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ABSTRACT Objective: To describe the locations of food and beverage acquisition in Brazil, according to the level of food processing and household location (urban/rural). Methods: Data from 49,489 households from the Household Budget Survey 2017-2018 were used. Information regarding food and beverages was collected through a collective acquisition booklet over 7 consecutive days. Locations were classified into 10 groups on the basis of similarities in sales structure and mode of food offering, and food and beverages were categorized according to the NOVA classification. The frequency of households acquiring food in each location was estimated, as well as the acquisition frequency according to processing level, considering significance through non-overlapping 95% confidence intervals. Results: Half of the households (51.9%) acquired food in supermarkets, contributing to both the acquisition of fresh and minimally processed foods (92.2% in urban; 90.2% in rural) and ultra-processed foods (78.6% in urban; 74.1% in rural). For the urban area, the Supermarket (55.0%), Bakery (46.5%) and Small markets (43.1%) are among the places with the highest frequency of food acquisition, while for rural areas, it is found that Small Markets (53%), Supermarkets (32.3%) and Home production (31.0%) presented the highest frequencies. Conclusion: The acquisition of food and beverages for household consumption in Brazil differs according to household location (urban/rural), indicating the importance of the community food environment in the consumption patterns of ultra-processed foods.

In food intake studies, converting eaten foods into calories and nutrients and other food components using books and tables of food ingredients is a very time-consuming and error-prone task. ShaFA is new Microsoft Windows-based software for food component derivation of individual and group food intake data. This software is developed using C sharp programming language. Microsoft Access has been used to put the information of 8790 food types and their 85 food components based on the USDA-SR28 in the database of software. The user is capable to search in the database for desired food by the name or special code of the food and select them for each person. Each person’s food intake data can be stored via allocating an exclusive ID. Finally, the user can get a report of the imported data in a new window, and also can get a Microsoft Excel export which can be imported into statistical software such as SPSS and STATA. Each research project data can be stored in a file with the unique extension (ShaFA) which can be opened and edited in any system that its operating system is Microsoft Windows, and has ShaFA software installed on it. This software can provide researchers with valuable information in a short time, especially nutritional epidemiology studies. It can also be used in food industry to extract the information needed to label and complete food information table for a variety of food industry products.

BACKGROUND: Access to high-quality dietary intake data is central to many nutrition, epidemiology, economic, environmental, and policy applications. When data on individual nutrient intakes are available, they have not been consistently disaggregated by sex and age groups, and their parameters and full distributions are often not publicly available. OBJECTIVES: We sought to derive usual intake distributions for as many nutrients and population subgroups as possible, use these distributions to estimate nutrient intake inadequacy, compare these distributions and evaluate the implications of their shapes on the estimation of inadequacy, and make these distributions publicly available. METHODS: We compiled dietary data sets from 31 geographically diverse countries, modeled usual intake distributions for 32 micronutrients and 21 macronutrients, and disaggregated these distributions by sex and age groups. We compared the variability and skewness of the distributions and evaluated their similarity across countries, sex, and age groups. We estimated intake inadequacy for 16 nutrients based on a harmonized set of nutrient requirements and bioavailability estimates. Last, we created an R package-nutriR-to make these distributions freely available for users to apply in their own analyses. RESULTS: Usual intake distributions were rarely symmetric and differed widely in variability and skewness across nutrients and countries. Vitamin intake distributions were more variable and skewed and exhibited less similarity among countries than other nutrients. Inadequate intakes were high and geographically concentrated, as well as generally higher for females than males. We found that the shape of usual intake distributions strongly affects estimates of the prevalence of inadequate intakes. CONCLUSIONS: The shape of nutrient intake distributions differs based on nutrient and subgroup and strongly influences estimates of nutrient intake inadequacy. This research represents an important contribution to the availability and application of dietary intake data for diverse subpopulations around the world.

• Baby spinach contributed most to Australian lutein and zeaxanthin (L/Z) intake. • Broccoli contributed highly to United Kingdom dietary L/Z intake. • Correlational statistics overestimated L/Z dietary screener tool validity. • Bland-Altman plot analysis is key to deducing dietary L/Z screener tool validity. • Validity of diet L/Z intake from prior research should be interpreted with caution. Habitual dietary intake measurement of carotenoids lutein and zeaxanthin (L/Z) has often been omitted or attempted with tools of unknown validity in past research. It was hypothesized that the dietary assessment tool, the L/Z screener, developed as part of this study, would be valid with agreement within 0.25 mg/day when compared against multiple 24-hour diet recalls in healthy Australian and United Kingdom adults. Two screeners with 91 food items were developed, 1 with a recall timeframe of a month and the other a week. Over 4 weeks, 56 Australian and 47 United Kingdom participants completed 4 weekly screeners, 2 monthly screeners, and eight 24-hour diet recalls. Validity was assessed through Bland-Altman plot analysis. L/Z intake measured by all tools was significantly correlated, with correlation coefficients from 0.58 to 0.83. Despite these correlations, the screeners were not valid, with poor Bland-Altman plot agreement when compared with the diet recalls. The Australian weekly screener performed best, demonstrating a mean difference of 0.51 mg/day and 95% limits of agreement between –1.46 mg/day and 2.49 mg/day of L/Z intake. Baby spinach, broccoli, and pumpkin provided the greatest proportion of L/Z intake. The low validity may be explained by high rates of misestimation or missed capture of moderate to high L/Z containing foods such as baby spinach. Prior research reliant on correlational statistics for L/Z tool validity should be interpreted with caution, and future screener development should prioritize accurate capture of high contribution foods. A 91-item L/Z diet screener was developed with 2 recall timeframes: a month or a week. Screener L/Z intake compared with 24-hour diet recalls by Bland-Altman plot analysis and correlational statistics in 103 adults resulted in significant correlations. However, agreement was poor (95% limits of agreement ≥0.25 mg/day) because of memory recall bias and missed capture; therefore, the screeners were deemed not valid. Abbreviations: AU, Australia; L/Z, lutein and zeaxanthin; UK, United Kingdom. Created with BioRender.com. [Display omitted] [ABSTRACT FROM AUTHOR]

In food intake studies, converting eaten foods into calories and nutrients and other food components using books and tables of food ingredients is a very time-consuming and error-prone task. ShaFA is new Microsoft Windowsbased software for food component derivation of individual and group food intake data. This software is developed using C sharp programming language. Microsoft Access has been used to put the information of 8790 food types and their 85 food components based on the USDA-SR28 in the database of software. The user is capable to search in the database for desired food by the name or special code of the food and select them for each person. Each person's food intake data can be stored via allocating an exclusive ID. Finally, the user can get a report of the imported data in a new window, and also can get a Microsoft Excel export which can be imported into statistical software such as SPSS and STATA. Each research project data can be stored in a file with the unique extension (ShaFA) which can be opened and edited in any system that its operating system is Microsoft Windows, and has ShaFA software installed on it. This software can provide researchers with valuable information in a short time, especially nutritional epidemiology studies. It can also be used in food industry to extract the information needed to label and complete food information table for a variety of food industry products. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the prevalence of ultra-processed food consumption and associated factors among children enrolled in the public school system of the city of Barbacena, Minas Gerais, Brazil. Methods: This is a cross-sectional study conducted with schoolchildren aged 7–9 years, of both sexes, enrolled in state public schools. Food intake was assessed using the Previous Day Food Questionnaire and the level of physical activity by the Previous Day Physical Activity Questionnaire. The listed foods were classified according to the extent and purpose of industrial processing, using the NOVA classification. Pearson’s χ² test, Fisher’s exact test, χ² with Yates correction, and Poisson regression were used in the statistical analysis, estimating the crude and adjusted prevalence ratio, with 95% confidence intervals. Results: The prevalence of daily ultra-processed food consumption was 69.6%. After adjusted analyses, the consumption of ultraprocessed food was associated with the omission of breakfast, midafternoon snack, supper, low physical activity, and consumption of risk foods. On the other hand, consumption of in natura or minimally processed foods was associated with older age, the consumption of lunch, mid-afternoon snack, dinner, and protective foods. Conclusions: There is a high prevalence of ultra-processed foods consumption, associated with unhealthy dietary habits among schoolchildren. This highlights the need for nutritional counseling and educational actions, favoring healthy eating in childhood. [ABSTRACT FROM AUTHOR]

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Purpose: To evaluate maternal dietary intake during pregnancy compared with the 2015-2020 and 2020-2025 Dietary Guidelines for Americans (DGA). Study Design and Methods: A retrospective observational study design was used. The cohort included women who gave birth to preterm infants between 25 1/7 weeks and 33 6/7 weeks of gestation. Within 2 weeks of birth, participants were asked to recall their diet in the last month of pregnancy using the Dietary Screener Questionnaire. Participants' dietary intakes were compared to current 2020-2025 DGA that include specific recommendations for pregnant women and prior 2015-2020 DGA that were in place during the study period but were not pregnancy-specific. Results: Forty-five women participated in the study. None met the 2015-2020 or 2020-2025 DGA recommended intake of all seven dietary components. When compared to both DGAs, 2.2% of participants met the recommended dairy intake, 26.7% met the calcium intake, 15.6% were below the threshold for added sugar, and none met the vegetable or whole grain intake. When compared to the 2015-2020 DGA, 28.9% met the fruit intake and 2.2% met the fiber intake. However, when compared to the 2020-2025 DGA, only 2.2% met the fruit intake and none met the fiber intake. Clinical Implication: Women who gave birth preterm did not adhere to the 2015-2020 or 2020-2025 DGA recommendations in the last month of pregnancy. Nurses are uniquely positioned to provide pregnant women with nutritional screening and counseling as part of routine prenatal care. Diet is an important part of a healthy pregnancy, however all women do not have access to or can afford foods that promote good health. In this study, the diets of women who gave birth preterm were not consistent with the 2015–2020 or 2020–2025 recommendations in the Dietary Guidelines for Americans during the last month of their pregnancy. Nurses are uniquely positioned to provide pregnant women with nutritional screening and counseling as part of routine prenatal care to enhance pregnancy and birth outcomes. [ABSTRACT FROM AUTHOR]

The lack of nationally representative, individual-level dietary intake data has led researchers to increasingly turn to household-level data on food acquisitions and/or consumption to inform the design of food-fortification programs in low- and middle-income countries (LMICs). These nationally representative, household-level data come from household consumption and expenditure surveys (HCESs), which are collected regularly in many LMICs and are often made publicly available. Our objectives were to examine the utility of HCES data to inform the design of food-fortification programs and to identify best-practice methods for analyzing HCES data for this purpose. To this end, we summarized information needed to design fortification programs and assessed the extent to which HCES data can provide corresponding indicators. We concluded that HCES data are well suited to guide the selection of appropriate food vehicles, but because individual-level estimates of apparent nutrient intakes rely on assumptions about the intrahousehold distribution of food, more caution is advised when using HCES data to select the target micronutrient content of fortified foods. We also developed a checklist to guide analysts through the use of HCES data and, where possible, identified research-based, best-practice analytical methods for analyzing HCES data, including selecting the number of days of recall data to include in the analysis and converting reported units to standard units. More research is needed on how best to deal with composite foods, foods consumed away from home, and extreme values, as well as the best methods for assessing the adequacy of apparent intakes. Ultimately, we recommend sensitivity analyses around key model parameters, and the continual triangulation of HCES-based results with other national and subnational data on food availability, dietary intake, and nutritional status when designing food-fortification programs.

Abstract Background Effectiveness of actions to reduce sugar-sweetened beverage (SB) consumption in children still needs to be improved. Furthermore, the growing concern about sustainable food systems encourages to develop sustainability-based interventions. The objective of this cluster randomised controlled trial is to evaluate the long-term effectiveness of nutrition- and environmental sustainability-based interventions on the reduction in SB intake and on the increase in tap water consumption in 3rd to 6th grade primary school children (8 to 11 years of age). Methods Forty-eight French-speaking Belgian primary schools (equivalent to around 3500 pupils involved in the evaluation) are randomised using a factorial plan: (i) control, (ii) nutrition-based intervention, (iii) sustainability-based intervention, and (iv) both. The interventions (encouragement of water breaks; provision of posters, leaflets, reusable cups, and glass bottles; website; meetings at school) were undertaken from February 2022 to June 2023. Evaluation includes questionnaires for the children and their parents on various determinants of dietary behaviour, a 4-day diary to collect information on the child’s beverage consumption, and audits at schools. The first evaluation was conducted in Spring 2021 before any intervention, with the two post-intervention evaluations being held in 2022 and 2023. The main quantitative judgement criterion will be the change over time in the mean SB consumption (in ml/day) in the intervention groups compared with the control group. Given the context of the research (school), the safety of the intervention, and the content of data collection, a consent was acknowledged as unnecessary by the Ethical Committee of the Faculty of Psychology (ULB; n°073/2021), but children and parents are explicitly informed of their right to refuse to fill in the questionnaires. Discussion Multicomponent interventions based on nutrition and on environmental sustainability, alone or mixed, will provide an original and topical insight into health promotion at school around dietary behaviours. The dissemination plan will enable to widely inform stakeholders, school staff, and families, in addition to the scientific community through the usual medium (articles, conferences), about the research findings in 2024–2025. Trial registration ISRCTN Registry ISRCTN99843102. Retrospectively registered on 25 May 2021

BackgroundIndividual diet components and specific dietary regimens have been shown to impact the gut microbiome.ObjectivesHere, we explored the contribution of long-term diet by searching for dietary patterns that would best associate with the gut microbiome in a population-based cohort.MethodsUsing a priori and a posteriori approaches, we constructed dietary patterns from an FFQ completed by 1800 adults in the American Gut Project. Dietary patterns were defined as groups of participants or combinations of food variables (factors) driven by criteria ranging from individual nutrients to overall diet. We associated these patterns with 16S ribosomal RNA-based gut microbiome data for a subset of 744 participants.ResultsCompared to individual features (e.g., fiber and protein), or to factors representing a reduced number of dietary features, 5 a posteriori dietary patterns based on food groups were best associated with gut microbiome beta diversity (P ≤ 0.0002). Two patterns followed Prudent-like diets-Plant-Based and Flexitarian-and exhibited the highest Healthy Eating Index 2010 (HEI-2010) scores. Two other patterns presented Western-like diets with a gradient in HEI-2010 scores. A fifth pattern consisted mostly of participants following an Exclusion diet (e.g., low carbohydrate). Notably, gut microbiome alpha diversity was significantly lower in the most Western pattern compared to the Flexitarian pattern (P ≤ 0.009), and the Exclusion diet pattern was associated with low relative abundance of Bifidobacterium (P ≤ 1.2 × 10-7), which was better explained by diet than health status.ConclusionsWe demonstrated that global-diet a posteriori patterns were more associated with gut microbiome variations than individual dietary features among adults in the United States. These results confirm that evaluating diet as a whole is important when studying the gut microbiome. It will also facilitate the design of more personalized dietary strategies in general populations.

Background: Effectiveness of actions to reduce sugar-sweetened beverage (SB) consumption in children still needs to be improved. Furthermore, the growing concern about sustainable food systems encourages to develop sustainability-based interventions. The objective of this cluster randomised controlled trial is to evaluate the long-term effectiveness of nutrition- and environmental sustainability-based interventions on the reduction in SB intake and on the increase in tap water consumption in 3rd to 6th grade primary school children (8 to 11 years of age). Methods: Forty-eight French-speaking Belgian primary schools (equivalent to around 3500 pupils involved in the evaluation) are randomised using a factorial plan: (i) control, (ii) nutrition-based intervention, (iii) sustainability-based intervention, and (iv) both. The interventions (encouragement of water breaks; provision of posters, leaflets, reusable cups, and glass bottles; website; meetings at school) were undertaken from February 2022 to June 2023. Evaluation includes questionnaires for the children and their parents on various determinants of dietary behaviour, a 4-day diary to collect information on the child's beverage consumption, and audits at schools. The first evaluation was conducted in Spring 2021 before any intervention, with the two post-intervention evaluations being held in 2022 and 2023. The main quantitative judgement criterion will be the change over time in the mean SB consumption (in ml/day) in the intervention groups compared with the control group. Given the context of the research (school), the safety of the intervention, and the content of data collection, a consent was acknowledged as unnecessary by the Ethical Committee of the Faculty of Psychology (ULB; n°073/2021), but children and parents are explicitly informed of their right to refuse to fill in the questionnaires. Discussion: Multicomponent interventions based on nutrition and on environmental sustainability, alone or mixed, will provide an original and topical insight into health promotion at school around dietary behaviours. The dissemination plan will enable to widely inform stakeholders, school staff, and families, in addition to the scientific community through the usual medium (articles, conferences), about the research findings in 2024–2025. Trial registration: ISRCTN Registry ISRCTN99843102. Retrospectively registered on 25 May 2021 [ABSTRACT FROM AUTHOR]

Reliable information on dietary trends is essential. We compared individual-level dietary estimates for total energy, carbohydrate, fat, and protein intake over time with national supply data from the Global Expanded Nutrient Supply Model (186 paired estimates from 1961 to 2011, 18 countries). We hypothesized that supply data would overestimate individual measures and that the two measures would be weakly correlated. Individual- and supply-level estimates were compared using Spearman correlation coefficients and linear mixed-effect models were used to estimate the differences between measures. Overall, the correlations between individual- and supply-level measures were moderate for energy (r s = 0.34) and carbohydrate (r s = 0.39), strong for fat (r s = 0.85), and protein (r s = 0.69). Trends in total energy measured by individual-level surveys and total energy supply were positively correlated in 38.9% of countries, whereas trends in macronutrients aligned between estimates in most countries. Supply-level dietary data overestimated individual-level intakes, especially in higher income countries in Europe and in the United States. In the United States, supply-level data exceeded individual-level estimates by 26.3% to 29.9% for energy, carbohydrate, and fat, whereas protein estimates were similar between measures. In Europe, supply-level estimates overestimated individual-level intake by 19.9% for energy, 17.0% for carbohydrate, 13.7% for fat, and 7.7% for protein, whereas estimates for energy and macronutrients were similar in Asia. In Asia and lower income countries, our findings generally support the use of supply-level data in the absence of individual-level data, though this finding may be related to smaller sample size and differences in underlying national statistics that inform supply data. This article compares individual-level diet measures of energy, carbohydrate, fat, and protein to national supply-level data in 18 countries. Time trends in macronutrient intake and, to a lesser degree, total energy, align between individual and supply data. Supply data overestimated individual intakes, especially in the United States and higher income countries. Supply data may be an appropriate alternative in Asia and in lower income settings that lack individual data. Abbreviation: 95% CI, 95% confidence interval. [Display omitted] [ABSTRACT FROM AUTHOR]

BackgroundDiet has a major influence on the human gut microbiota, which has been linked to health and disease. However, epidemiological studies on associations of a healthy diet with the microbiota utilizing a whole-diet approach are still scant.ObjectivesTo assess associations between healthy food choices and human gut microbiota composition, and to determine the strength of association with functional potential.MethodsThis population-based study sample consisted of 4930 participants (ages 25-74; 53% women) in the FINRISK 2002 study. Intakes of recommended foods were assessed using a food propensity questionnaire, and responses were transformed into healthy food choices (HFC) scores. Microbial diversity (alpha diversity) and compositional differences (beta diversity) and their associations with the HFC score and its components were assessed using linear regression. Multiple permutational multivariate ANOVAs were run from whole-metagenome shallow shotgun-sequenced samples. Associations between specific taxa and HFC were analyzed using linear regression. Functional associations were derived from Kyoto Encyclopedia of Genes and Genomes orthologies with linear regression models.ResultsBoth microbial alpha diversity (β/SD, 0.044; SE, 6.18 × 10-5; P = 2.21 × 10-3) and beta diversity (R2, 0.12; P ≤ 1.00 × 10-3) were associated with the HFC score. For alpha diversity, the strongest associations were observed for fiber-rich breads, poultry, fruits, and low-fat cheeses (all positive). For beta diversity, the most prominent associations were observed for vegetables, followed by berries and fruits. Genera with fiber-degrading and SCFA-producing capacities were positively associated with the HFC score. The HFC score was associated positively with functions such as SCFA metabolism and synthesis, and inversely with functions such as fatty acid biosynthesis and the sulfur relay system.ConclusionsOur results from a large, population-based survey confirm and extend findings of other, smaller-scale studies that plant- and fiber-rich dietary choices are associated with a more diverse and compositionally distinct microbiota, and with a greater potential to produce SCFAs.

BackgroundPancreatic cancer risk is increasing in countries with high consumption of Western dietary patterns and rising obesity rates. We examined the hypothesis that specific dietary patterns reflecting hyperinsulinemia (empirical dietary index for hyperinsulinemia; EDIH), systemic inflammation (empirical dietary inflammatory pattern; EDIP), and postprandial glycemia [glycemic index (GI); glycemic load (GL)] are associated with pancreatic cancer risk, including the potential modifying role of type 2 diabetes (T2D) and body mass index (BMI).MethodsWe calculated dietary scores from baseline (1993-1998) food frequency questionnaires among 129,241 women, 50-79 years-old in the Women's Health Initiative. We used multivariable-adjusted Cox regression to estimate HRs and 95% confidence intervals (95% CI) for pancreatic cancer risk.ResultsDuring a median 19.9 years of follow-up, 850 pancreatic cancer cases were diagnosed. We observed no association between dietary scores and pancreatic cancer risk overall. However, risk was elevated among participants with longstanding T2D (present >3 years before pancreatic cancer diagnosis) for EDIH. For each 1 SD increment in dietary score, the HRs (95% CIs) were: EDIH, 1.33 (1.06-1.66); EDIP, 1.26 (0.98-1.63); GI, 1.26 (0.96-1.67); and GL, 1.23 (0.96-1.57); although interactions were not significant (all P interaction >0.05). Separately, we observed inverse associations between GI [0.86 (0.76-0.96), P interaction = 0.0068] and GL [0.83 (0.73-0.93), P interaction = 0.0075], with pancreatic cancer risk among normal-weight women.ConclusionsWe observed no overall association between the dietary patterns evaluated and pancreatic cancer risk, although women with T2D appeared to have greater cancer risk.ImpactThe elevated risk for hyperinsulinemic diets among women with longstanding T2D and the inverse association among normal-weight women warrant further examination.

Breastfeeding is the gold standard for feeding infants because of its long-term benefits to health and development, but most infants in the United States are not exclusively breastfed in the first six months. We enrolled 24 infants who were either exclusively breastfed or supplemented with formula by the age of one month. We collected diet information, stool samples for evaluation of microbiotas by 16S rRNA sequencing, and blood samples for assessment of immune development by flow cytometry from birth to 6 months of age. We further typed the Bifidobacterium strains in stool samples whose 16S rRNA sequencing showed the presence of Bifidobacteriaceae. Supplementation with formula during breastfeeding transiently changed the composition of the gut microbiome, but the impact dissipated by six months of age. For example, Bifidobacterium longum, a bacterial species highly correlated with human milk consumption, was found to be significantly different only at 1 month of age but not at later time points. No immunologic differences were found to be associated with supplementation, including the development of T-cell subsets, B cells, or monocytes. These data suggest that early formula supplementation, given in addition to breast milk, has minimal lasting impact on the gut microbiome or immunity.

Determining the proportion of a population at risk of inadequate or excessive nutrient intake is a crucial step in planning and managing nutrition intervention programs. Multiple days of 24-h dietary intake data per subject allow for adjustment of modeled usual nutrient intake distributions for the proportion of total variance in intake attributable to within-individual variation (WIV:total). When only single-day dietary data are available, an external adjustment factor can be used; however, WIV:total may vary by population, and use of incorrect WIV:total ratios may influence the accuracy of prevalence estimates and subsequent program impacts. WIV:total values were compiled from publications and from reanalyses of existing datasets to describe variation in WIV:total across populations and settings. The potential impact of variation in external WIV:total on estimates of prevalence of inadequacy was assessed through simulation analyses using the National Cancer Institute 1-d method. WIV:total values were extracted from 40 publications from 24 countries, and additional values were calculated from 15 datasets from 12 nations. Wide variation in WIV:total (from 0.02 to 1.00) was observed in publications and reanalyses. Few patterns by population characteristics were apparent, but WIV:total varied by age in children (< vs. >1 y) and between rural and urban settings. Simulation analyses indicated that estimates of the prevalence of inadequate intake are sensitive to the selected ratio in some cases. Selection of an external WIV:total estimate should consider comparability between the reference and primary studies with regard to population characteristics, study design, and statistical methods. Given wide variation in observed ratios with few discernible patterns, the collection of ≥2 days of intake data in at least a representative subsample in population dietary studies is strongly encouraged. In the case of single-day dietary studies, sensitivity analyses are recommended to determine the robustness of prevalence estimates to changes in the variance ratio.

Objective To investigate the association between dietary pattern and hyperuricemia (HUA) in middle-aged and elderly residents. Methods From January 2009 to December 2012, the stratified sampling method was used to select 3 349 middle-aged and elderly residents aged 45-74 years in Qingdao, China, and a questionnaire survey (demographic information, personal medical history, behavioral habits, and food intake), physical examination, and biochemical tests were performed for all residents. The factor analysis was used to identify dietary pattern, the non-conditional logistic regression analysis was used to investigate the association between dietary pattern and HUA, and the restricted cubic spline model was used to analyze the dose-response relationship between dietary pattern factor scores and HUA. Results The factor analysis obtained three dietary patterns, i.e., Offal-Poultry-Aquatic pattern, Fruits and Vegetables-Grain-Beans pattern, and Eggs-Meat-Dairy pattern. The non-conditional Logistic regression analysis showed that after adjustment for the confounding factors including age, sex, body mass index, drinking, exercise, hypertension, and dyslipidemia; the highest tertile of the Offal-Poultry-Aquatic pattern was positively associated with the risk of HUA (OR=1.32,95%CI=1.02-1.70), and the highest tertile of the Fruits and Vegetables-Grain-Beans pattern was ne-gatively associated with the risk of HUA (OR=0.74,95%CI=0.58-0.95), while the Eggs-Meat-Dairy pattern was not significantly associated with the risk of HUA. The restricted cubic spline model showed a linear dose-response relationship between Offal-Poultry-Aquatic pattern/Eggs-Meat-Dairy pattern and the prevalence rate of HUA and a non-linear dose-response relationship between Fruits and Vegetables-Grain-Beans pattern and the prevalence rate of HUA. The lowest risk of HUA was observed when the Fruits and Vegetables-Grain-Beans pattern had a score of 0.833 (OR=0.72,95%CI=0.56-0.92). Conclusion The Offal-Poultry-Aquatic pattern is positively associated with the risk of HUA in middle-aged and elderly residents, while the Fruits and Vegetables-Grain-Beans pattern is negatively associated with the risk of HUA. The middle-aged and elderly residents, especially those with HUA, should have a reasonable and balanced diet.

Dietary behavior change is difficult to accurately measure in a low-income youth population. Objective tools to measure fruit and vegetable consumption without relying on self-report present the opportunity to do this with less respondent burden and bias. A promising tool for quantifying fruit and vegetable consumption via proxy is skin carotenoids as measured by reflection spectroscopy through a device called the Veggie Meter®. To assess whether the Veggie Meter® is able to detect changes in skin carotenoids as a proxy for fruit and vegetable consumption in a low-income school setting, skin carotenoid measurements were collected at three time points, along with student level demographics, anthropometric measurements, and nutrition knowledge. A secondary goal of this study was to refine the protocol to be used based on researcher observations. Repeated measures analysis of variance with Bonferroni correction for multiple comparisons indicate that there was a significant difference in VM scores over the course of the study (F(2, 68) = 6.63, p = 0.002), with an increase in skin carotenoids from Fall 2018 to Spring 2019 (p = 0.005). This increase was sustained over the summer months when measured in Fall 2019. Changes to the protocol included the addition of a hand cleaning step and using the non-dominant ring finger for data collection. With these refinements, the results demonstrate that the Veggie Meter® is usable as a non-invasive tool for measuring fruit and vegetable consumption in a population that is traditionally difficult to assess.

Children eat more fruits and vegetables when more are available at home, but less is known about how the neighborhood food environment relates to children's diet and weight outcomes. The goal of this study was to determine whether parental perception of the food environment (neighborhood and home) is associated with children's fruit and vegetable (F&V) intake and weight outcomes, and to assess differences by household food security status and household income. Cross-sectional data from the 2013-2015 U.S. Healthy Communities Study included 5138 children, aged 4 to 15 years old, from 130 U.S. communities. Neighborhood and home food environments were assessed with parent-reported, perceived F&V availability scores. Associations were tested with multi-level linear regression models. Parents' perception of produce availability was associated with household F&V availability ratings (β = 0.09 points, p < 0.001). Household F&V availability was associated with child F&V intake (β = 0.32 cups/day or 25.6 g/day, p < 0.001). A higher child F&V intake was associated with a lower child BMI z-score (β = -0.05, p = 0.002). Weaker relationships were seen for children living in food insecure or low-income households. Optimizing neighborhood and home access to F&V may help children improve diet quality, but may not be as effective for children living in food insecure or low-income households.

BackgroundHealth-related warning labels may reduce the intake of sugar-sweetened beverages (SSBs), but the effectiveness of such labels in real-world settings is not well established.ObjectivesWe investigated the influence of warning labels on SSB intake among college students at a large public Midwestern university.MethodsWe conducted a quasi-experimental intervention study among 840 undergraduate students recruited from 3 dining halls on 1 university campus. One dining hall was selected as the intervention (I) site, whereas the other dining halls served as control (C) sites. In January 2019, warning labels were posted on SSB dispensers at the I site. All students reported their beverage intake using a modified beverage frequency questionnaire 2 mo before and 2 mo after the warning label implementation. Generalized linear models examined the influence of the warning labels on SSB consumption at the I site compared with the C sites, adjusting for students' sociodemographic characteristics.ResultsIn the sample, 68% were aged 17-18 y old at baseline, and 51% identified as female. From baseline to follow-up, there was a 19% decrease in SSB intake at the I site, compared with a 5% decrease at the C sites (P = 0.049 comparing I with C). This difference was driven by significant decreases in the intakes of fruit-flavored drinks, sweetened teas, and flavored milk at the I site compared with the C sites. Although not an SSB, 100% fruit juce consumption decreased 21% at the I site, compared with a 1% increase at the C sites (P = 0.01 comparing I with C). No significant differences were observed in the intakes of soda, energy drinks, sweetened coffees, and nonsugary drinks at the I site compared with the C sites.ConclusionsWarning labels were effective in reducing SSB intake among college students, particularly for fruit-flavored drinks, sweetened teas, and flavored milk.This trial was registered at clinicaltrials.gov as NCT04435145.

Abstract: Evidence points to a direct relationship between nutritional quality and food expenditure. However, food expenditure is highly susceptible to changes, and nutritional quality of household food presents limited evidence. The aim of this study was to assess the relationship between nutritional quality available and total food expenditure in Peruvian households, and whether there were differences by area (urban and rural) and between years of the COVID-19 pandemic. For this, we used Peru’s National Household Survey (ENAHO) from 2019 and 2020. We assessed total food expenditure in US dollars per day, whereas household nutritional quality available was assessed based on dietary diversity and compliance with the household calorie requirements, percentage of food expenditure, and potential confounders. We used the Student’s t-test, analysis of variance (ANOVA), linear regression, and the Wald test to assess the interaction effect. Households with adequate total/partial nutritional quality available by area were found to spend, on average, USD 2.00 more in urban than in rural areas and, by year, they presented 7.1% more percentage of food expenditure in 2020 than in 2019. Despite associations existing between nutritional quality available and total food expenditure by year and study area, the effect modification was only present by study area. In multivariable model, households with adequate total/partial nutritional quality available consistently presented a lower total food expenditure by year, with a lower total food expenditure in urban areas. An inverse relationship was found between nutritional quality available and total food expenditure, in contrast to the direct relationship of studies assessing dietary cost and nutritional quality. Our results reflect the nutritional deficit in the food purchases of Peruvian households.

Polyphenol-rich foods have beneficial properties that may lower cardiometabolic risk. We aimed to prospectively investigate the relationship between intakes of dietary polyphenols, and metabolic syndrome (MetS) and its components, in 676 Danish residents from the MAX study, a subcohort of the Danish Diet, Cancer and Health–Next Generations (DCH-NG) cohort. Dietary data were collected using web-based 24-h dietary recalls over one year (at baseline, and at 6 and 12 months). The Phenol-Explorer database was used to estimate dietary polyphenol intake. Clinical variables were also collected at the same time point. Generalized linear mixed models were used to investigate relationships between polyphenol intake and MetS. Participants had a mean age of 43.9y, a mean total polyphenol intake of 1368 mg/day, and 75 (11.6%) had MetS at baseline. Compared to individuals with MetS in Q1 and after adjusting for age, sex, lifestyle and dietary confounders, those in Q4 – for total polyphenols, flavonoids and phenolic acids–had a 50% [OR (95% CI): 0.50 (0.27, 0.91)], 51% [0.49 (0.26, 0.91)] and 45% [0.55 (0.30, 1.00)] lower odds of MetS, respectively. Higher total polyphenols, flavonoids and phenolic acids intakes as continuous variable were associated with lower risk for elevated systolic blood pressure (SBP) and low high-density lipoprotein cholesterol (HDL-c) (p < 0.05). Total polyphenol, flavonoid and phenolic acid intakes were associated with lower odds of MetS. These intakes were also consistently and significantly associated with a lower risk for higher SBP and lower HDL-c concentrations. • Dietary polyphenols have been associated with improved health outcomes. • Limited evidence on dietary polyphenols and cardiometabolic risk factors are available. • Prospective observational analysis, including data collection by three timepoints over 1 year of follow up. • Flavonoid and phenolic acid were associated with systolic blood pressure and HDL-c. • Dietary polyphenol intake might be a key dietary factor on metabolic syndrome. [ABSTRACT FROM AUTHOR]

BackgroundHuman milk vitamin B12 (B12) concentrations depend on maternal status and intake; only few data are available in high-income countries.ObjectiveWe assessed human milk B12 concentrations during the first 6 months postpartum in Norwegian women and its association with maternal dietary B12 intake and maternal urinary methylmalonic acid (MMA) concentration.MethodsIn this cross-sectional study, 175 mothers, exclusively (80%) or partially (20%) breastfeeding, were included. Milk B12 was measured by IMMULITE®/IMMULITE® 1000 B12 competitive protein binding assay and urinary MMA relative to creatinine (MMA/Cr) by liquid chromatography-tandem-mass spectrometry. Maternal habitual B12 intake and supplement use were estimated using a food frequency questionnaire.ResultsMean human milk B12 concentration was 327 pmol/L (range 140-1089), with 402 pmol/L at 1 month (n = 21), 333 pmol/L at four months (n = 32), and 299 pmol/L at 6 months (n = 21). Maternal B12 intake was 5 µg/d, 89% met the Estimated Average Requirement, and supplement use did not affect milk B12 concentrations. MMA/Cr was low in all women compared with published data. In exclusively breastfeeding women, MMA/Cr (beta (95% CI) -42.5 (-82.5, -2.5) and time since birth (-4.9 (-9.6, -0.3)) were significant predictors of human milk B12 concentrations. There was no association between total B12 intake and milk B12 concentration or between total B12 intake and MMA/Cr.ConclusionsMaternal B12 status and human milk B12 concentrations are likely sufficient, based on adequate maternal B12 dietary intake combined with low urinary MMA concentrations. Nevertheless, milk B12 concentration fell during 6 months postpartum while maternal B12 status did not change.

Aims: In this study, we aimed to estimate cross-sectional associations of fish or shellfish consumption with diabetes and glycemia in three South Asian mega-cities. Methods: We analyzed baseline data from 2010-2011 of a cohort (n = 16,287) representing the population ≥20 years old that was neither pregnant nor on bedrest from Karachi (unweighted n = 4017), Delhi (unweighted n = 5364), and Chennai (unweighted n = 6906). Diabetes was defined as self-reported physician-diagnosed diabetes, fasting plasma glucose ≥126 mg/dL (7.0 mmol/L), or glycated hemoglobin A1c (HbA1c) ≥6.5% (48 mmol/mol). We estimated adjusted and unadjusted odds ratios for diabetes using survey estimation logistic regression for each city, and differences in glucose and HbA1c using survey estimation linear regression for each city. Adjusted models controlled for age, gender, body mass index, waist-height ratio, sedentary lifestyle, educational attainment, tobacco use, an unhealthy diet index score, income, self-reported physician diagnosis of high blood pressure, and self-reported physician diagnosis of high cholesterol. Results: The prevalence of diabetes was 26.7% (95% confidence interval: 24.8, 28.6) in Chennai, 36.7% (32.9, 40.5) in Delhi, and 24.3% (22.0, 26.6) in Karachi. Fish and shellfish were consumed more frequently in Chennai than in the other two cities. In Chennai, the adjusted odds ratio for diabetes, comparing more than weekly vs. less than weekly fish consumption, was 0.81 (0.61, 1.08); in Delhi, it was 1.18 (0.87, 1.58), and, in Karachi, it was 1.30 (0.94, 1.80). In Chennai, the adjusted odds ratio of prevalent diabetes among persons consuming shellfish more than weekly versus less than weekly was 1.08 (95% CI: 0.90, 1.30); in Delhi, it was 1.35 (0.90, 2.01), and, in Karachi, it was 1.68 (0.98, 2.86). Conclusions: Both the direction and the magnitude of association between seafood consumption and glycemia may vary by city. Further investigation into specific locally consumed seafoods and their prospective associations with incident diabetes and related pathophysiology are warranted.

We investigated the associations between maternal dietary patterns during pregnancy and early childhood growth trajectories and overweight/obesity risk in offspring. Maternal diet was assessed using a food frequency questionnaire during the second trimester, and dietary patterns were derived by reduced rank regression. The associations between maternal dietary pattern scores and body mass index (BMI) trajectories from birth to age four (rising-high, moderate, and low BMI trajectories) as well as overweight/obesity risk at age four were analyzed (n = 1257). Two maternal dietary patterns were identified. The fast food pattern included a higher intake of fried chicken and fish, fruit juices, mayonnaise, and sugar-sweetened beverages, while the processed food pattern included a higher intake of dairy, salad dressing, processed meat, and cold breakfast cereal. Women with greater adherence to the fast food pattern were more likely to have children in the rising-high BMI trajectory group [OR (95% CI) = 1.32 (1.07-1.62); p = 0.008] or having overweight/obesity at age four [OR (95% CI) = 1.31 (1.11-1.54); p = 0.001]. The processed food pattern was not associated with these outcomes. The maternal dietary pattern during pregnancy represented by fried foods and sugar-sweetened beverages may contribute to rapid early childhood growth and increased risk for obesity in offspring.

: The gut microbiome is a key factor in chronic liver disease progression. In prior research, we found that the duodenal microbiome was associated with sex, ethnicity, and cirrhosis complications. Here, we examined the association between diet and the duodenal microbiome in patients with liver cirrhosis. This study included 51 participants who completed a detailed food frequency questionnaire and donated duodenal biopsies for microbiome characterization by 16S ribosomal RNA gene sequencing. Data were analyzed for alpha diversity, beta diversity, and association of taxa abundance with diet quality and components using QIIME 2 pipelines. Diet quality was assessed through calculation of the Healthy Eating Index 2010. Participants with higher adherence to protein recommendations exhibited increased microbial richness and evenness (p = 0.03) and a different microbial profile compared to those with lower adherence (p = 0.03). Prevotella-9 and Agathobacter were increased in association with increased protein adherence. Fiber consumption was also associated with the duodenal microbial profile (p = 0.01), with several taxa exhibiting significantly decreased or increased abundance in association with fiber intake. Coffee drinking was associated with microbial richness and evenness (p = 0.001), and there was a dose-response association between coffee drinking and relative abundance of Veillonella (p = 0.01). We conclude that protein, fiber, and coffee are associated with diversity and composition of the duodenal microbiome in liver cirrhosis.

The role of dietary habits as risk factor for the development of diverticular complications has strongly emerged in the last years. We aimed to evaluate possible differences in dietary habits between patients with diverticular disease (DD) and matched controls without diverticula. Dietary habits were obtained from standardized food frequency questionnaires collected at entry to the Diverticular Disease Registry (REMAD). We compared controls (C) (n = 119) with asymptomatic diverticulosis (D) (n = 344), symptomatic uncomplicated diverticular disease (SUDD) (n = 154) and previous diverticulitis (PD) (n = 83) patients, in terms of daily calories, macro and micronutrients and dietary vitamins. Daily kcal intake and lipids, both saturated and unsaturated, were significantly lower in patients with DD than C. Total protein consumption was lower in PD than D, with differing consumption of unprocessed red meat, white meat and eggs between groups. Consumption of fibre, both soluble and insoluble, was lower in patients with PD compared to patients with SUDD, D and C, whereas dietary vitamins A, C, D and E and Oxygen Radical Adsorbance Capacity index were lower in all DD groups compared to C. This observational study showed that DD patients have different dietary habits, mainly in terms of caloric, fat, fibre and vitamin intake, compared to control subjects. [ABSTRACT FROM AUTHOR]

Lactase persistence (LP) is a trait in which lactose can be digested throughout adulthood, while lactase non-persistence (LNP) can cause lactose intolerance and influence dairy consumption. One single nucleotide polymorphism (SNP ID: rs4988235) is often used as a predictor for dairy intake, since it is responsible for LP in people in European descent, and can occur in other ethnic groups. The objective of this study was to determine whether rs4988235 genotypes and ethnicity influence reported dairy consumption in the United States (U.S.). A food frequency questionnaire (FFQ) and multiple Automated Self-Administered 24-h recalls (ASA24®) were used to measure habitual and recent intake, respectively, of total dairy, cheese, cow's milk, plant-based alternative milk, and yogurt in a multi-ethnic U.S. cohort genotyped for rs4988235. Within Caucasian subjects, LP individuals reported consuming more recent total dairy and habitual total cow's milk intake. For subjects of all ethnicities, LP individuals consumed more cheese (FFQ p = 0.043, ASA24 p = 0.012) and recent total dairy (ASA24 p = 0.005). For both dietary assessments, Caucasians consumed more cheese than all non-Caucasians (FFQ p = 0.036, ASA24 p = 0.002) independent of genotype, as well as more recent intake of yogurt (ASA24 p = 0.042). LP subjects consumed more total cow's milk than LNP, but only when accounting for whether subjects were Caucasian or not (FFQ p = 0.015). Fluid milk and alternative plant-based milk consumption were not associated with genotypes or ethnicity. Our results show that both LP genotype and ethnicity influence the intake of some dairy products in a multi-ethnic U.S. cohort, but the ability of rs4988235 genotypes to predict intake may depend on ethnic background, the specific dairy product, and whether intake is reported on a habitual or recent basis. Therefore, ethnicity and the dietary assessment method should also be considered when determining the suitability of rs4988235 as a proxy for dairy intake.

Garlic consumption has been associated inversely with esophageal cancer (EC); however, its interactions with tobacco smoking and alcohol consumption have never been evaluated in an epidemiological study. We evaluated the potential interactions between garlic intake and tobacco smoking as well as alcohol consumption in a population-based case-control study with 2969 incident EC cases and 8019 healthy controls. Epidemiologic data were collected by face-to-face interviews using a questionnaire. The adjusted odds ratio (OR) and 95% confidence interval (CI) were estimated and additive and multiplicative interactions were evaluated using unconditional logistic regression models, adjusting for potential confounding factors. Semi-Bayes (SB) adjustments were used to reduce potential false-positive findings. EC was associated inversely with raw garlic intake [SB-adjusted OR for more than once a week=0.68, 95% CI: 0.57-0.80], with a strong dose-response pattern in the overall analysis and in the stratified analyses by smoking and drinking. EC was associated positively with smoking and alcohol drinking, with SB-adjusted OR of 1.73 (95% CI: 1.62-1.85) and 1.37 (95% CI: 1.28-1.46) in dose-response effects of increased intensity and longer duration of smoking/drinking. Moreover, garlic intake interacts with smoking [synergy index (S)=0.83, 95% CI: 0.67-1.02; ratio of OR=0.88, 95% CI: 0.80-0.98] and alcohol drinking (S=0.73, 95% CI: 0.57-0.93; ratio of OR=0.86, 95% CI: 0.77-0.95) both multiplicatively and additively. Our findings suggested that high intake of raw garlic may reduce EC risk and may interact with tobacco smoking and alcohol consumption, which might shed a light on the development of EC as well as a potential dietary intervention among high-risk smokers and drinkers for EC prevention in the Chinese population.

ObjectiveThis study determined how people who live in low-income households can consume an affordable, nutritious diet.DesignA community-based participatory research (CBPR) project was completed that developed and priced 2 weeks of healthy menus that met US Department of Agriculture Dietary Guidelines for Americans. Prices were collected from a market basket survey of 13 stores in the city of Chico during October, 2010. Initial menu development began in 2011-2012. Menus were reviewed in 2017 and reflect current guidelines.SettingChico, CA.Main outcome measuresMacro dietary objectives including the caloric content and servings of fat, sugar, whole grains, and fruits and vegetables. The cost of purchasing the market basket of goods for a family of 4 that achieved those objectives was determined.ResultsThe 2 weeks of menus all met dietary objectives on average. The daily cost varied from $19 to $31 when food was purchased from a bulk supermarket, with an average daily cost of $25. Average monthly cost was $756 in 2010 dollars, or $838 in 2015 dollars.Conclusions and implicationsPeople living in low-income households can afford to eat healthily. Using CBPR principles, daily targets, and technical support, public health partners can partner with community members for member-defined solutions that are affordable and meet dietary guidelines. Access to stores that sell low-price bulk items is important to being able to afford a healthy diet.

Promoting a more balanced animal/plant dietary protein ratio by changing portion sizes or introducing new foods is a promising means to improve diet quality, but little is known about the willingness of individuals to adopt such changes. Our objective was to assess the willingness to adopt dietary changes by these means. In a French cross-sectional study in 2018 (n = 2055), we analyzed the association between the willingness to eat smaller or larger portions or to introduce non-consumed protein foods and the current dietary patterns of individuals and their socio-demographic characteristics. These modifications had previously been identified as improving the nutrient adequacy of diets. Participants were more willing to eat smaller portion sizes than to introduce new foods and to eat larger portion sizes. The willingness for any modification varied depending on the food groups concerned. Participants were also more willing to eat larger portions and less willing to eat smaller portions when they were the most frequent consumers of the foods concerned. Participants were more willing to eat a new food if it was consumed in large quantities by individuals with a similar dietary pattern. This study underlines the importance of accounting for individual food habits when issuing nutritional recommendations.

Abstract Objective: To evaluate the prevalence of ultra-processed food consumption and associated factors among children enrolled in the public school system of the city of Barbacena, Minas Gerais, Brazil. Methods: This is a cross-sectional study conducted with schoolchildren aged 7–9 years, of both sexes, enrolled in state public schools. Food intake was assessed using the Previous Day Food Questionnaire and the level of physical activity by the Previous Day Physical Activity Questionnaire. The listed foods were classified according to the extent and purpose of industrial processing, using the NOVA classification. Pearson’s χ2 test, Fisher’s exact test, χ2 with Yates correction, and Poisson regression were used in the statistical analysis, estimating the crude and adjusted prevalence ratio, with 95% confidence intervals. Results: The prevalence of daily ultra-processed food consumption was 69.6%. After adjusted analyses, the consumption of ultra-processed food was associated with the omission of breakfast, mid-afternoon snack, supper, low physical activity, and consumption of risk foods. On the other hand, consumption of in natura or minimally processed foods was associated with older age, the consumption of lunch, mid-afternoon snack, dinner, and protective foods. Conclusions: There is a high prevalence of ultra-processed foods consumption, associated with unhealthy dietary habits among schoolchildren. This highlights the need for nutritional counseling and educational actions, favoring healthy eating in childhood.

The Food Frequency Questionnaire (FFQ) is often used to assess dietary intake in large-scale epidemiological studies. This study aimed to evaluate the reproducibility and validity of the FFQ newly developed for children aged 6 to 12 in western China. A total of 133 children were included in the analysis, and all the children and their caregivers completed the FFQs twice with a three-month interval period, and three 24 h recalls were carried out one month after the first FFQ. We assessed the relative validity and reproducibility using various methods, such as the Spearman correlation coefficient, intra-class correlation coefficient, weighed Kappa, quartile agreement, and Bland–Altman analysis. The Spearman correlation coefficients for food ranged from 0.30 to 0.84, and for nutrients from 0.46 to 0.82 regarding reproducibility. The food intra-class correlation coefficients ranged from 0.20 to 0.85, while nutrients' ranged from 0.37 to 0.75. In terms of relative validity, the average Spearman correlation coefficients for food were 0.20, and 0.30 for energy and nutrients. The energy-adjusted and de-attenuation coefficients were calculated. Moreover, the average percentage of participants misclassified into the extreme quartile for food and nutrients was 8.0% and 7.0%, respectively. Weighted Kappa values indicated acceptable agreement between the FFQs and 24 h recalls. Furthermore, the percentage of results in the limits of agreement (LOA) were all above 93.0%. In conclusion, The FFQ showed good reproducibility and acceptable relative validity for assessing the dietary intake of children aged 6–12 in western China. [ABSTRACT FROM AUTHOR]

BackgroundRecent studies, primarily in non-Hispanic whites, suggest that dietary patterns have distinct metabolomic signatures that may influence disease risk. However, evidence in South Asians, a group with unique dietary patterns and a high prevalence of cardiometabolic risk, is lacking.ObjectiveWe investigated the metabolomic profiles associated with 2 distinct dietary patterns among a sample of Asian Indians living in the United States. We also examined the cross-sectional associations between metabolomic profiles and cardiometabolic risk markers.MethodsWe used cross-sectional data from 145 Asian Indians, aged 45-79 y, in the Metabolic Syndrome and Atherosclerosis in South Asians Living in America (MASALA) pilot study. Metabolomic profiles were measured from fasting serum samples. Usual diet was assessed by using a validated food-frequency questionnaire. We used principal components analysis to derive dietary and metabolomic patterns. We used adjusted general linear regression models to examine associations between dietary patterns, individual food groups, metabolite patterns, and cardiometabolic risk markers.ResultsWe observed 2 major principal components or metabolite clusters, the first comprised primarily of medium- to long-chain acylcarnitines (metabolite pattern 1) and the second characterized by branched-chain amino acids, aromatic amino acids, and short-chain acylcarnitines (metabolite pattern 2). A "Western/nonvegetarian" pattern was significantly and positively associated with metabolite pattern 2 (all participants: β ± SE = 0.180 ± 0.090, P = 0.05; participants without type 2 diabetes: β ± SE = 0.323 ± 0.090, P = 0.0005). In all participants, higher scores on metabolite pattern 2 were adversely associated with measures of glycemia (fasting insulin: β ± SE = 2.91 ± 1.29, P = 0.03; 2-h insulin: β ± SE = 22.1 ± 10.3, P = 0.03; homeostasis model assessment of insulin resistance: β ± SE = 0.94 ± 0.42, P = 0.03), total adiponectin (β ± SE = -1.46 ± 0.47, P = 0.002), lipids (total cholesterol: β ± SE = 7.51 ± 3.45, P = 0.03; triglycerides: β ± SE = 14.4 ± 6.67, P = 0.03), and a radiographic measure of hepatic fat (liver-to-spleen attenuation ratio: β ± SE = -0.83 ± 0.42, P = 0.05).ConclusionsOur findings suggest that a "Western/nonvegetarian" dietary pattern is associated with a metabolomic profile that is related to an adverse cardiometabolic profile in Asian Indians. Public health efforts to reduce cardiometabolic disease burden in this high-risk group should focus on consuming a healthy plant-based diet.

Studying dietary patterns is often more informative than individual nutrients or foods. We found that a Prudent dietary pattern (rich in vegetables and fish) was associated with reduced loss of total hip BMD in older men. A Prudent dietary pattern may be a potential lifestyle strategy for minimizing bone loss. INTRODUCTION:This study aimed to identify baseline dietary patterns using factor analysis in a cohort of older men and to evaluate whether the dietary patterns were associated with bone mineral density change (%ΔBMD) at the total hip and femoral neck over time. METHODS:Participants (n = 4379; mean age 72.9 ± 5.5 years) were from the Osteoporotic Fractures in Men (MrOS) prospective cohort study and had dietary data collected at baseline (March 2000-April 2002) and BMD measured at baseline and Visit 2 (March 2005-May 2006). Dietary intake was assessed with a brief Block food frequency questionnaire (FFQ); factor analysis was used to derive dietary patterns. BMD was measured by dual-energy x-ray absorptiometry (DXA); %ΔBMD was calculated from baseline to Visit 2. We used generalized linear regression to estimate least square (LS) means of %ΔBMD in quartiles of the dietary pattern scores adjusted for potential confounding factors. RESULTS:Two major dietary patterns were derived: Prudent (abundant in vegetables, salad, and non-fried fish) and Western (rich in hamburger, fries, processed meats, cheese, and sweets/desserts). There was an inverse association between adherence to the Prudent pattern and total hip %ΔBMD (p-trend = 0.028 after adjusting for age and clinical site; p-trend = 0.033 after further adjustment for smoking, calcium supplement use, diabetes, hypertension, and total energy intake). No other consistent associations between dietary patterns and %ΔBMD were observed. CONCLUSIONS:Greater adherence to a Prudent dietary pattern may attenuate total hip BMD loss (%ΔBMD) in older men.

Non-communicable diseases are growing at an alarming rate in Latin America. We assessed total and added sugar intake in Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela, to verify the adequacy of the World Health Organization's recommendations, considering gender, socioeconomic level (SEL) and age. A total of 9218 non-institutionalized individuals living in urban areas (age range 15-65 years) were assessed in the Latin American Study of Nutrition and Health (ELANS), a multicenter household population-based cross-sectional survey. Socio-demographic data were collected. Total and added sugar intakes were measured using two non-consecutive 24-h dietary recalls. The prevalence of excessive sugar intake was estimated. A large proportion of individuals showed high consumption of total and added sugar intake, which reflected in the high prevalence of excessive sugar intake. With minimal differences across countries, in general, women, individuals with high SEL, and younger people had higher percentages of total energy intake from total and added sugar intake, and of contribution of carbohydrates from total and added sugars. Thus, there is high consumption of total and added sugar intake in the Latin American countries with some peculiarities considering socio-demographic variables, which should be considered in each country's health intervention proposals.

BACKGROUND: Nationally, child care providers serve nutritious food to over 4.5 million children each day as part of the federal Child and Adult Care Food Program (CACFP). As implementation of the first major revisions to the CACFP standards occurs in 2017, understanding how to support compliance is critical. METHODS: In 2016, surveys were sent to a randomly selected sample of 2400 licensed California child care centers and homes. Compliance with the new CACFP standards and best practices for infants under 1 year and children 1-5 years of age was assessed. Also, compliance was compared by CACFP participation, and between centers and homes. Interviews were conducted with 16 CACFP stakeholders to further understand barriers to and facilitators of compliance. RESULTS: Analysis of 680 survey responses revealed that compliance with most individual CACFP standards and best practices examined was high (>60% of sites). However, compliance with all new standards was low (

Background and Aims: Population-based studies suggest an inverse relationship between the dietary share of ultra-processed foods (UPF), as defined by NOVA classification, and the overall dietary nutritional quality. However, few studies have evaluated the impact of ultra-processed foods on the fatty acid profile of the diet. The aim of this study was to assess the association between consumption of UPF and the fatty acids profile of the diet in Portugal., Methods and Results: Cross-sectional data from IAN-AF 2015-2016 were used for this study. Food consumption data were collected through two 24-h food recalls, and food items were classified according to the NOVA system. For both adults and elderly, the contents of total fatty acids (TFA), saturated fatty acids (SFA) and trans fatty (TRFA) were higher in the fraction of UPF, compared to the other three NOVA groups, while [monounsaturated fatty acids (MUFA)+, polyunsaturated fatty acids (PUFA)/SFA] ratio was lower. The UPF population attributable fraction (PAF) demonstrated that if the dietary contribution of UPF was reduced to levels observed in the first quintile, statistically significant reductions in the prevalence of inadequate intakes of fatty acids would be observed for adults [TRFA (PAF 98.37%, 95% CI 87.27-99.79) and SFA (PAF 37.26%, 95% CI 25.46-47.19)] and for elderly [TRFA (PAF 94.61%, 95% CI 77.59-98.71) and PUFA (PAF 98.28, 95% CI 48.22-99.94)]., Conclusions: In this study the consumption of UPF was associated with a worse fatty acids profile in the Portuguese diet, adding evidence regarding the negative impact of UPF on diet quality., Competing Interests: Conflicts of interest All authors declare that they do not have any conflict of financial interests or personal relationships that could cause bias in this work., (Copyright © 2024 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

Background: Various foods and nutrients are linked with higher or lower risk of rheumatoid arthritis (RA), yet these associations are inconsistent across studies. Limited research has been done evaluating the association between diet quality and RA in a larger-scale prospective study on postmenopausal women., Objective: The objective of this study was to evaluate the association between dietary quality and risk of incident RA in postmenopausal women., Design: This was a prospective cohort study as part of the Women's Health Initiative (WHI), with an average follow-up time of 8.1 years. Baseline diet was measured using a food frequency questionnaire (FFQ). Diet quality was evaluated by the Healthy Eating Index (HEI)-2015 total score. In addition, intake of food groups and nutrients that align with HEI-2015 components was assessed., Participants/setting: Postmenopausal women (N = 109 591) were included in this study, which was conducted at various clinical centers across the United States with recruitment from 1993 to 1998. Women's Health Initiative participants who were missing outcome data, had unreliable/missing FFQ data, or had RA at baseline were excluded., Main Outcome Measures: The primary outcome measure was incident RA. Statistical analyses performed Multivariable Cox proportional regression analysis was performed evaluating the association of diet quality with self-reported physician-diagnosed RA after adjusting for age, race, ethnicity, education status, income, and body mass index (BMI)., Results: During 857 517 person-years of follow-up, 5823 incident RA cases were identified. After adjustment for multiple comparisons, compared with quartile 1, quartiles 2, 3, and 4 of the HEI-2015 total scores were associated with lower RA risks of 1%, 10%, and 19%, respectively (P-trend < .001). Greater consumption of total fruits (P-trend = .014), whole fruits (P-trend < .0002), total vegetables (P-trend = .008), greens and beans (P-trend < .0002), whole grains (P-trend = .008), and dairy (P-trend = .018) were significantly associated with lower rates of incident RA. Conversely, higher consumption of saturated fat (P-trend = .002) was significantly associated with higher rates of incident RA., Conclusion: A higher-quality diet reflected by higher HEI-2015 total scores was inversely associated with incident RA in postmenopausal women., (Copyright © 2024 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background/objectives: The Planetary Health Diet Index (PHDI) was recently introduced to assess adherence to the EAT-Lance recommendations. In this study, we aimed to evaluate the relationship between PHDI and metabolic syndrome (MS)., Subjects/methods: We used the data of 6465 participants from the PERSIAN cohort study at Mashhad University of Medical Sciences, Mashhad, Iran. Diet was assessed using a 130-item Food Frequency Questionnaire (FFQ). The PHDI comprises sixteen components and is scored between 0 and 150 points. We first assessed the validity and reliability of the PHDI for this population. We used regression logistic models to assess the relationships between PHDI and MS and its related indicators., Results: The average PHDI score was 52.3 ± 9. The Cronbach's alpha value was 0.53. After controlling for age and sex, the PHDI was positively related to the Diet Quality Index-International (DQI-I) and was negatively related to carbon and water footprints (p < 0.001). PHDI quartile was negatively associated with MS, hypo-HDL cholesterolemia, and abdominal obesity after controlling for confounders (P < 0.05)., Conclusion: The validity and reliability of the PHDI were found to be satisfactory for the Iranian population we studied. Our results showed that a higher PHDI was potentially related to a reduced likelihood of MS, hypo-HDL cholesterolemia, and abdominal obesity., (© 2024. The Author(s).)

Objective: The objective of the study was to compare the potential dietary impact of proposed and final front-of-pack labelling (FOPL) regulations (published in Canada Gazette I (CG1) and Canada Gazette II (CG2) , respectively) by examining the difference in the prevalence of foods that would require a 'High in' front-of-pack nutrition symbol and nutrient intakes from those foods consumed by Canadian adults., Design: Foods in a generic food composition database ( n 3676) were categorised according to the details of FOPL regulations in CGI and CGII , and the differences in the proportion of foods were compared. Using nationally representative dietary survey data, potential intakes of nutrients from foods that would display a 'High in' nutrition symbol according to CGI and CGII were compared., Setting: Canada., Participants: Canadian adults (≥ 19 years; n 13 495)., Results: Compared with CGI , less foods would display a 'High in' nutrition symbol (Δ = -6 %) according to CGII (saturated fat = -4 %, sugars = -1 %, sodium = -3 %). Similarly, potential intakes of nutrients-of-concern from foods that would display a 'High in' nutrition symbol were reduced according to CGII compared with CGI (saturated fat = -21 %, sugars = -2 %, sodium = -6 %). Potential intakes from foods that would display a 'High in' nutrition symbol were also reduced for energy and nutrients-to-encourage, including protein, fibre, calcium and vitamin D., Conclusions: Changes to FOPL regulations may have blunted their potential to limit intakes of nutrients-of-concern; however, they likely averted potential unintended consequences on intakes of nutrients-to-encourage for Canadians (e.g. calcium and vitamin D). To ensure policy objectives are met, FOPL regulations must be monitored regularly and evaluated over time.

Background: Previous studies have suggested a significant association between diet quality and mental health. However, a limited number of studies have utilized the Prime Diet Quality Score (PDQS) to examine this association. Additionally, no study has yet compared the PDQS and Healthy Eating Index-2015 (HEI-2015) in terms of their association with depression and anxiety., Aim: This cross-sectional study aimed to investigate the association between diet quality, measured by the PDQS and HEI-2015, and the odds of depression and anxiety in adults., Methods: This study utilized data from the LIPOKAP study, which was conducted between February 2018 and July 2019 in five cities in Iran. We included 1994 adults aged 18 and above who were selected through a multistage cluster sampling method. Participants completed a validated semiquantitative food frequency questionnaire (FFQ) to evaluate their dietary intake. The FFQ was used to calculate the PDQS and HEI-2015. Depression and anxiety levels were determined using the Hospital Anxiety and Depression Scale (HADS)., Results: The participants had a mean age of 39.79 ± 13.87 years, with females accounting for 1,041 (52.2%) of the total population. PDQS showed a significant inverse association with the odds of depression (OR = 0.45, 95% CI: 0.28-0.71) and anxiety (OR = 0.40, 95% CI: 0.25-0.62) in the fully adjusted model. Similarly, the highest quartile of HEI-2015 showed a significantly lower odds of depression (OR = 0.60, 95% CI: 0.40-0.90) and anxiety (OR = 0.62, 95% CI: 0.42-0.92) compared to the lowest quartile., Conclusion: Both PDQS and HEI-2015 were associated with a reduced risk of depression and anxiety. However, the PDQS demonstrated a stronger inverse association with these risks compared to the HEI-2015. This suggests that the PDQS could be a more beneficial dietary pattern for preventing depression and anxiety compared to HEI-2015. Further large-scale studies are required to confirm these findings., (© 2024. The Author(s).)

Background: Intake24, a web-based 24-hour dietary recall tool developed in the United Kingdom, was adapted for use in New Zealand (Intake24-NZ) through the addition of a New Zealand food list, portion size images, and food composition database. Owing to the customizations made, a thorough evaluation of the tool's usability was required. Detailed qualitative usability studies are well suited to investigate any challenges encountered while completing a web-based 24-hour recall and provide meaningful data to inform enhancements to the tool., Objective: This study aims to evaluate the usability of Intake24-NZ and identify improvements to enhance both the user experience and the quality of dietary intake data collected., Methods: We used a mixed methods approach comprising two components: (1) completion of a single 24-hour dietary recall using Intake24-NZ with both screen observation recordings and collation of verbal participant feedback on their experience and (2) a survey., Results: A total of 37 participants aged ≥11 years self-completed the dietary recall and usability survey (men and boys: 14/37, 38% and women and girls: 23/37, 62%; Māori: 10/37, 27% and non-Māori: 27/37, 73%). Although most (31/37, 84%) reported that Intake24-NZ was easy to use and navigate, data from the recorded observations and usability survey revealed challenges related to the correct use of search terms, search results obtained (eg, type and order of foods displayed), portion size estimation, and associated food prompts (eg, did you add milk to your tea?)., Conclusions: This comprehensive usability study identified challenges experienced by users in completing a dietary recall in Intake24-NZ. The results informed a series of improvements to enhance user experience and the quality of dietary data collected with Intake24-NZ, including adding new foods to the food list, optimizing the search function and ordering of search results, creating new portion size images, and providing clearer instructions to the users., (©Berit Follong, Caitlin Haliburton, Sally Mackay, Maria Maiquez, Jacqueline Grey, Cliona Ni Mhurchu. Originally published in JMIR Formative Research (https://formative.jmir.org), 18.10.2024.)

Aims: Various dietary risk factors for type 2 diabetes have been identified. A short assessment of dietary patterns related to the risk for type 2 diabetes mellitus may be relevant in clinical practice given the largely preventable nature of the disease. The aim of this study was to investigate the reproducibility of a short food frequency questionnaire based on available knowledge of diabetes-related healthy diets. In addition, we aimed to investigate whether a Diabetes Dietary Quality Index based on this questionnaire was related to metabolic risk factors, including measures of beta cell function and insulin sensitivity., Methods: A short food frequency questionnaire was composed by selecting fourteen questions (representing eight dietary factors) from existing food frequency questionnaires on the basis of their reported relationship with diabetes risk. Healthy participants (N = 176) from a Dutch family study completed the questionnaire and a subgroup (N = 123) completed the questionnaire twice. Reproducible items from the short questionnaire were combined into an index. The association between the Diabetes Dietary Quality index and metabolic risk factors was investigated using multiple linear regression analysis. Measures of beta cell function and insulin sensitivity were derived from a mixed meal test and an euglycemic-hyperinsulinemic and modified hyperglycemic clamp test., Results: Our results show that this new short food frequency questionnaire is reliable (Intraclass Correlations ranged between 0.5 and 0.9). A higher Diabetes Dietary Quality index score was associated with lower 2 h post-meal glucose (β -0.02, SE 0.006, p < 0.05), HbA1c (β -0.07, SE 0.02, p < 0.05), total cholesterol, (β -0.02, SE 0.07, p < 0.05), LDL cholesterol, (β -0.19, SE 0.07, p < 0.05), fasting (β -0.4, SE 0.16, p < 0.05) and post-load insulin, (β -3.9, SE 1.40, p < 0.05) concentrations and the incremental AUC of glucose during MMT (β -1.9, SE 0.97, p < 0.05). The scores obtained for the oral glucose insulin sensitivity-derived mixed meal test were higher in subjects who scored higher on the Diabetes Dietary Quality index (β 0.89, 0.39, p < 0.05). In contrast, we found no significant associations between the Diabetes Dietary Quality index and clamp measures of beta cell function., Conclusions: We identified a questionnaire-derived Diabetes Dietary Quality index that was reproducible and inversely associated with a number of type 2 diabetes mellitus and metabolic risk factors, like 2 h post-meal glucose, Hba1c and LDL, and total cholesterol. Once relative validity has been established, the Diabetes Dietary Quality index could be used by health care professionals to identify individuals with diets adversely related to development of type 2 diabetes.

Background/aim: Familial resemblance in dietary patterns has been a subject of interest, with both genetic and environmental factors playing crucial roles. This study aims to investigate trends in macronutrient intake correlations over a 9-year period among different familial pairs, including parent-offspring, siblings, and spouses, using data from the Tehran Lipid and Glucose Study (TLGS)., Methods: This longitudinal study, conducted within the framework of the TLGS, analyzed data from 1,814 families over a 9-year period. Dietary intakes were assessed using a validated 168-item food frequency questionnaire. Macronutrient intakes were calculated and adjusted for age. Familial correlations were estimated using intraclass correlation coefficients for various familial pairs (parent-offspring, siblings, and spouses) across four consecutive surveys. Changes in correlations were analyzed over 3-year, 6-year, and 9-year intervals, as well as across all four surveys, to determine overall trends in macronutrient intake correlations., Results: The results revealed diverse trends in intake correlations for carbohydrates, proteins, fats, and specific fatty acids across familial relationships. Parent-offspring dyads exhibited varied patterns, with some nutrients showing regression to the mean. Sister-sister pairs demonstrated strengthening correlations for energy, carbohydrates, fats, and saturated fatty acids over time. Conversely, brother-sister pairs displayed weakening correlations for most macronutrients, particularly energy, proteins, cholesterol, and fiber. Spouse correlations tended towards regression to the mean for energy, carbohydrates, and fats, and fiber., Conclusions: The present study illuminates the dynamic nature of familial dietary correlations over time. The contrasting trends between sister-sister and brother-sister dyads suggest a significant influence of gender on shared dietary patterns. These findings underscore the complex interplay of genetic and environmental factors in shaping family dietary behaviors and highlight the importance of considering both gender and relationship type when examining familial nutritional habits., (© 2024. The Author(s).)

Background and Objective: Tools to accurately and efficiently measure dietary intake in Nigeria are lacking. We aimed to develop and assess the usability of a new online dietary assessment tool for Nigeria-myfood24 West Africa., Methods: We developed the myfood24 West Africa database using data from existing food composition tables, packaged foods labels and research articles. The development followed seven steps: identified data sources, selected foods, processed/cleaned the data, calculated the nutrient content of recipes, created and allocated portion sizes, quality-checked the database and developed food accompaniments. To pilot the tool, we recruited 179 university staff in Nigeria using a cross-sectional design. Usability was assessed using a questionnaire that included the System Usability Scale (SUS) and a feedback session., Results: The database included 924 foods, with up to 54 nutrients and 35 portion-size images allocated to foods. Sixty percent of the data were sourced from the 2019 West Africa Food Composition Table, 17% from back-of-pack labels of packaged foods, 14% from the 2017 Nigerian Food Composition Table, 5% from generated recipes and 4% from the published literature. Of the participants, 30% (n = 53) self-recorded their food intake, with a total of 1345 food and drink entries from both self- and interviewer-collected data. The mean SUS score of 74 (95% CI: 68,79) indicated good usability. The feedback showed that the tool was user-friendly, educational and included a variety of local foods., Conclusions: This new tool will enhance the dietary assessment of the Nigerian population. More work will expand coverage to include more foods from the region.

Background : (Poly)phenol intake has been associated with reduced risk of non-communicable diseases in epidemiological studies. However, there are currently no dietary assessment tools specifically developed to estimate (poly)phenol intake in the UK population. Objectives : This study aimed to develop a novel food frequency questionnaire (FFQ) to capture the dietary (poly)phenol intake in the UK and assess its relative validity with 7 day diet diaries (7DDs) and plasma and urine (poly)phenol metabolites. Methods : The KCL (poly)phenol FFQ (KP-FFQ) was developed based on the existing EPIC (European Prospective Investigation into Diet and Cancer)-Norfolk FFQ, which has been validated for energy and nutrient intake estimation in the UK population. Participants aged 18-29 years ( n = 255) completed both the KP-FFQ and the EPIC-Norfolk FFQ. In a subgroup ( n = 60), 7DD, spot urine, and fasting plasma samples were collected. An in-house (poly)phenol database was used to estimate (poly)phenol intake from FFQs and 7DDs. Plasma and urinary (poly)phenol metabolite levels were analysed using a validated ultra-high-performance liquid chromatography-triple quadrupole mass spectrometry method. The agreements between (poly)phenol intake estimated using the KP-FFQ, EPIC-Norfolk FFQ and 7DDs, as well as plasma and urinary biomarkers, were evaluated by intraclass correlation coefficients (ICC), weighted kappa, quartile cross-classification, and Spearman's correlations, and the associations were investigated using linear regression models adjusting for energy intake and multiple testing (false discovery rate (FDR) < 0.05). Results : The mean (standard deviation, SD) of total (poly)phenol intake estimated from KP-FFQs was 1366.5 (1151.7) mg d -1 . Fair agreements were observed between ten (poly)phenol groups estimated from KP-FFQs and 7DDs (kappa: 0.41-0.73), including total (poly)phenol intake (kappa = 0.45), while the agreements for the rest of the 17 classes and subclasses were poor (kappa: 0.07-0.39). Strong positive associations with KP-FFQ were found in ten (poly)phenols estimated from 7DDs, including dihydroflavonols, theaflavins, thearubigins, flavones, isoflavonoids, ellagitannins, hydroxyphenylacetic acids, total stilbenes, resveratrol, and tyrosols with stdBeta ranged from 0.61 (95% confidence interval CI: 0.42 to 0.81) to 0.95 (95% CI: 0.86 to 1.03) (all FDR adjusted p < 0.05). KP-FFQs estimated (poly)phenol intake exhibited positive associations with 76 urinary metabolites (stdBeta: 0.28 (95% CI: 0.07-0.49) to 0.81 (0.62-1.00)) and 19 plasma metabolites (stdBeta: 0.40 (0.17-0.62)-0.83 (0.64-1.02)) (all FDR p < 0.05). The agreement between KP-FFQs and the EPIC-Norfolk FFQs was moderate (ICC 0.51-0.69) for all (poly)phenol subclasses after adjusting for energy intake. Compared with the EPIC-Norfolk FFQs estimated (poly)phenol intake, stronger and more agreements and associations were found in KP-FFQs estimated (poly)phenol with 7DDs and biomarkers. Conclusion : (Poly)phenol intake estimated from KP-FFQ exhibited fair agreements and moderate to strong associations with 7DDs and biomarkers, indicating the novel questionnaire may be a promising tool to assess dietary (poly)phenol intake.

Objective: To evaluate the association between ultra-processed food consumption and adherence to the EAT- Lancet diet in a representative sample of the Brazilian population., Design: The study used data from the Brazilian National Dietary Survey 2017-2018 and employed linear regression models to evaluate the association between ultra-processed food consumption and adherence to the EAT- Lancet diet, as measured by the Nova food system and Planetary Health Diet Index (PHDI), respectively., Setting: Nationally representative sample of the Brazilian population., Participants: The study included 46 164 Brazilians ≥ 10 years old., Results: The average PHDI total score was 45·9 points (95 % CI 45·6, 46·1). The ultra-processed food consumption was, with dose-response, inversely associated with the adherence to the EAT- Lancet diet. The PHDI total score was 5·38 points lower (95 % CI -6·01, -4·75) in individuals in the highest quintile of consumption of ultra-processed foods, as compared to those in the first quintile. The PHDI score was also inversely associated with the share of processed culinary ingredients and processed foods and positively associated with the share of unprocessed or minimally processed foods., Conclusions: Our study showed an inverse relationship between the consumption of ultra-processed foods and the adherence to a healthy and sustainable diet.