Correction to: Aligning nutrient profiling with dietary guidelines: modifying the Nutri-Score algorithm to include whole grains

199 Background: We examined compliance with the Dietary Guidelines for Americans and its association with symptom burden and clinical outcomes in patients with advanced cancer in early-phase clinical trials testing novel immunotherapeutic and targeted agents. Methods: Patients starting an early-phase clinical trial (ECOG-PS = 0-1) were recruited into a prospective, longitudinal design with assessments at baseline and at the end of Cycle 1. Diet and symptom burden were assessed using the validated National Cancer Institute Diet History Questionnaire (NCI-DHQ) and the MD Anderson Symptom Inventory, respectively. Compliance with the Dietary Guidelines for Americans recommendations was measured via the Healthy Eating Index (HEI) (a measure of dietary intake per total energy), computed from NCI-DHQ food group and nutrient scores; higher HEI scores indicate greater compliance with dietary guidance recommendations (possible range = 0–100). Statistical tests included Spearman rank correlations (rho), and Cox proportional hazards models. Results: Among early-phase clinical trial patients [N = 40; 50% female; 80% Non-Hispanic White; 80% ECOG = 1; 36% on trials including an immunotherapeutic agent and 64% on targeted therapy trials; mean age = 55y; mean BMI = 28], mean HEI was 69, compared to 59 for the US general population. The proportion of phase I clinical trial patients who met adequacy guidelines were 80% for whole fruit, 73% for total protein foods, 55% for seafood and plant proteins, 55% for total fruit, 50% for greens and beans, 28% for total vegetables, 15% for fatty acids [(PUFAs + MUFAs)/SFAs ≥2.5], 13% for dairy, and 0% for whole grains. The proportion of patients who met moderation guidelines were 28% for refined grains, 28% for added sugar, 13% for saturated fat, and 0% for sodium. Female patients had higher HEI scores than male patients (73 vs. 65, P = 0.004). Patients who were normal weight (BMI < 25) had higher scores for meeting the moderation in sugar intake guideline than overweight patients (BMI≥25) (7.7 vs. 5.5, P = 0.031). Higher intakes of cooked lean meat from beef, pork, veal, lamb, and game were linked to prolonged overall survival (HR = 0.5, 95%CI = 0.26, 0.96, P = 0.039). In immunotherapy patients, greater compliance with seafood and plant protein recommendations was associated with less fatigue at end of Cycle 1 (rho = -0.7, P = 0.008); in targeted therapy patients, higher glycemic load was associated with worse pain (rho = 0.7, P = 0.004). Conclusions: Diets of these early-phase clinical trial patients overall were congruent with recommendations in the Dietary Guidelines for Americans. However, increasing intakes of whole grains and reducing sodium intakes may be useful dietary goals for this population. Also, dietary factors may influence symptoms, such as fatigue and pain, in early-phase clinical trial patients with advanced cancer.

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Dietary intakes of whole grains, health benefits but do contaminants pose a major risk?

Proceedings of The Nutrition Society ◽

10.1017/s0029665120003845 ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

Anne Nugent ◽

Frank Thielecke

Keyword(s):

Heavy Metals ◽

Whole Grains ◽

Dietary Guidelines ◽

Food Storage ◽

Dietary Intakes ◽

Whole Grain ◽

Food Category ◽

Carbohydrate Source ◽

Potential Health ◽

The Impact

AbstractIntroductionThere is a long history of use for whole grain cereals as part of human dietary intakes with records of dietary grain consumption from the Middle Stone Ages. Whole grains are nutrient dense and research demonstrates that the healthiest diets (those associated with reduced risk of non-communicable diseases e.g. cardiovascular disease or cancer) are characterised by higher intake of fruit, vegetables, nuts and legumes and whole grains and lower intakes of red and processed meats. Currently, grains are a main energy and carbohydrate source and as such form a cornerstone of food based dietary guidelines and dietary guidance globally. However, grains also naturally contain contaminants and as a food category can represent a significant dietary source of foodborne contaminants.Materials and MethodsThe outcomes of a narrative review on the major contaminants present in whole grains, their potential health risks and suggested strategies to mitigate any risk are described. Contaminants are limited to mycotoxins (aflatoxinB1, ochratoxin A, Fumonisin B1, deoxynivalenol, zearalenone), heavy metals (e.g. arsenic, cadmium, lead) and the process contaminant acrylamide.ResultsWhole grains can contain more contaminants than refined versions e.g. whole grain rice with bran intact can have up to 80% more arsenic than white rice. However, whole grains also provide more nutrients which may mitigate against the impact of these contaminants. For example, for heavy metals, there is some evidence that dietary fibres (e.g. wheat bran) may bind to them and reduce their absorption, as can nutrients naturally found in whole grains e.g. zinc, magnesium or copper. Minerals such as iron, calcium, magnesium and zinc may also impede heavy metal absorption by down-regulating or competing for attachment to transporters that facilitate intestinal absorption. Although, strict regulatory thresholds and monitoring processes by competent authorities minimise any risk to public health, the consumer may further lessen any risk through their own dietary choices and food storage and preparation practicesDiscussionThere are a number of potential health-protective properties inherent to whole grains. Given that complete elimination of contaminants from grains is unlikely to be achieved, their presence merits continued monitoring with evidence to date suggesting any such risk does not outweigh the known benefits of wholegrain consumption.

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The Roles of Food Processing in Translation of Dietary Guidance for Whole Grains, Fruits, and Vegetables

Annual Review of Food Science and Technology ◽

10.1146/annurev-food-032818-121330 ◽

2019 ◽

Vol 10 (1) ◽

pp. 569-596 ◽

Cited By ~ 5

Author(s):

Min Li ◽

Kacie K.H.Y. Ho ◽

Micaela Hayes ◽

Mario G. Ferruzzi

Keyword(s):

Fruits And Vegetables ◽

Consumer Preferences ◽

Whole Grains ◽

Dietary Guidelines ◽

Processed Foods ◽

Processing Level ◽

Processing Strategies ◽

Vegetable Products ◽

Dietary Guidelines For Americans ◽

Food And Nutritional Security

The Dietary Guidelines for Americans (DGA) recommend the consumption of whole grains, fruits, and vegetables as part of a healthy diet. However, current consumption patterns suggest that most Americans are not meeting these recommendations. The challenge remains to align the DGA guidance with the food environment and consumers’ expectations for product quality, availability, and affordability. Currently, processed foods play an increasingly important role in American diets. Often characterized as unhealthy, processed foods are contributors to both food and nutritional security. When the alignment of processing strategies with DGA principles exists, achieving DGA goals is more likely, regardless of processing level. In this review, select processing strategies for whole grains, fruits, and vegetables are described to show how DGA principles can guide processing efforts to create healthier products. Although whole grains, supported by industry-wide innovation and guidance, have had some success with consumers, improving intake of fruit and vegetable products remains a challenge. Closing consumption gaps requires new innovations and products aligned with consumer preferences and DGA principles.

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Healthy Eating Index-2015 Is Associated with Grip Strength among the US Adult Population

Nutrients ◽

10.3390/nu13103358 ◽

2021 ◽

Vol 13 (10) ◽

pp. 3358

Author(s):

Galya Bigman ◽

Alice S. Ryan

Keyword(s):

Grip Strength ◽

Healthy Eating ◽

Adult Population ◽

Cross Sectional Study ◽

Whole Grains ◽

Healthy Eating Index ◽

Dietary Guidelines ◽

Cross Sectional ◽

Lower Odds ◽

Nationally Representative

The Healthy Eating Index-2015 (HEI-2015) was designed to reflect adherence to the 2015–2020 Dietary Guidelines for Americans (DGA). The study aims to examine the association between HEI-2015 and grip strength in a nationally representative sample of the U.S. adult population. This cross-sectional study used data from the National Health and Nutrition Examination Surveys of 2011–2014. Low grip strength was defined as <35.5 kg for men and <20 kg for women. HEI-2015 was computed from two days of 24-h dietary recalls and comprised 13 components. Each component was scored on the density out of 1000 calories and summed to a total score divided into quartiles. Weighted logistic regressions examined the study aim while controlling for associated covariates. The sample included 9006 eligible participants, of those, 14.4% (aged 20+ years), and 24.8% (aged ≥50 years) had low grip strength. Mean (±SD) HEI-2015 total score was 54.2 ± 13.6 and in the lowest and highest quartiles 37.3 ± 5.1 and 72.0 ± 6.5, respectively. In the multivariable model, participants in the highest vs. lowest HEI-2015 quartile had 24% lower odds of having low grip strength (Odds Ratio (OR) = 0.76; 95% CI: 0.60–0.96). Specifically, participants who met the DGA for protein intakes, whole grains, greens and beans, vegetables, or whole fruits had 20–35% lower odds of having low grip strength than those who did not. Higher compliance to the DGA might reduce the risk for low grip strength as a proxy measure for sarcopenia among U.S. adults, particularly adequate intakes of proteins, whole grains, greens and beans, vegetables, and whole fruits.

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The Healthy Menu Project: Role of the School Nurse: Youth–Adult Shared Partnerships Help Change a School Lunch Menu

NASN School Nurse ◽

10.1177/1942602x19852583 ◽

2019 ◽

Vol 34 (6) ◽

pp. 335-339

Author(s):

Sara A. Blessing ◽

Linda L. Mendonca

Keyword(s):

Rhode Island ◽

Fruits And Vegetables ◽

Positive Impact ◽

School Lunch ◽

School Nurses ◽

Whole Grains ◽

Dietary Guidelines ◽

School Year ◽

Lunch Program

School nurses play an important role in addressing childhood obesity. Although schools who participate in the Federal School Lunch Program follow mandated dietary guidelines, changes to the menu can be made that will have a positive impact on the health of our school community. Students receive nutrition health education, including learning about the importance of choosing whole and unprocessed foods, fresh fruits and vegetables, and whole grains and limiting sugars. However, what we are teaching students may not mirror what is actually being served during lunchtime. It is important to listen to students to determine if they are satisfied with what they are being served, as well as to determine if students are actually eating the food being served. Henry Barnard School, an elementary school, in Providence, Rhode Island, embarked on a successful project that took place during the 2017-2018 school year. The goal was to increase overall satisfaction and healthy options of our school lunch menu by creating youth–adult shared partnerships and empowering students throughout the process.

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Deriving Sustainable Food-Based Dietary Guidelines for Germany via Multidimensional Optimization: Insights to Operationalise the Diet-Health Dimension

Current Developments in Nutrition ◽

10.1093/cdn/nzab048_016 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 881-881

Author(s):

Anne Schäfer ◽

Rozenn Gazan ◽

Heiner Boeing ◽

Christina Breidenassel ◽

Typhaine Haurogne ◽

...

Keyword(s):

Environmental Impact ◽

Adult Population ◽

Whole Grains ◽

Red Meat ◽

Dietary Guidelines ◽

Sustainable Food ◽

Dietary Changes ◽

Food And Agriculture ◽

Life Years ◽

Optimization Methodology

Abstract Objectives Development of a diet optimization methodology, forming the next generation of food-based dietary guidelines (FBDG) in Germany, to identify dietary changes accounting for various dimensions: diet-health relations, environmental impact, and nutrient needs while staying culturally acceptable. Methods Three parameters define the German Nutrition Optimization Model (GNOM): The decision variables, which are observed food intakes (FoodEx2 food grouping); acceptability constraints (acceptability upper limits (AL) are set for foods based on P95), and the linear objective function. The latter consists of three components that are weighted between each other and minimizes environmental impact (greenhouse-gas emissions and land use), diet-related health burden (disability adjusted life years), and relative deviation from the observed dietary intake (cultural acceptability). Also, deviations from nutritional needs for 39 nutrients are minimized. Five models were run on the adult population by increasing weight on diet-health and decreasing weight on cultural acceptability progressively (by steps of 20%, from 0% in model 1 (M1) to 80% in model 5 (M5)), with a fixed environmental weight at 20%. Dietary changes are exemplary described for fruits, vegetables, whole grains and red meat. Results All models satisfied nutrient needs and, compared to the observed diet, increased in fruits, vegetables, and whole grains and decreased in red meat; dietary changes were higher with increasing weight on diet-health. Compared to the observed intake (174,4g/d), fruits increased moderately in M1–3 (205,7g/d - 338,8g/d) and reached the AL of 552g/d in M4 and M5. Vegetables reached the AL of 267g/d in every model (observed intake: 96,3g/d) except M1 (261,5g/d). Whole grains increased progressively from 13g/d in observed intake to 16,3g/d and 16,7g/d in M1 and M2, 61,9g and 67,9g in M3 and M4 and increased strongly to 250,7g/d in M5. The observed amount of red meat was 34,4g/d, which dropped from 2,5g/d in M1 to 0g/d in M5. Conclusions This methodology accounts for multidimensional requirements in FBDGs and is flexible regarding the importance given to each dimension. Preliminary results suggest that using this innovative approach to operationalize diet-health relations, GNOM is able to help derive German FBDG. Funding Sources German Federal Ministry of Food and Agriculture.

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Are the Eatwell Guide and Nutrient Profiling Models Consistent in the UK?

Nutrients ◽

10.3390/nu13082732 ◽

2021 ◽

Vol 13 (8) ◽

pp. 2732

Author(s):

Ana-Catarina Pinho-Gomes ◽

Asha Kaur ◽

Peter Scarborough ◽

Mike Rayner

Keyword(s):

Dietary Guidelines ◽

Dietary Advice ◽

Nutrition Surveys ◽

The Public ◽

Dietary Index ◽

Nutrient Profiling ◽

Food Policies ◽

The Uk ◽

Dietary Score ◽

Good Agreement

A nutrient profiling model (NPM) was developed in 2005 in the UK to regulate the marketing of foods to children. It was revised in 2018, but the new version has not been finalised. The Eatwell Guide (EWG) is the UK’s official food-based dietary guidelines. The aim of this study was to evaluate the agreement between the 2005 and 2018 versions of the NPM and the EWG. Using recent National Diet and Nutrition Surveys, we estimated the healthiness of individual diets based on an EWG dietary score and a NPM dietary index. We then compared the percentage of agreement and Cohen’s kappa for each combination of the EWG score and NPM index across the range of observed values for the 2005 and 2018 versions. A total of 3028 individual diets were assessed. Individuals with a higher (i.e., healthier) EWG score consumed a diet with, on average, a lower (i.e., healthier) NPM index both for the 2005 and 2018 versions. Overall, there was good agreement between the EWG score and the NPM dietary index at assessing the healthiness of representative diets of the UK population, when a low cut-off for the NPM dietary index was used, irrespective of the version. This suggests that dietary advice to the public is broadly aligned with NPM-based food policies and vice-versa.

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Longitudinal trajectories and prevalence of meeting dietary guidelines during the transition from adolescence to young adulthood

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqy333 ◽

2019 ◽

Vol 109 (3) ◽

pp. 656-664 ◽

Cited By ~ 8

Author(s):

Mary J Christoph ◽

Nicole I Larson ◽

Megan R Winkler ◽

Melanie M Wall ◽

Dianne Neumark-Sztainer

Keyword(s):

Young Adults ◽

Public Schools ◽

Dietary Intake ◽

Young Adulthood ◽

Dietary Habits ◽

Vegetable Intake ◽

Whole Grains ◽

Dietary Guidelines ◽

Food Groups ◽

Adjusted Least Squares

ABSTRACT Background Establishing healthy dietary habits during adolescence and young adulthood is critical for long-term health. Objectives This study assessed the prevalence of meeting US Dietary Guidelines and trajectories in dietary intake for 4 MyPlate food groups during the transition from adolescence to young adulthood. Methods Three waves of surveys and food frequency questionnaires were collected as part of Project EAT (Eating and Activity in Teens and Young Adults), a 15-y longitudinal study. Adolescents (n = 1177, 57% female, mean ± SD age 15.0 ± 1.5 y) were recruited in 1998–1999 in Minneapolis-St Paul, Minnesota public schools and were resurveyed twice in young adulthood at mean ± SD ages 25.3 ± 1.5 and 31.1 ± 1.5 y. The prevalence of meeting guidelines for each MyPlate food group was calculated at each time point. Mean daily servings were compared over 5 y in young adulthood through the use of paired t tests. Adjusted least-squares means were calculated to compare dietary intake in young adulthood across quartiles of adolescent intake. Results Adolescents had the highest prevalence of meeting dietary guidelines for fruit (37% for females and 30% for males) and dairy (53% for females and 61% for males); young adults >30 y had the highest prevalence of meeting dietary guidelines for vegetables (19% for females and 8% for males) and whole grains (23% for females and 17% for males). From the mid-twenties to early thirties, vegetable intake increased, whereas dairy intake decreased. Dietary intake generally tracked over time with individuals in the lower quartiles of intake at adolescence generally continuing to have low intake in young adulthood. Conclusions Although the prevalence of meeting dietary guidelines for whole grains and vegetables, and daily servings of vegetables increased with age, improving intake of whole fruit, whole grains, dairy, and vegetables remains key during the transition from adolescence to young adulthood.

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Association between plant-based diets and blood pressure in the INTERMAP study

BMJ Nutrition, Prevention & Health ◽

10.1136/bmjnph-2020-000077 ◽

2020 ◽

pp. bmjnph-2020-000077

Author(s):

Ghadeer Aljuraiban ◽

Queenie Chan ◽

Rachel Gibson ◽

Jeremiah Stamler ◽

Martha L Daviglus ◽

...

Keyword(s):

Blood Pressure ◽

International Study ◽

The United States ◽

Whole Grains ◽

Dietary Guidelines ◽

Sugar Sweetened Beverages ◽

Cross Sectional ◽

Refined Grains ◽

Sweetened Beverages ◽

Registration Number

BackgroundPlant-based diets are associated with a lower risk of cardiovascular diseases; however, little is known how the healthiness of the diet may be associated with blood pressure (BP). We aimed to modify three plant -based diet indices: overall plant-based diet index (PDI), healthy PDI (hPDI), and unhealthy PDI (uPDI) according to country-specific dietary guidelines to enable use across populations with diverse dietary patterns – and assessed their associations with BP.DesignWe used cross-sectional data including 4,680 men and women ages 40–59y in Japan, China, the United Kingdom, and the United States from the INTERnational study on MAcro/micronutrients and blood Pressure (INTERMAP). During four visits, eight BP measurements, and four 24-h dietary recalls were collected. Multivariable regression coefficients were estimated, pooled, weighted, and adjusted extensively for lifestyle/dietary confounders.ResultsModified PDI was not associated with BP. Consumption of hPDI higher by 1SD was inversely associated with systolic (-0.82 mm Hg;95% CI:-1.32,-0.49) and diastolic BP (-0.49 mm Hg; 95% CI:-0.91, -0.28). In contrast, consumption of an uPDI was directly associated with systolic (0.77 mm Hg;95% CI:0.30,1.20). Significant associations between hPDI with BP were attenuated with separate adjustment for vegetables and whole grains; associations between uPDI and BP were attenuated after adjustment for refined grains, sugar-sweetened beverages, and meat.ConclusionAn hPDI is associated with lower BP while a uPDI is adversely related to BP. Plant-based diets rich in vegetables and whole grains and limited in refined grains, sugar-sweetened beverages, and total meat may contribute to these associations. In addition to current guidelines, the nutritional quality of consumed plant foods is as important as limiting animal-based components.Trial registration numberThe observational INTERMAP study was registered at www.clinicaltrials.gov as NCT00005271.

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