At a time when the health benefits of the Mediterranean diet (MD) are pervasively recognised, a paradoxical observation is the decreasing adherence to this dietary pattern in its native countries. This study aims to investigate temporal trends in adherence to the MD among adolescents (10–19 years old) in Lebanon. Data were drawn from three national cross-sectional surveys conducted at three points in time: 1997 (n 2004), 2009 (n 3656) and 2015 (n 1204). Dietary intake was assessed using 24-h dietary recalls, and adherence to the MD was assessed using two country-specific indexes: the composite Mediterranean diet (c-MED) index and Lebanese Mediterranean diet (LMD) index. Significant decreases in c-MED and LMD scores and in the proportion of adolescents adhering to the MD were observed between 1997 and 2015, with more consistent results among females (P < 0·05). Projections for the year 2030 showed further decreases, with less than a quarter of adolescents remaining adherent to the MD. Based on linear regression analyses, belonging to the year 2009 was associated with significantly lower MD scores compared with 1997, even after adjustment for potential covariates (c-MED β = –0·16, 95 % CI –0·30, –0·01; LMD β = –0·42, 95 % CI –0·67, –0·17). Similar results were obtained when comparing survey year 2015 with 1997 (c-MED score β = –0·20, 95 % CI –0·33, –0·06; LMD score β = –0·60, 95 % CI –0·82, –0·37). Findings highlight the erosion of the MD among Lebanese adolescents and underline the need for a comprehensive food system approach that fosters the promotion of the MD as a nutritionally balanced and sustainable dietary pattern.

This study examined the effect of ambient temperature on energy intake, perceived appetite and gut hormone responses during rest in men. Thirteen men (age 21·5 (sd 1·4) years; BMI 24·7 (sd 2·2) kg/m2) completed three, 5·5 h conditions in different ambient temperatures: (i) cold (10°C), (ii) thermoneutral (20°C) and (iii) hot (30°C). A standardised breakfast was consumed after fasting measures, and an ad libitum lunch provided at 4–4·5 h. Blood samples (analysed for plasma acylated ghrelin, total peptide tyrosine-tyrosine (PYY) and total glucagon-like peptide 1 (GLP-1) concentrations), perceived appetite and thermoregulatory responses were collected throughout. Linear mixed models were used for statistical analyses. Ad libitum energy intake was 1243 (sd 1342) kJ higher in 10°C and 1189 (sd 1219) kJ higher in 20 v. 30°C (P = 0·002). Plasma acylated ghrelin, total PYY and GLP-1 concentrations did not differ significantly between the conditions (P ≥ 0·303). Sensitivity analyses for the 4 h pre-lunch period showed that perceived overall appetite was lower in both 30 and 10°C when compared with 20°C (P ≤ 0·019). In conclusion, acutely resting in a hot compared with a thermoneutral and cold ambient temperature reduced lunchtime ad libitum energy intake in healthy men. Suppressed perceived appetite may have contributed to the reduced energy intake in the hot compared with thermoneutral ambient temperature, whereas gut hormones did not appear to play an important role.

Flavonoid-rich foods have shown a beneficial effect against non-alcoholic fatty liver disease (NAFLD) in short-term randomised trials. It is uncertain whether the usual dietary intake of flavonoids may benefit patients with NAFLD. The present study evaluated the association between the usual intake of flavonoids and the risk of progression in NAFLD. The prospective study included 2694 adults from the Guangzhou Nutrition and Health Study. Face-to-face interviews using a seventy-nine-item FFQ were administered to assess habitual dietary flavonoid intake, while abdominal ultrasonography was conducted to evaluate the presence and degree of NAFLD, with measurements conducted 3 years apart. After adjustment for potential confounders, higher flavonoid intakes were gradely associated with reduced risks of worsen NAFLD status. The relative risks of worsening (v. non-worsening) NAFLD in the highest (v. lowest) quintile were 0·71 (95 % CI 0·54, 0·93) for total flavonoids, 0·74 (95 % CI 0·57, 0·95) for flavanones, 0·74 (95 % CI 0·56, 0·96) for flavan-3-ols, 0·90 (95 % CI 0·68, 1·18) for flavonols, 0·73 (95 % CI 0·56, 0·93) for flavones, 0·79 (95 % CI 0·61, 1·02) for isoflavones and 0·74 (95 % CI 0·57, 0·96) for anthocyanins. An L-shaped relationship was observed between total flavonoid intake and the risk of NAFLD progression. Path analyses showed that the association between flavonoids and NAFLD progression was mediated by decreases in serum cholesterol and homeostasis model assessment of insulin resistance. This prospective study showed that higher flavonoid intake was associated with a lower risk of NAFLD progression in the elderly overweight/obese Chinese population.

The effect of coffee consumption on functional disability has been scarcely investigated. Thus, this study aimed to examine the association between coffee consumption and functional disability in older American adults. Participants (≥60 years old, n 7704) were from the National Health and Nutrition Examination Survey 2007–2016. Coffee consumption was assessed through two 24-h dietary recall interviews. Five domains of functional disability including lower extremity mobility (LEM), general physical activity (GPA), leisure and social activities (LSA), activities of daily living (ADL) and instrumental activities of daily living (IADL) were self-reported. Age- and multivariate-adjusted logistic regression models and restricted cubic spline analyses were used. Total coffee consumption was inversely associated with LEM, GPA, LSA and IADL disability. Compared with non-drinkers of total coffee, those who consumed ≥2 cups/d reported lower odds of LEM (OR 0·67, 95 % CI 0·50, 0·91), GPA (OR 0·65, 95 % CI 0·47, 0·88), LSA (OR 0·61, 95 % CI 0·45, 0·83) and IADL (OR 0·59, 95 % CI 0·44, 0·78) disability. The dose–response analyses confirmed these relationships. Intake of ≥2 cups/d caffeinated coffee was also inversely linked to GPA (OR 0·67, 95 % CI 0·48, 0·92), LSA (OR 0·66, 95 % CI 0·46, 0·93) and IADL (OR 0·57, 95 % CI 0·43, 0·75) disability, whereas the inverse association of 2+ cups/d decaffeinated coffee was only on LEM (OR 0·43, 95 % CI 0·23, 0·81) and LSA (OR 0·39, 95 % CI 0·16, 0·94) disability. The present study suggested that coffee consumption was inversely associated with functional disability in older American adults. Those associations of diverse coffee types differed across domains of functional disability.

The rising popular belief that gluten is unhealthy has led to growth in gluten avoidance in people without coeliac disease. Little information is available on their dietary profiles and their dietary behaviours. Our aim was to compare the consumption of organic foods between gluten avoiders and non-avoiders, and their places of food purchase. We described their sociodemographic and dietary profiles. The study population included participants of the NutriNet-Santé cohort who completed both a food exclusion questionnaire and an organic semi-quantitative FFQ (n 23 468). Food intake and organic food consumption ratios were compared using multivariable adjusted ANCOVA models. Associations between gluten avoidance and organic food consumption as well as places of food purchase were investigated with multivariable logistic regression. Participants avoiding gluten were more likely to be women and had a healthier dietary profile. Organic food consumption was higher among gluten avoiders (48·50 % of total diet for total avoiders, 17·38 % for non-avoiders). After adjustments for confounders, organic food consumption and purchase in organic stores were positively associated with gluten avoidance: adjusted OR (aOR)Q5 v.Q1 organic food = 4·95; 95 % CI 3·70, 6·63 and aORorganic stores v.supermarkets = 1·82; 95 % CI 1·42, 2·33 for total avoiders. Our study highlights that individuals avoiding gluten are high organic consumers and frequently purchase their foods in organic stores which propose an extended offer of gluten-free food. Further research is needed to determine the underlying common motivations and the temporality of the dietary behaviours of healthy people avoiding gluten.

This study aims to investigate the dietary share of ultra-processed foods and its association with the non-communicable disease (NCD)-related nutrient profile of adult and elderly populations in Portugal. Cross-sectional data from the National Food, Nutrition and Physical Activity Survey (2015–2016) of the Portuguese population were analysed. Dietary intake was assessed by two non-consecutive 24-h recalls, and food items were classified according to the NOVA system. We estimated the percentage of dietary energy provided by each of the NOVA food groups and assessed the NCD-related nutrient profile of the overall diet across quintiles of ultra-processed food consumption. Weighted t tests, besides crude and adjusted linear and Poisson regressions, were performed. Ultra-processed foods contributed to around 24 and 16 % of daily energy intake for adults and elderly, respectively. In both groups, as the consumption of ultra-processed foods increased, the dietary content of free sugars, total fats and saturated fats increased, while the dietary content of protein decreased. In adults, total energy intake, dietary energy density and content of carbohydrates also increased as the consumption of ultra-processed foods increased, while the dietary content of fibre, Na and K decreased. The prevalence of those exceeding the upper limits recommended for free sugars and saturated fats increased by 544 and 153 % in adults and 619 and 60 % in elderly, when comparing the lowest with the highest quintile of ultra-processed food consumption. Such a scenario demands for effective strategies addressing food processing in the Portuguese population to improve their diet quality and prevention against diet-related NCD.

The World Cancer Research Fund and American Institute for Cancer Research (WCRF/AICR) advise cancer survivors to follow their lifestyle recommendations for cancer prevention. Adhering to these recommendations may have beneficial effects on patient-reported outcomes after a cancer diagnosis, but evidence is scarce. We aimed to assess associations of the individual dietary WCRF/AICR recommendations regarding fruit and vegetables, fibre, fast foods, red and processed meat, sugar-sweetened drinks and alcohol consumption with patient-reported outcomes in colorectal cancer (CRC) survivors. Cross-sectional data of 150 stage I–III CRC survivors, 2–10 years post-diagnosis, were used. Dietary intake was measured by 7-d dietary records. Validated questionnaires were used to measure health-related quality of life (HRQoL), fatigue and neuropathy. Confounder-adjusted linear regression models were used to analyse associations of each WCRF/AICR dietary recommendation with patient-reported outcomes. Higher vegetable intake (per 50 g) was associated with better global QoL (β 2·6; 95 % CI 0·6, 4·7), better physical functioning (3·3; 1·2, 5·5) and lower levels of fatigue (−4·5; −7·6, −1·4). Higher fruit and vegetables intake (per 100 g) was associated with better physical functioning (3·2; 0·8, 5·5) and higher intake of energy-dense food (per 100 kJ/100 g) with worse physical functioning (−4·2; −7·1, −1·2). No associations of dietary recommendations with neuropathy were found. These findings suggest that adhering to specific dietary WCRF/AICR recommendations is associated with better HRQoL and less fatigue in CRC survivors. Although the recommendations regarding healthy dietary habits may be beneficial for the well-being of CRC survivors, longitudinal research is warranted to gain insight into the direction of associations.

Obesity caused by excessive deposited fat is generally classified as BMI ≥ 30 kg/m2. Research regarding the association between dietary advanced glycation end products (dAGE) and obesity is limited. The aim of the present study was to investigate the association between dAGE and obesity and body composition in Iranian adults. This cross-sectional study included 265 adults aged 18–75 years from Tehran, Iran. dAGE were estimated using a validated semi-quantitative FFQ, according to the published food carboxymethyl lysine–AGE database for 549 routinely consumed food items for the Northeastern American multiethnic urban population, and were reported by dividing total energy intake. Dietary intake, sociodemographic data and physical activity status were collected using validated questionnaires, and anthropometric characteristics were measured. Body composition was assessed by bioelectrical impedance analysis, and obesity was defined based on WHO guidelines. The intake of fat and meat was significantly increased in higher tertiles, compared with the first tertile of dAGE (P < 0·001). No association between dAGE and body composition measures and obesity was observed; however, there was a significant negative association between dAGE and BMI (BMI; P = 0·01), waist circumference (P = 0·01), waist:hip ratio (P = 0·03), fat-free mass (P = 0·02) and muscle mass index (P = 0·01) in non-linear models. In conclusion, higher consumption of dAGE was associated with increased intake of fat and meat and was negatively related to changes in body composition measurements. Therefore, dAGE may connect obesity to diet by energy imbalance.