Assessing the Cost of Nutritionally Adequate and Low-Climate Impact Diets in Finland.

Background: Dietary changes form an important component of the sustainability transition of food systems but could be hindered by the cost of sustainable diets. Objectives: This study aimed to characterize the cost of nutritionally adequate and culturally acceptable diets with low-greenhouse gas emissions (GHGEs) in Finland. Methods: Two optimization models were built to find diets complying with nutritional and emissions requirements. The first model minimizes diet cost and the second one deviation from current diets. Both are calibrated to Finnish sociodemographic groups using dietary intake data, household budget survey data (for prices), and life cycle assessment coefficients (for GHGE). Three scenarios are simulated: "Health only" imposes only compliance with nutritional constraints, whereas "Health and GHGE-33%" and "Health and GHGE-50%" impose, in addition, minimum reductions in GHGE. Results: Minimum cost diets have a low-carbon footprint [-65% (-73%) for females (males)] and low cost [-69% (-73%) for females (males)] when compared with current diets but lack diversity and cultural acceptability. The more culturally acceptable health-only minimum deviation diets are marginally less costly and have a lower climate impact than baseline diets across all population groups. Reducing GHGE results in a substantial decrease in the cost of the minimum deviation diets. The lower cost of the minimum deviation diets with reduced GHGE results from both intercategory and intracategory substitutions. Conclusions: Affordability is not the key obstacle to the adoption of nutritionally adequate and lower GHGE diets, but cultural acceptability is. Reducing the climate footprint of diets can generate side benefits in terms of nutrition and affordability, which confirms that dietary change should be central to the sustainability transition of the Finnish food system. However, more attention should be paid to the issues of taste, convenience, social norms, and other aspects determining the cultural acceptability of sustainable diets.

Reducing the carbon footprint of diets across socio-demographic groups in Finland: a mathematical optimisation study.

OBJECTIVES: To characterise nutritionally adequate, climate-friendly diets that are culturally acceptable across socio-demographic groups. To identify potential equity issues linked to more climate-friendly and nutritionally adequate dietary changes. DESIGN: An optimisation model minimises distance from observed diets subject to nutritional, greenhouse gas emissions (GHGE) and food-habit constraints. It is calibrated to socio-demographic groups differentiated by sex, education and income levels using dietary intake data. The environmental coefficients are derived from life cycle analysis and an environmentally extended input-output model. SETTING: Finland. PARTICIPANTS: Adult population. RESULTS: Across all population groups, we find large synergies between improvements in nutritional adequacy and reductions in GHGE, set at one-third or half of the current level. Those reductions result mainly from the substitution of meat with cereals, potatoes and roots and the intra-category substitution of foods, such as beef with poultry in the meat category. The simulated more climate-friendly diets are thus flexitarian. Moving towards reduced-impact diets would not create major inadequacies related to protein and fatty acid intakes, but Fe could be an issue for pre-menopausal females. The initial socio-economic gradient in the GHGE of diets is small, and the patterns of adjustments to more climate-friendly diets are similar across socio-demographic groups. CONCLUSIONS: A one-third reduction in GHGE of diets is achievable through moderate behavioural adjustments, but achieving larger reductions may be difficult. The required changes are similar across socio-demographic groups and do not raise equity issues. A population-wide policy to promote behavioural change for diet sustainability would be appropriate.

The impacts of partial replacement of red and processed meat with legumes or cereals on protein and amino acid intakes: a modelling study in the Finnish adult population.

BACKGROUND: A shift towards more plant-based diets is considered healthy and environmentally sustainable but may cause a concern regarding protein and amino acid intakes. This modelling study aimed to assess the impacts of partial replacement of red and processed meat with legumes or cereals on the protein and indispensable amino acid intakes in the Finnish adult population. MATERIALS AND METHODS: We used the cross-sectional data of the National FinDiet 2017 Survey (two non-consecutive 24-h recalls, n = 1655, 47% men, aged 18-74 years). Six replacement scenarios were created in which the amount of red and processed meat exceeding 70 g/day (Finnish nutrition recommendation), or 30 g/day (EAT-Lancet recommendation) was replaced with the same amounts of legumes, cereals or their combination. Differences to the reference diet were evaluated based on non-overlapping 95% confidence intervals. Population shares (%) below estimated average requirements (EAR) were calculated using the usual intake modelling methodology (SPADE). RESULTS: The replacement scenarios decreased the protein and indispensable amino acid intakes depending on gender and age. At the 70-g level, decreases were observed only in men aged 18-64 years. At the 30-g level, decreases were observed in other gender and age groups except women aged 65-74 years. In the scenarios, the mean daily protein intake was 15-18% of total energy intake (E%) (reference 17-18 E%), and the proportions below the EAR were 7-10% in men and 8-10% in women aged 18-64 years (reference 5-7%) and 20-25% in men and 16-20% in women aged 65-74 years (reference 14-17%). For total indispensable amino acids, the proportions below the EAR were <5% in the reference diet and the scenarios. CONCLUSIONS: The mean daily protein intake remained sufficient when red and processed meat was partially replaced with legumes or cereals in the Finnish adult population. However, protein adequacy in the elderly population warrants attention and more research.

This modelling study supports global efforts towards more plant-based diets, essential to human and planetary health, by providing insight into the impacts of partial replacement of red and processed meat with legumes or cereals on protein and indispensable amino acid intakes in the Finnish adult population.In general, the mean daily protein and indispensable amino acid intakes decreased but remained sufficient also when substantial amounts of red and processed meat were replaced with legumes or cereals.Some elderly men and women, however, had protein intake below the estimated average requirement, which needs to be considered particularly in the transition towards more plant-based and sustainable diets.

Partial replacement of red and processed meat with legumes: a modelling study of the impact on nutrient intakes and nutrient adequacy on the population level.

OBJECTIVE: The shift towards plant-based diets with less meat and more legumes is a global target and requires an understanding of the consequences of dietary adequacy on the population level. Our aim was to model the impact of partial replacement of red and processed meat with legumes on nutrient intakes and population shares below dietary reference intakes. DESIGN: Modelling study with three scenarios anchored in meat cut-offs: ≤ 70 g/d (Finnish dietary guideline); ≤ 50 g/d (Danish dietary guideline); ≤ 30 g/d (EAT-Lancet recommendation). In all subjects, the amount of meat in grams over the cut-off was replaced with the same amount of legumes. The SPADE method was used to model usual intake distributions. Meaningful differences in average intakes and in population shares below dietary reference intakes compared to the reference (FinDiet) were evaluated based on non-overlapping 95 % CI. SETTING: Finnish national food consumption survey (FinDiet 2017). SUBJECTS: Finnish adults (n 1655) aged18-74 years (47 % men). RESULTS: The scenarios introduced increases in the average intakes of fibre, folate, K, Mg, Cu and Fe, and decreases in intakes of saturated fat, niacin, vitamin B12, Se and Zn. Meaningful shifts of the usual intake distributions of fibre and folate towards improvement in intakes emerged already in 'scenario 70 g'. Overall, distribution shifts towards a higher probability of inadequate intakes of the studied nutrients were not observed. CONCLUSIONS: These results support the public health message to partly replace meat with legumes and may benefit nutrition policy actions towards sustainable diets in the Nordic countries and beyond.

Disparities in Nutritional Adequacy of Diets between Different Socioeconomic Groups of Finnish Adults.

Information on dietary adequacy is needed to assess food and nutrition security in a modern society, especially in the transition towards climate-friendly food systems. In this study, differences in the nutritional adequacy of diets among Finnish adults were evaluated in population groups of different education, income and urbanisation levels. The study used data from the FinDiet 2017 Survey (n = 1655, 18-74 years). Modelled usual intakes of foods and nutrients were evaluated relative to food-based dietary guidelines issued by the National Nutrition Council of Finland (FNNC) and with respect to nutrient adequacy following the Nordic Nutrition Recommendations and FNNC. For about half of the nutrients studied, intakes were found to be adequate. Intakes of protein, fat, saturated fatty acids and salt were estimated to be high. By contrast, inadequate intakes were seen in folate and vitamins A, D, B1, B2 and C in almost all groups studied. Groups with a higher education and income, groups that lived in urban areas and, in particular, women adhered more closely to recommended food consumption and nutrient intakes than others. However, major challenges posed by the Finnish diet are common to all groups studied, and only certain dietary features evaluated in view of nutritional adequacy are associated with socioeconomic differences.

Dose-Dependent Associations of Dietary Glycemic Index, Glycemic Load, and Fiber With 3-Year Weight Loss Maintenance and Glycemic Status in a High-Risk Population: A Secondary Analysis of the Diabetes Prevention Study PREVIEW.

OBJECTIVE: To examine longitudinal and dose-dependent associations of dietary glycemic index (GI), glycemic load (GL), and fiber with body weight and glycemic status during 3-year weight loss maintenance (WLM) in adults at high risk of type 2 diabetes. RESEARCH DESIGN AND METHODS: In this secondary analysis we used pooled data from the PREVention of diabetes through lifestyle Intervention and population studies in Europe and around the World (PREVIEW) randomized controlled trial, which was designed to test the effects of four diet and physical activity interventions. A total of 1,279 participants with overweight or obesity (age 25-70 years and BMI ≥25 kg ⋅ m-2) and prediabetes at baseline were included. We used multiadjusted linear mixed models with repeated measurements to assess longitudinal and dose-dependent associations by merging the participants into one group and dividing them into GI, GL, and fiber tertiles, respectively. RESULTS: In the available-case analysis, each 10-unit increment in GI was associated with a greater regain of weight (0.46 kg ⋅ year-1; 95% CI 0.23, 0.68; P < 0.001) and increase in HbA1c. Each 20-unit increment in GL was associated with a greater regain of weight (0.49 kg ⋅ year-1; 0.24, 0.75; P < 0.001) and increase in HbA1c. The associations of GI and GL with HbA1c were independent of weight change. Compared with those in the lowest tertiles, participants in the highest GI and GL tertiles had significantly greater weight regain and increases in HbA1c. Fiber was inversely associated with increases in waist circumference, but the associations with weight regain and glycemic status did not remain robust in different analyses. CONCLUSIONS: Dietary GI and GL were positively associated with weight regain and deteriorating glycemic status. Stronger evidence on the role of fiber is needed.

Associations of healthy food choices with gut microbiota profiles.

BACKGROUND: Diet has a major influence on the human gut microbiota, which has been linked to health and disease. However, epidemiological studies on associations of a healthy diet with the microbiota utilizing a whole-diet approach are still scant. OBJECTIVES: To assess associations between healthy food choices and human gut microbiota composition, and to determine the strength of association with functional potential. METHODS: This population-based study sample consisted of 4930 participants (ages 25-74; 53% women) in the FINRISK 2002 study. Intakes of recommended foods were assessed using a food propensity questionnaire, and responses were transformed into healthy food choices (HFC) scores. Microbial diversity (alpha diversity) and compositional differences (beta diversity) and their associations with the HFC score and its components were assessed using linear regression. Multiple permutational multivariate ANOVAs were run from whole-metagenome shallow shotgun-sequenced samples. Associations between specific taxa and HFC were analyzed using linear regression. Functional associations were derived from Kyoto Encyclopedia of Genes and Genomes orthologies with linear regression models. RESULTS: Both microbial alpha diversity (ß/SD, 0.044; SE, 6.18 × 10-5; P = 2.21 × 10-3) and beta diversity (R2, 0.12; P ≤ 1.00 × 10-3) were associated with the HFC score. For alpha diversity, the strongest associations were observed for fiber-rich breads, poultry, fruits, and low-fat cheeses (all positive). For beta diversity, the most prominent associations were observed for vegetables, followed by berries and fruits. Genera with fiber-degrading and SCFA-producing capacities were positively associated with the HFC score. The HFC score was associated positively with functions such as SCFA metabolism and synthesis, and inversely with functions such as fatty acid biosynthesis and the sulfur relay system. CONCLUSIONS: Our results from a large, population-based survey confirm and extend findings of other, smaller-scale studies that plant- and fiber-rich dietary choices are associated with a more diverse and compositionally distinct microbiota, and with a greater potential to produce SCFAs.

Links between gut microbiome composition and fatty liver disease in a large population sample.

Fatty liver disease is the most common liver disease in the world. Its connection with the gut microbiome has been known for at least 80 y, but this association remains mostly unstudied in the general population because of underdiagnosis and small sample sizes. To address this knowledge gap, we studied the link between the Fatty Liver Index (FLI), a well-established proxy for fatty liver disease, and gut microbiome composition in a representative, ethnically homogeneous population sample of 6,269 Finnish participants. We based our models on biometric covariates and gut microbiome compositions from shallow metagenome sequencing. Our classification models could discriminate between individuals with a high FLI (≥60, indicates likely liver steatosis) and low FLI (<60) in internal cross-region validation, consisting of 30% of the data not used in model training, with an average AUC of 0.75 and AUPRC of 0.56 (baseline at 0.30). In addition to age and sex, our models included differences in 11 microbial groups from class Clostridia, mostly belonging to orders Lachnospirales and Oscillospirales. Our models were also predictive of the high FLI group in a different Finnish cohort, consisting of 258 participants, with an average AUC of 0.77 and AUPRC of 0.51 (baseline at 0.21). Pathway analysis of representative genomes of the positively FLI-associated taxa in (NCBI) Clostridium subclusters IV and XIVa indicated the presence of, e.g., ethanol fermentation pathways. These results support several findings from smaller case-control studies, such as the role of endogenous ethanol producers in the development of the fatty liver.

Insulin-like growth factor I, binding proteins -1 and -3, risk of type 2 diabetes and macronutrient intakes in men.

The insulin-like growth factor (IGF) axis may be involved in the development of type 2 diabetes. We examined the associations of IGF-I and IGF binding proteins (IGFBP)-1 and -3 with diabetes risk and evaluated macronutrient intakes related to the observed associations. In a nested case-control study of the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study of Finnish male smokers aged 50-69 years, the IGF variables were measured from baseline serum samples for a random sample of 310 men with diabetes diagnosed during a 12-year follow-up and for 310 controls matched by age, recruitment day and intervention group. Diet at baseline was assessed using a validated FFQ. The associations of IGF proteins with diabetes risk were estimated using conditional logistic regression and the associations with macronutrient intakes using linear regression. IGF-I and IGFBP-3 were not associated with the incidence of diabetes. Higher IGFBP-1 was associated with lower diabetes risk in an unadjusted crude model (OR 0·25; 95 % CI 0·15, 0·42 in the highest quartile compared with the lowest), but not after adjustment for BMI (corresponding OR 0·76; 95 % CI 0·41, 1·40). Intakes of carbohydrates, plant protein and milk protein associated positively and intake of meat protein and fat negatively with IGFBP-1 (P<0·005). IGFBP-1 was inversely associated with diabetes risk, but the association was substantially dependent on BMI. The associations between macronutrient intakes and IGFBP-1 may reflect influences of nutrients or foods on insulin concentrations.

Naturally occurring and added sugar in relation to macronutrient intake and food consumption: results from a population-based study in adults.

Associations between sugar intake and the remaining diet are poorly described in modern food environments. We aimed at exploring associations of high naturally occurring and added sugar intakes with sociodemographic characteristics, intake of macronutrients, fibre and selected food groups. Our data comprised 4842 Finnish adults aged 25-74 years, who participated in the population-based DIetary, Lifestyle and Genetic determinants of Obesity and Metabolic syndrome (DILGOM) study. Diet was assessed by a validated 131-item FFQ. The food item disaggregation approach was used to estimate sucrose and fructose intakes from natural sources (naturally occurring sugar) and all other sources (added sugar). Sex-specific trends in macronutrient, fibre and food group intakes across sugar type quartiles were determined with general linear modelling adjusting for age, energy intake, leisure-time physical activity, smoking, education and BMI. Overall, results were similar across sexes. Young age was found to be a determinant of higher added sugar and lower naturally occurring sugar intakes (P < 0·0001). High added sugar intake was associated with low fibre intake (P < 0·0001) accompanied with lower fruit (P < 0·0001 women; P = 0·022 men) and vegetable consumption (P < 0·0001) and higher wheat consumption (P = 0·0003 women; P < 0·0001 men). Opposite results were found for naturally occurring sugar. Butter consumption increased by 28-32 % (P < 0·0001) when shifting from the lowest to the highest added sugar intake quartile, while a decrease of 26-38 % (P < 0·0001) was found for naturally occurring sugar. Therefore, the associations of sugar types with dietary carbohydrate and fat quality seem opposing. Proper adjustments with dietary variables are needed when studying independent relationships between sugar and health.

Dietary carbohydrate quantity and quality in relation to obesity: A pooled analysis of three Finnish population-based studies.

BACKGROUND: The relationship between carbohydrate intake, dietary glycaemic index (GI) and load (GL), and obesity remains unsolved. Sugar intake and obesity represent a timely topic, but studies on sugar subcategories are scarce. We aimed to study whether total carbohydrate, sucrose, lactose, fibre, dietary GI, and GL are associated with obesity in 25-79-year-old Finns. METHODS: Our pooled analysis included three cross-sectional population-based studies: the DILGOM Study (n = 4842), the Helsinki Birth Cohort Study (n =1979), and the Health 2000 Survey (n = 5521). Diet was assessed by a validated food-frequency questionnaire, and anthropometric measurements were collected by standardised protocols. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated using logistic regression analysis. RESULTS: In the model, which included sex, age, education, smoking, physical activity, and energy intake, the likelihood of being obese (body mass index ⩾ 30 kg/m(2)) appeared lower in the highest quartiles of total carbohydrate (OR 0.65; 95% CI 0.57-0.74; P for trend < 0.0001), sucrose (OR 0.53; 95% CI 0.47-0.61; P < 0.0001), and dietary GL (OR 0.64; 95% CI 0.56-0.73; P < 0.0001) compared to the lowest quartiles. In contrast, dietary GI did not associate with obesity. Fibre intake associated inversely with abdominal obesity (OR 0.80; 95% CI 0.71-0.90; P < 0.001). The inverse sucrose-obesity relationship appeared stronger in high fruit consumers compared to low fruit consumers (P for interaction 0.02). CONCLUSIONS ALTHOUGH MOST OF THE STUDIED CARBOHYDRATE EXPOSURES WERE ASSOCIATED WITH A DIMINISHED LIKELIHOOD OF BEING OBESE, PROSPECTIVE STUDIES ARE NEEDED TO ASSESS TEMPORAL RELATIONS TO SUPPORT CAUSAL INFERENCE.

Dietary intake and food sources of choline in European populations.

Choline is an important nutrient for humans. Choline intake of the European population was assessed considering the European Food Safety Authority European Comprehensive Food Consumption Database and the United States Department of Agriculture Nutrient Database. Average choline intake ranges were 151-210 mg/d among toddlers (1 to ≤3 years old), 177-304 mg/d among other children (3 to ≤10 years old), 244-373 mg/d among adolescents (10 to ≤18 years old), 291-468 mg/d among adults (18 to ≤65 years old), 284-450 mg/d among elderly people (65 to ≤75 years old) and 269-444 mg/d among very elderly people (≥75 years old). The intakes were higher among males compared with females, mainly due to larger quantities of food consumed per day. In most of the population groups considered, the average choline intake was below the adequate intake (AI) set by the Institute of Medicine in the USA. The main food groups contributing to choline intake were meat, milk, grain, egg and their derived products, composite dishes and fish. The main limitations of this study are related to the absence of choline composition data of foods consumed by the European population and the subsequent assumption made to assess their intake levels. Given the definition of AI, no conclusion on the adequacy of choline intake can be drawn for most European population groups. Such results improve the knowledge on choline intake in Europe that could be further refined by the collection of choline composition data for foods as consumed in Europe.

Dietary intake and main sources of plant lignans in five European countries.

BACKGROUND: Dietary intakes of plant lignans have been hypothesized to be inversely associated with the risk of developing cardiovascular disease and cancer. Earlier studies were based on a Finnish lignan database (Fineli(®)) with two lignan precursors, secoisolariciresinol (SECO) and matairesinol (MAT). More recently, a Dutch database, including SECO and MAT and the newly recognized lignan precursors lariciresinol (LARI) and pinoresinol (PINO), was compiled. The objective was to re-estimate and re-evaluate plant lignan intakes and to identify the main sources of plant lignans in five European countries using the Finnish and Dutch lignan databases, respectively. METHODS: Forty-two food groups known to contribute to the total lignan intake were selected and attributed a value for SECO and MAT from the Finnish lignan database (Fineli(®)) or for SECO, MAT, LARI, and PINO from the Dutch database. Total intake of lignans was estimated from food consumption data for adult men and women (19-79 years) from Denmark, Finland, Italy, Sweden, United Kingdom, and the contribution of aggregated food groups calculated using the Dutch lignin database. RESULTS: Mean dietary lignan intakes estimated using the Dutch database ranged from 1 to 2 mg/day, which was approximately four-fold higher than the intakes estimated from the Fineli(®) database. When LARI and PINO were included in the estimation of the total lignan intakes, cereals, grain products, vegetables, fruit and berries were the most important dietary sources of lignans. CONCLUSION: Total lignin intake was approximately four-fold higher in the Dutch lignin database, which includes the lignin precursors LARI and PINO, compared to estimates based on the Finnish database based only on SECO and MAT. The main sources of lignans according to the Dutch database in the five countries studied were cereals and grain products, vegetables, fruit, berries, and beverages.

Early growth and postprandial appetite regulatory hormone responses.

Strong epidemiological evidence suggests that slow prenatal or postnatal growth is associated with an increased risk of CVD and other metabolic diseases. However, little is known whether early growth affects postprandial metabolism and, especially, the appetite regulatory hormone system. Therefore, we investigated the impact of early growth on postprandial appetite regulatory hormone responses to two high-protein and two high-fat content meals. Healthy, 65-75-year-old volunteers from the Helsinki Birth Cohort Study were recruited; twelve with a slow increase in BMI during the first year of life (SGI group) and twelve controls. Subjects ate a test meal (whey meal, casein meal, SFA meal and PUFA meal) once in a random order. Plasma glucose, insulin, TAG, NEFA, ghrelin, peptide tyrosine-tyrosine (PYY), glucose-dependent insulinotropic peptide, glucagon-like peptide-1 and a satiety profile were measured in the fasting state and for 4 h after each test meal. Compared with the controls, the SGI group had about 1·5-fold higher insulin responses after the whey meal (P= 0·037), casein meal (P= 0·023) and PUFA meal (P= 0·002). TAG responses were 34-69 % higher for the SGI group, but only the PUFA-meal responses differed significantly between the groups. The PYY response of the SGI group was 44 % higher after the whey meal (P= 0·046) and 115 % higher after the casein meal (P= 0·025) compared with the controls. No other statistically significant differences were seen between the groups. In conclusion, early growth may have a role in programming appetite regulatory hormone secretion in later life. Slow early growth is also associated with higher postprandial insulin and TAG responses but not with incretin levels.

Glycaemic index, carbohydrate substitution for fat and risk of CHD in men.

We have examined the associations between dietary glycaemic index (GI), substitutions of total, low-, medium- and high-GI carbohydrates for fat and the risk of CHD. The study consisted of 21 955 male smokers, aged 50-69 years, within the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. The diet was assessed at baseline using a validated FFQ. During a 19-year follow-up, 4379 CHD cases (2377 non-fatal myocardial infarctions and 2002 CHD deaths) were identified from national registers. Relative risks (RR) and CI for CHD were analysed using Cox proportional hazards modelling, and multivariate nutrient density models were applied to examine the associations between the substitutions of macronutrients and the risk of CHD. Dietary GI was inversely associated with CHD risk: multivariate RR in the highest v. lowest quintile was 0·89 (95 % CI 0·81, 0·99). Replacement of higher-GI carbohydrates with lower-GI carbohydrates did not associate with the risk. Replacing saturated and trans-fatty acids with carbohydrates was associated with decreased CHD risk: RR for substitution of 2 % of energy intake was 0·97 (95 % CI 0·94, 0·99). On the contrary, replacing MUFA with carbohydrates was associated with an increased risk: RR for substitution of 2 % of energy intake was 1·08 (95 % CI 1·01, 1·16). We conclude that in the present study population, contrary to the hypothesis, a lower GI does not associate with a decreased risk of CHD. The associations of carbohydrates with CHD risk depend on the fatty acid composition of the diet.

Effect of low- and high-glycemic load on circulating incretins in a randomized clinical trial.

OBJECTIVE: Low-glycemic load diets lower post-prandial glucose and insulin responses; however, the effect of glycemic load on circulating incretin concentrations is unclear. We aimed to assess effects of dietary glycemic load on fasting and post-prandial glucose, insulin and incretin (i.e., glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1)) concentrations and to examine for effect modification by adiposity. MATERIALS AND METHODS: We conducted a single-center, randomized controlled crossover feeding trial in which a subset of participants had post-prandial testing. Participants were recruited from the local Seattle area. We enrolled 89 overweight-obese (BMI 28.0-39.9 kg/m(2)) and lean (BMI 18.5-25.0 kg/m(2)) healthy adults. Participants consumed two 28-day, weight-maintaining high- and low-glycemic load controlled diets in random order. Primary outcome measures were post-prandial circulating concentrations of glucose, insulin, GIP and GLP-1, following a test breakfast. RESULTS: Of the 80 participants completing both diet interventions, 16 had incretin testing and comprise the group for analyses. Following each 28-day high- and low-glycemic load diet, mean fasting concentrations of insulin, glucose, GIP and GLP-1 were not significantly different. Mean integrated post-prandial concentrations of glucose, insulin and GIP were higher (1504±476 mg/dL/min, p<0.01; 2012±644 µU/mL/min, p<0.01 and 15517±4062 pg/mL/min, p<0.01, respectively) and GLP-1 was lower (-81.6±38.5 pmol/L/min, p<0.03) following the high-glycemic load breakfast as compared to the low-glycemic load breakfast. Body fat did not significantly modify the effect of glycemic load on metabolic outcomes. CONCLUSIONS: High-glycemic load diets in weight-maintained healthy individuals lead to higher post-prandial GIP and lower post-prandial GLP-1 concentrations. Future studies evaluating dietary glycemic load manipulation of incretin effects would be helpful for establishing diabetes nutrition guidelines.

Body size at birth is associated with food and nutrient intake in adulthood.

BACKGROUND: Small body size at birth is associated with an increased risk of cardiovascular disease and type 2 diabetes. Dietary habits are tightly linked with these disorders, but the association between body size at birth and adult diet has been little studied. We examined the association between body size at birth and intake of foods and macronutrients in adulthood. METHODOLOGY/PRINCIPAL FINDINGS: We studied 1797 participants, aged 56 to 70, of the Helsinki Birth Cohort Study, whose birth weight and length were recorded. Preterm births were excluded. During a clinical study, diet was assessed with a validated food-frequency questionnaire. A linear regression model adjusted for potential confounders was used to assess the associations. Intake of fruits and berries was 13.26 g (95% confidence interval [CI]: 0.56, 25.96) higher per 1 kg/m(3) increase in ponderal index (PI) at birth, and 83.16 g (95% CI: 17.76, 148.56) higher per 1 kg higher birth weight. One unit higher PI at birth was associated with 0.14% of energy (E%) lower intake of fat (95% CI: -0.26, -0.03) and 0.18 E% higher intake of carbohydrates (95% CI: 0.04, 0.32) as well as 0.08 E% higher sucrose (95% CI: 0.00, 0.15), 0.05 E% higher fructose (95% CI: 0.01, 0.09), and 0.18 g higher fiber (95% CI: 0.02, 0.34) intake in adulthood. Similar associations were observed between birth weight and macronutrient intake. CONCLUSIONS: Prenatal growth may modify later life food and macronutrient intake. Altered dietary habits could potentially explain an increased risk of chronic disease in individuals born with small body size.

Modifying effects of alcohol on the postprandial glucose and insulin responses in healthy subjects.

BACKGROUND: Moderate alcohol consumption associates with lower risk of type 2 diabetes, but in postprandial studies, alcohol induced impaired insulin sensitivity. The measurement of the glycemic index (GI) for beer has been considered challenging because of its low carbohydrate content. Therefore, imputed GI values from 36 to 95 on the basis of carbohydrate-rich beverages have been used for beer in epidemiologic studies. OBJECTIVES: We investigated the acute effects of alcohol on glucose and insulin responses and measured GIs and insulinemic indexes (IIs) of nonalcoholic and alcoholic beers. DESIGN: In a crossover design, 10 healthy volunteers were served beer with 4.5% alcohol by volume, nonalcoholic beer, and a glucose solution with alcohol once and the reference glucose solution twice. Each portion contained 25 g available carbohydrate, and the beer and glucose solution with alcohol contained 21 g alcohol. Capillary blood samples were collected up to 2 h after ingestion, and the incremental AUCs (IAUCs), GIs, and IIs were calculated. RESULTS: Compared with the reference glucose solution, the glucose solution with alcohol produced an 18% higher postprandial glucose IAUC (P = 0.03) and had no significant effect on the insulin IAUC. Compared with the reference glucose solution, beer had no significant effect on glucose or insulin IAUCs, and nonalcoholic beer tended to reduce the glucose IAUC (P = 0.06) but not the insulin IAUC. GIs of beer and nonalcoholic beer were 119 and 80, and IIs were 130 and 88, respectively. CONCLUSIONS: Alcohol increases the postprandial glucose response, probably through impaired insulin sensitivity. GI values published for alcohol-containing beers have underestimated the true glycemic effects.

Relative validity of a FFQ in measuring carbohydrate fractions, dietary glycaemic index and load: exploring the effects of subject characteristics.

FFQ require validation as part of epidemiological research of diet-disease relationships. Studies exploring associations between carbohydrate type and chronic diseases are rapidly increasing, but information on the validity of carbohydrate fractions, dietary glycaemic index (GI) and the glycaemic load (GL) estimated by FFQ is scarce. Likewise, the effects of subject characteristics on FFQ validity have been poorly documented. The present study evaluates the relative validity of an 131-item FFQ in relation to two 3 d food records (FR) performed 6 months apart focusing on the intake of carbohydrate fractions, dietary GI and the GL. Furthermore, we assessed the extent to which subjects' age, education and BMI explain differences between these methods. The study sample comprised 218 men and 292 women aged 25-74 years participating in a large population-based survey in Finland. Energy-adjusted Spearman's rank correlations ranged from 0.27 (sugars) to 0.70 (lactose) for men and from 0.37 (sugars) to 0.69 (lactose) for women. On average, 73 % of the subjects were categorised into the same or adjacent distribution quintile based on the two methods. In general, the FFQ overestimated the intakes compared with FR. Especially in women, FFQ validity for some nutrients was associated with the level of intake, subjects' age and, to a lesser extent, education but not BMI. In conclusion, the FFQ appears to be reasonably valid in the assessment of carbohydrate exposure variables, but the findings show a need for adjustment of diet-disease relationships for subjects' age and education.

Coffee does not modify postprandial glycaemic and insulinaemic responses induced by carbohydrates.

BACKGROUND: Strong epidemiological evidence suggests that coffee consumption is associated with lower risk of type 2 diabetes. In postprandial studies, however, caffeine consumption has been associated with impaired glucose regulation. AIM OF THE STUDY: To study the acute effects of coffee and caffeine-containing soft drinks on glycaemic and insulinaemic responses. DESIGN: Twelve healthy volunteers were served each test food once and the reference glucose solution twice, containing 50 g of available carbohydrates, after an overnight fast at 1-week intervals in a random order. Capillary blood samples were drawn at 15-30 min intervals for 2 h after each study meal. The incremental areas under the curve (IAUC), glycaemic index (GI) and insulinaemic index (II), were calculated to estimate the glycaemic and insulinaemic responses. RESULTS: Glucose and insulin responses of coffees with glucose containing 150 or 300 mg of caffeine did not differ from responses of pure glucose solution; the GIs were 104 and 103, and the IIs were 89 and 92, respectively. When a bun or sucrose and milk were consumed together with coffee, lower GI values and insulin responses were observed, reflecting the carbohydrate quality and protein content of the accompaniments. Sucrose-sweetened cola produced a high GI value of 90 and an II of 61. CONCLUSIONS: Coffee does not modify glycaemic and insulinaemic responses when ingested with a carbohydrate source. Therefore, there is no need to avoid coffee as a choice of beverage in GI testing.