, PI17/00855, PI17/01347, PI17/00525, PI17/01827, PI17/00532, PI17/00215, PI17/01441 PI13/00673, PI13/00492, PI13/00272, PI13/01123, PI13/00462, PI13/00233, PI13/02184, PI13/00728, PI13/01090, PI13/01056, PI14/01722, PI14/00636, PI14/00618, PI14/00696, PI14/01206, PI14/01919, PI14/00853, PI14/01374, PI14/00972, PI14/00728, PI14/01471 PI17/00508, PI17/01732, PI17/00926, PI19/00957, PI19/00386, PI19/00309, PI19/01032, PI19/00576, PI19/00017, PI19/01226, PI19/00781, PI19/01560, PI19/01332

Introduction: The low FODMAP diet (fermentable oligosaccharides, monosaccharides, disaccharides, and polyols) has shown to be effective in adult patients with irritable bowel syndrome, but there are few studies on paediatric patients. The aim of this study is to assess the implementation and the outcomes of a low FODMAP diet in the treatment of functional abdominal pain in children from a Mediterranean area. Material and methods: A table was designed in which foods were classified according to their FODMAP content, as well as a ‘Symptoms and Stools Diary’. A prospective study was conducted on children with functional abdominal pain in our Paediatric Gastroenterology Unit. Results: A total of 22 patients were enrolled in the trial, and 20 completed it. Data were collected of the abdominal pain features over a period of 3 days, and then patients followed a two-week low FODMAP diet. Afterwards, information about abdominal pain features was collected again. After the diet, they showed fewer daily abdominal pain episodes compared to baseline (1.16 [IQR: 0.41–3.33] versus 2 [IQR: 1.33–6.33] daily episodes, P = .024), less pain severity compared to baseline (1.41 cm [IQR: 0.32–5.23] versus 4.63 cm [IQR: 2.51–6.39] measured by 10-cm Visual Analogue Scale, P = .035), less interference with daily activities, and less gastrointestinal symptoms. Only 15% of patients found it difficult to follow the diet. Conclusions: The implementation of a low FODMAP diet for 2 weeks in a Mediterranean paediatric population diagnosed with functional abdominal pain is possible with adapted diets. It was highly valued by patients, and they showed an improvement in abdominal pain symptoms assessed by objective methods. Resumen: Introducción: La dieta baja en FODMAP (acrónimo en inglés de polioles, monosacáridos, disacáridos y oligosacáridos fermentables) ha demostrado eficacia como tratamiento del síndrome de intestino irritable en adultos, siendo escasos los estudios en niños. Nuestro objetivo es analizar la implantación de esta dieta como tratamiento del dolor abdominal crónico funcional en población pediátrica de un área mediterránea, y su respuesta a esta. Material y métodos: Se elaboró una tabla clasificando los alimentos según su contenido en FODMAP, y se diseñó un «Diario de síntomas y deposiciones» para recoger los datos. Posteriormente se realizó un estudio prospectivo con niños con dolor abdominal crónico funcional de nuestra Unidad de Gastroenterología Pediátrica. Resultados: Se reclutaron 22 pacientes, 20 de los cuales completaron el estudio. Se recogieron durante 3 días datos sobre el dolor abdominal; posteriormente recibieron dieta baja en FODMAP 2 semanas, y al finalizarla recogieron de nuevo dichos datos. Tras la dieta se objetivó disminución en frecuencia diaria de episodios de dolor abdominal (1,16 [RIQ: 0,41-3,33] frente a 2 [RIQ: 1,33-6,33] inicialmente, p = 0,024), menor intensidad del dolor (1,41 cm [RIQ: 0,32-5,23] frente a 4,63 cm [RIQ: 2,51-6,39] inicial, p = 0,035, medido mediante Escala Visual Analógica de 10 cm), menor interferencia con la actividad diaria y menos síntomas acompañantes. Solo un 15% de los pacientes consideraron la dieta difícil. Conclusiones: La implantación de una dieta baja en FODMAP durante 2 semanas en una población pediátrica mediterránea con dolor abdominal crónico funcional es posible utilizando dietas adaptadas, es bien valorada por los pacientes, y su evaluación mediante herramientas objetivas muestra mejoría en los síntomas de dolor abdominal.

Wprowadzenie. Uważa się, że w cukrzycy typu 1 (T1DM), niezależnie od zastosowanego modelu insulinoterapii, dieta i prawidłowe nawyki żywieniowe są kluczowe w leczeniu cukrzycy. Stosowanie odpowiedniej diety ma na celu utrzymanie prawidłowej masy ciała, uzyskanie prawidłowego poziomu glukozy we krwi po posiłku, optymalnego profil lipidowy i prawidłowe wartości ciśnienia krwi. Cel. Celem badania była ocena diety i kontrola metaboliczna w homogennej grupie osób dorosłych z T1DM leczonych osobistymi pompami insulinowymi. Materiał i metody: Badaniem objęto 141 dorosłych pacjentów (57% kobiet) z cukrzycą typu 1 leczonych osobistymi pompami insulinowymi. Badana populacja charakteryzowała się średnim wiekiem 25,8 ± 6,2 lat, średnim czasem trwania cukrzycy 13,9 ± 6,9 lat oraz średnim czasem leczenia osobistą pompą przez 8,2 ± 4,1 lat i średnim BMI 23,0 ± 2,8 g / m2. Wszyscy byli mieszkańcami południowo-wschodniej Polski. Walidowany kwestionariusz KomPAN wykorzystano do oceny częstotliwości spożycia poszczególnych produktów spożywczych. Wyniki. Średni odsetek HbA1c w grupie badanej wynosił 7,3% [56 mmol/mol]. Średni poziom całkowitego cholesterolu wynosił 4,4 mmol / l, HDL - 1,7 mmol / l, LDL - 2,3 mmol / l i triglicerydów - 0,8 mmol / l. W modelu regresji wielorakiej nie stwierdzono korelacji między wskaźnikami diety i wyrównaniem metabolicznym mierzonym za pomocą HbA1c lub lipidogramu oraz miejscem zamieszkania (wieś, małe miasteczko, duże miasto). Jednak różnice w jakości diety zależały od płci. Kobiety charakteryzowały się wyższym wskaźnikiem zdrowej diety (pHDI-10) (26,3 vs 21,4, p = 0,005) i niższym wskaźnikiem niezdrowej diety (nHDI-14) (13,3 vs 18,6, p

Endoscopic bariatric therapies (EBTs) are promising strategies for the treatment of obesity. However, there is still great variability in its effectiveness in weight loss. Thus, we investigated whether adherence to healthy lifestyle habits is a significant determinant of weight loss effectiveness among patients undergoing EBTs. Additionally, the role of eating behaviors and psychological traits in the effectiveness of weight loss was studied. A cohort of 361 participants (81.4% women; age 41.8 ± 9.5 years; BMI 37.8 ± 4.3 kg/m2) was followed for 1 year after EBT. Anthropometric parameters, adherence to healthy lifestyle habits, emotional eating, and psychological traits (anxiety and depression) were evaluated. General linear models were used to compare outcome variables according to weight loss effectiveness groups (poor vs. good weight-loss-responders). Additionally, a hierarchical linear regression model was used to determine whether adherence to healthy lifestyle habits, emotional eating, or psychological traits were significant predictors of excess weight loss (%EWL). One year after EBT, weight loss differed significantly between good and poor weight-loss-responders (67.5% EWL [95% CI: 64.2, 70.8] vs. 28.2% EWL [95% CI: 25.5, 30.9], p < 0.001). Participants who adhered to good lifestyle habits had 4.37 more odds [95% CI: 2.19, 8.88] of being good weight-loss-responders. We also observed that eating four to five meals/day and practicing muscle-strengthening activities >2 times/week were the two lifestyle habits that most significantly determined weight loss response. Furthermore, our results revealed that while adherence to healthy lifestyle habits was a significant determinant of %EWL 3, 6, and 12 months after EBT (p < 0.001), emotional eating was a significant determinant of %EWL only 3 and 6 months after the intervention (p < 0.01 and p < 0.05, respectively). Regarding psychological traits, we observed that neither anxiety nor depression were significant determinants of %EWL. Our results revealed that adherence to healthy lifestyle habits is a significant determinant for weight loss effectiveness among patients with obesity undergoing EBT. These findings highlight the importance of implementing an adequate nutritional intervention program, especially since patients who adhere to good lifestyle habits are able to achieve a weight loss that would be comparable with bariatric surgery.

[Background] The development and implementation of effective physical activity (PA) intervention programs is challenging, particularly in older adults. After the first year of the intervention program used in the ongoing PREvención con DIeta MEDiterránea (PREDIMED)-Plus trial, we assessed the initial effectiveness of the PA component., [Methods] PREDIMED-Plus is an ongoing randomized clinical trial including 6874 participants randomized to an intensive weight-loss lifestyle intervention based on an energy-restricted Mediterranean diet (MedDiet), physical activity promotion and behavioral support and to a control group using MedDiet recommendations but without calorie restriction or PA advice. Body mass index (BMI) and waist circumference (WC) are measured by standard clinical protocols. Duration and intensity of PA is self-reported using the validated REGICOR Short Physical Activity Questionnaire. The primary endpoint of the PREDIMED-Plus trial is a combined cardiovascular outcome: myocardial infarction (acute coronary syndromes with positive troponin test), stroke, or cardiovascular mortality. The present study involved secondary analysis of PA data (n = 6059; mean age 65 ± 4.9 years) with one-year changes in total, light, and moderate-to-vigorous PA within and between intervention groups as the outcome. Generalized estimating equation models were fitted to evaluate time trends of PA, BMI, and WC within groups and differences between intervention and control groups., [Results] After 12 months, average daily MVPA increased by 27.2 (95%CI 5.7;48.7) METs-min/day and 123.1 (95%CI 109.7–136.6) METs-min/day in the control and intervention groups, respectively. Total-PA, light-PA, and MVPA increased significantly (p, [Conclusion] After one year of follow-up, the PREDIMED-Plus PA intervention has been effective in increasing daily PA in older adults., [Trial registration] Retrospectively registered at the International Standard Randomized Controlled Trial (http://www.isrctn.com/ISRCTN89898870), registration date: 24 July 2014., This work was supported by the Spanish Ministry of Health (Carlos III Health Institute) through the Fondo de Investigación para la Salud (FIS), which is co-funded by the European Regional Development Fund (two coordinated FIS projects led by Jordi Salas-Salvado and Josep Vidal, funded by the following grant codes: PI13/00673, PI13/00492, PI13/00272, PI13/01123, PI13/00462, PI13/00233, PI13/02184, PI13/00728 PI13/01090 PI13/01056, PI14/01722, PI14/00636, PI14/00618, PI14–00696, PI14/01471, PI14/01206, PI14/01919, PI14/00853 [JV and JSS]; the European Research Council (Advanced Research Grant 2013–2018; grant number 340918) [MAMG]; Recercaixa (2013ACUP00194); the Consejería de Salud de la Junta de Andalucía (grant number PI0458/2013) and a SEMERGEN grant. None of the funding sources took part in the design, collection, analysis or interpretation of the data, or in the decision to submit the manuscript for publication. CIBERobn (Centros de Investigación Biomedica en Red: Obesidad y Nutrición), CIBEResp (Centros de Investigación Biomedica en Red: Epidemiología y Salud Publica) and CIBERdem (Centros de Investigación Biomedica en Red: Diabetes y Enfermedades Metabolicas asociadas) are initiatives of ISCIII, Madrid, Spain.

The coordination of EPIC is financially supported by the European Commission (DG-SANCO) and the International Agency for Research on Cancer. The national cohorts are supported by Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l’Education Nationale, Institut National de la Santé et de la Recherche Médicale (INSERM) (France); German Cancer Aid, German Cancer Research Center (DKFZ), Federal Ministry of Education and Research (BMBF), Deutsche Krebshilfe, Deutsches Krebsforschungszentrum and Federal Ministry of Education and Research (Germany); the Hellenic Health Foundation (Greece); Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy and National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF); ERC-2009-AdG 232997 and Nordforsk, Nordic Centre of Excellence programme on Food, Nutrition and Health (Norway); Health Research Fund (FIS), PI13/00061 to Granada; PI13/01162 to EPIC-Murcia, Regional Governments of Andalucía, Asturias, Basque Country, Murcia and Navarra, and the Catalan Institute of Oncology (Spain); Swedish Cancer Society, Swedish Research Council and County Councils of Skåne and Västerbotten (Sweden); Cancer Research UK (14136 to EPIC-Norfolk; C570/A16491 and C8221/A19170 to EPIC-Oxford), Medical Research Council (1000143 to EPICNorfolk, MR/M012190/1 to EPIC-Oxford) (UK). We thank the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, and the National Institute for Public Health and the Environment (RIVM)-Bilthoven, the Netherlands, for their contribution and ongoing support to the EPIC Study., For information on how to submit an application for gaining access to EPIC data and/or biospecimens, please follow the instructions at http://epic.iarc.fr/ access/index.php., Informed consent was given by all study participants, and ethical approval for the entire EPIC cohort was obtained from the Institutional Review Board of the International Agency for Research on Cancer in Lyon, France, under protocol numbers SC/24/4 and SC/24/6, as well as from local ethics committees in the participating countries., The authors thank the EPIC participants and staff for their valuable contribution to this research and Bertrand Hemon (International Agency for Research on Cancer) for managing the data for the EPIC project., Background Trans fatty acids (TFAs) have been hypothesised to influence breast cancer risk. However, relatively few prospective studies have examined this relationship, and well-powered analyses according to hormone receptor-defined molecular subtypes, menopausal status, and body size have rarely been conducted. Methods In the European Prospective Investigation into Cancer and Nutrition (EPIC), we investigated the associations between dietary intakes of TFAs (industrial trans fatty acids [ITFAs] and ruminant trans fatty acids [RTFAs]) and breast cancer risk among 318,607 women. Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models, adjusted for other breast cancer risk factors. Results After a median follow-up of 8.1 years, 13,241 breast cancer cases occurred. In the multivariable-adjusted model, higher total ITFA intake was associated with elevated breast cancer risk (HR for highest vs lowest quintile, 1.14, 95% CI 1.06-1.23; P trend = 0.001). A similar positive association was found between intake of elaidic acid, the predominant ITFA, and breast cancer risk (HR for highest vs lowest quintile, 1.14, 95% CI 1.06-1.23; P trend = 0.001). Intake of total RTFAs was also associated with higher breast cancer risk (HR for highest vs lowest quintile, 1.09, 95% CI 1.01-1.17; P trend = 0.015). For individual RTFAs, we found positive associations with breast cancer risk for dietary intakes of two strongly correlated fatty acids (Spearman correlation r = 0.77), conjugated linoleic acid (HR for highest vs lowest quintile, 1.11, 95% CI 1.03-1.20; P trend = 0.001) and palmitelaidic acid (HR for highest vs lowest quintile, 1.08, 95% CI 1.01-1.16; P trend = 0.028). Similar associations were found for total ITFAs and RTFAs with breast cancer risk according to menopausal status, body mass index, and breast cancer subtypes. Conclusions These results support the hypothesis that higher dietary intakes of ITFAs, in particular elaidic acid, are associated with elevated breast cancer risk. Due to the high correlation between conjugated linoleic acid and palmitelaidic acid, we were unable to disentangle the positive associations found for these fatty acids with breast cancer risk. Further mechanistic studies are needed to identify biological pathways that may underlie these associations., European Commission European Commission Joint Research Centre, International Agency for Research on Cancer, Danish Cancer Society, Ligue Contre le Cancer (France), Institut Gustave Roussy (France), Mutuelle Generale de l'Education Nationale (France), Institut National de la Sante et de la Recherche Medicale (Inserm), Deutsche Krebshilfe, German Cancer Research Center (DKFZ) (Germany), Federal Ministry of Education & Research (BMBF), Deutsches Krebsforschungszentrum (Germany), Hellenic Health Foundation (Greece), Associazione Italiana per la Ricerca sul Cancro (AIRC), Consiglio Nazionale delle Ricerche (CNR), Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Netherlands Organization for Scientific Research (NWO), World Cancer Research Fund International (WCRF), Instituto de Salud Carlos III PI13/00061 PI13/01162, Junta de Andalucia, Catalan Institute of Oncology (Spain), Swedish Cancer Society Swedish Research Council, County Council of Skane (Sweden), County Council of Vasterbotten (Sweden), Cancer Research UK 14136 C570/A16491 C8221/A19170, UK Research & Innovation (UKRI) Medical Research Council UK (MRC) 1000143 MR/M012190/1, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, National Institute for Public Health and the Environment (RIVM)-Bilthoven, the Netherlands, Nordforsk, Nordic Centre of Excellence programme on Food, Nutrition and Health (Norway), Regional Government of Asturias (Spain), Regional Government of Basque Country (Spain), Regional Government of Murcia (Spain), Regional Government of Navarra (Spain), ERC-2009-AdG 232997

Background: Adoption of a certain dietary pattern is determined by different factors such as taste, cost, convenience, and nutritional value of food. Objective: To assess the association between the daily cost of a diet and its overall quality in a cohort of 6–12-year-old Spanish schoolchildren. Methods: A cross-sectional survey was conducted on a cohort (n = 130, 47% female) of 6–12-year-old children schooled in primary education in the central region of Spain. Three-day 24 h records were administered, and the nutritional quality of the diet was also determined by means of Mediterranean Adequacy Index (MAI). A questionnaire on sociodemographic data, frequency of eating in fast-food restaurants, and supplement intake were also recorded. The person responsible for the child’s diet and the schooler himself completed the questionnaires, and homemade measures were used to estimate the size of the portions. Food prices were obtained from the Household Consumption Database of the Spanish Ministry of Agriculture, Fisheries and Food. The economic cost of the diet was calculated by multiplying the amount in grams of the food consumed by each child by the corresponding price in grams and adding up the total amount for each participant. The total economic cost of the diet was calculated in €/day and in €/1000 kcal/day. Results: The area under the curve (AUC) for €/day and €/1000 kcal/day represent 62.6% and 65.6%, respectively. According to AUC values, adherence to Mediterranean diet (MD) is a moderate predictor of the monetary cost of the diet. A direct relationship between the cost of the diet and the adherence to MD was observed [OR (€/1000 kcal/day) = 3.012, CI (95%): 1.291, 7.026, p = 0.011]. Conclusions: In a cohort of Spanish schoolchildren with low adherence to the MD, a higher cost of the diet standardized to 1000 kcal was associated with above-average MAI values.

Food-Based Dietary Guidelines (FBDG) include dietary recommendations based on food groups according to the general and accepted nutrition principles and current scientific evidence. Adoption of FBDG contributes to the prevention of malnutrition in all its forms, promotes human health, and reduces environmental impact. The present review aims to perform an international comparative analysis of the FBDG adopted in different countries from three different continents (America, Asia, and Europe), with particular reference to the Spanish Food Safety and Nutrition Agency (AESAN, Agencia Española de Seguridad Alimentaria y Nutrición) Scientific Committee dietary recommendations. A total of twelve countries with the most updated FBDG and/or closest to the traditional and cultural preferences of Spain were finally selected. All the reviewed FBDG provided recommendations for fruits, vegetables, cereals, legumes, nuts, milk and dairy products, meat and derivatives, fish, eggs, water, and oil, however, remarkable differences regarding recommended amounts were found among countries.

Background In general, plant protein intake was inversely associated with mortality in studies in middle-aged adults. Our aim was to evaluate the long-term associations of animal and plant protein intake with mortality in older adults. Methods A prospective cohort study including 1 139 community-dwelling older adults (mean age 75 years, 56% women) living in Tuscany, Italy, followed for 20 years (InCHIANTI study) was analyzed. Dietary intake by food frequency questionnaires and clinical information were assessed 5 times during the follow-up. Protein intakes were expressed as percentages of total energy. Time-dependent Cox regression models adjusted for confounders were used to assess the association between plant and animal protein intake, and mortality. Results During the 20 years of follow-up (mean: 12 years), 811 deaths occurred (292 of cardiovascular- and 151 of cancer-related causes). Animal protein intake was inversely associated with all-cause (hazard ratio [HR] per 1% of total energy from protein increase, 95% confidence interval [CI]: 0.96, 0.93–0.99) and cardiovascular mortality (HR per 1% of total energy from protein increase, 95% CI: 0.93, 0.87–0.98). Plant protein intake showed no association with any of the mortality outcomes, but an interaction with baseline hypertension was found for all-cause and cardiovascular mortality (p < .05). Conclusions Animal protein was inversely associated with all-cause and cardiovascular mortality in older adults. Further studies are needed to provide recommendations on dietary protein intake for older adults.

SCOPE: Diet is considered an important modulator of cognitive decline and dementia, but the available evidence is, however, still fragmented and often inconsistent.METHODS AND RESULTS: The article studies the long-term prospective Three-City Cohort, which consists of two separate nested case-control sample sets from different geographic regions (Bordeaux, n = 418; Dijon, n = 424). Cognitive decline is evaluated through five neuropsychological tests (Mini-Mental State Examination, Benton Visual Retention Test, Isaac's Set Test, Trail-Making Test part A, and Trail-Making Test part B). The food-related and microbiota-derived circulating metabolome is studied in participants free of dementia at baseline, by subjecting serum samples to large-scale quantitative metabolomics analysis. A protective association is found between metabolites derived from cocoa, coffee, mushrooms, red wine, the microbial metabolism of polyphenol-rich foods, and cognitive decline, as well as a negative association with metabolites related to unhealthy dietary components, such as artificial sweeteners and alcohol.CONCLUSION: These results provide insight into the early metabolic events that are associated with the later risk to develop cognitive decline within the crosstalk between diet, gut microbiota and the endogenous metabolism, which can help identify potential targets for preventive and therapeutic strategies to preserve cognitive health.

IntroductionThe intestinal microbiota comprises bacteria, fungi, archaea, protists, helminths and viruses that symbiotically inhabit the digestive system. To date, research has provided limited data on the possible association between an active lifestyle and a healthy composition of human microbiota. This review was aimed to summarize the results of human studies comparing the microbiome of healthy individuals with different physical activity amounts.MethodsWe searched Medline/Ovid, NIH/PubMed, and Academic Search Complete between August–October 2020. Inclusion criteria comprised: (a) cross-sectional studies focused on comparing gut microbiome among subjects with different physical activity levels; (b) studies describing human gut microbiome responses to any type of exercise stimulus; (c) studies containing healthy adult women and men. We excluded studies containing diet modifications, probiotic or prebiotic consumption, as well as studies focused on diabetes, hypertension, cancer, hormonal dysfunction. Methodological quality and risk of bias for each study were assessed using the Risk Of Bias In Non-randomized Studies—of Interventions tool. The results from cross-sectional and longitudinal studies are shown independently.ResultsA total of 17 articles were eligible for inclusion: ten cross-sectional and seven longitudinal studies. Main outcomes vary significantly according to physical activity amounts in longitudinal studies. We identified discrete changes in diversity indexes and relative abundance of certain bacteria in active people.ConclusionAs literature in this field is rapidly growing, it is important that studies incorporate diverse methods to evaluate other aspects related to active lifestyles such as sleep and dietary patterns. Exploration of other groups such as viruses, archaea and parasites may lead to a better understanding of gut microbiota adaptation to physical activity and sports and its potentially beneficial effects on host metabolism and endurance.

Evidence has identified unhealthy lifestyle behaviors as the main contributors to obesity in children, so it is essential to identify factors that could influence children's lifestyles. The objective of the present study was to analyze the association of baseline maternal educational level with child's physical activity, screen time, and dietary habits at follow-up. This community-based cohort study was carried out between 2012 and 2014 and included 1405 children aged 8 to 10 years old. Maternal educational level was used as an indicator of child's socioeconomic status. Physical activity, screen time, and dietary habits were assessed by validated questionnaires. The odds of having commercially baked goods for breakfast [OR 1.47 (95% CI 1.03 to 2.10)], going more than once a week to a fast-food restaurant [OR 1.64 (95% CI 1.20 to 2.26)], and taking sweets and candys several times a day [OR 3.23 (95% CI 2.14 to 4.87) were significantly higher among children whose mothers had a lower educational level compared to their peers whose mothers had a higher level. These associations held for taking sweets and candy several times a day after additional adjustment for the corresponding dietary behavior at baseline. Maternal educational level was inversely associated (p < 0.001) with child's screen time at follow up and being in the lowest maternal educational category was associated with an increased odds of surpassing the maximum recommended time of screen time of 120 min per day (OR (95% CI) 1.43 (1.07 to 1.90), p = 0.016). Maternal education is a predictor for unhealthy dietary habits and high screen time in children. This work was supported by a grant from Instituto de Salud Carlos III FEDER, (PI11/01900).Centro de Investigación Biomédica en Red Epidemiologia y Salud Publica (CIBERESP) is an initiativeof the Instituto de Salud Carlos III (ISCIII) of Spain, which is financed by the European RegionalDevelopment Fund (ERDF), “A way to make Europe”/“Investing in your future” (CB06/03). Itis supported by the official funding agency for biomedical research of the Spanish government,ISCIII, Spain.

Regular exercise during school hours is encouraged since childhood obesity has reached epidemic proportions. Moreover, a great majority of adolescents do not meet the recommendations for moderate-to-vigorous physical activity. The present study aimed to determine the effects of school-based high-intensity interval training (HIIT) and nutrition intervention on body composition and physical fitness in overweight adolescent girls. Forty-eight girls were included in the study, of whom 24 (age = 15.5 &plusmn, 0.7 years) were randomized to a experimental group (EXP) (HIIT and nutrition intervention school-based program) and 24 (age = 15.7 &plusmn, 0.6 years) to a control group (CON) that maintained their usual physical education activities. HIIT consisted of 10 stations of own bodyweight exercise and was done three times per week for eight weeks. Moreover, the EXP participated in the nutrition program led by a nutritionist two times a week. Apart from body composition assessment, participants performed countermovement jump (CMJ), medicine ball throw, hand-grip test, and Yo-Yo Intermittent Recovery Level 1 Test (YYIRT1). A significant effect of group (EXP vs. CON) x time (pre vs. post) interaction was observed for weight [F(1,44) = 7.733, p = 0.008], body mass index [F(1,44) = 5.764, p = 0.020], body fat (in kg) [F(1,44) = 17.850, p &lt, 0.001], and body fat (in %) [F(1,44) = 18.821, 0.001]. Moreover, a significant interaction was observed for the medicine ball throw [F(1,44) = 27.016, 0.001] and YYIRT1 [F(1,44) = 5.439, p = 0.024]. A significant main effect for time was found for hand grip [F(1,44) = 9.300, p = 0.004] and CMJ [F(1,44) = 12.866, p = 0.001].The present study has demonstrated that just eight weeks school-based HIIT and nutrition intervention, including three sessions a week, can improve body composition and muscular and physical aerobic performance in overweighted adolescent girls

Diet may influence the development of inflammatory bowel disease through the modulation of inflammation. We investigated whether the inflammatory potential of the diet is associated with the risk of Crohn’s disease (CD) and ulcerative colitis (UC) in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain). The study included 32,633 participants aged 29–69 years. The inflammatory potential of the diet was measured by using an inflammatory score of the diet (ISD) based on a baseline dietary history questionnaire. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). During 21 years (674,547 person-years) of follow-up, 32 and 57 participants developed CD and UC, respectively. In multivariable analysis, a one-standard deviation (SD) increment in the ISD (two-unit increase) was associated with a higher risk of CD (HR of 1.71; 95% CI: 1.05–2.80; p = 0.031). By contrast, ISD was not associated with UC (HR for one-SD increment of 0.89; 95% CI: 0.66–1.19; p = 0.436). Our results suggest that consuming a more pro-inflammatory diet may contribute to the risk of CD, supporting that a healthy diet might be beneficial in its prevention. Further, larger studies are needed to verify these findings., Instituto de Salud Carlos III (PIE14/00045), Crohn’s and Colitis UK (M2017-2), e Intra-CIBERESP mobility program (ESPF60/2017), International Agency for Research on Cancer (IARC), Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, NIHR Imperial Biomedical Research Centre (BRC), Health Research Fund (FIS)-Instituto de Salud Carlos III (ISCIII), e Regional Governments of Andalusia, Asturias, Basque Country, Murcia and Navarra, and the Catalan Institute of Oncology-ICO (Spain)

Elderly Costa Ricans have lower mortality rates compared to their counterparts from developed countries. Reasons for this survival advantage are not completely known. In the present study, we aimed to identify dietary factors associated with leukocyte telomere length (LTL), a marker of biologic aging, in the elderly population of Costa Rica. We conducted prospective analysis in 909 participants aged 60+ years from the Costa Rican Longevity and Healthy Aging Study (CRELES). We used a food frequency questionnaire to assess usual diet. We calculated dietary patterns using Principal Component Analysis (PCA). We used generalized linear models to examine the association of dietary patterns and food groups with leukocyte telomere length. We found two major dietary patterns explaining 9.15% and 7.18% of the total variation of food intake, respectively. The first dietary pattern, which represents a traditional Costa Rican rice and beans pattern, was more frequent in rural parts of the country and was positively associated with baseline LTL: (95% CI) = 42.0 base-pairs (bp) (9.9 bp, 74.1 bp) per one-unit increase of the traditional dietary pattern. In analysis of individual food groups, intake of grains was positively associated with baseline LTL: (95% CI) = 43.6 bp (13.9 bp, 73.3 bp) per one-serving/day increase of consumption of grains. Our results suggest that dietary factors, in particular a traditional food pattern, are associated with telomere length and may contribute to the extended longevity of elderly Costa Ricans. Universidad de Costa Rica/[]/UCR/Costa Rica National Institutes of Health/[P30 AG012839]/NIH/Estados Unidos National Institutes of Health/[R01 AG031716]/NIH/Estados Unidos UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Sociales::Centro Centroamericano de Población (CCP) UCR::Vicerrectoría de Docencia::Ciencias Básicas::Facultad de Ciencias::Escuela de Biología

As the most likely primary caregivers, mothers are an integral part of children’s social influence and are therefore greatly involved in shaping their children’s behaviors. The objectives were to determine the prospective associations between maternal and child diet quality and sedentary behaviors. This study, within the framework of a community-based intervention study, included 1130 children aged 8–10 years and their mothers. The study was carried out during two academic years (2012/2014) with a mean follow-up of 15 months. Exposure and outcome variables were measured at baseline and follow-up, respectively. Diet quality was assessed by the KIDMED questionnaire and the short Diet Quality Screener, respectively. Sedentary behaviors were determined by standardized questions of sedentary behaviors. Maternal consumption of fruits, vegetables, fish, legumes, pasta/rice, dairy products, nuts and baked goods were positively associated (p &lt, 0.05) with the corresponding child behavior. Multiple linear regression models adjusted for sex, age, maternal education and intervention group revealed significant cross-sectional (p &lt, 0.005) and prospective (p &lt, 0.01) associations between maternal and child overall diet quality and sedentary behaviors. Maternal diet quality and sedentary behaviors were predictive for these lifestyle behaviors in children.

Objective: To evaluate the association between nutritional status, physical activity, sedentary behavior, diet, and lifestyle in childhood with respiratory diseases during adolescence. Methods: Prospective study conducted in São Caetano do Sul, São Paulo - Brazil, as part of the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE). During childhood, indicators of lifestyle (body composition, physical activity, sedentary behavior, diet) and family environment were measured in 2012 and 2013. After five years, participants answered the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire for the diagnosis of respiratory diseases (asthma and/or rhinitis). Analyses were determined by logistic regression. Results: A total of 168 schoolchildren (56% boys) were evaluated, and the prevalence of asthma and rhinitis accounted for 15.5 and 25.6%, respectively. Whole milk consumption (Odds Ratio [OR]=1.24; 95% confidence interval [95%CI] 1.03-1.49), having a television in the bedroom (OR=0.29; 95%CI 0.12-0.71), and attending physical education classes ≥2 times/week (OR=0.30; 95%CI 0.11-0.81) in childhood were associated with the presence of asthma in adolescence. Factors significantly associated with rhinitis were as follows: female participants (OR=2.45; 95%CI 1.20-4.98) and whole milk consumption (OR=1.21; 95%CI 1.04-1.40). Conclusions: Higher consumption of whole milk, not having a television in the bedroom, few physical education classes, and being a girl were factors associated with respiratory diseases. Public policies should be directed toward a healthier lifestyle and the prevention of respiratory diseases. RESUMO Objetivo: Avaliar a associação entre estado nutricional, atividade física, comportamento sedentário, dieta e estilo de vida na infância e doenças respiratórias durante a adolescência. Métodos: Estudo prospectivo realizado em São Caetano do Sul, São Paulo, como parte do International Study of Childhood Obesity, Lifestyle and the Environment. Indicadores do estilo de vida (composição corporal, atividade física, comportamento sedentário, dieta) e do ambiente familiar foram mensurados durante a infância, em 2012 e 2013. Após cinco anos, os escolares responderam o questionário do International Study of Asthma and Allergies in Childhood (ISAAC) para o diagnóstico de doenças respiratórias (asma e/ou rinite). Análises foram determinadas por meio da regressão logística. Resultados: Foram avaliados 168 escolares (56% meninos), e as prevalências de asma e rinite observadas foram 15,5 e 25,6%, respectivamente. Consumir leite integral (Odds Ratio [OR]=1,24; intervalo de confiança 95% [IC95%] 1,03-1,49), ter televisão no quarto (OR=0,29; IC95% 0,12-0,71) e praticar aulas de educação física ≥2 vezes/semana (OR=0,30; IC95% 0,11-0,81) na infância foram associados com a presença de asma na adolescência. Os fatores significativamente associados à rinite foram: ser do sexo feminino (OR=2,45; IC95% 1,20-4,98) e consumir leite integral (OR=1,21; IC95% 1,04-1,40). Conclusões: Consumir mais leite integral, não ter televisão no quarto, ter tido poucas aulas de educação física e ser do sexo feminino foram fatores associados às doenças respiratórias. Políticas públicas devem ser dirigidas para um estilo de vida mais saudável e a prevenção de doenças respiratórias.

The objective of this study was to explore what motivates pregnant and breastfeeding women to make changes in their diet, specifically to examine how their perceptions regarding diet facilitate or act as obstacles to introducing healthy eating habits. For the optimal development of the mother, the fetus, or breastfeeding baby, it is important to avoid foods containing substances, such as persistent toxic substances (PTSs), that are harmful to health during pregnancy and after the baby&rsquo, s birth. This study used a qualitative research methodology, based on semi-structured individual interviews, food diaries, free lists, and focus groups with 111 pregnant and breastfeeding women in Spain. This approach was followed by a systematic and exhaustive exploitation of the qualitative data obtained, following the methodological principles of grounded theory. From the study results, we conclude that the motivation for a change in diet to avoid PTSs is based on the desire to promote good health, beliefs about the importance of having a varied diet, and the avoidance of potential risks. The main obstacles to change can be attributed to inadequate information, contradictory discourses, and socioeconomic difficulties.

Diet is a key factor for obesity development; however, limited data are available on dietary cluster analysis in children with obesity. We aimed to assess the associations between dietary patterns and obesity and several cardiometabolic markers. Anthropometry, bioelectrical impedance, blood pressure and plasma biomarkers of oxidative stress, inflammation and endothelial damage were determined in 674 Caucasian children, aged 5–16, with normal or excess weight. Using a food frequency questionnaire and cluster analysis, two consistent dietary patterns were shown, labeled as health conscious (HC) and sweet and processed (SP). The HC pattern included a greater proportion of participants with overweight/obesity than the SP cluster (80.1% vs. 63.8%). However, children with obesity within the HC cluster, showed less abdominal fat, through waist to hip (0.93 vs. 0.94) and waist to height (0.61 vs. 0.63) indexes (p < 0.01). Univariate general models showed several additional di erences in cardiometabolic risk biomarkers in the global and stratified analyses, with a healthier profile being observed mainly in the HC cluster. However, multivariate models questioned these findings and pointed out the need for further studies in this field. Anyhow, our findings support the benefits of a healthy diet and highlight the importance of dietary patterns in the cardiometabolic risk assessment of children with overweight/obesity, beyond weight control., Plan Nacional de Investigacion Cientifica, Desarrollo e Innovacion Tecnologica (I+D+I), Instituto de Salud Carlos III-Health Research Funding (FONDOS FEDER) PI05/1968 PI11/01425 PI11/02042 PI11/02059 PI16/01301 PI16/01205 PI1600871, CIBEROBN Network CB15/00131 CB15/00043, Juan de la Cierva-Formacion from the Spanish Government FJCI-2017-34967 FJCI-2014-19795, Vice-Rectorate of Research and Transfer of the University of Granada, Spain