bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of vitamin D3 supplementation on vitamin D status and associated health outcomes in children
Authors: Royle Emily , McSorley Emeir M. , Kirsty Pourshahidi L. , Armstrong David , Magee Pamela J.
Published: December 2024

Sufficient vitamin D status is required in childhood for normal skeletal health and the development of muscle and motor function(1). Vitamin D primarily acts through the promotion of calcium absorption from the gut and mobilisation from bone tissue(2). Childrens’ vitamin D dietary intakes are currently below the recommended guidelines within the UK and Ireland suggesting a need for vitamin D3 supplementation to prevent the risk of developing vitamin D deficiency(3). The aim of this study was to examine the effect of 12 weeks’ supplementation with 10µg/d vitamin D3 vs placebo control on vitamin D status and to determine if improved vitamin D status impacted muscle function and cognition in children aged 4-11 years.

In the D-VinCHI randomised, double-blind, placebo-controlled trial, healthy children (n = 118; mean age 8.1 ± 1.8 y; 51% girls) were randomly assigned to either placebo or 10µg/day of vitamin D3 for 12 weeks (year-round). Baseline and endpoint measures included anthropometric measures, hand grip strength, balance, and cognitive assessment. Blood samples were analysed for plasma 25hydroxyvitamin D [25(OH)D], and parathyroid hormone. Vitamin D consumption from food sources was assessed via a 13-item food frequency questionnaire.

Following the 12-week intervention vitamin D status [25(OH)D concentration] increased in the treatment group from 66.31 ± 17.25 nmol/L to 69.04 ± 16.92 nmol/L. Change in status was significantly different compared to the placebo group within which a decrease in 25(OH)D was observed from 63.67 ± 19.48 to 56.29 ± 18.58 nmol/L, p<0.001. Supplementation with vitamin D3 prevented deficiency of plasma 25(OH)D during the winter months. Vitamin D3supplementation had a positive effect on cognitive function, improving simple movement time from 707 ± 380 to 599 ± 207 milliseconds, compared to the placebo group within which time increased from 680 ± 284 to 728 ± 372 milliseconds, p = 0.017. Vitamin D mean dietary intake from food sources alone was 2.68µg/day. There was no effect of supplementation on muscle function.

Vitamin D3 supplementation maintained year-round sufficiency in children and importantly, prevented deficiency during the extended winter months. Vitamin D supplementation may enhance cognitive function via improvements in attention and psychomotor speed. The reported intakes of vitamin D food sources were low and were well below the current dietary reference value for this age group. Further health promotion policies and (bio)fortification strategies should be considered within this age group to maximise vitamin D status for optimal growth and development.
Body composition, body mass index, waist circumference and perimenopausal symptoms in women living in Ireland
Authors: Murphy M.B. , Owens R. , Edwards L. , Cuskelly G.J. , Heavey P.M.
Published: December 2024

Menopause, as signified by 12 months of amenorrhea, marks the end of female fertility(1). The perimenopausal stage preceding this event, is frequently symptomatic, with previous research suggesting that a higher body mass index (BMI) may be associated with more severe menopausal symptoms(2). Changes to body composition have also previously been linked to the decline in hormones that accompany this midlife transition(3). This cross-sectional, observational study aimed to shed light on this underexplored area in Ireland.

Approval was granted by the Technological University of the Shannon Research Ethics Committee. A convenience sample of perimenopausal women (>40 years old) were recruited via social media and workplaces. Participants self-reported their symptom severity using the previously validated Menopause Rating Scale (MRS)(4). Psychological, somatic, and urogenital symptom categories were rated from 0 (no symptoms) to 4 (very severe symptoms), with a potential maximum score of 44. An overall score and a sub-score for each of the 3 symptom categories was generated. Participants self-identified their perimenopausal stage (early or late) based on descriptions of the STRAW+10 criterion(5). A range of anthropometric measurements were taken including height, weight, waist circumference (WC) and body fat (BF) percentage (using TANITA MC-580 tetrapolar bioelectrical impedance scales). Following descriptive analysis, Spearman’s correlation coefficient was utilised to test the relationship between MRS and anthropometric measurements.

Participants (N = 112) had a mean age of 48.05 ± 3.48 years, a mean WC of 95.2 ± 16.9cm, a mean BF percentage of 34.9 ± 7.3. Prevalence of healthy, overweight, and obesity BMI amongst participants was 29%, 36% and 36% respectively, with a mean of 29.0 ± 6.6kg/m2amongst the sample. Overall mean MRS symptom score was 15.3 ± 6.9. There was a positive correlation between participant’s overall symptom rating and, their BF percentage (r = 0.30, P = 0.001), WC (r = 0.30, P = 0.002), and BMI (r = 0.31, P = 0.001). This relationship was also observed in the symptom sub-score categories. Somatic sub-score positively correlated with BF percentage (r = 0.24, P = 0.010), WC (r = 0.31, P<0.001) and BMI (r = 0.31, P<0.001). Urogenital sub-score was similarly positively correlated to all 3 anthropometric measurements, BF percentage (r = 0.24, P = .010), WC (r = 0.24, P = 0.011), and BMI (r = 0.23, P = 0.014). Psychological sub-score was correlated positively with BF percentage (r = 0.23, P = 0.015) and BMI (r = 0.21, P = 0.026), but not WC.

The findings from this study suggest that a higher BF percentage, WC and BMI may be associated with a more symptomatic perimenopausal stage. Further studies are warranted to further explore this, and how to target interventions.
Reduction in menopause symptom severity following a personalised app-based dietary intervention program: a pre-post longitudinal analysis of the ZOE PREDICT 3 study
Authors: Pounis G. , Bermingham K. M. , Capdevila J. , Bulsiewicz W. J. , Roomans A. , Creedon A. , Amati F. , Wolf J. , Spector T. D. , Hall W. L. , Berry S. E.
Published: December 2024

Digital health technologies delivering dietary and lifestyle advice1,2 may offer a contemporary approach to menopause symptom mitigation in a large population base3. This study aimed to evaluate alterations in both diet quality and menopause symptom burden following the implementation of an app-based, personalised dietary intervention in peri- and postmenopausal participants.

Baseline and follow-up data (mean follow-up time, 207 ± 72 days) on diet, menopause symptom number (from 20 vasomotor, sexual, psychological and somatic symptoms), symptom severity (0-not at all, 1-a little, 3-quite a bit and 5-extremely) and other characteristics of 4,287 UK based participants of the ZOE PREDICT 3 study (1,000 perimenopausal and 3,287 postmenopausal) were analysed (NCT04735835). Dietary assessment was performed through an app-based food frequency questionnaire (PREDICT-FFQ)2 and diet quality assessed using the Healthy Eating Index-2020 (HEI, score 0-100)4. A novel Menopause Symptom Tracker Score (MSTS 0-100, Copyright © 2024 Zoe Limited) was used to capture symptom number and severity.

There was a modest increase in diet quality after the intervention in both peri- and postmenopausal participants; mean HEI from 76.4 ± 8.4 to 79.7 ± 6.8 (P<0.001) and from 78.7 ± 7.8 to 81.1 ± 6.4 (P<0.001), respectively. Baseline MSTS was higher in peri- versus postmenopausal participants 28.9 ± 15.1 vs. 18.1 ± 15.0 (P<0.001). However, both groups showed a significant decrease in mean MSTS after the intervention compared to baseline; mean change (95%CI) in perimenopausal was -8.7 (-9.5, -7.9; 30.1% reduction) and in postmenopausal was -6.6 (-6.9, -6.2; 36.5% reduction) (P for both <0.001).

The reduction in the overall MSTS was greater in perimenopausal compared to postmenopausal (P<0.001). Reductions in domain-specific MSTS for peri- and postmenopausal groups respectively, were as follows: vasomotor −0.56 (−0.71, −0.40; 24.9% reduction) and −0.47 (−0.54, −0.41; 31.8% reduction), sexual −0.72 (−0.87, −0.57; 18.6%) and -1.08 (-1.16, −0.99; 28.7%), psychological -2.3 (-2.5, 2.0; 35.0%) and -1.2 (-1.3, -1.1; 44.2%), somatic -5.1 (-5.6, -4.7; 31.5%) and -3.8 (-4.0, -3.6; 37.5%) (P for all <0.001). The reduction in the psychological and somatic domain-specific MSTS was greater in peri-compared to postmenopausal group (P for both <0.001).

This study supports the potential of personalised app-based dietary interventions in the mitigation of menopausal symptoms during menopause transition and its potential to affect the health and quality of life of millions. Further studies should investigate their efficacy in a randomised, controlled dietary intervention setting.
Diet quality is associated with lower prevalence of menopausal symptoms: the ZOE PREDICT 3 study
Authors: Pounis G. , Bermingham K. M. , Capdevila J. , Bulsiewicz W. J. , Roomans A. , Creedon A. , Amati F. , Wolf J. , Spector T. D. , Hall W. L. , Berry S. E.
Published: December 2024

The role of diet in the prevention and management of menopausal symptoms is poorly understood1,2. Digital health platforms have the potential to optimise collection of population-level menopause symptom data particularly in a rapidly changing environment2,3. This study explored the prevalence of menopause symptoms utilising data collection capabilities of a mobile app in a large population of peri- and postmenopausal women and to investigate novel associations between diet quality and symptoms.

Baseline data on diet, 20 menopause symptoms (i.e. 3 vasomotor, 3 sexual, 4 psychological and 10 somatic) and other characteristics of 70,412 participants of the ZOE PREDICT 3 app-based study in UK (n = 27,932 peri- and n = 42,480 postmenopausal) were analysed (NCT04735835). Dietary assessment was performed through an app-based food frequency questionnaire (PREDICTFFQ)4 and diet quality assessed using the Healthy Eating Index-2020 (HEI, score 0-100)5.

The burden of menopausal symptomatology was high; with 99.8% and 92.7% of peri- and postmenopausal participants reporting 1 or more symptoms respectively and 66.0% and 41.2% of peri- and postmenopausal participants experiencing >12 symptoms, respectively (P<0.001). Mean ( ± SD) symptom number was greater in the peri- versus postmenopausal group; 13.5 ± 3.8, vs. 10.5 ± 5.5 (P<0.001). HEI (mean ± SD) was slightly lower in the peri- versus postmenopausal group; 73.9 ± 9.7 vs. 76.6 ± 8.9 respectively (P<0.001). Logistic regression analyses showed that a 20 unit increase in HEI was associated with reduction of 6%-37% and 12%-43% in likelihood of symptom presence (dependent on the symptom) in peri- and postmenopausal participants, respectively (P<0.05). ORs remained significant in adjusted models (for age, BMI, use of hormone replacement therapy, total energy intake and home environment (urban, rural) showing reductions of 7%-19% and 6-21%, respectively (P<0.05). Logistic regression analyses revealed that a similar increase in HEI (20 units) was associated with 17% and 19% reductions in the number of symptoms reported by peri- and postmenopausal women after multiple adjustments (P<0.05).

This large observational study confirms the high prevalence of menopausal symptoms among peri- and postmenopausal women and provides new evidence between adherence to healthy eating and reduced likelihood of menopausal symptoms, increasing the potential for symptom reduction by specific dietary approaches. Further studies should examine this relationship in longitudinal and dietary intervention settings.
Partial replacement of milk and dairy products with plant-based alternatives – would fortification of bread reduce the impact on iodine intake?
Authors: Nicol K. , Nugent A.P. , Woodside J.V. , Hart K.H. , Bath S.C.
Published: December 2024

Plant-based dairy alternatives (PBDAs) consumption has assumed a more significant role in populations shifting to more sustainable eating habits. However, PBDAs do not necessarily replace the nutrient value of cow’s milk and dairy products, particularly that of essential micronutrients such as iodine(1). Cow’s milk and dairy products are the primary source of iodine in the UK diet(2), and substituting with PBDAs may negatively affect iodine intake. Here, we aimed to (i) investigate the implications for iodine intake and adequacy of partial replacement of milk, cheese, and yoghurt with commercially available PBDAs per UK Net Zero recommendations(3) and (ii) evaluate the potential of introducing bread products made using iodised salt as prophylaxis against iodine deficiency in population intakes due to the proposed changes.

The present study used the dietary modelling software DaDiet(4) to examine iodine intake in the diets of children aged 1.5-13 years and females aged 14-49 years. We used data from the National Diet and Nutrition Survey (2016-2019) and brand-level iodine concentration data(5). Firstly, several scenarios that accounted for the population impact of replacing 20% or 35% of milk and dairy product consumption with PBDAs were modelled. Secondly, we modelled the changes by substituting salt in bread with iodised salt at a 30 µg/kg concentration. Relative to the usual diet, we calculated the change in iodine intake and the proportion with intake below the UK Lower Reference Nutrient Intake (LRNI) or above the Upper Limit (UL).

Replacing 20% of dairy products with PBDAs would result in a meaningful decrease in usual iodine intake in all population groups, except females aged 14-18 years, without impacting the population proportion below the LRNI. A 35% replacement would result in a meaningful decrease in iodine intake (9-20%) compared to the usual diet for all population groups. A 35% replacement would also increase the proportion of females aged 19-49 years with iodine intakes below the LRNI to 21%. Adding iodised salt to bread products would increase the usual iodine intake across all population groups and decrease the proportion of intakes below the LRNI (2-14% change). Particularly for females aged 14-18 years, where 40% increases in iodine intake were observed (97 to 136 µg/day) and would not have a meaningful impact on the proportion above the UL in any population group.

Introducing iodised salt in bread products would counteract the negative effect of PBDAs on iodine intake in all population groups. Replacing milk and dairy products with PBDAs per current UK Net Zero goals would reduce population iodine intake unless measures are implemented to minimise the impact on usual iodine intake. Introducing iodised salt to bread products is one countermeasure that would minimise the impact on iodine intake without increasing the population above the UL.
Modelled replacement of meats by dairy products and incident coronary heart disease: Evidence from the UK Biobank Study
Authors: Vogtschmidt Y.D. , Soedamah-Muthu S.S. , Givens D.I. , Lovegrove J.A.
Published: December 2024

There is uncertainty about the impact of replacing meats by dairy products (milk, yogurt, cheese) on the risk of coronary heart disease (CHD)(1,2). Our objective was to examine the modelled replacement of red meat (unprocessed), processed meat, and poultry meat by milk, yogurt, and cheese in relation to CHD incidence in the UK adult population.

Prospective longitudinal data were used of 117,216 participants in the UK Biobank Study, who were free of CHD at entry, had completed at least two 24hr dietary assessments and had complete covariate data. We modelled the replacement of 1 serving of red meat (unprocessed) (100 g/d) or processed meat (50 g/d) or poultry meat (100 g/d) by 1 serving of milk (200 g/d), yogurt (120 g/d) and cheese (30 g/d). These portion sizes were chosen based on previously reported portion sizes(3). Information on the incident cases of non-fatal or fatal CHD events were obtained from hospital inpatient admissions and death registries. The hazard ratios (HR) and 95% confidence intervals (CI) were derived from Cox regression models and multivariable adjustments included sociodemographic, lifestyle, family history, total energy, dietary factors, and BMI.

In our study population, 57% were female. The mean ± SD was 56 ± 7.8 years for age and 26.6 ± 4.6 kg/m2 for BMI. During a median follow-up of 11 years, a total of 7060 cases of incident CHD were found. There was a lower risk of CHD for the modelled replacement of 1 serving of red meat (unprocessed) by 1 serving of cheese (HR: 0.90; 95% CI: 0.84, 0.97), but not by milk (0.93; 0.87, 1.00) or yogurt (0.94; 0.87, 1.02). Similarly, replacement of 1 serving of poultry meat by 1 serving of cheese was associated with lower risk of CHD (0.92; 0.85, 0.98) and no significant associations were observed with replacement by milk (0.97; 0.90, 1.04) or yogurt (0.98; 0.90, 1.05). Replacing 1 serving of processed meat by 1 serving of milk (0.92; 0.87, 0.97), yogurt (0.93; 0.87, 0.99) or cheese (0.87; 0.82, 0.92) was associated with lower CHD incidence.

Our study findings support current recommendations for CVD prevention of limiting intake of meats, especially processed meat. Data suggest benefits of dairy foods, in comparison with meats, for reducing the risk of CHD. These findings should be replicated in other cohorts with different intake ranges.
Association between predicted hsCRP score and hyperlipidemia among women: the Korea Nurses’ Health study
Authors: Lee Soomin , Cha Chiyoung , Lee Jung Eun
Published: December 2024

Hyperlipidemia is known to be closely associated with diet and inflammation.(1) This study aimed to examine the relationship between predicted hsCRP score and hyperlipidemia among women in the Korea Nurses’ Health Study.

In this prospective cohort study, a total of 6,921 women aged 21-50 years were included from the Korea Nurses’ Health Study (KNHS)(2) module 1 to 11. The predicted hsCRP score was derived from demographic, lifestyle, dietary, and anthropometric factors.(3) Dietary factors were derived based on a validated food frequency questionnaire (FFQ).

Hyperlipidemia was defined as the presence of any one of the following: 1) total cholesterol ≥240 mg/dl, 2) HDL-cholesterol <50 mg/dl, or 3) triacylglycerol ≥200mg/dl.(4) We also considered participants with a history of diagnosed hyperlipidemia or current use of hyperlipidemia medication as having hyperlipidemia. Cox proportional hazard regression analysis was used to calculate relative risk (RRs) and 95% confidence intervals (CIs) with adjustment for potential confounding factors.

During a mean follow-up of 5.81 person-years, 1,862 cases of hyperlipidemia were identified. After multivariable adjustment, the RRs (95% CIs) for hyperlipidemia comparing the highest predicted hsCRP score with the lowest predicted hsCRP score were 1.22 (1.04-1.43), 1.12 (0.96-1.32), 1.27 (1.08-1.49), and 1.61 (1.37-1.89), respectively (P for trend < 0.001).

Our results support that increasing predicted hsCRP scores were associated with increased risk of hyperlipidemia. These findings suggest that dietary and lifestyle changes aimed at reducing inflammation may help prevent hyperlipidemia.
Evaluating Modifiable Hypertension Risk in Nigerian Adults — The Nigerian Diet Risk Score
Authors: Batubo Nimisoere P. , Auma Carolyn I. , Moore J. Bernadette , Zulyniak Michael A.
Published: December 2024

Cardiovascular diseases account for 31% of all global deaths, the majority (80%) of which are associated with hypertension.(1,2) As of 2019, hypertension is expected to affect 1 in 3 adults living in West Africa, with prevalence standing at 36.1% In Nigeria.(3,4) Poor dietary habits, including high intakes of salt, processed meat, ultra-processed foods, and unhealthy fats and oils and low intakes of vegetables, fruits, fibre, and nutrients such as potassium and omega-3 fatty acids, account for 9–17% of cases of hypertension globally, and our recent meta-analysis confirms their contribution in Nigeria and other West African countries.(1,5,6) This study aimed to develop and deliver a culturally-appropriate diet risk score for clinical practice that can (i) rapidly and accurately identify and stratify individuals at risk of hypertension and (ii) support clinicians and other healthcare professionals to provide tailored and effective personalised dietary advice.

We used a culturally-appropriate Nigerian Dietary Screening Tool (that we recently designed and validated(7,8)) to assess the dietary intake among 151 patients in a Nigerian hospital and used methods similar to Framingham and INTERHEART to: (i) construct and validate a Nigerian Dietary Risk Score (NiDRS) for hypertension, and (ii) evaluate the NiDRS against a panel of clinical biomarkers of hypertension, using multiple logistic regression models, internal validation using measures of discrimination and calibration, decision analysis curve and mediation analysis to facilitate its use in clinical practice.

Each incremental increase in the overall NiDRS was associated with a 2-fold increase in odds of overall hypertension (OR: 2.04, 95%CI: 1.16, 1.16, p = 0.01), with the highest score category associated with >18-food increased odds of hypertension, compared to lowest NiDRS (OR: 18.27, 95%CI: 1.33, 251.21, p = 0.03). The NiDRS demonstrated good discrimination with an AUC of 0.92%, high sensitivity (0.85), specificity (0.94), calibration (with a Brier score of 0.1) and a positive net benefit. In addition, via mediation analysis, total cholesterol (50%), triglycerides (47%), LDL-c (49%), VLDL-c (17%), CRP (68%), and homocysteine (71%) were mediators of the NiDRS-hypertension pathway in a positive direction.

The NiDRS is an accurate and valuable tool for clinicians to identify and stratify individuals at risk of hypertension and discuss dietary prevention strategies to address the rising prevention of hypertension and its associated cardiovascular complications in Nigeria.
Low-carbohydrate vs low-fat diets for the secondary prevention of cardiovascular diseases. A meta-analysis
Authors: Nikitara K. , Kontogianni M. , Haidich AB. , Bountziouka V.
Published: December 2024

The scientific evidence surrounding the efficacy of low-carbohydrate diets (LCDs) compared to low-fat diets (LFDs) in the secondary prevention of cardiometabolic diseases is diverse. While some studies indicate that LCDs can lead to superior cardiometabolic outcomes(1), others conclude that higher intakes of MUFA, or PUFA could have a better impact on the risk of CVD(2). However, despite inconclusive findings, only a limited number of reviews have employed precise meta-analytical methods and used the most recent scientific evidence to derive quantitative estimates of the relative effect of these two diets.

This study aims to exploit the advantages of meta-analysis to compare the efficacy of LCDs (CHO <30% of total energy intake) and LFDs (FAT <35% of total energy intake) against cardiovascular diseases (CVDs), based on the most recent scientific evidence.

A systematic review was performed by retrieving studies from 5 bibliographic databases from January 2013 to 31 May 2023. The studied population included adults at high risk for CVDs, and the outcomes covered indicators for glycemic control, adiposity, lipidemia, and inflammation. Data were extracted in a pre-defined template and a meta-analysis was performed, along with sensitivity analyses. This abstract provides a preliminary analysis of outcomes from a subset of identified studies, focusing on two specific parameters, including triacylglycerols (TGs) and Body Mass Index (BMI).

Six studies (769 subjects) were included in the meta-analysis. Overall, participants in the LCD had on average 0.30 mmol/L lower TG levels at the end of the intervention (95% CI: −0.43; −0.17) whilst for participants in the LFD the magnitude of the effect was smaller (i.e., −0.22 (−0.36; −0.08) mmol/L). However, we found no evidence of a significant impact of the LCD on TG levels against the LFD (change in mean difference (95% CI): −0.096 (−0.245; 0.053) mmol/L), whilst study heterogeneity was moderate (I2 = 56%). Moreover, participants in the LCD achieved a reduction in BMI of -2.04 kg/m2 on average (95% CI: -2.77; -1.31), whilst those in LFD achieved on average a reduction of -1.20 kg/m2 in BMI (95% CI: -1.95; −0.44), with the reduction in BMI being greater for participants in the LCD compared to the LFD (−0.47 kg/m2 (−0.91; −0.04), I2 = 12%).

The findings of this pairwise meta-analysis underscore the complex interplay between dietary composition and metabolic outcomes and will provide the best practices for the risk reduction of developing CVDs.
The experiences of people with Type 2 diabetes (T2DM) who recently induced remission by low-carbohydrate diets (LCDs) in primary care settings
Authors: Aksoy A.N. , Abayomi J. , Relph N. , Butler T.
Published: December 2024

Low-carbohydrate diets (LCDs) can be effective in inducing Type 2 diabetes (T2DM) remission(1). Although there are large interventional studies conducted on quantitative outcomes for remission, qualitative aspects -primarily patient experiences- are less likely to be explored. This study aimed to investigate experiences of participants who recently induced remission using a LCD in primary care.

Participants were recruited from two GP practices in England after receiving advice to follow a LCD by their GP and recently achieved T2DM remission. Semi-structured interviews were performed virtually, audio recorded and transcribed. The interview questions focussed on barriers and facilitators when adopting a new diet and lifestyle for inducing remission. Verbatim transcripts were analysed using Braun&Clarke’s(2) guide. Ethical approval was granted from Edge Hill University and the NHS (ETH2122-0228 and 22/SC/0451, respectively).

Twelve participants (4 female/8 male) completed the study. Mean ( ± SD) age of participants was 69 ± 8 years. Duration of T2DM prior to remission was 66 ± 54 months. Mean ( ± SD) HbA1c was 44 ± 2 mmol/mol. Thematic analysis yielded four overarching themes: 1) motivation, 2) empowerment and autonomy,3) challenges and 4) integrating LCD into daily life.

The analysis indicated that a behaviour change in participants was observed as evidenced by theme 4 integrating LCD into daily lives. In this theme, participants mentioned they built new habits such as reading food labels and cooking fresh meals, with new and more mindful attitudes towards food. Especially on days where they deviated from LCD, usually due to social events, they strived for balance and continued to follow LCD the next day.

“I just went for it. I just ate everything that was there. I sort of a budgeted in my head. So, OK, let’s go for this. This is for your birthday and enjoy it. Embrace it and then back to it tomorrow. Back to sensible eating tomorrow. I’m really proud of myself for what I’ve achieved so far. But you know when those moments come, I’ll probably just go with it.” P01

The findings aligned with a UK study(3) where participants who followed LCD found enjoyment in their food and they viewed LCD as a lifestyle change rather than a short-term fix, as well as allowing for some flexibility (striving for balance) within LCD. These factors were similarly observed in our study, and this facilitated adherence to LCD.

This study suggests that LCD advice by GPs was well-received by patients and was associated with positive lifestyle changes. Participants report that having some flexibility with LCD, such as taking breaks for special occasions, aided long term compliance. Initiatives that aim to encourage long-term compliance need to consider the importance of flexible management allowing participants to plan and recover from relapse.
Prevalence of non-dipping amongst adults with normal clinic blood pressure
Authors: Goland C.A , Heavey P.M , Cuskelly G.J
Published: December 2024

Hypertension is the leading risk factor for cardiovascular disease (CVD), responsible for approximately 12.8% of global deaths(1). Twenty-four hour ambulatory blood pressure monitoring (ABPM) is effective in detecting, confirming, and monitoring hypertension(2). In comparison to seated clinic blood pressure (CBP), ABPM assesses overall blood pressure (BP) variability across 24 hours, identifying specific additional components such as nocturnal hypertension and altered daytime to night-time BP profiles (i.e. non-dipping pattern of BP). Furthermore, a non-dipping BP profile is an independent risk factor for CVD(3)(4). This study aimed to measure the prevalence of non-dipping in apparently healthy males and females aged >50 years.

After approval by TUS Research Ethics Committee, 100 participants not on antihypertensive medication were recruited from various workplace locations in Athlone, Ireland. ABPM was measured using a Welch Allyn 7100 ABPM and CBP was measured using an Omron M3 BP monitor. CBP was measured on the day immediately after the ABPM was performed (same arm for both measurements). Standard protocols for ABPM were employed using the NICE Guidelines(5). Awake and asleep BP levels were computed as the mean of all readings during each period. Night time was determined according to patient reported sleep period. Nocturnal hypertension was defined as an asleep SBP/DBP ≥120/70 mmHg and non-dipping was defined as a decline in SBP from wakefulness to sleep of <10%.

Of 92 participants recruited, 85 completed both ABPM and CBP measurements of which n = 30 male. Participants were stratified into BP categories according to the International Society of Hypertension (ISH) reference ranges for CBP[6]. BP category was defined according to seated CBP and by the highest level of BP, whether systolic or diastolic[6]. Hypertensive BP groups (grades 1 and 2) were merged into one group and renamed as “hypertensive”

Thirty-seven participants had normal CBP (43.5%), 24 had high normal CBP (28.2%), and 24 were classified as hypertensive (28.2%) of which 16 (43.2%), 2 (8.3%) and 9 (37.5%) were non-dippers, respectively. Data analysis shows a significantly higher proportion of non-dippers than dippers in the normal CBP group (Chi square, p = 0.024) when compared to the higher CBP groups.

There is a high prevalence of non-dipping amongst adults with normal CBP. Therefore, CBP and ABPM classify adults differently with regard to BP status. Our results show the importance of using a combination of both CBP and ABPM to comprehensively determine BP status in adults over 50 years.
A qualitative study of barriers and facilitators of parental adherence to the Food Safety Authority of Ireland’s dietary guidelines for 1-to-5-year-olds
Authors: Eslami O. , Cuskelly GJ. , Cantwell M. , O’Connor Á.
Published: December 2024

In 2020, the Food Safety Authority of Ireland (FSAI) published, for the first time, food-based dietary guidelines for 1 to 5-year-olds. The guidelines highlight suboptimal intakes of vitamin D (VitD) and iron in toddlers and preschoolers. To help parents meet their child’s daily nutrient requirements, the FSAI recommends parents of 1-5 year-olds offer their child (1) a low-dose (5 μg/day) VitD-only supplement during the extended winter months (2) 30 g red meat three days a week and (3) 30 g ready-to-eat cereals (RTECs) with added iron (≥ 12 mg iron per 100 g) five days a week(1). Findings from our previous survey of parents of 1- to 5-year-olds (n = 185) revealed low awareness of, and adherence to, the FSAI recommendations (2). The present qualitative study aimed to gain insight into factors influencing parental guideline adherence.

One-to-one, online, semi-structured interviews were conducted among a sample of 15 parents of 1to-5-year-olds who had completed our online survey (2). Participants were college-educated mothers, with the majority being Irish and within the age range of 36 to 45 years old. The interviews investigated participants’ attitudes towards the recommended items and perceived barriers and facilitators of adherence to the recommendations. Qualitative data were analysed using Braun and Clarke’s six-phase thematic analysis framework (3), facilitated by NVivo 12 Plus software.

Thematic analysis identified five themes capturing factors that were perceived to influence guideline uptake by parents: (1) Perceptions of healthy eating (i.e., eating a varied, balanced, and nutrient-dense diet); (2) Impact of the community food environment on the accessibility of the recommended items (i.e., food price and availability in community settings); (3) The interplay between family members’ dietary preferences and meal choices within the familial food setting (e.g., child food dislikes and picky eating habits, as well as parents’ preferences and experiences about the recommended items); (4) Convenience in food preparation and supplement use (i.e., time, energy, and skills required to adhere to the recommendations); and (5) Gaps in communicating the guidelines and opportunities to promote them (i.e., visibility of credible nutrition-related information).

Overall, this study showed that guideline adherence is a complex, multi-dimensional phenomenon that is affected by individual factors, the food and nutrition environment. It highlights the need for implementing a holistic approach, such as the socio-ecological model, to improve guideline adherence that involves families, healthcare professionals, policymakers, and the food industry to create a supportive, positive food environment for parents.
Associations between macronutrient sources and psoriasis severity in a UK-based population: results from the Asking People with Psoriasis about Lifestyle and Eating study
Authors: Zanesco Sylvia , Maruthappu Thiviyani , Griffiths Christopher E.M. , Dalrymple Kathryn V. , Gibson Rachel , Hall Wendy L.
Published: December 2024

Psoriasis is a chronic dermatological disease often linked with systemic conditions such as cardiovascular disease, obesity, and type 2 diabetes(1). Unlike many other systemic diseases, psoriasis lacks specific dietary recommendations for its management(2). To develop evidencebased dietary advice, profiling dietary intakes in this population group is paramount. As part of the Asking People with Psoriasis about Lifestyle and Eating (APPLE) study, we aimed to quantify macronutrient intakes and their food group sources and assess associations with psoriasis severity.

The APPLE study is a web-based cross-sectional survey recruiting UK-based adult volunteers with psoriasis (King’s College London Research Ethics Committee LRS/DP-21/22-29257; NCT05448352). Recruitment was between June 2022 and January 2024 through social media. Participants self-reported age, weight, height, and alcohol use, depression or anxiety diagnosis, as well as psoriasis severity by responding to the self-assessed Simplified Psoriasis Index (possible score range 0-70 points). Diet was self-reported with a validated 147-item food frequency questionnaire. Nutritional composition was determined using the Composition of Food Integrated Dataset(3).Linear models tested associations between food groups sources and psoriasis severity.

The final sample (n = 270) primarily constituted mid-life (median (IQR) 40 (20) years), White-British (85%), female participants (82%) with psoriasis, of which 51% were living with overweight or obesity. Protein intake from animal sources (processed meat, poultry, and red meat) was significantly positively associated with psoriasis severity, adjusted for age, gender, smoking, alcohol use, energy intake, and diagnosed depression/anxiety (β between 0.133 and 0.225, P<0.05). Plant-based (excluding tree nuts) and tree nut sources of protein were inversely associated with psoriasis severity (adjusted β between −0.145 and −0.131, P<0.05). Protein from red meat and plant-based protein remained significantly associated with psoriasis when adjusting for BMI. Poultry and processed meat sources of n-6 polyunsaturated fatty acids were also positively associated with psoriasis severity (βbetween 0.125 and 0.133, P<0.05), whilst tree-nut sources were inversely associated with disease severity (β = −0.144, P<0.05), but associations were no longer significant when adjusting for BMI.

Our findings highlight that associations between psoriasis severity and protein and n-6 polyunsaturated fatty acids intakes depend on their source, suggesting that healthy plant-based diets warrant further investigation by randomised controlled trials for the dietary management of psoriasis.
Dietary flavonoid intakes are associated with lower risk of NAFLD: a UK biobank study
Authors: Bell W. , Jennings A. , Thompson A.S. , Bondonno N.P. , Tresserra-Rimbau A. , Kühn T. , Cassidy A.
Published: December 2024

Mechanistic studies and short-term randomised trials suggest that higher intakes of dietary flavonoids may protect against non-alcoholic fatty liver disease (NAFLD)(1–3). However, little research has been conducted at a population level, and to date no long term prospective study has assessed the associations between flavonoid intakes and NAFLD risk(4). We aim to perform the first population-based study with long-term follow-up on flavonoid consumption and NAFLD incidence.

In a prospective study, we assessed the associations between flavonoid intakes based on ≥2 24hour dietary assessments and NAFLD risk among 121,563 adults aged 40 to 69 years by multivariable regression analyses. Flavonoid intakes were assessed on three levels: a novel flavodiet score (FDS), flavonoid rich foods, and flavonoid subclasses. Cox proportional hazard models were used to assess NAFLD risk, and linear trend tests were used to test for significance. Additional sensitivity analysis was conducted using both a FDS excluding red wine, and non flavonoid containing equivalent foods as negative controls.

Over 10 years of follow-up, 1090 cases of NAFLD were observed. When compared to the lowest Quartile, the highest quartile (Q4) of the Flavodiet Score (FDS) was associated with a 20% lower risk of NAFLD (HR (95%CI): 0.80 (0.66−0.96), P trend = 0.02). Additionally, higher apple intake was associated with a 22% lower risk of NAFLD (HR (95%CI): 0.78 (0.66 - 0.92), P trend = <0.01), while higher tea consumption was associated with a 13% lower risk of NAFLD (HR (95%CI): 0.87 (0.73 -1.03), P trend = 0.046). Of the flavonoid subclasses, we observed that higher intakes of proanthocyanidins, theaflavins and thearubigins, flavonols and flavan-3-ols were also associated with lower risk.

In a large UK cohort, we demonstrate for the first time that flavonoid-rich diets, containing approximately 6-servings of flavonoid rich food per day, are associated with lower risk of NAFLD. As such, the consumption of flavonoid-rich foods may reduce the risk of NAFLD and its sequalae among middle-aged adults.
Association between carrot intake and cancer risk in a prospective observational study of >85-year-olds does not deviate from other age groups
Authors: Ojobor Charles C , Granic Antoneta , O’Brien Gerard M , Brandt Kirsten
Published: December 2024

Carrot consumption reduces tumour development in several animal models, possibly as sources of polyacetylenes, resistant starch, carotenes or other active constituents. In a recent systematic review and meta-analysis of prospective studies(1), we showed that carrot intake measured directly or using α-carotene as a marker of carrot intake was associated with reduced risk of cancer incidence. However, since the incidence of cancers among very old people (aged 85 and over) is lower than in those aged 65 to 85(2), it is of interest to understand how carrot intake affects cancer risk across different age groups. Here we compare the results from the Newcastle 85+ study3 and a meta-analysis of prospective studies1 of older adults aged 65-85 years at baseline.

In the Newcastle 85+ study(3) (n = 387, 65% women), baseline dietary carrot intake was assessed using a multiple-pass recall tool (2×24 h recalls) and α-carotene concentration measured in plasma samples by reverse phase high-performance liquid chromatography. Cancer incidence data were ascertained from medical records, and the association between carrot intake and α-carotene and cancer risk (any type) tested using multivariable Cox proportional hazard regression models. For the meta-analysis(1), mean ± SD of the reported upper age range at baseline in 50 studies (with 52000 cases) with data on carrot intake reported directly or indirectly (as α-carotene intake) was 68 ± 12 years, and in 30 studies (9331 cases) reporting plasma concentration of α-carotene it was 69 ± 9 years.

In the Newcastle 85+ study, the summary risk ratio (RR) for cancer incidence was 0.82 (95% CI: 0.24 – 2.79, n = 129 cases, 258 non-cases) for consumption of ≥ 1 vs < 1 serving/day of carrots after adjusting for key confounders. RR for cancer for the highest compared with lowest quartile of plasma α-carotene was 0.68 (0.33 –1.39). The corresponding values comparing highest versus lowest exposure groups for the younger age groups in the meta-analysis(1) were: RRs (95% CI) for carrot intake 0·90 (0·87–0·94) and 0·80 (0·72–0·89) for plasma α-carotene. For most (67 of 80) of the individual studies included in the meta-analysis, the RRs were not statistically significantly different from 1, as was the case for the Newcastle 85+ study, due to small sample size and limited duration of the dietary records. However, the similarity of the RR values from the Newcastle 85+ study with the two corresponding independent datasets in the meta-analysis means that the results do not support a difference in effect between the age groups.

The association of carrot consumption with incident cancer in the very old does not differ from younger age groups of older adults. Carrot consumption should be encouraged among the very old, and the causal mechanisms further investigated.
Effect of Beta- and Alpha-Carotene Intake on Tumour Formation in the Intestines of APCMin/+ Mice
Authors: Smith N. H. , Ojobor C.C. , Huang L. , Brandt K.
Published: December 2024

Carotene-rich vegetables like carrots have been consistently associated with lowered cancer risk in observational studies(1). Beta-carotene, a phytochemical found in fruits and vegetables, is known for its antioxidant properties. In rodent trials, supplementation with carrot (containing both carotenes and polyacetylenes) significantly reduced tumour numbers in the APCMin/+ mouse model(2). However, human intervention trials with pure beta-carotene showed more adverse effects than benefits(3). This study aimed to investigate the impact of beta- and alpha-carotene supplementation (without polyacetylenes) on colorectal cancer using the APCMin/+ mouse model, which spontaneously develops intestinal tumours and an enlarged liver(4).

APCMin/+ mice were fed either a daily supplement of 10mg/kg mouse of a polyacetylene-free extract from carrots containing a beta- and alpha-carotene mixture, in a dose corresponding to the beneficial carrot supplementation, or the control diet, with a very low beta-carotene content (providing approx. 0.02mg/kg mouse/day). The 8-week supplementation commenced at 5 weeks of age. Tumour quantification in the small intestines of APCMin/+ mice was performed by histology of the entire small intestine, with one slide per 0.3mm, using the H&E staining method and Imagescope software.

Supplementation with carotenes had no significant effect on the total number of tumours (≥0.5 mm), showing no discernible difference between the control (n = 6) (20.5, 95% CI [14.69, 26.31]) and treatment (n = 8) (24.5, [19.21, 29.79]) group (P = 0.237). However, the liver weight, in % of body weight, showed a significant 25% decrease in the treatment group (n = 7) (4.78 95% CI [4.45, 5.15]) compared to controls (6.42, [5.71, 7.13]) (P<0.0003), reaching a level comparable with wildtype mice (4.48, [4.13, 4.83].

These findings confirm the results from the human intervention trials by indicating that beta- and alpha-carotene do not confer any benefit for cancer prevention, while the decrease in liver weight suggests a potential beneficial effect on another aspect of liver health. Additional research is necessary to fully understand these relationships and uncover the underlying mechanisms behind these results. Specifically, beta-and alpha-carotene from carrots do not provide the reduction in tumour numbers in a mouse model of colon cancer found when feeding the corresponding dose of freeze-dried carrot. However, the carotenes significantly attenuate the liver enlargement also seen in this model.
Associations among dietary intake, gene polymorphisms and adipose fatty acid in TwinsUK study
Authors: Yan Xinyu , Costeira Ricardo , Tomlinson Max , Bell Jordana T. , Small Kerrin S.
Published: December 2024

Fatty acids are essential molecules, which function as structural components, energy sources, and signaling mediators(1). Subcutaneous adipose tissue (SAT) is the largest fat depot and plays a crucial role in maintaining health and homeostasis(2,3). While regulation and health impacts of circulating fatty acid levels are well established, less is known about the regulation of fatty acid levels within adipose tissue itself. The aim of this study was to investigate the effect of dietary and genetic contribution to fatty acid contents in adipose tissue and identify the interaction between single nucleotide polymorphism (SNP) and diet on adipose fatty acids.

In 427 healthy female twins from TwinsUK, 18 types of fatty acids were measured in SAT biopsies alongside genotype, RNA-Seq and clinical phenotypes. Dietary intake was collected by food frequency questionnaire. The associations between dietary intake and adipose fatty acids were tested with linear mixed models, adjusting for age, smoking, physical activity, index of multiple deprivation, energy intake, and relatedness. Genome-wide association studies (GWAS) were performed adjusting for age.

The association between dietary scores, food intake, nutrient intake and fatty acid levels in adipose tissue were examined. Most dietary scores were positively correlated with polyunsaturated fatty acid (PUFA) but negatively correlated with trans-unsaturated fatty acid (TFA) (PFDR < 0.05). We highlighted the positive association between polyunsaturated margarine and fish intake and PUFA levels, as well as butter and cream intake and saturated fatty acid (SFA) levels (PFDR < 0.05). Negative associations between fresh red meat including lamb and beef, butter, and cream intake and PUFA levels in adipose tissue were observed (PFDR < 0.05). Regarding nutrient intake, PUFA, SFA, TFA, cholesterol, vitamin D, and vitamin E were correlated with fatty acid levels in adipose tissue (PFDR < 0.05). To reveal local genetic regulation of fatty acids in adipose tissue, we performed GWAS and identified 10 fatty acid-associated genetic loci across 13 fatty acids (i.e. palmitic acid/palmitoleic acid – at the SCD locus, dihomo-γ-linolenic acid/arachidonic acid at the FADS1 locus, P < 5 × 10-8). The integration of adipose gene expression data revealed the mediation effects of SCD and FADS1 expressions in the associations between FADS1 SNP and the conversion of unsaturated fatty acids. We took forward two GWAS lead SNPs (SCD SNP and FADS1 SNP) to test the SNP-by-diet interaction on adipose fatty acids. Milk intake showed SNP-by-diet interaction with FADS1 SNP for linoleic acid and docosapentaenoic acid levels (P < 0.001). The interactions between roasted potatoes/chips and FADS1

SNP were significant for dihomo-γ-linolenic acid/linoleic acid (P < 0.001).

Adipose fatty acid levels were regulated by both genetic variants and dietary intake. We found suggestive evidence for the interaction of genetic variant and diet.