Elena S. George

Background: The Dietary Inflammatory Index (DII^®) is a commonly used tool to assess diet-related inflammation. Higher DII scores have been associated with increased cardiovascular disease risk in observational studies. However, evidence examining cardiovascular outcomes across DII levels in controlled settings remains limited. This secondary analysis examined cross-sectional differences and longitudinal associations between dietary inflammatory potential and cardiovascular outcomes in healthy Australian adults. Methods: This study used data from a double-blind randomised crossover trial, in which 50 participants consumed 60 mL/day of either extra virgin high-polyphenol olive oil (HPOO; 320 mg/kg) or low-polyphenol olive oil (LPOO; 86 mg/kg) across two 3-week intervention periods, separated by a 2-week washout. Anthropometric measures (weight, height, waist circumference, and BMI) and cardiovascular outcomes (i.e., blood pressure, lipids, oxidised LDL, and HDL cholesterol efflux capacity) were assessed at four timepoints. DII and energy-adjusted DII (E-DII^TM) scores were derived from 3-day food diaries. Linear mixed-effects models were used to compare cardiovascular outcomes across repeated-measures DII tertiles (low, medium, and high), adjusting for intervention, period, sequence, age, sex and waist circumference. Results: Forty-three participants completed this study. At baseline, BMI, waist circumference, systolic blood pressure, total cholesterol, and LDL differed significantly across DII tertiles (p < 0.05). However, over time, cardiovascular outcomes did not differ between medium or high versus low DII tertiles, and no significant time-by-tertile interactions were observed (all p > 0.05). DII values remained stable, while E-DII showed modest within-person reductions during both intervention periods (mean reduction: 0.886 units vs. 0.596 units). Conclusions: In this healthy cohort, there was no evidence of a consistent association between DII and short-term differences in cardiovascular outcomes across the intervention period. These findings should be interpreted cautiously, given the observational nature of DII groupings. Longer-duration studies with greater variation in dietary inflammatory potential are warranted to clarify the relationship between DII and cardiovascular health.

The GLIM malnutrition diagnostic framework includes the etiologic criterion for reduced dietary intake or assimilation (i.e., digestion or absorption). This criterion required further specification to support consistent use in clinical practice. Three rounds of a modified Delphi was undertaken to develop consensus on guidance to support identification of this criterion. A working group ( n = 10) developed surveys iteratively. Invited global experts with diverse disciplines and practice contexts ( n = 30) fully completed surveys; consensus was determined at 75% agreement. Three surveys and rounds of voting resulted in 15 guidance statements. Notable points include: (a) using usual intake as the comparator for reduced dietary intake rather than energy requirement, (b) use of gastrointestinal symptoms and nutrition impact symptoms to determine challenges with absorption or assimilation, rather than solely gastrointestinal conditions, and (c) using clinical judgment to determine severity of these symptoms. The final criterion is “less than or equal to 50% dietary intake in the last week or any reduction in intake greater than 2 weeks OR severe gastrointestinal or nutrition impact symptoms (e.g., dysphagia, nausea, vomiting, diarrhea) as a result of an acute or chronic condition or therapy.” Future work should confirm the feasibility of this criterion in clinical practice and its criterion validity within the GLIM framework.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent liver condition worldwide, affecting approximately 30% of the population globally. MASLD often coexists with hypertension, central obesity, type 2 diabetes and dyslipidaemia, yet globally, national treatment strategies are still being established. Pharmacological options are limited and lifestyle modification to achieve weight loss through combining diet, physical activity (PA) and structured exercise remains the cornerstone of MASLD management. The Mediterranean diet (MedDiet) is an evidence-based dietary approach for MASLD prevention and treatment; however, its application in culturally and linguistically diverse, non-Mediterranean populations requires adaptation. In fact, the need for cultural adaptation for all lifestyle interventions (diet, PA and sleep) needs better acknowledgement and implementation. There are limited interventions which combine all lifestyle behaviours and even fewer that consider cultural safety and appropriateness. Furthermore, limited healthcare staffing resources, geographical location and health system pressures highlight the need for more accessible and cost-effective delivery methods. This review summarises evidence on MedDiet for MASLD in multicultural populations, explores the synergistic benefits of combining with PA and sleep interventions and provides practical recommendations for culturally tailored approaches. Finally, we outline future directions for research and healthcare delivery, emphasising the urgent need for holistic, culturally safe, culturally responsive, efficient and digitally enabled strategies to address the growing global burden of MASLD.

Background: The Dietary Inflammatory Index (DII®) is a commonly used tool to assess diet-related inflammation. Higher DII scores are associated with increased cardiovascular disease risk in large observational cohorts yet, controlled-trial evidence evaluating cardiovascular outcomes across DII levels is scarce. This secondary analysis examined cross-sectional differences and longitudinal associations between dietary inflammatory potential and cardiovascular outcomes in healthy Australian adults. Methods: In a double-blind randomised crossover trial, 50 participants consumed 60 mL/day of either high-phenolic (320 mg/kg) or low-phenolic (86 mg/kg) olive oil for two 3-week intervention periods, separated by a 2-week washout. Anthropometry (weight, height, waist circumference, BMI) and cardiovascular outcomes (i.e., blood pressure, lipids, oxidised LDL, and HDL-cholesterol efflux capacity) were measured at four timepoints. DII and energy-adjusted DII (E-DIITM) scores were calculated from 3-day food diaries at baseline and follow-up of each 3-week intervention phase. Linear mixed-effects models compared cardiovascular outcomes across DII tertiles (low, medium, high) adjusting for intervention, period, sequence, age, sex, and waist circumference. Results: Forty-three participants completed the study. At baseline, BMI, waist circumference, systolic blood pressure, total cholesterol, and LDL differed significantly across DII tertiles (p0.05). DII values remained stable across timepoints, while E-DII decreased modestly within individuals in both intervention periods. Conclusions: In this healthy cohort, DII was not associated with adverse short-term changes in cardiovascular outcomes. Longer-duration studies with greater contrast in dietary inflammatory potential are warranted to clarify the relationship between DII and cardiovascular health.

Mediterranean diet (MedDiet) is central to metabolic dysfunction-associated steatotic liver disease (MASLD) management; however, evidence in non-Mediterranean populations is limited. This study examined the association between MedDiet adherence and MASLD, hospitalisation and mortality in a non-Mediterranean population. This longitudinal study included 119 536 UK Biobank adults with at least one 24-hour dietary recall and available sociodemographic and clinical data. Diet quality was assessed using the Modified-Mediterranean Diet Score (M-MedDietScore). MASLD was determined by fatty liver index (FLI) at baseline and by liver imaging in a subgroup. Hospitalisation and mortality data were obtained from linked records, with MASLD outcomes identified using International Classification of Diseases, 10th Revision codes. Binary logistic regression and Cox proportional hazard models estimated Odds Ratio (OR) for MASLD and hazard ratio (HR) for hospitalisation and mortality. Each five-unit increase in M-MedDietScore was associated with 19 % lower OR of MASLD as identified by FLI and confirmed in the imaging sub-analysis in a multivariate adjusted Model 2. Higher adherence to the MedDiet was associated with lower HR of hospitalisation due to liver-related, CVD, diabetes, respiratory and renal disease (all P < 0·05). During a median follow-up of 9·7 years, 5552 deaths occurred. Higher MedDiet adherence was associated with lower HR of all-cause, CVD and extrahepatic cancer mortality and lower all-cause mortality risk in those with MASLD (HR: 0·94, 95 % CI: 0·90, 0·98). Higher adherence to the MedDiet was associated with lower odds of MASLD and with reduced MASLD-related hospitalisations and mortality and lower all-cause mortality in those with MASLD. These findings support the role of MedDiet in reducing hepatic and cardiovascular burden in non-Mediterranean population.

Background: Accessibility barriers contribute to low participation in center-based cardiac rehabilitation. We developed an innovative, comprehensive, dual-phase telerehabilitation program to address this gap (Smartphone Cardiac Rehabilitation, Assisted Self-Management; SCRAM). Objective: The study aimed to determine the effectiveness of SCRAM for increasing maximal aerobic exercise capacity (VO ₂ max). Methods: A multicenter, parallel 2-arm randomized controlled trial recruited clinically stable adults (aged ≥18 y) with diagnosed coronary heart disease at 3 hospitals in Victoria, Australia (Melbourne, Geelong, and Bendigo) from 2018 to 2021. Participants were randomized (1:1), stratified by sex and study site, to receive SCRAM plus usual cardiovascular care (intervention) or usual cardiovascular care alone (control). SCRAM provided 24 weeks of remote exercise supervision, coaching, and behavior change support via smartphone. Usual cardiovascular care included standard medical care and advice to seek a referral to center-based cardiac rehabilitation, which was heavily impacted during the COVID-19 pandemic. Due to the nature of the treatments, participants were not blinded to allocation; primary outcome assessors and biostatisticians were blinded. The primary outcome was VO ₂ max at 24 weeks, analyzed on the principle of intention-to-treat, using linear regression adjusted for baseline and stratification factors on multiple imputed data. Results: Recruitment and data collection were heavily impacted by COVID-19, although SCRAM delivery was sustained throughout. Of 220 required participants, only 123 (56%) were recruited and randomized (intervention n=63, control n=60); 45% (55/123) had missing VO ₂ max at 24 weeks—largely due to enforced COVID-19 restrictions. Mean VO ₂ max at 24 weeks favored SCRAM (26.10, SD 10.72 mL/kg/min) over control (24.65, SD 7.87 mL/kg/min), but the difference was not statistically significant (mean difference=1.61 mL/kg/min, 95% CI –1.38 to 4.61, P =.28). Among secondary outcomes, patients receiving SCRAM had lower diastolic blood pressure at 24 weeks (mean difference=–5.54 mm Hg, 95% CI –10.01 to –1.06). All reported adverse events (control n=6, intervention n=16) were deemed mild or moderate, with only one deemed as possibly related to treatment. There were no deaths or hospitalizations. Conclusions: This was an underpowered trial, but SCRAM did not lead to a clinically important difference in VO ₂ max compared to usual cardiac care. SCRAM was resilient to COVID-19–related disruptions that significantly impacted the delivery of cardiac rehabilitation and supervised exercise training in particular. Further research is needed to conclusively assess treatment effects and understand how virtual cardiac rehabilitation can be translated into routine practice to augment center-based delivery and enhance equity of access.

Background: Nut consumption has been associated with a reduced risk of functional decline, but evidence from randomised controlled trials to support functional benefit is lacking. Therefore, this study aimed to investigate whether daily supplementation of peanut butter over 6 months, relative to usual care, can improve physical function in community‐dwelling older adults. Methods: One hundred and twenty older adults (aged ≥ 65 years) at risk of falls were randomly assigned to receive peanut butter (43 g/day, n = 60) or maintain usual care (control, n = 60) for 6 months. Outcomes assessed at baseline and 6 months included physical function (4‐m gait speed [primary outcome], standing balance test, four‐square step test [FSST], five times sit‐to‐stand [5STS] test time and muscle power, 30‐s sit‐to‐stand (30‐s STS) and timed up and go [TUG] tests), muscle strength (handgrip [HGS] and isometric knee extensor strength tests [KES]) and anthropometry/body composition (weight, body mass index [BMI], total lean and fat mass and appendicular lean mass). Linear regression models, adjusting for age, sex, baseline value of the dependent variable, BMI, physical activity and diet quality, estimated intention‐to‐treat intervention effects. Results: A total of 108 (90%) participants completed the study. At baseline, 70% were female, and the mean ± SD age and BMI were 76.1 ± 4.6 years and 27.5 ± 4.2 kg/m ² , respectively. At 6 months, there were no significant treatment effects on the primary outcome of gait speed or other measures of physical function ( p > 0.05), with the exception that 5STS time and muscle power improved significantly more in the peanut butter compared to control group (estimated treatment effect: time, −1.23 s [95% CI, −2.09, −0.37], p = 0.006; absolute power, 22.0 W [95% CI: 7.1 to 36.9], p = 0.004; relative power, 0.27 W/kg [95% CI: 0.10 to 0.45], p = 0.002). Changes in HGS, KES, weight, BMI, total fat mass, total lean mass or appendicular lean mass did not differ between groups. In the peanut butter group, among those who completed the follow‐up, the mean (SD) adherence was 86.0 (13.8) %. Conclusion: In community‐dwelling older adults at risk for falls, daily peanut butter consumption for 6 months improved 5STS time and muscle power based on 5STS, but not gait speed, muscle strength or body composition. Trial Registration: Australian New Zealand Clinical Trials: ACTRN12622001291774