healthy diet research topic

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• Published: 06 December 2017

Healthy food choices are happy food choices: Evidence from a real life sample using smartphone based assessments

• Deborah R. Wahl 1   na1 ,
• Karoline Villinger 1   na1 ,
• Laura M. König   ORCID: orcid.org/0000-0003-3655-8842 1 ,
• Katrin Ziesemer 1 ,
• Harald T. Schupp 1 &
• Britta Renner 1  

Scientific Reports volume  7 , Article number:  17069 ( 2017 ) Cite this article

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Research suggests that “healthy” food choices such as eating fruits and vegetables have not only physical but also mental health benefits and might be a long-term investment in future well-being. This view contrasts with the belief that high-caloric foods taste better, make us happy, and alleviate a negative mood. To provide a more comprehensive assessment of food choice and well-being, we investigated in-the-moment eating happiness by assessing complete, real life dietary behaviour across eight days using smartphone-based ecological momentary assessment. Three main findings emerged: First, of 14 different main food categories, vegetables consumption contributed the largest share to eating happiness measured across eight days. Second, sweets on average provided comparable induced eating happiness to “healthy” food choices such as fruits or vegetables. Third, dinner elicited comparable eating happiness to snacking. These findings are discussed within the “food as health” and “food as well-being” perspectives on eating behaviour.

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Introduction.

When it comes to eating, researchers, the media, and policy makers mainly focus on negative aspects of eating behaviour, like restricting certain foods, counting calories, and dieting. Likewise, health intervention efforts, including primary prevention campaigns, typically encourage consumers to trade off the expected enjoyment of hedonic and comfort foods against health benefits 1 . However, research has shown that diets and restrained eating are often counterproductive and may even enhance the risk of long-term weight gain and eating disorders 2 , 3 . A promising new perspective entails a shift from food as pure nourishment towards a more positive and well-being centred perspective of human eating behaviour 1 , 4 , 5 . In this context, Block et al . 4 have advocated a paradigm shift from “food as health” to “food as well-being” (p. 848).

Supporting this perspective of “food as well-being”, recent research suggests that “healthy” food choices, such as eating more fruits and vegetables, have not only physical but also mental health benefits 6 , 7 and might be a long-term investment in future well-being 8 . For example, in a nationally representative panel survey of over 12,000 adults from Australia, Mujcic and Oswald 8 showed that fruit and vegetable consumption predicted increases in happiness, life satisfaction, and well-being over two years. Similarly, using lagged analyses, White and colleagues 9 showed that fruit and vegetable consumption predicted improvements in positive affect on the subsequent day but not vice versa. Also, cross-sectional evidence reported by Blanchflower et al . 10 shows that eating fruits and vegetables is positively associated with well-being after adjusting for demographic variables including age, sex, or race 11 . Of note, previous research includes a wide range of time lags between actual eating occasion and well-being assessment, ranging from 24 hours 9 , 12 to 14 days 6 , to 24 months 8 . Thus, the findings support the notion that fruit and vegetable consumption has beneficial effects on different indicators of well-being, such as happiness or general life satisfaction, across a broad range of time spans.

The contention that healthy food choices such as a higher fruit and vegetable consumption is associated with greater happiness and well-being clearly contrasts with the common belief that in particular high-fat, high-sugar, or high-caloric foods taste better and make us happy while we are eating them. When it comes to eating, people usually have a spontaneous “unhealthy = tasty” association 13 and assume that chocolate is a better mood booster than an apple. According to this in-the-moment well-being perspective, consumers have to trade off the expected enjoyment of eating against the health costs of eating unhealthy foods 1 , 4 .

A wealth of research shows that the experience of negative emotions and stress leads to increased consumption in a substantial number of individuals (“emotional eating”) of unhealthy food (“comfort food”) 14 , 15 , 16 , 17 . However, this research stream focuses on emotional eating to “smooth” unpleasant experiences in response to stress or negative mood states, and the mood-boosting effect of eating is typically not assessed 18 . One of the few studies testing the effectiveness of comfort food in improving mood showed that the consumption of “unhealthy” comfort food had a mood boosting effect after a negative mood induction but not to a greater extent than non-comfort or neutral food 19 . Hence, even though people may believe that snacking on “unhealthy” foods like ice cream or chocolate provides greater pleasure and psychological benefits, the consumption of “unhealthy” foods might not actually be more psychologically beneficial than other foods.

However, both streams of research have either focused on a single food category (fruit and vegetable consumption), a single type of meal (snacking), or a single eating occasion (after negative/neutral mood induction). Accordingly, it is unknown whether the boosting effect of eating is specific to certain types of food choices and categories or whether eating has a more general boosting effect that is observable after the consumption of both “healthy” and “unhealthy” foods and across eating occasions. Accordingly, in the present study, we investigated the psychological benefits of eating that varied by food categories and meal types by assessing complete dietary behaviour across eight days in real life.

Furthermore, previous research on the impact of eating on well-being tended to rely on retrospective assessments such as food frequency questionnaires 8 , 10 and written food diaries 9 . Such retrospective self-report methods rely on the challenging task of accurately estimating average intake or remembering individual eating episodes and may lead to under-reporting food intake, particularly unhealthy food choices such as snacks 7 , 20 . To avoid memory and bias problems in the present study we used ecological momentary assessment (EMA) 21 to obtain ecologically valid and comprehensive real life data on eating behaviour and happiness as experienced in-the-moment.

In the present study, we examined the eating happiness and satisfaction experienced in-the-moment, in real time and in real life, using a smartphone based EMA approach. Specifically, healthy participants were asked to record each eating occasion, including main meals and snacks, for eight consecutive days and rate how tasty their meal/snack was, how much they enjoyed it, and how pleased they were with their meal/snack immediately after each eating episode. This intense recording of every eating episode allows assessing eating behaviour on the level of different meal types and food categories to compare experienced eating happiness across meals and categories. Following the two different research streams, we expected on a food category level that not only “unhealthy” foods like sweets would be associated with high experienced eating happiness but also “healthy” food choices such as fruits and vegetables. On a meal type level, we hypothesised that the happiness of meals differs as a function of meal type. According to previous contention, snacking in particular should be accompanied by greater happiness.

Eating episodes

Overall, during the study period, a total of 1,044 completed eating episodes were reported (see also Table  1 ). On average, participants rated their eating happiness with M  = 77.59 which suggests that overall eating occasions were generally positive. However, experienced eating happiness also varied considerably between eating occasions as indicated by a range from 7.00 to 100.00 and a standard deviation of SD  = 16.41.

Food categories and experienced eating happiness

All eating episodes were categorised according to their food category based on the German Nutrient Database (German: Bundeslebensmittelschlüssel), which covers the average nutritional values of approximately 10,000 foods available on the German market and is a validated standard instrument for the assessment of nutritional surveys in Germany. As shown in Table  1 , eating happiness differed significantly across all 14 food categories, F (13, 2131) = 1.78, p  = 0.04. On average, experienced eating happiness varied from 71.82 ( SD  = 18.65) for fish to 83.62 ( SD  = 11.61) for meat substitutes. Post hoc analysis, however, did not yield significant differences in experienced eating happiness between food categories, p  ≥ 0.22. Hence, on average, “unhealthy” food choices such as sweets ( M  = 78.93, SD  = 15.27) did not differ in experienced happiness from “healthy” food choices such as fruits ( M  = 78.29, SD  = 16.13) or vegetables ( M  = 77.57, SD  = 17.17). In addition, an intraclass correlation (ICC) of ρ = 0.22 for happiness indicated that less than a quarter of the observed variation in experienced eating happiness was due to differences between food categories, while 78% of the variation was due to differences within food categories.

However, as Figure  1 (left side) depicts, consumption frequency differed greatly across food categories. Frequently consumed food categories encompassed vegetables which were consumed at 38% of all eating occasions ( n  = 400), followed by dairy products with 35% ( n  = 366), and sweets with 34% ( n  = 356). Conversely, rarely consumed food categories included meat substitutes, which were consumed in 2.2% of all eating occasions ( n  = 23), salty extras (1.5%, n  = 16), and pastries (1.3%, n  = 14).

Left side: Average experienced eating happiness (colour intensity: darker colours indicate greater happiness) and consumption frequency (size of the cycle) for the 14 food categories. Right side: Absolute share of the 14 food categories in total experienced eating happiness.

Amount of experienced eating happiness by food category

To account for the frequency of consumption, we calculated and scaled the absolute experienced eating happiness according to the total sum score. As shown in Figure  1 (right side), vegetables contributed the biggest share to the total happiness followed by sweets, dairy products, and bread. Clustering food categories shows that fruits and vegetables accounted for nearly one quarter of total eating happiness score and thus, contributed to a large part of eating related happiness. Grain products such as bread, pasta, and cereals, which are main sources of carbohydrates including starch and fibre, were the second main source for eating happiness. However, “unhealthy” snacks including sweets, salty extras, and pastries represented the third biggest source of eating related happiness.

Experienced eating happiness by meal type

To further elucidate the contribution of snacks to eating happiness, analysis on the meal type level was conducted. Experienced in-the-moment eating happiness significantly varied by meal type consumed, F (4, 1039) = 11.75, p  < 0.001. Frequencies of meal type consumption ranged from snacks being the most frequently logged meal type ( n  = 332; see also Table  1 ) to afternoon tea being the least logged meal type ( n  = 27). Figure  2 illustrates the wide dispersion within as well as between different meal types. Afternoon tea ( M  = 82.41, SD  = 15.26), dinner ( M  = 81.47, SD  = 14.73), and snacks ( M  = 79.45, SD  = 14.94) showed eating happiness values above the grand mean, whereas breakfast ( M  = 74.28, SD  = 16.35) and lunch ( M  = 73.09, SD  = 18.99) were below the eating happiness mean. Comparisons between meal types showed that eating happiness for snacks was significantly higher than for lunch t (533) = −4.44, p  = 0.001, d  = −0.38 and breakfast, t (567) = −3.78, p  = 0.001, d  = −0.33. However, this was also true for dinner, which induced greater eating happiness than lunch t (446) = −5.48, p  < 0.001, d  = −0.50 and breakfast, t (480) = −4.90, p  < 0.001, d  = −0.46. Finally, eating happiness for afternoon tea was greater than for lunch t (228) = −2.83, p  = 0.047, d  = −0.50. All other comparisons did not reach significance, t  ≤ 2.49, p  ≥ 0.093.

Experienced eating happiness per meal type. Small dots represent single eating events, big circles indicate average eating happiness, and the horizontal line indicates the grand mean. Boxes indicate the middle 50% (interquartile range) and median (darker/lighter shade). The whiskers above and below represent 1.5 of the interquartile range.

Control Analyses

In order to test for a potential confounding effect between experienced eating happiness, food categories, and meal type, additional control analyses within meal types were conducted. Comparing experienced eating happiness for dinner and lunch suggested that dinner did not trigger a happiness spill-over effect specific to vegetables since the foods consumed at dinner were generally associated with greater happiness than those consumed at other eating occasions (Supplementary Table  S1 ). Moreover, the relative frequency of vegetables consumed at dinner (73%, n  = 180 out of 245) and at lunch were comparable (69%, n  = 140 out of 203), indicating that the observed happiness-vegetables link does not seem to be mainly a meal type confounding effect.

Since the present study focuses on “food effects” (Level 1) rather than “person effects” (Level 2), we analysed the data at the food item level. However, participants who were generally overall happier with their eating could have inflated the observed happiness scores for certain food categories. In order to account for person-level effects, happiness scores were person-mean centred and thereby adjusted for mean level differences in happiness. The person-mean centred happiness scores ( M cwc ) represent the difference between the individual’s average happiness score (across all single in-the-moment happiness scores per food category) and the single happiness scores of the individual within the respective food category. The centred scores indicate whether the single in-the-moment happiness score was above (indicated by positive values) or below (indicated by negative values) the individual person-mean. As Table  1 depicts, the control analyses with centred values yielded highly similar results. Vegetables were again associated on average with more happiness than other food categories (although people might differ in their general eating happiness). An additional conducted ANOVA with person-centred happiness values as dependent variables and food categories as independent variables provided also a highly similar pattern of results. Replicating the previously reported analysis, eating happiness differed significantly across all 14 food categories, F (13, 2129) = 1.94, p  = 0.023, and post hoc analysis did not yield significant differences in experienced eating happiness between food categories, p  ≥ 0.14. Moreover, fruits and vegetables were associated with high happiness values, and “unhealthy” food choices such as sweets did not differ in experienced happiness from “healthy” food choices such as fruits or vegetables. The only difference between the previous and control analysis was that vegetables ( M cwc  = 1.16, SD  = 15.14) gained slightly in importance for eating-related happiness, whereas fruits ( M cwc  = −0.65, SD  = 13.21), salty extras ( M cwc  = −0.07, SD  = 8.01), and pastries ( M cwc  = −2.39, SD  = 18.26) became slightly less important.

This study is the first, to our knowledge, that investigated in-the-moment experienced eating happiness in real time and real life using EMA based self-report and imagery covering the complete diversity of food intake. The present results add to and extend previous findings by suggesting that fruit and vegetable consumption has immediate beneficial psychological effects. Overall, of 14 different main food categories, vegetables consumption contributed the largest share to eating happiness measured across eight days. Thus, in addition to the investment in future well-being indicated by previous research 8 , “healthy” food choices seem to be an investment in the in-the moment well-being.

Importantly, although many cultures convey the belief that eating certain foods has a greater hedonic and mood boosting effect, the present results suggest that this might not reflect actual in-the-moment experiences accurately. Even though people often have a spontaneous “unhealthy = tasty” intuition 13 , thus indicating that a stronger happiness boosting effect of “unhealthy” food is to be expected, the induced eating happiness of sweets did not differ on average from “healthy” food choices such as fruits or vegetables. This was also true for other stereotypically “unhealthy” foods such as pastries and salty extras, which did not show the expected greater boosting effect on happiness. Moreover, analyses on the meal type level support this notion, since snacks, despite their overall positive effect, were not the most psychologically beneficial meal type, i.e., dinner had a comparable “happiness” signature to snacking. Taken together, “healthy choices” seem to be also “happy choices” and at least comparable to or even higher in their hedonic value as compared to stereotypical “unhealthy” food choices.

In general, eating happiness was high, which concurs with previous research from field studies with generally healthy participants. De Castro, Bellisle, and Dalix 22 examined weekly food diaries from 54 French subjects and found that most of the meals were rated as appealing. Also, the observed differences in average eating happiness for the 14 different food categories, albeit statistically significant, were comparable small. One could argue that this simply indicates that participants avoided selecting bad food 22 . Alternatively, this might suggest that the type of food or food categories are less decisive for experienced eating happiness than often assumed. This relates to recent findings in the field of comfort and emotional eating. Many people believe that specific types of food have greater comforting value. Also in research, the foods eaten as response to negative emotional strain, are typically characterised as being high-caloric because such foods are assumed to provide immediate psycho-physical benefits 18 . However, comparing different food types did not provide evidence for the notion that they differed in their provided comfort; rather, eating in general led to significant improvements in mood 19 . This is mirrored in the present findings. Comparing the eating happiness of “healthy” food choices such as fruits and vegetables to that of “unhealthy” food choices such as sweets shows remarkably similar patterns as, on average, they were associated with high eating happiness and their range of experiences ranged from very negative to very positive.

This raises the question of why the idea that we can eat indulgent food to compensate for life’s mishaps is so prevailing. In an innovative experimental study, Adriaanse, Prinsen, de Witt Huberts, de Ridder, and Evers 23 led participants believe that they overate. Those who characterised themselves as emotional eaters falsely attributed their over-consumption to negative emotions, demonstrating a “confabulation”-effect. This indicates that people might have restricted self-knowledge and that recalled eating episodes suffer from systematic recall biases 24 . Moreover, Boelsma, Brink, Stafleu, and Hendriks 25 examined postprandial subjective wellness and objective parameters (e.g., ghrelin, insulin, glucose) after standardised breakfast intakes and did not find direct correlations. This suggests that the impact of different food categories on wellness might not be directly related to biological effects but rather due to conditioning as food is often paired with other positive experienced situations (e.g., social interactions) or to placebo effects 18 . Moreover, experimental and field studies indicate that not only negative, but also positive, emotions trigger eating 15 , 26 . One may speculate that selective attention might contribute to the “myth” of comfort food 19 in that people attend to the consumption effect of “comfort” food in negative situation but neglect the effect in positive ones.

The present data also show that eating behaviour in the real world is a complex behaviour with many different aspects. People make more than 200 food decisions a day 27 which poses a great challenge for the measurement of eating behaviour. Studies often assess specific food categories such as fruit and vegetable consumption using Food Frequency Questionnaires, which has clear advantages in terms of cost-effectiveness. However, focusing on selective aspects of eating and food choices might provide only a selective part of the picture 15 , 17 , 22 . It is important to note that focusing solely on the “unhealthy” food choices such as sweets would have led to the conclusion that they have a high “indulgent” value. To be able to draw conclusions about which foods make people happy, the relation of different food categories needs to be considered. The more comprehensive view, considering the whole dietary behaviour across eating occasions, reveals that “healthy” food choices actually contributed the biggest share to the total experienced eating happiness. Thus, for a more comprehensive understanding of how eating behaviours are regulated, more complete and sensitive measures of the behaviour are necessary. Developments in mobile technologies hold great promise for feasible dietary assessment based on image-assisted methods 28 .

As fruits and vegetables evoked high in-the-moment happiness experiences, one could speculate that these cumulate and have spill-over effects on subsequent general well-being, including life satisfaction across time. Combing in-the-moment measures with longitudinal perspectives might be a promising avenue for future studies for understanding the pathways from eating certain food types to subjective well-being. In the literature different pathways are discussed, including physiological and biochemical aspects of specific food elements or nutrients 7 .

The present EMA based data also revealed that eating happiness varied greatly within the 14 food categories and meal types. As within food category variance represented more than two third of the total observed variance, happiness varied according to nutritional characteristics and meal type; however, a myriad of factors present in the natural environment can affect each and every meal. Thus, widening the “nourishment” perspective by including how much, when, where, how long, and with whom people eat might tell us more about experienced eating happiness. Again, mobile, in-the-moment assessment opens the possibility of assessing the behavioural signature of eating in real life. Moreover, individual factors such as eating motives, habitual eating styles, convenience, and social norms are likely to contribute to eating happiness variance 5 , 29 .

A key strength of this study is that it was the first to examine experienced eating happiness in non-clinical participants using EMA technology and imagery to assess food intake. Despite this strength, there are some limitations to this study that affect the interpretation of the results. In the present study, eating happiness was examined on a food based level. This neglects differences on the individual level and might be examined in future multilevel studies. Furthermore, as a main aim of this study was to assess real life eating behaviour, the “natural” observation level is the meal, the psychological/ecological unit of eating 30 , rather than food categories or nutrients. Therefore, we cannot exclude that specific food categories may have had a comparably higher impact on the experienced happiness of the whole meal. Sample size and therefore Type I and Type II error rates are of concern. Although the total number of observations was higher than in previous studies (see for example, Boushey et al . 28 for a review), the number of participants was small but comparable to previous studies in this field 20 , 31 , 32 , 33 . Small sample sizes can increase error rates because the number of persons is more decisive than the number of nested observations 34 . Specially, nested data can seriously increase Type I error rates, which is rather unlikely to be the case in the present study. Concerning Type II error rates, Aarts et al . 35 illustrated for lower ICCs that adding extra observations per participant also increases power, particularly in the lower observation range. Considering the ICC and the number of observations per participant, one could argue that the power in the present study is likely to be sufficient to render the observed null-differences meaningful. Finally, the predominately white and well-educated sample does limit the degree to which the results can be generalised to the wider community; these results warrant replication with a more representative sample.

Despite these limitations, we think that our study has implications for both theory and practice. The cumulative evidence of psychological benefits from healthy food choices might offer new perspectives for health promotion and public-policy programs 8 . Making people aware of the “healthy = happy” association supported by empirical evidence provides a distinct and novel perspective to the prevailing “unhealthy = tasty” folk intuition and could foster eating choices that increase both in-the-moment happiness and future well-being. Furthermore, the present research lends support to the advocated paradigm shift from “food as health” to “food as well-being” which entails a supporting and encouraging rather constraining and limiting view on eating behaviour.

The study conformed with the Declaration of Helsinki. All study protocols were approved by University of Konstanz’s Institutional Review Board and were conducted in accordance with guidelines and regulations. Upon arrival, all participants signed a written informed consent.

Participants

Thirty-eight participants (28 females: average age = 24.47, SD  = 5.88, range = 18–48 years) from the University of Konstanz assessed their eating behaviour in close to real time and in their natural environment using an event-based ambulatory assessment method (EMA). No participant dropped out or had to be excluded. Thirty-three participants were students, with 52.6% studying psychology. As compensation, participants could choose between taking part in a lottery (4 × 25€) or receiving course credits (2 hours).

Participants were recruited through leaflets distributed at the university and postings on Facebook groups. Prior to participation, all participants gave written informed consent. Participants were invited to the laboratory for individual introductory sessions. During this first session, participants installed the application movisensXS (version 0.8.4203) on their own smartphones and downloaded the study survey (movisensXS Library v4065). In addition, they completed a short baseline questionnaire, including demographic variables like age, gender, education, and eating principles. Participants were instructed to log every eating occasion immediately before eating by using the smartphone to indicate the type of meal, take pictures of the food, and describe its main components using a free input field. Fluid intake was not assessed. Participants were asked to record their food intake on eight consecutive days. After finishing the study, participants were invited back to the laboratory for individual final interviews.

Immediately before eating participants were asked to indicate the type of meal with the following five options: breakfast, lunch, afternoon tea, dinner, snack. In Germany, “afternoon tea” is called “Kaffee & Kuchen” which directly translates as “coffee & cake”. It is similar to the idea of a traditional “afternoon tea” meal in UK. Specifically, in Germany, people have “Kaffee & Kuchen” in the afternoon (between 4–5 pm) and typically coffee (or tea) is served with some cake or cookies. Dinner in Germany is a main meal with mainly savoury food.

After each meal, participants were asked to rate their meal on three dimensions. They rated (1) how much they enjoyed the meal, (2) how pleased they were with their meal, and (3) how tasty their meal was. Ratings were given on a scale of one to 100. For reliability analysis, Cronbach’s Alpha was calculated to assess the internal consistency of the three items. Overall Cronbach’s alpha was calculated with α = 0.87. In addition, the average of the 38 Cronbach’s alpha scores calculated at the person level also yielded a satisfactory value with α = 0.83 ( SD  = 0.24). Thirty-two of 38 participants showed a Cronbach’s alpha value above 0.70 (range = 0.42–0.97). An overall score of experienced happiness of eating was computed using the average of the three questions concerning the meals’ enjoyment, pleasure, and tastiness.

Analytical procedure

The food pictures and descriptions of their main components provided by the participants were subsequently coded by independent and trained raters. Following a standardised manual, additional components displayed in the picture were added to the description by the raters. All consumed foods were categorised into 14 different food categories (see Table  1 ) derived from the food classification system designed by the German Nutrition Society (DGE) and based on the existing food categories of the German Nutrient Database (Max Rubner Institut). Liquid intake and preparation method were not assessed. Therefore, fats and additional recipe ingredients were not included in further analyses, because they do not represent main elements of food intake. Further, salty extras were added to the categorisation.

No participant dropped out or had to be excluded due to high missing rates. Missing values were below 5% for all variables. The compliance rate at the meal level cannot be directly assessed since the numbers of meals and snacks can vary between as well as within persons (between days). As a rough compliance estimate, the numbers of meals that are expected from a “normative” perspective during the eight observation days can be used as a comparison standard (8 x breakfast, 8 × lunch, 8 × dinner = 24 meals). On average, the participants reported M  = 6.3 breakfasts ( SD  = 2.3), M  = 5.3 lunches ( SD  = 1.8), and M  = 6.5 dinners ( SD  = 2.0). In comparison to the “normative” expected 24 meals, these numbers indicate a good compliance (approx. 75%) with a tendency to miss six meals during the study period (approx. 25%). However, the “normative” expected 24 meals for the study period might be too high since participants might also have skipped meals (e.g. breakfast). Also, the present compliance rates are comparable to other studies. For example, Elliston et al . 36 recorded 3.3 meal/snack reports per day in an Australian adult sample and Casperson et al . 37 recorded 2.2 meal reports per day in a sample of adolescents. In the present study, on average, M  = 3.4 ( SD  = 1.35) meals or snacks were reported per day. These data indicate overall a satisfactory compliance rate and did not indicate selective reporting of certain food items.

To graphically visualise data, Tableau (version 10.1) was used and for further statistical analyses, IBM SPSS Statistics (version 24 for Windows).

Data availability

The dataset generated and analysed during the current study is available from the corresponding authors on reasonable request.

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Acknowledgements

This research was supported by the Federal Ministry of Education and Research within the project SmartAct (Grant 01EL1420A, granted to B.R. & H.S.). The funding source had no involvement in the study’s design; the collection, analysis, and interpretation of data; the writing of the report; or the decision to submit this article for publication. We thank Gudrun Sproesser, Helge Giese, and Angela Whale for their valuable support.

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Deborah R. Wahl, Karoline Villinger, Laura M. König, Katrin Ziesemer, Harald T. Schupp & Britta Renner

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B.R. & H.S. developed the study concept. All authors participated in the generation of the study design. D.W., K.V., L.K. & K.Z. conducted the study, including participant recruitment and data collection, under the supervision of B.R. & H.S.; D.W. & K.V. conducted data analyses. D.W. & K.V. prepared the first manuscript draft, and B.R. & H.S. provided critical revisions. All authors approved the final version of the manuscript for submission.

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Wahl, D.R., Villinger, K., König, L.M. et al. Healthy food choices are happy food choices: Evidence from a real life sample using smartphone based assessments. Sci Rep 7 , 17069 (2017). https://doi.org/10.1038/s41598-017-17262-9

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Will Healthy Eating Make You Happier? A Research Synthesis Using an Online Findings Archive

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Healthy eating adds to health and thereby contributes to a longer life, but will it also add to a happier life? Some people do not like healthy food, and since we spend a considerable amount of our life eating, healthy eating could make their life less enjoyable. Is there such a trade-off between healthy eating and happiness? Or instead a trade-on , healthy eating adding to happiness? Or do the positive and negative effects balance? If there is an effect of healthy eating on happiness, is that effect similar for everybody? If not, what kind of people profit from healthy eating happiness wise and what kind of people do not? If healthy eating does add to happiness, does it add linearly or is there some optimum for healthy ingredients in one’s diet? I considered the results published in 20 research reports on the relation between nutrition and happiness, which together yielded 47 findings. I reviewed these findings, using a new technique. The findings were entered in an online ‘findings archive’, the World Database of Happiness, each described in a standardized format on a separate ‘findings page’ with a unique internet address. In this paper, I use links to these finding pages and this allows us to summarize the main trends in the findings in a few tabular schemes. Together, the findings provide strong evidence of a causal effect of healthy eating on happiness. Surprisingly, this effect is not fully mediated by better health. This pattern seems to be universal, the available studies show only minor variations across people, times and places. More than three portions of fruits and vegetables per day goes with the most happiness, how many more for what kind of persons is not yet established.

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Introduction

Healthy eating, in particular a diet rich in fruit and vegetables (FV) adds to our health; primarily because it reduces our chances of contracting a number of eating related diseases (Oyebode et al. 2014 ; Bazzano et al. 2002 ; Liu et al. 2000 ). Since good health adds to happiness, it is likely that healthy diets will also add to happiness, but a firm connection has not been established.

In recent years, the relationship between obesity and mental states has begun to attract serious research interest (Becker et al. 2001 ; Rooney et al. 2013 ), as has the relationship between specific micro-nutrients and psychological health (Stough et al. 2011 ). As yet, there is little research on the relationship between nutrition and happiness.

It is worth knowing to what extent our eating habits affect our happiness. One reason is that most people are concerned about their happiness and look for ways to increase it. Most determinants of happiness are beyond our control, but what we eat is largely in our own hands. In this context, we would like to know whether there is a trade-off between healthy eating and happy living. Gains in length of life due to healthy eating may be counterbalanced by loss of satisfaction with life, as is argued in the debate on the benefits of drinking alcohol (Baum-Baicker 1985 ). If so, healthy eating may mean that we live longer, but not happier.

Empirical assessment of the effects of healthy eating on happiness is fraught with complications. One complication is that the effect of nutrition is probably not the same for everybody. Hence, we must identify what food pattern is optimal for what kind of person. A second problem is that happiness can influence nutrition behaviour, for example unhappiness can lead to the consumption of unhealthy comfort foods. Cause and effect must be disentangled. If a healthy diet does appear to add to happiness, then a third question arises: Is eating more healthy food always better or is there an optimum amount one should eat? For instance, is one apple a day enough to make us feel happy? Or will we feel better with four daily portions of fruit? How about small sins, such as a bar of chocolate or a daily glass of wine?

Research Questions

Is there a trade-of or between healthy eating and happiness? Or rather a trade-on , healthy eating adding to happiness? Or do the positive and negative effects balance?

Is this effect of healthy eating on happiness similar for everybody? If not, what kind of people profit from healthy eating and what kind of people do not?

Is the shape of the relationship between healthy eating and happiness linear? The healthier one’s diet, the happier one is? Or is there an optimum?

I explored answers to these three questions in the available research literature and took stock of the findings obtained in quantitative studies on the relation between healthy eating and happiness. I applied a new technique for research reviewing, that takes advantage of an on-line findings archive, the World Database of Happiness (Veenhoven 2018a ), which allows us to present a lot of findings in a few easy to oversee tabular schemes.

To my knowledge, the research literature on this subject has not been reviewed as yet. One review has considered the observed effect of eating fruit and vegetables on psychological well-being (Rooney et al. 2013 ), however, this review does not really deal with happiness, as will be defined in “ Happiness ” section, but is about mental disorders, such as depression and anxiety.

Structure of the Paper

The remainder of this paper is organized as follows. I define the key concepts in “ Concepts and Measures ” section; healthy eating and happiness and give a short account of happiness research. Next, I describe the new review technique in more detail: how the available research findings were gathered and how these are presented in an easy to overview way ( Methods section). Then I discuss what answers the available findings have provided for our research questions ( Results section). I found a clear answer to the first research question, but no clear answers to the second and third question. I discuss these findings in “ Discussion ” section and draw conclusions in “ Conclusions ” section.

Concepts and Measures

There are different view on what constitutes ‘healthy eating’ and ‘happiness’; for this reason, a delineation of these notions is required.

Healthy Eating

I follow the WHO ( 2018 ) characterization of a ‘healthy diet’ as involving’: 1) a varied diet, 2) rich in fruit and vegetables 3) a moderate amount of fats and oil and 4) less salt and sugar than usual these days. The typical Mediterranean diet is considered to fit these demands well. Unhealthy foods are considered to be rich in sugar and fat, such as processed meat, fast foods, sweets, cakes, sodas, deserts, alcohol and other foods high in calories, but low in nutritional content.

Throughout history, the word happiness has been used to denote different concepts that are loosely connected. Philosophers typically used the word to denote living a good life and often emphasize moral behaviour. ‘Happiness’ has also been used to denote good living conditions and associated with material affluence and physical safety. Today, many social scientists use the word to denote subjective satisfaction with life , which is also referred to as subjective well-being (SWB).

Definition of Happiness

In that latter line, I defined happiness as the degree to which an individual judge the overall quality of his/her life-as-a-whole favourably Footnote 1 (Veenhoven 1984 ) and in a later paper distinguished this definition of happiness from other notions of the good life (Veenhoven 2000 ). In this paper, I follow this conceptualization as it is also the focus of the World Database of Happiness (Veenhoven 2018a ) from which the data reported in this paper are drawn.

Components of Happiness

Our overall evaluation of life draws on two sources of information: a) how well one feels most of the time and b) to what extent one perceives one is getting from life what one wants from it. I refer to these sub-assessments as ‘components’ of happiness, called respectively ‘hedonic level of affect’ and ‘contentment’ (Veenhoven 1984 ). The affective component tends to dominate in the overall evaluation of life (Kainulainen et al. 2018 ).

The affective component is also known as ‘affect balance’, which is the degree to which positive affective (PA) experiences outweigh negative affective (NA) experiences Positive experience typically signals that we are doing well and encourages functioning in several ways (Fredrickson 2004 ) and protects health (Veenhoven 2008 ). As such, this aspect of happiness was particularly interesting for this review of effects of healthy eating.

Difference with Wider Notions of Wellbeing

Happiness in the sense of the ‘subjective enjoyment of one’s life-as-a-whole’, should not be equated with satisfaction with domains of life, such as satisfaction with one’s life-style, one’s diet in particular. Likewise, happiness in the sense of the ‘subjective enjoyment of one’s life’ should not be equated with ‘objective’ notions of what is a good life, which are sometimes denoted using the same term. Though strongly related to happiness, mental health is not the same; one can be pathologically happy or be happy in spite of a mental condition.

Differences in wider notions of well-being are discussed in more detail in Veenhoven (15).

Measurement of Happiness

Since happiness is defined as something that is on our mind, it can be measured using questioning. Various ways of questioning have been used, direct questions as well as indirect questions, open questions and closed questions and one-time retrospective questions and repeated questions on happiness in the moment.

Not all questions used fit the above definition of happiness adequately, e.g. not the question whether one thinks one is happier than most people of one’s age, which is an item in the Subjective Happiness Scale (Lyobomirsky and Lepper 1999 ). Findings obtained using such invalid measures are not included in the World Database of Happiness and hence were not considered in this research synthesis. Further detail on the validity assessment of questions on happiness is available in the introductory text to the collection Measures of Happiness of the World Database of Happiness (Veenhoven 2018b ) chapter 4. Some illustrative questions deemed valid for archiving in the WDH are presented below.

Question on overall happiness:

Taking all together, how happy would you say you are these days?

Questions on hedonic level of affect:

Would you say that you are usually cheerful or dejected?

How is your mood today? (Repeated several days).

Question on contentment:

How important are each of these goals for you?

How successful have you been in the pursuit of these goals?

Happiness Research

Over the ages, happiness has been a subject of philosophical speculation and in the second half of the twentieth century it also became the subject of empirical research. In the 1960’s, happiness appeared as a side-subject in research on successful aging (Neugarten et al. 1961 ) and mental health (Gurin et al. 1960 ). In the 1970’s happiness became a topic in social indicators research (Veenhoven 2017 ) and in the 1980s in medical quality of life research (e.g. Calman 1984 ). Since the 2000’s, happiness has become a main subject in the fields of ‘Positive psychology’ (Lyubomirsky et al. 2005 ) and ‘Happiness Economics’ (Bruni and Porta 2005 ). All this has resulted in a spectacular rise in the number of scholarly publications on happiness and in the past year (2017) some 500 new research reports have been published. To date (May 2018), the Bibliography of Happiness list 6451 reports of empirical studies in which a valid measure of happiness has been used (Veenhoven 2018c ).

Findings Archive: The World Database of Happiness

This flow of research findings on happiness has grown too big to oversee, even for specialists. For this reason, a findings archive has been established, in which quantitative outcomes are presented in a uniform format and are sorted by subject. This ‘World Database of Happiness’ is freely available on the internet at https://worlddatabaseofhappiness.eur.nl

Its structure is shown on Fig.  1 and a recent description of this novel technique for the accumulation of research findings can be found with Veenhoven ( 2019 ).

Start page of the World Database of Happiness, showing the structure of this findings archive

One of the subject categories in the collection of correlational findings is ‘Happiness and Nutrition’ (Veenhoven 2018c ). I draw on that source for this paper.

A first step in this review was to gather the available quantitative research findings on the relationship between happiness and healthy eating. The second step was to present these findings in an uncomplicated form.

Gathering of Research Findings

In order to identify relevant papers for this synthesis, I inspected which publications on the subject of healthy eating were already included of the Bibliography of World Database of Happiness, in the subject sections ‘ Health behaviour’ and consumption of ‘ Food ’. Then to further complete the collection of studies, various databases were searched such as Google Scholar, EBSCO, ScienceDirect, PsycINFO, PubMed/Medline, using terms such as ‘ happiness ’, ‘ life satisfaction ’, ‘ subjective well-being ’, ‘ well-being ’, ‘ daily affect ’, ‘ positive affect ’, ‘ negative affect ’ in connection with terms such as ‘ food ’, ‘ healthy food ’, ‘ fruit and vegetables ’, ‘ fast food ‘and ‘ soft drinks ’ in different sequences.

All reviewed studies had to meet the following criteria:

A report on the study should be available in English, French, German or Spanish.

The study should concern happiness in the sense of life-satisfaction (cf. Healthy Eating section). I excluded studies on related matters, such as on mental health or wider notions of ‘flourishing’.

The study should involve a valid measure of happiness (cf. Happiness section). I excluded scales that involved questions on different matters, such as the much-used Satisfaction With Life Scale (Diener et al. 1985 ).

The study results had to be expressed using some type of quantitative analysis.

Studies Found

Together, I found 20 reports of an empirical investigation that had examined the relationship between healthy eating and happiness, of which two were working papers and one dissertation. None of these publication s reported more than one study . Together, the studies yielded 47 findings.

All the papers were fairly recent, having been published between 2005 and 2017. Most of the papers (44.4%) were published in Medical Journals, including the International Journal of Behavioural Medicine, Journal of Health Psychology, The Journal of Nutrition, Health & Aging, The Journal of Nutrition, Health & Aging, The Journal of Psychosomatic Research, The International Journal of Public Health, and Social Psychiatry & Psychiatric Epidemiology.

People Investigated

Together, the studies covered 149.880 respondents and 27 different countries. The publics investigated in these studies, included the general population in countries and particular groups such as students, children, veterans and medical patients. The majority of respondents belonged to a general public group (50%), students made up 27.8%, with children and veterans each forming 11.1%.

Research Methods Used

Most of the studies were cross-sectional 64.4%, longitudinal and daily food diaries accounted for 22% and 10.2% of the total number of studies respectively, and one experimental study accounted for 3.4%.

I present an overview of all the included studies, including information about population, methods and publication in Table 1 .

Format of this Research Synthesis

As announced, I applied a new technique of research reviewing, taking advantage of two technical innovations: a) The availability of an on-line findings-archive (the World Database of Happiness) that holds descriptions of research findings in a standard format and terminology, presented on separate finding pages with a unique internet address. b) The change in academic publishing from print on paper to electronic text read on screen, in which links to that online information can be inserted.

Links to Online Detail

In this review, I summarize the observed statistical relationships as +, − or 0 signs. Footnote 2 These signs link to finding pages in the World Database of Happiness, which serves as an online appendix in this article. If you click on a sign, one such a finding page will open, on which you can see full details of the observed relationship; of the people investigated, sampling, the measurement of both variables and the statistical analysis. An example of such an electronic finding page is presented in Fig.  2 . This technique allows me to present the main trends in the findings, without burdening the reader with all the details, while keeping the paper to a controllable size, at the same time allowing the reader to check in depth any detail they wish.

Example of an online findings page

Organization of the Findings

I first sorted the findings by the research method used and these are presented in three separate tables. I distinguished a) cross-sectional studies, assessing same-time relationships between diet and happiness (Table 2 ), b) longitudinal studies, assessing change in happiness following changes in diet (Table 3 ), and c) experimental studies, assessing the effect of induced changes in diet on happiness (Table 4 ).

In the tables, I distinguish between studies at the micro level, in which the relation between diet and happiness of individuals was assessed and studies at the macro level, in which average diet in nations is linked to average happiness of citizens.

I present kinds of foods consumed vertically and horizontally two kinds of happiness: overall happiness (life-satisfaction) and hedonic level of affect.

Presentation of the Findings

The observed quantitative relationships between diet and happiness are summarized using 3 possible signs: + for a positive relationship, − for a negative relationship and 0 for a non-relationship. Statistical significance is indicated by printing the sign in bold . See Appendix . Each sign contains a link to a particular finding page in the World Database of Happiness, where you can find more detail on the checked finding.

Some of these findings appear in more than one cell of the tables. This is the case for pages on which a ‘raw’ (zero-order) correlation is reported next to a ‘partial’ correlation in which the effect of the control variables is removed. Likewise, you will find links to the same findings page at the micro level and the macro level in Table 2 ; on this page there is a time-graph of sequential studies in Russia from which both micro and macro findings can be read.

Several cells in the tables remain empty and denote blanks in our knowledge.

Advantages and Disadvantages of this Review Technique

There are pros and cons to the use of a findings-archive such as the World Database of Happiness and plusses and minuses to the use of links to an on-line source in a text like this one.

Use of a Findings-Archive

Advantages are: a) efficient gathering of research on a particular topic, happiness in this case, b) sharp conceptual focus and selection of studies on that basis, c) uniform description of research findings on electronic finding pages, using a standard format and a technical terminology, d) storage of these finding pages in a well searchable database, e) which is available on-line and f) to which links can be made from texts. The technique is particular useful for ongoing harvesting of research findings on a particular subject.

Disadvantages are: a) the sharp conceptual focus cannot easily be changed, b) considerable investment is required to develop explicit criteria for inclusion, definition of technical terms and software, Footnote 3 c) which pays only when a lot of research is processed on a continuous basis.

Use of Links in a Review Paper

The use of links to an on-line source allows us to provide extremely short summaries of research findings, in this text by using +, − and 0 signs in bold or not, while allowing the reader access to the full details of the research. This technique was used in an earlier research synthesis on wealth and happiness (Jantsch and Veenhoven 2019 ) and is described in more detail in Veenhoven ( 2019 ). Advantages of such representation are: a) an easy overview of the main trend in the findings, in this case many + signs for healthy foods, b) access to the full details behind the links, c) an easy overview of the white spots in the empty cells in the tables, and d) easy updates, by entering new sign in the tables, possibly marked with a colour.

The disadvantages are: a) much of the detailed information is not directly visible in the + and – signs, b) in particular not the effect size and control variables used, and c) the links work only for electronic texts.

Differences with Traditional Reviewing

Usual review articles cannot report much detail about the studies considered and rely heavily on references to the research reports read by the reviewer, which typically figure on a long list at the end of the review paper that the reader can hardly check. As a result, such reviews are vulnerable to interpretations made by the reviewer and methodological variation can escape the eye.

Another difference is that the conceptual focus of many traditional reviews in this field is often loose, covering fuzzy notions of ‘well-being’ rather than a well-defined concept of ‘happiness’ as used here. This blurs the view on what the data tell and involves a risk of ‘cherry picking’ by reviewers. A related difference is that traditional reviews of happiness research often assume that the name of a questionnaire corresponds with its conceptual contents. Yet, several ‘happiness scales’ measure different things than happiness as defined in “ Healthy Eating ” section, e.g. much used Life Satisfaction Scale (Neugarten et al. 1961 ), which measures social functioning.

Still another difference is that traditional narrative reviews focus on interpretations advanced by authors of research reports, while in this quantitative research synthesis I focus on the data actually presented. An example of such a difference in this review, is the publication by Connor & Brookie (Conner et al. 2015 ) who report no effect of healthier eating on mood in the experimental group, while their data show a small but significant gain in positive affect and a small but insignificant reduction of negative effect (Table 3 ), which together denote a positive effect on affect balance.

Difference with Traditional Meta-Analysis

Though this research synthesis is a kind of meta-analysis, it differs from common meta-analytic studies in several ways. One difference is the above- mentioned conceptual rigor; like narrative reviews many meta-analyses take the names given to variables for their content thus adding apples and oranges. Another difference is the direct online access to full detail about the research findings considered, presented in a standard format and terminology, while traditional meta-analytic studies just provide a reference to research reports from which the data were taken. A last difference is that most traditional meta-analytic studies aim at summarizing the research findings in numbers, such as an average effect size. Such quantification is not well possible for the data at hand here and not required for answering our research questions. My presentation of the separate findings in tabular schemers provides more information, both of the general tendency and of the details.

Let us now revert to the research questions ( Structure of the Paper section) and answer these one by one.

Is there a Trade-Of between Healthy Eating and Happiness?

Or does healthy eating rather add to happiness or do the positive and negative effects balance.

This question was addressed using different methods, a) same-time comparison of diet and happiness (cross-sectional analysis) b) follow-up of change in happiness following change in diet (longitudinal) and c) assessing the effect on happiness of induced change in diet (experimental). The results are summarized in, respectively, Tables  2 , 3 and 4 .

Cross-Sectional Findings

Together I found 42 correlational findings, which are presented in Table 2 . Of these findings 14 concerned raw correlations, while 28 reflected the results of a multivariate analysis. In Table 2 I see only micro level studies.

There were 16  +  signs, which indicates that people who eat healthy tend to be happier than people who do not. A few (3) – signs were linked to unhealthy eating habits, i.e. fast food, soft drinks and sweets, and as such support this pattern.

Not all the findings supported the view that healthy eating goes with greater happiness. Consumption of soft-drinks was positively related to overall happiness, though not significantly, while the correlation with affect balance was significantly negative. A high intake of high caloric protein and fat is generally deemed to be unhealthy but appeared in one case to go with greater overall happiness, a study among medical patients in Arkhangelsk in Russia, where the medical conditions and cold climate may have require a higher intake of such foods.

The findings were mixed with respect to the relation of happiness with consumption of animal products, dairy and meat. For these foods a positive relation with overall happiness was found and a negative relation with affect level, in the case of milk products both relations were insignificant.

Several studies report both raw correlations and partial ones for the same population. Controls reduced the effect size somewhat but did not change the direction of the correlation. Importantly, the control for health and other health behaviours in 8 studies Footnote 4 did not change the direction of the correlation.

Longitudinal Findings

The findings of two studies that assessed the change in happiness following change in diet are presented in Table 3 , one study at the micro level among students and another study at the macro-level among the general population in Russia. Both studies found positive correlations, indicating that healthier eating adds to one’s happiness. The effects of greater consumption of meat and milk were not significant. No control variables were used in these studies. The relationship between healthy eating and affect level was not investigated longitudinally.

Experimental Study

To date, there is only one study on the effect of induced change to a healthier diet on an individual’s happiness. In this study people were randomly assigned to an experimental group and stimulated in various ways to consume more fruit and vegetables (FV), among other things by providing vouchers for health foods and sending e-mail reminders. After 2 weeks of increased FV consumption, the participant’s mood level had increased more than those of the control group.

Together, these findings provide a clear answer to our first research question. The net effect of healthy eating on happiness tends to be positive. If there is any trade-off at all, this is apparently more than compensated by the trade-on . The positive relationship is robust across research methods and measures of happiness.

Is this Effect of Healthy Eating on Happiness Similar for Everybody?

If not, what kind of people profit from healthy eating and what kind of people do not.

The 19 studies reported here cover a wide range of populations, the general public in several parts of the world, children, students, church members, medical patients and elderly war veterans. No great differences in the correlation between diet and happiness appear in these findings, though children seem to be happier when allowed to consume sweets and soft drinks. The cross-national study by Grant et al. ( 2009 ) observed some differences in strength of the correlation between healthy eating and happiness across part of the world, but no difference in direction of the correlation. The micro-level studies by Pettay ( 2008 ) and Warner et al. ( 2017 ) found no differences between males and females, while Ford et al. ( 2013 ) found a slightly bigger negative effect of unhealthy eating among women than among men.

The observed positive effect of healthy eating on happiness seems to be universal. Possible differences in what diet provides the most happiness for whom have not (yet) been identified.

Is the Shape of The Relationship Linear; the Healthier One’s Diet, the Happier One Is?

Or is there an optimum, if so what is optimal for whom.

Two studies find a linear relation between happiness and the number of portions fruits and vegetables per day, Lesani et al. ( 2016 ) among students in Iran and Blanchflower et al. ( 2013 ) among the general public in the UK, the latter study up to 7–8 portion a day. Another study observed an optimum at the lower level of 3–4 portions a day among female Iranian students (Fararouei et al. 2013 ). These thee studies suggest that the optimum is at least beyond three portions a day. As yet the focus of research has been on particular kinds of food, while the relationship between happiness and total diet composition has not been investigated.

Together, our findings leave no doubt that healthy eating ads to happiness, frequent consumption of fruit and vegetables in particular.

Causal Effect

Though happiness may influence nutrition behaviour, happier people being more inclined to follow a healthy diet, there is strong evidence for a causal effect of healthy eating on happiness. Spurious correlation is unlikely to exist, since correlations remain positive after controlling for many different variables. Causality is strongly suggested by 3 out of the 4 longitudinal findings and the experimental study.

This is not to say that healthy eating will always add to the happiness of everybody, but the trend is sufficiently universal and strong to be used in policies that aim at greater happiness for a greater number of people, such as in happiness education.

Causal Paths

Healthy eating will add to good health and good health will add to happiness. An unexpected finding is that the effect of healthy eating on happiness is not fully mediated by better health. As mentioned in “ Is there a Trade-Of between Healthy Eating and Happiness? ” section, significant positive correlations remain when health is controlled. This means that healthy eating also affects happiness in other ways. As yet I can only speculate about what these ways are. Possibly effects are that healthy eaters attract nicer people or that intake of fruit and vegetables has a direct effect on mood.

Limitations

This first synthesis of the research on happiness and healthy eating draws on 20 empirical studies, which together yielded 47 findings. Though these results provide strong indications of a positive effect of healthy eating on happiness, we need more research to be sure. This research synthesis limits to happiness defined as the subjective enjoyment of one’s life as a whole and measure that matter adequately. This conceptual focus has a piece, we came to know more about less. The available research findings do not allow a traditional meta-analysis, both because of the limited numbers and their heterogeneity. Hence, we cannot yet compute effect sizes or test statistical significance of differences.

Topics for Further Research

Although we now know that healthy eating tends to make one’s life more satisfying, we do not know in much detail what particular diets are the most conducive to the happiness of what kinds of people. We are also largely in the dark about the causal mechanisms involved. The focus of current research is very much on particular food items, consumption of fruit and vegetables in particular. Future research should pay more attention to the effect of total diets on happiness.

Conclusions

Healthy eating adds to happiness, not just by protecting one’s health but also in other, as yet unidentified, ways. This finding deserves to be drawn to the public’s attention. People should know that changing to a healthier diet will not be at the cost of their happiness but will add to it. Faulty beliefs and misleading advertisements should be counter-balanced by this established fact.

Likewise, Diener (26) defined ‘life satisfaction’ as an overall judgement of one’s life.

The technique also allows summarization in a number, which can be presented in a stem-leaf diagram, or in short verbal. Statements, such as ‘U shaped relationship’

The archive can be easily adjusted for other subjects. The software is Open Source

Blanchflower et al. ( 2013 ); Fararouei et al. ( 2013 ); Ford et al. ( 2013 ); Huffman and Rizov ( 2016 ); Lesani et al. ( 2016 ); Lengyel et al. ( 2009 ) and Kye and Park ( 2014 )

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positive correlation, statistically significant

positive correlation, not statistically significant

positive and negative correlations, depending on control variables used

no correlation

negative correlation, not statistically significant

negative correlation, statistically significant

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Veenhoven, R. Will Healthy Eating Make You Happier? A Research Synthesis Using an Online Findings Archive. Applied Research Quality Life 16 , 221–240 (2021). https://doi.org/10.1007/s11482-019-09748-7

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Received : 20 December 2018

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Global scientific trends on healthy eating from 2002 to 2021: a bibliometric and visualized analysis.

1. Background

2.1. data source, 2.2. search strategy, 2.3. patient and public involvement, 2.4. data analysis, 3.1. global publishing volume and trend, 3.2. distribution and contribution of countries/regions, 3.3. contribution of journals, 3.4. contribution and cooperation of institutions, 3.5. contribution and cooperation of authors, 3.6. analysis of keywords and research trend, 4. discussion, 4.1. global publishing trends, 4.2. international research status and cooperation, 4.3. hot spots and novel themes, 5. conclusions, supplementary materials, author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest, abbreviations.

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Fang, T.; Cao, H.; Wang, Y.; Gong, Y.; Wang, Z. Global Scientific Trends on Healthy Eating from 2002 to 2021: A Bibliometric and Visualized Analysis. Nutrients 2023 , 15 , 1461. https://doi.org/10.3390/nu15061461

Fang T, Cao H, Wang Y, Gong Y, Wang Z. Global Scientific Trends on Healthy Eating from 2002 to 2021: A Bibliometric and Visualized Analysis. Nutrients . 2023; 15(6):1461. https://doi.org/10.3390/nu15061461

Fang, Te, Hongyi Cao, Yue Wang, Yang Gong, and Zhongqing Wang. 2023. "Global Scientific Trends on Healthy Eating from 2002 to 2021: A Bibliometric and Visualized Analysis" Nutrients 15, no. 6: 1461. https://doi.org/10.3390/nu15061461

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• > Journals
• > Public Health Nutrition
• > Volume 22 Issue 13
• > What is healthy eating? A qualitative exploration

Article contents

• Participants:
• Conclusions:

Supplementary material

What is healthy eating a qualitative exploration.

Published online by Cambridge University Press:  17 May 2019

• Supplementary materials

The present study aimed to explore how healthy food choices are translated into everyday life by exploring definitions of healthy food choices, perceptions of own food choice, and healthy food choice drivers (facilitators) and barriers.

An exploratory qualitative study design was employed using semi-structured face-to-face interviews. Convenience sampling was used to recruit participants. Interviews were audio-recorded, transcribed verbatim and cross-checked for consistency. Thematic analysis was used to identify patterns emerging from the data.

Canberra, Australia, October 2015–March 2016.

A total of twenty-three participants aged 25–60 years were interviewed. The mean age was 38 years and the mean BMI was 29·1 kg/m 2 . All male participants ( n 4) were within the healthy weight range compared with 58 % of female participants, with 26 % being overweight and 16 % being obese.

(i) Healthy food choices are important but are not a daily priority; (ii) healthy eating information is known but can be difficult to apply into everyday life; (iii) popular diets are used in attempts to improve healthy eating; and (iv) social media inspires and connects people with healthy eating.

Social media facilitates healthy food choices by providing access to healthy eating information. In addition to Facebook and Instagram, healthy eating blogs were highlighted as a source of nutrition information. Research should consider exploring the use of healthy eating blogs and whether these blogs can be used as a tool by dietitians to communicate procedural healthy eating information more effectively in the future.

According to the 2012 National Nutritional Survey, Australian adults are opting for diets low in fruits and vegetables, and consuming energy-dense foods high in fat, salt and sugar ( 1 ) . Long-term consumption of energy-dense foods is a major contributor to a range of chronic diseases including obesity ( Reference Pongutta, Chongwatpol and Tantayapirak 2 – Reference Flaherty, McCarthy and Collins 5 ) . The Australia’s Health 2018 report identified a range of diseases resulting from overweight and obesity, examples include various cancers, cardiovascular conditions, chronic kidney disease, diabetes, dementia, gallbladder disease, osteoarthritis and asthma ( 6 ) . It is estimated that 64 % of Australian adults are currently either overweight or obese, and it is predicted that by 2025, 34 % of Australian adults will be obese ( 1 , Reference Coopers 7 ) . Optimal nutrition and regular exercise are known preventive measures against obesity ( Reference Barbosa, Vasconcelos and Correia 8 ) . Improving an individual’s knowledge of healthy eating has been a central component in many interventions aiming to improve an individual’s nutritional intake ( Reference Barbosa, Vasconcelos and Correia 8 – Reference Sobal, Bisogni and Jastran 17 ) .

While there are many closely related and intertwined factors which contribute to the aetiology and maintenance of obesity, associations have been identified of improved nutritional knowledge with increased fruit and vegetable intake and lower intake of energy-dense foods ( Reference Barbosa, Vasconcelos and Correia 8 , Reference Paquette 18 – Reference Dunn, Mohr and Wilson 20 ) . Nutrition knowledge has been identified as influencing not only food choice and consumption, but also how individuals perceive and define healthy eating ( Reference Pandit-Agrawal, Khadilkar and Chiplonkar 3 , Reference Paquette 18 , Reference Hammer, Vallianatos and Nykiforuk 19 ) . Various studies conducted during the late 1980s and 1990s explored definitions of healthy eating ( Reference Povey, Conner and Sparks 21 – Reference Landry, Lemieux and Lapointe 25 ) . Most recently, a Canadian qualitative study explored perceptions and definitions of healthy eating and eating pleasure ( Reference Landry, Lemieux and Lapointe 25 ) . Responses from twelve focus groups suggested that healthy eating was described in accordance with characteristics related to the nutritional quality of food ( Reference Landry, Lemieux and Lapointe 25 ) , thus further supporting previous definitions from studies that categorised healthy eating by factors that were perceived to be important, for example ‘freshness’, ‘natural’, ‘fruits and vegetables’ ( Reference Povey, Conner and Sparks 21 – Reference Margetts, Martinez and Saba 24 , Reference Lake, Hyland and Rugg-Gunn 26 ) . Furthermore, many reasons may influence an individual’s perception of what factors are important when defining a healthy food choice, including current popular diet trends, health promotion campaigns, social media, family, friends, advice from health professionals and general nutrition knowledge ( Reference Mela 10 , Reference Bisogni, Connors and Devine 13 , Reference Sobal, Bisogni and Jastran 17 ) .

Of these factors, nutritional knowledge is especially important, and can be classified in accordance with the ability to recall and state nutritional facts (declarative knowledge) and the ability to apply these facts into everyday life (procedural knowledge) ( Reference Worsley 27 ) . Therefore, healthy eating is influenced by an individual’s ability to not only understand what a healthy food choice is, but also his/her ability to apply that understanding practically through daily food choices. To address the current obesity problem, an understanding of how individuals define and translate healthy eating (declarative and procedural knowledge) in everyday life is needed. Through this understanding, there is an opportunity to direct and influence future dietetic communication of healthy eating to adults. The present study aimed to explore how healthy food choices are translated into everyday life by exploring definitions of healthy food choices, perceptions of own food choice, and healthy food choice drivers (facilitators) and barriers.

An exploratory qualitative study design was utilised to investigate definitions of healthy eating, and how healthy food choices are translated into everyday life by adults, using convenience sampling. Convenience sampling was used to collect data from the recruitment of willing participants who were geographically accessible to the researcher, and catered for practical constraints, including researcher availability ( Reference Etikan, Musa and Alkassim 28 ) . This method allowed for the collection of data without requiring formal access to specific population lists and relevant contact details ( Reference Etikan, Musa and Alkassim 28 ) . Additionally, considering that the aims of the study are exploratory by nature, the collection of data from a wide range of individuals was pursued, in order to broadly provide insight into food choices made by individuals. A qualitative design was chosen to gain an understanding into how an individual gives meaning to the notion of a healthy food by exploring own perception of healthy food choices as well as perceived barriers and drivers (facilitators) ( Reference Bisogni, Jastran and Seligson 29 , Reference Ritchie, Lewis and Nicholls 30 ) . The COREQ checklist was utilised to ensure transparency when reporting the study methods (see online supplementary material, Supplemental Table S1 ) ( Reference Tong, Sainsbury and Craig 31 ) .

Participants

The study took place in the Australian Capital Territory, Australia. Adults were recruited from health-care centres, on Facebook and via community health based-newsletters. Individuals were eligible to participate if they met the following criteria: (i) aged 25–65 years; and (ii) could speak and understand English.

A semi-structured interview guide was developed based on a review of relevant literature. Questions from previous interview and focus group studies which investigated food choice and healthy eating were reviewed and influenced the development of a provisional question guide. Adaptions were made to the question guide after a soft pilot of the questions to fellow postgraduate research students (see online supplementary material, Supplemental Table S2 ). Interviews were conducted between October 2015 and March 2016, either face-to-face or via telephone with the researcher. Telephone interviews were also included to cater for participants who were willing to participate, however, could not meet face to face with the researcher due to factors including work and family time commitments. Individuals expressed their interest to participate by contacting the researcher via email. They were then directly contacted by the researcher and asked to complete a brief questionnaire to determine eligibility for participation and gather basic demographic data. Demographic data collected included participant gender (male, female, other), age, country of birth, self-reported height (in metres), self-reported weight (in kilograms) and highest level of education attained. An appointment was made to schedule either an individual face-to-face or telephone interview. Both signed and verbal consent was required before an interview commenced. The researcher (R.M.), who has qualifications in nutrition and dietetics and previous experience in conducting individual semi-structured interviews and focus groups, conducted all face-to-face and telephone interviews.

A total of nine open-ended questions were asked to allow participants to discuss their thoughts on healthy food choices, for example ‘Can you share your thoughts on what you describe a healthy food choice to be?’ Cues and probing questions were also used to clarify information and gain additional data, where the researcher felt appropriate. Hand-written notes were made during and at the end of each interview to record the researcher’s thoughts and ideas, as proposed by Fook and Gardner ( Reference Fook and Gardner 32 ) . Each telephone interview was audio-recorded using the app TapeACall (TelTech Systems, Inc.) and a Zoom H1 Audio Recorder was used during face-to-face interviews.

Data analysis

Data were collected and analysed concurrently. Thematic analysis was used to identify major themes relating to the translation of healthy food choices. The analysis followed the guidelines developed by Braun and Clarke ( Reference Braun and Clarke 33 ) . An essentialist paradigm was adopted as the principal interest of the research was to report interpretations, perceptions and meanings from the reality of the participant ( Reference Braun and Clarke 33 , Reference Clarke and Braun 34 ) . An essentialist paradigm acknowledges the importance of how individuals differ in the way reality is conceptualised and understood, finding meaning in the way individuals describe and perceive phenomena ( Reference Braun and Clarke 33 , Reference Clarke and Braun 34 ) . Thematic analysis as a qualitative method is used for identifying, analysing and reporting patterns within the data ( Reference Braun and Clarke 33 ) . This qualitative approach was chosen to allow for the collection of insightful data through the exploration of perceptions and thoughts of participants ( Reference Braun and Clarke 33 , Reference Harris, Gleason and Sheean 35 ) .

The process of analysis began with data familiarisation, whereby the primary researcher listened and re-listened to audio recordings of each interview. Each interview was then transcribed verbatim, read and re-read to ensure word-for-word transcription. Each transcript was given full and equal attention, enabling the generation of initial codes with aid from the qualitative data analysis software NVivo version 10. Initial codes were developed inductively by the researcher (R.M.) and continuously refined while analysing each transcript. Repetitive codes were clustered into one main code and all codes were analysed and broadly placed into subsequent themes. Each theme was then reviewed and refined, ensuring each theme contained a coherent pattern, supported by coded data. Themes were then defined and described with consideration to the research question, the degree of overlap and relationships with other themes (see Table 1 ). To ensure integrity and consistency of themes, researchers (J.K., R.B. and A.S.) were randomly assigned to a transcript and were all given a common transcript. Researchers read, re-read and reviewed codes and themes. All researchers met face-to-face to discuss each other’s interpretations of codes and themes. At the conclusion of the meeting there was common agreement on emerging codes and themes. In the current study, it was believed that the point of saturation occurred by the twenty-third interview, as no new emerging themes were present and ideas became repetitive.

Table 1 Theme generation from semi-structured interviews conducted with adults aged 25–60 years from Canberra, Australia, October 2015–March 2016

* P# refer to study participants.

Semi-structured interviews provided insight into the barriers and facilitators influencing the translation of healthy food choices among this population. The major themes that arose consistently from the data were: (i) healthy food choices are important, but not a daily priority; (ii) healthy eating information is known but can be difficult to apply into everyday life; (iii) popular diets are used in attempts to improve healthy eating; and (iv) social media inspires and connects people with healthy eating. Representative examples of quotes are shown in Table 1 .

A total of twenty-three participants aged 25–60 years were interviewed (see Table 2 for demographic characteristics). The mean age of participants was 38 years and the mean BMI was 29·1 kg/m 2 . All male participants ( n 4) were within the healthy weight range compared with 58 % of female participants, with 26 % being overweight and 16 % being obese, in accordance with the WHO criteria ( Reference De Onis and Habicht 36 ) . Data showed most participants were well educated with either a postgraduate or bachelor’s degree (30 and 39 %, respectively).

Table 2 General characteristics of the study participants: adults aged 25–60 years from Canberra, Australia, October 2015–March 2016

* Healthy weight range, BMI = 18·5–24·9 kg/m 2 ; overweight, BMI = 25·0–29·9 kg/m 2 ; obese, BMI ≥ 30·0 kg/m 2 .

† Australian Technical and Further Education (TAFE).

Participants were not only able to describe their perceptions of what constitutes a healthy food choice, but also acknowledge the importance of healthy food consumption. Healthy food choices were described differently among participants (see Table 3 ). The types of words and terminology participants used to describe healthy eating included: identifying specific foods (e.g. fruits and vegetables), the presence of macro- and micronutrients (e.g. protein, carbohydrates, fat, vitamins and minerals), the state and preparation of the food (e.g. natural, unprocessed and homemade), the occurrence of consumption (e.g. balance and variety) and perceived value of food (e.g. good and bad).

Table 3 Example descriptions associated with healthy eating from semi-structured interviews conducted with adults aged 25–60 years from Canberra, Australia, October 2015–March 2016

Theme 1: Healthy food choices are important, but not a daily priority

While definitions of a healthy food choice varied between participants, a common acknowledgement was the importance of a healthy food choice. Reasons as to why healthy food choices were described as important were linked to improved functioning in daily activities, well-being, improved physical activity performance and family relationships, as illustrated respectively by the following quotes:

‘Yeah so it’s really just changed my approach to life and making sure that I’m really focused on eating healthy because that’s my building block for everything that I’m doing.’ (P17)

‘I do make the effort to make those healthy food choices more regularly. I, mean I have to say it does make me feel a lot better.’ (P21)

‘Yes, so I think that depending on what you eat depends on how you feel, I feel like a lot of the good food you eat you get good energy from, for example, run longer and like last longer, depends on what you eat basically and how hard you can go.’ (P10)

‘It just keeps you accountable [because] you know that someone knows and you’re feeding someone else, it’s not just you that you’re choosing to give that food to, if that makes sense?’ (P8)

Interestingly, while participants commonly agreed that healthy food choices were an integral component of health and well-being, it was not always a daily priority:

‘It’s important, obviously not as important as it should be.’ (P1)

Importance of healthy food choices seemed to be assessed and re-prioritised daily:

‘It’s important, but not, not day to day like does that make sense? Oh, I guess at the moment, not so important … Depends on the day, depends on the moment … The food choices I choose and the food choices I choose at the moment are crap. They’re not healthy.’ (P2)

It appeared various factors influenced the positioning of the priority of healthy eating. A perceived lack of time due to work and family commitments saw the emergence of prior eating habits:

‘So, I suppose I just, you know, when you go to full time work and you have kids, you just revert to the same things.’ (P1)

Daily stressors and declining energy towards the end of the day were described to lower both expectations and the priority of healthy eating:

‘I just didn’t cope with the pressure and the stress of it and because I am an emotional eater particularly at work, I did not cope with the stress. So, of an afternoon I’d wander around sculling diet soft drinks and going to the candy machine and just getting my hands on whatever, I could to really act as a distraction.’ (P21)

Overall, healthy food choices appeared to be regarded as a luxury, second to obligatory daily activities described by participants as ‘life’:

‘It’s probably really important but the reality is that, in the moment, it doesn’t feel important … I really feel like our lives are so busy that nutrition has to be, it’s a priority that you have to choose, it’s something that’s not easy to choose.’ (P3)

Participants mainly described the feeling of not having the ‘luxury’ of time to make healthy food choices due to work and family commitments.

Theme 2: Healthy eating information is known but can be difficult to apply into everyday life

While most participants could describe aspects of healthy eating, translating and applying this knowledge into everyday life was perceived as challenging:

‘So, I would say that I am well across all the theory, so for me I know what a healthy portion looks like, I know what a healthy meal involves, but it doesn’t you know, necessarily translate into my food choices … I don’t know, [because] I feel I do know all the theory, I could pass the theory exam on nutrition, so it’s something else, for me it’s not knowing, for a lot of people I know it is, they have no idea what might be low GI [glycaemic index], they don’t even know what GI means, for me I do have all that knowledge you know, I’m just not putting into practice.’ (P1)

It was expressed that most participants had a knowledge of healthy food choices; however, they were not always chosen:

‘When I’m explaining all this, these are theoretically, I’m not saying I eat all of these, not all the time.’ (P22)

Confusion, along with uncertainly and fear about choosing the ‘wrong’ foods, were described as debilitating due to perceived consequences:

‘There’s so much different information out there … you’re almost paralysed by those choices because you’re afraid of choosing the wrong one and if you make a good one and it’s all good, you’re happy but if you make a bad one…’ (P2)

Mixed information from family, friends and the media also contributed to the aura of confusion, leading to self-doubt when making a food decision:

‘A lot of people will say you know, low fat is a really good way to go, other people will say actually the research is showing that low fat isn’t that great for you because they add extra sugar, and then sugar is bad for you and as you can tell, clearly I’m still not getting on top of my weight, so I’m very confused.’ (P3)

Theme 3: Popular diets are used in attempts to improve healthy eating

It appeared participants were currently, or previously, involved with different popular diets:

‘I’ve done the Atkin’s diet before, so anything that wasn’t a carb was good pretty much, I did 5:2 intermittent fasting until about a month ago.’ (P12)

Popular diets were perceived to be the solution for improving healthy food choices, assisting with ‘getting back on track’ with healthy eating:

‘I’ve been on the Atkins diet, I’ve been on Weight Watchers, I’ve been on Easy Slim, everything and everything that has come out over the years I have tried … I mean, when I was younger, I went to Jenny Craig.’ (P23)

Common diets described by participants included Weight Watchers, Jenny Craig, I Quit Sugar, Easy Slim, Atkins, local 12-week challenges and protein shake supplementation programmes:

‘[Laugh] Which diet have I not done? If you could give me a pill to lose weight you know within a month give it to me now.’ (P22)

A complicated relationship between participants and popular diets emerged. Paradoxically, on one hand, participants continuously tried different diets; however, on the other, acknowledged their lack of scientific rigour and failure to deliver on weight loss promises:

‘I’ll be honest, I recently brought another lot of supplements off the Internet, which logically I know there is no evidence that what they say is in it, is even in it, let alone that it will actually do what it says it would do … I’ve done the Atkins shakes, I’ve done the iso-whey powders, I have done what was it, Tony Ferguson shakes, god who knows?’ (P2)

Interestingly, despite acknowledging previously unsuccessful diet outcomes, this was continuously outweighed by personal testimonials or referrals:

‘Someone lost this much weight on that so I’ll, I’ll do that to see if that’s works for me [because] I’m that person, and it turns out to all be a sales pitch, but the problem is there’s so much of that in your face.’ (P9)

As participants moved from one diet to the next, they described confounding healthy eating messages and principles that they were exposed to. However, overall, the inability to maintain compliance with popular diets over time was commonly described as the factor limiting success:

‘I came across this diet, that diet, this food, that food plan, you know the paleo food, the clean eating, this eating, so I’ve you know, I’ve gone through all of that and I’ve printed all of that off and I’ve tried it, here and there you know, three or four days, I usually last about a week and it’s too difficult.’ (P22)

Theme 4: Social media inspires and connects people with healthy eating

Facebook and Instagram were commonly referred to as a source of healthy eating information. Participants described using these means to receive engaging and up-to-date information through posts:

‘I just follow a lot of fitness people on Instagram and they post meals that they’ve been eating, and I look them up. I think just, eating healthy, healthy lifestyle is big at the moment. I feel that everyone is posting, everyone is coming up with something new that’s healthy or an alternative for a bad food, and I feel like that’s becoming a trend, whatever I can see on Facebook or Instagram we look into it.’ (P10)

Interestingly, while the main social media platforms were identified as Facebook and Instagram, some participants referred to blogs as an emerging platform for accessible advice and information on healthy eating:

‘Probably more and more information has become more accessible so blogs and podcasts and that. I guess potentially maybe looking at more of those natural, gut health blogs.’ (P18)

It appears through the variety of different blogs available that niche information can be found that aligns with the interests of the participant. For example, blogs were described to be inspirational and motivating by connecting participants to other individuals’ personal journeys and experiences:

‘I guess, honestly blog reading it’s amazing, you can see other people’s journey. That may not work for you, but you may think a different way, it certainly made me think a different way.’ (P17)

The present study confirmed that definitions of health eating given by study participants are comparable to prior research ( Reference Povey, Conner and Sparks 21 , Reference Keane and Willetts 23 , Reference Lake, Hyland and Rugg-Gunn 26 , Reference Paquette 37 , Reference Buckton, Lean and Combet 38 ) . Interviews with twenty-three participants provided insight into what influences the translation of healthy eating information in daily life; and highlighted a potential new direction for the future development and improvement of healthy eating communication.

Despite the 20-year gap between prior research and the present study, healthy eating continues to be described in multiple ways ( Reference Landry, Lemieux and Lapointe 25 , Reference Lake, Hyland and Rugg-Gunn 26 , Reference Paquette 37 , Reference Buckton, Lean and Combet 38 ) . Healthy eating has been defined through foods which are perceived as being of benefit (e.g. fruits and vegetables) ( Reference Povey, Conner and Sparks 21 , Reference Margetts, Martinez and Saba 24 , Reference Lake, Hyland and Rugg-Gunn 26 ) ; through the perceived state and quality of a food (e.g. fresh, natural, unprocessed, homemade) ( Reference Margetts, Martinez and Saba 24 , Reference Lake, Hyland and Rugg-Gunn 26 ) ; through the concept of moderation (e.g. balanced) ( Reference Margetts, Martinez and Saba 24 ) ; and through macronutrient and micronutrient consumption (e.g. fat, carbohydrate, protein, vitamins and minerals) ( Reference Margetts, Martinez and Saba 24 ) . These factors were all evident in the current study, indicating that the findings are consistent with past research exploring definitions of healthy eating in the adult population.

Findings from the present study indicated that participants held a broad understanding of healthy eating, as most definitions were generally in line with nutrition recommendations from the Australian Dietary Guidelines ( 39 ) . This was similar to a previous study investigating the relationship between definitions of healthy eating and measured food intake ( Reference Lake, Hyland and Rugg-Gunn 26 ) . Results from a study based in the UK suggested participants had a broad understanding of healthy eating, generally in line with national nutritional guidelines in the UK ( Reference Lake, Hyland and Rugg-Gunn 26 ) . This declaration of knowledge may suggest that decades of healthy eating campaigns are being heard and associated with what constitutes a healthy food choice ( Reference Lake, Hyland and Rugg-Gunn 26 ) . Additionally, a large proportion of participants in the present study (69 %) reported to have obtained a tertiary qualification. This high proportion is similar to statistics from the 2016 Commonwealth Electoral Divisions which reported that 37·1 % of individuals aged 15 years and over living in the Australian Capital Territory have obtained a tertiary qualification ( 40 ) . Within the literature, it has been shown that nutrition knowledge and overall diet quality increase with level of formal education ( Reference Hendrie, Coveney and Cox 41 , Reference Backholer, Spencer and Gearon 42 ) . Considering the level of education reported by participants in the present study, this may have resulted in an overestimation of participant understanding of a healthy food choice in line with the Australian Dietary Guidelines. Despite this however, while participants had a broad understanding of healthy eating and could acknowledge the importance of healthy eating, participants reported difficulty in translating knowledge into daily practice ( Reference Pandit-Agrawal, Khadilkar and Chiplonkar 3 ) .

How individuals apply nutrition knowledge into daily practice has been a recurring challenge identified within the literature ( Reference Pandit-Agrawal, Khadilkar and Chiplonkar 3 , Reference Ares, Aschemann-Witzel and Vidal 4 , Reference Boles, Adams and Gredler 43 – Reference Raine 45 ) . A study conducted by Boles et al . evaluated a sugary drink mass media campaign in Portland, Ontario, in Canada ( Reference Boles, Adams and Gredler 43 ) . The study reported the mass media campaign was positively associated with knowledge about excessive sugar consumption, however no change in dietary behaviour was observed ( Reference Boles, Adams and Gredler 43 ) . This may shed light on the discrepancy between knowledge of the consequences of sugary drink consumption (declarative) and the application of knowledge by choosing different drinks with less sugar content (procedural) ( Reference Boles, Adams and Gredler 43 , Reference Davison, Smith and Frankel 46 ) . It is therefore argued that knowing about healthy eating does not always result in the translation (consumption) of healthy food choices ( Reference Lake, Hyland and Rugg-Gunn 26 , Reference Boles, Adams and Gredler 43 , Reference Davison, Smith and Frankel 46 ) , thus suggesting that future healthy eating education could benefit from disseminating procedural focused knowledge, to help address the described difficulty, in addition to targeting other determinants of food choice (e.g. perceived barriers and motivations to make healthy food choices) ( Reference Lake, Hyland and Rugg-Gunn 26 , Reference Bisogni, Jastran and Seligson 29 , Reference Boles, Adams and Gredler 43 , Reference Davison, Smith and Frankel 46 ) .

Traditionally, popular diets are seen to influence food choice through limiting variety of food choice ( Reference Khawandanah and Tewfik 47 ) , manipulating macronutrient ratios ( Reference Khawandanah and Tewfik 47 – Reference Dansinger, Gleason and Griffith 49 ) and liquidising foods ( Reference Khawandanah and Tewfik 47 ) . Defining popular diets remains ambiguous, as a handful of popular diets have been supported by scientific evidence, while others may not ( Reference Khawandanah and Tewfik 47 , Reference Gardner, Kim and Bersamin 48 , Reference Tsai and Wadden 50 ) . However, while popular diets can be defined in a variety of ways, they are most commonly described as any diet which promises rapid weight loss ( Reference Khawandanah and Tewfik 47 – Reference Dansinger, Gleason and Griffith 49 ) . A systematic review of several commercial and self-help weight-loss programmes was conducted to investigate the efficacy of weight-loss programmes in the USA ( Reference Tsai and Wadden 50 ) . With the exception of Weight Watchers, the review reported diminished dietary adherence and weight regain after 1- and 2-year follow-ups ( Reference Tsai and Wadden 50 ) . This finding was also supported by another randomised control trial comparing four diets (Atkins, Ornish, Weight Watchers and Zone Diet) ( Reference Dansinger, Gleason and Griffith 49 ) . Interestingly, while these findings support the notion that there are limited weight-loss benefits when following popular diets, individuals are still opting to participate, as highlighted by results from the present study. Therefore, despite the saturation of different diets available, there is still limited knowledge on how popular diets influence and impact long-term adult food choices ( Reference Khawandanah and Tewfik 47 , Reference Johnston, Kanters and Bandayrel 51 , Reference Gudzune, Doshi and Mehta 52 ) .

Interestingly, despite acknowledging a lack of scientific rigour and sustainability of popular diets, participants in the present study reported persevering and continuing to try different diets. Persevering through different popular diets despite limited weight-loss benefits may be influenced by the ease and promise of a ‘quick fix’ that individuals are offered through marketing ( Reference Malik and Hu 53 , Reference Alhassan, Kim and Bersamin 54 ) . The lack of sustainability of popular diets due to their restrictive nature has been discussed within the literature, highlighting regain of weight lost within the first 12 months ( Reference Malik and Hu 53 , Reference Alhassan, Kim and Bersamin 54 ) . As suggested by Malik et al. , low popular diet adherence is likely due to the difficulty experienced by individuals following specific guidelines ( Reference Malik and Hu 53 ) . A study investigating self-set dieting rules stated that only 27·6 % of participants ( n 132) reported following the same dieting rules at follow-up two months later. This suggests that there is low adherence to dieting rules set by the individual ( Reference Knäuper, Cheema and Rabiau 55 ) . The promise of quick weight loss from celebrity endorsements has also been argued to influence an individual’s participation in popular diets ( Reference Rousseau 56 ) . In addition, programmes are typically promoted through ‘success stories’ rather than scientific data ( Reference Rousseau 56 ) . However, clever marketing and celebrity endorsements often encourage individuals to try and follow popular diets that are often not compatible with the practicalities of everyday life (e.g. food intake restrictions during working hours, long food and meal preparation time, specific eating times during the week and unaccounted-for social events) ( Reference Rousseau 56 , Reference Williams and Williams 57 ) .

It is proposed that individuals turn to popular diets for procedural information about healthy food choices. When commencing a new diet programme, individuals are provided with a detailed set of guidelines that clearly specify how to eat healthily and the steps required to achieve this (e.g. weekly meal plans and shopping lists). By providing meal plans and shopping lists, nutrition information is already translated into daily tasks (procedural knowledge), allowing the individual to simply follow the instructions. It could be argued that the success of the popular diet industry is in part due to the identification of this discrepancy between an individual’s knowledge of healthy eating and the application of knowledge into daily life.

While findings from the present study highlight that participants use social media, particularly Facebook and Instagram, to gain up-to-date healthy eating information, it was also suggested by some participants that healthy eating blogs were accessed. Blogs have transformed from their origins of being used for personal online diaries, narrating an individual’s life journey, to presenting current news and acting as a platform for disseminating educational materials ( Reference Garden 58 ) . Currently, with information accessible continuously through social media, blogs are gaining popularity as a source of nutrition and health information ( Reference Dumas, Lemieux and Lapointe 59 ) . Nutrition and health-related blogs are not always written by dietetic professionals ( Reference Garden 58 ) . Rather, nutrition and health blogs may be written by the general population, celebrity personalities and companies who are describing their personal health, nutrition experiences and achievements ( Reference Garden 58 ) .

There is a growing body of research investigating the influence and nature of nutrition-related blogs ( Reference Dumas, Lemieux and Lapointe 59 – Reference Bissonnette-Maheux, Dumas and Provencher 62 ) . One study investigated the potential use of healthy eating blogs by participants who were categorised as having suboptimal dietary habits ( Reference Bissonnette-Maheux, Dumas and Provencher 62 ) . Participants were interviewed and questioned initially about their Internet and blog use, and were invited to participate in a follow-up focus group to discuss their perceptions of consulting healthy eating blogs to improve dietary habits ( Reference Bissonnette-Maheux, Dumas and Provencher 62 ) . Interestingly, participants highlighted the usefulness of blogs in receiving recipe ideas and tips to help improve diet quality ( Reference Bissonnette-Maheux, Dumas and Provencher 62 ) . Most recently, a study investigated the use of social media from the perspective of dietetic practice to investigate whether dietitians could help individuals make informed decisions about their diet to improve health ( Reference Dumas, Lapointe and Desroches 60 ) . That study highlighted the use of social media in dietetic practice already, with discussion forums being the most frequently used platform, followed by blogs and then Facebook ( Reference Dumas, Lapointe and Desroches 60 ) . This supports the growing interest in blogs within dietetic practice to improve the translation of nutrition knowledge ( Reference Dumas, Lapointe and Desroches 60 ) . However, while research is still in its infancy, there are recommendations for future research to investigate how dietitians can utilise blogs to promote healthy eating ( Reference Dumas, Lemieux and Lapointe 59 – Reference Bissonnette-Maheux, Dumas and Provencher 62 ) .

Considering the growing popularity of blogs, there is an opportunity to take advantage of what seems to be an attractive method of accessing healthy eating information ( Reference Dumas, Lemieux and Lapointe 59 ) . It is proposed that successful healthy eating blogs have formulated a method to engage their followers by providing relevant and valued nutrition information; they inspire their followers by translating healthy eating information and connect with their followers by posting frequently. Further investigation is warranted to assess if reading healthy eating blogs contributes to healthier food choices and to identify how future dietitians can better integrate evidenced-based healthy eating information into engaging blog posts. This could potentially strengthen the bridge between individuals seeking healthy eating information and dietitians.

The present study highlighted several key issues. Individuals have a broad understanding on what is a healthy food choice in line with the Australian Dietary Guidelines; healthy food choices are not always a daily priority; there are challenges with applying nutrition knowledge into everyday life; and blogs are being used to access nutrition information. The use of a reflexive diary by the main researcher during the collection and analysis of the interviews and team discussion during each stage of the study process enhanced the rigour and trustworthiness of findings ( Reference Graneheim and Lundman 63 , Reference Morrow 64 ) . A limitation of the study was the use of convenience sampling, as participant narratives are not necessarily representative of the wider community ( Reference Ritchie, Lewis and Nicholls 30 , Reference Graneheim and Lundman 63 , Reference Marshall 65 ) . Verification of results by a larger and more diverse sample size is needed ( Reference Ritchie, Lewis and Nicholls 30 , Reference Graneheim and Lundman 63 , Reference Marshall 65 ) . Data collected during the brief screening questionnaire were based on self-reported measures and may have resulted in an underestimation or overestimation of participant BMI. Additionally, the interpretation of findings must take into consideration that the quality of participants’ dietary intake was not evaluated.

It is recommended that future research continues to investigate the potential platform of blogs as an avenue to communicate healthy eating knowledge in a procedural manner. While there needs to be a larger collective knowledge on healthy eating blogs, this could potentially provide an opportunity for dietitians to communicate future healthy eating messages more effectively and to a larger population.

The present study suggested that even when individuals have a broad understanding of what constitutes a healthy food choice, there are challenges when translating this knowledge into everyday practice. Although other forms of social media were highlighted as an avenue for healthy eating information (Facebook and Instagram), healthy eating blogs could soon become a preferred source of information. Future research should consider exploring the use of healthy eating blogs and whether these blogs can be used as a tool by dietitians to communicate procedural healthy eating information more effectively in the future.

To view supplementary material for this article, please visit https://doi.org/10.1017/S1368980019001046

Acknowledgements

Financial support: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. Conflict of interest: No conflict of interest to disclose. Authorship: R.M contributed to the study design, data collection, data analysis and wrote the manuscript. J.K., R.B., A.S. and K.M. provided research supervision, refined the study design, assisted in the interpretation and validation of data, and writing of the manuscript. Ethics of human subject participation: This study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving human subjects were approved by the University of Canberra Human Ethics Committee (HREC 16–192). Written and verbal informed consent was obtained from all subjects and verbal consent was witnessed and formally recorded.

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• DOI: https://doi.org/10.1017/S1368980019001046

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Guidance for monitoring healthy diets globally

Monitoring of dietary intake at national and global levels is becoming increasingly important with the changing food systems and diets. Better measurement and monitoring are needed to support governments in establishing policies and programmes to promote healthy diets and assess the effectiveness of these actions. However, there is lack of consensus on the indicators that best capture the properties of healthy diets. Recognizing the need for consensus and action, the Food and Agriculture Organization of the United Nations (FAO), the United Nations Children’s Fund (UNICEF), and the World Health Organization (WHO), have joined forces to chart a way forward via Healthy Diets Monitoring Initiative (HDMI) .

This is the first version of the guidance for monitoring healthy diets globally, which provides an overview of healthy diets measurement purposes, types of surveys suitable for the monitoring purpose, appropriate dietary assessment methods, relevant dietary data types and potential healthy diet metrics for national and global monitoring purposes. The guidance will be enhanced in the coming years to reflect the most up to date technical and operational recommendations, after rounds of consultations with countries and experts actively engaged in the implementation of surveys and data collection processes.

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Nutrition research topics encompass a wide study spectrum of explorations in dietary science and human health. They often delve into various areas like nutritional epidemiology that analyzes possible correlations between diet patterns and disease incidence. Nutrigenomics studies how specific nutrients impact gene expression, while functional foods evaluate the health benefits of particular food components. Additional study areas include research into eating disorders and how socioeconomic factors influence diet. Child and prenatal nutrition form a critical aspect, examining how early dietary habits shape long-term health. Sustainability and public health nutrition also make key research areas, investigating global food supply issues and dietary policy development. Such studies may employ methods from biochemical analysis to large-scale population surveys. Therefore, nutrition research topics underscore nutrition’s vital role in supporting human health and well-being.

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• Omega-3 Fatty Acids: The Key to Heart Health
• Minerals in Human Health: Exploring the Underrated Components
• Examining the Health Benefits of Polyphenols
• Vitamin D and Bone Health: Going Beyond Calcium
• Holistic Health Benefits of a Plant-Based Diet
• Relevance of Hydration in Physical Health and Performance
• Nutrition’s Influence on Mental Health: Decoding the Gut-Brain Axis
• Unraveling the Connections: Obesity and Nutritional Imbalances
• Iodine, Thyroid Health, and Metabolism: A Detailed Investigation
• Importance of Amino Acids in Muscle Health and Recovery
• Iron Deficiency: Anemia and Beyond
• Magnesium: An Essential Nutrient for Nervous System Functioning
• Power of Zinc in Immune Health and Disease Resistance
• The Link Between Nutrition and Skin Health: An In-Depth Analysis

Nutrition Research Topics on Dietetics

• Dietary Approaches to Stop Hypertension: A Dietitian’s Perspective
• Understanding the Science Behind Ketogenic Diets
• Vegetarian and Vegan Diets: Nutrient Adequacy and Health Implications
• Clinical Nutrition in Managing Chronic Kidney Disease
• Intervention Strategies in Pediatric Obesity: A Dietetic Approach
• Effectiveness of Mediterranean Diet in Chronic Disease Prevention
• Influence of Low-FODMAP Diet on Irritable Bowel Syndrome
• Nutrition Therapy in Cancer Management: Dietetics in Action
• Low Carbohydrate Diets and Type 2 Diabetes Management
• Examining Nutritional Issues in Geriatric Populations
• Dietary Management in Celiac Disease: Beyond Gluten-Free
• Micronutrient Requirements in Pregnancy: A Dietetic Approach
• Nutritional Interventions in Post-Bariatric Surgery Patients
• Pediatric Nutrition: Addressing Failure to Thrive
• Decoding the Nutritional Management of Eating Disorders
• Balancing Nutrition and Palatability in Dysphagia Management
• Managing Food Allergies: A Dietetics Perspective
• Enteral and Parenteral Nutrition: Practical Issues and Challenges
• Influence of Plant-Based Diets on Cardiovascular Health
• Nutrition Support in Critically Ill Patients: The Role of Dietetics

Research Topics About Nutrition for the Treatment of Eating Disorders

• Recovery Nutrition Strategies for Anorexia Nervosa
• Implementing Mindful Eating in Bulimia Nervosa Treatment
• Food Phobia and Its Nutritional Consequences in Eating Disorders
• Orthorexia Nervosa: Where Health Consciousness Crosses the Line
• Nutrient-Dense Diets in the Management of Eating Disorders
• Balanced Diet Plans for Binge Eating Disorder Patients
• Ketogenic Diets: A Possible Intervention for Eating Disorders?
• Addressing the Nutritional Deficiencies in Anorexia Athletica
• Understanding Refeeding Syndrome in Severe Anorexia Nervosa Cases
• Carbohydrate-Centric Approach to Treat Bulimia Nervosa
• Exploring the Nutritional Implications of Avoidant Restrictive Food Intake Disorder
• Macro and Micronutrients Management in Anorexia Nervosa Treatment
• Assessing the Role of Dietary Fats in Bulimia Nervosa Recovery
• Managing the Nutritional Challenges in Night Eating Syndrome
• Food Variety and Its Importance in Eating Disorders Treatment
• Bariatric Surgery for Severe Binge Eating Disorder: Nutritional Challenges
• Influence of Veganism on the Progression of Eating Disorders
• Postprandial Timing: Its Influence on Binge Eating Disorder
• Nutritional Rehabilitation in Hospitalized Eating Disorder Patients

Sports Nutrition Research Paper Topics

• Optimization of Protein Intake in Endurance Athletes
• Micronutrients’ Importance for Athletic Performance
• Carbohydrate Loading: A Tool for Marathon Runners
• Ketogenic Diet and Its Effect on Athletic Performance
• Hydration Strategies for Long-Distance Athletes
• Nutritional Strategies to Enhance Recovery in High-Intensity Sports
• Effects of Caffeine on Athletic Performance
• Iron Requirements in Female Athletes: Meeting the Demand
• Dietary Supplements and Performance in Elite Athletes
• Bone Health and Nutrition in Weightlifting Athletes
• Optimizing Pre-Game Nutrition for Competitive Athletes
• Nutritional Implications of Aging on Athletic Performance
• Creatine Supplementation in High-Intensity Training
• Influence of Plant-Based Diets on Athletic Performance
• Gut Health and Performance in Athletes: The Link
• Nutrition Strategies for Managing Injuries in Athletes
• Understanding Energy Availability in Endurance Sports
• Probiotics and Their Potential Benefit for Athletes
• Omega-3 Fatty Acids and Their Relevance to Athletic Performance
• Alcohol and Its Consequences on Sports Performance

Nutrition Research Topics About Veganism & Vegetarianism

• B12 Deficiency in Vegan and Vegetarian Diets
• Plant-Based Diets: Protein Quality and Quantity
• Bone Health Among Vegans and Vegetarians
• Exploring Iron Bioavailability in Plant-Based Diets
• Omega-3 Fatty Acids: Achieving Adequate Intake on a Vegan Diet
• Veganism, Vegetarianism, and Cardiovascular Health
• Effect of Plant-Based Diets on Blood Glucose Control
• Zinc Absorption in Vegan and Vegetarian Diets
• Evaluating Vegan and Vegetarian Diets for Athletes
• Nutrient Density in Vegan and Vegetarian Diets
• Challenges of Meeting Calcium Needs on a Vegan Diet
• Plant-Based Diets and Gut Microbiota
• Weight Management in Vegan and Vegetarian Lifestyles
• Influence of Vegan Diet on Inflammatory Markers
• Plant-Based Diets: Effect on Mental Health
• Comparison of Antioxidant Intake: Vegans vs. Omnivores
• Influence of Veganism on the Ageing Process
• Plant-Based Diets and All-Cause Mortality
• Perception of Hunger and Fullness in Vegans vs. Omnivores

Food Science Research Paper Topics

• Microbial Safety of Fermented Foods
• Structural Changes in Proteins During Cooking
• Antioxidant Properties of Spices and Herbs
• Functional Foods and Gut Health
• Bioavailability of Nutrients From Different Cooking Methods
• Flavor Chemistry and Perception in Food Development
• Effects of Processing on Phytonutrient Content
• Metabolic Pathways Involved in Fermentation
• Novel Techniques in Food Preservation
• Food Texture and Its Effect on Satiety
• Influence of Food Structure on Nutrient Absorption
• Bioactive Compounds in Functional Beverages
• Chemical Changes in Food During Storage
• Advancements in Food Packaging Technologies
• Understanding Maillard Reaction in Different Food Products
• Innovative Techniques in Food Fortification
• Sustainable Food Processing Techniques
• Potential Health Benefits of Probiotic Foods
• Food Allergens: Detection and Quantification Methods
• Sugar Substitutes: Health Benefits and Risks

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Masks Strongly Recommended but Not Required in Maryland, Starting Immediately

Due to the downward trend in respiratory viruses in Maryland, masking is no longer required but remains strongly recommended in Johns Hopkins Medicine clinical locations in Maryland. Read more .

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Pilot Study Provides ‘Blueprint’ for Evaluating Diet’s Effect on Brain Health

A new study of 40 older adults with #obesity and insulin resistance randomly assigned to either an #IntermittentFasting diet or a standard healthy diet offers important clues about the potential benefits of both eating plans on #brain health. ›

Researchers from Johns Hopkins Medicine and the National Institutes of Health’s National Institute on Aging say their study of 40 older adults with obesity and insulin resistance who were randomly assigned to either an intermittent fasting diet or a standard healthy diet approved by the U.S. Department of Agriculture (USDA) offers important clues about the potential benefits of both eating plans on brain health.

Insulin resistance is a hallmark of type 2 diabetes and is common in people with obesity. Studies suggest that people with insulin resistance are at higher risk than usual for Alzheimer’s disease and other cognitive impairment. As a result, various weight loss regimens figure widely as ways to reduce risk of these metabolic and brain disorders.

Previous Johns Hopkins research on animal models of diabetes and Alzheimer’s disease showed that intermittent fasting can improve cognition and insulin sensitivity. The new study, published June 19 in Cell Metabolism , tested the effects of intermittent fasting on women and men at risk for cognitive impairment, and it offers a “blueprint,” the authors write, for using a wide panel of biomarkers to assess dietary impact, including analysis of extracellular vesicles — tiny packets of materials shed from neurons, which are types of brain cells that send messages. Such neuron-derived extracellular vesicles are shed into circulating blood and were collected from the new study’s participants during an eight-week period while each person followed one of the two diets.

The results revealed that both types of diet plans had benefits regarding decreasing insulin resistance and improving cognition, with improvements in memory and executive function with both diets, but more strongly with the intermittent fasting diet, according to Mark Mattson, Ph.D. , adjunct professor of neuroscience at the Johns Hopkins University School of Medicine and former chief of the laboratory of neurosciences at the National Institute on Aging in Baltimore. “Other scientists may want to incorporate the (brain) markers (we used) into additional, larger studies of diet and brain health,” Mattson says.

Because people with obesity and insulin resistance may be more at risk of cognitive impairment and Alzheimer’s disease than people with normal metabolism and body mass index (BMI), Dimitrios Kapogiannis, M.D. , chief of the human neuroscience section at the National Institute on Aging and adjunct associate professor of neurology at the Johns Hopkins University School of Medicine, developed a method to isolate neuron-derived extracellular vesicles from blood. His laboratory found molecular evidence of insulin resistance in extracellular vesicles shed from neurons of people with diabetes and Alzheimer’s disease, and because blood samples are relatively easy to collect, they were considered good candidates for widespread use.

To test the effects of the two diets on brain function biomarkers, participants in the new study were recruited from June 2015 and December 2022, and four in-person assessments were completed at facilities run by the National Institute on Aging at MedStar Harbor Hospital in Baltimore. Among the participants, 40 completed their eight-week study. Also, 20 were assigned to an intermittent fasting diet that restricted calories to one-quarter of the recommended daily intake for two consecutive days per week, and they followed the USDA’s healthy living diet — which consists of fruits, vegetables, whole grains, lean proteins, low-fat dairy products and limited added sugars, saturated fats and sodium — for the remaining five days. The USDA’s healthy living diet was assigned to 20 other study participants each day of the week.

The average age of participants in both groups was 63, and 25 were white, 14 were Black and one was Hispanic. There were 24 men and 16 women. All were obese and had insulin resistance.

The researchers found that both diets had equally positive effects on reducing insulin resistance markers in extracellular vesicles, improving BrainAGE (a measurement of the brain’s biological age using structural MRI data) and lowering glucose concentration in the brain. Reduced glucose concentration is a corollary of higher glucose use.

Both diets also improved customary measurements of metabolic health, including weight, BMI, measurement of waist circumference, blood lipids such as cholesterol, and insulin resistance. Executive function and memory (which are a set of mental skills that helps with planning and achieving goals) improved approximately 20% more in the intermittent fasting group than in the healthy living diet group.

A few study participants reported modest side effects including constipation and loose stools, and occasional headaches.

The researchers also saw increased levels of a neurofilament protein (a structural protein in neurons) in both diet groups, but mainly in the intermittent fasting group. What that means regarding brain health is unclear.

“This is a marker to continue to evaluate in further studies,” says Mattson. “Neurons release a lot of proteins, and one idea is that intermittent fasting may be causing some kind of neuroplasticity (a change in structure) in neurons, causing the release of neurofilament proteins.”

The Johns Hopkins researchers and others caution that people interested in intermittent fasting should plan carefully with a health care practitioner because it could be harmful to some people, including those with type 1 diabetes and eating disorders.

The research reported in Cell Metabolism was supported by the National Institutes of Health’s National Institute on Aging (ZIAAG000966, ZIAAG000975).

Other researchers who contributed to the study are Apostolos Manolopoulos, Francheska Delgado-Peraza, Maja Mustapic, Carlos Nogueras-Ortiz, Pamela Yao, Krishna Pucha, Janet Brooks, Qinghua Chen, Lisa Hartnell, Mark Cookson and Josephine Egan from the National Institute on Aging, Roger Mullins from Morgan State University, Konstantinos Avgerinos from Wayne State University, Shalaila Haas and Sophia Frangou from Mount Sinai School of Medicine and Ruiyang Ge from the University of British Columbia.

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Cacfp family childcare home sponsor perspectives – serious deficiency challenges.

The federal Child and Adult Care Food Program, commonly known as CACFP, ensures over 4.2 million children, mostly in families with low income, receive nutritious meals and snacks in childcare. However, not all qualifying childcare providers participate in this beneficial program. Research suggests that the serious deficiency process, designed to ensure program integrity, may hinder More

Mixed methods evaluation of the COVID-19 changes to the WIC cash-value benefit for fruits and vegetables

Recent cash-value benefit (CVB) increases are a positive development to help increase WIC participant fruits and vegetables (FV) access. This mixed method study aimed to evaluate (a) the CVB changes’ impact on FV access among WIC child participants measured by CVB redemption rates, (b) facilitators and barriers to CVB changes’ implementation, and (c) differences in More

Height and Weight Measurement and Communication With Families in Head Start: Developing a Toolkit and Establishing Best Practices

Head start (HS) programs are required to collect children’s height and weight data. Programs also communicate these results to families. However, no standardized protocol exists to guide measurements or communicate results. The purpose of this article was to describe the development of a measurement toolkit and best practices for communication. HS programs contributed to the More

Promoting Healthier Purchases: Ultraprocessed Food Taxes and Minimally Processed Foods Subsidies for the Low Income

Fiscal policies can shift relative food prices to encourage the purchase and consumption of minimally processed foods while discouraging the purchase and consumption of unhealthy ultraprocessed foods, high in calories and nutrients of concern (sodium, sugar, and saturated fats), especially for low-income households. The 2017–2018 packaged food purchase data among U.S. households were used to More

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Inequalities in the Costs and Affordability of a Healthy Diet in Europe between 2017 and 2021

Csákvári T 1 , Egyed J 1 , Elmer D 2 , Kajos L 3 , Kovács B 4 , Pónusz-Kovács D 4 , Boncz I 4 1 University of Pécs, Pécs, Hungary, 2 University of Pécs, Pécs, PE, Hungary, 3 University of Pécs, Pécs, BA, Hungary, 4 University of Pécs, BUDAPEST, PE, Hungary

OBJECTIVES: According to the World Bank, an unaffordable healthy diet means its cost is more than 52% of one’s household income. As poor diet is a risk factor for many noncommunicable diseases, it is key to know which populations have the highest risk of being unable to afford a healthy diet.

METHODS: Our quantitative, retrospective descriptive study assessed selected indicators from the Food & Agriculture Organization statistical database. These indicators were the following: ‘Cost of a healthy diet (PPP dollar per person per day)’; ‘Percentage of the population unable to afford a healthy diet (percent)’; ‘Number of people unable to afford a healthy diet (million)’. 38 European member states, four Regions (Eastern, Northern, Southern, and Western), and the European average were analyzed between 2017 and 2021.

RESULTS: In 2017, the European average was $3.00/capita/day, which increased to $3.22 by 2021 (+7.3%). Among the Regions, there was a 1.28-fold difference, with the lowest value recorded in Northern Europe ($2.80/capita/day) and the highest in Southern Europe ($3.60/capita/day) in 2021. We observed an increase in costs in every Region, with the highest one in Eastern Europe during the examined period (+9.78%). However, in each Region, the percentage of those unable to afford a healthy diet decreased. Between 2017 and 2021, this indicator decreased by 1% in Europe (from 2.5% to 1.5%). In 2021, Southern European countries had the highest observed percentage (2.6%), while Western Europe had the lowest (0.2%). Nevertheless, the most significant improvement is also associated with Southern Europe (-1.9%).

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Scientists Identify Key Pathway for Brain Health Boost via Ketogenic Diet

By Buck Institute for Research on Aging June 24, 2024

The ketogenic diet improves memory in aging mice by enhancing synapse function through a newly identified molecular signaling pathway involving ketone bodies, particularly β-hydroxybutyrate (BHB). Future research seeks to replicate these benefits without the diet by targeting specific pathways.

Understanding these mechanisms offers new targets for enhancing memory, potentially without the need for a ketogenic diet.

The ketogenic diet has both enthusiasts and critics among dieters, but it undeniably has a scientifically documented impact on memory in mice. In their research, Buck Institute scientists and a team from the University of Chile discovered how this high-fat, low-carbohydrate diet enhances memory in older mice. They identified a novel molecular signaling pathway that improves synapse function, shedding light on the diet’s benefits for brain health and aging.

These findings, published in the June 5, 2024, issue of Cell Reports Medicine , offer new avenues for targeting memory effects at a molecular level without the need for a ketogenic diet or its byproducts.

“Our work indicates that the effects of the ketogenic diet benefit brain function broadly, and we provide a mechanism of action that offers a strategy for the maintenance and improvement of this function during aging,” said the study’s senior author, Christian González-Billault, PhD, who is a professor at the Universidad de Chile and director of their Geroscience Center for Brain Health and Metabolism, and adjunct professor at the Buck Institute.

Collaboration and Previous Findings

“Building off our previous work showing that a ketogenic diet improves healthspan and memory in aging mice, this new work indicates that we can start with older animals and still improve the health of the aging brain, and that the changes begin to happen relatively quickly,” said John Newman, MD, PhD, whose laboratory at Buck collaborated with Dr. González-Billault on the study. Newman is both an assistant professor at the Buck Institute, and a geriatrician at University of California, San Francisco. “It is the most detailed study to date of the ketogenic diet and aging brain in mice.”

More than a century ago, researchers observed that rats that consumed less food lived longer. “We now know that being able to manipulate lifespan is not about specifically eating less,” said Newman, but actually is related to signals inside cells that turn on and off specific pathways in response to available nutrients. Many of those pathways are related to aging, such as controlling protein turnover and metabolism.

Some of those signals are the ketone bodies, which consist of acetoacetate (AcAc), β-hydroxybutyrate (BHB), and to a much lesser extent, acetone. These molecules are routinely produced in the liver. They ramp up when glucose is in short supply, whether due to caloric restriction, intense exercise, or low carbohydrate intake, such as with a ketogenic diet.

Previous Studies on Ketogenic Diet and Longevity

Seven years ago, Newman led a team that published the first proof of the concept that if a ketogenic diet exposes mice to increased levels of ketone bodies over much of their adult life, it helps them to live longer and age in a more healthy way. “The most striking effect on their health as they aged was that their memory was preserved; it was possibly even better than when they were younger,” he said.

The current study, designed to answer what part of the ketogenic diet was having the effect and how it was affecting the brain on a molecular level to improve memory, was led by González-Billault in collaboration with scientists at the Buck. Mice on a ketogenic diet were fed a ratio of 90 percent calories from fat and 10 percent from protein, while mice on a control diet received the same amount of protein but only 13 percent fat. The test mice, of “advanced age” of more than two years old, received one week of the ketogenic diet, cycled with one week of the control diet, to keep the mice from overeating and becoming obese.

Neurophysiological and Behavioral Experiments

The benefits of the ketogenic diet, said, González-Billault, were demonstrated through neurophysiological and behavioral experiments with the mice that test how well the mechanisms involved in memory generation, storage, and retrieval function in aged animals. When these showed that the ketogenic diet appeared to benefit how well the synapses responsible for memory worked, they took a deep dive into the protein composition at these synapses in the hippocampus, in collaboration with Buck professor Birgit Schilling, PhD, who directs the Proteomics and Mass Spectrometry Center.

“Surprisingly, we saw that the ketogenic diet caused dramatic changes in the proteins of the synapse,” said Schilling. Even more surprising, she said, was that the changes started after a relatively brief exposure to the diet (tested after only one week on the diet) and only became more pronounced over time (tested again after six weeks and a year).

Further testing indicated that in synapses, a particular signaling pathway (protein kinase A, which is critical to synapse activity) was activated by the ketogenic diet. In isolated cells, the team then showed that it appears that BHB, the main ketone body produced in a ketogenic diet, is activating this pathway. This leads to the idea, said González-Billault, that ketone bodies (specifically BHB) play a crucial role not only as an energy source, but also as a signaling molecule.

“BHB is almost certainly not the only molecule in play, but we think this is an important part of understanding how the ketogenic diet and ketone bodies work,” said Newman “This is the first study to really connect deep molecular mechanisms of ketone bodies all the way through to improving the aging brain.”

Looking forward, he said, the next step would be to see if the same memory protection could be achieved by using BHB alone, or possibly going even more targeted than that by manipulating the protein kinase A signaling pathway directly. “If we could recreate some of the big-picture effects on synapse function and memory just by manipulating that signaling pathway in the right cells,” he said, “we wouldn’t even need to eat a ketogenic diet in the end.”

Reference: “Ketogenic diet administration later in life improves memory by modifying the synaptic cortical proteome via the PKA signaling pathway in aging mice” by Diego Acuña-Catalán, Samah Shah, Cameron Wehrfritz, Mitsunori Nomura, Alejandro Acevedo, Cristina Olmos, Gabriel Quiroz, Hernán Huerta, Joanna Bons, Estibaliz Ampuero, Ursula Wyneken, Magdalena Sanhueza, Felipe Arancibia, Darwin Contreras, Julio César Cárdenas, Bernardo Morales, Birgit Schilling, John C. Newman and Christian González-Billault, 5 June 2024, Cell Reports Medicine . DOI: 10.1016/j.xcrm.2024.101593

This work was supported in part through funds from the National Institutes of Health , the Chilean National Fund for Scientific and Technological Development (FONDECYT), the Center of Interventional Medicine for Precision and Advanced Cellular Therapy (IMPACT) at Universidad de Los Andes, and the Chilean National Research and Development Agency (ANID).

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For healthy adults, taking multivitamins daily is not associated with a lower risk of death

Findings come from an NIH analysis of more than two decades of dietary data from 390,124 U.S. adults.

A large analysis of data from nearly 400,000 healthy U.S. adults followed for more than 20 years has found no association between regular multivitamin use and lower risk of death. The study, led by researchers at the National Institutes of Health’s National Cancer Institute, was published June 26, 2024, in JAMA Network Open .

Many adults in the United States take multivitamins with the hope of improving their health. However, the benefits and harms of regular multivitamin use remain unclear. Previous studies of multivitamin use and mortality have yielded mixed results and been limited by short follow-up times.

To more deeply explore the relationship between long-term regular multivitamin use and overall mortality and death from cardiovascular disease and cancer, the researchers analyzed data from three large, geographically diverse prospective studies involving a total of 390,124 U.S. adults who were followed for more than 20 years. The participants included in this analysis were generally healthy, with no history of cancer or other chronic diseases.

Because the study population was so large and included lengthy follow-up and extensive information on demographics and lifestyle factors, the researchers were able to mitigate the effects of possible biases that may have influenced the findings of other studies. For example, people who use multivitamins may have healthier lifestyles in general, and sicker patients may be more likely to increase their use of multivitamins.

The analysis showed that people who took daily multivitamins did not have a lower risk of death from any cause than people who took no multivitamins. There were also no differences in mortality from cancer, heart disease, or cerebrovascular diseases. The results were adjusted for factors such as race and ethnicity, education, and diet quality. 

The researchers noted that it is important to evaluate multivitamin use and risk of death among different kinds of populations, such as those with documented nutritional deficiencies, as well as the potential impact of regular multivitamin use on other health conditions associated with aging.

Erikka Loftfield, Ph.D., M.P.H., Division of Cancer Epidemiology and Genetics, National Cancer Institute

  “Multivitamin Use and Mortality Risk in 3 Prospective US Cohorts” appears June 26, 2024, in JAMA Network Open .

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An Evidence-based Look at the Effects of Diet on Health

Sean kandel.

1 Internal Medicine, University of Connecticut, New Britain, USA

Diet is a daily activity that has a dramatic impact on health. There is much confusion in society, including among medical professionals, about what constitutes a healthy diet. Many reviews focus on one aspect of healthy dietary practices, but few synthesize this data to form more comprehensive recommendations. This article will critically review and holistically synthesize the data on diet with firm morbidity and mortality endpoints derived from three key, high quality studies, which are further supported with several additional articles. Specific recommendations of types and quantities of food to reduce the risk of heart disease and stroke will be provided. The effect of these diets on cancer and mood disorders as covered in the articles reviewed will also be discussed.

Introduction and background

Why do we care about diet?

Cardiovascular disease (CVD) is the number one cause of death in the United States [ 1 ]. Obesity and type 2 diabetes, both directly diet modifiable, are two of the largest contributors to CVD. Additionally, cancer and mood disorders both also have significant impacts on morbidity and mortality. What we eat may allow us to powerfully intervene on these issues, which are the largest health issues affecting our country. 

Article selection methods

A keyword search was performed in the PubMed database through July 2018 using permutations of the phrases: “diet randomized controlled trial,” “diet morbidity mortality,” and “fish coronary artery disease.” Fish was specifically searched for as it has been identified as possibly being cardioprotective, as noted by the American Heart Association. Only randomized controlled trials, large, carefully controlled observational studies, or meta analyses looking at firm morbidity/mortality endpoints were considered. Three such representative articles will be reviewed in depth here, with many supporting articles also referenced. Although some data related to cancer and mood disorders is discussed, the primary focus of this review is the effect of diet on coronary artery disease (CAD) and stroke.

What we already knew about diet and its effects on health

Most of the data we have about diets are from observational studies. Some of these studies are outstanding, but nonetheless are limited by the biases that any observational study can have (i.e. confounding variables and correlation without demonstration of causation). Despite this, several massive studies have been replicated and statistically controlled to afford some general trends worth noting. Studies looking at up to 2.88 million patients have reproducibly shown that being at extremes of weight (either morbidly obese or underweight) leads to an increased risk of death, and being overweight or obese leads to an increased risk of death from diabetes or kidney disease [ 2 - 3 ]. Abdominal obesity has been shown to increase coronary artery plaque deposition on computed tomography (CT) imaging [ 4 ]. Thus, being a healthy body weight is the first step in reducing cardiovascular risk. The Dietary Approaches to Stop Hypertension (DASH) diet randomized control trial showed that a diet that favors vegetables, fruits, low fat dairy, and minimizes red meats, fats, oils, and snacks/sweets (processed foods with high sugar/simple carbohydrates) leads to a slightly lower blood pressure (about a 5.5 mm Hg and a 3 mm Hg lower systolic and diastolic, respectively) when applied to hypertensive patients [ 5 ]. The causative role of diabetes on (CAD) and kidney disease has been well documented [ 6 ]. Notably, type 2 diabetes has a dramatic role in morbidity and mortality, and despite some people having a genetic predisposition is ultimately diet induced. It can be prevented by eating a healthy diet, and even after its development can usually be completely reversed with diet and exercise, even in later stages [ 7 - 8 ].

Does low cholesterol correlate with a lower risk of cardiovascular disease?

The foundational studies looking at cholesterol and its effects on health, based on the Framingham study, did not definitely show that the cholesterol levels predicted CVD risk in the general population. The study only achieved statistical significance for total cholesterol in certain age groups (men over age 65 years and women between the ages of 50-79 years). The study did show that the total cholesterol to high density lipoprotein (HDL) ratio seemed to be more predictive of cardiovascular events than the absolute cholesterol numbers [ 9 ]. Subsequent to this, 19 studies looking at low density lipoprotein (LDL) cholesterol showed no association or an inverse association between LDL levels and CVD in people over the age of 60 years [ 10 ]. Low HDL did seem to have a correlation with CAD in these studies. Notably, in a review of 115,000 patients who had a myocardial infarction, patients with lower LDLs had higher mortalities post myocardial infarction [ 11 ]. This study is referred to as “The Lipid Paradox.” In addition, despite eating very high levels of saturated fat and cholesterol, the French have very low rates of CVD [ 12 ] - this is referred to as “The French Paradox.” 

If we are to follow the logic that the higher the cholesterol level, the more plaque deposits in the coronary arteries, and thus the more cardiac ischemia/infarctions occur, you would expect that as a person ages and continues to eat unhealthy food that the amount of plaque deposition and ischemia/infarction would also increase. However, this is not the pattern seen in the original Framingham study publication. We also have “The Lipid Paradox,” “The French Paradox,” and a meta-analysis of 19 studies showing no or an inverse correlation of LDL with risk of CVD. LDL cholesterol levels likely do not correlate with the development of CAD as well as was once believed.

Effects of diet are hard to study

The above discussion of the lack of correlation of LDL cholesterol levels with the development of CAD is important to understand why the articles discussed in this review were chosen and why others were excluded. The effects of diet are cumulative and take decades to manifest. However, most researchers want answers much sooner than this, and thus turn to surrogates to measure dietary effects on health, with the most common surrogate being cholesterol. However, as discussed above, cholesterol levels may not reliably predict CAD. Studies that evaluate the effects of diet based on firm endpoints, such as a diagnosis of myocardial infarction, stroke, cancer, or mood disorder, are the most reliable data from which to draw conclusions. This literature is the focus of the remainder of this article.

The Mediterranean diet

Estruch and his colleagues have produced a large randomized controlled trial looking at the effects of diet on health with hard morbidity and mortality endpoints [ 13 ]. Their study was recently retracted and republished after they discovered that 1588 of the 7400 participants really weren’t randomized. The resubmitted work includes statistical modeling which validates their initial results despite the non-randomized group. 

The study design involved a parallel group randomized control trial in Spain with three groups: a Mediterranean diet group supplemented with extra-virgin olive oil (1L per week, at least 4 tablespoons per day), a Mediterranean diet group supplemented with nuts (30 g per day: 15 g of walnuts, 7.5 g of hazelnuts, and 7.5 g of almonds), and a low fat control group. Dietary training sessions were done at baseline and quarterly, and 14 item dietary screeners to assess adherence were also done at baseline and quarterly. The study spanned just over seven years from October 1, 2003 to December 1, 2010.

The primary endpoint was a major cardiovascular event, which was a composite made up of stroke, myocardial infarction, and death from “cardiovascular causes.” The primary endpoint achieved statistical significance in the two Mediterranean diet groups, thus the authors concluded that a Mediterranean diet results in a reduction in all major cardiovascular events. However, in reviewing the subgroup analysis of secondary endpoints, only stroke achieved statistical significance, with the highest statistical significance being in the nut supplemented group. Thus, although the primary endpoint achieved statistical significance, it was entirely powered by a reduction in stroke. In addition, although the intention was to test the Mediterranean diet against a low fat diet, review of the dietary adherence data shows that all three groups, including the control group, scored the same for adherence to the Mediterranean diet. Thus, all three groups were eating the Mediterranean diet. As a result, this study is really comparing the effect of nut or olive oil supplementation on top of the Mediterranean diet compared to the Mediterranean diet by itself. In the re-published version of their article the authors have changed the wording of their conclusions to more closely reflect this. 

Limitations

The study has several limitations. As mentioned above, approximately 20% of participants were not actually randomized and required post study statistical analysis to try to control for this. Also, the study design was changed midway through from 9000 people over four years to 7400 patients over six years, which could have affected the data analysis. Patients in this study were aged 55-80 years and were higher risk patients (with diabetes or multiple other cardiovascular risk factors) which may limit the study’s generalizability to younger, healthier populations. Also, almost all participants were Caucasian, which raises the question of the effects of this diet on other races. Finally, the control group had a higher rate of obesity than the two Mediterranean diet groups, which may have skewed the poor outcomes towards the control group as obesity itself is a risk factor for CAD.

Conclusions

This study shows that eating a significant amount of olive oil or nuts on top of a Mediterranean diet reduced the risk of stroke among high risk Caucasian individuals. 

The China Study

The China study is a compilation of studies related to two large observational studies and related bench research. The primary goal was to assess the effect of varying dietary patterns on the inhabitants of rural China on several health parameters [ 14 - 15 ]. 

The primary studies were observational and done in counties throughout rural China. A total of 6500 adults in 65 counties (with a 50:50 male to female ratio) were involved in the initial study done in 1983-1984. These same 6500 adults were studied again in 1989-1990 with additional participants added to make the second total study population encompass 10,200 participants in 69 counties. Study participants were surveyed for dietary habits (questionnaires and three-day dietary information) and had concurrent laboratory testing (blood, urine, and food samples). Mortality rates for approximately 50 different diseases were reviewed, and dietary, lifestyle, and disease characteristics were analyzed for trends.

CAD mortality rates in China were 4.0 per 100,000 for men and 3.4 per 100,000 for women, compared with 66.8 per 100,000 men and 18.9 per 100,000 women in the United States. These figures represent a remarkable 16.7-fold and 5.6-fold greater mortality rates among US men and women, respectively, than among their Chinese counterparts. The combined CAD mortality rates for both genders in rural China were inversely associated with the frequency of intake of green vegetables (p =0.01). Notably, one of the regions studied that had some of the lowest rates of animal product consumption had no CAD during the entire study period. The authors concluded that a diet comprised of a variety of high-quality plant-based foods yields the lowest disease rates, and that, “there is no evidence of a threshold beyond which further benefits do not accrue with increasing proportions of plant-based foods in the diet.” The authors thus advocate a whole food plant-based diet consistent with a vegan diet.

Despite advocating a diet that is consistent with veganism, none of the groups studied were vegan. The closest group to this level of animal product restriction ate approximately 10% of the animal protein consumed by its US counterparts. This is a marked reduction in animal product consumption, but is not the same as no animal products. Without tangible evidence of an outcome related to a given action, we cannot assume that because some of the action is good, more is necessarily better. The authors also state that eating eggs and dairy increases CVD, but these results did not achieve statistical significance in their analysis. A study published by Dehghan and colleagues shows just the opposite of this claim, indicating that higher yogurt and milk consumptions was linked to lower risks of stroke and major CVD [ 16 ]. Other limitations include that this study was observational, thus it is subjected to the possible biases of observational studies. The study also looked only at the Chinese, thus whether it translates to other races in unclear. The study population tended to be rural and be physically active (i.e. farming, etc.), which may mean that their activity levels may be different than other populations. Finally, their recommendation of adopting a diet consistent with veganism needs to be balanced with the health risks. It is well known that vegans cannot avoid serious cognitive issues and peripheral neuropathies without artificially supplementing their diets with Vitamin B12 [ 17 - 19 ]. Any diet that cannot be healthy without artificial supplementation needs to be questioned for long-term safety and sustainability.

Focusing on the tangible results from the study, that eating about 10% of the animal products that a typical American eats may lead to dramatically lower rates of CAD in the Chinese, is a powerful and compelling discovery. If we assume the average person eats about three meals per day (21 meals per week), that correlates to eating approximately 2-3 meals per week with animal protein with the rest being vegan.

There are some data that show that eating fish can decrease the severity of mood disorders, but conflicting data also exist and more research is needed to draw definitive conclusions [ 20 - 22 ]. However, overall the trend seems to be that fish consumption (particularly fatty fish such as salmon) lowers the risk of CAD [ 23 - 27 ]. Although there is some conflicting data, many studies show an inverse relationship between fish consumption and risk of CAD. The prospective study populations in the articles reviewed that support this ranged from 852 to 84,000 patients and were monitored between 6 and 30 years of follow up, with three of these studies following patients for 16 or more years. The CAD protective effects seem to be most prominent after 12 years of fish consumption. Critics of fishs’ role in preventing CAD stem from the original studies in the Greenland Eskimos [ 28 ]. These studies were subsequently found to be incorrect, as the low perceived rates of CAD were actually found to be an underreporting error due to the studied societies being rural with inaccurate death reporting. However, the five subsequent studies referenced above suggest that fish consumption is beneficial in preventing from CAD. 

The ideal serving of fish is likely around three 4 ounce servings per week; although more may have a small additional cardioprotective benefit, this needs to be weighed against the increased mercury consumption that might occur and its potential adverse neurological effects. This is consistent with the American Heart Association recommendations [ 29 ].

What about pescatarians? The Adventist Health Study 2

The China Study suggests that being overall vegan with a few servings of animal products per week may confer the greatest protection against cancer and cardiac disease. Fish consumption is likely cardioprotective. If these two findings combined would confer further health benefits was evaluated in the Adventist Health Study 2.

The Adventist Health study is an observational study that looked at the effects of many different types of diets on CVD and cancer [ 30 ]. It involved about 73,000 people over approximately a five-year period. Participants were broken into groups, including non-vegetarian, “semi-vegetarian” (< 1 serving of meat per week), pescovegetarians (eating only fish as their meat), lacto-ovo vegetarians (typical vegetarians that eat eggs and dairy animal products, but not the animal meat itself), and vegans (vegetarians that eat no animal products whatsoever including no meat, eggs, or dairy).

A trend towards reduction in death from all cause mortality, ischemic heart disease, CVD and cancer was seen in almost all categories by the vegetarian groups. It was largely powered by statistically significant reductions in risk of all cause and ischemic heart disease by pescovegetarians in both sexes, along with reductions in “other” causes of death in both sexes by vegans and pescovegetarians. The most statistically significant reductions were in ischemic heart disease among male vegans (55% reduction) and female pescovegetarians (49% reduction). Only pescovegetarians obtained statistically significant reductions in women. Male vegans (42% reduction), pescovegetarians (23% reduction), and lacto-ovo vegetarians (34% reduction) also achieved statistically significant reductions in CVD mortality. No groups achieved statistically significant reductions in cancer risk.

The authors note that, “Vegetarian groups tended to be older, more highly educated, and more likely to be married, to drink less alcohol, to smoke less, to exercise more, and to be thinner.” Many of these factors could bias the reduction in mortality risk towards the vegetarian groups regardless of the diet that they ate. This observation may be indicative of the fact that people who take the time to monitor their diet may also be more health conscious in general. It is also important to consider the specific characteristics of the group being studied. Seventh Day Adventists are strict in their observance of a Sabbath day of non-work, and also are required to refrain from all tobacco, alcohol, or illicit drug use. It is important to keep these restrictions and expectations in mind when interpreting this study, as they may have led to underreporting biases. These study results may also not be as directly extrapolatable to the general population given the restrictions on this population’s lifestyle. 

The Adventist Health Study 2 provides evidence that a vegan inclined diet with a few servings of animal product per week may be better at reducing cardiovascular risk than other diets when studied in Seventh Day Adventists. Within vegetarian subtypes, a pescovegetarian diet was best for women and a vegan diet was best for men for cardiovascular protection. Males also experienced a reduction in cardiovascular events on pescovegetarian and lacto-ovo vegetarian diets.

Glycemic index and load

Glycemic index and load refer to the increase in blood glucose caused by eating a particular food. The lower these numbers, the less that blood sugar levels are increased by a given food. The Harvard School of Public Health website provides the glycemic indexes of many common foods [ 31 ]; a more comprehensive list was published in 2008 [ 32 ]. Eating low glycemic foods is likely healthier for everyone, but it is particularly important for diabetic patients to prevent dangerously high blood sugar spikes. Larger quantities of low glycemic foods (for example garbanzo beans) can be eaten by diabetics with far less impact on the blood sugar than even small quantities of high glycemic index foods (such as Jell-O). Eating lower glycemic index foods may have many additional health benefits, from reducing the occurrence of symptoms with mood disorders [ 33 - 34 ] and reducing fatigue [ 34 ] to reducing the risk of acne [ 35 ].

Whole grains

A meta analysis of 64 observational and cohort studies showed that whole grain consumption up to 200 g, including whole grain bread, breakfast cereal, and grain products with bran added, has been shown to reduce CAD, CVD, and total cancer [ 36 ]. The results in some cases were in a dose-dependent manner, with higher consumption leading to greater risk reduction. A key limitation of this article is that the specific types of whole grains consumed in the various studies were not always clearly identified. Also, cancer was reported as “total cancer,” without discussion of the specific types. These limitations make it difficult to draw conclusions on whether a specific grain type is responsible for the protective benefits, or what specific cancers may be affected by diet.

So what should we eat?

The above articles have made significant contributions to our understanding of the effects of diet on health, but also have limitations. With this in mind, the above literature suggests that a lacto-ovo-vegetarian inclined diet, with around three servings per week of fish such as wild salmon (ideal) or meat may be the best diet to reduce the risk of CVD and stroke. Some data in the articles reviewed suggested that certain cancers and mood disorders may also be modifiable by diet. The emphasis should be on low glycemic foods in their natural, unprocessed form. Green vegetables and complex carbohydrates such as whole grains should comprise the majority of the diet. Eating 200 g per day of whole grains may be more protective than lesser amounts. Nuts and olive oil are likely protective against stroke when eaten regularly. A handout summarizing these findings that can be given to patients can be found in Appendix A. 

These findings make sense from an evolutionary standpoint. Our hunter gatherer ancestors didn’t have the luxury of supermarkets or restaurants, and thus likely had only a few servings of meat or fish per week when they were able to catch their prey. These meals likely served to provide vitamins and nutrients not readily available in plants, most notably vitamin B12. The majority of their diet thus consisted of plants and fruits that were readily available in their environment, creating a diet similar to that shown to be healthy in our studies.

Although more randomized controlled trial data are needed for more definitive conclusions, our current literature suggests that a lacto-ovo-vegetarian inclined diet, with around three servings per week of fish such as wild salmon (ideal) or meat may be the best diet to reduce the risk of CVD and stroke. In order for any diet to be effective, it must be sustainable. Patients should be advised to pick a diet closest to that described above that they can maintain for maximum health benefits. A healthy diet can dramatically reduce the risk of future health problems.

Acknowledgments

I’d like to thank Thomas Chen DO, Armando Del Portillo MD PhD, Thomas Lane MD, and Melissa Pepin BS for their feedback when creating this article.

Healthy eating handout

Diet, exercise, avoiding smoking, drinking alcohol in moderation, not doing recreational drugs, managing (not avoiding) stress, and getting 7-9 hours of sleep per night are the most important things you can do to improve your health. What you eat is much more important than how much. Your goal should be a mostly vegetarian diet (plant focused, with some servings of eggs and dairy), with a few servings (approximately 3) per week of fish (best) or meat. The emphasis should be on eating food in its natural, unprocessed form. A simple equation is the most important determinant of your weight: calories in minus calories out. Eating healthy will give you more energy, help you think more clearly, prevent heart disease, strokes, and diabetes, and may improve your mood. Eating healthy is not about eating perfectly all the time, it is about establishing overall healthy habits that you can maintain for life. In general, you should be choosing foods that protect your blood vessels in your heart/brain and prevent your blood sugar from being very high (to prevent diabetes, or possibly reverse it if you have it). The glycemic index and load are useful tools to help approximate how much a particular food will spike your blood sugar. You should aim for most of the food you eat to have a glycemic index around 50 or below. If you exercise frequently (such as 5x a week for 30 min each time), you may require more food around or slightly above the glycemic index of 50 cutoff. Helpful lists of glycemic indexes for common foods can be found by searching Google for either the “Harvard School of Public Health Glycemic Index” (website) or the “Diabetes Care Glycemic Index” (journal article - more detailed). Organic foods without pesticides, antibiotics, and added growth hormones are preferable, although this is not always practical. Avoiding foods with preservatives and artificial ingredients/chemicals is ideal. Wash fruits/vegetables before eating. Foods that are high in omega 3 fatty acids (such as salmon, walnuts, and flaxseed) are anti-inflammatory. Inflammation irritates the inside of blood vessels and makes it easier for a heart attack or stroke to occur. So, foods that contain omega 3 reduce inflammation and thus help prevent heart attacks and strokes. These foods may also help improve your mood and reduce anxiety and depression. You should try to include these foods in your diet. In contrast, foods that are high in omega 6 fatty acids and/or arachidonic acid (such as beef) may cause inflammation and thus may increase your risk of heart attack and stroke. Thus, these foods should be eaten sparingly. 

Foods to Eat and Foods to Avoid

In general, you should eat a mixture of complex (low glycemic) carbohydrates, leafy green vegetables, broccoli, low glycemic index fruit, and a few servings per week of fish (ideal) or other animal meat.

Ideal: Salmon (should aim to eat 3x/week as has protective effects for the heart and likely for mood, although contains mercury so should not eat every day). Fish in general (contains mercury so do not eat every day), egg whites, beans (have some carbohydrates in them, but low glycemic and mostly fiber, which slows sugar absorption and prevents sugar spikes), nuts (the nuts with the most data are walnuts, hazelnuts, and almonds - eat a handful or two per day, probably protective against stroke).

Also acceptable: Chicken breast with fat removed, turkey breast with fat removed.

Eat sparingly: Beef, pork

Eat as much as you want, unless on Coumadin/warfarin - then avoid leafy greens. Leafy greens (spinach, kale, cabbage, chard, bok choy, collard greens, etc.), broccoli, cauliflower, zucchini/squash, asparagus, celery, onions, bamboo shoots, eggplant, etc.

Low glycemic fruits - eat in moderation: Peaches, pears, apples, strawberries, grapes, oranges, blueberries, tomatoes.

Eat sparingly - very high in sugar: Melons (ex. watermelon, cantaloupe, etc.), dates, bananas.

Complex Carbohydrates

In general, the longer you have to cook something, the less it will spike your blood sugar.

Steel cut oats (best) or rolled oats (ok), pearled barley, brown rice (eat in moderation, contains arsenic), sweet potatoes/yams, pasta cooked al dente (still chewy) can be consumed sparingly (unless you are an athlete with high caloric needs, in which case you can eat more frequently), sprouted grains such as sprouted wheat in Ezekiel bread, quinoa, etc. Breads where the first ingredient is a whole grain are still not ideal, but are better than “enriched wheat” or processed bread.

Eat sparingly: Quick oats, white bread, white rice (caution, contains arsenic), potatoes.

Eat sparingly in general: Candy, cakes, chocolate, pastries, high sugar foods, processed foods (such as lunch meats, have been linked to increased cancer).

Ideal: Water is the best thing for you. Non-fat/1% organic milk can be consumed in moderation - there is a conflicting research about whether this increases your risk of heart disease or lowers it. Dairy products may also increase your risk of breast cancer.

Almond/soy milk: Can consider soy - has a higher omega 6 (pro-inflammatory) content, although overall is a low sugar and high protein option.

Sparingly consume/avoid: Juices are very high in sugar - they are not the same thing as eating the whole fruit because they lack the fiber and your body does not have to break them down as much. Regular soda has tons of sugar, diet soda has artificial chemicals which are not optimal for your body’s functioning.

A reasonable goal for the typical person without heart disease or strokes would be to allow 1-2 “cheat meals” per week where they can eat whatever they would like, with the rest of the meals strictly adhering to the healthy diet above. If you find it very difficult to control your cravings, consider making most of your cheat meals extra portions of your favorite healthy diet foods.

The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus.

The authors have declared that no competing interests exist.

Americans are just about failing when it comes to nutrition, says a food-as-medicine researcher. A few simple diet tweaks could help.

• Americans' diets have remained largely unchanged since 1999, according to a new study.
• Meals remain high in processed foods that can increase a person's risk of disease.
• Ditching sugary drinks and eating two fewer processed meals a week could help.

Americans are eating healthier than in previous years, but they still have a long way to go, according to a researcher who studies food as medicine.

Dr. Dariush Mozaffarian, director of the Food is Medicine Institute at Tufts University in Boston, co-authored a study on the quality of nearly 52,000 American adults' diets between 1999 and 2020. The results were published online Tuesday in the Annals of Internal Medicine.

Mozaffarian and his co-author, Junxiu Liu, examined data from the National Health and Nutrition Examination Survey and found that the American diet has remained nearly the same over the past two decades.

Between 1999 and 2020, 10.5% of study participants transitioned from "poor" diets to healthier diets with more fruits, vegetables, and whole grains and less sodium, processed meat, and saturated fat.

But only 1% of study participants ate an "ideal" diet — 4 to 5 cups of fruits and vegetables daily, plus beans, whole grains, and nuts — during that same time period.

"People often ask me, 'Well, if the diet's slowly improving, why is obesity and diabetes still going up?' It's still going up because only 1.58% of Americans have an ideal diet. We still have a long way to go," Mozaffarian told CNN .

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"We have stalled as a nation — and that does not bode well for our health. If I was grading America on its diet, I'd give it a D—just up from an F," Mozaffarian said.

Why are Americans failing in the diet department?

Typically, the American diet consists of ultra-processed foods and foods high in salt and sugar. These foods can increase a person's risk of cancer , heart disease, stroke, and early death Accordingng to Heidi Silver, a registered dietitian and director of the Vanderbilt Diet, Body Composition, and Human Metabolism Core at Vanderbilt University Medical Center in Nashvil, factors like food insecurity and poverty have contributed to the overall lack of improvement in peoples' diets over the last two decadesle.

"Food insecurity affects diet quality via lower consumption of healthier foods, especially those that are more expensive, don't have a long shelf life and don't provide enough volume to fill a hungry child," Silver told Yahoo .

These systemic limitations can make it difficult for food-insecure populations like Black people, older people, and low-income people to make lasting diet changes.

Simple diet tweaks could help reduce health risks

For those seeking simple and inexpensive ways to improve their diets, removing sugary drinks is a good first step, according to Dr. Gregory Katz, a cardiologist at NYU Langone.

" Drinking calories and drinking alcohol are the biggest modifiable risk factors. The number of people I see drinking 500 calories a day blows my mind," Katz told Business Insider's Gabby Landsverk. "Just because it's simple doesn't make it easy."

Katz suggested doing away with soda, juice, sugar-laden coffee drinks, and cocktails and replacing them with unsweetened tea or water flavored with a splash of juice or flavored with citrus.

Aiming to swap out two servings of processed foods each week is another strategy that doesn't involve overhauling your entire diet, according to Dr. W. Taylor Kimberly. Kimberly, a professor of neurology at Harvard Medical School and the senior author of a recent study linking ultra-processed foods to health risks like dementia and stroke.

You could, for example, swap French fries for a baked sweet potato or nosh on nuts and carrots instead of cookies and crackers.

Kimberly said that a good rule of thumb is to prepare meals at home as much as possible.

"If you look at it and think, that could be made in my kitchen, that's a good indicator," he said.

Watch: How to spot ultra-processed foods we mistake for healthy

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