Obesity is an established risk factor for colorectal cancer (CRC), however little is known about changes in body composition during chemotherapy and its impact on survival. The aim of this study was to examine in patients with CRC: (1) The prevalence of abnormal body composition phenotypes, (2) The impact of baseline body composition on overall survival, (3) Changes in body composition throughout treatment and its impact on overall survival.

A prospective study of adult CRC patients undergoing chemotherapy between 2012–2016 was conducted. Longitudinal changes in body composition were examined using computed tomography (CT) images at two timepoints (interval 7 months, IQR: 5–9 months) using paired t-tests. Sarcopenia and low muscle attenuation (MA) were defined using published cut-offs. Cox proportional-hazards models were used to estimate mortality hazard ratios, adjusted for known prognostic covariates – stage, age, sex, performance status & systemic inflammation.

In total, 268 patients were recruited (66% male, mean age 63 years) and 51% were undergoing chemotherapy with a palliative intent. At baseline, 4% were underweight (BMI < 20 kg/m2), 38% had a normal BMI, and 58% were overweight/obese. Despite this, 38% had cancer cachexia, 34% were sarcopenic and 43% had low MA. Neither sarcopenia, sarcopenic obesity nor cachexia at baseline predicted survival. Over 100 days, 68% were muscle stable (± 1 kg), while 25% lost > 1 kg and 7% gained > 1 kg. Fat mass remained stable ± 1 kg in 49%, while 28% lost > 1 kg and 23% gained > 1 kg. When adjusted for known prognostic covariates, baseline BMI (20–25 kg/m2) in those having palliative chemotherapy was independently associated with reduced survival compared to those with BMI indicating overweight (BMI 25–30 kg/m2) [HR: 1.80 (95% CI: 1.04–3.14), p = 0.037]. In those undergoing chemotherapy with palliative intent, a loss of > 6.4% subcutaneous fat (Q1 SAT) over 100 days was predictive of poor survival versus those with small losses, remaining stable or gaining SAT (Q2-4), independent of changes in muscle mass [HR: 2.22 (95% CI: 1.07–4.62), p = 0.033].

Patients with CRC, particularly those treated with a palliative intent, experience significant losses in muscle and fat mass during chemotherapy. Loss of SAT mass during palliative chemotherapy is prognostic of poor survival, independent of changes in muscle mass. Baseline BMI in the overweight range confers a survival advantage. Nutritional strategies to prevent or attenuate weight loss during chemotherapy are advisable especially in the context of advanced CRC.

Current French National Health and Nutrition Plan (PNNS) recommends 2 servings of dairy products per day for adults. However, dairy contributes to dietary saturated fat intake, of which reduced consumption is often recommended for cardiovascular disease (CVD) prevention. Epidemiological evidence on the association between dairy product consumption and CVD risk remains unclear, with findings from recent prospective cohorts suggesting either null or inverse associations between dairy intake and CVD risk(1,2). This study aimed to investigate the associations between intakes of dairy products (overall and specific types) and CVD risk in a large cohort of French adults.

This prospective study included self-selected participants aged ≥ 18 years from the NutriNet-Santé cohort (2009–2019). Dietary data were collected every 6 months using 24 h-dietary records, averaged in daily intakes and coded as sex-specific quartiles. Dairy foods were classified according the PNNS dairy groups: milk, cheese, and yogurts (i.e. yogurts, curd cheese and petit-suisses). Total, fermented and low-fat dairy intakes were also investigated. CVD cases (n = 1,952) included cerebrovascular (i.e. stroke and transient ischemic attack, n = 878 cases) and coronary heart diseases (i.e. myocardial infarction, angina, acute coronary syndrome and angioplasty, n = 1,219 cases). Multivariable Cox models were performed to characterize associations and were adjusted for age, gender, without-alcohol energy intake, number of 24h-dietary records, smoking status, educational level, physical activity, BMI, alcohol intake and family history of CVD.

This analysis included n = 104,805 French adults with a mean age 42.8 (SD 14.6) years and the mean number of dietary records per subject was 5.7 (SD 3.1). There was no association between total or specific dairy intakes and total CVD or coronary heart disease risks. However, consumption of fermented dairy, such as cheese and yogurts, was associated with a 19% reduction in the risk of cerebrovascular disease (HRQ4 vs. Q1 = 0.81 [0.66–0.98], p trend = 0.01).

Despite being important dietary sources of saturated fat, dairy product consumption was not associated with total CVD or coronary heart disease risks in a large cohort of French adults. However, fermented dairy products may be associated with a lower risk of cerebrovascular diseases. Further observational and interventional studies may be needed to further assess the impact of dairy on CVD risk and to identify potential mechanisms underlying the beneficial effects of fermented dairy products on cerebrovascular disease risk.

Early childhood is a well-established critical period for growth and development, potentially impacting on life-long health. Healthy dietary habits formed during the transition from a predominantly milk-based to a food-based diet track into later life. Globally, there is no established process for developing food-based dietary guidelines (FBDG) for 1–5 year old children. This study aims to establish a protocol for developing FBDG for 1–5 year old children for use in population health globally.

Foods consumed by > 10% of consumers aged 1–5 years (at each eating occasion) were identified by secondary analysis of the Irish National Pre-School Nutrition Survey (NPNS; 2012). Consultations were held with registered dietitians to update the NPNS data and reflect current dietary habits. Dietary modelling, based on healthy eating principles, was conducted on boys (n30) and girls (n30) at five percentiles on the World Health Organisation (WHO) growth charts (0.4th; 25th; 50th; 75th; 99.6th) and at six age time-points (1y; 1.5y; 2y; 3y; 4y and 5y). Intake targets were identified for energy, macronutrients and 6 key micronutrients. For those with inadequate nutrient intakes, key contributing foods were identified and used in the modelling.

Dietary modelling yielded 640 four-day food intake patterns. For 1–3 year olds, especially those < 25th growth percentile, iron was identified as an at-risk nutrient as the intake target was not achieved. For all 1–5 year olds, vitamin D was identified as an at-risk nutrient. Red meat and iron-fortified cereal (> 12mg/100g) were identified as key contributors to iron intake. A combination of red meat (30 g, 3 days/week) and iron-fortified cereal (30 g, 5 days/week) resolved inadequate iron intakes for 1–3 year olds, except those < 25th growth percentile. For those children, the additional inclusion of 4 mg iron from use of iron-fortified milk (1.2mg/100mL) or a low-dose iron supplement (7 mg, 4 days/week) resulted in adequate iron intakes. For all children aged 1–5 years, vitamin D intakes improved by including a daily 5μg vitamin D supplement, but still did not reach the intake target.

Worldwide, significant resources are invested in assessing growth and development of 1–5 year olds. This study provides a protocol for developing FBDG to meet nutritional needs of 1–5 year olds at various growth parameters (age and percentiles), using WHO charts. This enables the provision of practical food-based interventions to nutritionally vulnerable children. Using national dietary data, this approach can be applied for developing FBDG specific to a country's needs.

Recognised as the optimum infant feeding method, breastfeeding affords substantial health benefits to mother and infant. Exclusive breastfeeding is recommended to 6 months, with continuation thereafter. In Ireland, data indicates that 60% breastfeed to any extent at hospital discharge and 40% do so at 3 months. However, nationally collected data is limited in detail, particularly with regard to breastfeeding continuation. The ongoing Cork-based COMBINE birth cohort study recruited 456 participants between 2015 and 2017. Through interviewer-led questionnaires, research midwives collected feeding data at hospital discharge, 1, 2, 4, 6 and 9 months of age. Infant feeding was classed as breast (breastmilk as main milk source), combination (both breastmilk and infant formula daily) or infant formula only feeding. Adherence to the World Health Organisation (WHO) recommendation to exclusively breastfeed (breastmilk only, no infant formula, supplementary fluids or solid foods) was examined longitudinally. To explore secular changes, breastfeeding rates in COMBINE were compared to the BASELINE birth cohort study, which recruited participants (n = 2116) between 2008 and 2011 in the same setting. In COMBINE, 75% of mothers provided any breastmilk (breast or combination) at hospital discharge, of whom 44% breastfed only. Two-fifths (40%), one-third (33%) and one-quarter (24%) breastfed at 1, 4 and 6 months, respectively. Combination feeding of breastmilk and infant formula was prevalent at discharge (31%) and 1 month (20%). Advice from healthcare professionals (31%) and concern baby was hungry (30%) were commonly reported reasons for this practice and throughout the study, mothers who combination fed were more likely to stop breastfeeding altogether than those who breastfed (all P < 0.001). Infant formula only feeding increased from 25% at discharge to 40% at 1 month, 49% at 2 months and 74% at 9 months. Half (45%) of mothers who breastfed did so for less than 4 months and insufficient milk/growth faltering was the most commonly cited reason for cessation (27%). The rate of WHO-defined exclusive breastfeeding was 40% from birth to discharge, 22% to 1 month, 15% to 4 months and 2% to 6 months. The breastfeeding (breastmilk as main milk source) rate at discharge did not differ between our two birth cohorts (44 vs. 40%, P = 0.23), but was significantly higher in COMBINE compared to BASELINE at 2 (36 vs. 27%) and 6 (24 vs. 12%) months (both P < 0.05). While these data provide evidence of some progress towards longer breastfeeding durations, there remains much scope to improve infant feeding practices in Ireland.

Type 2 Diabetes (T2D) is a chronic disease diagnosed based on fasting plasma glucose (FPG). A FPG > 6.9 mmol/L may result in the diagnosis of T2D by the general physician (GP) and result in general lifestyle advice to eat less and be more physically active. Because T2D can have different causes by the failure of one or multiple organs (especially pancreas, liver and muscle), it is of importance to determine this for a patient. Each specific organ failure will result in another lifestyle advice (diet, exercise or the combination). The aim of the present study was to examine whether this T2D subtyping resulted in a higher efficacy of the assigned lifestyle interventions as compared to general lifestyle advice.

118 newly diagnosed T2D subjects of multiple primary care practices in Hillegom, The Netherlands, participated. 60 subjects underwent a lifestyle treatment, coached by a dietitian and physiotherapist, based on the outcome of an Oral Glucose Tolerance Test (OGTT) at baseline. Based on 2-hr, 5-time points plasma glucose and insulin, organ specific insulin resistance indices were calculated for liver, muscle and pancreas. The resulting T2D subtypes differed in intervention: energy restriction, exercise training, or a combination of both for 13 weeks. Data of 58 control subjects who were provided general lifestyle advice were gathered retrospectively. The OGTT was repeated after 13 weeks of lifestyle treatment to examine changes in phenotype. Effectiveness of the intervention was compared with controls based on FPG, HbA1c and body weight (BW).

The six T2D subtypes at baseline were unevenly distributed. The main category were subjects with a poor □-cell function in combination with hepatic insulin resistance (45%). Due to the intervention, 19 subjects showed a healthy, normalized phenotype afterwards (32%). The interventions were effective and resulted in a significantly higher reduction of FPG (Δ-0.4 ± 0.1 mmol/L), reduced HbA1c (Δ-3.0 ± 0.6mmol/mol) and BW loss (Δ-8.1 ± 0.7kg) as compared to control subjects. The reduced BW, FPG and HbA1c were still present at one year follow-up, although some drop-out of subjects (n = 11) started to appear and still 49 subjects were in-study.

T2D subtyping resulted in personalization of treatment, thereby effectively improving glycemic parameters and body weight as compared to general care. T2D subtyping is therefore not only effective for a more detailed diagnosis, it also enables personalization of T2D lifestyle treatment.

Sarcopenia is a muscle disease rooted in adverse muscle changes that accrue across a lifetime. It is an independent risk factor for numerous adverse health outcomes. In 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a definition for the identification of people with sarcopenia (EWGSOP1). In 2018, this definition was updated based on the newest evidence (EWGSOP2), with the focus now on low muscle strength rather than low muscle quantity as the key characteristic of sarcopenia. In addition, EWGSOP2 provides clear cut-off points for measurements of variables that identify sarcopenia. The aim of this study was to determine the prevalence of sarcopenia among community-dwelling older adults in Ireland for the first time and to assess agreement between the EWGSOP1 and EWGSOP2 definitions. In a cross-sectional analysis, 490 community-dwelling adults (age 78.4 ± 8.0 y, body mass index 27.6 ± 5.1 kg/m2) were assessed. Skeletal muscle mass was estimated using bioelectrical impedance analysis, muscle strength was measured via handgrip dynamometry and physical performance via the Short Physical Performance Battery. Sarcopenia was defined according to both the 2010 criteria (EWGSOP1) and the updated 2018 criteria (EWGSOP2). Using the EWGSOP1 criteria, the prevalence of sarcopenia was 7.1% (2.6% sarcopenia, 4.5% severe sarcopenia) and 3.6% were classified as pre-sarcopenic (low muscle mass without a decrement in strength or physical performance). Using the EWGSOP2 criteria, the prevalence of sarcopenia was 5.5% (1.6% sarcopenia, 3.9% severe sarcopenia) and 23.4 % were classified as having low strength but without a decrement in muscle mass. Five of the participants who were classified as sarcopenic (2 sarcopenia, 3 severe sarcopenia) by EWGSOP1 were classified as “normal” using the EWGSOP2 criteria. In conclusion, the prevalence of sarcopenia in community-dwelling older adults in Ireland is in line with the prevalence reported in other European countries using the EWGSOP1 criteria (3.3–11.4 %). To our knowledge this is the first study to compare the prevalence based on the EWGSOP1 and the EWGSOP2 criteria. We report a slightly lower prevalence using the EWGSOP2 definition compared to the EWGSOP1 definition. Importantly however, in contrast to EWGSOP1, the EWGSOP2 definition identified a substantial proportion of older adults with poor strength in the absence of overt sarcopenia (23.4%). These older adults represent a group who would benefit from further clinical investigation and intervention.

The Food Safety Authority of Ireland (FSAI) have set target maximum daily salt intakes for children (4–6y: 3 g, 7–10y: 5 g, 11–14y: 6g) while the European Food Safety Authority (EFSA) have set Adequate Intakes (AI) for potassium of 1100mg/d, 1800mg/d and 2700mg/d for children of the same respective age groups. An individual's sodium to potassium (Na:K) intake ratio is an important predictor of hypertension and the World Health Organization (WHO) recommend a Na:K intake ratio of ≤ 1.0mmol/mmol for both adults and children. Although the morbidities associated with hypertension may not be seen until adulthood, blood pressure in childhood has a significant association with blood pressure in adulthood. Therefore, estimation of Na:K intake ratios (best measured by urinary excretion) in children may predict their susceptibility to hypertension related diseases in later life. The aim of this study was to estimate sodium and potassium intake and mean molar Na:K intake ratio of Irish children and to assess compliance with dietary guidance.

Morning spot urine samples were collected for 572 children aged 5–12 years (95% of total sample) as part of the nationally representative Irish National Children's Food Survey II (2017–2018) (NCFSII; www.iuna.net). Samples were transported, processed and stored using best practice procedures. Urinary excretion of sodium and potassium were measured using a Randox RX Daytona and were corrected for gender and age-specific 24-hour urine volume estimations based on 24-hour urine volume estimates from Australian children. SPSS Version 25 was used for all analyses.

Mean 24-hour urinary sodium excretion was 2018mg/d, equivalent to an average salt excretion of 5.0g/d exceeding the FSAI maximum target intake for all age groups except 11–12 year olds. Mean 24-hour urinary potassium excretion was 1411mg/d with mean intakes below the AI from EFSA for all age groups with the exception of 5–6 year olds. The mean molar Na:K ratio of Irish children was 2.8 for boys and 3.4 for girls. Only 5% of Irish children met the WHO recommendation for a Na:K ratio of ≤ 1.0mmol/mmol.

High intakes of sodium and low intakes of potassium reported in this study result in a low compliance with the WHO recommendation of a Na:K ratio ≤ 1.0mmol/mmol. This may lead to a higher risk of hypertension and related morbidities in later life. Based on these findings, dietary interventions to combat hypertension related diseases (such as lowering sodium and increasing potassium intakes) should be implemented from childhood.

Oxylipins and endocannabinoids (eCBs) both belong to superclasses of lipid mediators with potent inflammation modulatory activities. The adipose tissue (AT) plays a key role in metabolic syndrome-related inflammation, via altered adipocyte physiology, infiltrated macrophages and altered profile of eCBs. We previously reported that DHA is more potent than EPA at modulating systemic inflammation, but the underlying mechanisms remain unclear. The objective of this study was to compare the individual effect of high-dose DHA and of EPA on circulating lipid mediators, i.e. plasma oxylipins and eCBs, and AT-related inflammation. In a randomized double-blind crossover trial, 154 volunteers with abdominal obesity and low-grade inflammation were subjected to three 10-wk supplementation phases: 1- EPA (2.7 g/d); 2- DHA (2.7 g/d); 3- corn oil (control), each separated by a 9-wk washout. Supplements were provided as re-esterified triacylglycerols. Profiling of plasma oxylipins and eCBs was performed on 58 subjects after each phase. Abdominal subcutaneous AT biopsies were also obtained from 13 individuals after each phase. Plasma DHA-, EPA-, arachidonic acid-derived oxylipins were analyzed by LC-MS. eCBs and some of their bioactive congeners were analyzed in plasma and AT by LC-APCI-MS. Adipocyte diameter was determined by histological analysis and AT macrophage infiltration was quantified by double immunofluorescence. Compared with EPA, DHA increased plasma levels of hydroxy-docosahexaenoic acids (7-, 11-, 14-, 4-, 17-HDOHE; P < 0.0001) and palmitoylethanolamide (PEA; P = 0.04). Compared with DHA, EPA led to higher plasma level of hydroxy-eicosapentaenoic acids (12-, 15-, 5-HEPE; P < 0.0001). In the AT, EPA increased the level of oleoylethanolamide (OEA; P = 0.01) compared with DHA, but no other difference was observed between treatments in adipose eCBs and eCB-related lipids. DHA and EPA did not differentially modify adipocyte size distributions (P > 0.50) and proportions of M1-type and M2-type macrophages (P > 0.30). In conclusion, increased plasma levels of anti-inflammatory DHA-derived oxylipins and plasma PEA may be responsible, at least to some extent, for the more potent anti-inflammatory effects of DHA compared with EPA observed in the ComparED study. Conversely, subcutaneous AT does not seem to be involved in explaining such differences between EPA and DHA.

Excess dietary sodium plays an important role in hypertension, a leading risk factor for cardiovascular disease (CVD). To counteract some of the negative effects of sodium, an increased intake of potassium has shown beneficial effects on blood pressure. In fact, the sodium to potassium ratio might be a stronger risk factor for CVD than either sodium or potassium alone. The objective of the present study was to estimate the effect of A) a salt reduction strategy (providing salt reduced bread) and B) a salt reduction and potassium promoting strategy (providing salt reduced bread combined with dietary counselling), on intake of sodium, potassium and the sodium/potassium ratio. The study is a 4-month cluster randomized controlled trial with families randomly assigned to either intervention A, intervention B or control. Participants in intervention A received bread gradually reduced in salt content from 1.2 g salt/100 g to 0.6 g salt/100 g in ryebread and 0.4 g salt/100 g in wheat bread. Participants in intervention B received the same salt reduced bread and in addition dietary counselling on how to eat food with less salt and more potassium. The control group received standard bread (1.2 g salt/100g). Sodium and potassium intake were measured through three consecutive 24-hour urine measurements in adults and one in children at baseline and follow-up. Changes in outcomes were assessed using linear mixed models. Eighty-nine families, including 155 adults (46.5 % men) and 156 children (51.9 % boys), from the suburb of Copenhagen, Denmark, participated in the study. The sodium/potassium ratio was significantly reduced by -0.57 ± 0.19 mmol/L (P = 0.003) in intervention B compared to control group, resulting from a non-significant lower sodium and increased potassium intake. No significant differences were found between intervention A and control group (preliminary results). These findings support future actions to reduce salt intake, focusing on a combination of structural and educational strategies.

The association of MeHg exposure through fish consumption on human autoimmunity remains unclear. Fish also contain n-3 long chain polyunsaturated fatty acids (LCPUFA) that are known to regulate inflammation and mitigate autoimmune disease symptoms. We studied the association of low-level exposure to methylmercury (MeHg) through fish consumption in the SCDS. We examined this association at age 19 years in the SCDS Main Cohort (n = 497). We measured MeHg exposure at 3 time points [prenatal, weighted average (6 months to 19 years) and concurrent (19 years) and LCPUFA status and a panel of 13 autoimmune markers at age 19 years. The autoimmune markers included antinuclear antibodies (ANA), anti-dsDNA and anti-RNP, and total (non-specific) immunoglobulins (Ig) IgG, IgA, and IgM. A combined ANA variable was also calculated based on being within or above reference range for any of the ANA markers; 56% of the subjects met this criterion. Multivariable regression models adjusted for prenatal MeHg, sex and waist circumference, with and without adjustment for LCPUFA, were fit for the three MeHg exposure metrics and each immune marker. Mean (SD) prenatal, weighted average and concurrent MeHg was 6.84 (4.55), 7.46 (2.82), and 10.23 (6.02) ppm, respectively. Combined ANA was positively associated with concurrent MeHg following adjustment for the n6:n3 LCPUFA ratio (β = 0.036, 95%; CI: 0.001, 0.073). Prenatal and average MeHg exposures were not significantly associated with any individual ANA. IgM was negatively associated with concurrent (β = -0.016, 95%CI: -0.016, -0.002), and average (β = -0.042, 95%CI: -0.042, -0.009) MeHg exposure in the models adjusted for n-3, n-6 LCPUFA and when separately adjusted for the n6:n3 LCPUFA ratio. Total (19-year) n-3 PUFA status was negatively associated with anti-RNP (β = -20.355, 95%CI: -36.89, -4.34) and IgG (β = -1.384, 95%CI: -2.682, -0.087). Total n-3 LCPUFA was associated with lower markers of autoimmunity. MeHg exposure at 19 years was associated with higher ANA and lower IgM but only following adjustment for LCPUFA. The clinical significance of these findings is unclear and further research is warranted to determine if these associations precede autoimmune disease development.

Introduction: The Middle East and North Africa region features marked gender excess adiposity inequalities detrimental to women in a context of nutrition transition with major shifts in lifestyle and diet. We assessed gender inequalities in dietary intake with a focus on diet quality. Sociodemographic patterning of these gender dietary inequalities was explored.

Methods: A cross-sectional study in the Greater Tunis region (Tunisia) in 2009–2010 surveyed 20–49 y old adults of both genders (women n = 1689, men n = 930) using a stratified, two-stage cluster sample. Dietary intake was assessed using a 3-day food record. We assessed diet quality by the Diet Quality Index-International (DQI-I) /100 and sub-components (variety, adequacy, moderation, balance); DQI-I > 60 defined good diet quality. Gender inequalities measures were women vs. men differences of means for interval variables and odds-ratios (OR) for DQI-I > 60. Their variation with sociodemographic characteristics were estimated by models featuring gender x covariate interactions.

Results: Mean energy intake in kcal was 2300 ± 15 for women vs. 2859 ± 32 for men. By 1000 g/kcal/day women consumed more fruits and sweets but less red meat and soft drinks than men. Mean DQI-I was lower among women vs. men (58.6 ± 0.3 vs. 60.4 ± 0.3, diff = -1.8[-2.6;-1.0], P < 0.0001) as well as proportion of DQI-I > 60 (45.2% vs. 55.7%, OR = 0.7[0.5;0.8], P < 0.0001). Gender differences varied with the 4 sub-components: women vs. men had lower mean variety (10.1 ± 0.1 vs. 12.1 ± 0.2, diff = -2.0[-2.3;-1.6], P < 0.0001) and adequacy scores (30.8 ± 0.1 vs. 32.5 ± 0.1, diff = -1.8[-2.0;-1.5], P < 0.0001) (for the latter they scored a little better than men for the fruit item, but had much lower scores than men for iron and also calcium). But women scored better than men on the moderation score (14.2 ± 0.2 vs. 12.3 ± 0.2, diff = + 1.8[1.4;2.2], P < 0.0001), mostly due to their better score on the cholesterol and sodium items. There was no difference for the balance subcomponent. Adjusted gender inequalities in DQI-I decreased with age, were higher in larger households and were also higher in the extreme categories of education i.e. no-schooling and university vs. the middle categories.

Conclusions: Diet quality was overall average. It was lower for women than men. Women vs. men differences in diet quality varied somewhat according to sociodemographic indicators linked to different gender roles. We also showed that gender contrasts depend on which dimension of diet quality is considered (better moderation but worse adequacy and variety for women). That maybe a pathway for gender specific prevention.