Glycemic Index and Glycemic Load and Their Association with C-Reactive Protein and Incident Type 2 Diabetes

Objective. To investigate whether the Glycemic Index (GI) or Glycemic Load (GL) of a diet is associated with C-reactive Protein (CRP) and risk of type 2 diabetes in a prospective study. Materials and Methods. Our analysis included 4,366 participants who did not have diabetes at baseline. During follow-up 456 diabetes cases were confirmed. Dietary GI and GL were derived from a food-frequency questionnaire and its association with CRP was examined cross-sectionally using linear regression models. The association of GI and GL with diabetes incidence was examined using Cox proportional hazard models. Results. GL, but not GI, was associated with lnCRP at baseline (bGL = 0.11 per 50 units; P = .01). When comparing the highest to the lowest tertile of GI with respect to diabetes incidence, a Relative Risk (RR) of 0.95 [95%CI 0.75, 1.21] was found after adjustment for lifestyle and nutritional factors. For GL the RR for diabetes incidence was 1.00 [95%CI 0.74, 1.36]. Additional adjustment for CRP did not change RRs. Conclusion. Since GI was not associated with CRP and risk of type 2 diabetes, it is unlikely that a high GI diet induces the previously shown positive association between CRP and risk of type 2 diabetes by increasing CRP concentrations

Dietary choices and environmental impact in four European countries

Effective food policies in Europe require insight into the environmental impact of consumers’ diet to contribute to global nutrition security in an environmentally sustainable way. The present study therefore aimed to assess the environmental impact associated with dietary intake across four European countries, and to explain sources of variations in environmental impact by energy intake, demographics and diet composition. Individual-level dietary intake data were obtained from nationally-representative dietary surveys, by using two non-consecutive days of a 24-h recall or a diet record, from Denmark (DK, n = 1710), Czech Republic (CZ, n = 1666), Italy (IT, n = 2184), and France (FR, n = 2246). Dietary intake data were linked to a newly developed pan-European environmental sustainability indicator database that contains greenhouse gas emissions (GHGE) and land use (LU) values for ∼900 foods. To explain the variation in environmental impact of diets, multilevel regression models with random intercept and random slopes were fitted according to two levels: adults (level 1, n = 7806) and country (level 2, n = 4). In the models, diet-related GHGE or LU was the dependent variable, and the parameter of interest, i.e. either total energy intake or demographics or food groups, the exploratory variables. A 200-kcal higher total energy intake was associated with a 9% and a 10% higher daily GHGE and LU. Expressed per 2000 kcal, mean GHGE ranged from 4.4 (CZ) to 6.3 kgCO2eq/2000 kcal (FR), and LU ranged from 5.7 (CZ) to 8.0 m2*year/2000 kcal (FR). Dietary choices explained most of the variation between countries. A 5 energy percent (50 g/2000 kcal) higher meat intake was associated with a 10% and a 14% higher GHGE and LU density, with ruminant meat being the main contributor to environmental footprints. In conclusion, intake of energy, total meat and the proportion of ruminant meat explained most of the variation in GHGE and LU of European diets. Contributions of food groups to environmental footprints however varied between countries, suggesting that cultural preferences play an important role in environmental footprints of consumers. In particular, Findings from the present study will be relevant for national-specific food policy measures towards a more environmentally-friendly diet.</p

Geographic and socioeconomic diversity of food and nutrient intakes: a comparison of four European countries

Purpose: Public health policies and actions increasingly acknowledge the climate burden of food consumption. The aim of this study is to describe dietary intakes across four European countries, as baseline for further research towards healthier and environmentally-friendlier diets for Europe. Methods: Individual-level dietary intake data in adults were obtained from nationally-representative surveys from Denmark and France using a 7-day diet record, Italy using a 3-day diet record, and Czech Republic using two replicates of a 24-h recall. Energy-standardised food and nutrient intakes were calculated for each subject from the mean of two randomly selected days. Results: There was clear geographical variability, with a between-country range for mean fruit intake from 118 to 199 g/day, for vegetables from 95 to 239 g/day, for fish from 12 to 45 g/day, for dairy from 129 to 302 g/day, for sweet beverages from 48 to 224 ml/day, and for alcohol from 8 to 15 g/day, with higher intakes in Italy for fruit, vegetables and fish, and in Denmark for dairy, sweet beverages and alcohol. In all countries, intakes were low for legumes ( 80 g/day). Within countries, food intakes also varied by socio-economic factors such as age, gender, and educational level, but less pronounced by anthropometric factors such as overweight status. For nutrients, intakes were low for dietary fibre (15.8–19.4 g/day) and vitamin D (2.4–3.0 µg/day) in all countries, for potassium (2288–2938 mg/day) and magnesium (268–285 mg/day) except in Denmark, for vitamin E in Denmark (6.7 mg/day), and for folate in Czech Republic (212 µg/day). Conclusions: There is considerable variation in food and nutrient intakes across Europe, not only between, but also within countries. Individual-level dietary data provide insight into the heterogeneity of dietary habits beyond per capita food supply data, and this is crucial to balancing healthy and environmentally-friendly diets for European citizens

The potential role of producer and consumer food policies in the EU to sustainable food and nutrition security

EU sustainable food and nutrition security is no sure-fire success. The future ofthe agro-food system is uncertain and subject to different macro-level trends.Previous analysis revealed the role of food system drivers creating challenges andopportunities for dietary and environmental improvements under certain futureconstellations. However, these challenges and opportunities need to be addressed by policies to allow for actual improvements in the sustainabilityperformance of EU food systems, for people, planet and profit. In this deliverable,an assessment and pre-test of potential policy measures is carried out. The policyanalyses are contrasted to a ‘business-as-usual’ baseline scenario with currenttrends of food system drivers. We apply the SUSFANS modelling toolbox in orderto test relevant policy measures in four distinct aqua-agro-food policy sectors.Regarding health and nutrition of the EU population, we provide a ranking ofpotential dietary policies and interventions based on their effectiveness,implementation costs and restrictiveness for consumers and producers. Based onthis overview, options for health and nutrition policy are designed containing amixture of different policy instruments. These apply – in line with the allocationof policy responsibilities in the EU - at the level of individual member states andnot at the realms of an EU policy. In the context of the Common AgriculturalPolicy (CAP), we assess the impact of a livestock density restriction on EU Agricultural areas. Results indicate a reduction of soil nutrient surpluses (-9 to -13%) and of greenhouse gas emissions (-9%) at EU average and considerably stronger in the livestock density and over-fertilization hotspots. Trade openness restricts the impact on food consumption and dietary change of EU consumers. Three Common Fisheries Policies (CFP) are tested with the newly developed fish modules of GLOBIOM and CAPRI: Directing capture in EU waters to levels that keep fish stocks at the maximum sustainable yield (MSY), or at the maximum economic yield (MEY), and the implementation of national aquaculture growth plans composed by EU member states. Our results show limited policy impacts due to the rlatively small size of the EU fish producing sector with some trade butlimited consumption changes. Finally, different storage policies are tested with the new short-term volatility module of GLOBIOM. The scenarios reveal that storage availability and intervention prices reduce price volatility caused by yield shocks. The assessments illustrate that individual, yet unaligned policy measures can already contribute significantly to reaching sustainable food and nutritionsecurity. On the way to the final foresight assessment extensions are require regarding a) metrics quantifiability, b) the harmonization of metrics computationapproaches, and c) smaller model improvement

Operationalising the health aspects of sustainable diets : a review

Objective: Shifting towards a more sustainable food consumption pattern is an important strategy to mitigate climate change. In the past decade, various studies have optimised environmentally sustainable diets using different methodological approaches. The aim of the present review was to categorise and summarise the different approaches to operationalise the health aspects of environmentally sustainable diets. Design: Conventional keyword and reference searches were conducted in PubMed, Scopus, Web of Knowledge and CAB Abstracts. Inclusion criteria were: (i) English-language publication; (ii) published between 2005 and October 2015; (iii) dietary data collected for the diet as a whole at the national, household or individual level; (iv) comparison of the current diet with dietary scenarios; and (v) for results to consider the health aspect in some way. Setting: Consumer diets. Subjects: Adult population. Results: We reviewed forty-nine studies that combined the health and environmental aspects of consumer diets. Hereby, five approaches to operationalise the health aspect of the diet were identified: (i) food item replacements; (ii) dietary guidelines; (iii) dietary quality scores; (iv) diet modelling techniques; and (v) diet-related health impact analysis. Conclusions: Although the sustainability concept is increasingly popular and widely advocated by nutritional and environmental scientists, the journey towards designing sustainable diets for consumers has only just begun. In the context of operationalising the health aspects, diet modelling might be considered the preferred approach since it captures the complexity of the diet as a whole. For the future, we propose SHARP diets: environmentally Sustainable (S), Healthy (H), Affordable (A), Reliable (R) and Preferred from the consumer’s perspective (P).</p

SHARP-Indicators Database towards a public database for environmental sustainability

To initiate the achievement of an European-wide applicable public database for indicators of environmental sustainability of the diet, we developed the SHARP Indicators Database (SHARP-ID). A comprehensive description of the development of the SHARP-ID is provided in this article. In the SHARP-ID, environmental impact assessment was based on attributional life cycle analyses using environmental indicators greenhouse gas emission (GHGE) and land use (LU). Life cycle inventory data of 182 primary products were combined with data on production, trade and transport, and adjusted for consumption amount using conversions factors for production, edible portion, cooking losses and gains, and for food losses and waste in order to derive estimates of GHGE and LU for the foods as eaten. Extrapolations based on similarities in type of food, production system and ingredient composition were made to obtain estimates of GHGE and LU per kg of food as eaten for 944 food items coded with a unique FoodEx2-code of EFSA and consumed in four European countries, i.e. Denmark, Czech Republic, Italy and France. This LCA-food-item database can be linked to food intake data collected at the individual level in order to calculate the environmental impact of individual's diets. The application of this database to European survey data is described in an original research article entitled “Dietary choices and environmental impact in four European countries” (Mertens et al., 2019).</p

Diet quality indices for research in low- and middle-income countries: A systematic review

Context: Dietary intake research has increasingly focused on improving diet quality in low- and middle-income countries (LMICs). Accompanying this is the need for sound metrics to assess diet quality. Objective: This systematic literature review aims to describe existing diet quality indices for general populations and highlights recommendations for developing such indices for food system research in LMICs. Data sources: Three electronic databases were searched for papers published between January 2008 and December 2017. Data extraction: Articles published in English and describing the development of an index to measure overall diet quality, irrespective of whether they were for high-income countries or LMICs, were included. Data analysis: Eighty-one indices were identified, over two thirds were based on national dietary guidelines from high-income countries. Of the 3 key diet quality dimensions, "diversity" was included in all 18 indices developed for LMICs, "moderation" was captured by most, and "nutrient adequacy" was included 4 times. Conclusions: Indices need to be developed that include all dimensions, include foods and/or food groups rather than nutrients, use an optimal range for individual components in the score, and express the intake of healthy and unhealthy components separately. Importantly, validation of the index should be part of its development. 2019 The Author(s) 2019. Published by Oxford University Press on behalf of the International Life Sciences Institute.</p

Methodological Aspects of Diet Quality Indicators in Childhood : A Mapping Review

Diet quality indicators (DQIns) are tools that aim to assess an individual's overall diet quality. Previous reviews focused mainly on health-related outcomes but did not provide detailed information about components, assessment variables, or important methodological issues for the development and application of DQIns in the pediatric age. The current mapping review aims to provide comprehensive guidance regarding DQIns developed through a priori methodology in children aged ≤14 y that have been applied worldwide. A mapping review was conducted, whereby 1665 original articles describing the development, modifications, and updates of DQIns, published up to June 26, 2020, in English and Spanish, were retrieved. A total of 139 articles were identified and classified into 13 subgroups. There were 10 overall DQIns: Healthy Eating Indexes (n = 25), Dietary Diversity Scores (n = 20), Diet Quality Indexes (n = 16), Food Variety Scores (n = 11), Healthy and Unhealthy Scores (n = 11), Feeding and Eating Indexes (n = 10), Diet Quality Scores (n = 5), Nutritional Adequacy and Micronutrients Indexes (n = 5), Dietary Guidelines Indexes (n = 5), and Other Healthy Diet Indexes (n = 13). Three additional subgroups of dietary and lifestyle indicators found were Mediterranean Diet Indexes (n = 10), Diet-Lifestyle Indexes (n = 5), and Breakfast Quality Indexes (n = 3). This compilation of DQIns will help researchers select the most appropriate tool for future epidemiological studies by considering a careful selection of information about the assessment components, scoring methods, and key methodological issues. The main limitations of this review are that, due to its nature, a risk-of-bias assessment was not performed and the article screening was completed in 2 databases (PubMed/MEDLINE and Scopus). More research is needed to identify health-related outcomes associated with DQIns in the pediatric population, using clearer and more standardized methodological criteria

Diet quality indices for research in low- and middle-income countries: A systematic review

Context: Dietary intake research has increasingly focused on improving diet quality in low- and middle-income countries (LMICs). Accompanying this is the need for sound metrics to assess diet quality. Objective: This systematic literature review aims to describe existing diet quality indices for general populations and highlights recommendations for developing such indices for food system research in LMICs. Data sources: Three electronic databases were searched for papers published between January 2008 and December 2017. Data extraction: Articles published in English and describing the development of an index to measure overall diet quality, irrespective of whether they were for high-income countries or LMICs, were included. Data analysis: Eighty-one indices were identified, over two thirds were based on national dietary guidelines from high-income countries. Of the 3 key diet quality dimensions, "diversity" was included in all 18 indices developed for LMICs, "moderation" was captured by most, and "nutrient adequacy" was included 4 times. Conclusions: Indices need to be developed that include all dimensions, include foods and/or food groups rather than nutrients, use an optimal range for individual components in the score, and express the intake of healthy and unhealthy components separately. Importantly, validation of the index should be part of its development. 2019 The Author(s) 2019. Published by Oxford University Press on behalf of the International Life Sciences Institute.</p

Relation between plasma enterodiol and enterolactone and dietary intake of lignans in a Dutch endoscopy-based population.

Item does not contain fulltextEnterolignans are phytoestrogenic compounds derived from the conversion of dietary lignans by the intestinal microflora that may be protective against cardiovascular diseases and cancer. To evaluate the use of enterolignans as biomarkers of dietary lignan intake, we studied the relation between plasma and dietary lignans. We determined the dietary intake of 4 lignans (secoisolariciresinol (SECO), matairesinol (MAT), pinoresinol, and lariciresinol) using the European Prospective Investigation into Cancer and Nutrition FFQ, and plasma enterodiol (END) and enterolactone (ENL) concentrations were determined by liquid chromatography-tandem mass spectrometry. The population consisted of 637 men and women, aged 19-75 y, participating in a case-control study on colorectal adenomas. Participants did not use antibiotics in the preceding calendar year. We found a modest association between lignan intake and plasma END (Spearman r = 0.09, P = 0.03) and ENL (Spearman r = 0.18, P <0.001). The correlation of total lignan intake with plasma enterolignans was slightly stronger than that of only SECO plus MAT. The plasma concentrations of both END and ENL were associated with intake of dietary fiber and vegetable protein but not with intake of other macronutrients. The relation between lignan intake and plasma END was modulated by age and previous use of antibiotics, whereas for ENL, it was modulated by weight, current smoking, and frequency of defecation. However, even when we included these nondietary factors in the regression models, the explained variance in plasma END and ENL remained low (2 and 13%, respectively)