bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.” P01The 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.
Influences on the dietary patterns and eating behaviours of 18–36-month-old toddlers in Ireland
Authors: Leen Smith Ben , Kiely Mairead E , McCarthy Elaine K 
Published: December 2024

Inadequate dietary intakes are widespread amongst pre-school aged children, with 56% of preschool children worldwide suffering from a deficiency in at least one of iron, zinc or vitamin A(1). The neurological and physical development of children is sensitive to changes in micronutrient status, with nutrient deficiencies at this age likely to have irreversible effects on childhood development(2). This study aims to evaluate the major influences on the dietary patterns, feeding practices and eating behaviours of young children in Ireland.A self-administered, web-based survey was administered to parents/guardians of 18-36 months old children. The survey consisted of 103 questions, delivered across 5 sub-sections (demographics, parental nutrition knowledge, feeding practice, barriers to healthy eating and dietary patterns). Validated questionnaires were used to assess fussy eating (Child Eating Behaviour Questionnaire, CEBQ) and parental feeding practice (Child Feeding Questionnaire,CFQ)(3–5). Adherence with the 2020 FSAI Scientific Recommendations for Food-Based Dietary Guidelines for 1-5-Year-Olds in Ireland was evaluated using FFQ-style questions to estimate consumption patterns of food groups.Parents/guardians (n = 1141) answered with respect to 608 male and 529 female toddlers, with a mean ( ± SD) age of 26.2 ± 5.8 months. The greatest barriers to healthy eating reported by parents/guardians were food fussiness (49%), time to prepare healthy foods (47%), provision of unhealthy foods by caregivers outside the home (47%), the short shelf life of “healthy foods” (42%) and the marketing of unhealthy foods to children (42%). The children’s food pyramid was recognised by 76% of parents. A large number of toddlers met the FSAI’s dietary recommendations for consumption of fish (70%) and fruit and vegetables (97%). Fewer children met the FSAI’s recommendations for consumption of processed meat (24%), beverages (40%), red meat (52%) and confectionary (57%).Using the CEBQ food fussiness scale, 36% had a score indicative of moderate to severe fussy eating (Score ≥ 3). Higher levels of food fussiness were noted among children who did not meet recommendations for consumption of red meat (2.81 vs 2.64, p = 0.001), fish (2.82 vs 2.68, p = 0.010) and confectionary (2.85 vs 2.62, p<0.001). The nutrition knowledge assessment showed that parents had a mean ( ± SD) knowledge score of 58.0 ± 14.6%. Higher knowledge scores were observed among parents/guardians of toddlers who met the dietary recommendations for dairy (64% vs 47%), fish (59% vs 56%), red meat (59% vs 57%), confectionary (59% vs 57%) and fruit and vegetables (58% vs 55%) (all p<0.05).This study highlights a multitude of interrelated and dynamic factors, particularly fussy eating and parental nutrition knowledge, that influence the dietary intakes and patterns of toddlers. Understanding these factors may help to guide the development of targeted multi-factorial interventions to improve dietary quality among toddlers.
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.