Dietary patterns: nutritional biomarkers and non-communicable disease risk factors

Abstract

Dietary patterns provide a holistic approach to capture nutritional intake and potentially predict NCD risks more accurately. Nutritional biomarkers enable objective dietary assessment, providing a better understanding of diet-disease relationships. NCD risk factors are widely accepted as surrogate endpoints, presenting an opportunity to uncover the comparative and specific effects of dietary patterns on NCD prevention. This thesis aimed to enhance knowledge of using nutritional biomarkers to assess dietary patterns and determine the effects of dietary patterns on NCD risk factors. Chapter 2 quantified nutritional biomarkers at multiple postprandial time points, which were found to be relevant for objective dietary pattern assessment. Chapter 3 raised the need for biomarker panels to capture overall and specific dietary patterns. Chapter 4 developed multi-biomarker panels of the Healthy Eating Index by applying machine learning techniques, incorporating circulating fatty acids, vitamins, and carotenoids. Chapter 5 detailed a Network Meta-Analysis, which ranked 11 dietary patterns based on their effects on 11 NCD biomarkers. The Paleo, DASH, and Mediterranean diets were ranked best for overall NCD prevention, independent of the underlying macronutrient composition. Chapter 6 investigated the postprandial effects of plant-based meat alternatives on arterial endothelial function and blood pressure, and suggests that they are unlikely to be superior to animal-derived counterparts, although the study was underpowered to achieve definitive conclusions. This thesis contributes to the construction of biomarker panels for capturing dietary patterns and the evidence base for dietary patterns in NCD prevention. More reliable biomarkers are necessary to improve current biomarker panels and capture various dietary patterns more fully. Future research should continue to strengthen the evidence for dietary patterns that balance environmental impact, animal welfare, and human health.