The latest medical research on Bariatric Surgery

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Trends and Inequities in Food, Energy, Protein, Fat, and Carbonhydrate Intakes in Rural Bangladesh.

Journal of Nutrition

Tracking dietary changes can inform strategies to improve nutrition, yet there is limited evidence on food consumption patterns and how disparities in food and nutrient intakes have changed in Bangladesh.

We assessed trends and adequacies in energy and macronutrient intakes and evaluated changes in inequities by age group, sex, and expenditure quintile.

We used panel data from the 2011 and 2018 Bangladesh Integrated Household Survey (n = 20,339 and 19,818 household members ≥ 2 years, respectively). Dietary intakes were collected using 24-hour recall and food-weighing methods. Changes in energy and macronutrient intakes were assessed using generalized linear models and adjusted Wald tests. Inequities in outcomes were examined by age group, sex, and expenditure quintile using the Slope Index of Inequality and Concentration Index.

Between 2011 and 2018, dietary diversity improved across sex and age groups (30-46% in children, 60-65% in adolescents, 37-87% in adults), but diets remain imbalanced with around 70% of energy coming from carbohydrates. There were declines in intakes of energy (3-8%), protein (3-9%), and carbohydrate (9-16%) for all age groups (except children 2-5 years), but an increase in fat intake (57-68% in children and 22-40% in adults). Insufficient intake remained high for protein (>50% among adults) and fat (>80%) while excessive carbohydrate intake was > 70%. Insufficient energy, protein, and fat intakes, and excessive carbohydrate intakes were more prevalent among poor households across survey years. Inequity gaps reduced for insufficient energy intake in most age groups, remained stable for insufficient protein intake, and increased for insufficient fat and excessive carbohydrate intakes.

Despite improvements in dietary diversity, diets remain imbalanced and inequities in insufficient energy, protein, and fat intakes persist. Our findings call for coherent sets of policies and investments toward a well-functioning food system and social protection to promote healthier, more equitable diets in rural Bangladesh.

Threshold of Body Mass Index for the Development of Hypertension Among Japanese Adults.

Journal of Nutrition

The optimal value of body mass index (BMI) for the development of hypertension and the influence of BMI on the development of stage 1 or stage 2 hypertension remain unclear.

We sought to identify the BMI threshold for the prevention of hypertension and how changes in BMI would influence the risk of developing hypertension.

We analyzed 1,262,356 participants (median age;43 years;50.9% men) with normal blood pressure (BP) (systolic BP [SBP]< 120 mmHg and diastolic BP [DBP]< 80 mmHg) or elevated BP (SBP 120-129 mmHg and DBP < 80 mmHg). The primary outcome was stage 1 (SBP 130-139 mmHg or DBP 80-89 mmHg) or stage 2 hypertension (SBP ≥ 140 mmHg or DBP ≥ 90 mmHg). We analyzed the relationship between baseline BMI, change in BMI, and the risk of developing hypertension using generalized additive models with a smoothing spline.

During the median follow-up of 851 days, 341,212 cases of stage 1 hypertension and 70,968 cases of stage 2 hypertension were detected. The risk of developing stage 1 or stage 2 hypertension increased steeply after BMI exceeded 20 kg/m2. The annual change in BMI was positively correlated with the risk of developing stage 1 or 2 hypertension. Contour mapping using generalized additive models demonstrated an additive increase in the risk of developing hypertension with higher baseline BMI and increases in BMI over one year. Body weight gain increases the risk of developing hypertension even in underweight or normal-weight individuals based on the World Health Organization classification.

In Japanese adults with normal or elevated BP, risk of developing hypertension increased with BMI when baseline BMI was greater than 20 kg/m². Body weight gain additively interacted with baseline BMI during hypertension development. Our results underscore the importance of maintaining body weight in preventing the development of hypertension.

Access to Workplace Supports is Positively Associated with Exclusive Breastfeeding Among Formally Employed Mothers in Kenya.

Journal of Nutrition

Mothers in low-income settings work in agricultural employment are challenged to meet breastfeeding (BF) recommendations. Recent legislation in Kenya mandates maternity leave and workplace supports, yet the relationship of these benefits with BF practices is poorly understood.

We evaluated the associations with workplace-provided BF supports and BF practices among formally employed mothers in Kenya. The availability of supports was hypothesized to be associated with a higher prevalence and greater odds of exclusive breastfeeding (EBF).

We conducted repeated cross-sectional surveys among formally employed mothers at 1-4 days, 6 weeks, 14 weeks, and 36 weeks (to estimate 24 weeks) postpartum in Naivasha, Kenya. We used logistic regression, adjusted for maternal age, education, physical burden of work, HIV status, and income, to evaluate associations between workplace supports and EBF practices.

Among formally employed mothers (n = 564), those who used onsite workplace childcare were more likely to practice EBF than those who used community- or home-based childcare at both 6 weeks (95.7% versus 82.4%, p = 0.030) and 14 weeks (60.6% versus 22.2%, p < 0.001; (aOR: 5.11, 95% CI: 2.3, 11.7). Likewise, at 14 weeks, among mothers who currently used daycares, a higher proportion who visited daycares at or near workplaces practiced EBF (70.0%) than those not visiting a daycare (34.7%, p = 0.005). EBF prevalence was higher among mothers with access to workplace private lactation spaces than those without such spaces (84.6% vs. 55.6%, p = 0.037), and among mothers who lived in workplace housing than those without onsite housing (aOR: 2.06, 95% CI: 1.25, 3.41).

Formally employed mothers in Kenya who have access to and use workplace-provided BF supports were more likely to practice EBF than mothers who lacked these supports. As the Kenya Health Act is implemented, lactation rooms, onsite housing and daycare, and transportation to visit children can support employed mothers' breastfeeding.

Diet Patterns Are Associated With Circulating Metabolites and Lipid Profiles of South Asians in the United States.

Journal of Nutrition

South Asians are at higher risk for cardiometabolic disease than many other racial/ethnic minority groups. Diet patterns in U.S. South Asians have unique components associated with cardiometabolic disease.

We aimed to characterize the metabolites associated with three representative diet patterns.

We included 722 participants in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) cohort study aged 40-84 years without known cardiovascular disease. Fasting serum specimens and diet and demographic questionnaires were collected at baseline and diet patterns previously generated through principal components analysis. LC-MS-based untargeted metabolomic and lipidomic analysis was conducted with targeted integration of known metabolite and lipid signals. Linear regression models of diet pattern factor score and log-transformed metabolites adjusted for age, sex, caloric intake and body mass index and adjusted for multiple comparisons was performed, followed by elastic net linear regression of significant metabolites.

There were 443 metabolites of known identity extracted from the profiling data. The 'Animal protein' diet pattern was associated with 61 metabolites and lipids; including glycerophospholipids PE(O-16:1/20:4) and/or PE(P-16:0/20:4) (β 0.13; 95% Confidence Interval (CI) [0.11, 0.14]) and N-acyl phosphatidylethanolamines (NAPE) NAPE(O-18:1/20:4/18:0) and/or NAPE(P-18:0/20:4/18:0) (β: 0.13; 95%CI [0.11, 0.14]), LPI (22:6/0:0) (β 0.14; 95% CI [0.12, 0.17]) and fatty acids FA (22:6) (β: 0.15; 95% CI [0.13, 0.17]. The 'Fried snacks, sweets, high-fat dairy' pattern was associated with 12 lipids; including PC(16:0/22:6) (β: -0.08; 95%CI[-0.09, -0.06]) and FA(22:6) (β 0.14; 95%CI [-0.17, -0.10]). The 'Fruits, Vegetables, Nuts and Legumes' pattern was associated with five metabolites including proline betaine (β: 0.17 [0.09, 0.25]) [p < 0.0002].

Three predominant dietary patterns in U.S. South Asians are associated with circulating metabolites differentiated by lipids including glycerophospholipids and polyunsaturated fatty acids and the amino acid proline betaine.

Fecal Metabolites as Biomarkers for Predicting Food Intake By Healthy Adults.

Journal of Nutrition

The fecal metabolome is impacted by diet and includes metabolites generated by human and microbial metabolism. Advances in -omics technologies and analytic approaches have allowed researchers to identify metabolites and better utilize large datasets to generate usable information. One promising aspect of these advancements is the ability to determine objective biomarkers of food intake.

We aimed to utilize a multivariate, machine learning approach to identify metabolite biomarkers that accurately predict food intake.

Data were aggregated from five controlled feeding studies in adults that tested the impact of specific foods (almonds, avocados, broccoli, walnuts, barley, and oats) on the gastrointestinal microbiota. Fecal samples underwent gas chromatography-mass spectrometry (GC-MS) metabolomic analysis; 307 metabolites were detected. Changes in metabolite relative concentration (treatment post-intervention minus pre-intervention) were utilized in random forest models to 1) examine the relationship between food consumption and fecal metabolome changes and 2) rank the fecal metabolites by their predictive power (i.e., feature importance score).

Using the change in relative concentration of fecal metabolites, six single-food random forest models for almond, avocado, broccoli, walnuts, whole-grain barley, and whole-grain oats revealed prediction accuracies between 47% and 89%. When comparing foods to one another, almond intake was differentiated from walnut intake with 91% classification accuracy.

Our findings reveal promise in utilizing fecal metabolites as objective complements to certain self-reported food intake estimates. Future research on other foods at different doses and dietary patterns is needed to identify biomarkers that can be applied in feeding study compliance and clinical settings.

Associations of Biomarker-Calibrated HEI-2010 Scores With Chronic Disease Risk and Their Dependency On Energy Intake and Body Mass Index in Postmenopausal Women.

Journal of Nutrition

Prior studies examined associations between Healthy Eating Index (HEI) and chronic disease risk based on self-reported diet without measurement error correction.

Our objective was to test associations between biomarker-calibration of food frequency questionnaire (FFQ)-derived HEI-2010 with incident cardiovascular disease (CVD), cancer, and type 2 diabetes (T2D) among Women's Health Initiative (WHI) participants. WHI is registered at NCT00000611.

Data were derived from WHI postmenopausal women (n = 100,374) aged 50-79 y at enrollment (1993-1998) at 40 US clinical centers, linked to nutritional biomarker substudies and outcomes over subsequent decades of follow-up. Baseline or year 1 FFQ-derived HEI-2010 scores were calibrated with nutritional biomarkers and participant characteristics [e.g., body mass index (BMI)] for systematic measurement error correction. Calibrated data were then used in hazard ratio (HR) models examining associations with incidence of CVD (total, subtypes, mortality), cancer (total, subtypes, mortality), and T2D in WHI participants with approximately two decades of follow-up. Models were multivariable-adjusted with further adjustment for BMI and doubly-labeled water (DLW)-calibrated energy.

Multivariable adjusted HRs modeled a 20% increment in HEI-2010 score in relation to outcomes. HRs were modest using uncalibrated HEI-2010 scores (HRs = 0.91-1.09). Using biomarker calibrated HEI-2010, 20% increments in scores yielded multivariable-adjusted HRs (95%CIs) of: 0.75 (0.60-0.93): coronary heart disease; 0.75, (0.61.-0.91): myocardial infarction; 0.96 (0.92-1.01): stroke; 0.88 (0.75-1.02): CVD mortality; 0.81 (0.70-0.94): colorectal cancer; 0.81 (0.74-0.88): breast cancer; 0.79 (0.73-0.87): cancer mortality; and 0.45 (0.36-0.55): T2D. Except for cancer mortality and T2D incidence, results became null when adjusted for DLW-calibrated energy intake and BMI.

Biomarker calibration of FFQ-derived HEI-2010 was associated with lower CVD and cancer incidence and mortality and lower T2D incidence in postmenopausal women. Attenuation after adjustment with BMI and DLW-calibrated energy suggest that energy intake and/or obesity are strong drivers of diet-related chronic disease risk in postmenopausal women.

Participant Characteristics Associated With High Responsiveness to Personalized Healthy Food Incentives: a Secondary Analysis of the Randomized Controlled Crossover Smart Cart Study.

Journal of Nutrition

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-month 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 % 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 analysis of variance and whether they predicted the likelihood of being high vs. unresponsive or moderate responsive using logistic regression.

Participants had a mean (SD) age of 56.0 (13.8) years 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 % 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 < 25 versus ≥ 25 kg/m2 (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 BMI ≥25 kg/m2 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. Clinical Trial Registry: (Identifier: NCT03748056).

Dietary macronutrients and Circulating Non-esterified Fatty Acids: A Secondary Analysis of the OMNI Heart Crossover Trial.

Journal of Nutrition

Non-esterified fatty acids (NEFAs) play key roles in the pathophysiology of diabetes and cardiovascular disease (CVD).

We sought to determine whether macronutrient content differences affect NEFA concentrations in a randomized crossover trial.

Total NEFAs were measured from post intervention specimens of participants in the Optimal Macronutrient Intake Trial to Prevent Heart Disease (OMNI Heart). OMNI Heart compared three healthful diets- carbohydrate-rich diet (58%CHO); protein-rich diet (25%PRO), about half from plant sources; and a diet rich in unsaturated fatty acids (21%UFA), predominantly monounsaturated fatty acids- to evaluate their effect on systolic blood pressure and serum LDL cholesterol. The trial included 164 participants who consumed the 3 diets, each for 6 weeks. Data from the 156 participants with unthawed serum available from the week 6 visit for all diet periods were analyzed. We used analysis of covariance (ANCOVA) and generalized estimating equations (GEE) to compare serum NEFA concentrations across the 3 diet periods.

The mean age of study participants was 52.9 (±10.6) years, and mean body-mass index (BMI) was 30.3 (6.1). Fifty-five percent of participants were women, and 55% were African American. Comparisons of adjusted mean serum NEFA concentrations after each diet intervention identified no statistically significant differences (58%CHO = 0.144±0.083mEq/L; 25%PRO = 0.143±0.076mEq/L; 21%UFA = 0.143±0.084mEq/L; ANCOVA p-value = 0.99). Likewise, we observed no significant serum NEFA concentration difference by diet in adjusted GEE models. In adjusted models, serum NEFA concentrations were positively associated, as anticipated, with female sex and with higher BMI.

In this randomized crossover trial, we observed nearly identical serum NEFA concentrations after each of three healthful diets, regardless of macronutrient content.

Early Childhood Lutein and Zeaxanthin Intake is Positively Associated with Early Childhood Receptive Vocabulary and Mid-childhood Executive Function but no Other Cognitive or Behavioral Outcomes in Project Viva.

Journal of Nutrition

Lutein and zeaxanthin are carotenoids associated with better cognition in older adults. Recent evidence suggest that their dietary intake may also have cognitive implications in childhood.

To examine associations of early childhood lutein and zeaxanthin (L/Z) intake with cognition in early and mid-childhood.

Among 1378 children in Project Viva, a prospective cohort, mothers reported their child's dietary intake in early childhood (median 3.2 years) using a food frequency questionnaire. Child cognition and behavior were assessed at the same timepoint using the Peabody Picture Vocabulary Test (PPVT-III) and the Wide Range Assessment of Visual Motor Abilities (WRAVMA); and at mid-childhood (median 7.7 years) using the Kaufman Brief Intelligence Test, the WRAVMA drawing subtest, the Wide Range Assessment of Memory and Learning, the Behavior Rating Inventory of Executive Function (BRIEF), and the Strengths and Difficulties Questionnaire.

Children consumed a daily mean (SD) of 1.0 (0.4) mg of L/Z in early childhood. Children in the third quartile category of L/Z intake had a mean PPVT-III score 2.40 (95%CI: 0.27, 4.53) points higher than children in the lowest quartile category in early childhood, suggesting better receptive vocabulary. Children in the highest quartile category of L/Z intake had a parent-reported mean BRIEF Global Executive Composite score 1.65 (95%CI: -3.27, -0.03) points lower than children in the lowest quartile category in mid-childhood, indicating better executive function. We did not observe associations between L/Z intake and any of the other cognitive or behavioral outcomes assessed.

The overall findings do not provide strong evidence of an association between child L/Z intake and cognition and behavior. However, the positive associations found between early childhood L/Z intake and early childhood receptive vocabulary and mid-childhood executive function, in addition to previous evidence of neurodevelopmental benefit of L/Z intake, suggest that this relationship deserves further investigation.

Testing the Feasibility and Dietary Impact of a "Produce Prescription" Program for Adults with Undermanaged Type 2 Diabetes and Food Insecurity in Australia.

Journal of Nutrition

There is growing interest in Food is Medicine programs that incorporate food-based interventions into health care for patients with diet-related conditions.

We aimed to test the feasibility of a "produce prescription" program and its impact on diet quality for people with type 2 diabetes (T2D) experiencing food insecurity in Australia.

We conducted a pre-post intervention study in n = 50 adults experiencing food insecurity with T2D and glycated hemoglobin (HbA1c) ≥8%. Once enrolled, participants received healthy food boxes weekly free of charge, with the contents sufficient to create 2 meals/d, 5 d/wk for the entire household, over 12 wk. Participants were also provided with tailored recipes and behavioral change support. The primary outcome was change in diet quality assessed by 24-h diet recalls. Secondary outcomes included differences in cardiovascular disease risk factors; blood micronutrients; and feasibility indicators. Differences in the baseline and 12-wk mean primary and secondary outcomes were assessed by paired t tests.

Participants were older adults with mean ± SD age 63 ± 9 y (range: 40-87 y), HbA1c 9.8% ± 1.5%, and 46% were female. Overall, 92% completed the final study follow-up for the primary outcome. Compared with baseline, diet quality improved at week 12, with an increase in the mean overall diet quality (Alternate Healthy Eating Index score) of 12.9 (95% CI: 8.7, 17.1; P < 0.001), driven by significant improvements in vegetables, fruits, whole grains, red/processed meat, trans fat, sodium, and alcohol consumption. Blood lipids also improved (total:HDL cholesterol: -0.48; 95% CI: -0.72, -0.24; P < 0.001), and there was significant weight loss (-1.74 kg; 95% CI: -2.80, -0.68 kg, P = 0.002), but no changes in other clinical outcomes. Participants reported high levels of satisfaction with the program.

These findings provide strong support for an adequately powered randomized trial to assess effects of produce prescription as an innovative approach to improve clinical management among individuals with T2D experiencing food insecurity.This trial was registered at as ACTRN12621000404820.

Higher Dietary Intake of Animal Protein Foods in Pregnancy is Associated with Lower Risk of Adverse Birth Outcomes.

Journal of Nutrition

The prevalence of adverse birth outcomes is highest in resource-limited settings such as sub-Saharan Africa. Maternal consumption of diets with adequate nutrients during pregnancy may protect against these adverse outcomes.

To determine the association between maternal dietary animal source foods (ASF) consumption and the risk of adverse birth outcomes among HIV-negative pregnant women in Tanzania.

Using dietary intake data from 7564 HIV-negative pregnant, we used Poisson regression with the empirical variance (GEE) to estimate the relative risk (RR) of adverse birth outcomes (preterm birth, very preterm birth, small for gestation age (SGA), low birth weight (LBW), stillbirth and neonatal death) for higher versus lower ASF frequency of intake.

Median (interquartile range) daily dietary intake of animal protein was 17 (1-48) grams. Higher ASF protein intake frequency was associated with lower risk of neonatal death (Q4 vs Q1 RR: 0.59; 95% CI: 0.38, 0.90; P for trend = 0.01). Higher fish intake was associated with lower risk of very preterm birth (high vs low tertile RR: 0.76; 95% CI: 0.58, 0.99; P for trend = 0.02). Meat intake was protective of preterm birth (RR = 0.73; 95% CI: 0.65, 0.82; P<0.001), very preterm birth (P<0.001), LBW (P<0.001), and neonatal death (P = 0.01) but associated with increased risk of SGA (RR = 1.19; 95% CI: 1.01, 1.39; P = 0.04). Any egg intake was protective of very preterm birth (RR = 0.52; 95% CI: 0.32, 0.86; P = 0.01) compared to no egg intake. Finally, dairy intake was associated with lower risk of preterm birth (RR = 0.82; 95% CI: 0.68, 0.98; P = 0.03) and very preterm birth (RR = 0.53, 95% CI: 0.34, 0.84; P = 0.01).

Higher frequency of dietary intake of ASF is associated with lower risk of adverse birth outcomes in urban Tanzania. Promoting prenatal dietary intake of ASF may improve birth outcomes in this region and similar resource-limited settings.Clinical Trial Registry Number: NCT00197548.

Non-invasive, Reflection Spectroscopy Measurement of Skin Carotenoid Score in Infants is Feasible and Reliable.

Journal of Nutrition

Skin carotenoid measurement by reflection spectroscopy (RS) offers a non-invasive biomarker of carotenoid intake, but feasibility, reliability, and validity are not established in infants.

To determine feasibility and reliability of 4 month-old infant skin carotenoid score (SCS) measurement and its correlation with total carotenoid intake and plasma concentrations.

: SCSs were measured in a prospective, observational study by a modified, portable RS device at the index finger and heel of the foot in 4-months olds (n = 21). Infant plasma, human milk, and formula carotenoid concentrations were measured by HPLC-PDA, and carotenoid intake was estimated from 7-day food diaries corrected for actual milk carotenoid content. Mean SCS, time to acquire measurements, replicate intraclass correlations, and bivariate correlations between SCS, carotenoid intake, and plasma carotenoids were examined. Exploratory analyses of returning 6- (n = 12), and 8- (n = 9) month old infants were conducted.

Mean ± SD finger and heel SCS in 4, 6, and 8-month-olds were 92 ± 57 and 92 ± 51; 109 ± 41 and 119 ± 44; and 161 ± 89 and 197 ± 128 units, respectively. Replicate SCS measurements were reliable, with high intra-correlation (≥0.70) within subject-visits. Four-month olds' finger SCSs were correlated with carotenoid intake (rho = 0.48, P = 0.0033), and finger and heel SCS were correlated with total plasma carotenoid concentrations (rho = 0.71, P < 0.0001 and rho = 0.57, P = 0.0006, respectively). Eight-month olds' finger and heel SCSs were correlated with total carotenoid intake (rho = 0.73, P < 0.001; rho = 0.58, P = 0.0014, respectively), while SCSs in 6-month olds', in transition from exclusive milk to complementary feeding, did not correlate with plasma carotenoid or dietary carotenoids, despite correlation between plasma and dietary carotenoid intake (rho = 0.86, P = 0.0137). Mixed models suggest plasma total carotenoid concentration, age, carotenoid intake, and age*carotenoid intake, but not measurement site, are determinants of infant SCS.

Infant skin carotenoids are feasibly and reliably measured by RS, and may provide a biomarker of carotenoid intake in 4-month olds. [NCT03996395].