Vegetarian diets are consistently associated with improved health outcomes, and higher diet quality may contribute to improved health outcomes. This systematic review aims to qualitatively compare ...the a priori diet quality of vegetarian and nonvegetarian diets.
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, 2 online databases (Web of Science and PubMed) were searched for English language studies comparing diet quality among vegetarian and nonvegetarian adults using an a priori diet quality index. Two reviewers assessed study eligibility. Comparisons were made between total and component (when available) diet quality scores among the 12 studies meeting inclusion criteria.
Lacto-ovo vegetarians or vegans had higher overall diet quality (4.5-16.4 points higher on the Healthy Eating Index 2010 HEI-2010) compared with nonvegetarians in 9 of 12 studies. Higher HEI-2010 scores for vegetarians were driven by closer adherence to recommendations for total fruit, whole grains, seafood and plant protein, and sodium. However, nonvegetarians had closer adherence to recommendations for refined grains and total protein foods. Higher diet quality in vegetarian diets may partially explain improvements in health outcomes compared with nonvegetarians; however, more research controlling for known confounders like health consciousness is needed.
The evolution of dietary guidelines from isolated nutrients to broader dietary pattern recommendations results from growing knowledge of the synergy between nutrients and their food sources as they ...influence health. Macronutrient and micronutrient needs can be met by consuming various dietary patterns, but guidance is often required to facilitate population-wide adherence to wise food choices to achieve a healthy dietary pattern. This is particularly true in this era with the proliferation of nutrition misinformation and misplaced emphasis. In 2021, the American Heart Association issued a scientific statement outlining key principles of a heart-healthy dietary pattern that could be operationalized in various ways. The objective of this scientific statement is to assess alignment of commonly practiced US dietary patterns with the recently published American Heart Association criteria, to determine clinical and cultural factors that affect long-term adherence, and to propose approaches for adoption of healthy dietary patterns. This scientific statement is intended to serve as a tool for clinicians and consumers to evaluate whether these popular dietary pattern(s) promote cardiometabolic health and suggests factors to consider when adopting any pattern to improve alignment with the 2021 American Heart Association Dietary Guidance. Numerous patterns strongly aligned with 2021 American Heart Association Dietary Guidance (ie, Mediterranean, DASH Dietary Approaches to Stop Hypertension, pescetarian, vegetarian) can be adapted to reflect personal and cultural preferences and budgetary constraints. Thus, optimal cardiovascular health would be best supported by developing a food environment that supports adherence to these patterns wherever food is prepared or consumed.
Poor diet quality is strongly associated with elevated risk of cardiovascular disease morbidity and mortality. This scientific statement emphasizes the importance of dietary patterns beyond ...individual foods or nutrients, underscores the critical role of nutrition early in life, presents elements of heart-healthy dietary patterns, and highlights structural challenges that impede adherence to heart-healthy dietary patterns. Evidence-based dietary pattern guidance to promote cardiometabolic health includes the following: (1) adjust energy intake and expenditure to achieve and maintain a healthy body weight; (2) eat plenty and a variety of fruits and vegetables; (3) choose whole grain foods and products; (4) choose healthy sources of protein (mostly plants; regular intake of fish and seafood; low-fat or fat-free dairy products; and if meat or poultry is desired, choose lean cuts and unprocessed forms); (5) use liquid plant oils rather than tropical oils and partially hydrogenated fats; (6) choose minimally processed foods instead of ultra-processed foods; (7) minimize the intake of beverages and foods with added sugars; (8) choose and prepare foods with little or no salt; (9) if you do not drink alcohol, do not start; if you choose to drink alcohol, limit intake; and (10) adhere to this guidance regardless of where food is prepared or consumed. Challenges that impede adherence to heart-healthy dietary patterns include targeted marketing of unhealthy foods, neighborhood segregation, food and nutrition insecurity, and structural racism. Creating an environment that facilitates, rather than impedes, adherence to heart-healthy dietary patterns among all individuals is a public health imperative.
Allostatic load, a measure of stress-related physiologic dysregulation, is associated with numerous mortality risk factors. This systematic review and meta-analysis examines the relationship between ...high allostatic load (i.e., increased dysregulation versus low dysregulation) and mortality (cardiovascular disease and all-cause mortality).
Systematic searches of 2 databases conducted in May 2021 yielded 336 unique records; 17 eligible studies (2001–2020) were included.
High allostatic load was associated with increased risk of all-cause mortality across all the 17 individual studies (hazard ratio=1.08–2.75) and in 6 of 8 studies examining cardiovascular disease mortality (hazard ratio=1.19−3.06). Meta-analyses indicated that high allostatic load was associated with increased risk of all-cause mortality, overall (hazard ratio=1.22, 95% CI=1.14, 1.30, n=10) and across subgroups (hazard ratio=1.11−1.41), and similarly for cardiovascular disease mortality (hazard ratio=1.31, 95% CI=1.10, 1.57, n=6). Although studies were generally of good quality (n=13), heterogeneity was high in most pooled estimates (I2>90%).
In this review of relatively good-quality studies, high allostatic load was associated with an increased mortality risk of 22% for all-cause mortality and 31% for cardiovascular disease mortality. Thus, allostatic load is an emerging and potent modifiable risk factor for all-cause and cardiovascular disease mortality that shows promise as a prognostic indicator for mortality. The heterogeneity in allostatic load assessment across studies highlights the need for standardized measurement. The findings underscore the importance of allostatic load's dynamic nature, which may be especially relevant for mitigating mortality risk in younger adults. Because older adults are oversampled, future allostatic load research should prioritize younger adults and longitudinal monitoring and specific cardiovascular disease mortality risk associations and individualize behavioral and lifestyle targets for reducing allostatic load.
Obesity is a major public health threat and policies aimed at curbing this epidemic are emerging. National calorie labeling legislation is forthcoming and requires rigorous evaluation to examine its ...impact on consumers. The purpose of this study was to examine whether point-of-purchase calorie labels in New York City (NYC) chain restaurants affected food purchasing patterns in a sample of lower income adults in NYC and Newark, NJ.
This study utilized a difference-in-difference design to survey 1,170 adult patrons of four popular chain restaurants in NYC and Newark, NJ (which did not introduce labeling) before and after calorie labeling was implemented in NYC. Receipt data were collected and analyzed to examine food and beverage purchases and frequency of fast food consumption. Descriptive statistics were generated, and linear and logistic regression, difference-in-difference analysis, and predicted probabilities were used to analyze the data.
A difference-in-difference analysis revealed no significant favorable differences and some unfavorable differences in food purchasing patterns and frequency of fast food consumption between adult patrons of fast food restaurants in NYC and Newark, NJ. Adults in NYC who reported noticing and using the calorie labels consumed fast food less frequently compared to adults who did not notice the labels (4.9 vs. 6.6 meals per week, p <0.05).
While no favorable differences in purchasing as a result of labeling were noted, self-reported use of calorie labels was associated with some favorable behavioral patterns in a subset of adults in NYC. However, overall impact of the legislation may be limited. More research is needed to understand the most effective way to deliver calorie information to consumers.
Tumors display profound changes in cellular metabolism, yet how these changes aid the development and growth of tumors is not fully understood. Here we use a multi-omic approach to examine liver ...carcinogenesis and regeneration, and find that progressive loss of branched-chain amino acid (BCAA) catabolism promotes tumor development and growth. In human hepatocellular carcinomas and animal models of liver cancer, suppression of BCAA catabolic enzyme expression led to BCAA accumulation in tumors, though this was not observed in regenerating liver tissues. The degree of enzyme suppression strongly correlated with tumor aggressiveness, and was an independent predictor of clinical outcome. Moreover, modulating BCAA accumulation regulated cancer cell proliferation in vitro, and tumor burden and overall survival in vivo. Dietary BCAA intake in humans also correlated with cancer mortality risk. In summary, loss of BCAA catabolism in tumors confers functional advantages, which could be exploited by therapeutic interventions in certain cancers.
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•BCAA catabolism is lost during the development and progression of multiple cancers•BCAA catabolic enzyme expression predicts tumor aggressiveness and patient survival•Tumors display increased BCAA content and enhanced mTORC1 activation•Dietary BCAAs correlate with tumor burden in mice and cancer mortality in humans
Using a multi-omic approach to characterize normal, regenerating, and cancerous liver tissues in mice and humans, Ericksen et al. find that BCAA catabolism is lost during tumor development and progression, but maintained in normal proliferating cells. Tissue BCAA content is also influenced by dietary BCAA intake and affects mTORC1 activity.
Energy density (ED) and the variety of foods are 2 factors that may have a combined effect on preschool-aged children's ability to regulate food intake. However, little is known about the variety of ...foods consumed within different ED categories by children in the United States.
Therefore, we explored the variety of high ED (HED, 4-9 kcal/g) and very low ED (VLED, <0.6 kcal/g) foods consumed by a nationally representative sample of children aged 2-5 y in the United States and the relationship between variety with food intake, diet quality, and weight status.
ED, variety, and diet quality were assessed using two 24-h dietary recalls collected as part of the National Health And Nutrition Examination Survey 2011-2018 cycles (n = 1682). We assessed associations between HED and VLED varieties with energy intake, volume of food, diet quality, and weight status using multivariable linear and logistic regressions.
The HED variety was positively associated with energy intake (P < 0.0001). The VLED variety was positively associated with the volume of food (P < 0.0001) and diet quality (P < 0.0001). VLED was negatively associated with the odds of having obesity in minimally adjusted models odds ratio (OR): 0.62; 95% confidence interval (CI): 0.31, 0.87; however, the relationship was not significant in fully adjusted models. Patterns of variety intake were differently associated with energy, volume, and diet quality. Children consuming the high VLED variety and the low HED variety had lower odds of obesity OR: 0.43; 95% CI: 0.21, 0.90; however, this pattern was rare (10%).
These findings suggest that the variety of HED foods is associated with higher average energy intake per day, and the variety of VLED foods is associated with a higher volume of food consumed per day and diet quality in a nationally representative sample of preschool-aged children.
This secondary analysis explored the association between gestational weight gain, pre-pregnancy body mass index (BMI), and prenatal diet quality in a United States national sample. The sample ...comprised 1322 pregnant women in the longitudinal Infant Feeding Practices Study II with Diet History Questionnaire data. Diet quality in the third trimester was assessed using the Alternative Healthy Eating Index for Pregnancy. Self-reported pre-pregnancy BMI (categorized as underweight<18.5, normal weight 18.5-24.9, overweight 25.0-29.9, and obese≥30.0) and total gestational weight gain were used to categorize adherence to the Institute of Medicine's recommendations as inadequate, adequate, or excessive weight gain. Diet quality in pre-pregnancy BMI and gestational weight gain groups were compared using Tukey-adjusted generalized linear models adjusted for sociodemographic factors, Women, Infants, and Children participation, parity, and energy intake. Due to missing gestational weight gain data, sensitivity analyses with multiply imputed data were conducted. Women were on average 28.9 years old and of higher socioeconomic status (40% college graduates) and mostly non-Hispanic White (84%), and the mean Alternative Healthy Eating Index for Pregnancy score was 61.2 (of 130). Both pre-pregnancy BMI and gestational weight gain were inversely associated with diet quality scores (p<0.01). The interaction between pre-pregnancy BMI and gestational weight gain was significant (p = 0.04), therefore gestational weight gain models were stratified by BMI group. In stratified adjusted models, gestational weight gain was differently associated with diet quality scores (p<0.05) among women with underweight, normal weight, overweight, and obesity. The relationship between gestational weight gain and prenatal diet quality depended on pre-pregnancy BMI. For example, within women with normal weight, higher diet quality was observed in the adequate gestational weight gain group. Interventions to broadly improve prenatal diet quality are needed, however, resources can be used to target women with higher pre-pregnancy BMIs and women with inadequate or excessive gestational weight gain.
Personalized dietary behavioral interventions could be enhanced by understanding factors accounting for individual variability in dietary decisions.
This study was a secondary analysis of the Smart ...Cart randomized controlled trial to determine whether participant characteristics predicted high responsiveness to personalized grocery incentives for purchasing healthy food.
This secondary analysis of a 9-mo crossover study included 192 regular shoppers (86%) from a Rhode Island supermarket. To analyze whether health, behavioral, and/or sociodemographic characteristics predicted responsiveness to a personalized grocery incentive intervention, participants were divided into 3 categories high (n = 47), moderate (n = 50), and unresponsive (n = 95) based on percentage changes in their Grocery Purchase Quality Index scores during the intervention versus control period calculated from sales data. We tested whether participant characteristics, including individual, household, and intervention-related factors, differed across responsiveness groups using ANOVA and whether they predicted the likelihood of being high responsive versus unresponsive or moderate responsive using logistic regression.
Participants had a mean (SD) age of 56.0 (13.8) y and were 89% female. Education, self-reported BMI, income, diet-related medical condition, food insecurity, cooking adequacy, and value consciousness differed across responsiveness categories (P < 0.1). High versus moderate and unresponsive participants increased their percentage of spending on targeted foods (P < 0.0001) and purchased fewer unique items (P = 0.01). In multinomial adjusted models, the odds of being high versus unresponsive or moderate responsive were lower for participants with a BMI (in kg/m2) <25 versus ≥25 (OR: 0.41; 95% CI: 0.19, 0.90) and higher with a diet-related medical condition present (OR: 3.75; 95% CI: 1.20, 11.8). Other characteristics were not associated with responsiveness.
Findings demonstrated that a BMI ≥25 and having a diet-related medical condition within the household predicted high responsiveness to a personalized grocery purchasing intervention, suggesting that personalized dietary interventions may be particularly effective for households with higher health risk. This trial is registered at www.clinicaltrials.gov as NCT03748056.
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