Good to eat : food and health at a time of information overload

For most of the world's population, eating is no longer what it was just a few decades ago. The diversification and globalisation of the food supply, the industrialisation of food, and the abundance of information have simplified this everyday activity, but they have also made it more complex. Never before has it been so easy to eat well and to eat poorly. The proof is that obesity and overweight are no longer a problem exclusive to the richest, while nutritional deficiencies do not affect only the most impoverished. The new thing about our time is that both problems, over-nutrition and under-nutrition, coexist not only in countries and cities, but also within the same family and even throughout a person's lifetime. Growing concern for health has fuelled interest in the relationship between diet and disease prevention. But despite the remarkable scientific advances, there are still many unanswered questions, and many evidence-based messages do not reach the population and are lost in a sea of misinformation and half-truths. In this monograph, apart from presenting a brief social history of food, we will delve into the advances in nutritional epidemiology, we will separate facts and fiction regarding current food, we will review what reliable dietary recommendations are and how they are identified, we will explain the evolution of dietary guidelines with an example, we will tackle the problem of ultra-processed food from the point of view of addiction and we will analyse miracle diets and how to detect them

Resveratrol metabolite profiling in clinical nutrition research-from diet to uncovering disease risk biomarkers: epidemiological evidence

Resveratrol is a bioactive plant compound that has drawn scientific and media attention owing to its protective effects against a wide variety of illnesses, including cardiovascular diseases and cancer. In the last two decades, a plethora of preclinical studies have shown these beneficial effects, and some of them have been supported by clinical trials. However, there are few epidemiological studies assessing these relationships, showing mostly inconsistent results among them. This could be partially due to the difficulty of accurately estimating dietary resveratrol exposure. The development of Phenol-Explorer, a database containing resveratrol food-composition data, will facilitate the estimation of resveratrol intake. Moreover, the discovery and validation of a nutritional biomarker of this exposure, urinary resveratrol metabolite profile, will allow a more accurate assessment of dietary resveratrol exposure. Few epidemiological studies have assessed the potential health effects of resveratrol. Resveratrol was not associated with total mortality, cancer, or cardiovascular events, but it was associated with an improvement of serum glucose and triglyceride levels and a decrease in heart rate. Together, these findings suggest a potential cardioprotective effect of resveratrol in epidemiological studies, although the evidence is still scarce

Low levels of a urinary biomarker of dietary polyphenol are associated with substantial cognition decline over a three-year period in older adults: the Invecchiare in Chianti (InCHIANTI) Study.

Objectives: To investigate the association of total urinary polyphenols (TUP) and total dietary polyphenols (TDP) with cognitive decline in an older population. Design: The Invecchiare in Chianti (InCHIANTI) study, a cohort study with a 3-year of follow-up. Setting: tuscany, italy. Participants: Non-demented adults aged 65 and older (N=652). Measurements: TUP and TDP concentrations were analysed at baseline using the Folin-Ciocalteu assay and a validated food frequency questionnaire, respectively. Cognition was assessed using the Mini-Mental State Examination (MMSE) and Trail Making Test (TMT) at baseline and after three years of follow-up. A substantial cognitive decline was defined as a reduction in the MMSE score of 3 or more points and as an increase of at least 29 seconds on the TMT A and 68 seconds on the TMT B (these thresholds represent the worst 10% of the distribution of decline) or as test discontinued due to multiple mistakes in TMT A and B at follow-up. Results: Higher TUP levels were associated with lower risk of substantial cognitive decline on the MMSE (odds ratio [OR] comparing extreme tertiles = 0.53; 95% confidence interval [CI] = 0.340.85; P-trend = 0.008) and on the TMT-A (OR = 0.52; 95 % CI = 0.280.96; P-trend = 0.03), but not on TMT-B in a logistic regression model that adjusted for baseline cognitive score and potential confounding factors. TDP did not affect the developing substantial cognitive decline in both tests. Conclusion: High concentrations of polyphenols, a nutritional biomarker of polyphenol intake, were associated with a lower risk of substantial cognitive decline in the older population studied over a three-year period, suggesting a protective effect against cognitive impairment

Comparison of 24-h volume and creatinine-corrected total urinary polyphenol as a biomarker of total dietary polyphenols in the InCHIANTI Study

Polyphenols have beneficial effects on several chronic diseases but assessing polyphenols intake from self-reported dietary questionnaires tends to be inaccurate and not very reliable. A promising alternative is to use urinary excretion of polyphenols as a proxy measure of intake. The best method to assess urinary excretion is to collect 24-h urine. However, since collecting 24-h urine method is expensive, time consuming and may be difficult to implement in large population-based studies, measures obtained from spot urine normalized by creatinine are commonly used. The purpose of the study was to evaluate the correlation between polyphenols dietary intake and total urinary polyphenol excretion (TPE), expressed by both 24-h volume and urinary creatinine normalization in 928 participants from the InCHIANTI study. Dietary intake data were collected using a validated food frequency questionnaire. Urinary TPE was analyzed by Folin-Ciocalteau assay. Both urinary TPE expression models were statistically correlated (r=0.580), and the partial correlation coefficient improved (pr=0.722) after adjusting for the variables that modify the urinary creatinine excretion (i.e. gender, age, BMI, physical activity and renal function). In crude models, polyphenol intake was associated with TPE corrected by 24-h volume (r=0.211; P<0.001), but not with creatinine normalization (r=0.014; P=0.692). However, urinary TPE expressed by creatinine correction was significantly correlated with dietary polyphenols after adjusting for covariates (pr=0.113; P=0.002). We conclude that urinary TPE expressed by 24-h volume is a better biomarker of polyphenol dietary intake than by urinary creatinine normalization. After covariate adjustment, both can be used for studying the relationships between polyphenol intake and health in large-scale epidemiological studies

The relationship between urinary total polyphenols and the frailty phenotype in a community-dwelling older population: the InCHIANTI study.

Background. Frailty, an age-related state of increased vulnerability, is associated with a higher risk of multiple adverse events. Studies have suggested that the quality of dietary intake may affect the development of frailty. We hypothesized that frailty in older subjects would be associated with dietary total polyphenols (DTP) intake and its biomarker, urinary total polyphenols (UTP). Methods. The Invecchiare in Chianti (InCHIANTI) Study is a prospective cohort study set in the Chianti area (Italy). We used data at baseline from 811 participants aged 65 years and older. UTP was determined using the Folin-Ciocalteu assay after solid-phase extraction. DTP was estimated using a validated Food Frequency Questionnaire and our own polyphenol database. The frailty, prefrailty, and nonfrailty states were defined according to the Fried and colleagues' criteria. Multinomial logistic regressions adjusted for potential confounders were used to assess the relationship between polyphenols and frailty. Results. Both DTP and UTP concentrations progressively decrease from nonfrail to frail participants. Participants in the highest UTP tertile compared to those in the lowest tertile were significantly less likely to be both frail (odds ratio [OR] = 0.36 [0.14-0.88], p = .025) and prefrail (OR = 0.64 [0.42-0.98], p = .038). Exhaustion and slowness were the only individual frailty criteria significantly associated with UTP tertiles. No significant association was observed between frailty and DTP, after adjustment for covariates. Conclusions. High concentrations of UTP were associated with lower prevalence of frailty and prefrailty in an older community-dwelling population. A polyphenol-rich diet may protect against frailty in older persons. Our findings should be confirmed in longitudinal studies

Dietary Epicatechin Is Available to Breastfed Infants through Human Breast Milk in the Form of Host and Microbial Metabolites

Polyphenols play an important role in human health. To address their accessibility to a breastfed infant, we planned to evaluate whether breast milk (BM) (colostrum, transitional, and mature) epicatechin metabolites could be related to the dietary habits of mothers. The polyphenol consumption of breastfeeding mothers was estimated using a food frequency questionnaire and 24 h recalls. Solid-phase extraction-ultra performance liquid chromatography-tandem mass spectrometry (SPE-UPLC-MS/MS) was applied for direct epicatechin metabolite analysis. Their bioavailability in BM as a result of dietary ingestion was confirmed in a preliminary experiment with a single dose of dark chocolate. Several host and microbial phase II metabolites of epicatechin were detected in BM among free-living lactating mothers. Interestingly, a modest correlation between dihydroxyvalerolactone sulfate and the intake of cocoa products was observed. Although a very low percentage of dietary polyphenols is excreted in BM, they are definitely in the diet of breastfed infants. Therefore, evaluation of their role in infant health could be further promoted

Novel strategies for improving dietary exposure assessment: Multiple-data fusion is a more accurate measure than the traditional single-biomarker approach

BACKGROUND: Accurate measurement of food intake is the cornerstone of understanding the links between diet and optimal health status or risk of disease. The utilization of metabolomics approaches is revolutionizing the field of dietary assessment by associating metabolic profiles with intake of specific foods or dietary patterns and/or investigating human health status in nutritional trials. Combining dietary biomarkers with conventional dietary assessment methods is considered a potential strategy for tackling the complexity of dietary exposure fingerprinting. SCOPE AND APPROACH: We discuss existing approaches among dietary assessment methods and dietary biomarkers. A combined approach taking into consideration data from dietary questionnaires with measurements of dietary biomarkers is emphasized. KEY FINDINGS AND CONCLUSIONS: Trends in novel strategies for improving dietary exposure assessment will be influenced by the discovery and validation of dietary exposure biomarkers. Among different strategies, multi-metabolite biomarker panels enable more reliable estimation of dietary exposure than does the traditional single-biomarker approach. Therefore, a combined approach using data from dietary questionnaires along with measurements of dietary biomarkers is considered an excellent strategy for improving dietary exposure assessment

Health related values and preferences regarding meat intake : a cross-sectional mixed-methods study

Background. In addition to social and environmental determinants, people's values and preferences determine daily food choices. This study evaluated adults' values and preferences regarding unprocessed red meat (URM) and processed meat (PM) and their willingness to change their consumption in the face of possible undesirable health consequences. Methods. A crosssectional mixed-methods study including a quantitative assessment through an online survey, a qualitative inquiry through semi-structured interviews, and a follow-up assessment through a telephone survey. We performed descriptive statistics, logistic regressions, and thematic analysis. Results. Of 304 participants, over 75% were unwilling to stop their consumption of either URM or PM, and of those unwilling to stop, over 80% were also unwilling to reduce. Men were less likely to stop meat intake than women (odds ratios < 0.4). From the semi-structured interviews, we identified three main themes: the social and/or family context of meat consumption, healthand non-health-related concerns about meat, and uncertainty of the evidence. At three months, 63% of participants reported no changes in meat intake. Conclusions. When informed about the cancer incidence and mortality risks of meat consumption, most respondents would not reduce their intake. Public health and clinical nutrition guidelines should ensure that their recommendations are consistent with population values and preferences

Association between both total baseline urinary and dietary polyphenols and substantial physical performance decline risk in older adults: A 9-year follow-up of the InCHIANTI study

Importance: The decline in physical performance that occurs in many older subjects is a strong predictor of falls, hospitalization, institutionalization and mortality. Polyphenols are bioactive compounds that may play a preventive role against physical performance decline due to their antioxidant and anti-inflammatory properties. Objective: To investigate the association between total urinary polyphenols (TUP) and total dietary polyphenols (TDP) and substantial physical performance decline over a nine-year period among older subjects. Methods: This longitudinal study included 368 participants aged 65 years or older from the InCHIANTI (Invecchiare in Chianti) study, an Italian population-based cohort. TUP and TDP concentrations were assessed at baseline using the Folin-Ciocalteau (F-C) assay and a validated food frequency questionnaire, respectively. Physical performance was objectively measured at baseline and at nine-year follow-up using the Short Physical Performance Battery (SPPB). A substantial decline in physical performance was considered as a decrease of three or more points in the SPPB score. Results: At the nine-year follow-up assessment, 71 participants had suffered a substantial decline in physical performance. In the fully adjusted logistic regression model, participants in the highest TUP tertile had a lower risk of substantial decline in physical performance than those in the lowest tertile (OR, 0.40; 95% CI, 0.170.93; P trend=0.033). However, no significant association between TDP intake and physical performance decline was observed. Conclusion: This study shows that high TUP concentrations, a biomarker of polyphenol-rich exposure, were associated with lower risk of substantial decline in physical performance in community-dwelling older subjects over a nine-year period. These results suggest that a polyphenol-rich diet may play a role in protecting against physical performance decline in older people