Search Results for: diet middle adulthood

MSHC-BSN2A: Nutrition and Diet Therapy: Health Education: Middle Adulthood
Group 7 of MSHC-BSN2A interviews a client for Nutrition and Diet Therapy class.

By: BSN1Avideos

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MSHC-BSN2A: Nutrition and Diet Therapy: Health Education: Middle Adulthood - Video

Coronary heart disease (CHD) is the leading cause of morbidity and mortality in the United States (US) and worldwide.According to estimates, 85.6 million Americans have cardiovascular disease (CVD), and the number is continuing to rise [1]. Healthy lifestyle choices may reduce the risk of myocardial infarction by more than 80% with nutrition playing a key role [2].

The refusal to eat meat (red meat, poultry, seafood, and the flesh of any other animal) is known as vegetarianism [3]. Vegetarians may be classified as vegans, pesco-vegetarians, lacto-vegetarians, lacto-ovo-vegetarians, and flexitarians [4,5]. Vegans avoid using or eating any animal products [4,5]. Pesco-vegetarians consume fish and other seafood [4,5]. Lacto-vegetarians eat dairy products; lacto-ovo-vegetarians eat dairy products and eggs [4,5]. Flexitarians occasionally or even once a week eat meat [4,5]. A plant-based diet is low in cholesterol, fat, animal products, salt, and sugar[6]. By way of dietary advice, well-planned vegetarian diets should be promoted as having advantages for preventing and reversing atherosclerosis and lowering risk factors for CVD [2].

Growing research points to health benefits and possible cardiovascular advantages of plant-based diets and eating habits that prioritize plant-based foods while reducing animal products [7]. Many studies have discovered that plant-based diets, particularly those abundant in high-quality plant foods including whole grains, fruits, vegetables, and nuts, are linked to a decreased risk of cardiovascular events and intermediate-risk factors [7,8]. The objective of this review is to determine the association between a vegetarian diet and CHD.

Over time, a lot of studies have been carried out on the prevalence of CHDs and various factors that predispose people of different races and ages to these diseases. Various modifications have been implicated over time in reducing the incidence and prevalence of these diseases. One of these is the application of a vegetarian diet.

Search Strategy

This review article was conducted using the scale for the assessment of non-systematic review articles (SANRA). We searched two databases: EMBASE (Excerpta Medica database) and PubMed (MEDLINE) using specific search terms. Search terms used were vegetarian diet AND ischemic heart disease AND cardiovascular disease. We searched for recent articles; hence, we used articles written from 2012 to 2022.

Inclusion Criteria

Original articles in the English language, from 2012 to 2022, related to the study's objectivewere included.

Exclusion Criteria

Review and commentary articles, articles older than 10 years, and articles not written in English language were excluded.

Our data search returned a total of 287 articles. These were screened for relevance to the objective, which resulted in six articles (Figure 1). Four of the six articles were observational studies and the other two were randomized studies. The articles reviewed provided the effects of vegetarian diet on CHD. The articles also revealed that adherence to a plant-based diet was inversely related to the incidence of heart failure risk and that vegetarian diet is beneficial for secondary prevention of CAD via modulation of lipid profile, reduction in BMI, and patients having a high concentration of plasma antioxidants micronutrients in their system. Also, it was seen that consumption of a plant-centered diet starting in young adulthood is associated with a lower risk of CVD by middle age (Table 1).

In a randomized cross-over study by Djekic et al., it was discovered that subjects with ischemic heart disease (IHD) experienced a reduction in oxidized low-density lipoprotein cholesterol (LDL-C) after being placed on avegetarian dietfor four weeks [9]. There was also a reduction in their cardiometabolic risk factors compared to their counterparts on an isocaloric meat diet (meat diet of the same calorie) [9]. This reduction in oxidized LDL-C has been attributed to the presence of a particular baseline gut microbiota rich in several genera of the families Ruminococcaceae and Barnesiellaceae in these individuals [9]. These gut microbes play important roles in the clearance of intestinal infections and immunomodulation [14]. Ordinarily, the conversion of LDL-C to its oxidized form enhances the formation of fatty streaks and the formation of atherosclerotic plaques [15]. People who suffer from IHD have a reasonably high level of oxidized LDL-C than people free from IHD [14]. Thus, even when on medical therapy, a vegetarian diethelp lowers the level of oxidized LDL-C in people with IHD. This was confirmed when four weeks of a vegetarian diet lowered the level of oxidized LDL-C in subjects with IHDwith a meat diet, who were also being treated with percutaneous coronary intervention (PCI) [9].Furthermore, coronary artery disease(CAD) patients on standard medical therapy, who were placed on a four-week vegetarian dietshowed a favorable and significant impact on plasma lipids, particularly sphingomyelins (SMs), alkyl phosphatidylcholine (O-PC), phosphatidylcholine (PC), and triglycerides (TGs) compared to isocaloric meat diet. Additionally, data from high-throughput lipidomics connected a vegetarian diet to the presence of long-chain polyunsaturated TGs in high concentrations and the absence of lipotoxic lipids such TGs with saturated fatty acyl chains [16]. According to another study, CAD patients had lower amounts of unsaturated TGs in their epicardial adipose tissue than persons without the condition[17].Generally, vegetarian diet improves plasma lipid profile by reducing the level of lipotoxic lipids species.

In another prospective cohort study conducted by Choi et al., a plant-centered over the long term was linked to a 52% decreased risk of incident CVD in people who were tracked since young adulthood [11]. Additionally, a 13-year rise in the quality of a plant-based diet was linked to a 61% decreased risk of CVD occurrences in the next 12-year period [11]. However, since there are other risk factors relevant to the incidence of CVDs, the timing and length of exposure to these risk factors may differ in how this illness manifests in adults. As a result, an assessment in middle or advanced age may not provide a comprehensive view of the whole spectrum of illness development in adulthood. This study demonstrated a link between a higher quality plant-based diet starting in early adulthood and a decreased risk of CVDs in adulthood[11]. Social parameters like race and educational background were also found to be mediators of the relationship between a plant-based diet and CVD incidence. A proposed mechanism of how a plant-based diet may reduce CVDs incidents is the trapping of free radicals which leads to a reduction in reactive oxygen molecules thereby preventing tissue damage. This successful endeavor has been linked to substances like phenolics, carotenoids, tocopherols, and ascorbic acid, which are plentiful in nuts and seeds, fruits, vegetables, and whole grains[18].

In a randomized controlled studyusing low-fat food plant-based diet in a community for obesity, IHD, or diabetes done by Wright et al., a reduction in BMI, cholesterol, and other risk factors was achieved [10]. The dietary approach included whole grains, legumes, vegetables, and fruits [10]. Participants were advised to eat until satiation and no restriction on total energy intake was placed. Participants were asked to not count calories. A diet chart was provided to participants outlining which foods to consume, limit, or avoid. Starches such as potatoes, sweet potato, bread, cereals, and pasta were also encouraged to satisfy their appetite and they were asked to avoid refined oils (e.g. olive or coconut oil), animal products (meat, fish, eggs, and dairy product, high-fat plant foods such as nuts and avocados, and highly processed foods. Participants were encouraged to minimize sugar, salt, and caffeinated beverages [10]. Daily vitamin B12(methylcobalamin) supplements (50g) were also provided for participants.This study was said to have had better weight reduction in six and 12 months compared to studies that do not impose calorie restrictions and frequent activity requirements.Participants in this study were focused on a whole food plant-based diet and this was attributed to the low energy density in the food consumed [10].

Shah et al, contrasted the effects of the American Heart Association's (AHA) recommended diet on CHD with those of a vegan dietin a prospective study design [1]. In patients with established CHD receiving medical treatment that followed guidelines, this research showed a considerably higher decrease in highly-sensitive C-reactive protein (hs-CRP) with a vegan diet compared to the AHA's diet recommendation. A risk indicator for serious negative cardiovascular outcomes in CHD is hs-CRP [19]. However, there was no significant difference in the degree of weight loss and waist circumference[1]. In a study of 46 patients with CHD who were assigned to a one-month vegan diet regimen with prepared meals and stress management, it was established that there was a resulting decrease in plasma cholesterol [20].Astudy analyzed the outcomes of the MultiSite Cardiac Lifestyle Intervention Program [19] and encompassed 56 CHD patients and 75 patients at risk for CHDs using a low-fat, plant-based diet, exercise, whole foods, stress management, and group support sessions. Over the course of the three months of this intervention, it was seen that waist-hip ratio, CRPs, BMI, insulin concentration, and lipid profile all decreased.

Navarro et al. demonstrated that a vegetarian diet is associated with decreased concentration of myeloperoxidase (MPO), metalloproteinase (MMP-9 and MMP-2), and tissue inhibitor of MMP (TIMP-1)/MMP-9 ratio when compared with omnivores in apparently healthy individuals [12]. The reduced concentration of these cardiovascular biomarkers has been linked to a high intake of fruits and vegetables with a reduced concentration of circulating neutrophils and leucocytes in vegetarians compared to omnivores. In metabolic syndrome and diabetes, there is an associated high concentration of leucocytes, which is also associated with high activity of MMP, cardiovascular dysfunction, and remodeling [12]. This study reiterates the association between a high intake of vegetarian meals and its associated reduced biomarkers of CVDs.

Cengiz1 et al., were able to elaborate on the general fact that a vegetarian diet reduces the risk of CVDs, a fact related to low saturated fat and cholesterol content [21]. Soy protein contains isoflavones and polyphenols, which are bioactive compounds that have been implicated in the reduction of low-density lipoprotein (LDL) levels which is important in atherosclerosis pathogenesis [22]. Studies on Isoflavones have shown that this compound is responsible for arterial vasodilation and the reduction of serum cholesterol in animal models [23]. It also inhibits atherosclerosis in postmenopausal monkeys [23]. It has been shown that vegetarian diets lower blood pressure and deaths from CHD and stroke decline when blood pressure levels drop [21].

According to Kahleova et al., the advantages of a vegetarian diet include lowering CVD risk factors and benefits in preventing atherosclerosis[2]. Blood vessels are lined with the endothelium, which helps in regulating angiogenesis and vascular tone as well as preventing leucocyte adhesion. Various adverse factors have been implicated in abnormal endothelial function; some of these are sedentary lifestyle, western diet type, hypertension, and inflammation. In a nutshell, a diet rich in meat has been associated with compromised endothelial function while high fruit and vegetable intake is associated with improved endothelial function [24]. As a matter of fact, the compromised endothelial function has been noted to improve with a vegetarian diet. Apart from CRP, other inflammatory biomarkers like interleukin-6 and soluble intercellular adhesion molecule-1 have been shown to reduce in the serum with plant based-diet [25]. These inflammatory biomarkers have been implicated in various CVDs, thus, plant based-diet plays a positive role in reversing the pathophysiology of these diseases. Increased level of trimethylamine N-oxide (TMAO) has also been associated with the risk of myocardial infarction, stroke, or even death [26].An organic substance produced by the gut bacteria is called TMAO and is a culprit which promotes atherosclerosis through the accumulation of cholesterol in foam cells [26]. Dietary phosphatidylcholine and carnitine, which are plentiful in a variety of food sources, such as eggs, dairy products, and red meat, are then used in its hepatic metabolism of it. Vegetarians' gut microbiome generates less triethylamine, which is the precursor of TMAO, thus, a consequential reduction in the incidence of CVDs [27].

This review demonstrated its strength in its ability to explore the effects of a vegetarian diet on CHD.Across all selected articles, the impact of the reduction in the risk factors associated with CHD was also demonstrated. The limitations observed include the following: studies conducted in clinical settings could have observer bias because of the possible influence of the researcher's expectations. Also, the causal relationship between a vegetarian diet and CHD could not be appreciated in the included articles that were observational studies.Another limitation was the attrition effect, as most of the patients were lost to follow-up and they may be underreporting dietary intake among participants. There is a need to use a population size that reflects the effects of a vegetarian diet on CHD across race, sex, and socioeconomic classification.

An increase in sensitization and education efforts is imperative to ensure that people are appropriately informed about this great option to improve their quality of life significantly. Beyond education, however, is the issue of accessibility. Good quality, organic whole foods are very expensive and most times outside the budget range of most families, and these disparities are even more glaring when you examine them by racial demographics.Working on subsidizing the prices of good quality foods to improve accessibility in addition to education will go a long way towards encouraging more people to adopt a vegetarian or vegan diet.

View post:
A Comprehensive Review on the Effects of Vegetarian Diets on Coronary Heart Disease - Cureus

Most people want to live a long and happy life or at least avoid a short and miserable one. If youre in that majority, then youre in luck. Over the last decade,a quiet research revolutionhas occurred in our understanding of the biology of aging.

The challenge is to turn this knowledge into advice and treatments we can benefit from. Here we bust the myth that lengthening healthy life expectancy is science fiction, and show that it is instead scientific fact.

Theres plenty of evidence for the benefits of doing the boring stuff, such as eating right. Astudy of large groups of ordinary peopleshow that keeping the weight off, not smoking, restricting alcohol to moderate amounts and eating at least five servings of fruit and vegetable a day can increase your life expectancy by seven to 14 years compared with someone who smokes, drinks too much and is overweight.

Cutting down calories even more by about a third, so-called dietary restriction improves health and extends life in mice and monkeys, as long as they eat the right stuff, though thats a tough ask for people constantly exposed to food temptation. The less extreme versions oftime-restricted or intermittent fasting only eating during an eight-hour window each day, or fasting for two days every week is thought to reduce the risk of middle-aged people getting age-related diseases.

You cant outrun a bad diet, but that doesnt mean that exercise does not do good things. Globally, inactivity directly causes roughly 10% of all prematuredeaths from chronic diseases, such as coronary heart disease, Type 2 diabetes and various cancers. If everyone on Earth got enough exercise tomorrow, the effect would probably be to increase healthy human life expectancy by almost a year.

But how much exercise is optimal? Very high levels are actually bad for you, not simply in terms of torn muscles or sprained ligaments. It can suppress the immune system andincrease the riskof upper respiratory illness. Just over30 minutesa day of moderate to vigorous physical activity is enough for most people. Not only does that make you stronger and fitter, it has been shown toreduce harmful inflammationand even improve mood.

However fit you are and well you eat, your immune system will, unfortunately, get less effective as you get older. Poor responses to vaccination and an inability to fight infection are consequences of this immunosenescence. It all starts to go downhill in early adulthood when the thymus a bowtie-shaped organ in your throat starts to wither.

That sounds bad, but its even more alarming when you realize that the thymus is where immune agents called T cells learn to fight infections. Closing such a major education center for T cells means that theycant learn to recognizenew infections or fight off cancer effectively in older people.

You can help a bit by making sure you have enough key vitamins, especially A and D. A promising area of research is looking at signals that the body sends to help make more immune cells, particularly a molecule calledIL-7. We may soon be able to producedrugs that contain this molecule, potentially boosting the immune system in older people.

Another approach is to use the food supplement spermidine to trigger immune cells to clear out their internal garbage, such as damaged proteins, which improves the elderly immune system so muchthat its now being testedas a way of getting better responses to COVID vaccines in older people.

Senescence is a toxic state that cells enter into as we get older, wreaking havoc across the body and generating chronic low-grade inflammation and disease essentially causing biological aging. In 2009, scientists showed that middle-aged micelived longer and stayed healthierif they were given small amounts of a drug called rapamycin, which inhibits a key protein called mTOR that helps regulate cells response to nutrients, stress, hormones and damage.

In the lab, drugs like rapamycin (called mTOR inhibitors) make senescent (aged) human cellslook and behave like their younger selves. Though its too early to prescribe these drugs for general use, a new clinical trial has just been set up to test whether low-dose rapamycincan really slow down aging in people.

Discovered in the soil of Easter Island, Chile, rapamycin carries with it significant mystique and [has been hailed] in the popular press as a possible elixir of youth. It can evenimprove the memory of micewith dementia-like disease.

But all drugs come with pros and cons and as too much rapamycin suppresses the immune system, many doctors are averse to even consider it to stave off age-related diseases. However, the dose is critical and newer drugs such asRTB101that work in a similar way to rapamycin support the immune system in older people, and can evenreduce COVID infection ratesand severity.

Completely getting rid of senescent cells is another promising way forward. A growing number of lab studies in mice using drugs to kill senescent cells so-called senolytics show overall improvements in health, and as the mice arent dying of disease,they end up living longer too.

Removing senescent cells also helps people. In a small clinical trial, people with severe lung fibrosis reported better overall function, including how far and fast they could walk,after they had been treatedwith senolytic drugs.

But this is only the tip of the iceberg. Diabetes and obesity, as well as infection with some bacteria and viruses, can lead to more senescent cells forming. Senescent cells also make the lungs more susceptible to COVID infection, and COVIDmakes more cells become senescent. Importantly, getting rid of senescent cells in old micehelps them to survive COVID infection.

Aging and infection are a two-way street. Older people get more infectious diseases as their immune systems start to run out of steam, while infection drives faster aging through senescence. Since aging and senescence are inextricably linked with both chronic and infectious diseases in older people, treating senescence is likely to improve health across the board.

It is exciting that some of these new treatments are already looking good in clinical trials and may be available to us all soon.

Richard Faragher is a professor of biogerontology at the University of Brighton in England. Lynne Cox is an associate professor of biochemistry at the University of Oxford, also in England. This was first published by The Conversation Life extension: the five most promising methods sofar.

Read more:
These are 5 promising ways to live healthier for longer - and it's more than diet and exercise - MarketWatch

Timothy J Key and colleagues describe the evidence linking diet and nutrition to cancer risk, concluding that obesity and alcohol are the most important factors

Scientists have suspected for decades that nutrition has an important influence on the risk of developing cancer. Epidemiological studies as early as the 1960s showed that cancer rates varied widely between populations and that cancer rates in migrants moving from low to high risk countries could rise to equal or sometimes exceed the rates in the host population.12 These observations implied the existence of important environmental causes of cancer, and other studies showed strong correlations between many types of cancer and dietary factors; for example, countries with high intakes of meat had high rates of colorectal cancer.3 Furthermore, experiments in animals showed that cancer rates could be altered by manipulating diet, with compelling evidence that restricting energy intake causes a general reduction in cancer development.45

Cancer is predicted to be the leading cause of death in every country of the world by the end of this century.6 Although dietary factors are thought to be important in determining the risk of developing cancer, establishing the exact effects of diet on cancer risk has proved challenging. Here we describe the relatively few dietary factors that clearly influence risk of cancers along the digestive tract (from top to bottom) and of other common types of cancer,78 as well as challenges for future research.

Nasopharyngeal cancer is common in a few populations around the globe, such as the Cantonese population in southern China and some indigenous populations of South East Asia, the Arctic, north Africa, and the Middle East.9 Consumption of foods preserved with salt has been linked with this cancer, and the mechanism might be through nitrosamine formation or reactivation of the Epstein-Barr virus.10 Based on case-control studies, Chinese style salted fish has been classified as a carcinogen by the International Agency for Research on Cancer (IARC), part of the World Health Organization.10

For oral and pharyngeal cancers overall, eating more fruits, vegetables, and related micronutrients such as vitamin C and folate is associated with lower cancer risk (boxes 1 and 2). These associations, however, might be influenced by residual confounding by smoking (a major non-dietary risk factor714) and alcohol consumption, so the evidence is only suggestive of a protective effect.814

Early case-control studies indicated that higher intakes of fruit and vegetables were associated with a lower risk of several types of cancer.11 But subsequent prospective studies, which are not affected by recall or selection bias, produced much weaker findings. In the 2018 World Cancer Research Fund report neither fruits nor vegetables were considered to be convincingly or probably associated with the risk of any cancer.8 There was suggestive evidence for protection of some cancers, and risk might increase at very low intakes. Specific components of certain fruits and vegetables might have a protective action.

Vegetarians eat no meat or fish and usually eat more fruit and vegetables than comparable non-vegetarians. The risk of all cancer sites combined might be slightly lower in vegetarians and vegans than in non-vegetarians, but findings for individual cancers are inconclusive. 12

By definition, deficiencies of vitamins and essential minerals cause ill health; this might include increased susceptibility to some types of cancer, but establishing the details of any such effects has proved difficult. High dose vitamin or mineral supplements have not reduced cancer risk in well nourished populations and might increase risk; for example, high dose carotene might increase the risk of lung cancer.13 Vitamin and mineral supplements should not be used for cancer prevention, although they can be important for other aspects of health, such as folic acid supplements for women before conception.

There are two types of oesophageal cancer: squamous cell carcinoma and adenocarcinoma. The squamous form predominates in most of the world, whereas adenocarcinoma is relatively common only in Western countries, where rates have recently increased. Obesity is an established risk factor for adenocarcinoma, probably partly owing to reflux of stomach contents into the oesophagus.1516 Alcohol increases the risk of squamous cell carcinoma but not of adenocarcinoma.17 Smoking increases the risk of both types, with a larger effect for squamous cell carcinoma.17

Oesophageal cancer incidence rates are very high in parts of eastern and southern Africa, Linzhou (China), and Golestan (Iran).617 People in high risk populations have often consumed a restricted diet, low in fruit, vegetables, and animal products, so deficiencies of micronutrients have been postulated to explain the high risk (boxes 1 and 2). Despite several observational studies and some randomised trials, however, the relative roles of various micronutrients are not yet clear.17181920 In Western countries early case-control studies indicated a protective role for fruit and vegetables,2122 but more recently published prospective studies show weaker associations, which might be due to residual confounding from smoking and alcohol consumption.16

Consumption of drinks such as tea and mate when scalding hot is associated with an increased risk of oesophageal cancer,232425 and drinking beverages above 65C is classified by IARC as probably carcinogenic to humans.26

Stomach cancer is the fifth most common cancer worldwide, with the highest rates in eastern Asia.6 Eating large amounts of salted foods, such as salt preserved fish, is associated with an increased risk27; this might be caused by the salt itself or by carcinogens derived from the nitrites in many preserved foods. Salted food might increase the risk of Helicobacter pylori infection (an established cause of stomach cancer)28 and act synergistically to promote development of the disease.29 Some evidence indicates that eating large amounts of pickled vegetables increases the risk of stomach cancer because of the production of N-nitroso compounds by mould or fungi, which are sometimes present in these foods.3031

The risk of stomach cancer might be decreased by diets high in fruit and vegetables and for people with high plasma concentrations of vitamin C (boxes 1 and 2).32 A trial in Linzhou, China, showed that supplementation with carotene, selenium, and tocopherol resulted in a significant reduction in stomach cancer mortality,18 and other trials have indicated enhanced regression of precancerous lesions with the use of supplements of vitamin C, carotene, or both.3334 Prospective studies in Japan have also shown an inverse association between stomach cancer risk and green tea consumption in women (the majority of whom are non-smokers), perhaps related to polyphenols.35 These studies indicate a protective role of antioxidant micronutrients or other antioxidant compounds, but these associations need clarification.

Colorectal cancer is the third most common cancer in the world.6 Overweight and obesity increase risk,83637 as do alcohol and smoking.7

Ecological analyses show striking positive correlations between eating meat and colorectal cancer rates.338 In 2015 IARC classified processed meat as carcinogenic to humans and unprocessed red meat as probably carcinogenic,3940 partly based on a meta-analysis reporting an increase in risk of 17% for each daily 50 g increment in consumption of processed meat and 18% for each 100 g increment in consumption of red meat.41 More recent systematic reviews have reported smaller increases in risk for unprocessed red meat.842

The chemicals used to preserve processed meat, such as nitrates and nitrites, might increase exposure of the gut to mutagenic N-nitroso compounds.40 Both processed and unprocessed red meat also contain haem iron, which might have a cytotoxic effect in the gut and increase formation of N-nitroso compounds. Cooking meat at high temperatures can generate mutagenic heterocyclic amines and polycyclic aromatic hydrocarbons.40 Whether any of these putative mechanisms explain the association between eating red and processed meat and risk for colorectal cancer is unclear.3940

Higher consumptions of milk and calcium are associated with a moderate reduction in risk of colorectal cancer.8434445 Calcium might be protective by forming complexes with secondary bile acids and haem in the intestinal lumen. Higher circulating concentrations of vitamin D are associated with a lower risk,46 but this might be confounded by other factors such as physical activity. Mendelian randomisation studies of genetically determined vitamin D have not supported a causal relation.4748

In the 1970s Burkitt suggested that the low rates of colorectal cancer in parts of Africa were caused by the high consumption of dietary fibre.49 Prospective studies have shown that consuming 10 g more total dietary fibre a day is associated with an average 10% reduction in risk of colorectal cancer; further analyses suggest that cereal fibre and wholegrain cereals are protective, but not fibre from fruit or vegetables.5051

High dietary folate intake has been associated with reduced risk of colorectal cancer, and adequate folate status maintains genomic stability,8 but high folate status might promote the growth of colorectal tumours.52 Whether folate or folic acid have any material impact on the risk of colorectal cancer is uncertain. Most randomised trials of folic acid supplementation have found no effect,5354 and although studies of the gene for methylenetetrahydrofolate reductase have indicated that lower circulating folate is associated with a slightly lower risk, the interpretation of these genetic data is not straightforward. 55

Alcohol is the main diet related risk factor for liver cancer, probably through the development of cirrhosis and alcoholic hepatitis.7 Overweight and obesity also increase risk.8 Aflatoxin, a mutagenic compound produced by the fungus Aspergillus in foods such as grains, nuts, and dried fruit when stored in hot and humid conditions, is classified as a carcinogen by IARC and is an important risk factor in some low income countries (for people with active hepatitis virus infection).56 The major non-dietary risk factor is chronic infection with hepatitis B or C viruses.

Some studies indicate an inverse association between coffee drinking and risk of liver cancer.8 Coffee might have a true protective effect because it contains many bioactive compounds,5758 but the association might be influenced by residual confounding, as well as by reverse causation if subclinical liver disease reduces appetite for coffee.

Obesity increases risk of pancreatic cancer by about 20%.8 Diabetes is also associated with increased risk, and a mendelian randomisation analysis indicates that this is due to raised insulin rather than diabetes itself.59 Studies of dietary components and risk have been inconclusive.8

Lung cancer is the most common cancer in the world, and heavy smoking increases risk around 40-fold.67 Prospective studies have indicated that diets higher in fruits and vegetables are associated with a slightly lower risk of lung cancer in smokers, but not in never smokers.6061 The weak inverse association of fruit and vegetables with lung cancer risk in smokers might perhaps indicate some true protective effect, but it might simply be due to residual confounding by smoking (box 1). Trials that tested supplements of carotene (and retinol in one trial) to prevent lung cancer showed an unexpected higher risk of lung cancer in participants in the intervention group.1362

Breast cancer is the second most common cancer in the world.6 Reproductive and hormonal factors are key determinants of risk.63 Obesity increases breast cancer risk in postmenopausal women, probably by increasing circulating oestrogens, which are produced by aromatase in adipose tissue.64 Most studies have shown that obesity in premenopausal women is associated with a reduction in risk, perhaps due to lower hormone levels related to an increased frequency of anovulation. 65 Alcohol increases risk by about 10% for each drink consumed daily866; the mechanism might involve increased oestrogens.

Much controversy has surrounded the hypothesis that a high fat intake in adulthood increases breast cancer risk. Early case-control studies supported this hypothesis, but prospective observational studies have overall been null,8 and two randomised controlled trials of a reduced fat diet were also null.6768

Studies of other dietary factors including meat, dairy products, and fruit are generally inconclusive.8 Some recent studies have indicated an inverse association between vegetable intake and risk of oestrogen receptor negative breast cancer86970 and between dietary fibre and overall risk.871 Isoflavones, largely from soya, have been associated with a lower risk of breast cancer in Asian populations.72 These associations are potentially important and should be investigated for causality.

Prostate cancer is the fourth most common cancer in the world.6 The only well established risk factors are age, family history, black ethnicity, and genetic factors.73 Obesity probably increases the risk for more aggressive forms of prostate cancer.8

Lycopene, primarily from tomatoes, has been associated with a reduced risk, but the data are not conclusive.8 Some studies have indicated that risk might be reduced with higher levels of other micronutrients including carotene, vitamin D, vitamin E, and selenium, but the findings from trials and mendelian randomisation analyses are overall null or inconclusive.47747576

Isoflavones, largely from soya foods, have been associated with a reduced risk for prostate cancer in Asian men,77 and plasma concentrations of the isoflavone equol might be inversely associated with prostate cancer risk in men in Japan.78

Substantial evidence shows that prostate cancer risk is increased by high levels of the hormone insulin-like growth factor 1, which stimulates cell division, and further research is needed to determine whether dietary factors, such as animal protein, might influence prostate cancer risk by affecting production of this hormone.79

Given the huge variation in diets around the world and the large number of cancers that diets can influence, how do we know which foods or diets should be avoided and which should be recommended? The World Cancer Research Fund (WCRF) and IARC have reviewed the carcinogenic risk of foods and nutrients using systematic reviews of the evidence and evaluation by expert panels. As with much nutritional research the topic is complex, but the WCRF and IARC have identified nutritional factors with convincing evidence or probable evidence of cancer risk.

WCRF and IARC concluded that obesity and alcohol cause cancer at several sites (fig 1). For overweight and obesity, increases in risk for every 5 kg/m2 rise in body mass index (BMI) vary from 5% for colorectal cancer to 50% for cancer of the endometrium (IARC also considered the evidence to be sufficient for meningioma, thyroid cancer, and multiple myeloma).80 For alcohol, risk increases for each 10 g rise in consumption a day vary from 4% for liver cancer to 25% for squamous cell carcinoma of the oesophagus.

Body mass index (BMI), alcohol, and cancer risk. Convincing associations according to the World Cancer Research Fund8 or the International Agency for Research on Cancer (marked by asterisks), or both,1080 with relative risks from meta-analyses.8 We also consider the association between BMI and risk of breast cancer in premenopausal women to be convincing.65 RR, relative risk (plotted with squares proportional to amount of statistical information); CI, confidence interval

Processed meat was judged to be a convincing cause of cancer by both WCRF and IARC; in the most recent WCRF report the relative risk for colorectal cancer was 1.16 (1.08 to 1.26) for each 50 g/day increment.8 IARC judged Chinese-style salted fish to be a carcinogen (with a relative risk of nasopharyngeal cancer of 1.31 (1.16 to 1.47) for each additional serving per week), 810 as well as foods contaminated with aflatoxin.56 Neither expert body judged any dietary factor to be convincingly protective against cancer.

WCRF and IARC judged some associations between nutritional factors and cancer risk to be probably causal or protective (table 1). Some researchers might think that the criteria for probable are not stringent enough. Further evidence might change the conclusions, and this should be kept in mind when using the reports to estimate the likely effects of diet or to make dietary recommendations. Notably, WCRF also categorised adult and young adulthood body fatness as probably protective for premenopausal breast cancer; with new evidence65 we consider this convincing, so the association is shown in figure 1 rather than table 1.

Still uncertain: dietary and nutritional factors that expert groups have classified as probable causal or protective factors for cancer

Obesity probably increases the risk of cancers of the oral cavity and pharynx and of aggressive prostate cancer. Alcohol probably increases the risk of stomach cancer but is inversely associated with the risk of kidney cancer, which might indicate a true biological effect or reflect residual confounding or bias.81 Very hot drinks probably increase the risk of cancer of the oesophagus, foods preserved by salting probably increase the risk of stomach cancer, and several dietary factors probably reduce the risk of colorectal cancer. The expert panels also concluded that the risk of endometrial cancer is probably increased by a diet with a high glycaemic load. Coffee was judged to probably be protective for liver and endometrial cancer, but some of the current authors think that this conclusion is too strong and that the data on coffee and endometrial cancer might be affected by selective publication of only part of the evidence.82

Independently from overweight and obesity, greater adult height is associated with the risk of several cancers (box 3).

The risk for most types of cancer increases with height. A WCRF systematic review showed that increases in risk for each 5 cm increment in height ranged from 4% for prostate cancer to 12% for malignant melanoma.83 The mechanism is uncertain but might be related to taller people having more stem cells at risk of cancer or a factor such as insulin-like growth factor 1 having effects on both height and cancer risk.84 Undernutrition causes restricted growth, and some aspects of adequate nutrition during childhood and adolescence, such as an ample intake of energy and protein, might lead to relatively greater height and a higher overall cancer risk.83 It is not clear, however, whether better understanding of this pathway could lead to strategies for reducing cancer risk.

Acrylamide, a chemical produced during high temperature cooking and in the manufacture of many types of carbohydrate-rich foods (such as potato chips, cereal crispbreads, and coffee), is classified by IARC as probably carcinogenic to humans.85 This conclusion was based largely on studies in experimental animals; epidemiological studies have been mostly null or inconclusive86 but are limited by the difficulty of estimating long term exposure and by confounding owing to smoking. Recent research on possible mutational signatures of this chemical indicate that it might contribute to risk.87

Figure 2 shows recent estimates of the proportions of cancer cases in the UK attributable to modifiable risk factors, including dietary factors classified by WCRF or IARC as convincing causes of cancer. 88 Overweight and obesity is the second largest attributable cause, responsible for 6.3% of cancers in the UK, and is the largest cause in non-smokers. Alcohol (3.3%), dietary fibre (3.3%), and processed meat (1.5%) are also among the top 10 causes (although dietary fibre is currently classed by WCRF as only probable). Analyses from some other countries have produced broadly similar estimates; recent estimates for Brazil were 4.9% for overweight and obesity, 3.8% for alcohol, 0.8% for dietary fibre, and 0.6% for processed meat. 89 In Japan, however, where the prevalence of obesity is lower, estimates were 1.1% for overweight and obesity and 6.3% for alcohol (and 1.6% for salt). 90

Percentages of cancer cases in the UK attributable to different exposures.88

Research into the effects of nutrition on health is difficult. 91 We have summarised here the relatively few well established clear links between nutrition and cancer, but future research might show further important risk factorsperhaps for specific food components or for broader dietary patterns, such as so called plant based diets. To move forward, the new generation of studies needs to improve estimates of long term exposure with, for example, repeated dietary records, which are now feasible using web based questionnaires.92 Biomarkers of dietary intake and nutritional status can be used more extensively, and new biomarkers might be found through metabolomics, for example, but they will need to be validated and interpreted in the light of possible confounding and reverse causation. For some exposures, both for intake and nutritional status, mendelian randomisation will help to clarify causality,93 and randomised trials will be needed to test specific hypotheses. It will also be important to attempt to coordinate systematic analyses of all the data available worldwide, to reduce the risk of publication bias.94 For public health and policy, the top priority should be tackling the known major diet related risk factors for cancer, particularly obesity and alcohol.

Obesity and alcohol increase the risk of several types of cancer; these are the most important nutritional factors contributing to the total burden of cancer worldwide

For colorectal cancer, processed meat increases risk and red meat probably increases risk; dietary fibre, dairy products, and calcium probably reduce risk

Foods containing mutagens can cause cancer; certain types of salted fish cause nasopharyngeal cancer, and foods contaminated with aflatoxin cause liver cancer

Fruits and vegetables are not clearly linked to cancer risk, although very low intakes might increase the risk for aerodigestive and some other cancers

Other nutritional factors might contribute to the risk of cancer, but the evidence is currently not strong enough to be sure

Contributors and sources: All authors contributed to the first draft of the manuscript and provided critical revisions. All authors gave intellectual input to improve the manuscript and have read and approved the final version. TJK is the guarantor. The authors all have experience in nutritional epidemiology, with particular expertise in cancers of the gastrointestinal tract (KEB, RS, ST), breast cancer (TJK), prostate cancer (TJK, APC), cancer in Asia (RS, ST), and mendelian randomisation (KKT). Sources of information for this article included published systematic reviews and primary research articles based on prospective observational studies and randomised controlled trials.

Competing interests: We have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

This research was partly supported by Cancer Research UK (C8221/A19170) and the Wellcome Trust Our Planet Our Health (Livestock, Environment and People, LEAP 205212/Z/16/Z). KEB is supported by the Girdlers New Zealand Health Research Council Fellowship. KKT is supported by WCRF (2014/1180).

Chang ET, Adami HO. Nasopharyngeal cancer. In: Adami H-O, Hunter DJ, Lagiou P, Mucci L. Textbook of Cancer Epidemiology, Third edition. Eds, Oxford, UK: Oxford University Press, 2018:159-181.

Rider JR, Brennan P, Lagiou P. Oral and pharyngeal cancer. In: Adami H-O, Hunter DJ, Lagiou P, Mucci L, eds. Textbook of Cancer Epidemiology, 3rd ed. Oxford, UK: Oxford University Press, 2018:137-157.

Abnet CC, Nyrn O, Adami HO. Esophageal cancer. In: Adami H-O, Hunter DJ, Lagiou P, Mucci L, eds. Textbook of Cancer Epidemiology, 3rd ed. Oxford, UK: Oxford University Press, 2018:183-211.

Ye W, Nyrn O, Adami HO. Stomach cancer. In: Adami H-O, Hunter DJ, Lagiou P, Mucci L, eds. Textbook of Cancer Epidemiology, 3rd ed. Oxford, UK: Oxford University Press, 2018:213-241.

Bamia C, Stuver S, Mucci L. Cancer of the liver and biliary tract. In: Adami H-O, Hunter DJ, Lagiou P, Mucci L, eds. Textbook of Cancer Epidemiology, 3rd ed. Oxford, UK: Oxford University Press, 2018:277-307.

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Diet, nutrition, and cancer risk: what do we know and what is the way forward? - The BMJ

Diet Cig's new album, Swear I'm Good At This, comes out April 7. Shervin Lainez/Courtesy of the artist hide caption

Diet Cig's new album, Swear I'm Good At This, comes out April 7.

Alex Luciano is a guitar-slinging human tornado on a Pixy Stix bender. As the singer, guitarist and one half of the undeniably charming duo Diet Cig, Luciano is known to bop, flail and high-kick around the stage. And that boundless exuberance is infectious, coaxing crowds into pop-punk sock hops. It's also emblematic of the joyful musical bond between Luciano and drummer Noah Bowman, who can frequently be spotted sharing a glance and a wide grin in the split seconds before Luciano leaps off the front of his bass drum. What began as a chance meeting at a house show in the Hudson Valley-based college town of New Paltz, N.Y., has sparked a vital collaboration and friendship.

Diet Cig brilliantly bottles Luciano's energy on the duo's debut album, Swear I'm Good At This. Every track here is a frenetic showcase for Luciano's thrashing guitars and cooing harmonies and Bowman's pounding drums. The record benefits from a tour-honed chemistry that yields sharper hooks and fuller production than any of Diet Cig's previous singles: Listen for the little synth phrase floating up from the distorted fray of "Maid Of The Mist", or the softly strummed guitar that opens "Bath Bomb." And with every taut banger comes the kind of candy-coated melodies that dare you to resist shouting along in unison.

For all the fizzy fun Diet Cig uncorks, those irresistible dynamics cloak the intimacy at the album's core. Writing with revealing honesty and searing wit, Luciano shows an innate knack for lyrics that reflect equal parts wide-eyed wonder, earnest vulnerability, and a fearless, "doing it on my own terms" ferocity. Frequently harvesting from her own past formative romances and breakups, it's Luciano's tiniest details that prove the most relatable. Luciano is capable of capturing the flittering giddiness of a new crush on "Leo" and "Apricots" ("I wanna kiss you in the middle of a party / I wanna to cause a scene"); depicting relationship-status conversations on "I Don't Know Her" ("I don't want you to feel nostalgic for something that never happened"); and even derives cringe-worthy humor from an awkward fling with someone who shares her name on "Sixteen." Similarly, "Barf Day" revisits the sadness of being ignored on her birthday ("I'm sick of being my own best friend / Will you be there in the end?"), only to stave off loneliness with a satisfying kiss-off: "I just wanna have ice cream on my birthday! / I know that you're sorry, I just don't care!"

Yet Diet Cig is at its most potent when deploying Luciano's experiences to wrestle with bigger ideas, like consent, identity and flipping gender roles. "I don't need a man to hold my hand / That's just something you'll never understand!" Luciano proudly proclaims on the invigorating closer "Tummy Ache." Elsewhere, "Maid Of The Mist" addresses past exes ("I am bigger than the outside shell of my body and if you touch it without asking then you'll be sorry") while turning her assurances into an empowering mantra: "I'm fine / You're alive / You'll be O.K. in some time." And on "Link In Bio," Luciano voices her frustrations over how women are all too often singularly defined or silenced for being too outspoken: "They say speak your mind / But not too loud / I'm not being dramatic / I've just f had it with the things that you say you think that I should be / I'm done with being a chill girl / I'm trying to take over the world."

Swear I'm Good At This all adds up to a snapshot of a young songwriter navigating through the yearning and boredom, ambition and insecurity that accumulates along the rocky path from adolescence to adulthood. The power of Diet Cig comes from the way Luciano and Bowman bolster these themes with affirming positivity in the form of delightful, explosive anthems. These songs will surely give anyone weathering their own tough moments the confidence to pick themselves up and dance.

Swear I'm Good At This is out April 7 on Frenchkiss Records.

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First Listen: Stream Diet Cig's Debut Album, 'Swear I'm Good At This ... - NPR

A year ago, Nick Turnbeaugh, 17, looked into a mirror pondering adulthood. "I looked at myself and said, 'If I'm this heavy now, what will I be when I'm 30?' "

Today, Turnbeaugh weighs 163 pounds, which is 87 pounds lighter than his peak weight of 250 pounds. His new weight is perfect for his 5-foot-11-inch frame.

Now he likes the guy in the mirror. "I never realized what I used to look like," he said. "I'm astonished at what my body can do now.

"I'm getting more confident."

Last semester, his grades jumped from middle C to a B average, the highest grades he has ever achieved.

Experts say physically fit youngsters do better in school, for any of a number of reasons, from being clear-headed and healthy to being less self-conscious and distracted by teasing or bullying.

Turnbeaugh said to make the change, he had to hate obesity more than he loved junk food. And he hated what obesity had done to his life.

Turnbeaugh's weight had set his life off balance for as far back as he could remember. The most wrenching times were when other children teased him.

"I had to change schools in junior high because it got so bad," he said. "People don't realize, that really hurts."

He added, "When I was with my friends, they'd get the girls and not me. It wasn't fun."

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New diet, exercise energize teen

School meals in the UK contain lots of highly processed foods, promoting poor health among children and increasing their risk of obesity.British primary and secondary schoolchildren are getting the majority of their lunchtime calories from ultra-processed foods, according to a study led by researchers at Imperial College London and published today in the journal Nutrients.The analysis, which looked at the content of school lunches of more than 3,000 children between 2008-2017, finds that 64% of the calories in meals provided by the school come from ultra-processed foods, contributing to the consumption of high levels of processed foods and increasing the risk of childhood obesity. Ultra-processed bread, snacks, puddings and sugary drinks were among the biggest contributors, and on the whole packed lunches contained more calories from highly processed foods, compared to school meals.According to the researchers, publicly funded school meals (i.e. free school meals and those that children buy in school) are a vital mechanism to deliver healthy food to children, especially those from families with low incomes. They explain the findings highlight a key opportunity for policy makers and educators to level the playing field by improving the nutritional quality of school lunches. They argue that urgent policy changes are needed to cap the amount processed foods school lunches contain and to increase access to free school meals, which could help to boost the diets and health of Britains children.Dr Jennie Parnham, from the School of Public Health at Imperial College London and first author on the paper, said: This is the first study to look at the extent of ultra-processed food content in school lunches for children of all ages. We need to view these findings as a call to action to invest in policies that can promote healthy eating. Owing to the current cost of living crisis, school meals should be a way for all children to access a low-cost nutritious meal. Yet, our research suggests this is not currently the case.She continued: Ultra-processed foods are often cheap, readily available, and heavily marketed often as healthy options. But these foods are also generally higher in salt, fat, sugar, and other additives, and linked with a range of poor health outcomes, so its important that people are aware of the health risks of children consuming them in high levels at school.As food prices continue to rise in the UK and globally, accessing affordable, healthy food will become more challenging for many more people. School meals should offer children from all backgrounds access to a healthy and minimally processed meal, yet they are currently failing to meet their potential.Ultra-processed foods (UPFs) are items which are heavily processed during their making: such as frozen pizzas, fizzy or milk-based drinks, mass-produced packaged bread and many ready meals.[1] Previous research has linked regular consumption of them with obesity and increased long-term risk of health conditions like Type 2 diabetes, cardiovascular disease and cancer.Previous research by the team reported the scale of UPFs being consumed by children in the UK, which is the highest in Europe. The work also highlighted that eating patterns established in childhood extend into adulthood, potentially setting children on a lifelong trajectory for obesity and a range of negative physical and mental health outcomes.In the latest study, the team looked at the diets of more than 3,300 children in primary and secondary school, collected through the National Diet and Nutrition survey [2]. The aim was to examine the proportion of UPFs in packed lunches (food brought from home) and school meals (which includes lunches provided by the school (free school meals) or bought by students at the school canteen).The analysis included data from 1,895 primary school children (aged 4-11) and 1,408 secondary school children (aged 11-18), looking at food groups making up the total calorie count, as well as the proportion of total food intake of the meal (in grams).Overall, around 75% of calories across all types of school lunches came from UPFs with 82% of calories from UPFs in packed lunches, compared with 64% in school meals across all ages.However, within school meals the study found that secondary schoolchildren had higher levels of UPFs (70% of calories) compared to primary schoolchildren (61% of calories). Secondary school meals contained a higher proportion of calories from fast food items, puddings and desserts.In general, children from lower-income backgrounds were more likely to have higher levels of UPF on their plates (77% of calories) than children from higher-income backgrounds (71% of calories).In primary school, almost half of the calories in packed lunches came from ultra-processed bread and snacks, compared to just 13% of calories of school meals. Packed lunches also tended to have fewer calories from minimally processed fruit and veg, meat and dairy, and starch (such as pasta or potatoes), compared to school meals.One of the largest UPF contributors, as a proportion of grams of food intake, came from ultra-processed drinks such as fizzy drinks, fruit juice, or yogurt drinks. According to the team, one of the easiest and most cost-effective opportunities to improve the nutritional value of school lunches would be to swap these high calorie, ultra-processed drinks for water.While the work is the first to bring together both primary and secondary school settings, the researchers highlight the limitation that secondary schoolchildren self-reported their dietary data while primary schoolchildren did not, but this mostly likely means that the scale of UPFs being consumed by secondary schoolchildren is under-estimated.Dr Eszter Vamos, from Imperials School of Public Health, added: With the rising cost of living, many families are struggling to access healthy foods, and school meals might be the only opportunity for many children to have a healthy regular main meal. School meals are critically important in making sure that every child has access to an affordable nutritious meal.Children in England consume very high levels of ultra-processed foods, and it is worrying that meals consumed at school contribute to this. Our findings call for urgent policy changes to improve the accessibility and quality of school meals as this could shape childrens overall diets considerably with important consequences for their current and future health.This study is funded by the National Institute for Health and Care Research (NIHR), through the NIHR School for Public Health Research.-The ultra-processed food content of school meals and packed lunches in the United Kingdom by Jennie Parnham is published in Nutrients.For more information, please contact:Emily HeadMedia Manager (Medicine)Imperial College LondonT: +44 (0) 20 7594 6900E: e.head21@imperial.ac.ukOut of hours: +44 (0) 7803 886 248.NOTES TO EDITORS:This press release uses a labelling system developed by the Academy of Medical Sciences to improve the communication of evidence. For more information, please see:http://www.sciencemediacentre.org/wp-content/uploads/2018/01/AMS-press-release-labelling-system-GUIDANCE.pdf%5B1%5D The term ultra-processed food comes from the NOVA classification, endorsed by the World Health Organization and the Food and Agriculture Organization of the United Nations, and is the most widely researched and validated food processing classification.NOVA categorises all foods and beverages into four groups based on their degree of industrial processing.Group 4: Ultra-processed foods, are mass-produced products using a series of industrial processes that include fractioning of a few whole foods into oils, fats, sugar, protein and other substances before recombining them back together.They typically have high levels of sugar, salt and saturated fat, and are often loaded with industrial substances that are not found in a household kitchen, such as additives to enhance colour and flavour, and those enable modification of shape and texture.They are designed to be cheap, convenient, durable, extremely tasty and attractively packaged. They are heavily marketed and created to displace all other foods and dishes.Examples include soft drinks, mass-produced packaged bread, flavoured yoghurts, most breakfast cereals, confectionery, packaged sweet and savoury snacks, chicken and fish nuggets, and many ready meals.Ultra-processed foods can be identified from the following characteristics: A long list of ingredients; Ingredients that you dont recognise or wouldnt use at home, such as additives; High fat, sugar and salt content; Long shelf life.Details of the NOVA classification of food types can be found online:https://www.fao.org/3/ca5644en/ca5644en.pdfFull details can also be found in the groups previous work:https://www.imperial.ac.uk/news/223573/urgent-action-needed-reduce-harm-ultra-processed/%5B2%5D The study used nationally representative data from the UKs National Diet and Nutrition Survey (2008-2017).https://www.gov.uk/government/collections/national-diet-and-nutrition-surveyAbout Imperial College London

Imperial College London is one of the world's leading universities. The College's 20,000 students and 8,000 staff are working to solve the biggest challenges in science, medicine, engineering and business.

Imperial is University of the Year 2022 in the Times and Sunday Times Good University Guide. It is the worlds fifth most international university, according to Times Higher Education, with academic ties to more than 150 countries. Reuters named the College as the UK's most innovative university because of its exceptional entrepreneurial culture and ties to industry.

Imperial has a greater proportion of world-leading research than any other UK university, according to the Research Excellence Framework (REF). Imperial ranks first in the UK for research outputs, first in the UK for research environment, and first for research impact among Russell Group universities.http://www.imperial.ac.uk/About the National Institute for Health and Care Research (NIHR)

The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:

Funding high quality, timely research that benefits the NHS, public health and social care;

Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services;

Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research;

Attracting, training and supporting the best researchers to tackle complex health and social care challenges;

Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system;

Funding applied global health research and training to meet the needs of the poorest people in low and middle income countries.

NIHR is funded by the Department of Health and Social Care. Its work in low and middle income countries is principally funded through UK Aid from the UK government.Imperial College London press-release mailing listSign up to Imperial Twitter at:http://twitter.com/imperialcollegeandhttp://twitter.com/imperialsparkSign up for Imperial RSS feeds at:http://www3.imperial.ac.uk/imperialnews/RSS_14150300.xmlMore media resources online at:http://www.imperial.ac.uk/mediaSearch for experts at:http://www.imperial.ac.uk/mediaguide

Observational study

People

The ultra-processed food content of school meals and packed lunches in the United Kingdom

20-Jul-2022

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Ultra-processed foods make up almost two-thirds of Britain's school meals - EurekAlert

Ever wondered what a CrossFit champion eats for breakfast? Or how a spin instructor powers themselves through multiple classes a day? Or how an Olympic gymnast snacks? Food Diaries takes you on an inside journey through the healthy eating habits of athletes at the top of their games because, admit it, youre curious. See More

Amanda Newhall, 31, knew she wanted to be a firefighter when she was 12 years old, the year that two planes crashed into the World Trade Center buildings. I was in middle school at the time and remember following the news coverage in the days that followed, and something just sort of clicked for me, she says.

It was an ambition that stuck with her throughout school and now into adulthood. I joined Explorers, which is essentially junior firefighting through the Boy Scouts of America. You make uniforms to wear and go on ride-alongs with local firefighters, she says. When she was 19, she got hired as a volunteer firefighter in Healdsburg, California, where she now works full-time.

Being a firefighter is always an intense job, but this years wildfires ravaging much of the Westincluding Sonoma County, where she workshave proved to be additionally challenging. Its affecting our whole city; we really cant get a break, Newhall says. The summers are always very hectic because of the wildfires and the wildfire season seems to last later and later every year. Mother Nature hasnt told us when it will end this year yet.

In addition to being a firefighter, Newhall is also a fitness instructor with FireFlex Yoga, a wellness program for first responders. A lot of the moves [in yoga] mimic what you actually have to do as a firefighter, like deep squats on and off the firetruck, she says. She adds that its also recovery-based, which helps soothe first responders muscles from the wear and tear they inevitably put their bodies through just by doing their jobs. Fire stations buy into the FireFlex program and then an instructor comes to the station and leads the team through a workout on a regular basis. Newhall hasnt been able to go to other stations to teach thanks to COVID-19, but shes enjoying teaching her own team.

Being both a firefighter and fitness instructor means Newhall has to fuel her body properly, and she says its especially important for her to pay attention to what she eats because she has a rare metabolic disorder called phenylketonuria [PKU]. Its a rare DNA defect that affects her bodys ability to break down the amino acid phenylalanine. I have a pretty mild case of it, but it affects the way I eat because I have to limit my protein intake. Otherwise [amino acids from the protein] will just float around in my bloodstream.

Thus, while many people are focused on high-protein everything, Newhall has to be particularly mindful of her intake. Each day, she eats 25 grams of protein from a supplemental formula designed for people who have PKU, and gets an additional 35 grams of protein through food. (The average person as active as Newhall should get a recommended 75 grams a day.)

Typically for breakfast, I have my protein formula and some cashew nut yogurt, Newhall says. She loves that its portable enough to take to work or on a hikewhich is one of her favorite day-off activities. I like having a breakfast that wont slow me down, she says.

Watch the video below to see what a registered dietitian thinks of plant-based yogurt:

For lunch, Newhall likes either having a big salad or soupdepending on what shes in the mood for that day. Whole grains are a big part of my diet, so thats typically incorporated in some way, she says. But she adds that during the day she tends to eat pretty light because her body absorbs carbohydrates at a slower rate than the average person and she doesnt want it to slow her down.

If she gets hungry between lunch and dinner, Newhall says she likes to snack on dried mangoespecially on days when shes out hiking. Like cashew nut yogurt, its also really portable, so she can put some in a resealable bag, throw it in her backpack, and munch on it whenever hunger strikes.

Newhall says evening meals are a big deal at the firehouse. Its the part of the day where everyone comes together to sit around the table and share a meal. (Unless they get called to an emergency, of course.) Everyone takes turns cooking and Newhall says it can get pretty complicated because there are so many different types of eaters at her station. A lot of the guys I work with are big meat eaters and want to go full-on carnivore, but then someone else may be doing Whole30 or another specific type of eating plan, she says.

When its her turn to cook, Newhall says she likes to incorporate Chinese, Japanese, and Thai flavors into her cooking. I like making soba noodles with a creamy cashew nut sauce or a stir-fry with cauliflower rice and veggies, she says.

Newhall says she usually skips dessert because she doesnt have much of a sweet toothwith one exception. There are these glazed doughnuts with a unicorn made out of frosting on them and I just love them, she says. My boyfriend will surprise me with one about once a week and its always a nice surprise.

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This Firefighter Doubles as a Fitness InstructorHeres What She Eats To Fuel Her Body - Well+Good

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(Tribune News Service) The world is hurtling toward an unprecedented hunger crisis.

As many as 132 million more people than previously projected could go hungry in 2020, and this year's gain may be more than triple any increase this century. The pandemic is upending food supply chains, crippling economies and eroding consumer purchasing power. Some projections show that by the end of the year, COVID-19 will cause more people to die each day from hunger than from virus infections.

What makes the situation unmatched: The massive spike is happening at a time of enormous global food surpluses. And it's happening in every part of the world, with new levels of food insecurity forecast for countries that used to have relative stability.

In Queens, New York, the lines snaking around a food bank are eight hours long as people wait for a box of supplies that might last them a week, while farmers in California are plowing over lettuce and fruit is rotting on trees in Washington. In Uganda, bananas and tomatoes are piling up in open-air markets, and even nearly give-away prices aren't low enough for out-of-work buyers. Supplies of rice and meat were left floating at ports earlier this year after logistical jams in the Philippines, China and Nigeria. And in South America, Venezuela is teetering on the brink of famine.

"We'll see the scars of this crisis for generations," said Mariana Chilton, director of the Center for Hunger-Free Communities at Drexel University. "In 2120, we'll still be talking about this crisis."

COVID-19 has exposed some of the world's deepest inequalities. It's also a determining force in who gets to eat and who doesn't, underscoring global social divides as the richest keep enjoying a breakneck pace of wealth accumulation. Millions of people have been thrown out of work and don't have enough money to feed their families, despite the trillions in government stimulus that's helped send global equities to all-time highs.

On top of the economic malaise, lockdowns and broken supply chains have also created a serious problem for food distribution. The sudden shift away from restaurant eating, which in places like the U.S. used to account for more than half of dining, means farmers have been dumping milk and smashing eggs, with no easy means to redirect their production to either grocery stores or those in need.

Don Cameron of Terranova Ranch in California took a hit of about $55,000 this year on his cabbage crop. Almost half the loss $24,000 came because Cameron decided to donate to local food banks after demand from his usual customers dried up. He had to pay for the labor needed to do the harvesting and truck loading. He even needed to cover the cost of some bins and pallets to get supplies moved. It would've been a lot cheaper to just let the crops rot in the field.

"We know other parts of the country need what we have here. But the infrastructure has not been set up, as far as I'm aware, to allow that. There are times when there is food available and it's because of logistics that it doesn't find a home," said Cameron, who still ended up destroying about 50,000 tons of the crop since nearby food banks "can only take so much cabbage."

Initial United Nations forecasts show that in a worst-case scenario, about a tenth of the world's population won't have enough to eat this year. The impact will go beyond just hunger as millions more are also likely to experience other forms of food insecurity, including not being able to afford healthy diets, which can lead to malnutrition and obesity.

The effects will be long lasting. Even in its best-case projections, the UN predicts that hunger will be greater over the next decade than forecast before the pandemic. By 2030, the number of undernourished people could reach as high as 909 million, compared with a pre-COVID scenario of about 841 million.

The current crisis is one of the "rarest of times" with both physical and economic limitations to access food, said Arif Husain, chief economist with the UN's World Food Programme.

By the end of the year, as many as 12,000 people could die a day from hunger linked to COVID-19, potentially more than those perishing from the virus itself, charity Oxfam International estimates. That's calculated based on a more than 80% jump for those facing crisis-level hunger.

Projections for increased malnutrition also have a profound human toll. It can weaken the immune system, limit mobility and even impair brain functioning. Children who experience malnutrition early in life can see its impact well into adulthood.

"Even the mildest forms of food insecurity have lifelong consequences," said Chilton of the Center for Hunger-Free Communities. Problems with physical and cognitive development in children and adolescents can hamper the chances of staying in school or getting a job, continuing a cycle of poverty.

Government programs, food charities and aid organizations have mobilized across the globe, but the need far outstrips their reach. The UN's WFP aid group alone needs a record $13 billion for the year to deliver food in 83 countries, and at the start of the second half faced a shortfall of $4.9 billion to meet the goal.

Hunger can spark seismic shifts in the political landscape. Going back to the days of the French Revolution, food insecurity has sent people into the streets demanding better conditions. Surging food prices were part of the economic crisis that helped fuel recent protests in Lebanon and demonstrations over shortages erupted in Chile earlier this year.

Deep-seated inequalities along gender and racial lines also correspond to disproportionate impacts from hunger. In the U.S., for example, Black Americans are two-and-a half times as likely as their White counterparts to have low or very low access to enough food for an active and healthy life. Globally, women are 10% more likely to be food insecure than men.

"We have to make sure that we're addressing gender inequality if the international community is not doing that, we will fail to avoid the worst of the hunger crisis," said Tonya Rawe, a director at hunger relief and advocacy group Care.

Data from the UN show that throughout the world, there are more than enough calories available to meet every individual's needs. But even in the U.S., the richest country in the world, almost 2% of the population, or more than 5 million people, can't afford a healthy diet (one that protects against all forms of malnutrition). More than 3 million Americans can't afford to even meet basic energy needs. In India, 78% of people can't afford healthy diets that's more than 1 billion people. Those figures don't even take into account the pandemic and its lasting effects.

Costs and logistics prevent food surpluses from being easily shifted to areas without. That's the dilemma faced by potato farmers in Belgium. When freezers filled during the pandemic, most of their spuds weren't fit for food banks or grocers. The main variety that's grown to meet demand from places like the country's famous fry shops get black and blue spots after just a few days, said Romain Cools of industry group Belgapom. Sales to supermarkets quickly stopped after complaints, and a bulk of the region's 750,000-ton surplus was instead used for animal feed or biogas.

"It's hard to take surplus milk in Wisconsin and get it to people in Malawi it's just not realistic or practical," said William Moseley, a geography professor at Macalester College who serves on a global food-security panel.

Despite the abundant supplies, food is growing more expensive because of bungled supply chains and currency devaluations. Costs are up in parts of Africa and the Middle East and they're also rising in developed countries, with Europeans and Americans paying extra to stock their fridges.

Even within major food-producing countries, being able to afford groceries is never a given.

Latin America, an agriculturally rich region that exports food to the world, is leading this year's surge in hunger, according to the UN's WFP.

In Brazil, a huge cash-distribution program has helped millions and driven poverty rates to historic lows. But that hasn't met all the need. In the country's northeast, Eder Saulo de Melo worked as a guard at parties until the virus arrived. With events suspended, he hasn't been paid in months. He's been locked out of the emergency cash program and the 130 reais ($25) he gets in regular monthly aid goes to energy, water and gas bills, leaving little to feed his three children. Baskets of non-perishables, vegetables, bread and eggs from a non-governmental organization are the family's main sustenance.

"I needed to stop buying fruit and meat," he said. "Instead of a slice of chicken, I buy offal to make a soup."

The hunger estimates for this year have a "high degree of uncertainty," and the disease's devastation is largely unknown, the UN cautioned about its figures.

The UN's Food and Agriculture Organization began tracking global hunger in the mid-1970s. Current data can't be compared past 2000 given revisions in methodology, said Carlo Cafiero, team leader for food security statistics. But general trends can be observed, and they show that hunger moved lower over the past several decades until a recent reversal started in 2015, spurred by by climate change and conflicts.

The increases in the last few years are nothing like what is forecast now even the best-case of the UN's tentative scenarios would see hunger surge in 2020 more than the past five years combined. And when looking at other notable periods of need in the world, such as the Great Depression, the level of food surplus that exists today is without comparison thanks to the advent of modern agriculture, which has seen crop yields explode.

"It's impossible to look at the situation and not think we have a problem," said Nate Mook, chief executive officer of food-relief group World Central Kitchen. "This pandemic has really exposed the cracks in the system and where it starts to break down."

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Hunger is threatening to kill more people than COVID this year - Stars and Stripes