research study on nutrition

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Nutrition articles from across Nature Portfolio

Nutrition is the organic process of nourishing or being nourished, including the processes by which an organism assimilates food and uses it for growth and maintenance.

Latest Research and Reviews

Selective industry adoption of a voluntary front-of-pack nutrition label results in low and skewed uptake: 10-year results for the Health Star Rating

• Mariel Keaney
• Damian Maganja
• Alexandra Jones

Effects of maternal exposure to biomass cooking fuel on birth size and body proportionality in full-term infants born by vaginal delivery

• Zannatun Nyma
• S. M. Tafsir Hasan
• Tahmeed Ahmed

The acute effects of variations in the flour composition of crackers on the glycemic index and glycemic responses in healthy adults

• Emilia Papakonstantinou
• Vasilis Alsab
• George Katsaros

Optimisation of acid hydrolysis conditions of choline esters and mass spectrometric determination of total choline in various foods

• Yoshinari Hirakawa
• Kazuhiro Fujita
• Kiyotaka Nakagawa

Flavor and taste recognition impairments in people with type 1 diabetes

• Immacolata Cristina Nettore
• Giuseppe Palatucci
• Paolo Emidio Macchia

Dairy consumption and vitamin D concentration in adolescents with challenge-confirmed cow’s milk allergy during infancy

• Sonja Piippo
• Helena Hauta-alus
• Mikael Kuitunen

News and Comment

Ketogenic diet benefits in critically ill patients with sepsis

• Monica Wang

This lab-grown meat probably tastes like real beef

Cultured meat that tastes and smells more appetizing could enhance public perception of artificial steaks.

• Helena Kudiabor

The dance of gut microbes on the keto diet

Li, Yang, Zhou et al. delve into the impact of a ketogenic diet on mice and humans, highlighting microbial contributions to taurine-conjugated bile acids as crucial catalysts for the metabolic benefits of this diet.

Optimizing the design of time-restricted eating human trials

Time-restricted eating has become a popular diet for weight management and has spurred tremendous interest in the scientific community. The translation of results from TRE trials heavily depends on trial design. In this Comment, we provide general guidelines on optimizing the design and performance of time-restricted eating trials in human participants.

• Krista A. Varady
• Lisa S. Chow

Debunking the myths of intermittent fasting

Despite the mounting evidence supporting the use of intermittent fasting as a safe and effective weight loss intervention, many myths about fasting persist in popular culture. Here, we review some common beliefs about intermittent fasting that are not supported by scientific evidence.

• Sofia Cienfuegos

Food fortification programmes and zinc deficiency

The complex realities of most countries grappling with zinc deficiency pose challenges to the implementation of highly compliant, mandatory, large-scale food fortification programmes.

• Nicola M. Lowe
• Swarnim Gupta

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Page 1 of 38

Methodology and challenges for harmonization of nutritional data from seven historical studies

Collection of detailed dietary data is labor intensive and expensive, harmonization of existing data sets has been proposed as an effective tool for research questions in which individual studies are underpowered

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Associations between dietary total antioxidant capacity and sarcopenia: a cross-sectional study

No study has investigated the relationship between dietary total antioxidant capacity and sarcopenia so far.

Artificially sweetened beverage consumption and all-cause and cause-specific mortality: an updated systematic review and dose-response meta-analysis of prospective cohort studies

Artificially sweetened beverages (ASB) are consumed globally, but their impact on overall health remains uncertain. We summarized published associations between ASB intake with all-cause and cause-specific mor...

Validation of an web-based dietary assessment tool (RiksmatenFlex) against doubly labelled water and 24 h dietary recalls in pregnant women

Digital technologies have enabled new possibilities to assess dietary intake and have shown promise in terms of decreased participant burden, improved accuracy and lower costs. However, their potential and val...

Disproportionately higher cardiovascular disease risk and incidence with high fructose corn syrup sweetened beverage intake among black young adults–the CARDIA study

The black/white heart disease mortality disparity began increasing in the early 1980’s, coincident with the switch from sucrose to high-fructose-corn-syrup/(HFCS) in the US food supply. There has been more fructo...

Validation of a digital food frequency questionnaire for the Northern Sweden Diet Database

Dietary habits strongly influence health, with poor diets contributing to numerous deaths annually. Addressing this requires improved dietary habits and consistent monitoring thereof. In northern Sweden, a val...

Reply to Ghobadi and Jafari: diet quality in relation to the risk of hypertension among Iranian adults: cross-sectional analysis of Fasa PERSIAN cohort study

Ghobadi and Jafari have mentioned some points about our article titled “Diet quality in relation to the risk of hypertension among Iranian adults: cross-sectional analysis of Fasa PERSIAN cohort study” which w...

The association between serum phosphate and length of hospital stay and all-cause mortality in adult patients: a cross-sectional study

Data is limited on the prevalence of hypophosphatemia in general hospitalized patients, and its association with length of hospital stay (LOS) and mortality remained unclear. We aimed to investigate the preval...

Effects of a cafeteria-based sustainable diet intervention on the adherence to the EAT-Lancet planetary health diet and greenhouse gas emissions of consumers: a quasi-experimental study at a large German hospital

Sustainable diets contribute to improving human health and reducing food-related greenhouse gas emissions (GHGE). Here, we established the effects of a facility-based sustainable diet intervention on the adher...

Very high high-density lipoprotein cholesterol may be associated with higher risk of cognitive impairment in older adults

Previous studies have shown that high-density lipoprotein cholesterol (HDL-C) levels are positively associated with cognitive function across a range of concentrations. However, recent studies have suggested t...

Is the frequency of breakfast consumption associated with life satisfaction in children and adolescents? A cross-sectional study with 154,151 participants from 42 countries

The promotion of daily breakfast consumption and the importance of making appropriate breakfast choices have been underscored as significant public health messages. The aim of this study was to examine the rel...

Seafood intake in childhood/adolescence and the risk of obesity: results from a Nationwide Cohort Study

Obesity has been linked to various detrimental health consequences. While there is established evidence of a negative correlation between seafood consumption and obesity in adults, the current research on the ...

Serum levels of vitamin B12 combined with folate and plasma total homocysteine predict ischemic stroke disease: a retrospective case-control study

This study aimed to identify and quantify the association and investigate whether serum vitamin B12 alone or vitamin B12 combined with folate and plasma total homocysteine (tHcy) levels could be used to predic...

Lower energy intake associated with higher risk of cardiovascular mortality in chronic kidney disease patients on a low-protein diets

An increasing number of studies shown that inadequate energy intake causes an increase in adverse incidents in chronic kidney disease (CKD) patients on low-protein diets (LPD). The study aimed to investigate t...

Experiences participating in federal nutrition assistance programs during the early months of the COVID-19 pandemic: an investigation in Vermont

Federal nutrition assistance programs serve as safety nets for many American households, and participation has been linked to increased food security and, in some instances, improved diet quality and mental he...

Brief instruments for measuring nutrition literacy - the Nutrition Health Literacy Scale and the Self-Perceived Food Literacy Scale Short Form

A healthy diet is a critical factor in maintaining long-term health. In addition to a health-promoting food environment, the nutrition health literacy (NHL) and food literacy (FL) of the population are importa...

Adverse events profile associated with intermittent fasting in adults with overweight or obesity: a systematic review and meta-analysis of randomized controlled trials

There is little evidence to comprehensively summarize the adverse events (AEs) profile of intermittent fasting (IF) despite its widespread use in patients with overweight or obesity.

Differences in the cost and environmental impact between the current diet in Brazil and healthy and sustainable diets: a modeling study

While healthy and sustainable diets benefit human and planetary health, their monetary cost has a direct impact on consumer food choices. This study aimed to identify the cost and environmental impact of the c...

Correlation between serum trimethylamine-N-oxide and body fat distribution in middle-aged and older adults: a prospective cohort study

Trimethylamine-N-oxide (TMAO) is linked with obesity, while limited evidence on its relationship with body fat distribution. Herein, we investigated the associations between serum TMAO and longitudinal change ...

Identifying the barriers and facilitators to fruit and vegetable consumption in rural Australian adults: a mixed methods analysis

Low fruit and vegetable consumption is a leading contributor to non-communicable disease risk. However, understanding of barriers and facilitators to fruit and vegetable intake in rural settings is limited. Th...

Dietary choline intake in European and non-european populations: current status and future trends—a narrative review

Choline is a nutrient necessary for the proper functioning of the body with a multidimensional impact on human health. However, comprehensive studies evaluating the dietary intake of choline are limited. The a...

Association of maternal ultra-processed food consumption during pregnancy with atopic dermatitis in infancy: Korean Mothers and Children’s Environmental Health (MOCEH) study

Maternal diet during pregnancy might influence the development of childhood allergic disorders. There are few studies on the association between processed food intake and infant atopic dermatitis (AD) during p...

Assessing the relative validity of a web-based self-administered 24-hour dietary recall in a Canadian adolescent’s population

Healthy eating habits at a young age are crucial to support growth and development and good general health. In this context, monitoring youth dietary intakes adequately with valid tools is important to develop...

Effects of DASH diet with or without time-restricted eating in the management of stage 1 primary hypertension: a randomized controlled trial

Time-restricted eating (TRE), a popular form of intermittent fasting, has shown benefits for improving metabolic diseases and cardiometabolic health. However, the effect of TRE in the regulation of blood press...

A comprehensive approach to lifestyle intervention based on a calorie-restricted diet ameliorates liver fat in overweight/obese patients with NAFLD: a multicenter randomized controlled trial in China

Nonalcoholic fatty liver disease (NAFLD) is a globally increasing health epidemic. Lifestyle intervention is recommended as the main therapy for NAFLD. However, the optimal approach is still unclear. This stud...

Fish oil supplementation and risk of incident systemic lupus erythematosus: a large population-based prospective study

Although fish oil has been considered to have an anti-inflammatory effect and has been proven to play a beneficial role in the incidence of numerous diseases, the association between fish oil supplementation a...

Association of weight-adjusted waist index with all-cause mortality among non-Asian individuals: a national population-based cohort study

The Weight-Adjusted Waist Index (WWI) is a new indicator of obesity that is associated with all-cause mortality in Asian populations. Our study aimed to investigate the linear and non-linear associations betwe...

Relationship between sex, APOE genotype, endocannabinoids and cognitive change in older adults with metabolic syndrome during a 3-year Mediterranean diet intervention

The Mediterranean diet (MedDiet) has demonstrated efficacy in preventing age-related cognitive decline and modulating plasma concentrations of endocannabinoids (eCBs) and N- acylethanolamines (NAEs, or eCB-like co...

Association between serum vitamin D level and Graves’ disease: a systematic review and meta-analysis

This meta-analysis aims to analyze the relationship between serum vitamin D (VD) levels and Graves’ disease (GD).

Gardening and subjective cognitive decline: a cross-sectional study and mediation analyses of 136,748 adults aged 45+ years

Given the benefits of gardening for physical and psychological health, we explored whether gardening was associated with lower risks of subjective cognitive decline (SCD), a precursor of dementia, and SCD-rela...

Association between watching eating shows and unhealthy food consumption in Korean adolescents

Eating habits formed during adolescence greatly influence the maintenance of health in adulthood. With the recent development of social media and easy access to the Internet, adolescents watch plenty of food v...

Diet quality from mid to late life and its association with physical frailty in late life in a cohort of Chinese adults

It is unclear if improving diet quality after midlife could reduce the risk of physical frailty at late life. We aimed to associate changes in diet quality after midlife with physical frailty at late life.

Adherence to the Mediterranean Diet and its association with sustainable dietary behaviors, sociodemographic factors, and lifestyle: a cross-sectional study in US University students

Promoting healthy and sustainable diets is increasingly important and the Mediterranean Diet (MD) has been recognized as an appropriate example that can be adapted to different countries. Considering that the ...

Trends in the contribution of greenhouse gas emissions from food and beverage purchases in Mexico: 1989–2020

Assessing the trends in dietary GHGE considering the social patterning is critical for understanding the role that food systems have played and will play in global emissions in countries of the global south. O...

Higher oxidative balance score was associated with decreased risk of erectile dysfunction: a population-based study

Erectile dysfunction (ED) is a prevalent condition that is thought to be significantly impacted by oxidative stress. The oxidative balance score (OBS) has been built to characterize the state of antioxidant/pr...

Correction: Effect of soy isoflavone supplementation on blood pressure: a meta-analysis of randomized controlled trials

The original article was published in Nutrition Journal 2024 23 :32

National trends in nine key minerals intake (quantity and source) among U.S. adults, 1999 to march 2020

Changes in economy and dietary guidelines brought a great shock to diet quality and meal behaviors, but if these transformations have extended to minerals intake and their sources was still poorly understood. ...

Causal relationship of interleukin-6 and its receptor on sarcopenia traits using mendelian randomization

Previous research has extensively examined the role of interleukin 6 (IL-6) in sarcopenia. However, the presence of a causal relationship between IL-6, its receptor (IL-6R), and sarcopenia remains unclear.

Development and application of the Meal and Snack Assessment (MESA) quality scale for children and adolescents using item response theory

Meals differ in terms of food items and nutritional quality. The aim of the present study was to propose a scale to measure the meals quality of schoolchildren according to food processing degree, perform a pr...

Estimating effects of whole grain consumption on type 2 diabetes, colorectal cancer and cardiovascular disease: a burden of proof study

Previous studies on whole grain consumption had inconsistent findings and lacked quantitative assessments of evidence quality. Therefore, we aimed to summarize updated findings using the Burden of Proof analys...

Nonlinear relationship between oxidative balance score and hyperuricemia: analyses of NHANES 2007–2018

Limited data regarding the correlation between oxidative balance score (OBS) and hyperuricemia highlights the necessity for thorough investigations. This study aims to examine the link between OBS, which incor...

Effects of whole grains on glycemic control: a systematic review and dose-response meta-analysis of prospective cohort studies and randomized controlled trials

Whole grains have recently been promoted as beneficial to diabetes prevention. However, the evidence for the glycemic benefits of whole grains seems to conflict between the cohort studies and randomized contro...

Remnant cholesterol is an effective biomarker for predicting survival in patients with breast cancer

Breast cancer is the most common malignancy in women worldwide. The relationship between remnant cholesterol (RC) and the prognosis of patients with breast cancer has not been clearly reported. This study inve...

Epidemiological study of pediatric nutritional deficiencies: an analysis from the global burden of disease study 2019

Nutritional deficiencies (ND) continue to threaten the lives of millions of people around the world, with children being the worst hit. Nevertheless, no systematic study of the epidemiological features of chil...

Association between watching eating broadcast “Mukbang and Cookbang” and body mass index status in South Korean adolescents stratified by gender

It has been suggested that Mukbang and Cookbang, a type of eating broadcast originating from Korea and gaining popularity, may contribute to obesity. However, despite suggestions that Mukbang might contribute ...

The global diet quality score as an indicator of adequate nutrient intake and dietary quality – a nation-wide representative study

The Global Diet Quality Score (GDQS) was developed to be a simple, timely and cost-effective tool to track, simultaneously, nutritional deficiency and non-communicable disease risks from diet in diverse settin...

Development of a sustainable diet index in US adults

A transformation towards healthy diets through a sustainable food system is essential to enhance both human and planet health. Development of a valid, multidimensional, quantitative index of a sustainable diet...

Maternal vitamin D status and risk of gestational diabetes mellitus in twin pregnancies: a longitudinal twin pregnancies birth cohort study

Gestational diabetes mellitus (GDM) is a common complication of pregnancy, with significant short-term and long-term implications for both mothers and their offspring. Previous studies have indicated the poten...

Correction: Dietary intake and gastrointestinal symptoms are altered in children with Autism Spectrum Disorder: the relative contribution of autism-linked traits

The original article was published in Nutrition Journal 2024 23 :27

A late eating midpoint is associated with increased risk of diabetic kidney disease: a cross-sectional study based on NHANES 2013–2020

Modifying diet is crucial for diabetes and complication management. Numerous studies have shown that adjusting eating habits to align with the circadian rhythm may positively affect metabolic health. However, ...

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NIH Releases 2020-2021 Nutrition Research Report

Did you know the National Institutes of Health (NIH) has released their Nutrition Research report?

Executive Summary:

The mission of the National Institutes of Health (NIH) is to seek fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to enhance health, lengthen life, and reduce illness and disability. NIH supports and conducts a broad array of transformative and impactful research studies to better understand nutrition and how it relates to human health and disease. This research focuses on understanding how nutrients and food components are ingested, digested, absorbed, metabolized, stored, and excreted and their overall impact on the body. It also includes research studies to better understand the effects of behavior, including eating and food choice, and environmental exposures on nutritional status.

NIH Nutrition Research Report

Research Study Types

There are many different types of research studies, and each has distinct strengths and weaknesses. In general, randomized trials and cohort studies provide the best information when looking at the link between a certain factor (like diet) and a health outcome (like heart disease).

Laboratory and Animal Studies

These are studies done in laboratories on cells, tissue, or animals.

• Strengths: Laboratories provide strictly controlled conditions and are often the genesis of scientific ideas that go on to have a broad impact on human health. They can help understand the mechanisms of disease.
• Weaknesses: Laboratory and animal studies are only a starting point. Animals or cells are not a substitute for humans.

Cross-Sectional Surveys

These studies examine the incidence of a certain outcome (disease or other health characteristic) in a specific group of people at one point in time. Surveys are often sent to participants to gather data about the outcome of interest.

• Strengths: Inexpensive and easy to perform.
• Weaknesses: Can only establish an association in that one specific time period.

Case-Control Studies

These studies look at the characteristics of one group of people who already have a certain health outcome (the cases) and compare them with a similar group of people who do not have the outcome (the controls). An example may be looking at a group of people with heart disease and another group without heart disease who are similar in age, sex, and economic status, and comparing their intakes of fruits and vegetables to see if this exposure could be associated with heart disease risk.

• Strengths: Case-control studies can be done quickly and relatively cheaply.
• Weaknesses: Not ideal for studying diet because they gather information from the past, which can be difficult for most people to recall accurately. Furthermore, people with illnesses often recall past behaviors differently from those without illness. This opens such studies to potential inaccuracy and bias in the information they gather.

Cohort Studies

These are observational studies that follow large groups of people over a long period of time, years or even decades, to find associations of an exposure(s) with disease outcomes. Researchers regularly gather information from the people in the study on several variables (like meat intake, physical activity level, and weight). Once a specified amount of time has elapsed, the characteristics of people in the group are compared to test specific hypotheses (such as a link between high versus low intake of carotenoid-rich foods and glaucoma, or high versus low meat intake and prostate cancer).

• Strengths: Participants are not required to change their diets or lifestyle as may be with randomized controlled studies. Study sizes may be larger than other study types. They generally provide more reliable information than case-control studies because they don’t rely on information from the past. Cohort studies gather information from participants at the beginning and throughout the study, long before they may develop the disease being studied. As a group, many of these types of studies have provided valuable information about the link between lifestyle factors and disease.
• Weaknesses: A longer duration of following participants make these studies time-consuming and expensive. Results cannot suggest cause-and-effect, only associations. Evaluation of dietary intake is self-reported.

Two of the largest and longest-running cohort studies of diet are the Harvard-based Nurses’ Health Study and the Health Professionals Follow-up Study.

If you follow nutrition news, chances are you have come across findings from a cohort called the Nurses’ Health Study . The Nurses’ Health Study (NHS) began in 1976, spearheaded by researchers from the Channing Laboratory at the Brigham and Women’s Hospital, Harvard Medical School, and the Harvard T.H. Chan School of Public Health, with funding from the National Institutes of Health. It gathered registered nurses ages 30-55 years from across the U.S. to respond to a series of questionnaires. Nurses were specifically chosen because of their ability to complete the health-related, often very technical, questionnaires thoroughly and accurately. They showed motivation to participate in the long-term study that required ongoing questionnaires every two years. Furthermore, the group provided blood, urine, and other samples over the course of the study.

The NHS is a prospective cohort study, meaning a group of people who are followed forward in time to examine lifestyle habits or other characteristics to see if they develop a disease, death, or some other indicated outcome. In comparison, a retrospective cohort study would specify a disease or outcome and look back in time at the group to see if there were common factors leading to the disease or outcome. A benefit of prospective studies over retrospective studies is greater accuracy in reporting details, such as food intake, that is not distorted by the diagnosis of illness.

To date, there are three NHS cohorts: NHS original cohort, NHS II, and NHS 3. Below are some features unique to each cohort.

NHS – Original Cohort

• Started in 1976 by Frank Speizer, M.D.
• Participants: 121,700 married women, ages 30 to 55 in 1976.
• Outcomes studied: Impact of contraceptive methods and smoking on breast cancer; later this was expanded to observe other lifestyle factors and behaviors in relation to 30 diseases.
• A food frequency questionnaire was added in 1980 to collect information on dietary intake, and continues to be collected every four years.
• Started in 1989 by Walter Willett, M.D., M.P.H., Dr.P.H., and colleagues.
• Participants: 116,430 single and married women, ages 25 to 42 in 1989.
• Outcomes studied: Impact on women’s health of oral contraceptives initiated during adolescence, diet and physical activity in adolescence, and lifestyle risk factors in a younger population than the NHS Original Cohort. The wide range of diseases examined in the original NHS is now also being studied in NHSII.
• The first food frequency questionnaire was collected in 1991, and is collected every four years.
• Started in 2010 by Jorge Chavarro, M.D., Sc.M., Sc.D, Walter Willett, M.D., M.P.H., Dr.P.H., Janet Rich-Edwards, Sc.D., M.P.H, and Stacey Missmer, Sc.D.
• Participants: Expanded to include not just registered nurses but licensed practical nurses (LPN) and licensed vocational nurses (LVN), ages 19 to 46. Enrollment is currently open.
• Inclusion of more diverse population of nurses, including male nurses and nurses from Canada.
• Outcomes studied: Dietary patterns, lifestyle, environment, and nursing occupational exposures that may impact men’s and women’s health; the impact of new hormone preparations and fertility/pregnancy on women’s health; relationship of diet in adolescence on breast cancer risk.

From these three cohorts, extensive research has been published regarding the association of diet, smoking, physical activity levels, overweight and obesity, oral contraceptive use, hormone therapy, endogenous hormones, dietary factors, sleep, genetics, and other behaviors and characteristics with various diseases. In 2016, in celebration of the 40 th  Anniversary of NHS, the  American Journal of Public Health’s  September issue  was dedicated to featuring the many contributions of the Nurses’ Health Studies to public health.

Growing Up Today Study (GUTS)

In 1996, recruitment began for a new cross-generational cohort called  GUTS (Growing Up Today Study) —children of nurses from the NHS II. GUTS is composed of 27,802 girls and boys who were between the ages of 9 and 17 at the time of enrollment. As the entire cohort has entered adulthood, they complete annual questionnaires including information on dietary intake, weight changes, exercise level, substance and alcohol use, body image, and environmental factors. Researchers are looking at conditions more common in young adults such as asthma, skin cancer, eating disorders, and sports injuries.

Randomized Trials

Like cohort studies, these studies follow a group of people over time. However, with randomized trials, the researchers intervene with a specific behavior change or treatment (such as following a specific diet or taking a supplement) to see how it affects a health outcome. They are called “randomized trials” because people in the study are randomly assigned to either receive or not receive the intervention. This randomization helps researchers determine the true effect the intervention has on the health outcome. Those who do not receive the intervention or labelled the “control group,” which means these participants do not change their behavior, or if the study is examining the effects of a vitamin supplement, the control group participants receive a placebo supplement that contains no active ingredients.

• Strengths: Considered the “gold standard” and best for determining the effectiveness of an intervention (e.g., dietary pattern, supplement) on an endpoint such as cancer or heart disease. Conducted in a highly controlled setting with limited variables that could affect the outcome. They determine cause-and-effect relationships.
• Weaknesses: High cost, potentially low long-term compliance with prescribed diets, and possible ethical issues. Due to expense, the study size may be small.

Meta-Analyses and Systematic Reviews

A meta-analysis collects data from several previous studies on one topic to analyze and combine the results using statistical methods to provide a summary conclusion. Meta-analyses are usually conducted using randomized controlled trials and cohort studies that have higher quality of evidence than other designs. A systematic review also examines past literature related to a specific topic and design, analyzing the quality of studies and results but may not pool the data. Sometimes a systematic review is followed by conducting a meta-analysis if the quality of the studies is good and the data can be combined.

• Strengths: Inexpensive and provides a general comprehensive summary of existing research on a topic. This can create an explanation or assumption to be used for further investigation.
• Weaknesses: Prone to selection bias, as the authors can choose or exclude certain studies, which can change the resulting outcome. Combining data that includes lower-quality studies can also skew the results.

A primer on systematic review and meta-analysis in diabetes research

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ORIGINAL RESEARCH article

Evaluation of the relationship between dietary acid load and cardiovascular risk factors in patients with type 2 diabetes: a case-control study.

• 1 Atılım University, Ankara, Türkiye
• 2 Başkent University, Ankara, Ankara, Türkiye

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Backround: Diets high in dietary acid load are thought to be associated with metabolic diseases. However, the number of studies examining the relationship between dietary acid load and metabolic diseases in Turkey is insufficient. The aim of this study was to investigate the relationship between cardiovascular disease risk factors and dietary acid load in individuals with type 2 diabetes. Material and methods: In this case-control study, 51 participants aged 30-65 years with type 2 diabetes and 59 participants in the control group were included. Blood pressure and biochemical findings were measured. Anthropometric measurements and body composition measurements were made. Dietary intake was assessed using a 3-day (1 day on weekends, 2 days on weekdays) food consumption record. Dietary acid load scores, including potential renal acid load (PRAL) and net endogenous acid production (NEAP), were calculated based on dietary intake. NEAP and PRAL scores were categorised as low and high according to the median value. Smoking status, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), trigylceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL), waist-hip ratio (WHR), waist-to- height ratio (WtHR), hemoglobin and fat mass (%) were evaluated as cardiovascular risk factors. Results: The cut-off values of PRAL and NEAP were 3.61 and 44.78 mEq/d, respectively. After adjustment for various covariates, a significant positive association between PRAL and TG levels was observed in the diabetic group (odds ratio [OR], 5.98; 95% CI, 1.45-24.67; P = 0.013). In contrast, a negative association was found between PRAL and SBP in the control group (odds ratio [OR], 0.21; 95% CI, 0.05-0.83; P = 0.026). However, these associations were not observed for NEAP values in either group. Conslusions: A higher PRAL value was consistently associated with higher TG level, but other cardiovascular risk factors were not. More longitudinal and interventional studies are needed to better establish a causal effect between dietary acid load and cardiovascular risk factors in individuals with diabetes.

Keywords: cardiovascular disease, DIETARY ACID LOAD, type 2 diabetes, Potential renal acid load, Net endogenous acid production

Received: 08 Jun 2024; Accepted: 05 Aug 2024.

Copyright: © 2024 Güngör and Saka. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Sedef Güngör, Atılım University, Ankara, Türkiye

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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More Evidence Links Ultraprocessed Foods to Dementia

Recent research, including a new study on processed meat, has suggested these foods can affect brain health. Experts are trying to understand why.

By Dana G. Smith and Alice Callahan

People who regularly eat processed red meat, like hot dogs, bacon, sausage, salami and bologna, have a greater risk of developing dementia later in life. That was the conclusion of preliminary research presented this week at the Alzheimer’s Association International Conference.

The study tracked more than 130,000 adults in the United States for up to 43 years. During that period, 11,173 people developed dementia. Those who consumed about two servings of processed red meat per week had a 14 percent greater risk of developing dementia compared to those who ate fewer than three servings per month.

Eating unprocessed red meat, like steak or pork chops, did not significantly increase the risk for dementia, though people who ate it every day were more likely to report that they felt their cognition had declined than those who ate red meat less often. (The results of the study have not yet been published in a journal.)

The vast majority of processed meats are classified as “ ultraprocessed foods ” — products made with ingredients that you wouldn’t find in a home kitchen, like soy protein isolate, high fructose corn syrup, modified starches, flavorings or color additives. Many of these foods also have high levels of sugar, fat or sodium, which have long been known to adversely affect health.

Ultraprocessed foods, which also include items like sodas, flavored yogurts, instant soups and most breakfast cereals, make up a huge part of the American diet. They account for about 58 percent of the calories consumed by both children and adults, on average. In the last decade, researchers have linked these foods to health conditions including heart disease, Type 2 diabetes, obesity and some types of cancer and gastrointestinal diseases.

Now scientists are examining the connection between these foods and brain health.

What does the research suggest?

Several studies published in the past few years have found an association between eating more ultraprocessed foods and cognitive decline. In one study of more than 10,000 middle-aged adults in Brazil , for example, people who consumed 20 percent or more of their daily calories from ultraprocessed foods experienced more rapid cognitive decline, particularly on tests of executive functioning, over the course of eight years.

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Heavy metals, including lead, found in many dark chocolate bars, research shows

A new study finds that dark chocolate products sold nationwide may contain excessive amounts of heavy metals. 

The research, led by scientists at George Washington University and published Wednesday in the peer-reviewed Frontiers in Nutrition, examined over 70 dark chocolate products from retailers such as Whole Foods Market, Amazon and GNC. The products were tested to see whether the heavy metals lead, cadmium or arsenic were in them. 

Overall, 43% of the products studied exceeded acceptable levels of lead and 35% exceeded cadmium levels, according to the study, which was based on a California law that sets maximum allowable dose levels for heavy metals in food. Food researchers often use the 1986 regulations, known as Prop 65, as a safety standard because the Food and Drug Administration doesn’t set limits on heavy metals in most foods, said Leigh Frame, director of integrative medicine at George Washington University School of Medicine and Health Sciences and lead author of the study.

The FDA does have suggested limits for chocolate and sugar-based candy but only for children.

According to the California guidelines, the threshold for heavy metals in foods is 0.5 micrograms a day. For the study, the scientists estimated the number of micrograms a day people would be exposed to if they ate the suggested serving amounts on the chocolate product labels. They found that the chocolate samples ranged from 0 to as high as 3.316 mcg per daily serving. Levels of cadmium, a carcinogen at high levels, ranged from 0.29 to 14.12 mcg, with the limit being 4.1 mcg per day.

None of the products exceeded the maximum level for arsenic. 

Frame said that because the products had varying amounts of lead in them, limiting consumption is the only sure way to reduce exposure.

“Don’t have large amounts of chocolate every single day,” she said. “One ounce serving size is what we recommend, or maybe you have 2 ounces every other day.” 

How to avoid lead in foods

Researchers agree that avoiding heavy metals entirely in our diet is nearly impossible. Foods such as rice, fish, fruits and vegetables have been known to contain varying amounts of metals. While heavy metals can be naturally excreted by the body through sweat and urine, if they are consumed in high amounts they can accumulate in the body and damage major organs. 

“You actually cannot avoid exposure to heavy metals in the diet,” Frame said. “It’s really not about avoiding them; it’s about making sure you’re not getting too much.” 

She emphasized a diversity in diet to avoid excessive exposure to any particular substance.

“Not eating the same thing day after day is going to help protect you from many different things, including heavy metals,” she said.

The authors intentionally left out which brands had what concentrations of metals given that levels could vary even within the same company. Interestingly, the study found that organic cocoa products were more likely to have higher levels of cadmium and lead. 

“Organic food doesn’t necessarily mean that it’s been checked for exposure to toxic metals like lead, cadmium and arsenic,” said Manish Arora, vice chairman of the department of environmental medicine and climate science at the Icahn School of Medicine at Mount Sinai in New York City.   

“I think to most of the public ‘organic’ just means cleaner, and in this case it’s counterintuitive,” he said. 

Arora, who was not involved with the study, said that while the new research was strong, a big unknown with the paper is how the heavy metals got into the chocolate products in the first place. 

“Is it the processing, the farming or the type of soil or the fertilizer or any other farming process that they’re using?” he asked. “We are left not being sure where the metal actually entered the food chain.”

Previous research has found that lead and cadmium can enter dark chocolate through different ways. Cadmium comes primarily through the cacao plant’s taking it up from the soil, while lead can be introduced at various points in the manufacturing process, including the harvesting, drying and fermenting of the cocoa bean. 

There is no safe level of lead. While the FDA does not set limits for cadmium or arsenic, almost all of the chocolate bars in the study were below its recommended level for lead: 2.2 mcg a day for children under age 7 and 8.8 mcg a day for women of child-bearing age.

That contrasts with the California guidance because levels set by Prop 65 tend to be more conservative, Frame said.

Tewodros Godebo, an assistant professor of environmental health sciences at Tulane University School of Public Health and Tropical Medicine, said that in his opinion the Prop 65 standards are too conservative and may cause unnecessary panic. He has published his own study this year, in which his team tested over 100 chocolate products. 

Instead of the Prop 65 limits, Godebo's research used a method proposed by the Environmental Protection Agency that found levels of heavy metals in chocolate were not enough to be concerning to adults. The EPA commonly uses the formula, called the hazard quotient, to determine a substance’s toxicity. 

Still, he recommended consuming no more than an ounce of dark chocolate per day and limiting consumption for children and pregnant women. 

The new study did not examine milk chocolate, but theoretically it should have a lower risk of heavy metal contamination, Frame said. That is because the metals are believed to come from the cocoa powder itself, which is present in higher levels in dark chocolate. 

Akshay Syal, M.D., is a medical fellow with the NBC News Health and Medical Unit. 

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FIP indicates International Pharmaceutical Federation.

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Ashraf AR , Mackey TK , Schmidt J, et al. Safety and Risk Assessment of No-Prescription Online Semaglutide Purchases. JAMA Netw Open. 2024;7(8):e2428280. doi:10.1001/jamanetworkopen.2024.28280

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Safety and Risk Assessment of No-Prescription Online Semaglutide Purchases

• 1 Department of Pharmaceutics, Faculty of Pharmacy, University of Pécs, Pécs, Hungary
• 2 Global Health Program, Department of Anthropology, University of California San Diego, La Jolla
• 3 Global Health Policy and Data Institute, San Diego, California
• 4 S-3 Research, San Diego, California
• 5 Institute of Biochemistry and Medical Chemistry, Medical School, University of Pécs, Pécs, Hungary
• 6 Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Pécs, Pécs, Hungary

The popularity of branded semaglutide is surging, with widespread media coverage, viral social media exposure, and celebrity endorsements. 1 Although Wegovy (Novo Nordisk) is approved for long-term weight management, Ozempic (Novo Nordisk) (only approved for type 2 diabetes) is often used off-label for this purpose. Global regulatory agencies, including the US Food and Drug Administration (FDA), European Medicines Agency, and World Health Organization (WHO), have warned about fake versions driven by patient demand, high cost, and shortages. Illegal online pharmacies, which operate without valid licenses and sell medicines like semaglutide without prescription, represent a consumer risk for ineffective and dangerous products.

In this qualitative study, we conducted risk assessment of semaglutide online sourcing ( Figure and eAppendix in Supplement 1 ). We followed the SRQR reporting guideline.

First, we conducted structured searches on Google and Bing to catalog websites advertising semaglutide without a prescription in July 2023. Websites meeting inclusion criteria were selected for a product test buy protocol. 2 Two 0.25-mg per dose prefilled pens or equivalent semaglutide injection vials were ordered from each website. Upon product receipt, authors (A.R.A., and A.F.) used the International Pharmaceutical Federation’s (FIP) checklist for visual inspection to assess potential counterfeiting or falsification risks, compared with genuine Ozempic brand 1-mg semaglutide solution for injection in a prefilled pen. 3 Products were then tested for quality, including sterility and microbiological contamination, according to European Pharmacopoeia and US Pharmacopeia guidelines. Quantification of active ingredients was performed using liquid chromatography–mass spectrometry (LC-MS). Test purchases and analytical testing were performed August from 2023 to March 2024.

Search engine monitoring generated 1080 hyperlinks, with 317 (29.35%) for online pharmacies. Nearly one-half (134 sites [42.27%]) belonged to illegal pharmacy operations; 763 links were websites not offering products for sale, including 615 news and informational websites and 148 telemedicine websites requiring consultation to obtain prescription before purchase.

Six online vendors classified as not recommended or rogue by LegitScript and/or National Association of Boards of Pharmacy and offering parenteral semaglutide products were included in test buys. Three websites offered prefilled 0.25-mg per dose semaglutide injection pens, and 3 sold vials of lyophilized semaglutide to be reconstituted to solution for injection (1-3 mg). All vendors referred to weight loss and obesity on their product page. Prices for the smallest dose and quantity ranged from US $113 to $360 (mean [SD], US $218.5 [$93.6]) ( Table ).

Test purchases were confirmed via email and WhatsApp. Of 6 products purchased, only 3 were received. Three vendors selling Ozempic injections engaged in nondelivery scams requesting extra payments (range, US $650-$1200) to purportedly clear customs, confirmed as fraudulent by customs agencies. Although genuine Ozempic scored the full 22 points on the FIP checklist, test purchased products scored 8 or 9 with clear discrepancies in regulatory registration information, accurate labeling, and evidence products were likely unregistered or unlicensed.

Upon quality testing, one sample had elevated presence of endotoxin (8.95 EU/mg) indicating possible contamination, although no viable microorganisms were detected. LC-MS revealed the presence of semaglutide in all samples, but with considerably lower purity levels (7%-14% vs advertised 99%). The measured semaglutide content substantially exceeded the labeled amount in each sample by 29% to 39%, meaning that users could receive up to 39% more semaglutide per injection. These risk factors indicate likely falsification that does not meet legitimate product quality standards.

This qualitative study found that semaglutide products are actively being sold without prescription by illegal online pharmacies, with vendors shipping unregistered and falsified products. Two websites evaluated were sent FDA warning letters for unlawful sale of unapproved and misbranded semaglutide. 4 , 5 US poison centers have reported a 1500% increase in calls related to semaglutide, highlighting the need for enhanced pharmacovigilance including for online sourcing harms. 6 Study limitations include limited sample of products tested due to nondelivery scams. Furthermore, although tested products represent some accessible semaglutide products sold online, higher priced offerings were excluded, limiting generalizability of the findings.

Accepted for Publication: June 21, 2024.

Published: August 2, 2024. doi:10.1001/jamanetworkopen.2024.28280

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2024 Ashraf AR et al. JAMA Network Open .

Corresponding Author: Tim K. Mackey, MAS, PhD, Global Health Program, Department of Anthropology, University of California San Diego, 9500 Gilman Dr, MC 0505, La Jolla, CA 92093 ( [email protected] ).

Author Contributions: Dr Ashraf had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Ashraf, Mackey, Vida, Li, Fittler.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Ashraf, Mackey, Kulcsár, Vida, Fittler.

Critical review of the manuscript for important intellectual content: Ashraf, Mackey, Schmidt, Kulcsár, Li, Fittler.

Statistical analysis: Ashraf, Kulcsár, Li.

Obtained funding: Mackey, Fittler.

Administrative, technical, or material support: Ashraf, Mackey, Vida, Li.

Supervision: Mackey, Fittler.

Conflict of Interest Disclosures: Mr Schmidt reported receiving grant TKP2021-EGA-17 from the Hungarian National Research, Development and Innovation Office outside the submitted work. No other disclosures were reported.

Funding/Support: The research was supported by the Hungarian Scientific Research Fund (grant NKFI-ID 143684).

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Data Sharing Statement: See Supplement 2 .

Additional Contributions: The research was performed in collaboration with Mass Spectrometry Core Facility at the Szentágothai Research Centre of the University of Pécs.

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Nutrition research to affect food and a healthy lifespan 1, 2

Sarah d. ohlhorst.

3 American Society for Nutrition, Bethesda, MD

Robert Russell

4 NIH Office of Dietary Supplements, Bethesda, MD, and Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA

Dennis Bier

5 USDA/Agricultural Research Service Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX

David M. Klurfeld

6 Human Nutrition Program, USDA/Agricultural Research Service, Beltsville, MD

Zhaoping Li

7 Center for Human Nutrition, University of California Los Angeles, and David Geffen School of Medicine at UCLA, Los Angeles, CA

Jonathan R. Mein

8 Monsanto Center for Food and Nutrition Research, Monsanto Vegetable Seed, Kannapolis, NC

John Milner

9 NIH National Cancer Institute, Bethesda, MD

A. Catharine Ross

10 Department of Nutritional Sciences, Pennsylvania State University, University Park, PA; and

Patrick Stover

11 Division of Nutritional Sciences, Cornell University, Ithaca, NY.

Emily Konopka

Proper nutrition offers one of the most effective and least costly ways to decrease the burden of many diseases and their associated risk factors, including obesity. Nutrition research holds the key to increasing our understanding of the causes of obesity and its related comorbidities and thus holds promise to markedly influence global health and economies. After outreach to 75 thought leaders, the American Society for Nutrition (ASN) convened a Working Group to identify the nutrition research needs whose advancement will have the greatest projected impact on the future health and well-being of global populations. ASN’s Nutrition Research Needs focus on the following high priority areas: 1 ) variability in individual responses to diet and foods; 2 ) healthy growth, development, and reproduction; 3 ) health maintenance; 4 ) medical management; 5 ) nutrition-related behaviors; and 6 ) food supply/environment. ASN hopes the Nutrition Research Needs will prompt collaboration among scientists across all disciplines to advance this challenging research agenda given the high potential for translation and impact on public health. Furthermore, ASN hopes the findings from the Nutrition Research Needs will stimulate the development and adoption of new and innovative strategies that can be applied toward the prevention and treatment of nutrition-related diseases. The multidisciplinary nature of nutrition research requires stakeholders with differing areas of expertise to collaborate on multifaceted approaches to establish the evidence-based nutrition guidance and policies that will lead to better health for the global population. In addition to the identified research needs, ASN also identified 5 tools that are critical to the advancement of the Nutrition Research Needs: 1 ) omics, 2 ) bioinformatics, 3 ) databases, 4 ) biomarkers, and 5 ) cost-effectiveness analysis.

INTRODUCTION

The attainment of good nutrition depends on and encompasses the entire food supply. Plant and animal foods and their various components are the primary vehicles that provide nourishment to human beings. Nutrition is vital, not only in the growth and development of humans and animals but also in the prevention and treatment of disease. Nutrition is also fundamental to the maintenance of good health and functionality. Basic and applied research on the interrelations between nutrition and noncommunicable diseases, nutrient composition, and nutrition monitoring represents the underpinnings for healthy populations and robust economies. Thus, innovative nutrition research and education provide the basis for solutions to larger health-related issues, allowing individuals to live healthier, more productive lives.

The importance of nutrition, as an integral part of the solution to many societal, environmental, and economic challenges facing the world, has just started to be fully appreciated. The American Society for Nutrition (ASN) has identified the “grand” challenges facing nutrition research and science in the 21st century, termed “Nutrition Research Needs.” Findings from these Nutrition Research Needs will elucidate strategies that can be applied toward the prevention and treatment of both infectious and noncommunicable diseases, including cardiovascular disease, diabetes, and cancer. Nutrition research holds the key to increasing our understanding of the underlying causes of obesity and its related comorbidities and thus holds promise to markedly influence global economies. Knowledge about adequate nutrition also has an important role in reducing or ending global and domestic food insecurity through direct and purposeful agricultural practices. Population growth will undeniably lead to increased global demand for a safe, available, sustainable, and affordable food supply, while continuing to demand nutritional adequacy.

The ASN Nutrition Research Needs project was originally conceptualized by ASN’s Public Policy Committee to identify worldwide nutrition research needs. This effort will be used to educate and communicate to policy makers and other stakeholders the need and value of increased nutrition research funding to meet societal needs. ASN’s Public Policy Committee reached out to nearly 75 thought leaders in September 2011 to develop a draft list of nutrition research needs.

In February 2012, ASN convened a Working Group of nutrition scientists and researchers representing a cross-section of the Society’s membership to determine the nutrition research needs that will have the greatest impact on the health and well-being of global populations. The names of the Working Group members are listed in the Acknowledgments. Starting with the draft list, the Working Group narrowed down and pulled together 6 nutrition research needs for which advancement would have the greatest projected impact on future health and well-being.

The ASN then informed its membership of the 6 priority research needs and sought further member input. A workshop was held during ASN’s 2012 Scientific Sessions and Annual Meeting in San Diego, CA, with nearly 250 attendees. The research needs were also shared via ASN’s member newsletter, which reaches the entire membership base of nearly 5000 individuals, to inform and seek input from members who did not attend the annual meeting or the workshop. Member feedback on the Nutrition Research Needs was incorporated during development of the final document.

THE TOP NUTRITION RESEARCH NEEDS

The top 6 nutrition research needs cut across the entire research spectrum from basic science to health policy, from discovery to application. Specific research areas are listed under each research need. These 6 nutrition research needs are highlighted in the hope that they will prompt scientists from all disciplines to collaborate to advance these challenging research needs that have high potential for translation and public health impact. Although the topics presented focus principally on human nutrition research, the Working Group recognized that nutrition research using animal models is an essential foundation for making new discoveries that can be translated to advances in human nutrition. Further, the importance of animal nutrition research is emphasized within these research needs in particular: “Understanding the role of nutrition in health maintenance” and “Understanding the food supply/environment.” The research community will benefit from clearly articulated nutrition research priorities that will lead to science-based information, help to shape policy and enhance future funding for nutrition research, and thereby further promote the field of nutrition science.

1) Understanding variability in individual responses to diet and foods

A top priority for future nutrition research is the need to better understand variability in metabolic responses to diet and food. Enormous variability exists in individual responses to diet and food components that affect overall health. Discoveries underpinning this variability will lead to advances in personalized nutrition interventions and will better inform health and food policies, including Dietary Reference Intakes (DRIs) for nutrient needs and, ideally, future recommendations for known bioactive food components. Research in the following areas is necessary to determine the origins and architecture of variability and to explain similar or dissimilar responses to diet and food components by subpopulations, as influenced by genetic, epigenetic, and ethnic and/or racial differences.

Omics research, such as nutrigenetics and nutrigenomics (e.g., epigenetics, transcriptomics, proteomics, and metabolomics), will help to determine how specific nutrients interact with genes, proteins, and metabolites to predict an individual’s health. Omics provide information on individualized nutrient requirements, including how nutrients are digested, absorbed, and metabolized, and their functions in the body. Omics will help to determine and reflect an individual’s nutritional status and will aid in the creation of new nutritional and disease biomarkers.

Microbiome.

Diverse microbes, such as bacteria and viruses, live in and on the body and contribute to the microbiome, which is estimated to have 10 times as many cells as the body itself ( 1 ). Microbes can vary in type and quantity, making each organism’s microbiome unique—although subpopulations may have similar microbiome characteristics. The microbiota needs to be better defined, and changes due to diet, age, physiologic state, and disease need to be determined. Research is needed to determine the microbiome’s role in varying biological responses to diet and food components and its importance in disease prevention and progression. Conversely, research is also needed to determine how the microbiome is influenced by diet and other environmental factors.

Biological networks.

Basic research is needed to provide a better understanding of biological networks, such as an individuals’ genome (DNA/RNA protein profiles), and how these networks affect metabolic responses to diet and food. Environmental interactions, including nutrients and other dietary components, bacteria, viruses, and chemical contaminants, all may affect the responsiveness of biological networks to specific foods and the entire diet.

Tissue specificity and temporality.

Research is needed to describe the mechanisms by which dietary factors affect variability in development and functioning, including which tissues are most influenced by dietary factors and when during the most critical stages in life this influence occurs.

2) Understanding the impact of nutrition on healthy growth, development, and reproduction

Epigenetics/imprinting..

Epigenetics and imprinting research examines how exposures to dietary components during critical periods of development may “program” long-term health and well-being. Research is needed to determine how early nutritional events contribute to disease later in life and alter normal developmental progression.

Early nutrition.

Research is necessary to better understand the role of diet and individual food components on normal growth and development. This includes the role of parent’s preconception diets, the maternal diet during pregnancy, and early nutritional events. Studies indicate that the timing of an infant’s introduction to solid foods may increase the likelihood of becoming obese later in life ( 2 ). These findings are important given that the number of overweight children in the United States has increased dramatically in recent years ( 3 ). Research is now needed to determine the best approaches to influence these factors during early life. The important role of nutrition throughout early life on growth and development, as well as on health and well-being, needs to be continually assessed.

Nutrition and reproductive health.

The impact of nutrition on reproductive health, including before and after conception, requires further research. Nutrition has a direct impact on both maternal and paternal fertility and the ability to conceive and also plays a key role in preventing diseases related to reproductive organs, including prostate and ovarian cancers. Although numerous studies have investigated how fruit and vegetable consumption may affect risk of breast, prostate, and other cancers, there is no clear consensus in the scientific literature. Thus, well-designed controlled intervention studies are needed to determine whether effects are limited to subpopulations, what factors influence a response and what mechanisms may account for changes in health.

3) Understanding the role of nutrition in health maintenance

Health maintenance includes noncommunicable disease prevention and treatment as well as weight management. The role that food components, particularly novel ingredients, contribute to health maintenance requires continuing research. Researchers and the public rely on dietary guidance, including the DRIs, to guide nutrition recommendations and health policy. Research is needed to better define the nutrient needs that best support health maintenance in all populations and their subgroups, from infancy throughout life. Nutrition across life is a fundamental issue that requires investigation so that recommendations will “match” with true biological needs.

Optimal bodily function.

Research is needed to determine the roles that nutrition and fitness, both singularly and together, have in maintaining bodily functions, including cognitive, immune, skeletal, muscular, and other functions. Evolving research areas include prevention of disease-related processes, such as inflammation, and definition of mechanisms that have an important role in health maintenance, such as immunocompetence. Animal models are used to understand the requirements for optimal health in humans and production animals.

Energy balance.

Research is also needed to examine the use of a systems approach to achieve energy balance including and integrating environmental, biological, psychosocial, and food system factors. A systems approach is preferable because the standard experimental approach of varying one factor at a time has accomplished little to address the populationwide problem of energy imbalance. A solution-oriented approach that is comprehensive in nature and takes into account the complexities of achieving energy balance must be created. Although far more research is needed to identify systemwide changes that maximize energy balance, intriguing examples exist. “Shape Up Somerville, MA,” effectively reduced weight gain in high-risk children through a multifaceted community-based environmental change campaign ( 4 ). Shape Up Somerville increased the community’s physical activity and healthful eating through physical infrastructure improvements and citywide policy and programming changes.

4) Understanding the role of nutrition in medical management

The rapid translation of nutrition research advances into evidence-based practice and policy is a priority for ensuring optimal patient care and effective disease management. Nutrition researchers have a key role in bridging the gap between disease prevention and disease treatment by fostering clinical research, providing innovative education for caregivers and patients, and delineating best practices for medical nutrition in primary care settings.

Disease progression.

To improve the medical management of disease, research is needed to determine how nutritional factors influence both disease initiation and progression, as well as how nutrition affects a patient’s response to therapy. Genetic and epigenetic variations among individuals can result in both positive and negative responses to diets, to specific foods, and to novel food components. The issue of individual variability is of considerable importance in refining medical management, including nutrition support, and requires continuing research.

Expanded research will allow us to better understand and minimize unfavorable impacts of both reduced and elevated nutrient intakes on disease progression and overall health. Disease/mortality response curves are U-shaped for many nutrients (that is, there is an increased risk of adverse outcomes if the nutrient is ingested in either too low or too high amounts). The importance of achieving a proper nutrient balance is seen in the example of chronic inflammation. Chronic inflammation contributes to many noncommunicable diseases and can result from high intakes of proinflammatory omega-6 fatty acids in the face of low intakes of anti-inflammatory omega-3 fatty acids ( 5 ). Research will help to determine the desired intake for essential and nonessential nutrients alone and when combined with other nutrients in the diet.

Nutrition support for special subgroups.

Nutrition research is needed to establish the required nutritional needs that best support survival, growth, and development in subpopulations, such as in chronically diseased patients, in children, and in aging adults. With the success of medical advances, as have been seen with in vitro fertilization and neonatal care, caring for preterm infants presents a new challenge in early nutritional management. Preterm infants have special nutrition needs that will greatly affect their future growth and development, as well as their eventual health status as adults.

5) Understanding nutrition-related behaviors

Drivers of food choice..

Understanding the link between behavior and food choices can help tackle obesity and other nutrition-related issues that are a public health priority. Individual food choices can be influenced by a number of different drivers including the following:

• Government policy
• Environmental cues
• Cultural differences
• Communication tools, such as social networking and food marketing

Research is needed to identify the impact of these various drivers and understand how they work alone or together to influence nutrition-related behavior. Research will show how these drivers should be altered to have the highest positive influence on individual behavior and therefore public health. For example, the state of Mississippi recorded a 13% decline in obesity among elementary school students from 2005 to 2011 ( 6 ). Multiple changes in the environment occurred, such as the setting of standards for foods sold in school vending machines, setting a requirement for more school exercise time, mandating healthier environments in childcare settings, and establishing programs that encouraged fruit and vegetable consumption. The challenge now is to determine what effect these combined actions will have on obesity-related behaviors in the long run.

Nutrition and brain functioning.

Further explorations of the biochemical and behavioral bases for food choices and intake over time are essential. Brain function as it relates to food desire and choice needs to be clarified through research, and the multiple hormones that affect eating require further study as well. Factors such as meal frequency and size, speed of meal consumption, and how these factors are influenced by social cues require objective data, which can only be provided by research. Understanding how the marketing of healthy behaviors could help consumers achieve dietary guidance goals should be a priority. As part of this approach, innovative and practical methods for accurately measuring and evaluating food purchases and eating occasions must be developed.

Imprinting.

Because of the high propensity of obese children remaining obese as adults ( 7 ), additional research is needed to determine how eating and satiety behaviors are imprinted during critical periods of development and to show how food components affect neural biochemistry and brain functioning—and therefore shape behavior. This research will provide us with a better understanding of how and why an individual makes particular food choices. Although scientists recently validated the concept that food availability during pregnancy has permanent effects on gene expression in children ( 8 ), human studies are needed to confirm or refute the hypothesis that fetal programming, resulting from maternal obesity, leads to excess weight in children and into adulthood.

6) Understanding the food supply/environment

Food environment and food choice..

Simply knowing or understanding what constitutes a healthy diet is not enough to change an individual’s diet or lifestyle. Understanding how the food environment affects dietary and lifestyle choices is necessary before effective policies can be instituted that will change a population’s diet in a meaningful way. Examples of key questions that should be addressed include the following:

• Is current dietary guidance an effective way of communicating dietary change?
• Do food assistance programs promote positive dietary patterns or have negative dietary and health consequences?
• What role does food advertising play in food decision-making among different age groups and educational levels?
• How do farm-to-fork food systems, with an increased emphasis on local agricultural production and consumption, influence dietary patterns and behaviors?
• How can farm-to-fork food systems ultimately be used to promote healthy behaviors and improve public health?
• How can we most effectively measure, monitor, and evaluate dietary change?

Food composition and novel foods and food ingredients.

Having an affordable, available, sustainable, safe, and nutritious food supply is also an important underpinning for making significant changes to a population’s diet and lifestyle. Examples of key research areas to address include the following:

• Enhancing our knowledge of the nutrient and phytonutrient content and bioavailability of foods produced, processed, and consumed
• Studying how to better align and foster collaboration between nutrition and agricultural production
• Can shifting agricultural focus from principally agronomic to include quality factors (such as taste, flavor, and nutritional value) have positive effects on fruit and vegetable consumption?
• Can we leverage technologies, such as biotechnology and nanotechnology, to develop novel foods and food ingredients that will improve health, both domestically and abroad, and provide credible, tangible functional health benefits?

Public/private partnerships.

To tackle these enormous challenges requires the coordinated efforts of public and private partners. The development of public/private partnerships between food and agricultural industries, government, academia, and nongovernmental organizations has the potential to advance nutrition research, enabling meaningful changes to be made to American and global diets (e.g., increased fruit and vegetable consumption to match government recommendations). We need to examine successful examples of public/private partnerships that have resulted in improved nutritional status and food security in specific populations ( 9 ).

CROSS-CUTTING TOOLS TO ADVANCE NUTRITION RESEARCH

Nutrition research is truly a cross-cutting discipline, and the Working Group identified several tools that are also necessary to advance the priority needs in nutrition research. Adequately powered intervention trials continue to be essential for validating research theories arising from experimental and epidemiologic studies. However, the development of new, impactful tools will help us to more effectively quantify dietary intake and food waste and to determine the effectiveness of nutrition standards, such as DRI values and the Dietary Guidelines for Americans . Although not a traditional tool, multidisciplinary partnerships among scientific societies, government, industry, academia, and others are fundamental to advance the nutrition research agenda. ASN and its membership must be proactive not only in efforts to advance nutrition research (including initiating and leading partnerships) but also in developing the tools needed to enhance the field. ASN recognizes the need to facilitate effective communication among academia, industry, government agencies, consumers, and other stakeholders to advance nutrition.

Omics (especially genomics, proteomics, and metabolomics) will enable us to determine how specific nutrients interact with genes, proteins, and metabolites to predict the future health of an individual. A field of study that encompasses technological advances as well as omics-based research, it is sometimes referred to as personalized nutrition. Omics hold the keys to major nutrition breakthroughs in noncommunicable disease and obesity prevention. Omics provide information on how well nutrients are digested, absorbed, metabolized, and used by an individual. Moreover, omics will lead to new biomarkers that reveal a person’s nutritional status and health status all at one time.

2) Bioinformatics

Bioinformatics is an interdisciplinary field that uses computer science and information technology to develop and enhance techniques to make it easier to acquire, store, organize, retrieve, and use biological data. Bioinformatics will enable nutrition researchers to manage, analyze, and understand nutrition data and to make connections between diet and health that were not previously possible. Databases are necessary to gain the full benefits of bioinformatics, because they make nutrition data easily accessible in a machine-readable format.

3) Databases

Accurate, up-to-date food and nutrient databases are essential to track and observe trends related to the nutrition and health of individuals. Databases link food and supplement composition and intake data to health outcomes. Nutrient databases should be expanded to cover more foods and their bioactive components, including nonessential nutrients. Nutrition data must be incorporated into databases related to novel research areas, such as nutrigenomics and the microbiome, to adequately link these areas with nutrition. Data collection must also be improved with enhancements such as photographic food intake documentation, direct upload of food composition and sensory characteristics (if not proprietary) from food manufacturers, and biological sample collection.

4) Biomarkers

Intake, effect, and exposure biomarkers allow us to determine and monitor the health and nutritional status of individuals and subpopulations, including ethnic and racial minorities. Biomarkers that are responsive to diet and nutrition will help assess disease progression and variability in response to treatment, while improving early diagnosis and prevention. Biomarkers must continue to be developed and validated to accurately track food and nutrient intake given our rapidly changing food supply.

5) Cost-effectiveness analysis

Cost-effectiveness analysis is a tool used to calculate and compare the relative costs and benefits of nutrition research interventions. Cost effectiveness analysis helps to determine the most cost-effective option that will have the greatest benefit to public health.

CONCLUSIONS

The multidisciplinary nature of nutrition research requires collaboration among research scientists with differing areas of expertise, many different stakeholders, and multifaceted approaches to develop the knowledge base required for establishing the evidence-based nutrition guidance and policies that will lead to better health and well-being of world populations. Proper nutrition offers one of the most effective and least costly ways to decrease the burden of chronic and noncommunicable diseases and their risk factors, including obesity. Although there is skepticism about the ability to complete large, well-controlled dietary interventions at a reasonable cost in the United States, the success of the Lyon Diet Heart study in France ( 10 , 11 ) and the PREvención con DIeta MEDiterránea (PREDIMED) study in Spain ( 12 ), both of which used variations of the Mediterranean diet, show this approach can be successful, even in the presence of drug treatment of cardiovascular risks in the latter study. Both of these studies showed significant reductions in cardiovascular disease (and cancer in the Lyon study) after relatively modest dietary changes.

Perhaps the greatest barrier to advancing the connections between food and health is the variability in individual responses to diet; it is also the origin of public skepticism to acceptance of dietary advice and the opportunity for entrepreneurship in the private sector. Imagine being able to identify, with certainty, those most likely to benefit from prescriptive nutrition advice through the various omic technologies and then providing these groups of people with customized nutrition advice based on their metabolic risk profiles. This is the new frontier of the nutritional sciences that offers the opportunity to predictably engineer our physiologic networks for health through diet. The confidence this approach would bring to the skeptical consumer would improve adherence to weight management and disease treatment techniques and improve the chances of success for disease prevention. To realize the full positive impact of achieving good nutrition on disease prevention and the health of populations, we must have the will to invest in and support the 6 key areas of nutrition research that have been outlined above.

Acknowledgments

The Nutrition Research Needs Working Group consisted of Dennis Bier, David M Klurfeld, Zhaoping Li, Jonathan R Mein, John Milner, A Catharine Ross, Robert Russell (Chair), and Patrick Stover. They were supported by ASN staff members Sarah D. Ohlhorst and Emily Konopka.