This study aimed to explore the combined association between the dietary antioxidant quality score (DAQS) and leisure-time physical activity on sleep patterns in cancer survivors. Data of cancer survivors were extracted from the National Health and Nutrition Examination Surveys database in 2007–2014 in this cross-sectional study. Weighted multivariable logistic regression models were used to estimate OR and 95 % CI for the association of DAQS and leisure-time physical activity on sleep patterns. The combined association was also assessed in subgroups of participants based on age and use of painkillers and antidepressants. Among the eligible participants, 1133 had unhealthy sleep patterns. After adjusting for covariates, compared with low DAQS level combined with leisure-time physical activity level < 600 MET·min/week, high DAQS level combined with leisure-time physical activity ≥ 600 MET·min/week was associated with lower odds of unhealthy sleep patterns (OR = 0·41, 95 % CI: 0·23, 0·72). Additionally, the association of high DAQS level combined with high leisure-time physical activity with low odds of unhealthy sleep patterns was also significant in < 65 years old (OR = 0·30, 95 % CI: 0·13, 0·70), non-painkiller (OR = 0·39, 95 % CI: 0·22, 0·71), non-antidepressant (OR = 0·49, 95 % CI: 0·26, 0·91) and antidepressant (OR = 0·11, 95 % CI: 0·02, 0·50) subgroups. DAQS and leisure-time physical activity had a combined association on sleep patterns in cancer survivors. However, the causal associations of dietary nutrient intake and physical activity with sleep patterns in cancer survivors need further clarification.

Ultra-processed foods (UPF), defined using the Nova classification system, are associated with increased chronic disease risk. More recently, evidence suggests the UPF subgroup of whole-grain breads and cereals is in fact linked with reduced chronic disease risk. This study aimed to explore associations of cardiometabolic risk measures with Nova UPF intake v. when foods with ≥ 25 or ≥ 50 % whole grains are excluded from the definition. We considered dietary data from the Australian National Nutrition and Physical Activity Survey 2011–2012. Impacts on associations of UPF intake (quintiles) and cardiometabolic risk measures were analysed using regression models. The median proportion of UPF intake from high whole-grain foods was zero for all quintiles. Participants in the highest Nova UPF intake quintile had significantly higher weight (78·1 kg (0·6)), BMI (27·2 kg/m2 (0·2)), waist circumference (92·7 cm (0·5)) and weight-to-height ratio (0·55 (0·003)) compared with the lowest quintile (P< 0·05). Associations were the same when foods with ≥ 25 and ≥ 50 % whole grains were excluded. Adjusted R-squared values remained similar across all approaches for all outcomes. In Australia, high whole-grain foods considered UPF may not significantly contribute to deleterious cardiometabolic risk associations. Until conclusive evidence on Nova UPF is available, prioritisation should be given to the nutrient density of high whole-grain foods and their potential contribution to improving whole-grain intakes and healthful dietary patterns in Australia.

The effect of diminished ovarian reserves after undergoing hysterectomies with bilateral salpingectomies is one of the health concerns among reproductive-age women with benign gynecological diseases. Coenzyme Q10 (CoQ10), an antioxidant, is crucial in mitochondrial energy production, improving oocyte quality and quantity. This study compares the benefit of a 14-d preoperative (CoQ10) v. placebo on ovarian reserve by measuring anti-Müllerian hormone (AMH) in women undergoing hysterectomy with bilateral salpingectomy. A double-blinded, randomised, placebo-controlled trial was conducted. Forty-four women with benign gynecological diseases were randomised to receive either oral CoQ10 300 mg per d or placebo for 14 d before undergoing hysterectomy with bilateral salpingectomy. Serum AMH levels were collected for analysis before taking CoQ10 and 6 weeks postoperatively in each group. The baseline demographic, clinical characteristics and baseline AMH levels were comparable between the groups (1·47 (0·45, 2·49) v. 1·29 (0·47, 2·11), P = 0·763). The serum AMH levels after the surgery were significantly decreased from preoperative levels (median 0·99 (0·37, 1·63) v. 1·34 (0·57, 2·30)), P = 0·001. However, there was no significant difference in the AMH change between the CoQ10 group and the placebo group (AMH per cent change −28·2 % (64·09, −4·81) v. −20·07 % (–61·51, −2·92)), P = 0·99, respectively. Age, gynecological disease, operative time and blood loss were not significantly associated with the AMH change. There were no significant side effects or adverse operative outcomes among CoQ10 users. In conclusion, hysterectomy with bilateral salpingectomy led to a significantly decreased AMH level. However, pretreatment with CoQ10 for 2 weeks was ineffective in protecting an ovarian reserve.

Prior observational studies have reported the potential protective effect of n-3 fatty acids on the prognosis of acute pancreatitis (AP). However, the causal impact of n-3 fatty acids on AP is unclear. We aimed to investigate further the association of n-3 fatty acids with AP. We performed a meta-analysis and Mendelian randomisation (MR) to explore the association between n-3 fatty acids and the prognosis of AP from clinical observation and genetics perspectives, respectively. Nine randomised controlled trials were included in this study. The result meta-analysis showed that complementary therapy of n-3 fatty acids significantly decreased mortality (Relative Risk (RR): 0·30; 95 % CI 0·14, 0·65, P < 0·05) and infectious complications in AP (RR: 0·45; 95 % CI 0·27, 0·77, P < 0·05). Compared with the control groups, the hospital stays (MD: −1·02; 95 % CI −1·85, −0·20, P < 0·05) in AP patients with n-3 fatty acids treatment were statistically reduced. However, the ICU stay (MD: −0·49; 95 % CI −1·29, −0·31, P > 0·05) between control groups and AP patients with n-3 fatty acids treatment was insignificant. Utilising genetic susceptibility analysis in the MR approach, the MR showed n-3 fatty acids have a significant causal effect on the AP risk (OR, 0·887; 95 % CI 0·797, 0·986, P = 0·027, fixed-effect; OR, 0·887; 95 % CI 0·792, 0·993, P = 0·037, random-effect). n-3 fatty acids complementary therapy may improve the prognosis of AP. Furthermore, genetically predicted serum levels of n-3 fatty acids can significantly lower AP risk.

Chrono-nutrition is an emerging field that examines how the frequency and timing of meals impact health. Previous research shows inconsistency in the relationship between chrono-nutritional components and cardiometabolic health. We investigated cross-sectional associations between these components and cardiometabolic health in 825 Iranian adults aged 20–59 years. Dietary data, including the number of eating occasions, meal timing and meal irregularity of energy intake, were collected using three 24-h dietary recalls. Anthropometric measurements, blood pressure and laboratory tests (fasting plasma glucose, lipid profile, insulin, uric acid and C-reactive protein) were conducted. Insulin resistance and sensitivity (homeostatic model assessment for insulin resistance, homeostatic model assessment for insulin sensitivity), the TAG-glucose, the lipid accommodation product and BMI were calculated. The demographic and morning-evening questionnaire was completed. General linear regression was used to assess associations between chrono-nutritional components and outcomes. Interactions with age and BMI were examined in all associations. Chrono-nutrition components were not significantly related to cardiometabolic risk factors in the total population. However, a lower number of eating occasions was associated with an increased LDL-cholesterol:HDL-cholesterol ratio (β (95 % CI): 0·26 (0·06, 0·48)) among overweight and obese participants. Additionally, less irregularity in breakfast energy intake was associated with a lower total cholesterol:HDL-cholesterol ratio (–0·37 (–0·95, –0·18)) and a lower LDL-cholesterol:HDL-cholesterol ratio (–0·32 (–0·79, –0·13)) among participants with a normal BMI (all P< 0·05). The study concluded that more frequent meals and regular energy intake might enhance cardiometabolic health cross-sectionally, highlighting the need for prospective studies to further investigate these associations and the mediating role of BMI.

Indigenous peoples are often not routinely included in iodine programmes because of language barriers and remote access and may thus be at higher risk of iodine deficiency disorders, which could adversely impact their quality of life. We conducted this cross-sectional study in the remote Pwo Karen community of Thailand to determine the urinary iodine concentration of school-aged children and women of reproductive age and investigate the iodine content in household salt. We measured urinary iodine concentration in spot urine samples from healthy school-aged children and women of reproductive age, administered a questionnaire, estimated daily iodine intake and collected household salt samples to determine salt iodine concentration. The median urinary iodine concentration (range) of school-aged children (n 170) was 192 (136–263) µg/l, which was significantly higher than women of reproductive age (n 306) (147 (89–233) µg/l) (P < 0·001). The estimated daily iodine intake in school-aged children and women of reproductive age were 135 and 195 μg/d, respectively. The median (range) iodine concentration in rock and granulated salts consumed in the households were 2·32 (0·52–3·19) and 26·64 (20·86–31·01) ppm, respectively. Surprisingly, the use of iodised salt and the frequency of seafood consumption were NS predictors of urinary iodine concentration in these two groups. Our data suggest that school children and women of the Pwo Karen community have sufficient iodine intake, indicating the Thai salt iodisation programme is effectively reaching even this isolated Indigenous community. Sentinel surveys of remote vulnerable populations can be a useful tool in national iodine programmes to ensure that programme coverage is truly universal.

Rheumatoid arthritis (RA) is a prevalent autoimmune disease, and there is growing evidence suggesting a potential correlation between dietary factors and the pathogenesis of this condition. In order to investigate the causal relationship between diet and RA, we conducted a two-sample Mendelian randomisation (MR) analysis to examine the causal associations between twenty-two dietary factors and RA. Summary data from genome-wide association studies (GWAS) of RA were obtained from large GWAS meta-analyses. GWAS summary data for twenty-two dietary factors were obtained from UK Biobank. Random-effects inverse variance weighted was used as the primary method for assessing causality, and analyses of heterogeneity and horizontal pleiotropy were performed to ensure the accuracy of the results. Research indicates a negative genetic causal relationship between cereal intake (OR = 0·64, 95 % CI: 0·41, 0·99, P = 0·048) and oily fish intake (OR = 0·70, 95 % CI: 0·52, 0·95, P = 0·020) with the risk of RA. Other dietary factors were not causally related to RA. Sensitivity analysis shows that our results are reliable. This study provides genetic evidence suggesting that cereal intake and oily fish intake are protective factors for RA, indicating that RA patients and individuals at high risk should make appropriate dietary adjustments.

The aim of this study was to analyse the validity and reliability of the Turkish version of the renal inpatient nutrition screening tool (Renal iNUT) for haemodialysis patients. The Renal iNUT and the malnutrition universal screening tool (MUST) were used in adult haemodialysis patients at two different centres to identify malnutrition. The subjective global assessment (SGA), regarded as the gold standard for nutritional status assessment, was utilised for comparison. Structural validity was assessed using biochemical values and anthropometric measurements, while reliability was assessed using repeated the Renal iNUT assessment. Of the 260 patients admitted, 42·3 % were malnourished (SGA score was B or C). According to the Renal iNUT, 59·6 % of the patients were at increased risk for malnutrition (score ≥ 1) and 3·8 % required referral to a dietitian (score ≥ 2). According to the MUST, 13·1 % of the patients were at increased risk for malnutrition and 8·5 % required referral to a dietitian. The Renal iNUT was found to be more sensitive in detecting increased risk of malnutrition in haemodialysis patients compared with the MUST (59·6 % v. 13·1 %). According to the SGA, the sensitivity of the Renal iNUT is higher compared to the MUST (89 % and 45 %, respectively). Kappa-assessed reliability of the Renal iNUT was 0·48 (95 % CI, 0·58, 0·9) and a moderate concordance was observed. The Renal iNUT is a valid and reliable nutritional screening tool for evaluating haemodialysis patients to determine their nutritional status. The use of the Renal iNUT by dietitians will contribute to the identification of malnutrition and its treatment.

Colorectal cancer (CRC), the third most common cancer globally, causes over 900 000 deaths annually. Although vitamin D is observed to have potential anti-carcinogenic properties, research findings on its preventable effect against CRC remain inconclusive. Notably, different subsites within the colon and rectum may be associated with distinct risk factors. While some studies have explored this relationship with circulating 25-hydroxyvitamin D (25(OH)D), the results remain contradictory. Our study employed a nested case–control design, involving 775 CRC cases matched with 775 cancer-free controls based on age, region of living and the time of blood sampling. The study was conducted within the Norwegian Women and Cancer post-genome cohort, which comprises approximately 50 000 women. We measured pre-diagnostic circulating plasma 25(OH)D status 5–13 years before diagnosis. Adjustment variables were based on self-administered questionnaires and included BMI, physical activity level, smoking, intake of processed meat, calcium, alcohol and fibre. An increase of 5 nmol/l in 25(OH)D reduced the risk of proximal colon cancer by 6 % (OR = 0·94, 95 % CI 0·89, 0·99). Furthermore, a sensitivity analysis revealed a 62 % increased risk among the women with 25(OH)D levels below 50 nmol/l compared with sufficient levels, ≥ 50 to < 75 nmol/l (OR = 1·62, 95 % CI 1·01, 2·61). No association was found with CRC, colon or distal colon cancer. We observed a subsite-specific association between 25(OH)D and CRC, highlighting the need for further investigation to elucidate the potential underlying mechanisms and clinical implications.

This study investigated the association between screen time and ultra-processed food (UPF) consumption across the lifespan, using data from the 2019 Brazilian National Health Survey, a cross-sectional and population-based study. A score was used to evaluate UPF consumption, calculated by summing the positive answers to questions about the consumption of ten UPF subgroups on the previous day. Scores ≥5 represented high UPF consumption. Daily time spent engaging with television or other screens was self-reported. Crude and adjusted models were obtained through Poisson regression and results were expressed in prevalence ratios by age group. The sample included 2315 adolescents, 65 803 adults and 22 728 older adults. The prevalence of UPF scores ≥5 was higher according to increased screen time, with dose–response across all age groups and types of screen time. Adolescents, adults and older adults watching television for ≥6 h/d presented prevalence of UPF scores ≥5 1·8 (95 % CI 1·2, 2·9), 1·9 (95 % CI 1·6, 2·3) and 2·2 (95 % CI 1·4, 3·6) times higher, respectively, compared with those who did not watch television. For other screens, the prevalence of UPF scores ≥5 was 2·4 (95 % CI 1·3, 4·1) and 1·6 (95 % CI 1·4, 1·9) times higher for adolescents and adults using screens for ≥ 6 h/d, respectively, while for older adults, only screen times of 2 to < 3 and 3 to < 6 h were significantly associated with UPF scores ≥5. Screen time was associated with high consumption of UPF in all age groups. Considering these associations when planning and implementing interventions would be beneficial for public health across the lifespan.

Oxidative stress is present in chronic obstructive pulmonary disease (COPD); however, the effect of increased dietary antioxidants on reducing COPD risk remains unclear. The aim of this study was to investigate the association of the composite dietary antioxidant index (CDAI) with COPD in adults. This study conducted a cross-sectional investigation using data from the National Health and Nutrition Examination Survey (NHANES) spanning from 2015 to March 2020 to explore the association between CDAI and COPD in adults. This study included 9295 participants. Three logistic regression models (crude model, partially adjusted model and fully adjusted model) and restricted cubic spline (RCS) curves were utilised to assess the association between CDAI levels and COPD risk. Subsequently, a two-sample Mendelian randomisation (MR) was employed to analyse the causal impact of antioxidant levels within CDAI on the occurrence of COPD. CDAI levels were inversely associated with COPD after adjusting for confounders (OR = 0·97, 95 % CI 0·95, 1·00), and the association was linear (P < 0·001), and the results of the RCS showed that CDAI was linearly correlated with COPD occurrence (P < 0·001). MR analysis revealed a causal relationship between vitamin C and COPD occurrence (OR = 0·99, 95 % CI 0·98, 1·00, P < 0·05). Our study indicates that dietary sources of antioxidants may reduce the risk of COPD occurrence, and the results of the MR analysis further show that vitamin C is causally associated with a reduced risk of COPD occurrence. However, further exploration is needed to understand how antioxidants prevent COPD.

Rheumatoid arthritis (RA) is characterised by chronic inflammation in joints. Obesity, stress, being women and dietary pattern are important in pathogenesis. The joint damage in RA is accelerated by oxidative stress. The aim of this study was to examine the serum total antioxidant level, nutritional status and Mediterranean diet adherence of adult women with RA. Thirty-five adult women RA patients and thirty-five healthy control participated in this study (45·4 ± 11·61 and 42·5 ± 8·50 years, respectively). Nutritional status, physical activity levels and adherence to the Mediterranean diet were questioned. Physicians assessed the disease activity score of patients with RA. Serum total antioxidant and oxidant status were analysed. The serum total antioxidant status of the control group was higher, whereas the oxidative stress index and total oxidant status were lower than that of the RA group. Dietary protein, fibre, EPA, retinol, Fe, Zn and total antioxidant intake in the RA group were lower than in the control group (P < 0·05). Individuals with higher fibre intake showed a significantly lower risk for RA after adjusting for potential confounding factors (OR = 0·845, 95 % CI = 0·773–0·923, P < 0·001). The mean physical activity level of the control group was higher than that of the RA group (1·59 ± 0·10 and 1·53 ± 0·13, respectively) (P = 0·01). In conclusion, serum antioxidant parameters and dietary antioxidant intake are decreased in patients with RA. Therefore, medical treatment for these patients should be supplemented with medical nutrition therapy to achieve optimal nutritional status.

Increased ultra-processed food (UPF) is associated with adverse health outcomes. However, with limitations in UPF evidence, and partial overlap between UK front-of-package labelling (FOPL) and degree of food processing, the value of food processing within dietary guidance is unclear. This study compared food and drink from the UK National Diet and Nutrition Survey (NDNS) database based on micronutrient content, Nova classification and FOPL. The aim was to examine the micronutrient contributions of UK food and drink to UK government dietary micronutrient recommendations for adult females and males, aged 19–64 years, based on the degree of food processing and FOPL. NDNS items were coded into minimally processed food (MPF), processed culinary ingredients, processed food (PF) and UPF, and FOPL traffic lights. MPF, PF and UPF provided similar average contributions per 100 g to micronutrient recommendations. Per 100 kcal, MPF provided the greatest average contribution (14·4 % (interquartile range (IQR): 8·2–28·1)), followed by PF (7·7 % (IQR: 4·6–10·9) and then UPF (5·8 % (IQR: 3·1–9·7)). After adjusting for healthy/unhealthy items (presence of 1+ red FOPL), MPF had higher odds of an above-average micronutrient contribution per 100 kcal than UPF (OR: 5·9 (95 % CI 4·9–7·2)) and PF (OR: 3·2 (95 % CI 2·4–4·2)). MPF were more likely to provide greater contributions to micronutrient recommendations than PF or UPF per 100 kcal. These findings suggest that UPF or PF diets are less likely to meet micronutrient recommendations than an energy-matched MPF diet. The results are important for understanding how consumers perceive the healthiness of products based on FOPL.

An assessment of systemic inflammation and nutritional status may form the basis of a framework to examine the prognostic value of cachexia in patients with advanced cancer. The objective of the study was to examine the prognostic value of the Global Leadership Initiative on Malnutrition criteria, including BMI, weight loss (WL) and systemic inflammation (as measured by the modified Glasgow Prognostic Score (mGPS)), in advanced cancer patients. Three criteria were examined in a combined cohort of patients with advanced cancer, and their relationship with survival was examined using Cox regression methods. Data were available on 1303 patients. Considering BMI and the mGPS, the 3-month survival rate varied from 74 % (BMI > 28 kg/m2) to 61 % (BMI < 20 kg/m2) and from 84 % (mGPS 0) to 60 % (mGPS 2). Considering WL and the mGPS, the 3-month survival rate varied from 81 % (WL ± 2·4 %) to 47 % (WL ≥ 15 %) and from 93 % (mGPS 0) to 60 % (mGPS 2). Considering BMI/WL grade and mGPS, the 3-month survival rate varied from 86 % (BMI/WL grade 0) to 59 % (BMI/WL grade 4) and from 93 % (mGPS 0) to 63 % (mGPS 2). When these criteria were combined, they better predicted survival. On multivariate survival analysis, the most highly predictive factors were BMI/WL grade 3 (HR 1·454, P = 0·004), BMI/WL grade 4 (HR 2·285, P < 0·001) and mGPS 1 and 2 (HR 1·889, HR 2·545, all P < 0·001). In summary, a high BMI/WL grade and a high mGPS as outlined in the BMI/WL grade/mGPS framework were consistently associated with poorer survival of patients with advanced cancer. It can be readily incorporated into the routine assessment of patients.

The aim of this randomised controlled trial was to investigate the effects of breakfast high or low in protein on body composition and cardiometabolic markers in young women with overweight. In total, fifty-six women aged 18–30 years consumed a breakfast containing either high protein (34 g protein, n 26) or low protein (6 g protein, n 30) for 12 weeks. Measurements of body composition by dual-energy X-ray absorptiometry, waist circumference, glucose tolerance, fasting glucose, insulin and lipid profile were performed before and after this period. The primary outcome was fat mass. Satiety and hunger were evaluated by self-reported Visual Analogue Scale (VAS) scores. Dietary intake was estimated by 4-d dietary records, and calcium intake was estimated by FFQ. At baseline, relative daily protein intake was 15·2 ± 2·8 E%, which increased to 19·3 ± 3·4 E% in high protein but was unchanged in low protein (P < 0·001 between groups). High protein reported higher satiety compared with low protein (P = 0·02). Yet, no group differences were observed in changes in energy intake, body composition, blood lipid profile or measures of glucose tolerance (all P > 0·10). However, bone mineral content tended to increase in high protein (P = 0·05) and decrease in low protein (P = 0·07, interaction effect: P = 0·01). Conclusively, a high v. low content of protein in breakfast increased satiety but did not affect body composition or cardiometabolic markers in young women with overweight. This study adds to the sparse evidence on the effects of breakfast with different macronutrient compositions on health parameters in women with overweight. Registered at clinicaltrials.gov: NCT04518605.

Dietitians working at evacuation shelters conduct weighed food records (WFR) for multiple days for dietary assessment. Because the menus in evacuation shelters do not change much from day to day, this study examined whether 1- and 2-d WFR are sufficient for dietary assessment at shelters and identified dietary components that can influence the number of assessment days. Overall, twenty-six WFR were collected from ten shelters in Kumamoto Prefecture, and the amounts of energy; protein; vitamins B1, B2 and C and salt were calculated. Correlation analysis and paired sample tests were conducted to examine significant differences between ‘one- and two-consecutive- or non-consecutive-day WFR’ and ‘three-consecutive-day WFR’, which were set as the standard in this study. Additionally, the (CV for the categories by meal and dish were calculated to examine the variables that affected the large variations. As a result, 1-d WFR had significant positive correlations with the standard; thus, it could be used for the triage of shelters requiring nutrition assistance as a substitute for 3-d WFR. Two-consecutive-day and non-consecutive-day WFR showed a stronger correlation with the standard compared with the 1-d WFR. For energy and nutrients and dish categories, ready-to-eat foods had larger CV than boxed meals or foods from hot meal services. Whenever the meals included ready-to-eat foods, a two-non-consecutive-day WFR is recommended considering large between-day variations. Salty soup or beverages affected the variation of some nutrients. Our result would help municipalities to consider the number of WFR during emergency.

Understanding protein fermentation in the hindgut of pigs is essential due to its implications for health, and ileal digesta is commonly used to study this process in vitro. This study aimed to assess the feasibility of utilising in vitro digested residues as a replacement for ileal digesta in evaluating the protein fermentation potential. In vitro residues from cottonseed meal, maize germ meal, peanut meal, rapeseed cake, rapeseed meal, soyabean meal and sunflower meal were analysed using a modified gas production (GP) technique and curve fitting model to determine their fermentation dynamics and compare with the use of ileal digesta. Significant variations were observed in GP parameters between in vitro digested residues, indicating differences in nitrogen utilisation by fecal microbiota. Soyabean meal and sunflower meal exhibited the highest maximum GP rates (Rmax), with values of 29·5 ± 0·6 and 28·0 ± 1·2 ml/h, respectively, while maize germ meal showed slowest protein utilisation (17·3 ± 0·2 ml/h). A positive relationship was found between the Rmax of in vitro residues and ileal digesta (R2 = 0·85, P < 0·01). However, GP potential (GPs) showed a tendency for a negative relationship (R2 = 0·39, P < 0·1), likely due to narrow observed GPs values and the presence of varied endogenous proteins in ileal digesta. Our results demonstrate the potential of using in vitro digested residues as a substitute for ileal digesta in assessing the fermentation potential of protein ingredients, particularly regarding the rate of protein fermentation.