Dietary Guidelines Meet NOVA: Developing a Menu for A Healthy Dietary Pattern Using Ultra-Processed Foods.

BACKGROUND: A proposed topic for the 2025 Dietary Guidelines for Americans (DGA) Scientific Advisory Committee to address is the relationship between dietary patterns with ultra-processed foods (UPF) and body composition and weight status. Implementing the NOVA system, the most commonly applied framework for determining whether a food is "ultra-processed," in dietary guidance could omit several nutrient-dense foods from recommended healthy diets in the DGA. OBJECTIVE: The purpose of this proof-of-concept study was to determine the feasibility of building a menu that aligns with recommendations for a healthy dietary pattern from the 2020 DGA and includes ≥80% kcal from UPF as defined by NOVA. DESIGN: To accomplish this objective, we first developed a list of foods that fit NOVA criteria for UPF, fit within dietary patterns in the 2020 DGA, and are commonly consumed by Americans. We then used these foods to develop a 7-d, 2000 kcal menu modeled on MyPyramid sample menus and assessed this menu for nutrient content as well as for diet quality using the Healthy Eating Index-2015 (HEI-2015). RESULTS: In the ultra-processed DGA menu that was created, 91% of kcal were from UPF, or NOVA category 4. The HEI-2015 score was 86 out of a possible 100 points. This sample menu did not achieve a perfect score due primarily to excess sodium and an insufficient amount of whole grains. This menu provided adequate amounts of all macro- and micronutrients except vitamin D, vitamin E, and choline. CONCLUSIONS: Healthy dietary patterns can include most of their energy from UPF, still receive a high diet quality score, and contain adequate amounts of most macro- and micronutrients.

Positive Health Outcomes Associated with Live Microbe Intake from Foods, Including Fermented Foods, Assessed using the NHANES Database.

BACKGROUND: Live dietary microbes have been hypothesized to contribute to human health but direct evidence is lacking. OBJECTIVES: This study aimed to determine whether the dietary consumption of live microbes is linked to improved health outcomes. METHODS: Data from the NHANES 2001-2018 were used to assess microbial intake and their adjusted associations with selected physiological parameters (e.g., blood pressure, anthropometric measures, and biomarkers) among adults aged 19 y and older. Regression models were constructed to assess the microbial intake with each physiological parameter and adjusted for demographics and other covariates. Microbial intake was assessed as both a continuous variable and a 3-level categorical variable. Fermented foods were assessed in a separate model. RESULTS: In continuous models, an additional 100-g intake of microbe-containing foods was associated with a lower systolic blood pressure (regression coefficient: -0.331; 95% CI: -0.447, -0.215 mm Hg), C-reactive protein (-0.013; 95% CI: -0.019, -0.008 mg/dL), plasma glucose -0.347; 95% CI: -0.570, -0.124 mg/dL), plasma insulin (-0.201; 95% CI: -0.304, -0.099 µU/mL), triglyceride (-1.389; 95% CI: -2.672, -0.106 mg/dL), waist circumference (-0.554; 95% CI: -0.679, -0.428 cm), and BMI -0.217; 95% CI: -0.273, -0.160 kg/m2) levels and a higher level of high density lipoprotein cholesterols (0.432; 95% CI: 0.289, 0.574 mg/dL). Patterns were broadly similar when microbial intake was assessed categorically and when fermented foods were assessed separately. CONCLUSIONS: To our knowledge, this study is the first to quantify, in a nationally representative data set of American adults and using stable sets of covariates in the regression models, the adjusted associations of dietary intakes of live microbes with a variety of outcomes, such as anthropometric measures, biomarkers, and blood pressure levels. Our findings suggest that foods with higher microbial concentrations are associated with modest health improvements across a range of outcomes.

Perspective: Assessing Tolerance to Nondigestible Carbohydrate Consumption.

Human intestinal enzymes do not hydrolyze nondigestible carbohydrates (NDCs), and thus, they are not digested and absorbed in the small intestine. Instead, NDCs are partially to completely fermented by the intestinal microbiota. Select NDCs are associated with health benefits such as laxation and lowering of blood cholesterol and glucose. NDCs provide functional attributes to processed foods, including sugar or fat replacers, thickening agents, and bulking agents. Additionally, NDCs are incorporated into processed foods to increase their fiber content. Although consumption of NDCs can benefit health and contribute functional characteristics to foods, they can cause gastrointestinal symptoms, such as flatulence and bloating. As gastrointestinal symptoms negatively affect consumer well-being and their acceptance of foods containing NDC ingredients, it is crucial to consider tolerance when designing food products and testing their physiological health benefits in clinical trials. This perspective provides recommendations for the approach to assess gastrointestinal tolerance to NDCs, with a focus on study design, population criteria, intervention, comparator, and outcome. Special issues related to studies in children and implications for stakeholders are also discussed. It is recommended that the evaluation of gastrointestinal tolerance to NDCs be conducted in randomized, blinded, controlled crossover studies using standard gastrointestinal questionnaires, with attention to study participant background diets, health status, lifestyle, and medications.

Dietary Fats, Human Nutrition and the Environment: Balance and Sustainability.

Dietary fats are essential ingredients of a healthy diet. Their production, however, impacts the environment and its capacity to sustain us. Growing knowledge across multiple disciplines improves our understanding of links between food, health and sustainability, but increases apparent complexity. Whereas past dietary guidelines placed limits on total fat intake especially saturated fats, recent studies indicate more complex links with health. Guidelines differ between regions of general poverty and malnutrition and those where obesity is a growing problem. Optimization of production to benefit health and environmental outcomes is hindered by limited data and shared societal goals. We lack a detailed overview of where fats are being produced, and their environmental impacts. Furthermore, the yields of different crops, for producing oils or feeding animals, and the associated land needs for meeting oil demands, differ greatly. To illuminate these matters, we review current discourse about the nutritional aspects of edible fats, summarize the inferred environmental implications of their production and identify knowledge gaps.

A Classification System for Defining and Estimating Dietary Intake of Live Microbes in US Adults and Children.

BACKGROUND: Consuming live microbes in foods may benefit human health. Live microbe estimates have not previously been associated with individual foods in dietary databases. OBJECTIVES: We aimed to estimate intake of live microbes in US children (aged 2-18 y) and adults (≥19 y) (n = 74,466; 51.2% female). METHODS: Using cross-sectional data from the NHANES (2001-2018), experts assigned foods an estimated level of live microbes per gram [low (Lo), <104 CFU/g; medium (Med), 104-107 CFU/g; or high (Hi), >107 CFU/g]. Probiotic dietary supplements were also assessed. The mean intake of each live microbe category and the percentages of subjects who ate from each live microbe category were determined. Nutrients from foods with live microbes were also determined using the population ratio method. Because the Hi category comprised primarily fermented dairy foods, we also looked at aggregated data for Med or Hi (MedHi), which included an expanded range of live microbe-containing foods, including fruits and vegetables. RESULTS: Our analysis showed that 52%, 20%, and 59% of children/adolescents, and 61%, 26%, and 67% of adults, consumed Med, Hi, or MedHi foods, respectively. Per capita intake of Med, Hi, and MedHi foods was 69, 16, and 85 g/d for children/adolescents, and 106, 21, and 127 g/d for adults, respectively. The proportion of subjects who consumed live microbes and overall per capita intake increased significantly over the 9 cycles/18-y study period (0.9-3.1 g/d per cycle in children across categories and 1.4 g/d per cycle in adults for the Med category). CONCLUSIONS: This study indicated that children, adolescents, and adults in the United States steadily increased their consumption of foods with live microbes between the earliest (2001-2002) and latest (2017-2018) survey cycles. Additional research is needed to determine the relations between exposure to live microbes in foods and specific health outcomes or biomarkers.

Effectiveness of Nutritional Ingredients on Upper Gastrointestinal Conditions and Symptoms: A Narrative Review.

Nutritional ingredients, including various fibers, herbs, and botanicals, have been historically used for various ailments. Their enduring appeal is predicated on the desire both for more natural approaches to health and to mitigate potential side effects of more mainstream treatments. Their use in individuals experiencing upper gastrointestinal (GI) complaints is of particular interest in the scientific space as well as the consumer market but requires review to better understand their potential effectiveness. The aim of this paper is to review the published scientific literature on nutritional ingredients for the management of upper GI complaints. We selected nutritional ingredients on the basis of mentions within the published literature and familiarity with recurrent components of consumer products currently marketed. A predefined literature search was conducted in Embase, Medline, Derwent drug file, ToXfile, and PubMed databases with specific nutritional ingredients and search terms related to upper GI health along with a manual search for each ingredient. Of our literature search, 16 human clinical studies including nine ingredients met our inclusion criteria and were assessed in this review. Products of interest within these studies subsumed the categories of botanicals, including fiber and combinations, and non-botanical extracts. Although there are a few ingredients with robust scientific evidence, such as ginger and a combination of peppermint and caraway oil, there are others, such as melatonin and marine alginate, with moderate evidence, and still others with limited scientific substantiation, such as galactomannan, fenugreek, and zinc-l-carnosine. Importantly, the paucity of high-quality data for the majority of the ingredients analyzed herein suggests ample opportunity for further study. In particular, trials with appropriate controls examining dose-response using standardized extracts and testing for specific benefits would yield precise and effective data to aid those with upper GI symptoms and conditions.

Do Refined Grains Have a Place in a Healthy Dietary Pattern: Perspectives from an Expert Panel Consensus Meeting.

Although dietary guidance recommends increasing consumption of whole grains and concurrently limiting consumption of refined and/or enriched grain foods, emerging research suggests that certain refined grains may be part of a healthy dietary pattern. A scientific expert panel was convened to review published data since the release of 2015 dietary guidance in defined areas of grain research, which included nutrient intakes, diet quality, enrichment/fortification, and associations with weight-related outcomes. Based on a 1-d roundtable discussion, the expert panel reached consensus that 1) whole grains and refined grains can make meaningful nutrient contributions to dietary patterns, 2) whole and refined grain foods contribute nutrient density, 3) fortification and enrichment of grains remain vital in delivering nutrient adequacy in the American diet, 4) there is inconclusive scientific evidence that refined grain foods are linked to overweight and obesity, and 5) gaps exist in the scientific literature with regard to grain foods and health.

Understanding the Intersection of Climate/Environmental Change, Health, Agriculture, and Improved Nutrition: A Case Study on Micronutrient Nutrition and Animal Source Foods.

With a growing global population, the demand for high-quality food to meet nutritional needs continues to increase. Our ability to meet those needs is challenged by a changing environment that includes constraints on land and water resources and growing concerns about the impact of human activity including agricultural practices on the changing climate. Adaptations that meet food/nutritional demands while avoiding unintended consequences including negatively affecting the environment are needed. This article covers a specific case study, the role of animal source foods (ASFs) in meeting micronutrient needs in a changing environment. The article covers our understanding of the role of ASFs in meeting micronutrient needs, evidence-based approaches to the development of nutrition guidance, the current issues associated with the relation between animal production practices and greenhouse gas emissions, and examples of how we might model the myriad sources of relevant data to better understand these complex interrelations.

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Definitions, regulations, and new frontiers for dietary fiber and whole grains.

The aim of this article is to review the definitions and regulations for dietary fiber and whole grains worldwide and to discuss barriers to meeting recommended intake levels. Plant foods, such as whole grains, that are rich in dietary fiber are universally recommended in dietary guidance. Foods rich in dietary fiber are recommended for all, but dietary recommendations for whole grains and dietary fiber depend on definitions and regulations. Official recommendations for dietary fiber in the United States and Canada are denoted by dietary reference intakes (DRIs), which are developed by the Institute of Medicine. An adequate intake (AI) for dietary fiber was based on prospective cohort studies of dietary fiber intake and cardiovascular disease risk that found 14 grams of dietary fiber per 1000 kilocalories protected against cardiovascular disease (CVD). This value was used to set AIs for dietary fiber across the life cycle based on recommended calorie intakes. Actual intakes of dietary fiber are generally about half of the recommended levels. Recommendations for whole grain intake are equally challenging, as definitions for whole grain foods are needed to set recommendations. The 2005 Dietary Guidelines for Americans recommended that half of all grain servings be whole grains, but usual intakes are generally less than 1 serving per day, rather than the recommended 3 servings per day. Scientific support for whole grain recommendations is based on the same prospective cohort studies and links to CVD protection used to inform dietary fiber guidance. Thus, dietary fiber is a recommended nutrient and whole grains are a recommended dietary pattern in dietary guidance in North America and around the world. Challenges for attaining recommended intakes of dietary fiber and whole grains include low-carbohydrate diets, low-gluten diets, and public health recommendations to avoid processed foods.

Potential Cardiometabolic Health Benefits of Full-Fat Dairy: The Evidence Base.

Since their inception in 1980, the Dietary Guidelines for Americans have promoted low- or fat-free dairy foods. Removing fat from dairy does not reduce putatively beneficial nutrients per serving, including calcium, vitamin D, and potassium. Additionally, links between saturated fat and dietary cholesterol intakes with cardiovascular disease risk have helped to sustain the view that low-fat dairy foods should be recommended. Emerging evidence shows that the consumption of full-fat dairy foods has a neutral or inverse association with adverse cardiometabolic health outcomes, including atherosclerotic cardiovascular disease, type 2 diabetes, and associated risk factors. Thus, although low-fat dairy is a practical, practice-based recommendation, its superiority compared with full-fat dairy is not obviously supported by results from recent prospective cohort studies or intervention trials. To evaluate the emerging science on full-fat dairy, a group of nutrition experts convened to summarize and discuss the scientific evidence regarding the health effects of consuming full-fat dairy foods. Future studies should focus on full-fat dairy foods (milk, yogurt, and cheese) in the context of recommended dietary patterns and consider meal composition and metabolic phenotype in assessing the relation between full-fat dairy consumption and cardiometabolic health.

The Influence of Diet Interventions Using Whole, Plant Food on the Gut Microbiome: A Narrative Review.

Dietary intake is a key determinant of gastrointestinal microbiota composition. Studies have considered the relationship between gut microbiota and dietary patterns. It is likely that certain plant foods that contain fiber and other bioactive matter may be more likely to drive microbial changes than others; however, study design and other factors can make interpretation of the literature difficult. Fifteen well-controlled, well-defined diet interventions published between 2008 and 2018 using whole, plant foods were evaluated for their influence on gut microbiota. There was limited effect on microbial diversity across studies and modest microbial changes were noted in 10 of 15 studies. More research is needed before specific plant foods can be recommended to improve gut microbiota and ultimately health. Methodologic considerations for future diet and microbiome studies are discussed. Additional research to better understand how specific whole, plant foods influence microbe composition, functionality, and metabolite production is needed, as are mechanistic studies linking diet-induced gut microbe changes to health.

Role of plant protein in nutrition, wellness, and health.

Plant-based diets, and more specifically plant-based proteins, have been the subject of growing interest from researchers and consumers because of their potential health benefits as well as their positive environmental impact. Of course, plant proteins are found in plant foods, and positive health benefits of plant foods are linked to dietary fiber, vitamins, minerals, and phytochemicals. In epidemiological studies it is not possible to separate out the health benefits of plant foods in general as opposed to plant proteins specifically. Additionally, few vegans, who consume only plant-based proteins, are included in existing prospective cohort studies. Isolated plant proteins (soy, pea) have been used in intervention trials, but often to improve biomarkers linked to disease risk, including serum lipids or blood pressure. This review is an overview of plant proteins, the whole foods they are associated with, and the potential health benefits linked to consumption of protein from plant sources. Plant proteins and their potential for reducing the risk of developing metabolic syndrome, diabetes management, cancer prevention, and weight management are each discussed, as are the various rating systems currently used to determine protein quality from plant sources. Although additional research is needed that focuses specifically on the role that plant protein plays in the prevention and management of these chronic illnesses, rather than the role played by a more general plant-based diet, evidence suggests that plant proteins offer nutritional benefits to those who consume them. Limitations to plant proteins, including lower protein quality, must also be considered in this discussion.

Effect of whole-grain consumption on changes in fecal microbiota: a review of human intervention trials.

Whole-grain (WG) consumption is known to have beneficial effects on human health. However, the influence of WGs on the microbiota is not well understood. To evaluate how WG intake modulates the gut microbiota composition, a literature review of human intervention studies was conducted. Whole grain, whether a mixed WG food or diet (n = 5) or specific WG intervention (WG wheat [n = 5], barley [n = 2], rye [n = 2] or rice, corn, or oats [n = 1 for each]), generally modified microbiota composition but did so inconsistently across measurements of microbial diversity and taxa. Interventions used both parallel and crossover designs and varied from single product substitutions to fully controlled diets with WG exposures of 3-12 weeks. The effect of amount of WG was difficult to capture due to variable reporting of WG. Methods used to measure microbiota varied in ability to resolve changes at different taxonomic levels, and comparisons of interventions using similar methods was lacking. Because many dietary components besides WGs alter gut microbiota, further research is needed, particularly in linking microbiota changes to health outcomes, and study design recommendations for future research on WGs and microbiota are warranted.

Relevance of the Glycemic Index and Glycemic Load for Body Weight, Diabetes, and Cardiovascular Disease.

Despite initial enthusiasm, the relationship between glycemic index (GI) and glycemic response (GR) and disease prevention remains unclear. This review examines evidence from randomized, controlled trials and observational studies in humans for short-term (e.g., satiety) and long-term (e.g., weight, cardiovascular disease, and type 2 diabetes) health effects associated with different types of GI diets. A systematic PubMed search was conducted of studies published between 2006 and 2018 with key words glycemic index, glycemic load, diabetes, cardiovascular disease, body weight, satiety, and obesity. Criteria for inclusion for observational studies and randomized intervention studies were set. The search yielded 445 articles, of which 73 met inclusion criteria. Results suggest an equivocal relationship between GI/GR and disease outcome. The strongest intervention studies typically find little relationship among GI/GR and physiological measures of disease risk. Even for observational studies, the relationship between GI/GR and disease outcomes is limited. Thus, it is unlikely that the GI of a food or diet is linked to disease risk or health outcomes. Other measures of dietary quality, such as fiber or whole grains may be more likely to predict health outcomes. Interest in food patterns as predictors of health benefits may be more fruitful for research to inform dietary guidance.

Considerations for best practices in studies of fiber or other dietary components and the intestinal microbiome.

A 2-day workshop organized by the National Institutes of Health and U.S. Department of Agriculture included 16 presentations focused on the role of diet in alterations of the gastrointestinal microbiome, primarily that of the colon. Although thousands of research projects have been funded by U.S. federal agencies to study the intestinal microbiome of humans and a variety of animal models, only a minority addresses dietary effects, and a small subset is described in sufficient detail to allow reproduction of a study. Whereas there are standards being developed for many aspects of microbiome studies, such as sample collection, nucleic acid extraction, data handling, etc., none has been proposed for the dietary component; thus this workshop focused on the latter specific point. It is important to foster rigor in design and reproducibility of published studies to maintain high quality and enable designs that can be compared in systematic reviews. Speakers addressed the influence of the structure of the fermentable carbohydrate on the microbiota and the variables to consider in design of studies using animals, in vitro models, and human subjects. For all types of studies, strengths and weaknesses of various designs were highlighted, and for human studies, comparisons between controlled feeding and observational designs were discussed. Because of the lack of published, best-diet formulations for specific research questions, the main recommendation is to describe dietary ingredients and treatments in as much detail as possible to allow reproduction by other scientists.

Health Effects and Sources of Prebiotic Dietary Fiber.

Prebiotic dietary fibers act as carbon sources for primary and secondary fermentation pathways in the colon, and support digestive health in many ways. Fructooligosaccharides, inulin, and galactooligosaccharides are universally agreed-upon prebiotics. The objective of this paper is to summarize the 8 most prominent health benefits of prebiotic dietary fibers that are due to their fermentability by colonic microbiota, as well as summarize the 8 categories of prebiotic dietary fibers that support these health benefits. Although not all categories exhibit similar effects in human studies, all of these categories promote digestive health due to their fermentability. Scientific and regulatory definitions of prebiotics differ greatly, although health benefits of these compounds are uniformly agreed upon to be due to their fermentability by gut microbiota. Scientific evidence suggests that 8 categories of compounds all exhibit health benefits related to their metabolism by colonic taxa.

Fructooligosaccharides and appetite.

PURPOSE OF REVIEW: Dietary fiber may play a role in obesity prevention through reduction of body weight and control of appetite, however, not all fibers are created equally, and characteristics of fiber such as viscosity, fermentability and solubility may affect appetite differently. RECENT FINDINGS: Although early studies supported that fructan fibers, including inulin, fructooligosaccharides, and oligofructose affected satiety, more recent studies are less supportive. We found that a higher dose of fiber such as oligofructose (16 g/day) is needed and for a longer duration (12-16 weeks) to detect differences in appetite and subsequent energy intake, whereas, practical amounts of fructooligosaccharides, less than 10 g/day, generally do not affect satiety or food intake. It should be noted that there are many sources of fructan fibers, both in native foods, chicory roots, agave, and Jerusalem artichokes and isolated forms that vary in chain length. SUMMARY: Fructan fibers, which include fructooligosaccharides, oligofructose, and inulin, provided in low doses (<10 g/day), generally do not affect measures of human appetite including satiety or food intake and should not be recommended as a fiber with sole satiating power.

The benefits of defining "snacks".

Whether eating a "snack" is considered a beneficial or detrimental behavior is largely based on how "snack" is defined. The term "snack food" tends to connote energy-dense, nutrient-poor foods high in nutrients to limit (sugar, sodium, and/or saturated fat) like cakes, cookies, chips and other salty snacks, and sugar-sweetened beverages. Eating a "snack food" is often conflated with eating a "snack," however, leading to an overall perception of snacks as a dietary negative. Yet the term "snack" can also refer simply to an eating occasion outside of breakfast, lunch, or dinner. With this definition, the evidence to support health benefits or detriments to eating a "snack" remains unclear, in part because relatively few well-designed studies that specifically focus on the impact of eating frequency on health have been conducted. Despite these inconsistencies and research gaps, in much of the nutrition literature, "snacking" is still referred to as detrimental to health. As discussed in this review, however, there are multiple factors that influence the health impacts of snacking, including the definition of "snack" itself, the motivation to snack, body mass index of snack eaters, and the food selected as a snack. Without a definition of "snack" and a body of research using methodologically rigorous protocols, determining the health impact of eating a "snack" will continue to elude the nutrition research community and prevent the development of evidence-based policies about snacking that support public health.

Fermentability of Novel Type-4 Resistant Starches in In Vitro System.

Resistant starches are non-digestible starches that are fermented in the colon by microbiota. These carbohydrates are prebiotic and can be beneficial to consumer health. Many types of resistant starch exist with varying physical properties that may result in differences in fermentability. The objective of this research project was to compare potential prebiotic effects and fermentability of four novel resistant starches using an in vitro fermentation system and measuring changes in total gas production, pH, and formation of SCFAs (short chain fatty acids). Fecal donations were collected from seven healthy volunteers. Four novel resistant starches, modified potato starch (MPS), modified tapioca starch (MTS), and modified maize starches (MMS-1 and MMS-2), were analyzed and compared to polydextrose and short chain fructooligosaccharides (FOS) as controls. After twenty-four hours of fermentation, MPS and MTS responded similarly in gas production (74 mL; 70.6 mL respectively), pH (5.93; 5.93 respectively), and SCFA production (Acetate: 115; 124, Propionate: 21; 26, Butyrate: 29; 31 µmol/mL respectively). While MMS-1 had similar gas production and individual SCFA production, the pH was significantly higher (6.06). The fermentation of MMS-2 produced the least amount of gas (22 mL), with a higher pH (6.34), and lower acetate production (78.4 µmol/mL). All analyzed compounds were fermentable and promoted the formation of beneficial SCFAs.