Skeletal muscle is of great importance for human activity and quality of life, as its loss contributes greatly to immobilization, especially for aged individuals. An increased dietary intake of antioxidant vitamins may be beneficial for muscle loss because of aging. However, the quantitative relationship between total antioxidation capacity (TAC) of antioxidant vitamins and muscle mass is undetermined. 4009 participants from the National Health and Nutrition Examination Survey (NHANES) were included. Multivariate linear regression analysis was performed with demographic, lifestyle and dietary intake adjustment factors. The dose saturation effect was also determined by a saturation effect analysis. Subgroup analysis were performed forage and sex. In the fully adjusted model, per unit increase of dietary TAC was associated with an increase of 0.018 g/kg appendicular lean mass (95% CI: 0.007–0.029), 0.014 g/kg trunk lean mass (95% CI: 0.004–0.024) and 0.035 g/kg total lean mass (95% CI: 0.014–0.055). TAC was associated with an decrease of 0.004 kg/kg total percent fat (95% CI: -0.006–-0.002), 0.005 kg/kg trunk percent fat (95% CI: -0.007–-0.002) and 0.003 kg/m2 BMI (95% CI: -0.006–-0.001) at the same time. Subgroup analysis indicated that women and adults <50 years may experience the most significant association between TAC and skeletal muscle mass. We revealed a positive correlation between TAC and lean body mass, a negative association between TAC and body fat and BMI. Saturation values were found among people aged 40–59. Age and sex mediate these associations.

This study aimed to estimate the nationwide prevalence of cardiometabolic diseases (CMDs) among adults with underweight in the US general population. Using data from the National Health and Nutrition Examination Survey (1999-2020), we estimated the age-standardized prevalence of dyslipidemia, hypertension, diabetes, chronic kidney disease, cardiovascular disease, and the presence of 0 or at least 2 CMDs. Multivariable Poisson regressions were used to compare CMD prevalence between subgroups, adjusting for age, sex, and race/ethnicity. Among the 855 adults with underweight included, the weighted mean age was 40.8 years, with 68.1% being women and 70.4% non-Hispanic White. The estimated prevalence rates were 23.4% for dyslipidemia (95% CI, 19.4%-27.5%), 15.6% for hypertension (95% CI, 13.3%-17.8%), 2.5% for diabetes (95% CI, 1.5%-3.5%), 7.9% for chronic kidney disease (95% CI, 6.9%-8.8%), and 6.1% for cardiovascular disease (95% CI, 4.3%-7.9%). The prevalence of having 0 and at least 2 CMDs was 50.6% (95% CI, 44.1%-57.0%) and 12.3% (95% CI, 8.1%-16.4%), respectively. Non-Hispanic Black adults had significantly higher prevalence of diabetes (adjusted prevalence ratio, 3.35; 95% CI, 1.35-8.30) compared to non-Hispanic White adults. In conclusion, approximately half of the underweight adults had at least one CMD, and 12.3% had at least two CMDs. Prevention and management of CMDs in underweight adults are critical yet neglected public health challenges.

It is well-known that many modern lifestyles, including the use of artificial light, shift work, irregular or short sleep, sedentary activity, and unhealthy diet can disrupt the circadian rhythm. This disruption can result in the so-called Circadian Syndrome (CircS) which has been identified as a risk factor for a variety of chronic diseases. The concept of Circadian Syndrome (CircS) was first proposed by Zimmet et al in 2019. CircS has been shown to be a better predictor for cardiovascular diseases (CVD) than the metabolic syndrome (MetS) in adults in China and USA 1,2. Dietary patterns are found to be associated with CircS 3, whereby western dietary pattern was positively related, while prudent pattern was inversely associated, with CircS in the US adults. However, no prior study has investigated the association between fiber intake and CircS. We, thus, aimed to fill this research gap. We analysed data from 10,486 adults aged 20 years and above years who attended the 2005-2016 National Health and Nutrition Examination Survey (NHANES). Fiber and other nutrients intake were assessed using two days 24 hours recall. CircS was derived from all five components of MetS (i.e. central obesity, elevated fasting glucose, elevated triglyceride, reduced HDL-Cholesterol and elevated blood pressure), in addition to short sleep (sleep duration <6 hours/day) and depressive symptoms (PHQ-9 score ≥5). A cut-off for CircS was set as ≥ 4 components. Multivariable logistic regression was used to assess the association between fiber intake and CircS. Mean age of participants was 50.3(SD 17.6) years, and 41.3% had CircS. The mean (SD) fiber intake was 7.8 (2.1), 12.9 (1.3), 17.9 (1.7), and 28.9 (8.2) g/day across the quartiles of fiber intake. The prevalence of CircS decreased across quartiles of fiber intake (44.5% in Q4 and 37.1% in Q1). In the multivariable logistic model adjusting for age, gender, ethnicity, energy intake, education and lifestyle factors, across the quartiles of fiber intake, the odds ratios (ORs) (95%CI) for CircS were: 1.00, 0.91 (0.76-1.08), 0.82 (0.70-0.96), 0.79 (0.63-0.98) (p trend 0.012), respectively. No significant interactions were found between fiber intake and race, gender, smoking, alcohol drinking, and physical activity, in relation to CircS. In conclusion, a high fiber intake was associated with a lower prevalence of CircS among US adults. The findings highlight the importance of fiber intake for the prevention of metabolic and circadian syndrome, suggesting a potentially accessible and cost-effective lifestyle approach to improve public health. Our results underscore the concern that most of the US adults had fiber intake below the recommended level. Longitudinal studies are needed to validate the findings in different populations.

This study aimed to evaluate the association between dietary carotenoid intake and periodontitis in diabetic patients. Data on diabetic patients were collected from the National Health and Nutrition Examination Survey (NHANES) 2009–2014 for this cross-sectional study. Dietary intake of carotenoids was assessed through the first 24-hour dietary recall interview. Full-mouth periodontal examinations were conducted by trained dental examiners. Subgroup analysis was conducted in terms of age, gender, the number of missing teeth, cardiovascular disease, smoking, and anti-diabetic drugs. Totally 1914 diabetic patients were included, with 1281 (66.93%) in the periodontitis group. After adjusting for age, gender, race, education, smoking, dental implants, hepatitis, and the number of missing teeth, α-carotene intake ≥55.82 mcg was associated with lower odds of periodontitis than α-carotene intake <55.82 mcg [OR = 0.70, 95% CI: 0.53–0.91, P = 0.010]; lutein and zeaxanthin intake ≥795.95 mcg was associated with decreased odds of periodontitis than lutein and zeaxanthin intake <795.95 mcg (OR = 0.75, 95%CI: 0.57–0.98, P = 0.039). The association between carotenoid intake and periodontitis varied across different subpopulations. In diabetes, dietary intake of α-carotene and lutein and zeaxanthin was inversely associated with the odds of periodontitis, which may facilitate clinical periodontitis management.

We aim to explore the association between caffeine and its metabolites and bone mineral density (BMD) in postmenopausal women. Data of 4286 postmenopausal women were extracted from the National Health and Nutrition Examination Survey (NHANES) database in 2009–14 in this cross-sectional study. Weighted linear regression and stepwise regression analyses were used to screen the covariates. Weighted univariate and multivariate linear regression analyses were used to explore the associations between caffeine and its metabolites and BMD. The evaluation index was estimated value (β) with 95 % confidence intervals (CIs). We also explored these relationships in age subgroups. The median BMD level among the eligible women was 0⋅7 gm/cm2. After adjusting for covariates including age, body mass index (BMI), fat intake, Calcium (Ca) supplements, diabetes mellitus (DM), angina pectoris, parental history of osteoporosis (OP), anti-osteoporosis therapy, poverty income ratio (PIR), vitamin D (VD) supplements, coronary heart disease (CHD), and previous fracture, we found that caffeine intake was not significantly related to the BMD reduction (β = 0, P = 0⋅135). However, caffeine metabolites, including MethyluricAcid3, MethyluricAcid7, MethyluricAcid37, Methylxanthine3, and Methylxanthine37, were negatively associated with the BMD (all P < 0⋅05). In addition, MethyluricAcid37 and Methylxanthine37 were negatively associated with BMD in females aged <65 years old, while MethyluricAcid3 and Methylxanthine3 were noteworthy in those who aged ≥65 years old. The roles of caffeine and its metabolites in BMD reduction and OP in postmenopausal women needed further exploration.

Metabolic-associated fatty liver disease (MAFLD) has been proposed to replace the term non-alcoholic fatty liver disease (NAFLD) in 2020. The association between micronutrients and MAFLD has not been reported. Therefore, this study aims to explore the association between micronutrients intake and MAFLD. This was a cross-section study based on the National Health and Nutrition Examination Survey (NHANES). The dietary intake of copper, zinc, iron, and selenium was evaluated using the 24-h dietary recall interview. Logistic regression analysis was used to explore the association between micronutrients and MAFLD, and the results were shown as odds ratio (OR) with 95 % confidence intervals (CIs). A total of 5976 participants were finally included for analysis, with 3437 participants in the MAFLD group. After adjusting potential confounders, copper intake at quartile Q3 (OR = 0⋅68, 95 % CI 0⋅50, 0⋅93) and Q4 (OR = 0⋅60, 95 % CI 0⋅45, 0⋅80) was found to be associated with lower odds of MAFLD. Iron intake at Q2 (OR = 0⋅64, 95 % CI 0⋅45, 0⋅92) and Q3 (OR = 0⋅61, 95 % CI 0⋅41, 0⋅91) was associated with the lower odds of MAFLD. Our findings found that high intake of copper and adequate intake of iron were associated with MAFLD, which may provide guidance for the management of MAFLD.

Though diet quality is widely recognised as linked to risk of chronic disease, health systems have been challenged to find a user-friendly, efficient way to obtain information about diet. The Penn Healthy Diet (PHD) survey was designed to fill this void. The purposes of this pilot project were to assess the patient experience with the PHD, to validate the accuracy of the PHD against related items in a diet recall and to explore scoring algorithms with relationship to the Healthy Eating Index (HEI)-2015 computed from the recall data. A convenience sample of participants in the Penn Health BioBank was surveyed with the PHD, the Automated Self-Administered 24-hour recall (ASA24) and experience questions. Kappa scores and Spearman correlations were used to compare related questions in the PHD to the ASA24. Numerical scoring, regression tree and weighted regressions were computed for scoring. Participants assessed the PHD as easy to use and were willing to repeat the survey at least annually. The three scoring algorithms were strongly associated with HEI-2015 scores using National Health and Nutrition Examination Survey 2017–2018 data from which the PHD was developed and moderately associated with the pilot replication data. The PHD is acceptable to participants and at least moderately correlated with the HEI-2015. Further validation in a larger sample will enable the selection of the strongest scoring approach.

Folate, also known as vitamin B9, is a water-soluble vitamin. Previous studies on dietary folate intake in severe headache patients were equivocal. Therefore, we conducted a cross-sectional study to elucidate the relationship between folate intake and severe headache. This cross-sectional study used data from participants over 20 years old who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004. The diagnosis of severe headache was made through participants’ self-report in the NHANES questionnaire section. We performed multivariate logistic regression and restricted cubic spline (RCS) regression to explore the relationship between folate intake and severe headache. A total of 9859 participants took part in the study, 1965 of whom were severe headache patients and the rest were non-severe headache. We found that dietary folate intake was significantly and inversely associated with severe headache. Compared with participants with lower folate intake Q1 (≤ 229·97 ug/d), the adjusted OR values for dietary folate intake and severe headache in Q2 (229·98–337 ug/d), Q3 (337·01–485 ug/d) and Q4 (≥ 485·01 ug/d) were 0·81 (95 % CI: 0·67, 0·98, P = 0·03), 0·93 (95 % CI: 0·77, 1·12, P = 0·41) and 0·63 (95 % CI: 0·49, 0·80, P < 0·001), respectively. For women aged 20–50 years, there was a non-linear association between folate intake and severe headache in the RCS. Women aged 20–50 years should have higher awareness of dietary folate and increase their dietary intake of folate, which may aid in preventing severe headache.

Cognitive decline occurs commonly as people age. Despite the complexity of cellular mechanisms, oxidative stress is a critical contributor to age-associated cognitive impairment. Selenium plays an important role in antioxidant defense systems. The purpose of the present study was to assess the correlation between selenium intake and cognitive function among older adults. The participants were individuals ≥65 years old (n=1681) who participated in the 2011–2014 National Health and Nutrition Examination Survey (NHANES), a country-wide cross-sectional survey. Dietary selenium intake and adequacy were evaluated with 2 d of 24-h recalls and the estimated average requirement (EAR) cut-point method, respectively. Cognitive function was assessed with the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) score, which was significantly higher when selenium intake was adequate. After adjusting for energy intake, the association was no longer significant. Inadequate intake of selenium is rare in the US and dependent on caloric intake in older adults.

Phytoestrogens may have potential effects on hormone-related cancers (HRC) and cancer biomarkers, but the findings have been inconsistent so far. Participants from the National Health and Nutrition Examination Survey 1999–2010 with information on the levels of urinary phytoestrogens, serum cancer biomarkers and cancer history were included. Sampling-weighted logistic regression models examined the association between urinary phytoestrogens concentrations (creatinine-standardised and log-transformed) and HRC, followed by stratified analyses by race/ethnicity, age and menopausal status for different gender. Correlation analyses between phytoestrogens and cancer biomarkers were performed. Of the total 8844 participants, there were 373 with HRC. We observed total isoflavone and enterodiol excretion were positively associated with HRC, especially in non-Hispanic white female subpopulations (Ptrend < 0·05). Similar association also existed in the total isoflavones and enterodiol levels with breast cancer. Whereas the highest concentration of total isoflavones was significantly linked to a reduced prevalence of HRC (OR = 0·40, 95 % CI: 0·19, 0·84) in white males and of prostate cancer (OR = 0·40, 95 % CI: 0·18, 0·86). Among twenty-four participants with HRC, urinary equol concentration was positively correlated with CA15.3. Also, an inverse correlation of total prostate-specific antigens (PSA) and positive correlation of the PSA ratio with urinary enterolactone were detected in thirteen prostate cancer patients. Our findings indicated that higher concentrations of total isoflavones and enterodiol were positively associated with HRC. Urinary certain phytoestrogen excretion may affect serum cancer biomarker levels in cancer patients. But further prospective studies are needed to provide stronger evidence.

Se is an indispensable trace element for the human body, and telomere length is considered a marker of biological ageing. Previous studies have shown that dietary Se intake is associated with telomere length. However, the relationship between Se intake and telomere length in patients with diabetes has not been well studied. Therefore, this study aimed to investigate the relationship between dietary Se intake and telomere length in patients with diabetes. We extracted 878 participants with diabetes from the National Health and Nutrition Examination Survey database for 1990–2002. Dietary Se intake was assessed using the 24 h dietary recall method, and telomere length was measured using quantitative PCR. Generalised linear models were constructed to assess the relationship between dietary Se intake and telomere length. After controlling for the confounders, 1 μg increase in dietary Se intake in female patients with diabetes, and telomere length increased by 1·84 base pairs (β = 1·84 (95 % CI: 0·15, 3·53)), there was a line relationship between dietary Se intake and telomere length in female patients with diabetes and telomere length increased with increasing dietary Se intake within the range of 0–250 μg. The study demonstrates that dietary Se intake is significantly associated with telomere length only in the female population with diabetes in the USA. However, further prospective studies are required to confirm this finding.

The objective of this study was to investigate the association between food patterns and serum vitamin D concentrations in US adults. Data from two cycles of National Health and Nutrition Examination Surveys, 2003–2004 and 2005–2006, were used (n 6637). Three major food patterns were derived using factor analysis. These three patterns were labeled as meat and processed meat foods (MPF), vegetables, fruit, nuts, and whole grains (VFNW), and sweet, snack, and beverage pattern (SSB). Serum vitamin D was measured with RIA and later standardized to reflect the assay changes over time. In multivariate-adjusted regression analysis, the MPF pattern was significantly, inversely associated with serum vitamin D concentrations (P < 0·001). However, the relation between the VFNW pattern and serum vitamin D was non-linear (P < 0·001). There was no relationship between SSB pattern and serum vitamin D in US adults. In conclusion, persons with a high intake of meat and processed meats are associated with lower serum vitamin D concentrations. Reducing processed foods and emphasizing VFNW will be beneficial from a health perspective.

Individuals with discordantly high apoB to LDL-cholesterol levels carry a higher risk of atherosclerotic CVD compared with those with average or discordantly low apoB to LDL-cholesterol. We aimed to determine associations between apoB and LDL-cholesterol discordance in relation to nutrient patterns (NP) using National Health and Nutrition Examination Survey data. Participants were grouped by established LDL-cholesterol and apoB cut-offs (Group 1: low apoB/low LDL-cholesterol, Group 2: low apoB/high LDL-cholesterol, Group 3: high apoB/low LDL-cholesterol, Group 4: high apoB/high LDL-cholesterol). Principle component analysis was used to define NP. Machine learning (ML) and structural equation models were applied to assess associations of nutrient intake with apoB/LDL-cholesterol discordance using the combined effects of apoB and LDL-cholesterol. Three NP explained 63·2 % of variance in nutrient consumption. These consisted of NP1 rich in SFA, carbohydrate and vitamins, NP2 high in fibre, minerals, vitamins and PUFA and NP3 rich in dietary cholesterol, protein and Na. The discordantly high apoB to LDL-cholesterol group had the highest consumption of the NP1 and the lowest consumption of the NP2. ML showed nutrients that had the greatest unfavourable dietary contribution to individuals with discordantly high apoB to LDL-cholesterol were total fat, SFA and thiamine and the greatest favourable contributions were MUFA, folate, fibre and Se. Individuals with discordantly high apoB in relation to LDL-cholesterol had greater adherence to NP1, whereas those with lower levels of apoB, irrespective of LDL-cholesterol, were more likely to consume NP3.