A local food-based approach, including school lunch with multiple-micronutrient fortified biscuits (MMB) as supplementary snacks, may enhance dietary adequacy, although current evidence remains limited. This study assessed nutrient inadequacies and developed food-based dietary recommendations (FBR) incorporating school lunch from the Ghana School Feeding Programme (GSFP) and MMB. Data from 292 girls aged 10–17 years, enrolled in the Ten2Twenty-Ghana study was analysed. Dietary intake was assessed via a quantitative 24-h dietary recall. Usual intakes were estimated using the National Cancer Institute method. Linear programming with Optifood was used to develop FBRs based on commonly consumed foods (≥5% of participants) and their median serving sizes, intake frequency, nutrient content, and cost per 100 g. Constraints included estimated energy needs and harmonised average nutrient requirements. The mean usual energy intake was 2351 (sd 66) kcal/d. Ca (99·8 %), vitamin B12 (99·8 %), riboflavin (96·2 %), vitamin A (91·5 %), vitamin C (87·6 %), Fe (73·7 %), folate (49·3 %) and Zn (8·5 %) inadequacies were prevalent. Optimised diets achieved adequacy for protein and most micronutrients, except Ca and vitamin B12, besides vitamin A for 15–17-year-old girls. School lunch from the GSFP did not enhance micronutrient levels when added to the daily diet. Adding MMB to the daily diet ensured adequacy for vitamin C, riboflavin and Fe, although marginal for Fe. Ca and vitamin A improved substantially with MMB for girls aged 15–17 but remained below the harmonised average requirements. Integrating regular school lunch with specialised fortified foods may be a cost-effective strategy to enhance dietary adequacy for adolescent girls in rural areas.

Impaired glycaemic control is a major risk factor for developing type 2 diabetes (T2D), a worldwide health epidemic intrinsically linked to diet and obesity. Whey proteins (WP) are increasingly popular supplements that are a rich source of branched-chain amino acids (BCAA), essential for muscle protein synthesis and metabolic regulation. In humans, fasting plasma concentrations of BCAA are maintained around 350 µM but become chronically elevated by 10–25% in persons with T2D. Little is known about whether BCAA from WP impacts circulating BCAA concentrations and contributes to this phenomenon. This narrative review used a systematic search approach with relevant keywords to identify evidence from randomised controlled trials in normoglycaemic humans and those with insulin resistance or T2D, on the effects of WP intake on plasma BCAA and glycaemic control. This review is, to the authors’ knowledge, the first to specifically examine the effects of WP intake on plasma BCAA concentrations in relation to glycaemic control. Whilst the majority of acute studies identified (n = 6) reported that WP consumption between 10 and 50 g significantly elevates postprandial BCAA and insulin responses (as evidenced by peak concentration and/or area under the curve), evidence from chronic studies (n = 3) report inconsistent findings on the impact of 9–51 g of WP/d on fasting BCAA and glycaemic control (for example, fasting glucose and insulin, insulin clearance). Findings from this literature review highlight the need for further studies that investigate the relationship between WP consumption with BCAA and glycaemic control, and to determine underlying mechanisms of action.

Persistent malnutrition is associated with poor clinical outcomes in cancer. However, assessing its reversibility can be challenging. The present study aimed to utilise machine learning (ML) to predict reversible malnutrition (RM) in patients with cancer. A multicentre cohort study including hospitalised oncology patients. Malnutrition was diagnosed using an international consensus. RM was defined as a positive diagnosis of malnutrition upon patient admission which turned negative one month later. Time-series data on body weight and skeletal muscle were modelled using a long short-term memory architecture to predict RM. The model was named as WAL-net, and its performance, explainability, clinical relevance and generalisability were evaluated. We investigated 4254 patients with cancer-associated malnutrition (discovery set = 2977, test set = 1277). There were 2783 men and 1471 women (median age = 61 years). RM was identified in 754 (17·7 %) patients. RM/non-RM groups showed distinct patterns of weight and muscle dynamics, and RM was negatively correlated to the progressive stages of cancer cachexia (r = –0·340, P < 0·001). WAL-net was the state-of-the-art model among all ML algorithms evaluated, demonstrating favourable performance to predict RM in the test set (AUC = 0·924, 95 % CI = 0·904, 0·944) and an external validation set (n 798, AUC = 0·909, 95 % CI = 0·876, 0·943). Model-predicted RM using baseline information was associated with lower future risks of underweight, sarcopenia, performance status decline and progression of malnutrition (all P < 0·05). This study presents an explainable deep learning model, the WAL-net, for early identification of RM in patients with cancer. These findings might help the management of cancer-associated malnutrition to optimise patient outcomes in multidisciplinary cancer care.

Kombucha is a fermented beverage rich in bioactive compounds. This beverage has demonstrated high antioxidant capacity in vitro and experimental animal studies. In this sense, this study aimed to evaluate the effect of daily consumption of green tea kombucha on oxidative stress and endothelial health in individuals with excess body weight. This is a randomized controlled clinical trial, lasting 10 weeks, during which the control group followed a healthy −500 kcal/d energy-restricted diet. In contrast, the kombucha group, in addition to the energy-restricted diet, consumed 200 ml of kombucha green tea daily. This study included men and women aged 18–45 years without chronic diseases. At the beginning and end of the study, fasting blood was collected, and colorimetric assays and immunoassay protocols evaluated markers of oxidative stress and endothelial health. Compared to the control group, kombucha consumption significantly reduced hydrogen peroxide (H2O2) levels (P = 0·007). Initial and final values were as follows: Control group (16·5 v. 15·09 µmol/ml; n 29) and Kombucha group (18·14 v. 14·67 µmol/ml; n 30). The other markers that were evaluated did not change after the kombucha consumption. In conclusion, daily consumption of 200 ml of green tea kombucha for 10 weeks reduces one pro-oxidant marker, without altering other markers of oxidative stress and endothelial health in individuals with excess body weight. Reducing a pro-oxidant marker suggests that kombucha is an antioxidant beverage with promising implications for human health. However, further studies are needed to elucidate other possible beneficial effects on health.

Previous studies on the association between fruit juice consumption and type 2 diabetes remain controversial, which might be due to heterogeneity in the polygenic risk score (PRS) for type 2 diabetes. We examined the association between fruit juice and type 2 diabetes by PRS for type 2 diabetes. We investigated whether fruit juice influences type 2 diabetes risk differently among individuals with varying genetic risks. Data from the Japan Multi-Institutional Collaborative Cohort (J-MICC) study, a cross-sectional study of 13 769 Japanese individuals was used for our analysis. The primary exposure was the frequency of fruit juice, categorised as do not drink, less than 1 cup per day or more than 1 cup per day. We selected PGS002379, a PRS for type 2 diabetes developed using East Asian populations. The primary outcome was physician-diagnosed type 2 diabetes, reported by participants. The consumption of fruit juice was significantly inversely associated with type 2 diabetes in the group with a high PRS for type 2 diabetes (OR: 0·78, 95 % CI: 0·65, 0·93 for < 1 cup/d and OR: 0·54, 95 % CI: 0·30, 0·96 for > 1/d), but this association was not observed in the low PRS group. Fruit juice consumption was inversely associated with type 2 diabetes, especially in genetically high-risk populations for type 2 diabetes.

There has been substantial research undertaken on the role of a health-promoting diet in depression. Yet, the evidence of the relationship between the Nordic diet and the risk of depression is scarce. This cross-sectional study aimed to assess whether a healthy Nordic diet is associated with depressive symptoms. In total, 2603 men aged 42–60 years from the Kuopio Ischaemic Heart Disease Risk Factor Study were included. Diet quality was evaluated with a healthy Nordic diet score derived from the 4-day food diaries and depressive symptoms with the self-reported Human Population Laboratory (HPL) depression scale. Quade ANCOVA was used to examine the mean values of HPL scores in quartiles of a healthy Nordic diet score. Participants’ mean age was 53 years and BMI 26·8 kg/m2; 31·7 % were current smokers, and 86·9 % were married or living as a couple. The mean healthy Nordic diet score was 12·8 (sd 4·0, range 2–25), and the mean HPL depression score was 1·9 (sd 2·1, range 0–13). The findings suggested that lower adherence to a healthy Nordic diet was associated with higher HPL depression scores after adjusting for age, examination year, daily energy intake, leisure-time physical activity, adulthood socio-economic status, smoking and marital status (extreme quartile difference: 0·33 points, 95 % CI 0·10, 0·56, P for trend across the quartiles = 0·003). The results support the hypothesis that a lower-quality diet increases the odds of having depressive symptoms. However, prospective studies are needed to confirm the association.

Understanding the interplay between adiposity and histopathological features of colorectal tumours is crucial for advancing strategies in disease management. We conducted a retrospective cohort study over an 8-year period (2007–2015), including patients who underwent surgical resection for colorectal cancer (CRC). Body composition was assessed via computed tomography (CT) at the level of the third lumbar vertebra, with visceral adipose tissue (VATd) and subcutaneous adipose tissue (SATd) radiodensities stratified into tertiles. Systemic inflammatory status was evaluated using the neutrophil-to-lymphocyte ratio (NLR). Logistic regression was employed to analyse the relationship between variables, using OR with 95 % CI. The Cox proportional hazards model assessed hazard ratios (HR) with 95 % CI. A total of 231 patients were included (48·9 % men, 51·1 % women), with 93·6 % in CRC stages II and III. Multivariate analyses demonstrated that CRC stages II and III (OR = 5·15, 95 % CI: 1·60, 16·62; OR = 5·16, 95 % CI: 1·59, 16·77) and low VATd (1st and 2nd tertiles; OR = 2·43, 95 % CI: 1·30, 4·53) were associated with the presence of desmoplasia. In the multivariate Cox analyses, only stage III disease (HR = 4·77, 95 % CI: 1·09, 20·89) and moderate to accentuated fibrous stroma (HR = 1·90, 95 % CI: 1·03, 3·46) were identified as predictors of reduced overall survival. These findings suggest that increased visceral adiposity may contribute to the development of a desmoplastic tumour microenvironment. Moreover, the presence of moderate to accentuated fibrous stroma is significantly associated with poorer long-term survival in patients with CRC.

My research on dietary protein and the regulation of proteostasis in muscle and the whole body during growth and adult maintenance is reviewed. Growth control involves both permissive and regulatory roles of protein acting with genetic determinants and functional demand, to mediate substrate flow into metabolic consumption, energy storage and growth. In 1995 a Protein-Stat hierarchical model for control of the fat-free mass was proposed and is updated here with special emphasis on the skeletal muscle mass. Control is exerted in large part through a central aminostatic appetite mechanism sensing changes in free amino-acid patterns in response to the balance between their supply in relation to their demand. This acts primarily to maintain skeletal muscle mass at a level set by the linear dimensions of the organism, which in turn is controlled by genetic programming and mediated by the developmental hormones acting together with an appropriate anabolic drive deriving from dietary protein. This, together with other important nutrients like zinc, calcium and vitamin D, provides the regulatory stimulus for growth and protein deposition in all tissues. The applicability of this model to childhood growth and development will be described as well as the maintenance of the adult phenotypic muscle mass within populations with protein intakes varying over a wide range, work which resulted in an adaptive metabolic demand model for protein and amino acid requirements and values for apparent adult protein and lysine requirements. Finally current understanding of aminostatic mechanisms of amino-acid sensing in the brain will be reviewed.

Epidemiological studies have reported an association between the planetary health diet (PHD), diet-related greenhouse gas emissions (GHGEs), and mortality. However, data from individuals from non-Western countries was limited. Therefore, we aimed to examine this association among Japanese individuals using a cross-sectional ecological study of all 47 prefectures in Japan. Prefecture-level data were obtained from government surveys. The dietary amount was estimated based on the weight of food purchased (211 items) from the 2021–2023 Family Income and Expenditure Survey. Adherence to PHD was scored using the EAT-Lancet index (range, 0 [worst] to 42 [best]) and categorised into four groups: ≤ 24 (n = 14, low), 25 (n = 17, medium-low), 26 (n = 10, medium-high), and 27 points (n = 6, high). Diet-related GHGEs were estimated using previously developed GHGE tables for each food item. Mortality data were obtained using the 2022 Vital Statistics. Mortality rate ratio (RR) was calculated using a multivariate Poisson regression model. After adjusting for confounders, compared to the prefecture in the medium-low group of adherence score, those in the low and high groups were associated with a higher mortality RR for all-cause (low group: RR = 1.03 [95% CI (confidence interval) = 1.01–1.05]; high group: RR = 1.03 [95% CI = 1.00–1.07]) and pneumonia. Moreover, although a higher adherence score was inversely associated with GHGE, it was linked to an increased mortality risk from heart disease and stroke. Our findings indicate a reverse J-shaped association between adherence to PHD and mortality.

Epidemiologic evidence on the association between dietary choline, betaine and mortality risk remains limited, particularly among non-Western populations. We examined the association of dietary choline and betaine with all-cause mortality in Chinese adults using data from the China Health and Nutrition Survey 1991–2015. We included 9027 men and 8828 women without CVD and cancer at baseline. Dietary intake was assessed using 3-day 24-hour dietary recalls and household food inventories. Death was ascertained through household surveys in each wave. Time-dependent Cox proportional hazards regression models estimated multivariable-adjusted hazard ratios (HRs) and 95 % CIs. During a median follow-up of 9·1 years, 891 men and 687 women were deceased. Higher total choline intake was associated with lower all-cause mortality in both men (HRQ5 v. Q1 = 0·58 (95 % CI: 0·45, 0·74)) and women (HRQ5 v. Q1 = 0·59 (95 % CI: 0·44, 0·78)). The dose–response curve were reverse J-shaped in men and L-shaped in women (both P-nonlinear ≤ 0·005). Similarly, fat-soluble choline intake was inversely associated with mortality in both men (HRQ5 v. Q1 = 0·59 (95 % CI: 0·46, 0·75)) and women (HRQ5 v. Q1 = 0·53 (95 % CI: 0·40, 0·70)), showing reverse J-shaped patterns (both P-nonlinear < 0·001). A J-shaped association between water-soluble choline and mortality was observed in women (P-nonlinear < 0·001), but a null association was found in men. Betaine intake was not associated with all-cause mortality in either sex. Our findings suggest that adequate choline intake is linked to reduced all-cause mortality in Chinese adults with predominantly plant-based diets.