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- TASTY trial: protocol for a study on the triad of nutrition, intestinal microbiota and rheumatoid arthritisPublication . Charneca, Sofia; Hernando, Ana; Almada-Correia, Inês; Polido Pereira, Joaquim; Vieira, Adriana; Sousa, Joana; Almeida, Ana S.; Motta, Carla Motta; Barreto, Gonçalo; Eklund, Kari K.; Alnso‑Pérez, Ana; Gómez, Rodolfo; Cicc, Francesco; Mauro, Daniele; Pinho, Salomé S.; Fonseca, João Eurico; Costa Reis, Patricia; Guerreiro, Catarina SousaBackground: The gut microbiota has been implicated in the onset and progression of Rheumatoid Arthritis (RA). It has been proposed that gut dysbiosis impairs gut barrier function, leading to alterations in mucosal integrity and immunity. This disruption allows bacterial translocation, contributing to the perpetuation of the inflammatory process. Since diet is recognised as a key environmental factor influencing the gut microbiota, nutritional interventions targeting RA activity are currently being explored. This study aims to investigate whether a dietary intervention based on a typical Mediterranean Diet enriched with fermented foods (MedDiet +) can impact the gut microbiota, intestinal permeability, and RA-related outcomes. Methods: One hundred RA patients are being recruited at Unidade Local de Saúde (ULS) Santa Maria in Lisbon, Portugal, and randomly assigned to either the intervention (MedDiet +) or the control group. The 12-week nutritional intervention includes a personalised dietary plan following the MedDiet + pattern, along with educational resources, food basket deliveries, and clinical culinary workshops, all developed and monitored weekly by registered dietitians. The control group receives standardised general healthy diet recommendations at baseline. The intervention's effects will be assessed by evaluating disease activity, functional status, quality of life, intestinal permeability, endotoxemia, inflammatory biomarkers, intestinal and oral microbiota, serum proteomics, and serum glycome profile characterisation. Discussion: We anticipate obtaining integrative insights into the interplay between diet, the gut, and RA, while also exploring the underlying mechanisms driving these changes. This study, conducted by a multidisciplinary research team of registered dietitians, rheumatologists, biologists, and immunologists, aims to bridge the current gap between nutrition-related knowledge and RA. Trial registration: Registered in ClinicalTrials.gov (NCT06758817; date of registry: January 6th 2025).
- Co-creation and implementation of a healthy snacks policy in primary schools: data from Sintra Grows HealthyPublication . Nogueira, Telma; Ferreira, Raquel J.; Liñan Pinto, Mariana; Silva, Vitória Dias da; Nogueira, Paulo Jorge; Sousa, JoanaPolicy interventions in the school food environment can improve dietary behaviors. However, the literature describing its development and implementation is scarce. This manuscript aims to describe the process of co-creation, implementation, monitoring, and evaluation of a Healthy Snacks Policy, in the scope of Sintra Grows Healthy intervention. Through a community-based participatory research methodology, the co-creation of the Healthy Snacks Policy comprises six stages: snacks evaluation, feedback sessions, class assemblies, school community assemblies, school cluster policy approval, and process evaluation. Within one school year, a Healthy Snacks Policy was co-created, approved, incorporated in the school regulations, implemented, continuously monitored, and evaluated. Regarding snacks evaluation, 1900 snacks were evaluated at the beginning of the school year and 1079 at the end of the school year. There were three feedback sessions, twenty-two class assemblies, and three school community assemblies. Most teachers perceived that children began to consume healthier snacks (72%); 66% of the children were considered to have started eating healthier; and most families said "yes or sometimes" when asked whether their children started requesting healthier snacks (70%), trying new foods (63%), and noticing improvements in their eating habits (74%). The co-creation of a Healthy Snacks Policy establishes an approach to effectively implement existing guidelines for school food supplies, complying with national priority implementation recommendations.
- Dietary content and combined training, but not daily physical activity, are associated with 6-month bone mineral changes in adolescents with obesity: a secondary analysis of the PAC-MAnO trialPublication . Videira-Silva, Antonio; Santos, Inês; Freaza, Dalise; Gameiro, Mariana; Sardinha, Luís B.; Fonseca, HelenaPurpose: The present study aimed to explore the influence of diet and physical activity (PA) changes on bone mineral content (BMC) and density (BMD) alterations in adolescents with obesity undergoing a weight loss program. Methods: Six-month longitudinal data from 71 adolescents (aged 15.1 [± 1.6] years; 57.7% girls) with a BMI z-score of 3.03 (± 0.78), previously recruited for the PAC-MAnO trial, were analyzed using Generalized Estimation Equations for over time changes and linear regressions with BMC, BMD and BMD z-score as dependent variables, adjusting for confounders (including type of exercise- aerobic vs. combined). Results: Adjusting for confounders, changes in carbohydrate (CH) and protein content showed to positively and negatively predict BMD z-score variance, respectively (β = 0.44, 95%CI: 0.01, 0.04, p < .001); β = -0.57, 95%CI: -0.06, -0.03, p < .001), yet no associations were found between PA and bone-related parameters. Combined exercise showed better results on BMC compared to aerobic exercise (β = 0.09, 95%CI: 0.05 to 0.13, p < .001). Conclusions: Increased CH content, instead of protein, may be associated with BMD improvements in adolescents with obesity. Type of exercise may moderate the impact of PA on bone health. Trial registration: Clinicaltrials.gov NCT02941770. What is Known • Adolescents with obesity may be at a higher risk of osteopenia/osteoporosis • Obesity and inadequate diet and physical activity (PA) may have an adverse effect on bone metabolism What is New • Improvements in adiposity and muscle mass and increased diet carbohydrate content are associated with bone mineral density (BMD) improvements • Type of exercise (i.e., combined training vs. aerobic) may moderate the impact of PA on BMD, and calcium intake may mediate this impact.
- “You get out of the house, you talk to each other, you laugh…And that’s fantastic” – a qualitative study about older people’s perceptions of social prescribing in mainland PortugalPublication . Costa, Andreia; Henriques, Joana; Alarcão, Violeta; Madeira, Teresa; Virgolino, Ana; Polley, Marie J.; Henriques, Adriana; Feteira-Santos, Rodrigo; Arriaga, Miguel; Nogueira, Paulo JorgeBackground: Social prescribing (SP) is a non-clinical approach, most commonly based in healthcare units, that aims to address non-medical health-related social needs by connecting individuals with community-based services. This qualitative study explores the perception of Portuguese older adults regarding the benefits of SP and their willingness to participate in SP initiatives. Methods: Three face-to-face focus group sessions were conducted with 23 participants in different cities in Portugal. Open and semi-open questions were used to guide the discussions and thematic analysis was used to analyze the data. Results: The participants recognized the potential benefits of SP for older adults, including diversifying leisure activities, improving mental health, and complementing existing support systems. They highlighted the need for external support, usually in the form of link workers, to facilitate personalized referrals and consider individual characteristics and preferences. While some participants expressed reluctance to engage in SP due to their existing busy schedules and a perceived sense of imposition, others showed openness to having new experiences and recognized the potential value of SP in promoting activity. Barriers to participation, including resistance to change, mobility issues, and family responsibilities, were identified. Conclusions: The study emphasizes the importance of a person-centered and co-designed approach to SP, involving older adults in the planning and implementation of interventions. The findings provide valuable insights for the development of SP programs tailored to the unique needs and aspirations of older adults in Portugal, ultimately promoting active and healthy aging. Future research should consider the perspectives of family doctors and include a broader representation of older adults from diverse geographic areas.
- Effect of HCV eradication by DAAs on liver steatosis, carotid atherosclerosis, and associated metabolic comorbidities: a systematic reviewPublication . Cespiati, Annalisa; Rodrigues, Inês Coelho; Santos, Inês; Policarpo, Sara; Carvalhana, Sofia; Fracanzani, Anna Ludovica; Cortez-Pinto, HelenaBackground and Aims The beneficial effect of Hepatitis C virus (HCV) eradication by direct antiviral agents (DAAs) on liver fibrosis is well defined. Despite this, the impact of viral eradication in both hepatic and extra-hepatic metabolic features is underreached. This systematic review aimed to synthesize the evidence on the impact of HCV eradication by DAAs on liver steatosis, carotid atherosclerosis, glucidic impairment, dyslipidaemia, and weight gain. Methods A systematic search of the existing literature (up to December 2022) identified 97 original studies that fulfilled the inclusion criteria. Results Whereas total cholesterol and low-density lipoprotein (LDL) seem to increase after viral eradication, the cardiovascular damage expressed as carotid plaques and intima-media thickness seems to improve. Otherwise, the effect on liver steatosis, glucidic homeostasis, and weight seems to be strictly dependent on the presence of baseline metabolic disorders. Conclusion Despite high heterogeneity and relatively short follow-up of included studies, we can conclude that the presence of metabolic risk factors should be strictly evaluated due to their impact on liver steatosis, glucidic and lipid homeostasis, and on weight gain to better identify patients at risk of liver disease progression despite the virus eradication.
- Nutritional genomics in nonalcoholic fatty liver diseasePublication . Vasconcellos, Carolina; Ferreira, Oureana; Lopes, Marta Filipa; Ribeiro, André Filipe; Vasques, João; Guerreiro, Catarina SousaNonalcoholic fatty liver disease (NAFLD) is a common chronic condition associated with genetic and environmental factors in which fat abnormally accumulates in the liver. NAFLD is epidemiologically associated with obesity, type 2 diabetes, and dyslipidemia. Environmental factors, such as physical inactivity and an unbalanced diet, interact with genetic factors, such as epigenetic mechanisms and polymorphisms for the genesis and development of the condition. Different genetic polymorphisms seem to be involved in this context, including variants in PNPLA3, TM6SF2, PEMT, and CHDH genes, playing a role in the disease's susceptibility, development, and severity. From carbohydrate intake and weight loss to omega-3 supplementation and caloric restriction, different dietary and nutritional factors appear to be involved in controlling the onset and progression of NAFLD conditions influencing metabolism, gene, and protein expression. The polygenic risk score represents a sum of trait-associated alleles carried by an individual and seems to be associated with NAFLD outcomes depending on the dietary context. Understanding the exact extent to which lifestyle interventions and genetic predispositions can play a role in the prevention and management of NAFLD can be crucial for the establishment of a personalized and integrative approach to patients.
- Beyond seasoning : the role of herbs and spices in rheumatic diseasesPublication . Charneca, Sofia; Hernando, Ana; Costa Reis, Patricia; Guerreiro, Catarina SousaAlthough we have witnessed remarkable progress in understanding the biological mechanisms that lead to the development of rheumatic diseases (RDs), remission is still not achieved in a substantial proportion of patients with the available pharmacological treatment. As a consequence, patients are increasingly looking for complementary adjuvant therapies, including dietary interventions. Herbs and spices have a long historical use, across various cultures worldwide, for both culinary and medicinal purposes. The interest in herbs and spices, beyond their seasoning properties, has dramatically grown in many immune-mediated diseases, including in RDs. Increasing evidence highlights their richness in bioactive molecules, such as sulfur-containing compounds, tannins, alkaloids, phenolic diterpenes, and vitamins, as well as their antioxidant, anti-inflammatory, antitumorigenic, and anticarcinogenic properties. Cinnamon, garlic, ginger, turmeric, and saffron are the most popular spices used in RDs and will be explored throughout this manuscript. With this paper, we intend to provide an updated review of the mechanisms whereby herbs and spices may be of interest in RDs, including through gut microbiota modulation, as well as summarize human studies investigating their effects in Rheumatoid Arthritis, Osteoarthritis, and Fibromyalgia.
- Comparing self-reported energy intake using an online dietary tool with energy expenditure by an activity trackerPublication . Vasileiou, Aikaterina; Searle, Dominique; Larsen, Sofus C.; Magkos, Faidon; Horgan, Graham; Stubbs, R. James; Santos, Inês; Palmeira, António L.; Heitmann, Berit L.Objective: The aim of this study was to compare self-reported total energy intake (TEI) collected using an online multiple-pass 24-h dietary recall tool (Intake24) with total energy expenditure (TEE) estimated from Fitbit Charge 2-improved algorithms in adults from the NoHoW trial (12-mo weight maintenance after free-living weight loss). Methods: Bland-Altman plots were used to assess the level of agreement between TEI and TEE at baseline and after 12 mo. The ratio of TEI to TEE was also calculated. Results: Data from 1323 participants (71% female) was included in the analysis (mean ± SD: age 45 ± 12 y, body mass index 29.7 ± 5.4 kg/m2, initial weight loss 11.5 ± 6.5 kg). The TEI was lower than TEE on average by 33%, with limits of agreement ranging from -91% to +25%. Men, younger individuals, those with higher body mass index, those with the greater weight loss before enrollment, and those who gained weight during the study underestimated to a greater extent. Conclusions: These findings contribute to the ongoing research examining the validity of technology-based dietary assessment tools.
- Digital approaches in the nutritional prevention and management of chronic diseasesPublication . Guerreiro, Mara Pereira; Félix, Isa Brito; Camolas, José Miguel LopesChronic diseases are a global epidemic, responsible for the majority of deaths worldwide. Diet and nutrition play an important role in preventing and managing high-burden chronic diseases. Digital technology became popular for supporting the nutrition care process and enhancing dietary self-management through interventions targeting persons at risk or living with chronic disease, health care professionals or both. Work portrayed in this Research Topic includes the development and validation of a nutrition self-screening tool (IBD-NST) for the management of inflammatory bowel disease by Wall et al. Digitization offers the advantage of automated calculation of measures integral to the tool, lessening the completion workload. Additionally, subsuming the tool in apps and digital platforms can improve access to self-screening and foster integration of care. Another example of digitisation is the work of Verbeke et al., which outlines the psychometric evaluation of a short food frequency questionnaire in Dutch, firstly paper-based and then in a web version. Food frequency questionnaires are amongst the most used dietary assessment instruments, therefore validated digital versions are useful both for research and clinical purposes. Griauzde et al. illustrate how a system for virtual consultations was successfully used to deliver a very low-carbohydrate diabetes prevention programme to US Veterans with prediabetes. Such an approach is promising for improved enrollment and retention, given the low participation of eligible Veterans in the in-person, telephone, or video sessions of the Weight Management Programme MOVE!
- Food reward associations with motivational eating behavior traits and body mass index in Portuguese former elite athletesPublication . Carraça, Eliana V.; Nunes, Catarina L.; Santos, Inês; Finlayson, Graham; Silva, Analiza MBackground: Motivational eating behavior traits (i.e. eating motivations and intuitive eating) have an important role in body weight regulation, as do food reward processes. Their associations might help explain different responses to food stimulus in the current environment but have never been explored. This study's primary goal was to investigate food reward associations with eating motivations, intuitive eating dimensions and body mass index in former Portuguese elite athletes with overweight/obesity. As a first step, a cultural adaptation of the Leeds Food Preference Questionnaire (LFPQ) was created and validated in an online-surveyed Portuguese sample. Results: Step 1: Analysis from an online survey (N = 348; 69.8% female) conducted to validate the food images from the cultural adaptation of the LFPQ showed that most food images were properly recognized in terms of their fat and sweet content by the Portuguese population, except for some savory items. Step 2: Regarding our primary analysis in 94 former elite athletes with overweight/obesity, self-determined motivations to regulate eating and (to a lower extent) more body-food congruent choices (both markers for healthier eating behaviors) were associated with more favorable food reward outcomes, as opposed to non-self-determined motivations. Less emotional (more intuitive) eaters presented higher implicit wanting for low-fat sweet foods compared to more emotional eaters. Conclusion: These findings suggest LFPQ usefulness to evaluate food preferences and detect relevant associations between food reward and motivational eating behavior traits in former elite athletes with overweight/obesity. Health professionals are encouraged to create need-supportive environments that foster self-determined motivations and help individuals make healthier food choices. © 2023 Society of Chemical Industry.