American Journal of Clinical Nutrition最新文献

{"title":"Coffee consumption, additive use, and risk of type 2 diabetes-results from 3 large prospective United States cohort studies.","authors":"Matthias Henn, Andrea J Glenn, Walter C Willett, Miguel A Martínez-González, Qi Sun, Frank B Hu","doi":"10.1016/j.ajcnut.2025.01.017","DOIUrl":"10.1016/j.ajcnut.2025.01.017","url":null,"abstract":"<p><strong>Background: </strong>Consumption of coffee has been consistently associated with lower risk of type 2 diabetes (T2D). However, it is unknown whether the use of additives may modify the association.</p><p><strong>Objectives: </strong>This study aimed to analyze the association between coffee consumption and risk of T2D by considering the addition of sugar, artificial sweeteners, cream, or a nondairy coffee whitener.</p><p><strong>Methods: </strong>We used 3 large prospective cohorts-Nurses' Health Study (NHS; 1986-2020), NHS II (1991-2020), and the Health Professionals Follow-up Study (HPFS 1991-2020). Self-reported coffee consumption, additive use, and T2D incidence were confirmed using validated questionnaires. Time-dependent Cox proportional hazards regression models were used to calculate hazard ratios (HRs) with multivariable adjustment.</p><p><strong>Results: </strong>During 3,665,408 person-years of follow-up, we documented 13,281 incident T2D cases. After multivariable adjustment, each additional cup of coffee without any additive was associated with 10% lower risk of T2D (HR: 0.90; 95% CI: 0.89, 0.92) in the pooled analysis of the 3 cohorts. The inverse association did not change among participants who added cream. Among participants who added sugar to coffee (on average 1 teaspoon per cup), the association was significantly weakened (HR: 0.95; 95% CI: 0.93, 0.97; interaction term HR: 1.17; 95% CI: 1.07, 1.27). A similar pattern was observed among those who used artificial sweeteners (HR: 0.93; 95% CI: 0.90, 0.96; interaction term HR: 1.13; 95% CI: 1.00, 1.28). The association between coffee consumption and T2D risk among those who used coffee whitener was also attenuated, although the interaction was not significant (HR: 0.95; 95% CI: 0.91, 1.00; interaction term HR: 1.16; 95% CI: 0.66, 2.06).</p><p><strong>Conclusions: </strong>Adding sugar or artificial sweetener significantly attenuates the magnitude of the inverse association between higher coffee consumption and T2D risk, whereas the use of cream do not alter the inverse association.</p>","PeriodicalId":50813,"journal":{"name":"American Journal of Clinical Nutrition","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plasma metabolomic signature of a proinflammatory diet in relation to breast cancer risk: a prospective cohort study.","authors":"Miao Long, Xikang Fan, Mian Wang, Xinyi Liu, Chengqu Fu, Jianv Huang, Yuefan Shen, Xueni Cheng, Pengfei Luo, Jian Su, Jinyi Zhou, Dong Hang","doi":"10.1016/j.ajcnut.2025.01.013","DOIUrl":"10.1016/j.ajcnut.2025.01.013","url":null,"abstract":"<p><strong>Background: </strong>A proinflammatory diet has been linked to an increased risk of breast cancer. However, the underlying metabolic roles remain to be elucidated.</p><p><strong>Objectives: </strong>This study aimed to investigate the metabolic mechanism between proinflammatory diet and breast cancer risk.</p><p><strong>Methods: </strong>This prospective study included 273,324 females from the UK Biobank. The dietary inflammatory potential was assessed via an energy-adjusted dietary inflammatory index (E-DII) based on a 24-h recall questionnaire. The plasma metabolome was profiled via high-throughput nuclear magnetic resonance spectroscopy. A metabolic signature was constructed by summing selected metabolite concentrations weighted by the coefficients via absolute shrinkage and selection operator analysis. Multivariate Cox regression was applied to assess the associations of the E-DII and metabolic signature with breast cancer risk.</p><p><strong>Results: </strong>We constructed a metabolic signature comprising 26 metabolites associated with a proinflammatory diet. These metabolites primarily included lipoproteins, amino acids, fatty acids, and ketone bodies. Both the E-DII and metabolic signature were positively associated with breast cancer risk [hazard ratio (HR) comparing the highest quintile with the lowest quintile: 1.17; 95% CI: 1.04, 1.32; and 1.21; 95% CI: 1.01, 1.46, respectively]. Furthermore, we found that saturated fatty acids to total fatty acids percentage and acetone concentration were positively associated (HR: 1.20; 95% CI: 1.04, 1.37; HR: 1.15; 95% CI: 1.01, 1.32, respectively), whereas the degree of unsaturation was inversely associated with breast cancer risk (HR: 0.86; 95% CI: 0.75, 0.99).</p><p><strong>Conclusions: </strong>We identified a metabolic signature that reflects a proinflammatory diet and is associated with increased risk of breast cancer.</p>","PeriodicalId":50813,"journal":{"name":"American Journal of Clinical Nutrition","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating eating architecture and the impact of the precision of recorded eating time: a cross-sectional study.","authors":"Francisca Ibacache, Kate Northstone, Mengxuan Zou, Laura Johnson","doi":"10.1016/j.ajcnut.2025.01.012","DOIUrl":"10.1016/j.ajcnut.2025.01.012","url":null,"abstract":"<p><strong>Background: </strong>The precision of recorded eating times directly affects the estimation of eating architecture, that is, size, timing, and frequency of eating. The impact of imprecise timing on estimates and associations of eating architecture with health remains unclear.</p><p><strong>Objectives: </strong>We compared eating architecture variables derived from precise with those of broad timing methods and examined associations with anthropometric-related and diet-related outcomes.</p><p><strong>Methods: </strong>Cross-sectional data came from 3-d diet diaries of 7-y-old children in the Avon Longitudinal Study of Parents and Children. We derived mean size, timing, and frequency of eating, using exact times (precise, n = 4855) and midpoint meal slot times (broad, n = 7285). Intraclass correlation coefficients (ICCs) estimated agreement between methods. Bland-Altman analysis determined mean difference and limits of agreement (LOAs). Correlations (95% CIs) estimated associations between eating architecture variables and anthropometric-related or diet-related traits.</p><p><strong>Results: </strong>Agreement varied from moderate to excellent for size (ICC: 0.75), last or first time (ICC: 0.80 or 0.58), and frequency (ICC: 0.43) of eating occasions. Broad times underestimated eating frequency (2.2 times/d; LOA: -1, 5) and overestimated size (83 g; LOA: -179, 13), last time (50 min; LOA: -142, 42), intermeal intervals (68 min; LOA: -126, -11), and eating window (49 min; LOA: -161, 63). Directions of eating architecture intercorrelations were consistent regardless of time precision but varied in magnitude, for example, larger eating occasion size correlated with lower eating frequency but was stronger with precise time (r_precise = -0.54; 95% CI: -0.56, -0.52; r_broad = -0.24; 95% CI: -0.27, -0.22). Correlations with anthropometric-related and diet-related outcomes were also directionally consistent.</p><p><strong>Conclusions: </strong>Precise timing improves the estimation of eating architecture. Differences in estimation will affect descriptions of children's eating habits and possibly dietary guidance. However, consistent directional associations across timing methods suggest that broad times could provide a pragmatic method for investigating eating architecture associations in large samples.</p>","PeriodicalId":50813,"journal":{"name":"American Journal of Clinical Nutrition","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dietary-Lifestyle Patterns and Colorectal Cancer Risk: Global Cancer Update Programme (CUP Global) Systematic Literature Review.","authors":"Anne H Y Chu, Kehuan Lin, Helen Croker, Sarah Kefyalew, Georgios Markozannes, Konstantinos K Tsilidis, Yikyung Park, John Krebs, Matty P Weijenberg, Monica L Baskin, Ellen Copson, Sarah J Lewis, Jacob C Seidell, Rajiv Chowdhury, Lynette Hill, Doris S M Chan, Dong Hoon Lee, Edward L Giovannucci","doi":"10.1016/j.ajcnut.2025.01.014","DOIUrl":"https://doi.org/10.1016/j.ajcnut.2025.01.014","url":null,"abstract":"<p><strong>Background: </strong>While healthy dietary and lifestyle factors have been individually linked to lower colorectal cancer (CRC) risks, recommendations for whole diet-lifestyle patterns remained unestablished due to limited studies and inconsistent pattern definitions.</p><p><strong>Objective: </strong>This updated review synthesized literature on dietary-lifestyle patterns and CRC risk/mortality.</p><p><strong>Methods: </strong>PubMed and Embase were searched through 31 March 2023 for randomized controlled trials and prospective cohort studies examining adulthood dietary patterns combined with modifiable lifestyle factors such as adiposity, smoking, alcohol consumption, physical activity, and/or others. Patterns were categorized by derivation methods: a priori, a posteriori, and a hybrid combining both; and were then descriptively reviewed for the primary outcomes: CRC risk or mortality. The Global Cancer Update Programme Expert Committee and Expert Panel independently graded the evidence on the likelihood of causality using pre-defined grading criteria.</p><p><strong>Results: </strong>Thirty-three observational studies were reviewed. 'Strong-probable' evidence was concluded for higher levels of alignment with the a priori-derived World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations score and lower CRC risk; and 'limited-suggestive' evidence for the American Cancer Society guidelines and Healthy Lifestyle Index with lower CRC risk (mainly due to concerns about risk of bias for confounding). A posteriori-derived patterns lack firm evidence (only one study). 'Strong-probable' evidence was concluded for higher levels of alignment with the Empirical Lifestyle Index for Hyperinsulinemia hybrid pattern and higher CRC risk. By cancer subsite, only the WCRF/AICR recommendations score showed 'strong-probable' evidence with lower colon cancer risk. All exposure-mortality pairs were graded 'limited-no conclusion'. The evidence for other pattern-outcome associations was graded as 'limited-no conclusion'.</p><p><strong>Conclusions: </strong>Adopting a healthy pattern of diet, maintaining a healthy weight, staying physically active, and embracing health-conscious habits, such as avoiding tobacco and moderating alcohol, are collectively associated with a lower CRC risk. Healthy lifestyle habits are key to primary CRC prevention.</p>","PeriodicalId":50813,"journal":{"name":"American Journal of Clinical Nutrition","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dietary patterns and omics: a meeting of 2 paradigm-shifting advances in nutrition science.","authors":"Katie A Meyer, David R Jacobs","doi":"10.1016/j.ajcnut.2025.01.011","DOIUrl":"10.1016/j.ajcnut.2025.01.011","url":null,"abstract":"","PeriodicalId":50813,"journal":{"name":"American Journal of Clinical Nutrition","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lignan Intake and Mortality Among Adults with Incident Type 2 Diabetes-Prospective Cohort Studies.","authors":"Binkai Liu, Yang Hu, Siyue Wang, Molin Wang, Eric B Rimm, Qi Sun","doi":"10.1016/j.ajcnut.2025.01.008","DOIUrl":"10.1016/j.ajcnut.2025.01.008","url":null,"abstract":"<p><strong>Background: </strong>Lignans are polyphenolic compounds abundant in plant-based foods such as seeds, whole grains, and certain fruits and vegetables and may lead to favorable metabolic health. It remains to be elucidated regarding the role of lignan consumption in the etiology of premature deaths among individuals with diabetes.</p><p><strong>Objectives: </strong>To prospectively examine the association between postdiagnosis lignan intake and mortality among individuals with type 2 diabetes (T2D).</p><p><strong>Methods: </strong>We analyzed data from 2 prospective United States cohorts, the Nurses' Health Study (1984-2020) and Health Professionals Follow-up Study (1986-2022). Mean daily consumption of total and individual lignans was calculated, and postdiagnosis lignan intakes were cumulatively averaged. Multivariable-adjusted Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between lignan intake and mortality.</p><p><strong>Results: </strong>Among 8465 incident T2D cases contributing 116,026 person-years of follow-up, 4372 deaths were documented, including 1318 from cardiovascular disease (CVD) and 752 from cancer. The pooled multivariable-adjusted HRs (95% CIs) of all-cause mortality comparing the highest compared with the lowest quintiles of postdiagnosis lignan intake were 0.83 (0.74, 0.94) for total lignans, 0.89 (0.80, 0.99) for matairesinol (MAT), 0.78 (0.69, 0.87) for secoisolariciresinol (SECO), 0.91 (0.81, 1.01) for pinoresinol (PINO), and 0.92 (0.82, 1.03) for lariciresinol (LARIC). Higher postdiagnosis SECO intake was also significantly associated with lower CVD and cancer mortality. Changes in lignan intake from pre- to postdiagnosis showed similar favorable associations: 0.83 (0.75, 0.93) for total lignans, 0.86 (0.77, 0.96) for MAT, and 0.81 (0.72, 0.90) for SECO. The associations of lignan intake were significantly stronger among nonwhite individuals.</p><p><strong>Conclusions: </strong>Among individuals with T2D, a higher intake of lignans, particularly SECO, was significantly associated with reduced overall CVD and cancer mortality. Minority groups may particularly benefit from lignan intake, although further studies are warranted to substantiate this observation.</p>","PeriodicalId":50813,"journal":{"name":"American Journal of Clinical Nutrition","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efforts to reduce sugar-sweetened beverages and combat childhood obesity.","authors":"Gita Wahi, Russell J de Souza","doi":"10.1016/j.ajcnut.2024.12.009","DOIUrl":"https://doi.org/10.1016/j.ajcnut.2024.12.009","url":null,"abstract":"","PeriodicalId":50813,"journal":{"name":"American Journal of Clinical Nutrition","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Planetary Health Diet Index Trends and Associations with Dietary Greenhouse Gas Emissions, Disease Biomarkers, Obesity, and Mortality in the United States (2005-2018).","authors":"Jiada Zhan, Linh Bui, Rebecca A Hodge, Meghan Zimmer, Tung Pham, Donald Rose, Amelia Willits-Smith, Walter C Willett","doi":"10.1016/j.ajcnut.2025.01.007","DOIUrl":"10.1016/j.ajcnut.2025.01.007","url":null,"abstract":"<p><strong>Background: </strong>Diet plays a vital role in human health and environmental effects. Monitoring diet quality and its relationship to both health and environment are essential for policy making.</p><p><strong>Objectives: </strong>This study aimed to analyze trends in the Planetary Health Diet Index (PHDI) and its associations with daily greenhouse gas (GHG) emissions from food, disease-related biomarkers, anthropometric measurements, obesity, and all-cause mortality in the United States population.</p><p><strong>Methods: </strong>We analyzed 27,181 adults in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018, except for the mortality analysis. 23,599 adults were analyzed as the 2017-2018 NHANES dietary data were removed due to the potential for reverse causation. We calculated PHDI scores by using 2 24-h dietary recalls and GHG by linking the consumption of individual foods to dataFRIENDS, a food-environmental impact database. To assess associations with the PHDI, we used generalized linear regression models for GHG, disease-related biomarkers, and obesity and used the Cox proportional hazards model for all-cause mortality.</p><p><strong>Results: </strong>The energy-adjusted mean of the PHDI (140 possible points) increased from 68.6 in 2005-2006 to 71.7 in 2017-2018 (P-trend < 0.001). Compared with the lowest quintile (Q1), the highest PHDI quintile (Q5) was associated with 25% lower GHG emissions, a better cardiometabolic profile, lower prevalence ratios of obesity [0.59; 95% confidence interval (CI): 0.50, 0.69] and abdominal obesity (0.74; 95% CI: 0.66, 0.82), and a lower risk of all-cause death [hazard ratio (HR): 0.65; 95% CI: 0.54, 0.78].</p><p><strong>Conclusions: </strong>These results underscore the potential health and GHG emission benefits aligned with the planetary health diet.</p>","PeriodicalId":50813,"journal":{"name":"American Journal of Clinical Nutrition","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early identification of potentially reversible cancer cachexia using explainable machine learning driven by body weight dynamics: a multicenter cohort study.","authors":"Liangyu Yin, Na Li, Xin Lin, Ling Zhang, Yang Fan, Jie Liu, Zongliang Lu, Wei Li, Jiuwei Cui, Zengqing Guo, Qinghua Yao, Fuxiang Zhou, Ming Liu, Zhikang Chen, Huiqing Yu, Tao Li, Zengning Li, Pingping Jia, Chunhua Song, Hanping Shi, Hongxia Xu","doi":"10.1016/j.ajcnut.2025.01.006","DOIUrl":"10.1016/j.ajcnut.2025.01.006","url":null,"abstract":"<p><strong>Background: </strong>Cachexia is associated with multiple adverse outcomes in cancer. However, clinical decision-making for oncology patients at the cachexia stage presents significant challenges.</p><p><strong>Objectives: </strong>This study aims to develop a machine learning (ML) model to identify potentially reversible cancer cachexia (PRCC).</p><p><strong>Methods: </strong>This was a multicenter cohort study. Cachexia was retrospectively diagnosed using Fearon's framework. PRCC was defined as a diagnosis of cancer cachexia at baseline that turned negative 1 mo later. Body weight dynamics accessible upon patient admission were screened and modeled to predict PRCC. Multiple ML models were trained and cross-validated using 70% of the data to predict PRCC, with the remaining 30% reserved for model evaluation. The interpretability and clinical usefulness of the optimal model were assessed, and external validation was performed in an independent cohort of 238 patients.</p><p><strong>Results: </strong>The study enrolled 1983 men and 1784 women (median age = 58 y). PRCC was identified in 1983 patients (52.6%). Breast cancer exhibited the highest rate of PRCC (72.1%), whereas cachexia associated with various gastrointestinal cancers was less likely to be reversed. Weight change (WC) from 6 mo ago to 1 mo ago, WC from 1 mo ago to baseline (-1 to 0), and baseline body mass index were selected for modeling. A multilayer perceptron model showed good performance to predict PRCC in the holdout test set [area under the curve (95% confidence interval): 0.887 (0.866, 0.907); accuracy: 0.836; sensitivity: 0.859; specificity: 0.812] and the external validation set [area under the curve (95% confidence interval): 0.863 (0.778, 0.948)]. The WC -1 to 0 showed the highest impact on model output. The model was demonstrated to be clinically useful and statistically relevant.</p><p><strong>Conclusions: </strong>This study presents an explainable ML model for the early identification of PRCC that utilizes simple body weight dynamics. The findings showcase the potential of this approach in improving the management of cancer cachexia to optimize patient outcomes.</p>","PeriodicalId":50813,"journal":{"name":"American Journal of Clinical Nutrition","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protein supplementation delivered alone or in combination with presumptive azithromycin treatment for enteric pathogens did not improve linear growth in Bangladeshi infants: results of a cluster-randomized controlled trial.","authors":"Amanda C Palmer, Md Iqbal Hossain, Hasmot Ali, Kaniz Ayesha, Saijuddin Shaikh, Md Tanvir Islam, Fatema-Tuz Johura, Monica M Pasqualino, Hafizur Rahman, Rezwanul Haque, Kelsey Alland, Lee Shu-Fune Wu, Kerry J Schulze, Subhra Chakraborty, Keith P West, Munirul Alam, Tahmeed Ahmed, Alain B Labrique","doi":"10.1016/j.ajcnut.2024.12.027","DOIUrl":"10.1016/j.ajcnut.2024.12.027","url":null,"abstract":"<p><strong>Background: </strong>Protein requirements established for healthy populations may be insufficient to support healthy growth in infants consuming largely cereal-based complementary foods and frequently exposed to enteric pathogens.</p><p><strong>Objectives: </strong>This study aimed to assess independent and combined effects of protein supplementation and antibiotic treatment on linear growth of infants aged 6-12 mo.</p><p><strong>Methods: </strong>We conducted a 2 × 4 factorial cluster-randomized trial in northwestern Bangladesh, allocating 566 clusters to masked azithromycin (10 mg/kg × 3 d) or placebo at 6 and 9 mo of age and unmasked delivery of an egg white protein-rich blended food supplement (250 kcal; 10 g added protein), a rice-based isocaloric supplement, egg, or nutrition education from 6 to 12 mo. We measured length at 6 and 12 mo. For this cluster-level intention-to-treat analysis of the 2 × 2 antibiotic and protein interventions, we used multiple linear or log-binomial regression with generalized estimating equations to assess changes in length-for-age z (LAZ) score and stunting (LAZ < -2), respectively.</p><p><strong>Results: </strong>We enrolled 2055 infants (283 clusters) and included 1821 infants (281 clusters) with complete anthropometry data at 6 and 12 mo in our analysis. There were no significant interactions between the protein and antibiotic interventions for any outcomes. Independently, protein supplement did not improve LAZ (β: 0.05; 95% CI: 0.00, 0.11; P = 0.07) or reduce stunting (prevalence ratio: 1.12; 95% CI: 0.85, 1.49; P = 0.41) compared with the isocaloric supplement. The antibiotic intervention had no effect on LAZ (β: -0.05; 95% CI: -0.11, 0.01; P = 0.09) or stunting (prevalence ratio: 0.99; 95% CI: 0.75, 1.31; P = 0.96), relative to the placebo.</p><p><strong>Conclusions: </strong>Supplementation to increase intakes of high-quality protein, provided with or without presumptive treatment for enteric pathogens, did not improve linear growth from 6 to 12 mo of age. This trial was registered at clinicaltrials.gov as NCT03683667.</p>","PeriodicalId":50813,"journal":{"name":"American Journal of Clinical Nutrition","volume":" ","pages":""},"PeriodicalIF":6.5,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}