Cardiometabolic diseases are highly prevalent in Aotearoa New Zealand(1). Dietary intake is a modifiable risk factor for such diseases and certain dietary patterns, specifically the Mediterranean diet (MedDiet), are associated with improved metabolic health(2). This study aims to test whether an intervention of a Mediterranean dietary pattern incorporating high quality New Zealand foods (NZMedDiet pattern) using behaviour change science can improve the metabolic health of participants and their household/whānau. This is a multi-centre, three-stage trial, with two randomised controlled trials (RCTs), both parallel groups, superiority trials, and a longitudinal cohort study. The first RCT (RCT1) is a comparison of the NZMedDiet pattern implemented using behaviour science compared to usual diet for 12 weeks, and the second (RCT2) is a behaviour-change intervention compared to no intervention for 12 weeks, administered after participants have been exposed to the intervention in RCT1. The third stage is a longitudinal cohort study where all participants are followed for up to a year. The primary outcome measure for each stage is the metabolic syndrome severity score (MetSSS). Two hundred index participants and their household/whānau have been recruited and randomised into the trial. Participants are from four centres, two of which are University research units (University of Auckland (n = 57) and University of Otago, Christchurch (n = 60)), one a community-based traditional meeting place (Tu¯ Kotahi Māori Asthma and Research Trust at Ko¯kiri Marae in Lower Hutt, Wellington (n = 19)), and the other based at a hospital-based research unit (the Centre for Endocrine Diabetes and Obesity Research (CEDOR) in Wellington (n = 64). The trial will test whether the NZMedDiet pattern and behaviour change support improves the cardiometabolic health of people in New Zealand.

Diet is implicated in the development of Inflammatory Bowel Disease (IBD). However, the role of diet in reducing inflammation and managing prevalent disease is unclear (1–3). Previous studies have analysed the relationship between dietary patterns and occurrence of flares or symptoms, but not disease activity or inflammation (4–5). It is important to explore the role of habitual diet in management of IBD to provide targeted dietary recommendations. We explored the relationship between dietary intake with disease activity and inflammation in an Australian adult cohort with and without IBD. We analysed dietary and clinical data from the Australian IBD Microbiome (AIM) study. AIM is a prospective longitudinal cohort study of adults and children with Crohn’s Disease (CD), Ulcerative colitis (UC) and healthy controls (HC). Habitual dietary intake of food groups, fibre, polyphenols and fermented foods was collected by merging dietary data from 3-day food records and food frequency questionnaires with PhenolExplorer and the Australian Fibre Categories Database. Dietary patterns were explored using Principal Component Analysis (PCA) and cluster analysis (CA) in IBM SPSS Statistics (V29). Associations between dietary intake, clinical disease activity categorised as remission or active, and faecal calprotectin (FCAL) were explored in adult participants. A total of 412 participants (IBD = 223, HC = 189) were included. FCAL data was available for 211 participants (HC = 100, CD = 49, UC = 62). Median (IQR) FCAL at baseline was 20 (20) mg/kg for HC and 33 (127) mg/kg for IBD, indicating clinically irrelevant inflammation (FCAL >50mg/kg = clinical inflammation). PCA identified 7 distinct dietary patterns for adults with IBD. A dietary pattern of high plant diversity was associated with active CD. In the total IBD cohort, low association to a 'Prudent’ pattern was positively associated with low FCAL, and high association to a 'Meat-eaters’ dietary pattern was positively associated with moderate FCAL. CA revealed 3 distinct clusters amongst participants with IBD. No significant difference between diet cluster and disease activity or FCAL was seen. There were no significant differences in intake of fibre or polyphenols between remission vs active disease in participants with IBD. A significant difference between total, soluble and insoluble fibre and FCAL categories was seen with a higher fibre intake associated with lower FCAL. Higher plant-diversity and 'Prudent’ dietary patterns are associated with active disease and higher FCAL in Australian adults with IBD. Reverse causality cannot be ruled out, with analysis of larger cohorts and clinical trial data needed to clarify this.

This study examined the relationship between childhood diet quality and arterial stiffness and thickness during adolescence/early adulthood. Participants were from the Avon Longitudinal Study of Parents and Children (ALSPAC) with dietary data at ages 7, 10 and 13 years and pulse wave velocity (PWV) and carotid intima-media thickness (cIMT) at ages 17 and/or 24 years. Diet quality (DQ) was assessed using five scores: a children’s Mediterranean-style diet (C-rMED) Z-score, a children’s Dietary Inflammatory Z-score (C-DIS), a DASH diet Z-score, a children’s Eatwell Guide (C-EWG) Z-score reflecting UK dietary guidelines and a data-driven obesogenic Z-score. Adjusted regression models examined the associations between DQ scores at 7–13 years and PWV and cIMT at 17 and 24 years. In adjusted models, a high v. low Obesogenic Z-score at 7 and 10 years was associated with higher PWV at 17: β 0.07 (95 % CI 0.01, 0.13) and β 0.10 (95 % CI 0.04, 0.16), respectively. A high v. low C-rMED Z-score at 7 years was associated with lower PWV at 17 (β −0.07; 95 % CI −0.14, −0.01). A high (more anti-inflammatory) vs low C-DIS Z-score at 10 years was associated with a lower PWV at 17 years: β −0.06 (95 % CI −0.12, −0.01). No other associations were observed. In conclusion, an Obesogenic dietary pattern in childhood (7–10 years) was related to increased arterial stiffness, while Mediterranean-style and anti-inflammatory diets were related to decreased arterial stiffness in adolescence. This highlights the importance of establishing healthy dietary habits early in life to protect against vascular damage.

The relationship between dietary habits and microbiota composition during adolescence has not been well examined. This is a crucial knowledge gap to fill considering that diet–microbiota interactions influence neurodevelopment, immune system maturation and metabolic regulation. This study examined the associations between diet and the gut microbiota in a school-based sample of 136 adolescents (Mage = 12·1 years; age range 11–13 years; 48 % female; 47 % Black, 38 % non-Hispanic White, 15 % Hispanic or other minorities) from urban, suburban and rural areas in the Southeast USA. Adolescents completed the Rapid Eating Assessment for Participants and provided stool samples for 16S ribosomal RNA gene sequencing. Parents reported their child and family socio-demographic characteristics. The associations between diet and socio-demographics with gut microbiota diversity and abundance were analysed using multivariable regression models. Child race and ethnicity, sex, socio-economic status and geographic locale contributed to variation within microbiota composition (β-diversity). Greater consumption of processed meat was associated with a lower microbial α-diversity after adjusting for socio-demographic variables. Multi-adjusted models showed that frequent consumption of nutrient-poor, energy-dense foods (e.g. sugar-sweetened beverages, fried foods, sweets) was negatively associated with abundances of genera in the family Lachnospiraceae (Anaerostipes, Fusicatenibacter and Roseburia), which are thought to play a beneficial role in host health through their production of short-chain fatty acids (SCFAs). These results provide new insights into the complex relationships among socio-demographic factors, diet and gut microbiota during adolescence. Adolescence may represent a critical window of opportunity to promote healthy eating practices that shape a homoeostatic gut microbiota with life-long benefits.

In studies that contain repeated measures of variables, longitudinal analysis accounting for time-varying covariates is one of the options. We aimed to explore longitudinal association between diet quality (DQ) and non-communicable diseases (NCDs). Participants from the 1973–1978 cohort of the Australian Longitudinal Study on Women’s Health (ALSWH) were included, if they; responded to survey 3 (S3, 2003, aged 25–30 years) and at least one survey between survey 4 (S4, 2006) and survey 8 (S8, 2018), were free of NCDs at or before S3, and provided dietary data at S3 or S5. Outcomes were coronary heart disease (CHD), hypertension (HT), asthma, cancer (except skin cancer), diabetes mellitus (DM), depression and/or anxiety, and multimorbidity (MM). Longitudinal modelling using generalised estimation equation (GEE) approach with time-invariant (S4), time-varying (S4–S8) and lagged (S3–S7) covariates were performed. The mean (± standard deviation) of Alternative Healthy Eating Index-2010 (AHEI-2010) of participants (n = 8022) was 51·6 ± 11·0 (range: 19–91). Compared to women with the lowest DQ (AHEI-2010 quintile 1), those in quintile 5 had reduced odds of NCDs in time-invariant model (asthma: OR (95 % CI): 0·77 (0·62–0·96), time-varying model (HT: 0·71 (0·50–0·99); asthma: 0·62 (0·51–0·76); and MM: 0·75 (0·58–0·97) and lagged model (HT: 0·67 (0·49–0·91); and asthma: 0·70 (0·57–0·85). Temporal associations between diet and some NCDs were more prominent in lagged GEE analyses. Evidence of diet as NCD prevention in women aged 25–45 years is evolving, and more studies that consider different longitudinal analyses are needed.

The present study identified dietary patterns (DP) and analyse their association with household composition. This is a cross-sectional school-based study, with a nationally representative sample of Brazilian adolescent students, aged 11–19 years, with data from National School Health Survey (n 102 072). Food consumption was obtained through the weekly frequency of consumption of food markers, and the confirmatory factor analysis was applied to examine the latent variables ‘Healthy’ (beans, legumes/vegetables and fresh fruit/fruit salad) and ‘Unhealthy’ (ultra-processed foods, sweets, soft drinks and snacks) DP. The association between household composition and DP was estimated considering lives with both parents as reference category. Among adolescents aged 11–14 years, adherence to healthy DP was lower for boys who lived only with mother (β = –2·1), and boys (β = –4·9) and girls (β = –4·5) who lived without any parents. Adherence to unhealthy DP was higher among boys (β = 7·6) and girls (β = 6·0) who lived only with mother, and boys (β = 4·6) and girls (β = 5·3) who lived only with father. For older adolescents (aged 15–19 years), adherence to the unhealthy DP was higher among boys who lived only with mother (β = 3·9) or only with father (β = 5·3) and girls who lived only with mother (β = 6·3). Adherence to healthy DP was lower among girls who lived only with father (β = –9·0). Thus, adolescents who lived in single-parent households had lower adherence to healthy DP and greater adherence to unhealthy DP. Among younger adolescents of both sexes, living without any parent contributed to lower adherence to healthy DP.

A healthy diet and regular physical activity (PA) are delineated as healthy behaviours. Their implementation is associated with better health outcomes and improved quality of life. There is less evidence of a relationship between dietary patterns (DP) and PA, especially in adults aged ≥ 85. Hence, this cross-sectional study investigates the association between DP and PA in people of this age group, using the data from The Kawasaki Aging and Well-Being Project. Brief-type self-administered diet history questionnaire was used to estimate the intake of fifty-eight types of food. After energy adjustment, principal component analysis was performed to identify DP. PA was measured objectively using an accelerometer and subjectively using a questionnaire validated for this age group. Thousand participants (median age: 86·9 years, men: 49·9 %) were included in the analysis. Three major DP (DP1 ‘various foods’, DP2 ‘red meats and coffee’, DP3 ‘bread and processed meats’) were identified. DP1 ‘various foods’ was similar to DP previously named ‘healthy’ or ‘prudent’ and showed a positive association with PA time (PAT) as measured by accelerometer (B, 6·25; 95 % CI 0·13, 12·37) and relatively shorter sedentary behaviour (SB) time. DP2 ‘red meats and coffee’ and DP3 ‘bread and processed meats’ were negatively associated with PAT and positively associated with SB time. This study observed the relationship between diet and PA behaviours in adults aged ≥ 85, with healthier and more food-diverse DP associated with longer PAT and relatively unhealthy DP with shorter PAT.

An increasing number of studies have evaluated the association between ultra-processed foods (UPF) consumption and metabolic disorders. However, the association between UPF intake and non-alcoholic fatty liver disease (NAFLD) remains unclear. In this study, we analysed data from 6545 participants who were recruited in National Health and Nutrition Examination Surveys 2011–2018. UPF were defined in light of the NOVA food classification system and divided into quartiles based on its proportion of total weight intake. Complex logistic regression models were used to assess the association between UPF and NAFLD. Mediation analyses were conducted to reveal underlying mediators. We found that NAFLD patients consumed more UPF than controls (925·92 ± 18·08 v. 812·70 ± 14·32 g/d, P < 0·001). Dietary intake of UPF (% weight) was negatively related to the Healthy Eating Index-2015 score (Spearman r = −0·32, P < 0·001). In the multivariable model, the highest quartile compared with the lowest, the OR (95 % CI) were 1·83 (1·33, 2·53) for NAFLD (OR per 10 % increment: 1·15; 95 % CI: 1·09, 1·22; P for trend < 0·001) and 1·52 (1·12, 2·07) for insulin resistance (OR per 10 % increment: 1·11; 95 % CI: 1·05, 1·18; P for trend = 0·002). Mediation analyses revealed that poor diet quality, high saturated fat and refined grain intake partly mediated the association between UPF and NAFLD. In conclusion, high UPF intake was associated with an increased risk of NAFLD in US adults. Further prospective studies are needed to verify these findings.

Dietary patterns (DP) rich in plant foods are associated with improved health and reduced non-communicable disease risk. In October 2021, the Nutrition Society hosted a member-led conference, held online over 2 half days, exploring the latest research findings examining plant-rich DP and health. The aim of the present paper is to summarise the content of the conference and synopses of the individual speaker presentations are included. Topics included epidemiological analysis of plant-rich DP and health outcomes, the effects of dietary interventions which have increased fruit and vegetable (FV) intake on a range of health outcomes, how adherence to plant-rich DP is assessed, the use of biomarkers to assess FV intake and a consideration of how modifying behaviour towards increased FV intake could impact environmental outcomes, planetary health and food systems. In conclusion, although there are still considerable uncertainties which require further research, which were considered as part of the conference and are summarised in this review, adopting a plant-rich DP at a population level could have a considerable impact on diet and health outcomes, as well as planetary health.

Evidence on the association between children’s food insecurity (FI) and dietary patterns (DPs) is scarce. This study assessed the association between children’s FI and a priori and a posteriori-defined DPs in a Portuguese population-based sample of children. A cross-sectional study including 2800 children from the 10-year-old follow-up of the Generation XXI birth cohort was performed. Data on food security status, assessed by the Self-administered Food Security Survey Module for children (SAFSSMC), dietary intake and socio-demographics were collected. A previously developed Healthy Eating Index (HEI) was adapted for this study. Using the HEI score and its food groups, linear and logistic regression models were performed. Using latent class analysis, five a posteriori-defined DPs were identified. The DPs names considered an overall picture of the DP. Food security status as a categorical (food security/FI) and continuous variable (SAFSSMC raw score: higher scores representing higher FI) was used. Multinomial logistic regression models were used to assess the association between food security status and DPs. Children’s FI (9·4 %) was inversely associated with the HEI score (β=–0·695;95%CI:–1·154,–0·235), representing worse diet quality. A higher SAFSSMC raw score was associated with low fruit and vegetables (OR=1·089;95%CI:1·023,1·159) and seafood and eggs consumption (OR=1·073;95%CI:1·009,1·142) and high consumption of meat and meat products (OR=1·091;95%CI:1·026,1·160), salty snacks (OR=1·067;95%CI:1·003,1·136) and soft drinks (OR=1·097;95%CI:1·031,1·168). The SAFSSMC raw score was positively associated with ‘Low consumption’ (OR=1·119;95%CI:1·016,1·232), ‘Energy-dense foods’ (OR=1·155;95%CI:1·028,1·298) and ‘Snacking’ (OR=1·119;95%CI:1·006,1·245) DPs. FI was associated with worse dietary choices. Intervention strategies targeting food insecure children should be developed to promote healthy dietary habits.

Most current nutrition policies and dietary recommendations still reflect decades of research addressing the mechanism of action or health risks of individual nutrients. Yet, most high-income countries including the UK are far from reaching the dietary intakes which are recommended for good health. Food-based dietary patterns (DPs) can help target specific combinations of foods that are associated with disease risk, recognising the coexistence of multiple nutrients within foods and their potential synergistic effects. Reduced rank regression (RRR) has emerged as a useful exploratory approach which uses a priori knowledge of the pathway from diet to disease to help identify DPs which are associated with disease risk in a particular population. Here we reviewed the literature with a focus on longitudinal cohort studies using RRR to derive DPs and reporting associations with non-communicable disease risk. We also illustrated the application of the RRR approach using data from the UK Biobank study, where we derived DPs that explained high variability in a set of nutrient response variables. The main DP was characterised by high intakes of chocolate and confectionery, butter and low-fibre bread, and low intakes of fresh fruit and vegetables and showed particularly strong associations with CVD, type 2 diabetes and all-cause mortality, which is consistent with previous studies that derived ‘Western’ or unhealthy DPs. These recent studies conducted in the UK Biobank population together with evidence from previous cohort studies contribute to the emerging evidence base to underpin food-based dietary advice for non-communicable disease prevention.

Average diet quality is low in the UK and is socioeconomically patterned, contributing to the risk of non-communicable disease and poor health. Achieving meaningful dietary change in the long term is challenging, with intervention required on a number of different levels which reflect the multiple determinants of dietary choice. Dietary patterns have been identified which contribute positively to health outcomes; one of these is the Mediterranean diet (MD) which has been demonstrated to be associated with reduced non-communicable disease risk. Most research exploring the health benefits of the MD has been conducted in Mediterranean regions but, increasingly, research is also being conducted in non-Mediterranean regions. The MD is a dietary pattern that could have positive impacts on both health and environmental outcomes, while being palatable, appetising and acceptable. In this review, we consider the studies that have explored transferability of the MD. To achieve long-term dietary change towards a MD, it is likely that the dietary pattern will have to be culturally adapted, yet preserving the core health-promoting elements and nutritional composition, while considering the food system transition required to support changes at population level. Population-specific barriers need to be identified and ways sought to overcome these barriers, for example, key food availability and cost. This should follow a formal cultural adaptation framework. Such an approach is likely to enhance the extent of adherence in the longer term, thus having an impact on population health.

In recent decades, different data-driven approaches have emerged to identify dietary patterns (DP) and little is discussed about how these methods are able to capture diet complexity within the same population. This study aimed to apply three statistical methods to identify the DP of the Longitudinal Study of Adult Health (ELSA-Brasil) population and evaluate the similarities and differences between them. Dietary data were assessed at baseline in the ELSA-Brasil study using a FFQ. DP were identified by applying three statistical methods: (1) factor analysis (FA), (2) treelet transform (TT) and (3) reduced rank regression (RRR). The characteristics of individuals classified in the last tertile of each DP were compared. Cross-classification and Pearson’s correlation coefficients were assessed to evaluate the agreement between individuals’ adherence to DP of the three methods. A similar convenience DP was identified for all three methods. FA and TT also identified a similar prudent DP and a DP highly loaded for the food groups rice and beans. Individuals classified in the third tertile of similar DP of each method presented similar socio-demographic and nutrient intake characteristics. Regarding the cross-classification, prudent DP from FA and TT presented a higher level of agreement (75 %), while convenience DP from TT and RRR presented the lowest agreement (44·8 %). The different statistical methods were able to capture the populations’ DP in a similar way while highlighting the particularities of each method.

Metabolically healthy obesity (MHO) might be an alternative valuable target in obesity treatment. We aimed to assess whether alternative Mediterranean (aMED) diet and Dietary Approaches to Stop Hypertension (DASH) diet were favourably associated with obesity and MHO phenotype in a Chinese multi-ethnic population. We conducted this cross-sectional analysis using the baseline data of the China Multi-Ethnic Cohort study that enrolled 99 556 participants from seven diverse ethnic groups. Participants with self-reported cardiometabolic diseases were excluded to eliminate possible reverse causality. Marginal structural logistic models were used to estimate the associations, with confounders determined by directed acyclic graph (DAG). Among 65 699 included participants, 11·2 % were with obesity. MHO phenotype was present in 5·7 % of total population and 52·7 % of population with obesity. Compared with the lowest quintile, the highest quintile of DASH diet score had 23 % decreased odds of obesity (OR = 0·77, 95 % CI 0·71, 0·83, P trend < 0·001) and 27 % increased odds of MHO (OR = 1·27, 95 % CI 1·10, 1·48, P trend = 0·001) in population with obesity. However, aMED diet showed no obvious favourable associations. Further adjusting for BMI did not change the associations between diet scores and MHO. Results were robust to various sensitivity analyses. In conclusion, DASH diet rather than aMED diet is associated with reduced risk of obesity and presents BMI-independent metabolic benefits in this large population-based study. Recommendation for adhering to DASH diet may benefit the prevention of obesity and related metabolic disorders in Chinese population.