This study aimed to estimate the nationwide prevalence of cardiometabolic diseases (CMDs) among adults with underweight in the US general population. Using data from the National Health and Nutrition Examination Survey (1999-2020), we estimated the age-standardized prevalence of dyslipidemia, hypertension, diabetes, chronic kidney disease, cardiovascular disease, and the presence of 0 or at least 2 CMDs. Multivariable Poisson regressions were used to compare CMD prevalence between subgroups, adjusting for age, sex, and race/ethnicity. Among the 855 adults with underweight included, the weighted mean age was 40.8 years, with 68.1% being women and 70.4% non-Hispanic White. The estimated prevalence rates were 23.4% for dyslipidemia (95% CI, 19.4%-27.5%), 15.6% for hypertension (95% CI, 13.3%-17.8%), 2.5% for diabetes (95% CI, 1.5%-3.5%), 7.9% for chronic kidney disease (95% CI, 6.9%-8.8%), and 6.1% for cardiovascular disease (95% CI, 4.3%-7.9%). The prevalence of having 0 and at least 2 CMDs was 50.6% (95% CI, 44.1%-57.0%) and 12.3% (95% CI, 8.1%-16.4%), respectively. Non-Hispanic Black adults had significantly higher prevalence of diabetes (adjusted prevalence ratio, 3.35; 95% CI, 1.35-8.30) compared to non-Hispanic White adults. In conclusion, approximately half of the underweight adults had at least one CMD, and 12.3% had at least two CMDs. Prevention and management of CMDs in underweight adults are critical yet neglected public health challenges.

Sleep apnoea is a known risk factor for cardiometabolic diseases (CMD), but it is unknown whether sleep apnoea or its symptoms contribute to increased CMD through an association with diet quality. This study assessed the association between sleep apnoea symptoms on future diet quality in the Bogalusa Heart Study (BHS). This prospective study included 445 participants who completed a sleep apnoea questionnaire in 2007–2010 and a FFQ in 2013–2016 (mean follow-up: 5·8 years; age 43·5 years; 34 % male; 71 % White/29 % Black persons). Diet quality was measured with the Alternate Healthy Eating Index (AHEI) 2010, the Healthy Eating Index (HEI) 2015 and the alternate Mediterranean diet score. Adjusted mean differences in dietary patterns by sleep apnoea risk, excessive snoring and daytime sleepiness were estimated with multivariable linear regression. Models included multi-level socio-economic factors, lifestyle and health characteristics including BMI, physical activity and depressive symptoms. Those with high sleep apnoea risk, compared with low, had lower diet quality 5·8 years later (percentage difference in AHEI (95 % CI −2·1 % (–3·5 %, −0·7 %)). Daytime sleepiness was associated with lower diet quality. After adjusting for dietary pattern scores from 2001 to 2002, having high sleep apnoea risk and excessive sleepiness were associated with 1·5 % (P < 0·05) and 3·1 % (P < 0·001) lower future AHEI scores, respectively. These findings suggest that individuals with sleep apnea or excessive sleepiness should be monitored for diet quality and targeted for dietary interventions to improve CMD risk.

Taste preference is a pivotal predictor of nutrient intake, yet its impact on mild cognitive impairment (MCI) remains poorly understood. We aimed to investigate the association between taste preferences and MCI and the role of cardiometabolic diseases (CMD) in this association. The study included older adults, aged 65–90 years, with normal cognitive function at baseline who were enrolled in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008 to 2018. MCI was measured by the Mini-Mental State Examination, and multivariable Cox regression models were applied. Among 6423 participants, 2534 (39·45 %) developed MCI with an incidence rate of 63·12 - per 1000 person-years. Compared with individuals with insipid taste, those preferring sweetness or spiciness had a higher MCI risk, while saltiness was associated with a lower risk. This association was independent of objective dietary patterns and was more pronounced among urban residents preferring sweetness and illiterate participants preferring spiciness. Notably, among sweet-liking individuals, those with one CMD experienced a significant detrimental effect, and those with co-occurring CMD had a higher incidence rate of MCI. Additionally, regional variations were observed: sweetness played a significant role in regions known for sweet cuisine, while the significance of spiciness as a risk factor diminishes in regions where it is commonly preferred. Our findings emphasize the role of subjective taste preferences in protecting cognitive function and highlight regional variations. Target strategies should focus on assisting individuals with CMD to reduce excessive sweetness intake and simultaneously receiving treatment for CMD to safeguard cognitive function.

Gene–nutrient interactions (GeNuIne) collaboration, a large-scale collaborative project, has been initiated to investigate the impact of gene–nutrient interactions on cardiometabolic diseases using population-based studies from ethnically diverse populations. In this project, the relationship between deficiencies of vitamins B12 and D, and metabolic diseases was explored using a nutrigenetic approach. A genetic risk score (GRS) analysis was used to examine the combined effect of several genetic variations that have been shown to be associated with metabolic diseases and vitamin B12 and D deficiencies, respectively. In Sri Lankan, Indonesian and Brazilian populations, those carrying a high B12-GRS had an increased risk of metabolic diseases under the influence of dietary protein, fibre and carbohydrate intakes, respectively; however, in Asian Indians, genetically instrumented metabolic disease risk showed a significant association with low vitamin B12 status. With regards to nutrigenetic studies on vitamin D status, although high metabolic-GRS showed an interaction with dietary carbohydrate intake on vitamin D status, the study in Indonesian women demonstrated a vitamin D GRS–carbohydrate interaction on body fat percentage. In summary, these nutrigenetic studies from multiple ethnic groups have provided evidence for the influence of the dietary factors on the relationship between vitamin B12/D deficiency and metabolic outcomes. Furthermore, these studies highlight the existence of genetic heterogeneity in gene–diet interactions across ethnically diverse populations, which further implicates the significance of personalised dietary approaches for the prevention of these micronutrient deficiencies and metabolic diseases.

The Paleolithic diet (PaleoDiet) is an allegedly healthy dietary pattern inspired by the consumption of wild foods and animals assumed to be consumed in the Paleolithic era. Despite gaining popularity in the media, different operational definitions of this Paleolithic nutritional intake have been used in research. Our hypothesis is that specific components used to define the PaleoDiet may modulate the association of this diet with several health outcomes. We comprehensively reviewed currently applied PaleoDiet scores and suggested a new score based on the food composition of current PaleoDiet definitions and the theoretical food content of a staple dietary pattern in the Paleolithic age. In a PubMed search up to December 2019, fourteen different PaleoDiet definitions were found. We observed some common components of the PaleoDiet among these definitions although we also found high heterogeneity in the list of specific foods that should be encouraged or banned within the PaleoDiet. Most studies suggest that the PaleoDiet may have beneficial effects in the prevention of cardiometabolic diseases (type 2 diabetes, overweight/obesity, CVD and hyperlipidaemias) but the level of evidence is still weak because of the limited number of studies with a large sample size, hard outcomes instead of surrogate outcomes and long-term follow-up. Finally, we propose a new PaleoDiet score composed of eleven food items, based on a high consumption of fruits, nuts, vegetables, fish, eggs and unprocessed meats (lean meats); and a minimum content of dairy products, grains and cereals, and legumes and practical absence of processed (or ultra-processed) foods or culinary ingredients.

Social and health care provision have led to substantial increases in life expectancy. In the UK this has become higher than 80 years with an even greater proportional increase in those aged 85 years and over. The different life stages give rise to important nutritional challenges and recent reductions in milk consumption have led to sub-optimal intakes of calcium by teenage females in particular when bone growth is at its maximum and of iodine during pregnancy needed to ensure that supply/production of thyroid hormones to the foetus is adequate. Many young and pre-menopausal women have considerably sub-optimal intakes of iron which are likely to be associated with reduced consumption of red meat. A clear concern is the low intakes of calcium especially as a high proportion of the population is of sub-optimal vitamin D status. This may already have had serious consequences in terms of bone development which may not be apparent until later life, particularly in post-menopausal women. This review aims to examine the role of dairy foods and red meat at key life stages in terms of their ability to reduce or increase chronic disease risk. It is clear that milk and dairy foods are key sources of important nutrients such as calcium and iodine and the concentration of some key nutrients, notably iodine can be influenced by the method of primary milk production, in particular, the iodine intake of the dairy cow. Recent meta-analyses show no evidence of increased risk of cardiovascular diseases from high consumption of milk and dairy foods but increasing evidence of a reduction in the risk of type 2 diabetes associated with fermented dairy foods, yoghurt in particular. The recently updated reports from the World Cancer Research Fund International/American Institute for Cancer Research on the associations between dairy foods, red meat and processed meat and various cancers provide further confidence that total dairy products and milk, are associated with a reduced risk of colorectal cancer and high intakes of milk/dairy are not associated with increased risk of breast cancer. Earlier evidence of a significant increase in the risk of colorectal cancer from consumption of red and particularly processed meat has been reinforced by the inclusion of more recent studies. It is essential that nutrition and health-related functionality of foods are included in evaluations of sustainable food production.

Cardiometabolic diseases exhibit changes in lipid biology, which is important as lipids have critical roles in membrane architecture, signalling, hormone synthesis, homoeostasis and metabolism. However, Developmental Origins of Health and Disease studies of cardiometabolic disease rarely include analysis of lipids. This short review highlights some examples of lipid pathology and then explores the technology available for analysing lipids, focussing on the need to develop imaging modalities for intracellular lipids. Analytical methods for studying interactions between the complex endocrine and intracellular signalling pathways that regulate lipid metabolism have been critical in expanding our understanding of how cardiometabolic diseases develop in association with obesity and dietary factors. Biochemical methods can be used to generate detailed lipid profiles to establish links between lifestyle factors and metabolic signalling pathways and determine how changes in specific lipid subtypes in plasma and homogenized tissue are associated with disease progression. New imaging modalities enable the specific visualization of intracellular lipid traffic and distribution in situ. These techniques provide a dynamic picture of the interactions between lipid storage, mobilization and signalling, which operate during normal cell function and are altered in many important diseases. The development of methods for imaging intracellular lipids can provide a dynamic real-time picture of how lipids are involved in complex signalling and other cell biology pathways; and how they ultimately regulate metabolic function/homoeostasis during early development. Some imaging modalities have the potential to be adapted for in vivo applications, and may enable the direct visualization of progression of pathogenesis of cardiometabolic disease after poor growth in early life.

Exposures to antioxidants (AO) are associated with levels of C-reactive protein (CRP), but the pattern of evidence is mixed, due in part to studying each potential AO, one at a time, when multiple AO exposures might affect CRP levels. By studying multiple AO via a composite indicator approach, we estimate the degree to which serum CRP level is associated with serum AO level. Standardised field survey protocols for the US National Health and Nutrition Examination Survey (NHANES) 2003–2006 yielded nationally representative cross-sectional samples of adults aged 20 years and older (n 8841). NHANES latex-enhanced nephelometry quantified serum CRP levels. Liquid chromatography quantified serum concentrations of vitamins A, E and C and carotenoids. Using structural equations, we regressed CRP level on AO levels, and derived a summary estimate for a composite of these potential antioxidants (CPA), with covariates held constant. The association linking CPA with CRP was inverse, stronger for slightly elevated CRP (1·8≤CRP<10 mg/l; slope= −1·08; 95 % CI −1·39, −0·77) and weaker for highly elevated CRP (≥10 mg/l; slope= −0·52; 95 % CI −0·68, −0·35), with little change when covariates were added. Vitamins A and C, as well as lutein+zeaxanthin, were prominent contributors to the composite. In these cross-sectional data studied via a composite indicator approach, the CPA level and the CRP level were inversely related. The stage is set for more confirmatory longitudinal or intervention research on multiple vitamins. The composite indicator approach might be most useful in epidemiology when several exposure constructs are too weakly inter-correlated to be studied via formal measurement models for underlying latent dimensions.