Search Results (157)

Background and Objectives: A provegetarian (PVG) food pattern, also known as a plant-based food pattern, which prioritizes the consumption of plant-based foods without completely excluding animal-based foods has been associated with health benefits. However, not all plant-based foods are healthy. We prospectively evaluated the association between different PVG food patterns and the risk of total mortality in the “Seguimiento Universidad de Navarra” (SUN) cohort. Methods: The SUN Project is a Mediterranean cohort study involving Spanish university graduates. A validated 136-item semi-quantitative food frequency questionnaire was used. A PVG food pattern, as previously proposed, was calculated assigning positive scores to plant-based foods and inverse scores to animal-based foods. Participants were categorized into quintiles based on their adherence to this pattern. Additionally, healthy and unhealthy PVG food patterns were derived. Results: Data from 17,989 participants with a mean baseline age (standard deviation) 38 (±12) years were analyzed. Over a mean follow-up period of 12 years, 460 deaths (2.6%) were recorded. Participants with higher adherence to the PVG food pattern (Q5) exhibited a 32% lower risk of total mortality [hazard ratio (HR): 0.68 (95% CI: (0.50–0.93); p for trend = 0.020] as compared to those with lower adherence (Q1), after adjusting for multiple confounders. This inverse association persisted for the healthy PVG food pattern [HR: 0.65 (95% CI: 0.47–0.90); p for trend = 0.016]. In contrast, the unhealthy PVG food pattern did not show any significant association with mortality [HR: 1.31 (95% CI: 0.94–1.83)]. Conclusions: Higher adherence to a PVG food pattern, which emphasizes the consumption of plant-based foods, reduces the risk of total mortality in the SUN cohort. Full article

Background/Objectives: Traditional dietary screeners face significant limitations: they rely on subjective self-reporting, average intake estimates, and are influenced by a participant’s awareness of being observed—each of which can distort results. These factors reduce both accuracy and reproducibility. The Guide Against Age-Related Disease (GARD) addresses these issues by applying Assembly Theory to objectively quantify food and food behavior (FFB) complexity. This study aims to validate the GARD as a structured, bias-resistant tool for dietary assessment in clinical and research settings. Methods: The GARD survey was administered in an internal medicine clinic within a suburban hospital system in the southeastern U.S. The tool assessed six daily eating windows, scoring high-complexity FFBs (e.g., fresh plants, social eating, fasting) as +1 and low-complexity FFBs (e.g., ultra-processed foods, refined ingredients, distracted eating) as –1. To minimize bias, patients were unaware of scoring criteria and reported only what they ate the previous day, avoiding broad averages. A computer algorithm then scored responses based on complexity, independent of dietary guidelines. Internal (face, convergent, and discriminant) validity was assessed using Spearman rho correlations. Results: Face validation showed high inter-rater agreement using predefined Assembly Index (A_i) and Copy Number (N_i) thresholds. Positive correlations were found between high-complexity diets and behaviors (rho = 0.533–0.565, p < 0.001), while opposing constructs showed moderate negative correlations (rho = –0.363 to −0.425, p < 0.05). GARD scores aligned with established diet patterns: Mediterranean diets averaged +22; Standard American Diet averaged −10. Full article

Background/Objectives: Recent research indicates a global transition from healthy and balanced diets to unhealthy Westernized dietary patterns (WDPs). This transition is linked to increased rates of non-communicable diseases (NCDs), e.g., obesity, type 2 diabetes, and cardiovascular diseases, often preceded by metabolic syndrome (MetS). Therefore, the objective of this study was to develop a diet quality index, termed Westernized Diet Index (WDI), to assess adherence to WDPs and its association with main cardiometabolic health issues, for which MetS and its components were chosen as representatives of NCDs. Methods: The development of the WDI was driven by a semi-systematic and comprehensive examination of the literature (n = 491 articles) that evaluated the influence of WDP components on health outcomes. The scoring algorithm involved multiple steps, assigning scores based on study design, sample size, and the direction of food effects on health outcomes. Results: The final developed index encompassed 30 food groups/items. It was revealed that soft drinks, processed foods, red meat, sodium, and hydrogenated fats had the most detrimental effects on health, significantly influencing the index’s coefficients. In contrast, dietary fiber, plant-based metabolites, vitamins, minerals, nuts/seeds, and fish had the most substantial beneficial impacts. Conclusions: The WDI aligns with the existing literature on the importance of specific food items and with other validated diet quality indices, e.g., the Dietary Inflammatory Index (DII) and Alternate Healthy Eating Index (AHEI). Thus, the WDI can provide evidence for clinicians and researchers in formulating evidence-based dietary guidelines as well as strategies for the prevention and treatment of diet-related health issues. However, further validation is proposed to verify the WDI’s capability across different contexts. Full article

Background: Exploring emerging dietary patterns, such as plant-based diets (PBD), often requires considerable effort to rebuild new systems or adapt existing food classification frameworks, presenting a substantial challenge for dietary research. Current systems were not originally designed for this purpose and vary in standardization and interoperability, complicating cross-study comparisons. This study aimed to adopt the harmonized, food description-incorporated, food classification system (HFDFC system) to develop a plant-based diet food classification system (PBDFC system), and to evaluate dietary intake and nutritional status among adults in Taiwan. Methods: A repeated cross-sectional design was applied using 24 h dietary recall data from the Nutrition and Health Survey in Taiwan (2013–2016 and 2017–2020), accessed via the national food consumption database. Adults aged 20–70 years were included. Data were processed through the HFDFC system to generate the PBDFC system. For each participant, the Plant-Based Diet Index (PDI), Body Mass Index (BMI), and Nutrient-Rich Food Index (NRF) were calculated and analyzed by age group. Results: Adults aged 46–70 had significantly higher O-PDI and H-PDI scores, lower Lh-PDI scores (all p < 0.0001), and higher NRF values. Despite higher average BMI, those in the highest H-PDI tertile had significantly lower BMI (p < 0.02). Conclusions: The HFDFC-based PBDFC system offers a flexible, scalable framework for plant-based diet classification and supports future cross-national research. Full article

Background/Objectives: Plant-based diets are associated with reduced chronic disease risk, though regional variations persist. In Zhejiang, China, where plant-based food intake is high, this study aimed to explore the association between plant-based diets and metabolic syndrome (MetS) in adults aged 35–75. Methods: This cross-sectional study utilized data from the 2024 Zhejiang Nutrition and Health Survey (ZJNHS). Three plant-based diet indices were calculated: the overall plant-based diet index (PDI), healthy plant-based diet index (hPDI), and unhealthy plant-based diet index (uPDI). Multivariate logistic regression models evaluated associations between diet index quintiles and MetS and its components. Results: Among the 4695 participants included in the study, 23.9% (n = 1122) had MetS. After adjusting for demographic and lifestyle factors, individuals in the highest uPDI quintile showed a significantly higher MetS risk compared to the lowest quintile (OR = 1.37, 95% CI: 1.08–1.73, p-trend = 0.013). Subgroup analyses revealed significant gender interaction (p for interaction < 0.001), with women exhibiting elevated MetS risk (OR = 1.03, 95% CI: 1.01–1.04, p < 0.001). For MetS components, the highest uPDI quintile was associated with increased risks of abdominal obesity (OR = 1.32, 95% CI: 1.05–1.66; p-trend = 0.032), elevated blood pressure (OR = 1.41, 95% CI: 1.12–1.78; p-trend = 0.003), and elevated fasting glucose (OR = 1.27, 95% CI: 1.01–1.59; p-trend = 0.037). Conclusions: Unhealthy plant-based foods are associated with increased MetS risk, particularly in women. Reducing intake of such foods, considering sex differences, and implementing precision nutrition interventions are essential. Full article

Background: The role of dietary patterns in the development of chronic obstructive pulmonary disease (COPD), particularly under varying levels of ambient air pollution, remains insufficiently understood. Aims: We aimed to investigate the association between adherence to multiple established dietary patterns and the risk of incident COPD, and to assess potential effect modification by exposure to ambient air pollutants. Methods: We conducted a prospective study including 206,463 participants from the UK Biobank free of COPD at baseline. Individual-level residential air pollution exposure was estimated for the year 2010. Nine dietary indices were derived from 24 h dietary recalls. Associations with incident COPD were assessed using Cox proportional hazards models. Effect modification was examined using smoking-specific tertiles of nitrogen oxides (NO, NO₂, and NO_x) and particulate matter (PM_2.5, PM_2.5–10, and PM₁₀). Results: Greater adherence to healthy dietary patterns was associated with a 14% to 34% reduced risk of COPD (highest vs. lowest quintile). In contrast, high adherence to the Unhealthful plant-based diet index (PDI) was associated with a 34% increased risk (HR = 1.34, 95% CI: 1.16–1.54). Notably, the protective associations of the AHA, EAT-Lancet, and MIND dietary patterns were most pronounced in settings with relatively high air pollution, as evidenced by elevated levels in at least four air quality indicators (p for interaction < 0.05). Conclusions: Adherence to AHA, EAT-Lancet, and MIND dietary patterns is associated with a reduced risk of incident COPD, with potentially amplified benefits observed in areas with higher ambient air pollution. Full article

Background/Objectives: Recent decades have seen a remarkable westernization of diets and a decline in adherence to the Mediterranean diet (MD). This study examined the eating habits of a representative sample of Italian university students to identify the determinants of adherence to the MD and the most relevant actions to improve their well-being. Methods: The Mediterranean Diet Quality Index for Children and Adolescents (KIDMED) and Sustainable Healthy Diet (SHED) index questionnaires were used to explore MD adherence as the primary outcome, and dietary behavior sustainability, respectively. Sociodemographic, anthropometric, and lifestyle information was also collected. Results: The final sample included 1434 subjects (18–24; 60% female). The median (IQR) KIDMED score was 6.0 (4.0–8.0) and 33% showed a high adherence to the MD. Having breakfast, eating fruit and vegetables at least once a day, consuming pasta or other grains almost daily, and using olive oil at home were among the most common positive aspects of students’ diets. However, regular consumption of fish, nuts, legumes, dairy products, and a second serving of fruit and vegetables was less prevalent. Having an active lifestyle, eating more plant products, and having more sustainable dietary behaviors in terms of the SHED index, were the main determinants of a high KIDMED score. Likewise, graduate students, daily consumers of plant-based meat alternatives, and students attending university canteens daily were more likely to adopt healthier diets. Conclusions: Future actions are crucial to create a food environment that facilitates healthy and sustainable dietary choices among young adults, such as improving the nutritional quality of processed products and regulating their promotion, as well as implementing initiatives to improve university food services and encourage the use of campus dining facilities. Full article

Food systems interact through multiple dimensions including food security, nutrition, and planetary health. This study aims to associate different dietary patterns with sustainable lifestyles in Latin America and Spain. This was an observational, analytical, multicenter, cross-sectional survey study, with a total of 6412 participants. A self-administered questionnaire was developed in an online format in the Google Docs interface. The questionnaire was divided into sections: (1) sociodemographic background: country of residence, age, sex, educational level, socioeconomic aspects, and place of residence; (2) body mass index classification; (3) dietary patterns (Western, vegetarian, vegan, ketogenic, Mediterranean, prudent, or paleolithic diets); and (4) the Sustainable Lifestyles Survey. Multivariate models were applied to adjust for potential confounding factors. The mean age of the participants was 35.2 years (SD 12.7). The majority of participants identified their dietary pattern as omnivorous (41.5%), followed by the Western diet (21.7%) and the Mediterranean diet (12.7%). Plant-based, vegan (β: 14.90; 95% CI: 9.75–20.05), and lacto egg (β: 12.08; 95% CI: 8.57–15.58) diets are significantly associated with a higher sustainability score compared to an omnivorous diet. In contrast, a Western diet is inversely associated (β: −5.63; 95% CI: −7.20 to −4.06). Finally, a vegan (Sub-score 1: β: 6.19; 95% CI: 4.43–7.96) diet is consistently associated with higher levels of sustainability in all areas assessed. In contrast, the Western diet shows a significant negative association with sustainability in all subcomponents assessed. Conclusions: Plant-based dietary patterns were shown to be associated with sustainable lifestyles, with the vegan diet having the greatest association, while the Western dietary pattern was inversely associated. Full article

Background/Objective: Type 2 diabetes mellitus (T2D) is a chronic metabolic disorder characterized by hyperglycemia. Plant-based interventions have gained attention as potential complementary treatments alongside conventional therapies. This systematic review evaluates the efficacy of plant-based interventions in improving glycemic control, insulin sensitivity, lipid profiles, and other outcomes such as GLUT-4, Tumor Necrosis Facto-alpha, dietary inflammation index, plasma lipopolysaccharide, total antioxidant capacity, and malondialdehyde in individuals with T2D. Methods: We conducted a systematic search of PubMed, Scopus, and ScienceDirect databases to identify randomized controlled trials (RCTs) and observational studies. RCTs were used as an additional screening criterion. The review included studies on the effects of plant-based interventions, encompassing fruits, vegetables, herbs, spices, and their extracts. We analyzed data on glycemic control, insulin sensitivity, lipid profiles, and other metabolic markers. Results: Twenty-six studies were included in our analysis. Various interventions showed potential benefits, with improved glycemic control, insulin sensitivity, and lipid profiles. Specific interventions such as Ziziphus jujuba juice, black tea, caper fruit extract, and balanced diets were linked with positive outcomes. Based on the Functional Food Claim framework, all 26 studies met the quality criteria for novel foods. However, the novel food score varied, and results were inconsistent across different interventions. Conclusion: Although some plant-based interventions appear promising in managing T2D, the evidence remains inconclusive due to variability in study quality and methodology. Further high-quality RCTs are necessary to confirm these findings and to establish the optimal dosage, duration, and combinations of interventions for effective T2D management. Despite inconclusive results, few plant-based diets have promising outcomes. Healthcare providers, especially nurse case managers, can incorporate the findings of this study into their practice protocol to support self-management for individuals with TD2. Full article

As aquaculture expands, plant-based feeds are increasingly used, but some fish species poorly tolerate them, affecting health and growth. Probiotics can help counter these effects by improving digestion, nutrient absorption, and immunity. This study evaluated the effect of dietary incorporation of Bacillus subtilis FI99 on the intestinal health of meagre. A nutritional challenge was performed with a practical control diet and three diets higher in plant-based ingredients: one without probiotic and two with probiotic incorporated at 1 × 10⁹ CFU g⁻¹ and 5.5 × 10¹¹ CFU g⁻¹. Histomorphological analysis was used to assess intestinal health and validate previously established machine learning models in predicting fish nutritional status. No differences were observed in zootechnical performance and biometric indexes. Most effects were observed in the anterior intestinal section, where probiotics improved total area, lumen area, lumen maximum diameter, total maximum diameter, villi area, and villi + lumen area. Additionally, probiotics improved supranuclear vacuole size, eosinophilic granulocytes, and intraepithelial leukocytes presence in anterior and intermediate sections. Machine learning models could not accurately predict the nutritional status of fish. Overall, the study indicates that dietary inclusion of B. subtilis enhances the intestinal health of meagre fed plant-based diets. Machine learning models require further development for improved accuracy. Full article

The pathogenesis of obesity is complex and incompletely understood, with an underlying interplay between our genetic architecture and obesogenic environment. The public understanding of the development of obesity is shrouded in myths with widespread societal misconceptions. Body Mass Index (BMI) is a highly heritable trait. However, despite reports from recent genome-wide association studies, only a small proportion of the overall heritability of BMI is known to be lurking within the human genome. Other non-genetic heritable traits may contribute to BMI. The gut microbiome is an excellent candidate, implicating complex interlinks with hypothalamic control of appetite and metabolism via entero-endocrine, autonomic, and neuro-humeral pathways. The neonatal gut microbiome derived from the mother via transgenerational transmission (vaginal delivery and breastfeeding) tends to have a permanence within the gut. Conversely, non-maternally derived gut microbiota manifest mutability that responds to changes in lifestyle and diet. We should all strive to optimize our lifestyles and ensure a diet that is replete with varied and unprocessed plant-based foods to establish and nurture a healthy gut microbiome. Women of reproductive age should optimize their gut microbiome, particularly pre-conception, ante- and postnatally to enable the establishment of a healthy neonatal gut microbiome in their offspring. Finally, we should redouble our efforts to educate the populace on the pathogenesis of obesity, and the role of heritable (but modifiable) factors such as the gut microbiome. Such renewed understanding and insights would help to promote the widespread adoption of healthy lifestyles and diets, and facilitate a transition from our current dispassionate and stigmatized societal approach towards people living with obesity towards one that is epitomized by understanding, support, and compassion. Full article

Background/Objectives: Evidence suggests that plant-based dietary patterns are beneficial for cardiometabolic health. However, it is unclear whether the quality of plant-based dietary patterns is differentially associated with cardiometabolic health. This study aimed to examine the association between three plant-based diet quality indices and cardiometabolic health among Australian adults. Methods: Data on 4877 adults (mean 45.1 years) from the cross-sectional Australian Health Survey 2011–2013 were used. Three plant-based diet quality indices (overall, healthful, and unhealthful) were derived from two 24 h dietary recalls. Anthropometric measures and blood pressure were assessed by trained interviewers. High-risk waist circumference was classified as ≥80 cm in females and ≥80 cm in males. Hypertension was defined as >140/90 mmHg. Fasting blood samples were used to estimate lipid profiles and diabetes status (based on plasma glucose or HbA1c). Multivariate logistic regression analyses were used to investigate the association between plant-based diet indices and cardiometabolic markers. Results: The healthy plant-based diet index was associated with lower odds of a high-risk waist circumference (OR 0.98; 95%CI 0.96–0.99), and the unhealthy plant-based diet index was associated with increased odds of having hypertension (OR 1.02; 95%CI 1.00–1.04). No other significant associations were identified between the plant-based diet quality indices and cardiometabolic outcomes. Conclusions: There was some evidence that the quality of plant-based dietary patterns was differentially associated with cardiometabolic health, with healthier plant-based dietary patterns associated with lower odds of a high-risk waist circumference, and less healthy plant-based dietary patterns associated with increased odds of hypertension. These findings support the consideration of the quality of plant foods consumed, and the need for targeted advice for optimising cardiometabolic health among adults. Full article

Background/Objectives: Dietary patterns rich in plant-based foods during pregnancy have been associated with neurodevelopmental outcomes in offspring. However, not all components of these diets are healthy, and the impact of their quality on behavioral outcomes remains unexplored. Therefore, this study aimed to examine the association between healthy and unhealthy plant-based diets and offspring behavioral problems at the age of four. Methods: This research involved 201 mother–child pairs from the ECLIPSES study. Maternal diet during pregnancy was assessed using a validated food frequency questionnaire, from which the healthy plant-based diet index (hPDI) was calculated, emphasizing the consumption of fruits, vegetables, legumes and nuts, along with the unhealthy plant-based diet index (uPDI), highlighting the intake of sugary drinks and refined grains. Children’s behavior was evaluated using the Child Behavior Checklist 1.5-5. Multivariable logistic regression analyses were conducted to estimated odds ratios (ORs) and their 95% confidence intervals (CIs). Results: Greater adherence to the uPDI during pregnancy was associated with higher odds for externalizing problems, including attention-deficit/hyperactivity problems (OR = 1.08; 95%CI from 1.01 to 1.16) and oppositional defiant behavior (OR = 1.09; 95%CI from 1.00 to 1.19) in offspring, particularly girls. Higher adherence to the hPDI was not associated with children’s behavior. Conclusions: The consumption of unhealthy components of a plant-based dietary pattern during gestation has been associated with adverse behavioral outcomes in children at age four. These findings underscore the importance of discerning between the healthy and unhealthy components of plant-based diets when assessing their impact on child development. Full article

Background/Objectives: Regiospecificity in triacylglycerols (TAGs) influences absorption/bioavailability of dietary fatty acids. We evaluated whether sn1,3 located DHA (22:6ω3) of a transgenic higher plant (DHA-Canola^®) preferentially facilitates its tissue incorporation as compared to sn2 positioned DHA (DHASCO^® of algal origin). Methods: Sprague Dawley rats were fed diets (12 weeks) containing DHA-Canola or DHA-Control (a blend of DHASCO^® and high oleic sunflower seed oil (HOSO)) at 0.3%, 1%, 3%, and 6% (w/w), or 7% HOSO prior to determination of tissue fatty acids. Results: At 0.3 and 1% w/w supplementation, plasma, liver and cardiac tissue DHA incorporation was higher in the plant-based oil (DHA-Canola vs. DHA-Control; p < 0.05), whilst sn2 enriched algal oil yielded better outcomes at higher doses (at 3% inclusion, plasma values were 7.8 vs. 5.9%, and at 6% supplementation, 10.0 vs. 7.9 in favor of DHA-Control, p < 0.05) At lower intakes, sn1,3 regiospecificity (DHA-Canola) increased the omega-3 index, a clinically relevant biomarker, compared to DHA-Control (p < 0.05). Similarly, a build-up of 20:5ω3 and 22:5ω3 occurred with DHA-Canola. Consequently, total omega3s were higher in this latter group. Conclusions: At lower intakes, sn1,3 regiospecificity of DHA leads to its preferential tissue incorporation compared to sn2 DHA. Full article

Background/Objectives: Plant-based diets are associated with human and planetary health. However, the overall quality of these diets may depend on the proportion of ultra-processed foods (UPFs). This study investigates the association between UPF consumption and plant-based diet quality in Australian adults. Methods: Analysis was conducted on 9111 participants (aged ≥ 19 years) from the National Nutrition and Physical Activity Survey 2011–2012. Food items reported from a 24 h recall were classified using the NOVA system, and the contribution of UPFs to total energy intake was calculated. Plant-based diet quality was examined using the overall plant-based diet index (PDI), healthy PDI (hPDI), and unhealthy PDI (uPDI). Multiple linear regression models were used to examine the association between the UPF intake and PDI, hPDI, uPDI, and their score components. Results: The proportion of energy from UPFs was positively associated with the uPDI (β = 0.80; 95% CI 0.72, 0.89) and negatively associated with the PDI (β = −0.13; 95% CI: −0.22, −0.04) and the hPDI (β = −0.65; 95% CI: −0.73, −0.57). All score components of the PDI, hPDI and uPDI, except whole grains, legumes and fruit juices, significantly contributed to these associations. The sugars and syrups group contributed most to the positive association between UPFs and the uPDI (β = 6.47; 95% CI: 6.07, 6.87) and the negative association of UPFs and the hPDI (β = −6.47; 95% CI: −6.07, −6.87). Conclusions: Higher consumption of UPFs was associated with a lower plant-based diet quality. These findings have implications for the design of dietary interventions that encourage the consumption of minimally processed plant-based foods. Full article