Protein intake is often suboptimal among older adults, which may lead to protein-energy malnutrition, sarcopenia and frailty. A need exists for a simple, efficient and feasible protein-specific dietary assessment tool. Thus, a novel protein screening test, adapted to the Finnish cultural context, was developed. The aim of this study was to validate a novel protein screening test against a 1-d food record among Finnish older adults. Data were collected as part of the Helsinki Aging Study. The sample (N 140) consisted of Finnish community-dwelling oldest-old individuals (age range 80–100 years) with sufficient cognitive ability for at-home dietary assessment. A 1-d food record and the protein screening test were completed on one habitual eating day. Validity was assessed using the food record as a reference, with suboptimal protein intake defined as <1·2 g/kg BW/d. A Bland–Altman plot and concordance correlation coefficient (0·87, 95 % CI: 0·83–0·91) demonstrated good agreement between the methods. Sensitivity (0·85, 95 % CI: 0·72–0·94), specificity (0·81, 95 % CI: 0·71–0·88), area under receiver operating characteristic curve (0·90, 95 % CI: 0·85–0·95) and positive likelihood ratio (4·40, 95 % CI: 2·86–6·77) indicated strong diagnostic performance of the protein screening test. An optimal cut-off for the screening test to identify suboptimal protein intake was assessed at <1·00 g/kg BW/d. The novel protein screening test has good concurrent validity with the food record in identifying Finnish community-dwelling oldest-olds with suboptimal protein intake. It shows diagnostic potential for identifying individuals with suboptimal intake and to engage in targeted intervention.

Despite established nutritional benefits of human milk, evidence regarding breastfeeding’s protective effect against childhood adiposity remains equivocal across subpopulations. This study investigates sex- and race-specific heterogeneity in the longitudinal association between duration of breastfeeding and early childhood BMI percentile trajectories. Data were drawn from the Early Childhood Longitudinal Study, Birth Cohort, a nationally representative US prospective cohort (N 8500). The primary outcome was child BMI percentile from anthropometric measurements taken at 9, 24, 36, 48 and 60 months. Breastfeeding duration was categorised as never, less than 6 months and 6 months or longer. Stepwise hierarchical linear modelling, specifying non–linear individual growth curves, was utilised. Models were stratified by sex and adjusted for maternal, obstetric and sociodemographic confounders. A distinct sex-specific effect of breastfeeding was identified, whereby a duration of 6 months or longer significantly lowered BMI percentile trajectories in girls (b = −3·70, 95 % CI: −5·86, −1·54) but yielded no significant association in boys. BMI percentiles by race/ethnicity also varied between sexes. Among boys, only Hispanic infants exhibited significantly higher percentiles than Non-Hispanic (NH) Whites (b = 4·61, 95 % CI: 2·63, 6·60), whereas among girls, both Hispanic (b = 3·26, 95 % CI: 1·24, 5·29) and NH Black infants (b = −3·14, 95 % CI: −5·38, −0·90) showed significant differences relative to NH Whites. No significant interaction emerged between breastfeeding duration and race/ethnicity. These findings suggest that paediatric obesity prevention strategies may benefit from considering sex-specific mechanisms and addressing the structural factors associated with racial disparities.

Acute stroke induces a hypermetabolic/hypercatabolic state, causing malnutrition and muscle wasting that hinder recovery. Weight-based predictive equations for nutritional support may fail to meet individual energy needs. This study compared resting energy expenditure (REE)-guided nutrition with weight-based calorie calculation in acute stroke patients. This single-centre, quasi-randomised controlled trial assessed seventy-four acute ischaemic stroke patients requiring enteral nutrition. Six patients were excluded before allocation, and sixty-eight were allocated by odd/even hospital admission number to the REE-guided group (n 30; energy target 120 % of indirect calorimetry-measured REE) or the control group (n 38; 25 kcal/kg/d). The complete-case analysis included fifty-four patients (REE-guided n 24; control n 30). Primary analyses compared day 14 fat-free mass surrogate indicators after adjustment for baseline values and prespecified covariates. Secondary outcomes included nutritional and inflammatory biomarkers, feeding efficiency and complications. Baseline energy and protein intake were comparable between groups. In unadjusted comparisons at day 14, no statistically significant differences were observed for left or right temporal muscle thickness, whereas calf circumference was lower in the REE-guided group. After adjustment for age, sex, baseline National Institutes of Health Stroke Scale (NIHSS) score, total energy intake and day 0 C-reactive protein (CRP), left temporal muscle thickness was significantly higher in the REE-guided group (β = 0·56, 95 % CI 0·07–1·05, P = 0·031). Right temporal muscle thickness and calf circumference showed non-significant adjusted differences. At day 14, prealbumin was numerically higher in the REE-guided group, but the difference was not statistically significant. Albumin and transferrin were similar between groups. Inflammatory biomarkers, including leucocyte count, CRP and procalcitonin, showed no statistically significant between-group differences. Clinical secondary outcomes, including complications, NIHSS score, time to reach target calories and enteral nutrition interruption, did not differ significantly between groups. REE-guided nutritional support was feasible and safe in acute ischaemic stroke patients and was associated with higher adjusted left temporal muscle thickness at day 14; biomarker findings were exploratory; only prealbumin showed a non-significant favourable numerical trend, whereas inflammatory biomarkers did not show a consistent favourable pattern. Effects on right temporal muscle thickness and calf circumference were not statistically significant. These findings support further evaluation in larger, randomised trials. Trial registration: Chinese Clinical Trial Registry, ChiCTR-IPR-16010051.

Body composition and fat distribution were found to display differential effects on the incidence and mortality of chronic disease. However, it remained unclear whether there is an interaction between lifestyle factors and genetic susceptibility on body composition and fat distribution. This study investigated the associations of lifestyle and genetic factors with body composition and fat distribution among 121 664 women from the UK Biobank cohort study. Women with a favourable lifestyle had lower BMI (BMI, –7·72 % (95 % CI: −7·93 %, −7·51 %)), fat mass index (FMI, −15·70 % (95 % CI: −16·09 %, −15·30 %)), fat-free mass index (FFMI, −2·86 % (95 % CI: −2·98 %, −2·74 %)), arm fat ratio (AFR, −5·19 %, (95 % CI: −5·38 %, −5·00 %)) and trunk fat ratio (TFR, −0·73 %, (95 % CI: −0·84 %, −0·62 %)) but higher leg fat ratio (LFR, 2·30 % (95 % CI: 2·16 %, 2·44 %)) than those with an unfavourable lifestyle. Significant interactions between lifestyle factors and genetic susceptibility on BMI, FMI and AFR were observed (Pinteraction < 0·05). Among women with a high genetic susceptibility to body composition or fat distribution, those with a healthy lifestyle still had a lower BMI, FMI, FFMI, AFR and TFR and higher LFR (Ptrend < 0·001). Women who adhere to a favourable lifestyle tend to have healthy body composition and fat distribution, and this association is consistent across all strata of genetic risk.

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.

The interaction between 25-hydroxyvitamin D [25(OH)D] and physical activity (PA) in influencing hypertension remains underexplored. This study aimed to examine their independent and joint associations with hypertension risk among 5327 participants aged ≥ 50 years from the English Longitudinal Study of Ageing. Participants were categorised by 25(OH)D status (sufficient, ≥ 50 nmol/l; insufficient, ≥ 30 to < 50 nmol/l; deficient, < 30 nmol/l) and self-reported PA levels. Multivariable logistic regression, adjusting for the season of measurement and sociodemographic confounders, showed that sufficient 25(OH)D (OR = 0·66, 95 % CI 0·56, 0·78) and higher PA (OR = 0·82, 95 % CI 0·71, 0·94) were independently associated with reduced hypertension prevalence. In joint analyses, the group combining higher PA and sufficient 25(OH)D exhibited the lowest odds of hypertension (OR = 0·55, 95 % CI 0·43, 0·70) compared with the lower PA and deficient group. A significant synergistic interaction was identified, indicating that the combined protective effect of these factors was greater than the sum of their individual associations. These results were corroborated by Mendelian randomisation analysis, which identified inverse causal associations between genetically predicted 25(OH)D, vigorous PA and hypertension risk across independent datasets. These findings emphasise that vitamin D sufficiency acts in synergy with an active lifestyle to enhance cardiovascular protection. This relationship underscores the critical importance in nutritional science of integrating micronutrient status with PA to develop more effective, multifaceted lifestyle-based strategies for hypertension management in middle-aged and older populations.

Given there is no prospective research evidence on the association between ultra-processed food (UPF) intake and human bone health, this study aimed to analyse the associations of UPF intake with bone mineral density (BMD) and risk of fractures using data from 163 855 participants in the UK Biobank. Multiple linear regression assessed BMD, and Cox regression models estimated fracture risk. Restricted cubic splines were used to evaluate non-linearity. Participants’ average age was 56·0 years, with 1097 hip fractures and 7889 all fractures recorded over 12·0 years of follow-up. Complex inverted U-shaped associations between UPF intake and BMD were found at the femur trochanter. Compared with the lowest UPF intake, the highest UPF intake was linked to a reduction in BMD at the femoral neck (β(se) = −0·0061 (0·0024), P < 0·05), femur trochanter (β(se) = −0·0083 (0·0024), P < 0·001), lumbar spine (β(se) = −0·0114 (0·0036), P < 0·01) and total body (β(se) = −0·0095 (0·0021), P < 0·001). The link was more pronounced in participants under 65 years of age and those who were underweight (Pinteraction < 0·01). Per sd increment of UPF intake was linked to 10·5 % and 2·7 % higher risks of incident hip fractures (hazard ratio (HR), 95 % CI 1·105, 1·029, 1·186; P < 0·01) and all fractures (HR, 95 % CI 1·027, 1·000, 1·055; P < 0·05), respectively. Our results suggest that higher UPF intake is associated with lower BMD and increased risk of fractures captured in hospital inpatient records, highlighting the need for dietary interventions to protect bone health.

Dietary magnesium (Mg) is a potentially modifiable factor in preventing dementia, but current evidence supporting this remains insufficient and inconclusive. This study aimed to determine whether dietary Mg is associated with the risk of dementia among middle-aged and older people. Participants of this 8-year cohort study were 13,032 community-dwelling individuals aged 40–74 years. Dietary data were collected using a validated food frequency questionnaire in 2011–2013. Mg intake was adjusted for energy intake using the residual method. The outcome was newly diagnosed dementia determined using Japan’s long-term care insurance database. Covariates included demographic characteristics, body size, lifestyles, and disease histories. Cox proportional hazard models were used to determine adjusted hazard ratios (HRs). The mean age of participants was 59.0 years. Dementia occurred in 148 males and 138 females. Lower quartiles of energy-adjusted Mg intake were associated with a higher risk of dementia (P for trend = 0.0410) in males, with the lowest quartile (Q1) having an elevated risk of dementia (HR = 1.73, 95% CI:1.07–2.83) compared to the highest quartile (Q4, reference); however, this association was not found in females. In a subgroup analysis by disease history in males, the HR of Q1 was attenuated in both subgroups; HR was 1.52 (95% CI:0.74–3.11) in those with a disease history and 1.40 (95% CI:0.73–2.69) in those without. In conclusion, low dietary Mg intake is associated with increased dementia risk in middle-aged and older Japanese males. However, this association may be partly attributable to underlying disease history.

Adequate protein intake is crucial for preventing frailty and sarcopenia in older adults, but conventional dietary assessments are time-consuming. Developing a rapid screening tool for identifying those at risk of low protein intake is essential; however, no such tool exists for Asian populations. This study developed a prediction model to identify older adults in Japan at risk of low protein intake using a simple food intake questionnaire. The model was developed using data from 4,085 older adults aged ≥65 years from the 2013 and 2017 National Health and Nutrition Surveys. Protein intake was assessed using a one-day dietary record with a semi-weighted method. A multivariable logistic regression model was developed to predict low protein intake (<1.0 g/kg adjusted body weight/day), incorporating sex, age, adjusted body weight, and food intake frequency of nine food groups. Model performance was evaluated using the area under the receiver operator characteristic (ROC) curve and a calibration plot, both adjusted for optimism through bootstrap resampling. Participants had a mean age of 74.1 years (standard deviation = 6.6), and 55.5% of all participants were female. The prevalence of low protein intake was 21.8%. Internal validation showed a bootstrap optimism-corrected ROC area of 0.695 and a calibration slope of 0.921. We developed a 12-item prediction model for identifying older adults at risk of low protein intake. The model provides a practical tool to identify older adults at high risk of low protein intake and is expected to be used in public health settings.

Patients with chronic liver disease (CLD) often experience hypozincemia. The clinical factors associated with hypozincemia have not been established. We investigated clinical factors that may be useful to predict hypozincemia in patients with CLD. The serum zinc levels CLD patients were measured; Study 1 investigated the predictive factors of hypozincemia, and Study 2 was performed to validate the factors identified in Study 1. Study 1 included 197 participants, of whom 28 and 106 had serum zinc levels <60 µg/dL and <80 µg/dL, respectively. A multivariate analysis revealed that serum zinc levels <60 µg/dL or <80 µg/dL were associated with the albumin–bilirubin (ALBI) score and serum albumin level. A receiver operating characteristic curve analysis revealed that the ALBI score ≥ −1.83 and the serum albumin level ≤3.3 g/dL were the cut-off values for a serum zinc level <60 µg/dL, whereas the ALBI score ≥ −2.44 and the serum albumin level ≤3.6 g/dL were the cut-off values for a serum zinc level <80 µg/dL. In Study 2 (n = 177), the diagnostic accuracy rates for serum zinc <60 µg/dL were 81.9% for the ALBI score and 75.1% for the serum albumin level, and those for serum zinc <80 µg/dL were 70.1% for both parameters. Together these findings indicate that the ALBI score may serve as a predictive factor of hypozincemia in CLD patients.

This study systematically evaluates the effects of probiotic interventions on gut microbiota and clinical outcomes in diabetic patients to determine the optimal target population and conditions for effective use, with an emphasis on precision treatment. A comprehensive search was performed across PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Internet (CNKI), and Wanfang databases until April 2024. Randomized controlled trials (RCTs) assessing probiotics as adjunctive therapy for diabetes were included. The control group received standard care, and the intervention group received probiotics alongside standard care. Data were managed with Endnote and Excel, and analyses were conducted using Revman 5.3 and Stata 16. Twelve RCTs involving 1113 participants were included. Probiotics significantly increased fecal Lactobacillus (standardized mean difference (SMD) 1.42, P < 0.0001, I2 = 95 %) and Bifidobacterium levels (SMD 1.27, P < 0.0001, I2; = 90 %) and reduced fasting plasma glucose (SMD −0.35, P = 0.004). Subgroup analysis showed that shorter intervention durations (≤ 3 months) improved FPG, HbA1c, and Bifidobacterium levels, while younger patients (≤ 60 years) experienced the most significant improvements in Bifidobacterium levels. In conclusion, probiotics improve gut microbiota and clinical outcomes in diabetic patients, with intervention duration and patient age as key factors influencing treatment effectiveness.

The threshold values of visceral fat area (VFA) proposed by existing studies for predicting metabolic syndrome (MetS) are contentious, necessitating further empirical evidence. We conducted a cross-sectional study to assess VFA using bioelectrical impedance analysis technology among middle-aged and elderly individuals in the Sichuan area of China. First, we compared the predictive ability of VFA, waist circumference (WC) and body mass index (BMI) among participants with MetS (excluding WC). In males, the area under the receiver operating characteristic curve (AUC) was 0·680 for VFA, 0·670 for WC and 0·665 for BMI, with corresponding optimal cut-off values of 77·45 cm2, 83·50 cm and 24·19 kg/m2. In females, the AUC values and optimal cut-offs were 0·628 (103·55 cm2) for VFA, 0·671 (77·50 cm) for WC and 0·643 (24·32 kg/m2) for BMI. Additionally, for MetS defined with WC included, the AUC of VFA for prediction was higher in males (0·785) than in females (0·717), with optimal cut-offs of 85·15 cm2 (males) and 109·55 cm2 (females). Further age-stratified analysis revealed sex-specific VFA cut-offs: in males, 80·95 cm2 (45–59 years), 85·15 cm2 (60–74 years) and 77·50 cm2 (≥ 75 years); in females, 109·65 cm2 (45–59 years), 112·15 cm2 (60–74 years) and 103·05 cm2 (≥ 75 years). In conclusion, VFA is an effective predictor of MetS, with its optimal cut-off value varying by age and being higher in females than in males.