We investigated the coverage of childhood vitamin A supplementation (VAS) across India from 2005-06 to 2019-21, and further explored how they related to childhood mortality. Data collected from mothers through standard questionnaires during the latest three rounds of National Family Health Survey (2005-06, 2015-16, and 2019-21) was used. Information on VAS in children aged 9-35 months was available from 2015-16 and 2019-21. Information on VAS among children aged 9-59 months was available from 2005-06 and 2015-16. Childhood VAS coverage was determined nationally and subnationally (viz., individual states, geography, socio-demographic index, and developmental groups). Nearly 40% eligible children aged 9-59 months and 30% eligible children aged 9-35 months missed VAS during recent times. But improvements in VAS coverage were noticed over the years: from 18.6% (2005-06) to 60.5% (2015-16) among children aged 9-59 months; and from 64.5% (2015-16) to 71.2 % (2019-21) among children aged 9-35 months. There were coverage disparities, with Western India documenting the highest and Northeastern India documenting the lowest coverage values. During simple linear regression analysis, childhood mortality between 1-5 years age varied inversely as a function of VAS coverage among children aged 9-59 months, with the association being less pronounced in 2015-16 (β = -0.47) than in 2005-06 (β = -0.40). However, this relationship disappeared when we accounted for potential confounders (viz., childhood immunization and socioeconomic factors) through multivariate analysis, suggesting that the role of VAS in promoting childhood survival may be limited during present times.

Diet in the first years of life is a key determinant of lifelong disease risk and is highly affected by socioeconomic status (SES). However, the specific relation between SES and food consumption in toddlers and preschoolers is poorly understood. This study assesses SES-related differences in food consumption in 1–5-year-olds in Germany using weighed food records (3+1 days) of a subsample of 887 children from the cross-sectional Children’s Nutrition Survey to Record Food Consumption (KiESEL) undertaken 2014–2017. Children were categorized as having a low, medium, or high SES depending on parental income, education, and occupation. A two-step generalized linear model corrected for age and sex was applied to assess differences in food consumption, using bootstrapping to address unequal group sizes. Differences between SES groups were found for unfavourable foods (and the subgroups sugar-sweetened beverages and confectionary/desserts), fruit, bread/cereals, and fats/oils (pBoot < 0.05). Mean daily consumption in the low SES-group as compared to the high-SES group was 84 g lower for total fruit, 22 g lower for bread/cereals, and 3 g lower for fats/oils, while being 123 g higher for sugar-sweetened beverages and 158 g higher for unfavourable foods in total (based on bootstrap 95 % confidence intervals). In conclusion, this study suggests a social gradient in the diet of German toddlers and preschoolers, with lower SES linked to lower diet quality. To prevent adverse health trajectories, public health measures to improve early life nutrition should address all children, prioritizing those of lower SES.

This meta-analysis assesses the relationship between vitamin D supplementation and incidence of major adverse cardiovascular events (MACEs). Pubmed, Web of science, Ovid, Cochrane Library and Clinical Trials were used to systematically search from their inception until July 2024. Hazard ratios (HR) and 95% confidence intervals (95%CI) were employed to assess the association between vitamin D supplementation and MACEs. This analysis included 5 randomized controlled trials (RCTs). Pooled results showed no significant difference in the incidence of MACEs (HR: 0.96; p=0.77), expanded MACEs (HR: 0.96; p=0.77) between the vitamin D intervention group and the control group. Further, the vitamin D intervention group had a lower incidence of myocardial infarction (MI), but the difference was not statistically significant (HR: 0.88, 95%CI: 0.77-1.01; p=0.061); nevertheless, vitamin D supplementation had no effect on the reduced incidence of stroke (p=0.675) or cardiovascular death (p=0.422). Among males (p=0.109) and females (p=0.468), vitamin D supplementation had no effect on the reduced incidence of MACEs. For participants with a body mass index (BMI)<25 kg/m2, the difference was not statistically significant (p=0.782); notably, the vitamin D intervention group had a lower incidence of MACEs for those with BMI≥25 kg/m2 (HR: 0.91, 95%CI: 0.83-1.00; p=0.055). Vitamin D supplementation did not significantly contribute to the risk reduction of MACEs, stroke and cardiovascular death in the general population, but may be helpful for MI. Notably, effect of vitamin D supplementation for MACEs was influenced by BMI. Overweight/obese people should be advised to take vitamin D to reduce the incidence of MACEs.

This study examined whether supplementation with collagen peptides (CP) affects appetite and post-exercise energy intake in healthy active females.

In this randomised, double-blind crossover study, 15 healthy females (23 ± 3 y) consumed 15 g/day of CP or a taste matched non-energy control (CON) for 7 days. On day 7, participants cycled for 45 min at ∼55% Wmax, before consuming the final supplement. Sixty min post supplementation an ad libitum meal was provided, and energy intake recorded. Subjective appetite sensations were measured daily for 6 days (pre- and 30 min post-supplement), and pre (0 min) to 280 min post-exercise on day 7. Blood glucose and hormone concentrations (total ghrelin, glucagon-like peptide-1 (GLP-1), and peptide YY (PYY), cholecystokinin (CCK), dipeptidyl peptidase-4 (sDPP4), leptin, and insulin, were measured fasted at baseline (day 0), then pre-breakfast (0 min), post-exercise (100 min), post-supplement (115, 130, 145, 160 min) and post-meal (220, 280 min) on day 7.

Ad-libitum energy intake was ∼10% (∼41kcal) lower in the CP trial (P=0.037). There was no difference in gastrointestinal symptoms or subjective appetite sensations throughout the trial (P≥0.412). Total plasma GLP-1 (area under the curve, CON: 6369±2330; CP: 9064±3021 pmol/L; P<0.001) and insulin (+80% at peak) were higher after CP (P<0.001). Plasma ghrelin and leptin were lower in CP (condition effect; P≤0.032). PYY, CCK, sDPP4 and glucose were not different between CP and placebo (P≥0.100).

CP supplementation following exercise increased GLP-1 and insulin concentrations and reduced ad libitum energy intake at a subsequent meal in physically active females.

Previous studies have reported comorbidities of autoimmune thyroid disorders (AITD), including Hashimoto’s disease (HT) and Graves’ disease (GD), and celiac disease (CeD), as well as the possible beneficial effects of a gluten-free diet (GFD) on AITD. Nonetheless, it remains uncertain whether there is a genetic causal relationship between AITD and CeD, while the beneficial effects on a GFD are controversial. This study aim to explore the causal relationship between CeD and AITD, particularly with HT, and to determine whether a GFD is beneficial for AITD. We performed a two-sample Mendelian Randomization (MR) analysis on data from the largest meta-analysis summary statistics of AITD, CeD and GFD. Genetic instrumental variables were established by pinpointing single nucleotide polymorphisms (SNPs) that relate to corresponding factors. In assessing sensitivity and heterogeneity, we conducted examinations of MR Egger, weighted median, simple mode, weighted mode, and MR Egger intercept tests. HT was found to play a pathogenic role in increasing the risk of CeD (ORIVW = 1.544 [95%CI 1.153-2.068], p = 0.00355), and our Mendelian randomization study does not support genetic liability related to CeD with GD (Graves’ disease) and GFD with AITD. This study supports the positive correlation between HT risk and CeD risk, while GFD has no protective effect on AITD and may exert its effect through other mechanisms. These findings provide valuable insights into potential targets for disease intervention and treatment at the genetic level.

This study explored whether lifestyle therapy that promoted adherence to a Mediterranean-style diet as a treatment for depression led to environmental co-benefits. Participants (N = 75 complete case) were Australian adults in the Curbing Anxiety and Depression using Lifestyle Medicine (CALM) non-inferiority, randomised controlled trial, which showed that lifestyle therapy was non-inferior to psychotherapy in reducing depressive symptoms, when delivered in group format via video conferencing over an 8-week treatment period. In this secondary analysis, we hypothesised that the lifestyle arm would be superior to the psychotherapy arm in reducing environmental impact of self-reported diet over time. Dietary intake derived from Food Frequency Questionnaires at baseline and 8 weeks were transformed into environmental impact scores by calculating Global Warming Potential (GWP)*. GWP* was calculated for total dietary intake and distinct food groups (Australian Dietary Guidelines [ADG] and NOVA classifications). Within-arm changes in GWP* over time were calculated using median difference. Neither arm showed significant changes. Between-arm differences in percentage change in GWP* scores over time were analysed using Generalised Estimating Equations (GEE) models. No between-arm difference for total GWP* score was found (β=11.06 [-7.04 29.15]). When examining distinct food groups, results were mixed. These novel findings contribute to the sparse evidence base that has measured the environmental impact of diets in a clinical trial context. Whilst lifestyle therapy that reduced depressive symptoms did not have clear environmental benefits relative to psychotherapy, nutritional counselling that focuses on the environmental impact of food choices may drive more pronounced planetary co-benefits.

Using a behavioural intervention to target nutrition during pregnancy may be key in meeting recommendations for healthy eating. The aim was to assess the use of a short-term dietary intake measurement tool (3-day food intake record) to infer long-term habitual dietary intake during pregnancy (using a short-form food frequency questionnaire). A convenience sample (n=90) between 12- and 18-weeks’ gestation were recruited from a larger randomised controlled trial for cross-sectional analysis. Participants completed a 44-item food frequency questionnaire and 3-day food intake record. Using the participant food intake record, the investigator blindly completed a second frequency questionnaire. The frequency questionnaires were scored using Dietary Quality Scores (DQS) and compared. Aggregate data were evaluated using a Wilcoxon signed rank test, and individual-level data were evaluated using a Bland-Altman plot. No significant difference was observed in the scores (Z=-1.88, p=0.06), with small effect size (r=0.19). The Bland-Altman plot showed that comparing the DQS derived from the two different dietary assessments underestimated scores by a mean difference of 0.4 points (95% limits of agreement: -3.50 to 4.26). The data points were evenly spread suggesting no systematic variation for over- or underestimation of scores. Minimal difference was observed between the functionality of the two assessment instruments. However, the food intake record can be completed by pregnant individuals to estimate short-term nutrient intake, and then scored by the investigator to estimate long-term dietary quality. Combining these two instruments may best capture the most accurate representation of dietary habits over time.

A Rank Forum was convened to discuss the evidence around food insecurity (FIS), its impact on health, and interventions which could make a difference both at individual and societal level, with a focus on the UK. This paper summarises the proceedings and recommendations. Speakers highlighted the growing issue of FIS due to current economic and social pressures. It was clear that the health implications of FIS varied geographically since food insecure women in higher income regions tend to be living with overweight or obesity, in contrast to those living in low-to-middle income countries. This paradox could be due to stress and/or metabolic or behavioural responses to an unpredictable food supply. The gut microbiota may play a role given the negative effects of low fibre diets on bacterial diversity, species balance and chronic disease risk. Solutions to FIS involve individual behavioural change, targeted services and societal/policy change. Obesity-related services are currently difficult to access. Whilst poverty is the root cause of FIS, it cannot be solved simply by making healthy food cheaper due to various ingrained beliefs, attitudes and behaviours in target groups. Person-centred models, such as Capability-Opportunity-Motivation Behavioural Change Techniques and Elicit-Provide-Elicit communication techniques are recommended. Societal change or improved resilience through psychological support may be more equitable ways to address FIS and can combine fiscal or food environment policies to shift purchasing towards healthier foods. However, policy implementation can be slow to enact due to the need for strong evidence, consultation and political will. Eradicating FIS must involve co-creation of interventions and policies to ensure that all stakeholders reach a consensus on solutions.

Nutrition education is crucial for improving nutritional knowledge. This study aims to evaluate the impact of healthy nutrition education on hedonic hunger, adherence to the Mediterranean diet, and self-efficacy for healthy eating among early adolescence. This one-group, pre-test-post-test, quasi-experimental study included 202 middle-school students. Data were collected using a researcher-designed survey that included demographic variables, the Children’s Power of Food Scale (CPOF-S), the Self-Efficacy for Healthy Eating Scale (SEHE-C), the Mediterranean Diet Score (KIDMED), and the Brief Nutritional Knowledge Assessment Form. Anthropometric measurements (weight, height, waist circumference, hip circumference, and neck circumference) were also taken. After the pre-test, each student received two hours of healthy nutrition education. A follow-up survey was administered four weeks later. The study revealed that most early adolescents exhibited unhealthy dietary habits, such as skipping main meals (15.3% all the time and 60.2% occasionally), snacking on sweet treats (33.3%), and having irregular eating patterns (47.4%). Additionally, the early adolescents had higher weights, body mass index (BMI), neck circumferences, and heights compared to reference values (p<0.01). Significant changes were observed post-intervention: lower hedonic hunger scores (beginning: 2.90±0.68, follow-up: 2.70±0.76, p<0.01), decreased self-efficacy for healthy eating (beginning: 5.41±3.50, follow-up: 4.33±3.61, p<0.01), and increased knowledge about healthy nutrition (beginning: 67.23±14.39, follow-up: 80.00±17.22, p<0.01). This study highlighted that healthy nutrition education enhances nutritional knowledge and decreases hedonic dietary tendencies among early adolescents. Continued nutrition education may further improve children’s preferences for healthy foods.

Metabolic syndrome (MetS) is associated with an increased risk of cardiovascular disease, type 2 diabetes, and death from all causes. Dietary factors correlate with MetS, making diet a potential target for intervention.

We used data from the 2012–2016 Korea National Health and Nutrition Examination Survey (KNHANES, n = 12,122) to identify a dietary pattern (DP) using 39 predefined food groups as predictors. MetS components were used as the response variable with the food groups in reduced rank regression followed by stepwise linear regression analyses. We then verified the Korean status of the DP externally in the Cardiovascular Disease Association Study (CAVAS) (n = 8,277) and the Health EXAminees (HEXA) study (n = 48,610).

The DP score, which included 20 food groups, showed significant positive associations with all MetS components and a higher prevalence ratio in KNHANES participants (p < 0.0001). Although the score was not significant in CAVAS (p = 0.0913), it showed a strong positive association with MetS prevalence in HEXA (p < 0.0001).

We identified and tested a DP associated with MetS in Korean populations. This DP may be a useful tool for assessing MetS risk. Although the score was linked to higher MetS risk, particularly in the predominantly urban population of the HEXA study, further validation in more diverse populations is needed.

Kombucha is a fermented beverage rich in bioactive compounds. This beverage has demonstrated high antioxidant capacity in vitro and experimental animal studies. In this sense, this study aimed to evaluate the effect of daily consumption of green tea kombucha on oxidative stress and endothelial health in individuals with excess body weight. This is a randomized controlled clinical trial, lasting 10 weeks, during which the control group followed a healthy -500 kcal/day energy-restricted diet. In contrast, the kombucha group, in addition to the energy-restricted diet, consumed 200 mL of kombucha green tea daily. This study included men and women aged 18 to 45 years without chronic diseases. At the beginning and end of the study, fasting blood was collected, and colorimetric assays and immunoassay protocols evaluated markers of oxidative stress and endothelial health. Compared to the control group, kombucha consumption significantly reduced hydrogen peroxide (H₂O₂) levels (p=0.007). Initial and final values were as follows: Control group (16.5 vs. 15.09 µmol/mL; n=29) and Kombucha group (18.14 vs. 14.67 µmol/mL; n=30). The other markers that were evaluated did not change after the kombucha consumption. In conclusion, daily consumption of 200 mL of green tea kombucha for 10 weeks reduces one pro-oxidant marker, without altering other markers of oxidative stress and endothelial health in individuals with excess body weight. Reducing a pro-oxidant marker suggests that kombucha is an antioxidant beverage with promising implications for human health. However, further studies are needed to elucidate other possible beneficial effects on health.

Persistent malnutrition is associated with poor clinical outcomes in cancer. However, assessing its reversibility can be challenging. The present study aimed to utilize machine learning (ML) to predict reversible malnutrition (RM) in patients with cancer. A multicenter cohort study including hospitalized oncology patients. Malnutrition was diagnosed using an international consensus. RM was defined as a positive diagnosis of malnutrition upon patient admission which turned negative one month later. Time-series data on body weight and skeletal muscle were modeled using a long short-term memory (LSTM) architecture to predict RM. The model was named as WAL-net, and its performance, explainability, clinical relevance and generalizability were evaluated. We investigated 4254 patients with cancer-associated malnutrition (discovery set=2977, test set=1277). There were 2783 men and 1471 women (median age=61 years). RM was identified in 754 (17.7%) patients. RM/non-RM groups showed distinct patterns of weight and muscle dynamics, and RM was negatively correlated with the progressive stages of cancer cachexia (r=−0.340, P<0.001). WAL-net was the state-of-the-art model among all ML algorithms evaluated, demonstrating favorable performance to predict RM in the test set (AUC=0.924, 95%CI=0.904-0.944) and an external validation set (n=798, AUC=0.909, 95%CI=0.876-0.943). Model-predicted RM using baseline information was associated with lower future risks of underweight, sarcopenia, performance status decline and progression of malnutrition (all P<0.05). This study presents an explainable deep learning model, the WAL-net, for early identification of RM in patients with cancer. These findings might help the management of cancer-associated malnutrition to optimize patient outcomes in multidisciplinary cancer care.

Overnutrition during before and pregnanabcy can cause maternal obesity and raise the risk of maternal metabolic diseases during pregnancy, and in offspring. Lentinus edodes may prevent or reduce obesity. This study aimed to to assess Lentinus edodes fermented products effects on insulin sensitivity, glucose and lipid metabolism in maternal and offspring, and explore its action mechanism. A model of overnutrition during pregnancy and lactation was developed using a 60% kcal high-fat diet in C57BL6/J female mice. Fermented Lentinus edodes (FLE) was added to the diet at concentrations of 1%, 3%, and 5%. The results demonstrated that FLE to the gestation diet significantly reduced serum insulin levels and homeostatic model assessment for insulin resistance (HOMA-IR) in pregnant mice. FLE can regulate maternal lipid metabolism and reduce fat deposition. Meanwhile, the hepatic phosphoinositide-3-kinase-protein kinase (PI3K/AKT) signaling pathway was significantly activated in the maternal mice. There is a significant negative correlation between maternal FLE supplementation doses and offspring body fat percentage and visceral fat content. Furthermore, FLE supplementation significantly increased offspring weaning litter weight, significantly reduced fasting glucose level, serum insulin level, HOMA-IR and serum glucose level, significantly activated liver PI3K/AKT signaling pathway in offspring, and upregulated the expression of liver lipolytic genes adipose triglyceride lipase, hormone-sensitive lipase and carnitine palmitoyltransferase 1 mRNA. Overall, FLE supplementation can regulate maternal lipid metabolism and reduce fat deposition during pregnancy and lactation, and it may improve insulin sensitivity in pregnant mothers and offspring at weaning through activation of the PI3K/AKT signaling pathway.

Previous studies on the association between fruit juice consumption and type 2 diabetes remain controversial, which might be due to heterogeneity in the polygenic risk score (PRS) for type 2 diabetes. We examined the association between fruit juice and type 2 diabetes by PRS for type 2 diabetes.

We investigated whether fruit juice influences type 2 diabetes risk differently among individuals with varying genetic risks.

Data from the J-MICC (Japan Multi-Institutional Collaborative Cohort) study, a cross-sectional study of 13,769 Japanese individuals was used for our analysis. The primary exposure was the frequency of fruit juice, categorized as do not drink, less than 1 cup per day, or more than 1 cup per day. We selected PGS002379, a PRS for type 2 diabetes developed using East Asian populations. The primary outcome was physician-diagnosed type 2 diabetes, reported by participants.

The consumption of fruit juice was significantly inversely associated with type 2 diabetes in the group with a high PRS for type 2 diabetes (OR: 0.78, 95%CI: 0.65 to 0.93 for <1 cup /day and OR: 0.54, 95%CI: 0.30 to 0.96 for >1/day), but this association was not observed in the low PRS group.

Fruit juice consumption was inversely associated with type 2 diabetes, especially in genetically high-risk populations for type 2 diabetes.

A local food-based approach, including school-lunch (SL) with multiple-micronutrient fortified biscuits (MMB) as supplementary snacks, may enhance dietary adequacy, although current data is sparse on this strategy. This study evaluated nutrient inadequacies in adolescent girls and evaluated food-based dietary recommendations (FBRs), incorporating SL from the Ghana School Feeding Programme (GSFP) and MBB. Data from 292 girls aged 10-17 were analysed as part of the Ten2Twenty-Ghana study using a quantitative 24-hour dietary recall. Model parameters included non-condiment foods consumed by at least 5% of the girls, median serving sizes, intake frequency, energy and nutrient content, and cost per 100g. Constraints were based on estimated energy intake and population reference nutrient intakes defined by harmonized average requirements (H-AR). Usual energy and nutrient intakes and the prevalence of nutrient inadequacies were estimated using the National Cancer Institute method. Optifood Linear Programming tool was used for FBRs. The mean usual energy intake was 2351±66 kcal/day. Calcium (99.8%), vitamin B12 (99.8%), riboflavin (96.2%), vitamin A (91.5%), vitamin C (87.6%), iron (73.7%), folate (49.3%), and zinc (8.5%) inadequacies were prevalent. Optimised-diets achieved adequacy for protein and most micronutrients, except calcium and vitamin B12, besides vitamin A for 15-17-years girls. SL from the GSFP did not enhance micronutrient levels when added to daily diet. Adding MMB to daily diet ensured adequacy for vitamin C, riboflavin, and iron, although marginal for iron. Calcium and vitamin A improved substantially with MMB for girls aged 15-17 but remained below the H-AR. Integrating regular SL with specialized fortified-foods may be a cost-effective strategy to enhance dietary adequacy for adolescent girls in rural areas.

Omega-3 Polyunsaturated Fatty Acids (n-3 PUFAs), including alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA), are widely found in plant oils and marine organisms. These fatty acids demonstrate significant biological effects, and their adequate intake is essential for maintaining health. However, modern diets often lack sufficient n-3 PUFAs, especially among populations that consume little fish or seafood,leading to a growing interest in n-3 PUFAs supplementation in nutrition and health research. In recent decades, the role of n-3 PUFAs in preventing and treating various diseases has gained increasing attention, particularly in cardiovascular, neurological, ophthalmic, allergic, hepatic, and oncological fields.In orthopedics, n-3 PUFAs exert beneficial effects through several mechanisms, including modulation of inflammatory responses, enhancement of cartilage repair, and regulation of bone metabolism. These effects demonstrate potential for the treatment of conditions such as osteoarthritis (OA), rheumatoid arthritis (RA), gout, osteoporosis (OP), fractures, sarcopenia, and spinal degenerative diseases (SDD). This review summarizes the clinical applications of n-3 PUFAs, with a focus on their research progress in the field of orthopedics, and explores their potential in the treatment of orthopedic diseases.

There has been substantial research undertaken on the role of a health-promoting diet in depression. Yet, the evidence of the relationship between the Nordic diet and the risk of depression is scarce. This cross-sectional study aimed to assess whether a healthy Nordic diet is associated with depressive symptoms. In total, 2603 men aged 42-60 years from the Kuopio Ischaemic Heart Disease Risk Factor Study were included. Diet quality was evaluated with a healthy Nordic diet score derived from the 4-day food diaries and depressive symptoms with the self-reported Human Population Laboratory (HPL) depression scale. Quade ANCOVA was used to examine the mean values of HPL scores in quartiles of a healthy Nordic diet score. Participants’ mean age was 53 years and BMI 26.8kg/m2; 31.7% were current smokers, and 86.9% were married or living as a couple. The mean healthy Nordic diet score was 12.8 (SD 4.0, range 2-25), and the mean HPL depression score was 1.9 (SD 2.1, range 0-13). The findings suggested that lower adherence to a healthy Nordic diet was associated with higher HPL depression scores after adjusting for age, examination year, daily energy intake, leisure time physical activity, adulthood socioeconomic status, smoking, and marital status (extreme quartile difference: 0.33 points, 95% CI 0.10–0.56, p for trend across the quartiles=0.003). The results support the hypothesis that a lower-quality diet increases the odds of having depressive symptoms. However, prospective studies are needed to confirm the association.

Epidemiologic evidence on the association between dietary choline and betaine and mortality risk remains limited, particularly among non-Western populations. We examined the association of dietary choline and betaine with all-cause mortality in Chinese adults using data from the China Health and Nutrition Survey (CHNS) 1991-2015. We included 9,027 men and 8,828 women without cardiovascular disease and cancer at baseline. Dietary intake was assessed using 3-day 24-hour dietary recalls in combination with a household food inventories. Death was ascertained through household surveys in each wave. We used time-dependent Cox proportional hazards regression models to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). During a median follow-up of 9.1 years, 891 men and 687 women were deceased. Higher total choline intake was associated with a lower risk of all-cause mortality in both men [HRQ5 vs. Q1 = 0.58 (95% CI: 0.45, 0.74)] and women [HRQ5 vs. Q1 = 0.59 (95% CI: 0.44, 0.78)]. The dose-response curve followed a reverse J-shape in men and an L-shape in women (both P-nonlinear ≤ 0.005). Similarly, fat-soluble choline intake was inversely associated with the risk of all-cause mortality in both men [HRQ5 vs. Q1 = 0.59 (95% CI: 0.46, 0.75)] and women [HRQ5 vs. Q1 = 0.53 (95% CI: 0.40, 0.70)], showing reverse J-shaped patterns (both P-nonlinear < 0.001). A J-shaped association between dietary water-soluble choline and all-cause mortality was observed in women (P-nonlinear < 0.001), but a null association was found in men. Betaine intake was not associated with all-cause mortality in either sex. Our findings suggest that adequate choline intake, but not betaine, is linked to reduced all-cause mortality in Chinese adults with predominantly plant-based diets, with both insufficient and excessive choline intake potentially increasing mortality risk.

Diet quality has been linked to socioeconomic status. However, evidence within rural and regional populations is lacking. This cross-sectional study examined the relationship between diet quality and socioeconomic position in adults living in rural and regional areas of Australia. The Australian Recommended Food Score (ARFS; range 0-73) measured diet quality (total and subscale scores). Area-level socioeconomic position was determined by postcode-linked Socio-Economic Index for Areas (SEIFA), Index of Relative Social Advantage and Disadvantage (IRSAD) scores, stratified into quintiles. The mean total ARFS (34.7; SD=9.1; n=836) was classified as “getting there”. Findings showed significantly lower mean total ARFS between SEIFA quintile 1 (1= lowest; mean total ARFS = 30.4; SD=10.2; categorised as ‘needs work’) compared to all other SEIFA quintiles (F (44,831) = 8.44, p = < 0.001). Linear regression, adjusting for age, sex, income, education, employment status, and household composition demonstrated significantly lower overall diet quality for SEIFA quintile 1 compared to SEIFA quintile 3 (B=-3.9; 95%CI [-6.2, -1.5]; p<0.001), and lower subscale scores for vegetables (B=-1.6; 95%CI [-2.7, -0.6]; p=0.003), fruit (B=-0.9; 95%CI [-1.6, -0.1]; p=0.018), and grains (B=-0.6; 95%CI [-1.3, -0.0]; p=0.050). After adjusting for individual confounders of diet quality, results indicate that lower area-level socioeconomic position remained associated with poorer diet quality in this sample of rural and regional Australian adults. This suggests that broader social and environmental factors unique to these areas may impact diet quality and amplify individual barriers to achieving a healthy diet.

Sessile serrated lesions (SSL) are recognised precursors to colorectal cancer. Little is known about risk factors for SSL due to their relatively recent clinical recognition as a cancer precursor and routine documentation of cases. Lifestyle and diet-related information were collected using validated questionnaires in a colonoscopy-based case-control study in Australia (257 SSL cases, 239 conventional adenoma (CA) cases, 180 polyp-free controls). A posteriori dietary patterns were derived from self-reported dietary intake in the past 12 months using principal component analysis. Multivariable-adjusted odds ratios (OR) and 95% confidence intervals (CI) were used to examine associations between lifestyle factors and dietary patterns on risk of SSL and CA vs. polyp-free controls and SSL vs. CA using logistic regression modelling. Use of anti-inflammatory medications was associated with reduced SSL risk (OR=0.61, 95% CI 0.38-1.00), while current smoking was associated with increased SSL risk (OR=1.96, 95% CI 1.09-3.53). Unlike CA, SSL risk was not increased by HRT use and current alcohol consumption but was increased by taller height. Higher adherence to a dietary pattern featuring processed meats, ready-made convenience foods, and high-energy drinks was associated with increased SSL risk (OR=2.13, 95% CI, 1.13-4.00; Ptrend=0.03) and CA (OR=2.60, 95% CI, 1.32-5.09; Ptrend=0.005). Compared to CA, a dietary pattern featuring wholegrains, low-fat dairy, nuts, seeds, and oily fish was associated with reduced SSL risk (OR=0.60, 95% CI, 0.36-0.98; Ptrend=0.04). This study supports a healthy diet as primary prevention for both SSL and CA and reinforces smoking as a risk factor for SSL.