The latest medical research on Dietician

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Preventive small-quantity lipid-based nutrient supplements reduce severe wasting and severe stunting among young children: an individual participant data meta-analysis of randomized controlled trials.

J Clin Nutrition

Meta-analyses show that small-quantity lipid-based nutrient supplements (SQ-LNS) reduce child wasting and stunting. There is little information regarding effects on severe wasting or stunting.

We aimed to identify the effect of SQ-LNS on prevalence of severe wasting (weight-for-length z-score < -3) and severe stunting (length-for-age z-score < -3).

We conducted a two-stage meta-analysis of individual participant data from 14 randomized controlled trials of SQ-LNS provided to children 6 to 24 mo of age. We generated study-specific and subgroup estimates of SQ-LNS vs. control and pooled the estimates using fixed-effects models. We used random effects meta-regression to examine study-level effect modifiers. In sensitivity analyses, we examined whether results differed depending on study arm inclusion criteria and types of comparisons.

SQ-LNS provision led to a relative reduction of 31% in severe wasting (Prevalence Ratio, PR 0.69 (0.55, 0.86), n=34,373) and 17% in severe stunting (PR 0.83 (95% CI: 0.78, 0.90), n=36,795) at endline. Results were similar in most of the sensitivity analyses but somewhat attenuated when comparisons using passive control arms were excluded: PR 0.74 (0.57, 0.96), n=26,327 for severe wasting and PR 0.88 (0.81, 0.95), n=28,742 for severe stunting. Study-level characteristics generally did not significantly modify the effects of SQ-LNS, but results suggested greater effects of SQ-LNS in sites with greater burdens of wasting or stunting, or with poorer water quality or sanitation.

Including SQ-LNS in preventive interventions to promote healthy child growth and development is likely to reduce rates of severe wasting and stunting. Registered at www.crd.york.ac.uk/PROSPERO as CRD42019146592.

Collagen peptide supplementation for pain and function: is it effective and if so, why?

Current Opinion in Cell Biology

Connective tissue injuries are prevalent in active and aging populations, leading to chronic pain and decreased function. Turnover of this tissue is not well understood, especially as it relates to aging and injury. Supplementation of collagen peptides has been shown to improve connective tissue recovery and pain through increased collagen production.

Collagen peptide supplementation improves pain and function, and upregulates metabolic pathways associated with muscle and tendon growth. Literature from the past 12-18 months supports that these pathways are also involved with increased synthesis and degradation of collagen and other elements of the extracellular matrix. Improvements in body composition and strength have been noted with collagen peptide supplementation when paired with resistance training. Collagen peptide supplements are hydrolyzed into small peptides, termed bioactive peptides, and individual amino acids. These bioactive peptides are associated with the benefits observed with collagen peptide supplementation and may play a critical role in the collagen turnover.

Collagen peptide supplementation has been shown to promote recovery, decrease pain, and improve strength and body composition when paired with resistance training. These benefits may be attributed to bioactive peptides in collagen peptide supplements. Additional research is warranted to examine the specific effects of these bioactive peptides.

Physical activity and academic achievement: an analysis of potential student- and school-level moderators.

International Journal of Epidemiology

This study was registered with the National Institutes of Health (NIH) ClinicalTrials.gov system, with ID NCT03765047 . Registered 05 December 2018-Retrospectively registered.

In a large, diverse metropolitan public school district in Georgia, 4,936 students in Grade 4 were recruited from 40 elementary schools. Students wore accelerometers to measure school-day MVPA for a total of 15 days across three semesters (fall 2018, spring 2019, fall 2019). Academic achievement data, including course marks (grades) for math, reading, spelling, and standardized test scores in writing, math, reading, and Lexile (reading assessment), were collected at baseline (Grade 3, ages 8-9) and at follow-up in Grade 4 (ages 9-10). Standardized test scores were not measured in Grade 5 (ages 10-11) due to COVID-19-related disruptions. Multilevel modeling assessed whether student-level and/or school-level characteristics were moderators in the cross-sectional and longitudinal MVPA-academic achievement relationship.

Cross sectional analyses indicated that the MVPA and AA relationship was moderated only by student Hispanic ethnicity for Grade 4 fall spelling marks (β = -0.159 p < 0.001). The relationship for Grade 4 fall spelling marks was also moderated by school physical activity opportunities (β = -0.128 (p < 0.001). Longitudinally, there was no significant moderation of the MVPA-academic achievement. A relationship by student gender, free/reduced-price lunch status, race/ethnicity; nor for school-level factors including proportion of students qualifying for free/reduced-price lunch, physical activity environment, and physical activity opportunities.

Overall, our results did not suggest that student- or school-level characteristics moderate the MVPA-academic achievement relationship. While statistically significant results were observed for certain outcomes, practical differences were negligible. In this population, school-based MVPA does not appear to differently affect academic performance based on student gender, race/ethnicity, free/reduced-price lunch, nor school characteristics.

Radiomics in addition to computed tomography-based body composition nomogram may improve the prediction of postoperative complications in gastric cancer patients.

Annals of Nutrition and Metabolism

To determine the impact of computed tomography (CT)-based body composition and radiomics nomogram on the prediction of postoperative complications in gastric cancer.

The clinical data of 457 individuals with surgically confirmed gastric cancer, 320 patients in the training cohort (TC) and 137 patients in the validation cohort (VC), were retrospectively analyzed. Body composition data were measured using CT. Postoperative complications were graded using the Clavien-Dindo system. Dedicated radiomics prototype software was used to segment lesions and extract characteristics from preoperative portal venous-phase CT images. Clinical, radiomics, and combined models were developed using logistic regression analysis. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), and the prediction ability of the optimal model was evaluated using calibration curves and decision curve analysis (DCA).

Nutritional Risk Screening 2002 (NRS2002) score, sarcopenia, and blood loss were independent predictors of postoperative complications in gastric cancer. A radiomics signature was created using 19 conserved radiomics features. The nomogram based on both the clinical model and radiomics signature showed the greatest predictive performance, with AUCs of 0.763 (95% confidence interval [CI], 0.708-0.817) and 0.748 (95% CI, 0.667-0.818) in the TC and VC, respectively. The calibration curve and DCA revealed that the nomogram was beneficial in clinical practice for the preoperative prediction of postoperative complications.

The combined model consisting of NRS2002 score, sarcopenia, blood loss, and a radiomics signature holds potential application value for the individualized prediction of postoperative complications in gastric cancer patients.

Coffee consumption and risk of endometrial cancer: a pooled analysis of individual participant data in the Epidemiology of Endometrial Cancer Consortium (E2C2).

J Clin Nutrition

Epidemiological studies suggest that coffee consumption may be inversely associated with risk of endometrial cancer (EC), the most common gynecological malignancy in developed countries. Furthermore, coffee consumption may lower circulating levels of estrogen and insulin, hormones implicated in endometrial carcinogenesis. Antioxidants and other chemopreventive compounds in coffee may have anticarcinogenic effects. Based on available meta-analyses, the World Cancer Research Fund concluded that consumption of coffee probably protects against EC.

Our main aim was to examine the association between coffee consumption and EC risk by combining individual-level data in a pooled analysis. We also sought to evaluate potential effect modification by other risk factors of EC.

We combined individual-level data from 19 epidemiologic studies (6 cohort, 13 case-control) of 12,159 endometrial cancer cases and 27,479 controls from the Epidemiology of Endometrial Cancer Consortium (E2C2). Logistic regression was used to calculate odds ratios (OR) and their corresponding 95% confidence intervals (CI). All models were adjusted for potential confounders including age, race, body mass index, smoking status, diabetes status, study design and study site.

Coffee drinkers had a lower risk of EC compared to non-coffee drinkers (multi-adjusted OR = 0.87, 95% CI = 0.79,0.95). There was a dose-response relationship between higher coffee consumption and lower risk of EC: compared to non-coffee drinkers, the adjusted pooled ORs for those who drank 1, 2-3 and more than 4 cups/day were 0.90 (95% CI = 0.82,1.00), 0.86 (95% CI = 0.78,0.95), and 0.76 (95% CI = 0.66,0.87), respectively (p for trend < 0.001). The inverse association between coffee consumption and EC risk was stronger in participants with body mass index (BMI) over 25 kg/m2.

The results of the largest analysis to date pooling individual-level data further support the potentially beneficial health effects of coffee consumption in relation to EC, especially among females with higher BMI.

Arginine metabolism regulates the pathogenesis of inflammatory bowel disease.

Nutrition Reviews

The pathogenesis of inflammatory bowel disease (IBD) is related to genetic susceptibility, enteric dysbiosis, and uncontrolled, chronic inflammator...

Top sources and trends in consumption of total energy and energy from solid fats and added sugars among youth 2-18 years: United States 2009-2018.

J Clin Nutrition

High energy intake from non-nutrient dense sources correlates with poorer diet quality.

To, 1) estimate total energy intake, and energy from solid fats and added sugars, and combined (SOFAS), and identify their top food category sources for ages 2-18 years in 2015-2018, and 2) describe trends over time in 2009-2018.

Data were from the National Health and Nutrition Examination Survey. Pairwise differences were examined using univariate t statistics (2015-2018, n=5,038), and trends by age, and over time (2009-2018, n=14,038) examined using orthogonal polynomials.

In 2015-2018, SOFAS contributed (mean [SE], 30.0% [0.3%]) of total energy. Solid fats 16.1% [0.2%] and added sugars 13.8% [0.2%] each contributed >10%. The contribution of added sugars increased with age from 11.1% (2-3 years) to 14.4% (14-18 years), and was higher for all other race/Hispanic origins than Non-Hispanic Asians. Top five sources of energy were sweet bakery products, savory snacks, pizza, other mixed dishes, and unflavored milk, and for SOFAS also included soft drinks, other desserts, candy and snack bars. Total energy did not change between 2009-2018, but energy from SOFAS, and servings of solid fats, and added sugars declined. The contribution of unflavored milk to total energy declined for all ages and most race/Hispanic origins. Fruit drinks (all ages) and soft drinks (9-18 years) remained among top added sugars sources despite declines. The contribution of sweet bakery products to energy from SOFAS increased for most ages, and candy and snack bars to energy from added sugars.

In 2015-2018, SOFAS contributed over 30% of total energy for ages 2-18 years, which doubled the Dietary Guidelines for Americans' recommended limit of 15%. Top five sources of total energy were similar to those of solid fats, and those of SOFAs similar to those of added sugars. These results may inform public health efforts for improving diet quality.

Diet, but not food type, significantly affects micronutrient and toxic metal profiles in urine and/or plasma; a randomized, controlled intervention trial.

J Clin Nutrition

Observational studies have linked Mediterranean Diets (MedDiet) and organic food consumption with positive health outcomes, which may be explained by higher mineral micronutrient and phenolic intake and lower dietary exposure to toxic compounds.

To determine the effects of diet and food type (organic versus conventional) on urinary excretion (UE) and/or plasma concentrations of mineral micronutrients, phenolics and toxic metals.

Healthy, adult participants were randomly allocated to a conventional (n=14) or an intervention (n=13) group. During a two-week period, the intervention group consumed a MedDiet made entirely from organic foods, while the conventional group consumed a MedDiet made from conventional foods. Before and after the intervention period, both groups consumed their habitual Western diets made from conventional foods. The primary outcome was UE and/or plasma concentrations of selected mineral micronutrients, toxic metals and phenolic markers. In addition, we monitored diets using food diaries. The participants were aware of study group assignment, but the study assessors were not.

Changing from a Western to a MedDiet for two weeks resulted in significant increases in UE of total phenolics and salicylic acid (by 46 and 45% respectively), the mineral micronutrients Co, I, and Mn (by 211, 70 and 102% respectively) and the toxic metal Ni (by 42%), and plasma Se concentrations (by 14%). However, no significant effects of food type (organic versus conventional) were detected. Redundancy analysis identified vegetables, coffee, wine and fruit as positive drivers for UE of phenolic markers and mineral micronutrients, and fish consumption as a positive driver for UE of Cd and Pb.

Although small effects of food type cannot be ruled out, our study suggests that only changing to a MedDiet with higher fruit and vegetable, and lower meat consumption results in a large increase in phenolic and mineral micronutrient intake.

An agent-based model of child sugar-sweetened beverage consumption: implications for policies and practices.

J Clin Nutrition

A strong body of evidence links young children's intake of sugar-sweetened beverages (SSBs) with myriad negative outcomes.

Our research provides insight into whether and to what extent potential intervention strategies can reduce young children's consumption of SSBs.

We built an agent-based model (ABM) of SSB consumption representing participants in the Project Viva longitudinal study between ages 2 and 7 years. In addition to extensive data from Project Viva, our model used nationally representative data as well as recent, high-quality literature. We tested the explanatory power of the model through comparison to consumption patterns observed in the Project Viva cohort. Then, we applied the model to simulate the potential impact of interventions that would reduce SSB availability in one or more settings or affect how families receive and respond to pediatrician advice.

Our model produced age-stratified trends in beverage consumption that closely match those observed in Project Viva cohort data. Among the potential interventions we simulated, reducing availability in the home-where young children spend the greatest amount of time-resulted in the largest consumption decrease. Removing access to all SSBs in the home resulted in them consuming 1.23 (95% CI: 1.21, 1.24) fewer servings of SSBs per week on average between the ages of two and seven, a reduction of about 60%. By comparison, removing all SSB availability outside of the home (i.e., in schools and childcare) had a smaller impact (0.77; CI: 0.75, 0.78), a reduction of about 40%.

These results suggest that interventions reducing SSB availability in the home would have the strongest effects on SSB consumption.

Healthy dietary patterns and risk of cardiovascular disease in US Hispanics/Latinos: the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

J Clin Nutrition

Multiple dietary patterns haven been recommended by 2015-2020 Dietary Guidelines for Americans for the prevention of cardiovascular disease (CVD). The adherence to these patterns and its relationship with risk of CVD remain unclear in the US Hispanic/Latino population.

We aimed to evaluate three healthy eating patterns measured by three dietary pattern scores (the Alternate Mediterranean diet (aMED), the Healthy Eating Index (HEI)-2015, and the healthful Plant-based Diet Index (hPDI)) across different Hispanic/Latino backgrounds and generations. We further examined the associations of these dietary scores with incident CVD in US Hispanics/Latinos.

We included 10,293 adult participants of US Hispanics/Latinos of six backgrounds (Mexican, Puerto Rican, Cuban, Dominican, Central American and South American), free of CVD or cancer at baseline, in the Hispanic Community Health Study/Study of Latinos. Dietary pattern scores were derived at the baseline visit using two 24-hour dietary recalls. The primary outcome was the major incident CVD (n = 232), comprised of coronary heart disease and stroke, during an average 6-year follow-up.

Mean levels of all three dietary scores were significantly different across 6 Hispanic/Latino background groups (all P < 0.001), with highest (i.e., healthiest) in those of Mexican background and lowest in those of Puerto Rican background. Compared to non-mainland-US-born Hispanics/Latinos, mainland-US-born Hispanics/Latinos had significantly lower dietary scores (P < 0.001). Differences in dietary scores between mainland-US-born and non-mainland-US-born Hispanics/Latinos were majorly driven by differences in dietary intakes of healthy plant-based foods. After adjusting for multiple covariates, significantly lower risk ratios (95% CI) of CVD were observed for one standard deviation increment of the dietary scores, with 0.74 (0.60,0.91) for aMED, 0.80 (0.63,1.00) for HEI-2015, and 0.74 (0.60,0.93) for hPDI.

Although adherence to healthy eating patterns varies by Hispanic/Latino backgrounds and generations, greater adherence to these eating patterns is associated with lower risk of CVD across diverse US Hispanics/Latinos.

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.