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* Virtues of Fruits, Veggies, and Grains


* New Birth to 24 months Feeding Recommendations Whole Grains Confusion



Two new studies explore the impact of higher consumption of fruit, vegetables, and whole-grain foods on lowering the risk of developing type 2 diabetes mellitus (T2DM). The findings suggest that even a modest increase in consumption of these foods as part of a healthy diet could decrease risk of T2DM. In the first study, a team of European researchers examined the association between blood levels of vitamin C and carotenoids with risk of developing T2DM. Vitamin C and carotenoid levels are more reliable indicators of fruit and vegetable intake than using dietary questionnaires. Their findings are based on almost 10 000 adults who developed new-onset T2DM and a comparison group of 13 600 adults who remained free of diabetes during follow-up from among a little over 340 000 participants who were taking part in the European Prospective Investigation into Cancer and Nutrition-InterAct study in 8 European countries. They adjusted for lifestyle, social, and dietary risk factors for diabetes. They found that higher blood levels of each of vitamin C and carotenoids and their sum, which was combined into the "composite biomarker score," were associated with a lower risk of developing T2DM. Compared with people who had the lowest composite biomarker score, the risk in people whose biomarker score was in the top 20% of the population was 50% lower. The risk in those with biomarker scores between these 2 extremes was intermediate. The researchers calculate that every increase of 66 g per day in total fruit and vegetable intake was associated with a 25% lower risk of developing T2DM. What needs more exploration is whether differences in weight status or other factors accounted for some of those differences as well. In the second study, researchers in the United States examined associations between total and individual whole-grain food intake and T2DM. Their findings were based on a little over 158 000 women and close to 36 500 men who were free from diabetes, heart disease, and cancer and participating in 2 large observational studies; the Nurses' Health Study, Nurses' Health Study II, and Health Professionals Follow-up Study. After adjusting for lifestyle and dietary risk factors for diabetes, participants in the highest category for total whole-grain consumption had a 29% lower rate of T2DM compared with those in the lowest category. For individual whole-grain foods, the researchers found that consuming 1 or more servings a day of whole-grain cold breakfast cereal or dark bread was associated with a lower risk of T2DM (19% and 21%, respectively) compared with consuming less than 1 serving a month. For other individual whole-grain products with lower average intake levels, consumption of 2 or more servings a week compared with less than 1 serving a month was associated with a 21% lower risk for oatmeal, a 15% lower risk for added bran, and a 12% lower risk for brown rice and wheat germ. These reductions in risk seemed to plateau at approximately 2 servings a day for total whole-grain intake and at approximately half a serving a day for whole-grain cold breakfast cereal and dark bread. Of course, those who were in these groups probably varied in other ways as well and because both studies are observational cause and effect cannot be established, and there is a possibility that some of the results may be due to unmeasured (confounding) factors. Nevertheless, these are useful clues to pursue in studying what the mechanisms for such effects might be. Also, other research links a healthy diet with better health, and the findings provide further support for current recommendations to increase fruit, vegetable, and whole-grain consumption as part of a healthy diet to prevent T2DM.


Sources: Zheng J, et al Association of plasma biomarkers of fruit and vegetable intake with incident type 2 diabetes: EPIC-InterAct case-cohort study in eight European countries. BMJ 2020; m2194, doi: 10.1136/bmj.m2194.


Hu, Y. et al. Intake of whole-grain foods and risk of type 2 diabetes: results from three prospective cohort studies. BMJ 2020; m2206 DOI: 10.1136/bmj.m2206.



Guidelines about feeding children younger than 2 are generally consistent, but there are some inconsistencies. One is the minimum recommended age to which breastfeeding should be continued, says a new report from the National Academies of Sciences, Engineering, and Medicine. There is substantial opportunity to harmonize the development of future feeding guidelines across government agencies, professional societies, and nonprofit organizations-in order to establish more consistent guidance, avoid duplicate efforts, and ensure effective communication and dissemination, says Feeding Infants and Children From Birth to 24 Months: Summarizing Existing Guidance.


The report-which reviews 43 guideline documents from authoritative groups-compares recommendations across these groups, evaluates their breadth and consistency, and assesses the type of evidence underpinning each recommendation. Recommendations are grouped into 26 topics covering "what to feed" and "how to feed."


Among the "what to feed" topics in the report, the committee reviewed recommendations on breastfeeding; formula-feeding; the suitability of cow's milk; substances to avoid or limit; vegetarian and vegan diets; introduction of foods associated with allergies, including peanuts; and the use of nutrient supplements. The "how to feed" topics include the safety of certain foods and feeding practices, bottle use and propping, hunger and satiety cues, the introduction of complementary foods (foods other than breast milk or infant formula), and food consistency and texture.


For many of the topics, the recommendations from the various sources were consistent or had only slight nuances in wording. However, there was some inconsistency in the specific ages or age ranges stated in some of the recommendations, and other recommendations varied in their specificity. For example, some organizations made recommendations about the timing of introduction of peanuts based on the infant's risk of peanut allergy, whereas others did not differentiate on that basis.


Of the 43 guideline documents reviewed, most were targeted to healthcare providers (particularly physicians, nurse practitioners, nurses, dentists, and registered dietitian nutritionists), who are typically expected to provide the information to parents and guardians. Other important audiences include early care and education providers, policymakers, and administrators of programs such as the Child and Adult Care Food Program and the Special Supplemental Nutrition Program for Women, Infants, and Children. The report calls for guideline developers to identify effective ways to communicate with all stakeholders.


The committee also identified several evidence gaps related to the communication and dissemination of feeding guidelines, including the use of telehealth; the impact of social media dissemination; and the role of community health workers and peer counselors in sharing information with socioeconomically vulnerable, rural, and other hard-to-reach populations.


The report offers insights to help align and improve future guidelines, including collaboration between organizations during the guideline planning and development process; the use of best practices for guideline development; and timely and effective dissemination of evidence-based recommendations, based on the principles of dissemination and implementation science. The Dietary Guidelines Advisory Committee 2020-2025 reports provides additional information that may be useful.


For more information, go to A free copy of the report is available at the website, long with many other interesting reports on related topics.