Depression is a common mental disorder and a leading cause of global disease burden. Emerging evidence supports diet as an adjunct treatment for depression. Previous studies are limited, meaning it is unclear whether improvements are directly due to dietary change. The OPTIMISM trial aims to address this gap through a sham-controlled randomised feeding trial design.The OPTIMISM trial is a 4-week double-blind, sham-controlled, randomised feeding trial. A total of 44 participants with MDD in a current major depressive episode of moderate to severe severity will be recruited and randomised to a Mediterranean or a sham control diet, designed to reflect typical dietary intake of the general population. All food will be provided for four weeks. Participants will complete assessments and have blood and stool collected at baseline and four weeks. The primary outcome is the differential change in clinician-rated depressive severity at four weeks. Exploratory outcomes include patient-rated depressive and anxiety symptoms, and quality of life. Potential mechanisms will be evaluated through analysis of biological samples. An additional group of 22 healthy individuals without depression will also be recruited and will receive a Mediterranean diet for four weeks; their data will determine whether clinical and biological responses to the intervention are unique to depression and whether the diet treatment modulates depression-related pathology.If the intervention diet leads to a greater reduction in depressive symptoms compared with a sham control diet, this trial will provide preliminary evidence supporting the use of a Mediterranean diet in the treatment of depression.
The aim of this study was to investigate the predictive validity of a proposed revision of the Nutri-Score and the current Nutri-Score by investigating associations between the diet quality scores measured in mid-pregnancy and the risk of dispended prescription of medications for hypertension up to 11 years following delivery, and blood pressure mid-pregnancy. The study population (N=70,730) were participants in the Norwegian Mother, Father and Child Cohort Study. Food intake was assessed mid-pregnancy using a food frequency questionnaire. Nutritional scores for each food item were calculated based on content of energy, sugars, saturated fat, salt, fibre, protein, fruit, vegetables, and legumes. Diet quality scores were derived using energy-weighted means of nutritional scores. Anti-hypertensive medications were registered in the national prescription database. We estimated hazard ratios (HR) with 95% confidence intervals (95% CI) using Cox regression models. During a mean follow-up of 6 years, 4,736 (6.7%) women got dispended prescription of medications for hypertension. There was a non-linear association between diet quality and hypertension medication. Compared with the median diet quality score, poorer diet quality (90th percentile of the score) was associated with higher risk of medications for hypertension (HR=1.08, 95% CI 1.02-1.14) and cross-sectional high diastolic blood pressure (odds ratio=1.18, 95% CI 1.03-1.32). Both diet quality scores yielded similar results overall. Poorer diet quality during pregnancy, assessed with a proposed version, and the current Nutri-Score, were associated with a higher risk of medications for hypertension, indicating its usefulness as a valuable tool for guiding consumers and improving public health.
Black African women face disproportionately high rates of obesity, with prevalence reaching 37% in the UK. These elevated rates significantly contribute to chronic non-communicable disease burdens, yet comprehensive dietary data for this group in the UK remain limited. Accurate dietary assessment is essential for identifying nutritional risks and guiding interventions, especially in ethnically diverse populations. Standard tools, including the EPIC food frequency questionnaire (FFQ), often lack cultural specificity and have not been adapted or validated for Black African populations in the UK. This study aimed to modify and validate a culturally tailored EPIC FFQ for dietary assessment among Black African adults in the UK. A cross-sectional study with 112 Black African women (BMI >25 kg/m2) was conducted. The EPIC FFQ was adapted by including culturally relevant African foods, identified via literature review and three non-consecutive 24-hour recalls using Intake24. Participants completed the modified FFQ, and nutrient intakes from both methods were compared using correlation analyses, adjusted for within-person variation. Bland-Altman plots and energy-adjusted correlations assessed agreement. The modified FFQ expanded to 141 food items and showed significant correlations with 24-hour recalls for various nutrients. Crude correlation coefficients ranged from 0.21 (fibre) to 0.87 (protein); energy-adjusted values ranged from 0.19 to 0.86. De-attenuated correlations improved further. Bland-Altman plots showed systematic overestimation of intake, particularly protein and fibre, but good overall agreement. The adapted EPIC FFQ is a valid tool for dietary assessment in Black African adults, though overestimation occurred. Further validation using dietary biomarkers is recommended.
This study aimed to examine infant feeding practices and associated factors among infants affected by the great earthquakes in Türkiye. This descriptive, cross-sectional study included mothers of infants aged 4-12 months who experienced earthquakes in Kahramanmaraş, Kilis, Diyarbakır, Adana, Osmaniye, Gaziantep, Şanlıurfa, Adıyaman, Malatya and Hatay and who were residing in Hatay at the time of data collection. A total of 396 mothers participated in the study. All participants voluntarily completed the Family Introduction Form and the Complementary Feeding Transition Questionnaire. Data were analysed using descriptive statistics and χ2 tests. Among the infants, 50 % were aged between 10 and 12 months and 61·6 % were male. 50·8 % did not continue breast-feeding after the earthquake, 59·6 % of infants under one year were not breastfed, and only 19·2 % were exclusively breastfed for the first six months. Additionally, 58·3 % of the infants began complementary feeding before six months of age, and 49·5 % initiated complementary feeding with jarred baby food. A statistically significant difference was observed among the number of relocations, first-degree loss due to the earthquake and continuation of breast-feeding (P = 0·016 and P < 0·001, respectively). Mothers ceased breast-feeding after the earthquake and experienced a decline in milk supply; both relocation and the loss of a relative were found to adversely affect infant nutrition. To support optimal infant feeding, it is recommended that mothers be provided with comprehensive education and counselling on breast-feeding and transition to complementary foods.
This study aimed to investigate the association between the timing and quality of the last meal and sleep quality among Iranian adults. In this cross-sectional study, healthy Iranian adults were included. Dietary intake and meal timing were assessed using three non-consecutive 24-h dietary recalls to calculate the interval between the last meal and bedtime. Dinner quality was evaluated using the NRF9·3 index, and sleep quality was measured using the Pittsburgh Sleep Quality Index. Multivariable logistic and ordinal regressions assessed associations of meal timing and dinner quality with sleep outcomes, adjusting for confounders. The study included 450 adults (mean age: 38·1 (sd 9·7) years), of whom 55·8 % had good sleep quality. The mean interval between the last meal and sleep was 2·38 (sd 1·08) h. A longer interval between the last meal and bedtime was associated with higher odds of poor global sleep quality (OR = 2·03, 95 % CI: 1·24, 3·32; P = 0·005). Longer intervals were significantly associated with better subjective sleep quality, shorter sleep latency, longer sleep duration and higher habitual sleep efficiency. Dinner quality demonstrated a mixed pattern of association with sleep quality, showing higher odds of poor sleep in the second tertile (OR = 1·66, 95 % CI: 1·01, 2·73), whereas this association was not observed in the highest tertile (OR = 1·24, 95 % CI: 0·75, 2·04). In conclusion, longer dinner-to-bedtime intervals may improve specific sleep quality aspects, though results remain inconsistent. Further research is essential to clarify these associations and determine optimal meal timing.
The Healthy Eating Index (HEI) is widely used to assess diet quality, but certain contexts (e.g. pregnancy) may benefit from tailored versions. We evaluated whether the HEI's current approach of assigning approximately equal weights to all components to compute the total score is appropriate when studying diet quality around conception. Data were from a US prospective cohort of individuals who had not delivered a previous pregnancy past 20 weeks' gestation (2010-2013, n 7882). Usual dietary intake around conception was estimated from FFQ. Select adverse pregnancy outcomes (gestational diabetes, pre-eclampsia, preterm delivery and small-for-gestational age birth) were abstracted from the medical record. We regressed each outcome on the thirteen HEI-2015 component scores using SuperLearner, an ensemble machine learning method that combines predictions from multiple algorithms and avoids relying on parametric assumptions that characterise standard regression. We assessed the relative importance of each component using two permutation-based metrics: change in negative log likelihood (global influence) and absolute difference in the predicted probabilities (individual-level influence). Six of the thirteen components (Greens and Beans, Saturated Fats, Total Protein Foods, Seafood and Plant Proteins, Fatty Acids and Added Sugars) were important according to at least one metric for at least two of the four outcomes. In contrast, the Refined Grains component was not appreciably important for any outcome. These findings suggest that equal weighting of the HEI components may not be appropriate when evaluating diet quality for studies of pregnancy.
Understanding children's diet quality is crucial for developing effective interventions to address dietary-related issues. Thus, this study examines the distribution of energy and nutrient intakes across meals and snacks among primary schoolchildren aged 6·0-12·9 years in Peninsular Malaysia and the implications of meal skipping on their nutritional status. Data from 1102 children in Peninsular Malaysia from the South East Asian Nutrition Surveys (SEANUTS) II were analysed. Children's height, weight and waist circumference were measured. Questionnaires captured sociodemographic information and meal consumption patterns. Nutrient distribution across meals and snacks was assessed through a 1-d 24-h dietary recall approach. Logistic regression analysed the association between meal skipping and nutritional status. Breakfast contributed significantly to essential micronutrients but provided the least energy and macronutrients compared with lunch and dinner. Approximately one-third of daily nutrient intake came from snacking, with contributions ranging from 25 % for cobalamin to 36 % for both Ca and thiamine. Children who skipped main meals had higher odds of being overweight/obese (skipped one type of meal at least once weekly (1·59; 95 % CI (1·08, 2·33)); skipped > 1 type of meal (1·77; 95 % CI (1·12, 2·79)) and abdominal obese (skipped > 1 type of meal (1·91; 95 % CI (1·17, 3·12))). In conclusion, primary schoolchildren in Peninsular Malaysia tended to have higher micronutrient intakes at breakfast and higher energy and macronutrients in subsequent main meals. Meal skipping was linked to elevated body fat. This study underscores the need to prioritise continued education on the importance of healthy dietary habits among children.
Flavanones represent a significant subgroup of flavonoids and offer various advantages for the human body, such as aiding in metabolic regulation and providing antioxidant properties. The objective of this research was to investigate the relationship between dietary flavanones and the prevalence of kidney stones among adults in the USA. Flavanones, including eriodictyol, hesperetin and naringenin, were sourced from the National Health and Nutrition Examination Survey (NHANES) conducted between 2007-2010 and 2017-2018, utilising two 24-h dietary recall interviews. The definition of kidney stones was established through a self-administered questionnaire. To evaluate the relationships between dietary flavanones and kidney stones, a variety of statistical methods were utilised, such as multivariable regression analysis, restricted cubic splines (RCS) and subgroup analysis. Data from 9790 participants were included in this analysis, with 9·67 % of them indicating that they had experienced kidney stones. After adjusting for potential confounding factors, it was found that kidney stones exhibited a negative correlation with total flavanones and naringenin, with OR of 0·96 (95 % CI 0·93, 1·00) and 0·89 (95 % CI 0·80, 0·99) for the highest intake group compared with the lowest intake group. The RCS plot revealed a notable negative linear association between the consumption levels of total dietary flavanones and the risk of kidney stones, including naringenin. The results of the subgroup analysis indicated that no significant interactions were observed in each subgroup. Our research indicated that a higher intake of flavanones correlates with a lowered prevalence of kidney stones in adults.
Low protein intake is prevalent in people with CHD and is inadequately addressed in UK-based cardiac rehabilitation. This pilot feasibility study aimed to identify whether targeted education increases protein intake in patients with CHD and low protein intake, compared with standard cardiac rehabilitation dietary education. People referred to cardiac rehabilitation with CHD (≥ 50 years) underwent anthropometric assessment and completed a food diary, sit-to-stand test and three questionnaires (physical activity, sarcopenia screening and nutrition knowledge). Participants with low protein intake (≤ 1·2 g/kg per d) were randomised to receive either extra protein education (intervention; protein group) or standard education (control; control group), embedded within their usual 6-week cardiac rehabilitation programme. At 6 and 12 weeks, outcome measures were repeated; thirty-four participants provided baseline data. Protein intake was inversely associated with waist circumference (r = -0·348). Twenty-seven participants (79 %) with low protein intake were randomised to the protein group (n 15) or control group (n 12). At week 6, the median (interquartile range) change in protein intake was 0·0 (-0·0-0·3) and 0·4 (0·2-0·5) g/kg per d in the protein group and control group, respectively (effect size 0·5). At week 12, the change in protein intake was 0·0 (-0·0-0·1) and -0·0 (-0·2-0·2) g/kg per d in the protein group and control group, respectively (effect size 0·3). Effect sizes for all other variables were ≤ 0·4. The intervention appeared well-received by those who completed the study; however, changes to primary and secondary outcomes were minimal. Uptake of the study was low, and attrition was high, limiting the interpretation of efficacy and the implementation of a definitive trial.
The aim is to examine the relationship between factors thought to potentially influence weight gain, such as sustainable nutrition (SN) behaviour and plate-clearing tendency (PCT) during pregnancy and gestational weight gain (GWG). This cross-sectional correlational study was conducted on 340 women in the last trimester of pregnancy. Study data were collected through face-to-face interviews using a questionnaire form between October and December 2024. PCT is lower among younger women, those with low income and those with insufficient GWG (P < 0·05). SN behaviours are higher in those who are older, have higher education levels, have lower income and have moderate physical activity (P < 0·05). A negative correlation was found between food preference, a component of SN behaviours, and GWG (P < 0·05). In the binary logistic regression model, higher pre-pregnancy BMI significantly increased the likelihood of excessive GWG (OR = 1·49, 95 % CI 1·332, 1·665, P < 0·001), whereas high physical activity was found to be protective against excessive GWG (OR = 0·214, 95 % CI 0·061, 0·747, P = 0·016). It was determined that pre-pregnancy BMI was higher and physical activity was lower in those with excessive GWG; in addition, food preference, one of the factors of SN behaviour, affected weight gain. Food preference can be considered as a factor that may affect GWG.
Plasma levels of procollagen type 1 N-propeptide (P1NP) and C-terminal telopeptide of type 1 collagen (CTX) are bone turnover markers (BTM) used to predict risk of fracture. We compared the effects of vitamin D supplements on plasma levels of P1NP and CTX in the Biochemical Efficacy and Safety Trial of vitamin D (BEST-D) trial (305 participants) after treatment with 2000 IU/d or 4000 IU/d vitamin D3 or placebo. The results of BEST-D were combined in a meta-analysis of all trials of vitamin D v. placebo on levels of P1NP (12 trials, 2654 participants) or CTX (16 trials, 2695 participants). In BEST-D, allocation to vitamin D3 resulted in a dose-dependent increase in 25-hydroxy-vitamin D (25(OH)D) levels but had no effects on P1NP or CTX. Geometric mean (se) levels at 12 months were similar for P1NP (41·7 (0·7) v. 42·9 (1·0) ng/ml; P = 0·29: either dose v. placebo) and likewise for CTX (0·23 (0·01) v. 0·23 (0·01) ng/ml; P = 0·98). In a meta-analysis of eighteen trials, the average difference between the within-trial change in P1NP for allocated vitamin D and control was -3·3 % (95 % CI -5·6, -1·0, P < 0·005). For CTX, this difference was slightly greater (-3·8 % (-6·8, -0·8); P = 0·01). There was no significant heterogeneity between these trials after stratifying trials with or without Ca, higher or lower doses of vitamin D, or lower v. higher pre-treatment levels of 25(OH)D. Overall, vitamin D supplementation was associated with modest reductions in both P1NP and CTX, and results provide support for further trials of vitamin D for prevention of fracture in older people.
Using National Health and Nutrition Examination Survey data (2011-2020), we assessed the association between the nutritional risk index (NRI) and stroke risk among 22 839 adults (mean age, 49·61 (sd 17·07) years), including 910 individuals (3·98 %) with stroke. Weighted multivariable logistic regression and restricted cubic spline (RCS) analysis were used to characterise the association, with subgroup analyses to examine consistency across populations and mediation analyses to investigate the roles of lipid and inflammatory biomarkers. Higher continuous NRI was inversely associated with stroke, with each 1-unit increase associated with 4 % lower odds (OR = 0·96, 95 % CI: 0·95, 0·97), and participants in the highest NRI quartile (Q4) had a significantly lower stroke risk than those in the lowest NRI quartile (Q1) (OR 0·60, 95 % CI 0·42, 0·85). RCS analysis indicated a linear relationship (P for nonlinearity > 0·05), and the protective effect of higher NRI remained robust across nearly all subgroups examined. Mediation analyses revealed that total cholesterol, systemic immune-inflammation index, product of platelet and neutrophil count, neutrophil:lymphocyte ratio and lymphocyte:monocyte ratio each partially mediated the NRI-stroke association, with mediation effects ranging from 1·71 % to 13·65 %. These findings suggest that favourable nutritional status, reflected by higher NRI, is linked to lower stroke risk, with lipid metabolism and inflammation playing mediating roles in this association. Further longitudinal and mechanistic studies are warranted.
Asparagus (Asparagus officinalis) contains bioactive compounds such as polyphenols and saponins, which have been shown to influence cognition, mood, sleep, stress, and related biomarkers. However, the evidence from human studies has not been systematically synthesised. To address this, we conducted a systematic review evaluating the effects of asparagus-based products on cognitive, affective, sleep outcomes, and related biomarkers in adults. A systematic search of PubMed, Scopus, Web of Science, PsycINFO, Google Scholar, and Amino Up Ltd's website (up to April 2025) identified studies assessing asparagus supplementation in adults, following PRISMA guidelines (PROSPERO registration number: CRD42025636834). Human studies that employed randomised controlled trials (RCTs) or quasi-experimental designs and assessed the effects of orally administered asparagus-based products on cognition, mood, sleep, or relevant biomarkers were included. Eighteen studies (thirteen RCTs and three pre-post studies; 503 participants) were included. Cognitive improvements were observed in reaction time, accuracy, and mental fatigue, while mood and stress-related outcomes showed reductions in anxiety and depressive symptoms. Sleep outcomes consistently demonstrated improvements in sleep quality and duration, while biomarker data showed effects on cortisol levels. Asparagus supplementation may offer modest benefits for cognition, mood, and stress-related physiology, with particularly consistent effects on sleep quality. However, the magnitude of benefits varies by population, dose, and duration, and the heterogeneity of interventions, small sample sizes, and limited studies may constrain the generalizability of findings. Well-powered, long-term clinical trials are needed to determine optimal dosage, clarify mechanisms, and assess efficacy across diverse populations.
This study aimed to develop an amino acid composition table for Japanese foods and evaluate the relative validity of the Meal-based Diet History Questionnaire (MDHQ) in estimating total and meal-specific amino acid intake, using a 4-d weighed dietary record (DR) as the reference. A total of 111 Japanese women and 111 Japanese men completed both online and paper MDHQ, along with a 4-d non-consecutive DR. The amino acid composition table was constructed based on the Standard Tables of Food Composition in Japan 2020. Median amino acid intakes estimated by the online MDHQ were generally lower than those from the DR across all calculation methods (crude, residual, density and %protein) in both sexes, with significant differences observed for most of the eighteen amino acids. Median Spearman's correlation coefficients between the online MDHQ and DR for total amino acid intake were 0·43-0·44 in women and 0·31-0·37 in men. Concordance correlation coefficients (CCC) were lower than the corresponding Spearman coefficients, and Bland-Altman analyses showed wide limits of agreement with proportional bias. Similar findings were observed for the paper MDHQ. In conclusion, the MDHQ showed limited relative validity for ranking total and individual amino acid intakes at main meals, with weaker performance for snacks and limited ability to estimate absolute individual intakes. Despite these limitations, the MDHQ provides a novel approach for examining meal-specific dietary patterns and may offer useful insights in epidemiological studies when its limitations are appropriately considered.
Metabolic disorders, as a global burden, have a detrimental effect on individuals' health status, regardless of their weight. We aimed to assess the link between diet-related behaviors and metabolic health status as well as serum levels of adropin and brain-derived neurotrophic factor (BDNF). A cross-sectional investigation involving 527 adults with ages of 20 and 65 years was carried out in Isfahan, Iran. Using a pre-tested questionnaire, dietary habits were assessed in five domains including meal pattern, eating rate, meal-to-sleep interval, intra-meal fluid intake, and fatty food intake. To identify these dietary behaviors, latent class analysis was performed. Based on the lipid and glycemic profile, inflammation status, and insulin resistance (IR), participants were classified as having either metabolically healthy (MH) or metabolically unhealthy (MU) status. Serum concentrations of BDNF and adropin were evaluated by obtaining a blood sample from participants after an overnight fast. Metabolic unhealthy normal-weight and overweight/obese status were respectively prevalent in 8.7% and 33.8% of study population. We recognized three distinct eating rate classes: 'moderate', 'fast', and 'slow'; two major meal pattern classes: 'regular' and 'irregular'; two main meal-to-sleep interval classes: 'short' and 'long'; two intra-meal fluid intake classes: 'moderate' and 'more'; and two major fatty food intake classes: 'high' and 'low'. After controlling for potential confounders, slow eating rate was related to lower odds of MU profile (OR=0.39, 95% CI: 0.17-0.91). Moreover, fast eating rate was positively associated with hyperglycemia (OR=3.55, 95% CI: 1.48-8.51). More intra-meal fluid intake was also associated with higher chance of MU profile (OR=2.21, 95% CI: 1.35-3.63), high HOMA-IR (OR=2.20, 95% CI: 1.06-4.58), hypertriglyceridemia (OR=2.23, 95% CI: 1.36-3.65), and hypertension (OR=1.66, 95% CI: 1.03-2.69). Serum BDNF or adropin was not associated with classes of diet-related habits. More intra-meal fluid intake was linked to higher chance of having MU profile, while slow eating rate was related to decreased odds of MU profile among Iranian adults.
We examined differences in characteristics between dietary supplement (DS) users and non-users in three age groups of Japanese women, including younger women (dietetic students), middle-aged women (their mothers) and older women (their grandmothers). In total, 3952 younger women (aged 18 years), 3780 middle-aged women (aged 34-60 years) and 2192 older women (aged 61-94 years) participated in this cross-sectional study in 2011 and 2012. DS use and other characteristics were self-reported using a questionnaire, and dietary intake from foods was assessed using a validated, self-administered diet history questionnaire. DS users were defined as participants who reported using DS at least once in the past month. We calculated the percentage of participants with nutrient intakes below the estimated average requirement (EAR) from the Japanese Dietary Reference Intakes. The proportion of DS users was 5·7 % in younger women, 24·3 % in middle-aged women and 27·7 % in older women. In younger and older women, DS users were more likely to live in a city with a population of ≥1 million. In middle-aged women, DS users were more likely to have an education level of more than high school or to be former smokers. In older women, DS users tended to have shorter sleep duration. Among the 15 nutrients examined, DS users were less likely to have intake levels below the EAR for 10 nutrients in younger women, 9 nutrients in middle-aged women and 4 nutrients in older women. Some characteristics of Japanese female DS users differed from non-users depending on the age group.
Mobility limitations due to chronic musculoskeletal pain are a major contributor to disability in older adults, yet current pharmacological treatments often have limited efficacy and increase the risk of polypharmacy. Omega (ω)-3 PUFA, particularly EPA and DHA, have demonstrated anti-inflammatory and analgesic properties, but are under-consumed among older USA adults. Krill oil, a marine-derived source of EPA and DHA with enhanced bioavailability compared with typical fish oils and additional bioactive compounds such as astaxanthin and choline, may offer a promising nutritional intervention. This pilot study will assess the feasibility and acceptability of a 3-month randomised, double-blind, placebo-controlled trial of krill oil supplementation (4 g/d: 1288 mg EPA + DHA, 0·45 mg astaxanthin, 320 mg choline) v. placebo (mixed vegetable oils) in forty community-dwelling adults aged ≥ 60 years with chronic musculoskeletal pain. Primary outcomes include feasibility (recruitment, retention and adherence) and acceptability (participant satisfaction). Secondary outcomes include changes in the omega-3 index, ω-6/ω-3 ratio and inflammation (high-sensitivity C-reactive protein), as well as exploratory changes in pain intensity and functional interference, and physical function (Short Physical Performance Battery, 6-Minute Walk Test). Findings will inform the design of future fully powered trials that may ultimately contribute to the evidence for omega-3 supplementation as a non-pharmacological strategy to support healthy aging and functional independence in older adults.
The Mediterranean diet has emerged as a promising dietary pattern for preventing non-alcoholic fatty liver disease (NAFLD). This study aimed to examine the role of the Mediterranean diet on the risk of NAFLD in Turkish adults. A total of 252 individuals (126 NAFLD and 126 age- and sex-matched controls) participated in this case-control study. Dietary intake was assessed with a 24-h recall, and adherence to the Mediterranean diet was evaluated using the Mediterranean Diet Adherence Screener (MEDAS). Logistic regression models were applied to estimate OR. The prevalence of NAFLD was higher in the lowest tertile (64·6 %) and lower in the highest tertile (30·5 %; P < 0·001). Moderate adherence to the Mediterranean diet was associated with a 57·0 % lower risk of NAFLD after adjusting for age, sex, BMI and energy intake. High adherence conferred an 86·0 % reduction after adjusting for age, sex, BMI, energy intake and co-morbidities. Frequent consumption of butter, margarine, cream (OR = 2·75; 95 % CI 1·72, 6·43) and sugar-sweetened beverages (OR = 2·87; 95 % CI 1·20, 6·87) significantly increased the risk. However, consuming nuts three or more servings per week was protective (OR = 0·46; 95 % CI 0·21, 0·99). In individuals who did not consume ≥ 3 servings of fruit daily, the risk of NAFLD was significantly reduced (OR = 0·28; 95 % CI 0·16, 0·69). Adherence to the Mediterranean diet was strongly associated with a reduced risk of NAFLD, highlighting the importance of limiting saturated fats and sugar-sweetened beverages while promoting nuts as practical strategies for prevention.
Elevated LDL-cholesterol concentration is a major risk factor for CVD. Regular consumption of marine fish and seafood is associated with a reduced risk of CVD, although the n-3 PUFAs EPA and DHA have no cholesterol-lowering effect when given in physiologically relevant doses. Recent studies have demonstrated a lower LDL-cholesterol concentration in rodents after intake of cetoleic acid (CA, C22:1n-11), found in pelagic fish species such as herring. The primary aim was to investigate the effect of consuming capsules containing CA on LDL-cholesterol concentration in adults with overweight or obesity. The study was designed as a randomised clinical trial with two arms. Eighty participants were enrolled, and data from 75 participants were included in the statistical analyses. Participants consumed capsules containing either a CA concentrate (CECO group; 1480 mg CA and 232 mg EPA per day) or soyabean oil mixed with an n-3 PUFA concentrate without CA as comparator arm (SOYO3 group; 258 mg EPA/d) for 8 weeks. The within-group changes in LDL-cholesterol were compared using ANCOVA with changes in body fat percentage as covariate. The LDL-cholesterol concentration was decreased from baseline to 8 weeks in the CECO group (n 37, median -0·1 (quartiles -0·1, 0·0) mmol/l) in comparison to the SOYO3 group (n 38, median 0·2 (quartiles 0·1, 0·2) mmol/l), with F = 19·35, P = 0·033 and ηp2 = 0·212, corresponding to a 7 % reduction in the CECO group relative to the SOYO3 group. To conclude, 8 weeks of dietary supplementation with CECO decreased the LDL-cholesterol concentration in adults with overweight or obesity.
This study evaluated the psychometric properties of the Turkish version of the Comprehensive Emotional Eating Scale (CEES) and examined its associations with emotion regulation, cognitive control, cognitive flexibility and perceived stress in adults. A cross-sectional design was conducted with 1521 adults aged 18-74 years (68 % female). The CEES was adapted following standard cross-cultural guidelines, including translation, back-translation and approval by the original scale developer. Participants also completed the Emotional Appetite Questionnaire (EMAQ), Difficulties in Emotion Regulation Scale, Cognitive Control and Flexibility Questionnaire and Perceived Stress Scale. Confirmatory factor analysis (CFA) assessed construct validity, while internal consistency, convergent validity and multiple linear regression analyses explored predictors of emotional eating. CFA supported a four-factor structure representing Undereating - Positive Emotions, Undereating - Negative Emotions, Overeating - Positive Emotions and Overeating - Negative Emotions, with item loadings of 0·48-0·77; one item was removed due to low loading. Internal consistency was high (α = 0·88-0·91), and convergent validity was confirmed via EMAQ correlations. Multiple regression analyses indicated that greater difficulties in emotion regulation, higher perceived stress, lower cognitive control and flexibility, smoking, higher BMI and chronic disease significantly increased emotional eating. Women showed higher Undereating - Negative Emotion and total emotional eating scores, while smoking, higher BMI and chronic disease elevated scores on specific subscales. The Turkish CEES demonstrates robust psychometric properties and reliably captures multidimensional emotional eating in adults. Psychological and demographic factors increase emotional eating subscales and total scores, supporting the scale's use in research and clinical settings in Türkiye.