The role of n-6 PUFA, especially linoleic acid (LA), in adiposity remains contested. While clinical interventions suggest improved body composition with higher LA intake, observational evidence using dietary data is inconsistent, and few studies consider circulating fatty acids or longitudinal changes in adiposity. Using multivariable linear models, we evaluated cross-sectional and longitudinal associations between n-6 PUFA and waist circumference (WC), weight and whole-body fat mass (FM) in the UK Biobank Cohort. Cross-sectionally (n 272 587, 54 % female, mean age 57 years), higher circulating LA was inversely associated with WC, weight and FM. Participants in the highest v. lowest quintile of LA had significantly smaller WC (–11·04 (–11·17, –10·91) cm), lower weight (–11·77 (–11·92, –11·62) kg) and lower FM (–7·87 (–7·97, –7·77) kg). Associations for total n-6 were generally consistent with those for LA. Conversely, non-LA n-6 was positively associated with WC (1·46 (1·32, 1·61) cm), weight (2·41 (2·25, 2·58) kg) and FM (1·81 (1·69, 1·92) kg). Longitudinal analyses (n 58 335, 51 % female, mean age 55 years) largely corroborate these patterns, with annual changes in WC, weight and FM inversely associated with LA and positively associated with non-LA n-6. Higher circulating LA, but not non-LA n-6, was associated with lower WC, weight and FM both cross-sectionally and longitudinally. Our findings potentially support dietary recommendations to promote LA-rich oils. Divergent associations between LA and non-LA n-6 caution against treating n-6 PUFA as a homogeneous group. Examining the distinct health effects of individual non-LA n-6 is warranted.

Diet is key for a healthy lifestyle, yet evidence on how diet quality affects body composition and cardiometabolic health during pregnancy is insufficient. The aims of this study were to examine associations of diet quality (Swedish Healthy Eating Index (SHEI)) with body composition, cardiometabolic health in early and late pregnancy (gestational weeks 14 and 37) and gestational weight gain (GWG). This observational study used cross-sectional and prospective data from the HealthyMoms trial at two timepoints: early (n 302) and late pregnancy (n 134). Exposure was diet quality (SHEI) assessed through online 24 h recalls, and outcomes included body composition (body fatness, BMI, fat mass index (FMI)), cardiometabolic health (homeostatic model assessment for insulin resistance (HOMA-IR), metabolic syndrome (MetS) score, glycaemia) and GWG. Linear regression was used to investigate associations between SHEI and outcomes. In the cross-sectional analyses, higher SHEI was associated with lower body fatness, BMI, FMI and MetS score in early pregnancy (all B ≤ −0·14, all P ≤ 0·02). Similar results were seen in late pregnancy, with the addition of an association with HOMA-IR (all B ≤ −0·20, all P ≤ 0·008). Prospectively, higher SHEI in early pregnancy was associated with lower body fatness, BMI, FMI, glycaemia, HOMA-IR and MetS score in late pregnancy (all B ≤ −0·09, all P ≤ 0·01). There were no statistically significant associations of change in SHEI with GWG or other outcomes (P ≥ 0·09). In conclusion, a healthy diet, especially in early pregnancy, seems beneficial for body composition and cardiometabolic health. Focusing on key dietary advice, as captured by SHEI, may be advantageous and feasible within maternity care.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading chronic liver disease worldwide. While total SFA intake has been linked to MASLD, the contribution of specific SFA and the mechanism underlying the SFA-MASLD association remain unclear. This study evaluated the associations of individual SFA with MASLD and the mediating roles of insulin resistance (IR) and serum albumin. We used data from seven National Health and Nutrition Examination Survey (NHANES) cycles (2005–2018) in a cross-sectional analysis. Associations between individual SFA and MASLD were estimated via logistic regression with restricted cubic splines (RCS). Weighted quantile sum (WQS) and quantile g-computation (QGC) models assessed the mixture associations. Mediation analysis evaluated the proportions of these associations accounted for by serum albumin and IR. Compared with the reference group, the highest tertile of intake was associated with increased odds of MASLD for C4:0 (OR = 1·12, 95 % CI 1·01, 1·25), C6:0 (OR = 1·15, 95 % CI 1·04, 1·28), C14:0 (OR = 1·20, 95 % CI 1·08, 1·33), C16:0 (OR = 1·24, 95 % CI 1·12, 1·38) and C18:0 (OR = 1·25, 95 % CI 1·12, 1·39). RCS models revealed largely linear dose–response relationships. Both WQS and QGC indicated a positive joint association of SFA with MASLD, with C16:0 identified as a major contributor. Among SFA significantly associated with MASLD, IR accounted for 30·0–47·4 % of the associations, while serum albumin accounted for 5·9–8·0 %. Higher intakes of short- and long-chain SFA, both individually and collectively, are associated with higher odds of MASLD. IR and serum albumin may partially explain these associations. These findings support the development of precision dietary strategies targeting specific SFA for MASLD prevention.

Jaboticaba, Plinia cauliflora [Mart.] Kausel (Myrtaceae) is a native Brazilian fruit high in bioactive compounds with potent antioxidant and anti-inflammatory properties. We present the first protocol (randomised crossover with a washout period) for a clinical trial investigating the effects of consuming jaboticaba peel extract on inflammation, oxidative stress and gut dysbiosis in patients with chronic kidney disease (CKD) undergoing haemodialysis. Thirty eligible patients will be randomly assigned to the intervention group (3·3 g/d of jaboticaba peel extract, providing 650 mg/d of phenolic compounds) or to the placebo group (corn starch). The total daily dose will be administered as four capsules, divided into two doses per day, for 2 months. Following the washout period (2 months), patients will continue the supplementation in a crossover design for the same duration. Blood and fecal samples, food intake data and anthropometric measurements will be evaluated. Inflammatory markers and antioxidant enzymes will be assessed using real-time protein chain reaction, cytokine plasma levels will be measured by Luminex, and uremic toxin plasma levels will be analysed using high-performance LC. The fecal microbiome will be evaluated through high-throughput sequencing of the 16S rRNA gene amplicons. Conducting a rigorously designed trial using jaboticaba will provide essential information and generate new evidence to support nutritional strategies that utilise typical Brazilian fruits for patients with CKD.

Evidence-based diet quality screeners that can be completed within a few minutes are suitable tools for evaluating diet quality in time-limited settings; however, no such tool has yet been developed in Japan. This study aimed to develop a screener to assess adherence to the Diet Quality Score for Japanese (DQSJ) and to describe its development process. The DQSJ is a 10-component index that was previously developed. The present study developed questions and assigned scores based on dietary data analysis and evidence on diet-health associations. Dietary data from 392 Japanese adults were analysed to identify the intake of food groups in the DQSJ. The mean intakes of 4-non-consecutive-day dietary records were described for each food group across the consumption frequencies in dietary questionnaires. Questions about sodium intake were derived from a sodium screener. Consequently, the DQSJ screener comprised 12 questions: two for red and processed meat, two for sodium and one for each of the other eight food groups (fruits, vegetables, whole grains, nuts, legumes, dairy, fish and sugar-sweetened beverages). The screener asked about the number of servings consumed for vegetables, dairy and sugar-sweetened beverages and the consumption frequencies for the other food groups. The maximum scores were assigned with consideration of optimal and feasible consumption for health outcomes. The total DQSJ was calculated by summing all item scores, resulting in a range of 0–30. The DQSJ screener has the potential to facilitate the assessment of diet quality in time-limited settings in Japan; the next step is to examine its validity.

Optimal nutrition is essential for reducing both all-cause and CVD mortality. Existing research highlights the importance of macronutrient type and quality in this context, with limited evidence in non-Western populations. We aimed to determine the association between macronutrient distribution and all-cause and CVD mortality in an African population as well as the contribution of the respective food sources. This cohort consisted of 1737 African men and women with a median observational time of 13 years, resulting in 19 456·6 person-years. CVD-related international classification for diseases, 10th revision (ICD-10) codes (I00–I99) were included when considering CVD mortality. Substitution analysis using partition and nutrient-density models assessed the relationship between macronutrient distribution and mortality. Higher intakes of complex carbohydrates (CHO), animal protein, total fat and MUFA were associated with decreased all-cause mortality risk. The partition model also revealed that substituting 200 calories (kcal) of plant protein with animal protein significantly reduced all-cause mortality risk by 39 % to 33 % (model 1–3). In addition, the isoenergetic substitution of 10 % total energy from total fat with total CHO led to a 17 % reduction in all-cause mortality risk (hazard ratio (HR) 0·83; 95 % CI 0·72, 0·96). No significant associations with CVD mortality were found. These findings partially agree with, yet also oppose, previous studies, emphasising the need for population-specific data. Research from high-income European populations may not directly apply to African contexts due to food insecurity, reliance on staple-based diets with low-quality plant proteins and lean, higher-quality animal protein sources, as well as differences in CVD disease aetiology.

Optimising nutrition during lactation is critical for the mother and infant. The relationship between fermented food consumption and the mother’s gut microbiota and nutritional and inflammation status is unknown. Mageu is a fermented grain commonly consumed in Southern Africa. We randomised South African mothers to consume a live-culture mageu, pasteurised store-bought mageu or no mageu from 4 to 10 weeks postpartum. Clinical and dietary data, stool microbiota and nutritional and inflammatory biomarkers were assessed until week 15. Plant protein intake was higher among mageu users than non-users. Live-culture mageu increased gut α-diversity from weeks 4 to 10. Circulating ferritin was lower among live-culture mageu users at week 10 compared with non-users. In systems analyses, mageu intake was associated with distinct bacterial, inflammatory and nutritional signatures, primarily driven by interleukin (IL)-6, ferritin, soluble transferrin receptor and Eubacterium hallii. These results suggest that mageu has benefits for lactating mothers’ gut health and, therefore, possibly their infants.

This study investigated the relationships of total dietary grain fibre (TGF) and its two subtypes (whole-grain fibre (WGF) and refined grain fibre (RGF)) with essential hypertension (EHP) in a large-scale prospective cohort study. The participants were recruited by UK Biobank. Dietary grain fibre was assessed using the baseline touchscreen FFQ. New-onset EHP was defined by International Classification of Disease version 10. Cox proportional hazards model and restricted cubic spline analysis were utilised to examine the associations of TGF and its subtypes with EHP. Additionally, mediation analysis was applied to assess whether the triglyceride-glucose (TyG) index and inflammatory index score (INFLA-score) mediated these associations. Among 60 315 participants without prior hypertension, 3651 (6·05 %) developed EHP over a median follow-up of 10·3 years, with an incidence density of 6·08 per 1000 person-years. The adjusted hazard ratios for Q4 compared with Q1 were 0·828 (95 % CI: 0·750, 0·914) for TGF and 0·842 (95 % CI: 0·767, 0·936) for WGF. Restricted cubic spline analysis confirmed inverse relationships for TGF and WGF with EHP risk. But RGF showed no significant association with EHP. The TyG index and INFLA-score partially mediated the associations of TGF and WGF with EHP, with mediation proportions of 4·2 % and 3·3 % for TGF, and 4·9 % and 5·2 % for WGF, respectively. Jointly, TyG index and INFLA-score together mediated 5·6 % between TGF and EHP, and 7·4 % between WGF and EHP. In conclusion, higher intake of TGF and WGF reduces EHP risk, and this effect is only partly mediated by TyG index and INFLA-score.

Normal reference values for body composition and physical performance measures are needed in order to determine cut-off values for suboptimal health such as obesity and related cardiometabolic diseases, and/or sarcopenia. Few studies have provided comparative normative reference ranges across different populations. We compare several body composition and physical performance measures between older Hong Kong Chinese and Canadians to derive and contrast their respective reference values. 17 451 older adults from the Canadian Longitudinal Study on Aging (CLSA) and 4000 from the Hong Kong Mr. and Ms. Osteoporosis (Os) cohort aged 65 years and over were included to derive reference values for walking speed, grip strength, 5-times chair stand test (CST), percentage body fat (PBF), weight, BMI, waist:hip ratio (WHR) and Conicity Index (C-index), stratified by age and sex. Overall normal reference values for Hong Kong males were higher compared with Canadians, particularly in younger age groups. The observations were reversed for females. Not surprisingly, Canadians have higher body weight and BMI compared with Hong Kong older adults. Older Canadian males also have a higher PBF and WHR, compared with Hong Kong older males. When fat distribution was compared, Hong Kong Chinese females have higher C-index, indicating greater central fat distribution compared with Canadian females. Normative reference values are best derived in the context of ethnicity and geographic regions, when used in relation to health assessments requiring physical performance measures and body composition.

Multiple myeloma (MM) is one of the most common blood cancers. Despite lengthening survival with modern therapy, it remains largely fatal. Understanding the influence of common modifiable risk factors on MM risk is necessary to inform prevention. We investigated the association between dietary exposures and MM in an Australian population-based case–control study (2010–2016). Incident cases of MM (n 746) were recruited primarily via cancer registries. Controls (n 706) were siblings or spouses of cases. We estimated OR and 95 % CI for associations between MM and dietary exposures, including dietary patterns, fish consumption and a healthy lifestyle index, adjusting for confounders. Higher scores on a modified version of the Alternative Healthy Eating Index-2010 were associated with reduced risk of MM (mAHEI: OR = 0·88, 95 % CI = 0·78, 0·98). There was weaker evidence for reduced risk associated with higher healthful plant-based dietary index score (hPDI: OR = 0·91, 95 % CI = 0·81, 1·02). Increased MM risks were observed with higher scores on empirical dietary indices for inflammatory pattern (OR = 1·20, 95 % CI = 1·07, 1·35), hyperinsulinaemia (OR = 1·15, 95 % CI = 1·02, 1·31) and insulin resistance (OR = 1·21, 95 % CI = 1·08, 1·37). There was no clear evidence of association with MM risk for fish consumption or a healthy lifestyle index. We observed an association between adherence to a healthy diet and lower MM risk. Adherence to dietary patterns with the potential to increase insulin levels, insulin resistance or promote inflammation was associated with increased MM risk. Results of studies assessing dietary intervention for MM prevention could reveal whether dietary modification directly influences MM risk.

To investigate the association between dietary advanced glycation end products (dAGE) and sarcopenia in USA adults. A total of 7590 participants aged 20–59 years were included in this study using data from the National Health and Nutrition Examination Survey 2011–2018. Dietary AGE intake was assessed by ultra-performance liquid chromatography-tandem MS-based AGE database combined with 24-h dietary recall. Sarcopenia was assessed by appendicular lean BMI (ALMI). Linear regression was used to examine the association between dAGE and ALMI. Logistic regression was adopted to examine the association between total and food-derived AGE with the prevalence of sarcopenia. The mediating role of bone mineral density (BMD) and serum 25 (OH) D3 on the association between dAGE and ALMI was also explored. The prevalence of sarcopenia was 7·26 %. Compared with the low intake tertile (T1), the OR for sarcopenia among participants in the high tertile (T3) of dAGE, (1-carboxyethyl) lysine and Nδ-(5-hydro-5-methyl-4-imidazolon-2-yl)-ornithine intake was 1·66 (95 % CI: 1·05, 2·64; Ptrend = 0·031), 1·56 (95 % CI: 1·01, 2·40; P trend = 0·042) and 1·60 (95 % CI: 1·03, 2·48; Ptrend = 0·033), respectively. Meat and baked foods derived AGE showed significant associations with the prevalence of sarcopenia. Mediation analysis demonstrated that 14·75% and 12·95 % of the association between dAGE and ALMI were mediated by the BMD and serum 25 (OH) D3, respectively. In the USA adult population, dietary AGE were positively associated with sarcopenia, particularly in meat and baked foods, with BMD and serum 25 (OH) D3 partially mediating this association.

While rapid four-compartment (4C) models have demonstrated cross-sectional validity in diverse populations, including athletes, their longitudinal validity remains unverified. This study aims to evaluate the longitudinal validity of utilising dual-energy X-ray absorptiometry (DXA)-derived estimates of body volume (BV) and bioelectrical impedance spectroscopy (BIS)-derived total body water (TBW) in rapid 4C models in athletes. Criterion 4C used DXA for bone mineral content, air displacement plethysmography for BV and 2H dilution for TBW. Analyses of longitudinal changes in fat mass (FM), in both kilograms and percentage, were performed in participants who experienced changes greater than 1 % (n 60) and in a subgroup exceeding the least significant change (1·97 kg, n 25). All alternative estimates underestimated changes relative to criterion 4C, with 4C TBWBIS providing the smaller mean difference (MD) (0·41 kg) and DXA the larger (0·94 kg). The MD for 4C BVSilvaTBWBIS and 4C BVHeymsfieldTBWBIS were 0·48 kg and 0·50 kg, respectively. Bland–Altman analyses showed wide limits of agreement (LOA) for all methods. Even the alternative with the smaller 95 % LOA had a wide LOA (4C TBWBIS: −2·9 %, 4·0 %, n 60). This investigation demonstrates that these rapid 4C models exhibit precision superior to or equivalent to DXA alone while offering reduced assessment times and broader accessibility than the criterion 4C. Regarding accuracy for evaluating changes over time, despite acceptable results at the group level, interpretation should be careful at the individual level.

The planetary health diet (PHD) is a mostly plant-based diet that aims to optimise human health while minimising the environmental impact of food production. Limited data exist on whether the PHD fulfils key nutritional requirements during pregnancy. This research aimed to examine the PHD in early pregnancy and how it aligns with daily nutrient intake and European Food Safety Authority (EFSA) dietary guidelines. Pregnant women (n 678) from two Irish cohorts (ROLO and MicrobeMom) were analysed, and PHD index (PHDI) scores were assigned based on data from 3-d food diaries. Women were dichotomised by the median score to create a ‘High PHDI’ (> 88·99) and a ‘Low PHDI’ group (≤ 88·99). Differences in nutrient intakes and adherence to dietary guidelines between ‘High’ and ‘Low’ PHDI groups were explored. Compared with those with a ‘Low’ score, those with a ‘High’ PHDI score reported higher intakes of dietary fibre (g/d) (17·32 (13·39, 21·08) v. 21·74 (18·28, 25·88), P < 0·001), Fe (mg/d) (10·48 (8·48, 12·82) v. 12·06 (9·48, 14·60), P < 0·001), folate (µg dietary folate equivalent per d) (250·73 (193·88, 312·45) v. 279·57 (219·43, 356·81), P < 0·001) and Ca (mg/d) (837·75 (695·36, 1056·72) v. 956·57 (751·84, 1155·03), P < 0·001). A greater proportion of women in the ‘High PHDI’ group met EFSA recommendations for dietary fibre intake (10·3 % v. 28·9 %, P < 0·001). The PHD may support maternal nutritional adequacy in pregnancy while promoting environmental sustainability. Our findings provide valuable insights that can inform future dietary recommendations for pregnancy, contributing to both maternal health and planetary well-being.

Military veterans (ex-serving members of the Armed Services) experience unique physical and mental health challenges, with diet playing a critical role in chronic disease management and well-being. This review aimed to evaluate veterans’ dietary intake against nutrient reference values (NRV) relevant to age and sex. A systematic search of CINAHL, MedLine, Scopus, PubMed and AMED (January 2024, updated March 2025) identified 1268 records; thirty-three studies (n 654 323) met inclusion criteria. Eligible designs included cross-sectional, cohort, quasi-experimental and randomised controlled trials. Data were extracted using the Joanna Briggs critical appraisal checklist, indicating low risk of bias. Across studies, veterans’ intake of fibre, folate, vitamin D, Ca, potassium, fruits, vegetables, wholegrains and legumes was consistently inadequate, with overall diet quality rated poor to average. BMI ranged widely, and veterans reported high rates of mood disorders and low quality-of-life scores. These findings highlight key nutrients and dietary patterns that might be considered and targeted in dietary and lifestyle interventions for promoting the physical and mental health of veterans.

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.

This study aimed to evaluate adherence to the Mediterranean diet, a recognised healthy eating pattern, and the tendency towards orthorexia nervosa in professional athletes, and to examine their relationship with physical activity levels. The study was conducted with athletes (n 134) at the Turkish Olympic Preparation Center (TOHM). Data were collected using a questionnaire covering sociodemographic information, dietary habits, anthropometric measurements, the Mediterranean Diet Quality Index (KIDMED), the International Physical Activity Questionnaire-Short Form (IPAQ-SF) and the Orthorexia-11 (ORTO-11) scale assessing orthorexic tendencies. Of the participants, 17·2 % had poor dietary quality, 60·4 % moderate and 22·4 % good dietary quality. According to the ORTO-11 (cut-off ≤ 25 points), 30·6 % of athletes exhibited orthorexic tendencies. Athletes adhering to a diet had significantly higher orthorexia tendencies compared with non-dieters (P < 0·05). A significant association was found between athletic experience and orthorexic tendencies, particularly among those with 4–8 years and ≥8 years of experience (P < 0·05). Moreover, athletes consuming three main meals had significantly higher KIDMED and ORTO-11 scores than those consuming two meals (P < 0·05). No statistically significant correlation was found between the KIDMED score, ORTO-11 score and physical activity level (P > 0·05). Professional athletes showed moderate adherence to the Mediterranean diet, while certain groups displayed higher orthorexia tendencies. Diet quality and orthorexic tendencies differed significantly with eating habits such as athletic experience and meal patterns, whereas physical activity level had no effect. These findings highlight the importance of multidisciplinary nutrition strategies focusing on both performance and sustainable healthy eating behaviours.

The objective is to describe energy, macro- and micronutrient intake according to Nova food groups and to estimate its association with ultra-processed foods (UPF) energy participation in the diets of children, stratified by age (6–23 m/24–59 m). A single 24-h recall from 12 553 children in the Brazilian National Survey on Child Nutrition was used to estimate the relative energy contribution of Nova groups: unprocessed or minimally processed foods and culinary ingredients (G1 + G2); processed foods (G3) and UPF (G4). Age-stratified linear regression and 95 % CI assessed differences in nutrient intake (per 1000 kcal) across UPF energy quintiles. The G1 + G2 group accounted for most of the energy consumed (6–23 m: 74·5 %; 24–59 m: 65·1 %) compared with G3 or G4. For both age groups, in the lowest quintile of UFP participation, ≤ 2 % of energy came from UPF, while in the highest quintile, this proportion was > 55 % and the G1 + G2 group provided most nutrients. In 6–23 m, higher UPF quintiles were associated with lower fat (β: –3·1 (–3·6, –2·5)), potassium (β: –49·7 (–67·9, –31·4)) and vitamin A RAE (β: –113·7 (–136·7, –90·6)) intake, but higher Ca ((β: 75·5 (57·6, 93·4)), Fe (β: 2·9 (2·5, 3·3)), vitamin A RE (β: 104·3 (72·3, 136·3)) and folate (β: 15·7 (12·0, 19·5)) intake. In 24–59 m, nutrient intake generally decreased with increasing UPF quintiles. For 6–23 m/24–59 m, UPF consumption was positively associated with energy (β: 73·6 (44·6, 102·7); 92·8 (66·7, 118·8), respectively) and carbohydrate (β: 7·3 (5·8, 8·7); 2·3 (1·2, 3·3), respectively), while contributing little to overall micronutrient intake.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease worldwide. Flavonoids may offer protective benefits, but the role of overall diet quality in modulating this remains unclear. In this cross-sectional study, we analysed 2815 participants from the Framingham Heart Study. Hepatic steatosis was defined by liver:phantom ratio < 0·33 using multidetector computed tomography. Dietary intake was assessed using a validated FFQ, and intake of six flavonoid subclasses and total flavonoid was estimated using the USDA database. Logistic regression models evaluated associations between flavonoid intake quartiles and hepatic steatosis, adjusting for demographic and lifestyle covariates, followed by additional models adjusting for a priori dietary quality indexes: the Alternative Healthy Eating Index, the Mediterranean-style diet score and the Dietary Approaches to Stop Hypertension score. Higher intake of flavonols, flavan-3-ols, anthocyanidins, flavonoid polymers and total flavonoids is associated with lower odds of hepatic steatosis (Ptrend < 0·05), with up to 40 % reduced odds at the highest quartiles before adjustment for diet quality. After adjustments, associations attenuated and lost statistical significance. The attenuation does not rule out a potential protective role of flavonoids; it may indicate that higher flavonoid intake is an important element of a broader healthy diet. Alternatively, the associations could be confounded by other components of diet which may independently reduce steatosis risk. Nonetheless, these findings underscore the importance of promoting flavonoid-rich diets in the context of overall healthy diet and support further investigation in prospective and interventional studies targeting MASLD prevention.

While chrono-nutrition behaviours are inter-related, few studies examined patterns of chrono-nutrition behaviours using a comprehensive set of these behaviours. This study aimed to identify chrono-nutrition behaviour patterns and examine their associations with sociodemographic characteristics, diet quality and obesity. This cross-sectional study included 1047 Japanese adults aged 20–69 years. Using 11-d diaries of eating, chrono-nutrition behaviours (such as frequency and timing of eating) were evaluated for workdays and non-workdays separately. Principal component analysis identified four patterns: ‘early, large breakfast on workdays’, ‘skipping breakfast on non-workdays’, ‘frequent snacking with small dinner’ and ‘early last eating with large lunch’. Female sex was associated with the ‘frequent snacking with small dinner’ and ‘early last eating with large lunch’ patterns; male sex was associated with the ‘skipping breakfast on non-workdays’ pattern. Age was positively associated with the ‘skipping breakfast on non-workdays’ and ‘early last eating with large lunch’ patterns. Having a full-time paid job was associated positively with the two patterns characterised mainly by breakfast but inversely with the remaining two patterns. After adjustment for potential confounders, none of the four patterns were significantly associated with diet quality (Healthy Eating Index-2020 score), general obesity (BMI ≥ 25 kg/m2) or abdominal obesity (waist circumference ≥ 90 cm for males; ≥ 80 cm for females). In conclusion, this study suggests that different chrono-nutrition behaviour patterns were differentially associated with sociodemographic characteristics, but not with diet quality or obesity. Further research is needed to clarify if the patterning approach is useful to comprehensively interrogate chrono-nutrition behaviours.

The relationship between mild ketosis and metabolic syndrome (MetS) remains unclear. We aimed to investigate the association between serum ketone levels and MetS and to examine how genetic and lifestyle factors influence this relationship. We conducted a cross-sectional observational study using data from the UK Biobank, comprising 269 178 participants. Participants were categorised into low and high serum ketone groups based on β-hydroxybutyrate levels (cut-off: 0·12 mM). Dietary patterns were assessed using validated questionnaires, and a polygenic risk score (PRS) was generated to examine genetic influences on ketone metabolism. Individuals with higher ketone levels showed significantly lower MetS prevalence, with reduced BMI, waist circumference, TAG and glucose levels, alongside higher HDL-cholesterol. These individuals also exhibited distinct dietary patterns, characterised by lower carbohydrate (CHO) and higher fat intake, as well as increased physical activity. The PRS was inversely associated with MetS risk, particularly for abdominal obesity, TAG and HDL-cholesterol components. Notably, PRS modified the relationship between plant-based diet and ketone levels, with stronger positive associations observed in individuals with higher PRS. However, a high CHO diet showed weaker associations with PRS. In conclusion, genetic predisposition influenced ketone metabolism and its protective association with MetS risk. The interaction between genetic predisposition and lifestyle factors has crucial clinical implications for developing personalised dietary and lifestyle interventions. This research provides evidence for individualised approaches to optimise metabolic health through targeted ketone metabolism modulation, which could inform precision medicine strategies for MetS prevention and management.