Current Developments in Nutrition
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Current Developments in Nutrition; doi:10.1093/cdn/nzaa022
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Current Developments in Nutrition; doi:10.1093/cdn/nzaa021
Abstract:Background Women without cardiovascular disease (CVD) or hypertension at baseline assigned to intervention in the Women's Health Initiative Dietary Modification (DM) trial experienced 30% lower risk of coronary heart disease (CHD), while results among women with hypertension or prior CVD may have been confounded by post-randomization use of statins. Objective Intervention participants reported various self-selected changes to achieve the 20% total fat goals. Reviewed are intervention versus comparison group hazard ratios for CHD, stroke, and total CVD in relation to specific dietary changes among normotensive participants. Methods Dietary change was assessed by comparing baseline to year 1 food frequency questionnaire (FFQ) data among women (n = 10,371) without hypertension or CVD at baseline with intake of total fat above the median to minimize biases due to use of the FFQ in trial eligibility screening. Results Intervention participants self-reported compensating reduced energy intake from total fat by increasing carbohydrate and protein. Specifically they increased plant protein, with those in the upper quartile (increased total protein by 3.3% of energy or more) having CHD hazard ratio (95% confidence interval) of 0.39 (0.22, 0.71), compared to 0.92(0.57, 1.48) for those in the smallest quartile of change (decreased total protein 0.6% or more of energy), with trend p-value of 0.04. CHD hazard ratio did not vary significantly with change in % energy from carbohydrate, and stroke hazard ratio did not vary significantly with any macronutrient changes. Scores reflecting adherence to recommended dietary patterns including the Dietary Approaches to Stop Hypertension (DASH) and the Healthy Eating Index (HEI) showed favorable changes in the intervention group. Conclusions Intervention group total fat reduction replaced with increased carbohydrate and some protein, especially plant-based protein, was related to lower CHD risk among normotensive women without CVD who reported high baseline total fat intake. This trial was registered at clinicaltrials.gov as NCT00000611. Link to the WHI trial protocol: https://www.whi.org/about/SitePages/Dietary%20Trial.aspx.
Current Developments in Nutrition; doi:10.1093/cdn/nzaa019
Abstract:Background Recent observational data and a controlled in-patient cross-over feeding trial show that consumption of “ultra-processed foods” (UPF) as defined by the NOVA classification system, is associated with higher energy intake, adiposity and at a population level, higher prevalence of obesity. A drawback of the NOVA classification is the lack of evidence supporting a causal mechanism for why UPF's lead to over-consumption of energy. In the recent study of Hall et al (2019) the energy intake rate in the UPF condition (48 kcal/min) was more than 50% higher than in the unprocessed condition (31 kcal/min). Extensive empirical evidence has shown the impact higher energy-density has on increasing ad libitum energy intake and body weight. A significant body of research has shown that consuming foods at higher eating rates is related to higher energy intake and a higher prevalence of obesity. Energy density can be combined with eating rate to create a measure of energy intake rate (kcal/min), providing an index of a food's potential to promote increased energy intake. Objective(s) The current paper compared the association between measured energy intake rate and level of processing as defined by the NOVA classification. Methods Data was pooled from 5-published studies that measured energy intake rates across a total sample of 327 foods. Results We show that going from unprocessed, to processed, to UPF the average energy intake rate increases from 35.5 ± 4.4, to 53.7 ± 4.3, to 69.4 ± 3.1 kcal/min (P < 0.05). However, within each processing category there is wide-variability in the energy intake rate. Conclusions We conclude that reported relationships between UPF consumption and obesity should account for differences in energy intake rates when comparing unprocessed and ultra-processed diets. Future research requires well-controlled human feeding trials to establish the causal mechanisms for why certain UPF's can promote higher energy intake.
Current Developments in Nutrition; doi:10.1093/cdn/nzaa020
Abstract:Malnutrition is a major concern in low- and middle-income countries (LMICs), but the full extent of nutritional deficiencies remains unknown largely due to lack of accurate assessment methods. This study seeks to develop and validate an objective, passive method of estimating food and nutrient intake in households in Ghana and Uganda. Household members (including under-5 s and adolescents) are assigned a wearable camera device to capture images of their food intake during waking hours. Using custom software, images captured are then used to estimate an individual's food and nutrient (i.e., protein, fat, carbohydrate, energy and micronutrients) intake. Passive food image capture and assessment provides an objective measure of food and nutrient intake in real-time, minimizing some of the limitations associated with self-reported dietary intake methods. Its use in LMICs could potentially increase the understanding of population's nutritional status, and the contribution of household food intake to the malnutrition burden. Trial Registration: This project is registered at ClinicalTrials.gov; Identifier: NCT03723460.
Current Developments in Nutrition; doi:10.1093/cdn/nzaa018
Abstract:Background Iron accrued in utero is critical for fetal and infant neurocognitive development. Psychosocial stress and obesity may each suppress fetal iron accrual. Their combined effects and differences by fetal sex are not known. In an observational pregnancy cohort study in Mexico City, we investigated associations of maternal prenatal life stressors, psychological dysfunction, and pre-pregnancy BMI with fetal iron status at delivery. Objective We hypothesized that greater maternal prenatal psychosocial stress and pre-pregnancy overweight and obesity is associated with lower cord blood ferritin and hemoglobin (Hb), with stronger associations in boys than girls. Methods Psychosocial stress in multiple domains of life stress (negative life events (NLEs), perceived stress, exposure to violence) and psychological dysfunction symptoms (depression, generalized anxiety and pregnancy-specific anxiety) were assessed with validated questionnaires during pregnancy. Pre-pregnancy BMI was predicted with a validated equation and categorized as normal/overweight/obese. Cord blood ferritin and Hb associations with prenatal psychosocial stress and BMI were modeled in multivariable linear regressions adjusted for maternal age, SES, child sex and prenatal iron supplementation. Interactions with child sex and 3-way stress-overweight/obesity-sex interactions were tested with product terms and likelihood ratio tests. Results In 493 dyads, median (IQR) cord blood ferritin and Hb were 185 µg/L (126–263) and 16 g/dL (14.7–17.1), respectively. Ferritin was lower in infants of mothers with higher prenatal perceived stress (-23%, 95% CI: -35, -9), violence exposure (-28%, -42, -12), anxiety symptoms (-16%, -27, -4), and obesity (-17%, -31, 0.2). Interaction models suggested sex differences and synergism between maternal stress and overweight/obesity. No associations were observed between stress or BMI and Hb. Conclusions Multiple prenatal psychosocial stressors and excess pre-pregnancy BMI were each inversely associated with fetal iron status at birth. Synergism between stress and obesity and sex-specific effects suggest pregnancies and infants at highest risk of impaired fetal iron accrual.
Current Developments in Nutrition; doi:10.1093/cdn/nzaa013
Abstract:Motivations to adopt plant-based diets are of great public health interest. We used evidence mapping to identify methods that capture motivations to follow plant-based diets and summarize demographic trends in dietary motivations. We identified 56 publications that described 90 samples of plant-based diet followers and their dietary motivations. We categorized the samples by type of plant-based diet: vegan (19%), vegetarian (33%), semi vegetarian (24%), and other, unspecified plant-based diet followers (23%). Of 90 studies examined, 31% administered multiple choice questions to capture motivations, followed by rate items (23%), Food Choice Questionnaire (17%), free response (9%), and rank choices (10%). Commonly reported motivations were health, sensory/taste/disgust, animal welfare, environmental concern, and weight loss. The methodological variation highlights the importance of using a structured questionnaire to investigate dietary motivations in epidemiological studies. Motivations among plant-based diet followers appear distinct, but evidence on the association between age and motivations appears limited.
Current Developments in Nutrition; doi:10.1093/cdn/nzaa011
Abstract:Background The ongoing negative health effects of colonization have disproportionately affected Indigenous women, who are disproportionately affected by diabetes, food insecurity and undernutrition. Indigenous women also perceive their health less positively than men. This paper draws theoretically from the socio-ecological model to explore health inequalities experienced by Indigenous women associated with the intergenerational effects of the residential school legacy, specifically related to food practices. Objectives Study objectives were to describe and compare the historical context of present-day urban and rural food environments, and explore the hypothesis that food insecurity may be associated with cultural loss resulting from the intergenerational trauma of residential schools in this region of southwestern Ontario, Canada. Methods Framed by a larger community-based participatory study, life history interviews took place with 18 Elder women living on- and off-reserve in southwestern Ontario, Canada. Results Women discussed painful circumstances of displacement from the land and social disconnection from families and communities. The ten participants who were residential school survivors conveyed the intergenerational effects of loss, responsibility, lack of support and an altered sense of identity as narratives of survival. Six women had moved away from their home communities, which created challenges to fully engage in local food procurement and sharing practices. These altered geographies present practical limitations, along with apparent mechanisms of social and cultural exclusion. Conclusions Research on Indigenous Peoples’ food systems requires further analysis of the root causes of disparities in the context of societal and gender relations. Food sovereignty has been the domain of women, who have led movements aimed at both social and environmental justice. Unraveling the historical, social, and environmental determinants of Indigenous food knowledge will support and guide community and policy recommendations, highlighting the ongoing effects of residential schooling and other indirect examples of environmental dispossession that have disproportionately affected Indigenous women.
Current Developments in Nutrition; doi:10.1093/cdn/nzaa015
Abstract:The purpose of this research is to compare the global reference diet from the EAT-Lancet Commission on Healthy Diets from Sustainable Food Systems with the healthy eating patterns from the 2015–2020 Dietary Guidelines for Americans. Conversion factors were developed to quantitatively compare the patterns. These factors are provided to enable investigators to incorporate the EAT-Lancet diet into analyses while maintaining relevance to US-based dietary guidance. Our findings show several areas of agreement between EAT-Lancet and the Dietary Guidelines for Americans, but key differences in the amounts of whole grains, fruit, starchy vegetables, red meat, nuts and seeds, and discretionary calories. Many of the differences between the patterns reflect divergent approaches to developing dietary recommendations, not only in the methods used but also whether current food consumption patterns are considered as constraints on recommendations. Continued interdisciplinary collaboration is needed to advance dietary guidance that promotes sustainable nutrition.
Current Developments in Nutrition; doi:10.1093/cdn/nzaa014
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Current Developments in Nutrition; doi:10.1093/cdn/nzaa016
Abstract:Background Pregnant women belonging to agricultural communities of low- and middle-income countries often face seasonal food insecurity and energy stress. Objective To investigate the effect of maternal exposure to different seasons during the second and third trimester of pregnancy on infant birthweight in rural Bangladesh. Methods Information on 3,831 singleton live births was obtained from the electronic databases of Matlab Health and Demographic Surveillance System and Matlab hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b). We collected information on all term births from July 2011 to June 2015 and excluded congenital anomalies and observations with missing data. Each year was divided into three distinct seasons: the post-aman harvest period (January-April), the height of the monsoon (May-August) and the post-aus harvest period (September-December). Seasonal exposure was measured in weeks, and multivariable linear regression models were fitted to determine the independent effect of each week exposure of different seasons during the second and third trimesters of pregnancy on birthweight. Results We observed peak birthweight in post-aman harvest season, especially among babies born in March (2930.5 ± 462.1 gm) and the lowest birthweight in the month of July (2830.6 ± 385.4 gm) during the monsoon season. Regression analysis showed that exposure to post-aman harvest season during the third trimester, and post-aus harvest period during the second trimester of pregnancy had significant positive effects on birthweight. In the final adjusted model, each week exposure to post-aman harvest season during third trimester is associated with 6.3 gm (95% CI: 1.6, 10.9; p = 0.008) increase in birthweight. Conclusions Infants born to women who have been exposed to the post-aman harvest season for the entire third trimester (14 weeks) are associated with 88.2 g higher weight at birth. Further investigations into the complex interplay between seasonal energy stress, maternal, and fetal nutrition and measures to alleviate it are warranted.