Dariush Mozaffarian's research while affiliated with Tufts University and other places

Publications (855)

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In every country, a clear national strategy, goals and metrics are needed to end hunger, improve nutrition, reduce diet-related diseases and create a just, sustainable and equitable food system. We identify six policy domains where real change can be made to deliver this vision in the United States.
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Background Effects of animal source foods (ASF) on atherosclerotic cardiovascular disease (ASCVD) and underlying mechanisms remain controversial. We investigated prospective associations of different ASF with incident ASCVD and potential mediation by gut microbiota-generated trimethylamine N-oxide, its L-carnitine-derived intermediates γ-butyrobeta...
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Background Few studies have assessed U.S. cardiometabolic health trends—optimal levels of multiple risk factors and absence of clinical cardiovascular disease (CVD)—or its impact on health disparities. Objectives The purpose of this study was to investigate U.S. trends in optimal cardiometabolic health from 1999 to 2018. Methods We assessed propo...
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Objectives Carbohydrate quality remains a concept under development in the field of Nutrition, and different methods have been proposed to assess healthfulness of carbohydrate-providing foods. The study investigated the relationships between carbohydrate metrics and glycemic index (GI) of grain foods. Methods The investigation was based on data fr...
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Objectives To assess current and altered food habits about two years into the COVID-19 pandemic. Methods We recruited a national sample of 1,878 adults balanced by age (18–34 years, 35–49, 50–64, 65+); sex (male, female); race/ethnicity (Non-Hispanic White, Hispanic/Latinx, Non-Hispanic Black/African-American, Asian/Other); and income (<25k/year,...
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Objectives To assess how American adults consider and define healthfulness of food and beverages. Methods In Fall 2021, a national sample of 1,878 adults balanced by age (18–34 years, 35–49, 50–64, 65+), sex, race/ethnicity (Non-Hispanic White, Hispanic/Latinx, Non-Hispanic Black, Asian/other), and annual income, completed an online survey asking...
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Poor diet increases cardiometabolic disease risk, yet the impact of food service guidelines on employee health and its cost effectiveness is poorly understood. Federal food service guidelines (FFSG) aim to provide United States (U.S.) government employees with healthier food options. Using microsimulation modeling, we estimated changes in the incid...
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Background Due to the increasing disease burden, strategies to predict and prevent heart failure (HF) are urgently needed. Objective We aimed to investigate whether the Alternative Healthy Eating Index (AHEI) and the clinically-abbreviated Prime Diet Quality Score (PDQS) are associated with the risk of overall HF, heart failure with preserved ejec...
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Importance: Little is known about the association of trimethylamine N-oxide (TMAO), a novel plasma metabolite derived from L-carnitine and phosphatidylcholine, and related metabolites (ie, choline, betaine, carnitine, and butyrobetaine) with risk of death among older adults in the general population. Objective: To investigate the associations of...
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Context Gut microbiota-derived metabolite trimethylamine N-oxide (TMAO) may adversely affect bone by inducing oxidative stress. Whether this translates into increased fracture risk in older adults is uncertain. Objective Determine the associations of plasma TMAO with hip fracture and bone mineral density (BMD) in older adults. Design and setting...
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Since 1990, obesity prevalence among U.S. adults has soared from 12% to 42%. The commonly accepted explanation is pervasive overeating: ever-increasing energy intake as the population gains weight, year after year. However, evidence does not support this hypothesis. National data on energy intake and energy availability show increases between 1961...
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Background: Diet is a major modifiable risk factor for human health and overall consumption patterns affect planetary health. We aimed to quantify global, regional, and national consumption levels of animal-source foods (ASF) to inform intervention, surveillance, and policy priorities. Methods: Individual-level dietary surveys across 185 countries...
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Background: Diet is a major modifiable risk factor for human health and overall consumption patterns affect planetary health. We aimed to quantify global, regional, and national consumption levels of animal-source foods (ASF) to inform intervention, surveillance, and policy priorities. Methods: Individual-level dietary surveys across 185 countri...
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The rapid development of nutrition science is embracing digital transformation to generate large amounts of data. Precision nutrition and "Big Data" place increasing demand for data repositories and visualization, which enhances the digital transformation. We defined the need for an integrated nutrition data platform as a web-based platform that ca...
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The rapid expansion of food and nutrition information requires new ways of data sharing and dissemination. Interactive platforms integrating data portals and visualization dashboards have been effectively utilized to describe, monitor, and track information related to food and nutrition. Yet, a comprehensive evaluation of emerging interactive syste...
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Background: n-3 and n-6 PUFAs have physiologic roles in sleep processes, but little is known regarding circulating n-3 and n-6 PUFA and sleep parameters. Objectives: We sought to assess associations between biomarkers of n-3 and n-6 PUFA intake with self-reported sleep duration and difficulty falling sleeping in the Fatty Acids and Outcome Resea...
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Background: Evidence for the role of omega-3 fatty acids in the prevention of atrial fibrillation (AF) remain inconsistent, with some recent RCTs even suggesting possible harm. Whether long-term dietary intake of these fatty acids, as assessed using objective biomarkers, is related to AF is not known. Aims: To prospectively evaluate circulating and...
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Background: Diet diversity and quality are each recommended to promote a healthy diet and prevent chronic disease. Yet, little is known on how diet diversity relates to diet quality or cardiometabolic health, particularly in underrepresented subgroups disproportionally affected by poor nutrition and CVD. Aims: To determine relationships of 1) dieta...
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Background: In 2021, the National Salt and Sugar Reduction Initiative (NSSRI) released voluntary sugar reduction targets for packaged foods and drinks in the United States (U.S). Objective: The objectives of this study were to describe trends in added sugar intake from NSSRI foods and beverages among children and youth and estimate possible redu...
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OBJECTIVE Trans fatty acids (TFAs) have harmful biologic effects that could increase the risk of type 2 diabetes (T2D), but evidence remains uncertain. We aimed to investigate the prospective associations of TFA biomarkers and T2D by conducting an individual participant-level pooled analysis. RESEARCH DESIGN AND METHODS We included data from an in...
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Importance: Poor diet is a leading global factor associated with cardiometabolic disease (CMD). Understanding the quality of evidence of the associations between specific dietary factors and CMD, including effect size (relative risk [RR]) and uncertainty, is essential to guide policy and consumer actions to achieve healthy diet and public health g...
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Objective The rapid growth in web-based grocery food purchasing has outpaced federal regulatory attention to the online provision of nutrition and allergen information historically required on food product labels. We sought to characterise the extent and variability that online retailers disclose required and regulated information and identify the...
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State legislators passed laws preempting, or prohibiting, local governments from regulating beverage containers. Although the primary purpose of these laws may be to ban local environmental regulations addressing single-use plastics, it is unknown the extent they also preempt public health policies aimed at reducing sugar-sweetened beverage consump...
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Importance Intense interest exists in novel ω-3 formulations with high bioavailability to reduce blood triglyceride (TG) levels. Objective To determine the phase 3 efficacy and safety of a naturally derived krill oil with eicosapentaenoic acid and docosahexaenoic acid as both phospholipid esters (PLs) and free fatty acids (FFAs) (ω-3–PL/FFA [CaPre...
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Purpose Suboptimal diet is a preventable cause of cancer. We aimed to estimate the economic burden of diet-associated cancer among US adults. Methods We used a Comparative Risk Assessment model to quantify the number of new cancer cases attributable to seven dietary factors among US adults ages 20 + years. A Markov cohort model estimated the 5-yea...
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Introduction: Findings on MRI of vascular brain injury, such as brain infarcts and white matter hyperintensities, are chronic manifestation of atherosclerosis. A gut-microbiome-generated metabolite, trimethylamine N-oxide (TMAO), is an independent predictor of clinical cardiovascular events. However, no study has examined associations between TMAO...
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Introduction Consumption of ultraprocessed foods has been linked with higher intake of added sugars, sodium, and unhealthful fats, but the associations of ultraprocessed foods with overall diet quality and major food groups are not well known. Methods Data were derived from the National Health and Nutrition Examination Survey (2015–2018), includin...
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Objectives. To quantify disparities in health and economic burdens of cancer attributable to suboptimal diet among US adults. Methods. Using a probabilistic cohort state-transition model, we estimated the number of new cancer cases and cancer deaths, and economic costs of 15 diet-related cancers attributable to suboptimal intake of 7 dietary factor...
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Nutrient profiling systems (NPS) aim to discriminate the healthfulness of foods for front-of-package labelling, warning labels, taxation, company ratings and more. Existing NPS often assess relatively few nutrients and ingredients, use inconsistent criteria across food categories and have not incorporated the newest science. Here, we developed and...
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Background The workplace offers a unique opportunity for effective health promotion. We aimed to comprehensively study the effectiveness of multicomponent worksite wellness programmes for improving diet and cardiometabolic risk factors. Methods We did a systematic literature review and meta-analysis, following PRISMA guidelines. We searched PubMed...
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Background and Aims In the Southern Cone of Latin America, previous studies have shown that blood hypertension is one of the most significant risk factor for cardiovascular disease, and diet plays a fundamental role. We analyzed the cross-sectional relationship between dietary patterns (DP) and blood pressure values in people involved in the CESCAS...
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Importance Although rodent studies suggest that trimethylamine N-oxide (TMAO) influences glucose homeostasis and risk of type 2 diabetes, evidence in humans is limited. Objective To examine the associations of serial measures of plasma TMAO and related metabolite concentrations with incident type 2 diabetes, fasting plasma insulin and glucose leve...
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Background: High intake of added sugar is linked to weight gain and cardiometabolic risk. In 2018, the US National Salt and Sugar Reduction Initiative (NSSRI) proposed government supported voluntary national sugar reduction targets. This intervention's potential health and equity impacts, and cost-effectiveness are unclear. Methods: A validated mic...
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Background: Earlier evidence on the association between dietary polyunsaturated fatty acids and risk of diabetes has been conflicting. Purpose: To quantitatively summarize previous studies on the association between dietary LA intake, its biomarkers, and the risk of type 2 diabetes mellitus (T2DM) in the general population. Data sources: Our d...
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Background Trimethylamine N‐oxide (TMAO) is a gut microbiota‐dependent metabolite of dietary choline, L‐carnitine, and phosphatidylcholine‐rich foods. On the basis of experimental studies and patients with prevalent disease, elevated plasma TMAO may increase risk of atherosclerotic cardiovascular disease (ASCVD). TMAO is also renally cleared and ma...
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Importance Identifying novel factors that protect against age-related diseases and promote healthy aging is critical to public health. Higher levels of circulating very-long-chain saturated fatty acids (VLSFAs) are integrated biomarkers of diet and metabolism shown to have beneficial associations in cardiovascular disease and total mortality, but w...
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Importance The childhood obesity rate has been steadily rising among US youths during the past 2 decades. Increasing evidence links consumption of ultraprocessed foods to excessive calorie consumption and weight gain, but trends in the consumption of ultraprocessed foods among US youths have not been well characterized. Objective To characterize t...
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Background - Carbohydrate responsive element binding protein (ChREBP) is a transcription factor that responds to sugar consumption. Sugar-sweetened beverage (SSB) consumption and genetic variants in the CHREBP locus have separately been linked to high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) concentrations. We hypothesized SSB...
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Background Children and adolescents in the USA consume large amounts of daily calories from ultraprocessed foods (UPFs). Recent evidence links UPF consumption to increased body fat in youth. We aimed to estimate the potential impact of reducing UPF consumption on childhood obesity rate in the USA. Methods We developed a microsimulation model to pr...
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Objectives Whole-grain (WG) foods have been defined in various ways, contributing to the challenge in guiding consumers and formulating nutrition policies to improve whole grain consumption. We aimed to compare the mean WG food consumption estimated using different definitions proposed by USDA, FDA, American Heart Association (AHA), American Associ...
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Objectives Trimethylamine N-oxide (TMAO) is a gut-microbiota generated metabolite of dietary phosphatidylcholine, choline, and carnitine. TMAO has been suggested to play a role in the pathogenesis of multiple diseases. Yet, studies of TMAO and mortality were conducted in convenience samples of patients with prevalent diseases and lacked socioeconom...
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Objectives Due to the increasing disease burden and the limited effectiveness of pharmacological therapies, strategies to predict and prevent heart failure (HF) are urgently needed. Healthy eating has been shown associated with lower risks of multiple cardiovascular diseases, while studies of dietary quality and HF incidence are still sparse. The P...
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Poor quality diets contribute to malnutrition globally, but evidence is weak on the cost-effectiveness of food-based interventions that shift diets. This study assessed 11 candidate interventions developed through Delphi techniques to improve diets in India, Nigeria, and Ethiopia. A Markov simulation model incorporated time, individual-level, nutri...
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Despite the accumulating evidence that increased consumption of ultra-processed food has adverse health implications, it remains difficult to decide what constitutes processed food. Indeed, the current processing-based classification of food has limited coverage and does not differentiate between degrees of processing, hindering consumer choices an...
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Background: Trends in junk food consumption, a risk for obesity, are not well established. Objectives: We examined national trends in types of junk food (excluding beverages) and their sources (grocery, restaurants, schools, etc.), overall and in population subgroups. Methods: We assessed 29,970 children (aged 2-19 y) and 44,501 adults (aged ≥...
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The enormous burden of diet-related chronic diseases has prompted interest in healthy food prescription programs. Yet, the impact of such programs remains unclear. The aim of this study was to conduct a systematic review of healthy food prescription programs and evaluate their impact on dietary behavior and cardiometabolic parameters by meta-analys...
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Importance In patients treated with ω-3 fatty acids, it remains uncertain whether achieved levels of eicosapentaenoic acid (EPA) or docosahexaenoic acid (DHA) are associated with cardiovascular outcomes. Objective To determine the association between plasma levels of EPA and DHA and cardiovascular outcomes in a trial of ω-3 fatty acids compared wi...
Preprint
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Purpose: Suboptimal diet is a preventable cause of cancer. We aimed to estimate the economic burden of diet-associated cancer among US adults. Methods: We used a Comparative Risk Assessment model to quantify the number of new cancer cases attributable to seven dietary factors among US adults ages 20+ years. A Markov cohort model estimated the 5-yea...
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The health effects of omega-3 fatty acids have been controversial. Here we report the results of a de novo pooled analysis conducted with data from 17 prospective cohort studies examining the associations between blood omega-3 fatty acid levels and risk for all-cause mortality. Over a median of 16 years of follow-up, 15,720 deaths occurred among 42...
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Importance Time trends and population disparities in nutritional quality of foods from major US sources, including grocery stores, restaurants, schools, worksites, and other sources, are not well established. Objective To investigate patterns and trends in diet quality by food sources among US children and adults overall and in sociodemographic su...
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Background Plasma omega‐3 polyunsaturated fatty acids (ω3‐PUFAs) have been shown to be inversely correlated with the risk of cardiovascular death in primary prevention. The risk relationship in the setting of an acute coronary syndrome is less well established. Methods and Results Baseline plasma ω3‐PUFA composition (α‐linolenic acid, eicosapentae...
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Importance: Obesity-associated cancer burdens are increasing in the US. Nutrition policies, such as the Nutrition Facts added-sugar labeling, may reduce obesity-associated cancer rates. Objective: To evaluate the cost-effectiveness of Nutrition Facts added-sugar labeling and obesity-associated cancer rates in the US. Design, setting, and partic...
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The prevalence of nutrition-sensitive conditions such as obesity and type 2 diabetes has increased substantially in the US during the past 30 years. These conditions, combined with other diet-related ones such as cardiovascular diseases and certain cancers, are associated with the majority of morbidity, mortality, and health care spending nationall...
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Fish and shellfish (hereafter referred to as fish) are major sources of the dietary long-chain ω-3 fatty acids eicosapentaenoic acid (20:5n-3) and docosahexaenoic acid (22:6n-3) and also contain other nutrients, such as vitamin D, riboflavin, iodine, calcium, phosphorus, magnesium, potassium, zinc, and iron. The summed results of observational stud...
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OBJECTIVE Prospective associations between n-3 fatty acid biomarkers and type 2 diabetes (T2D) risk are not consistent in individual studies. We aimed to summarize the prospective associations of biomarkers of a-linolenic acid (ALA), eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA) with T2D risk through an in...
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Objective: Prospective associations between n-3 fatty acid biomarkers and type 2 diabetes (T2D) risk are not consistent in individual studies. We aimed to summarize the prospective associations of biomarkers of α-linolenic acid (ALA), eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA) with T2D risk through an...
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Food contains thousands of different trace natural compounds, many of which remain largely unmeasured and undocumented. The network medicine approach sheds new light on how polyphenols, among the most important of these trace compounds, impact human health.
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BACKGROUND Risk of coronavirus disease 2019 (COVID‐19) hospitalization is robustly linked to cardiometabolic health. We estimated the absolute and proportional COVID‐19 hospitalizations in US adults attributable to 4 major US cardiometabolic conditions, separately and jointly, and by race/ethnicity, age, and sex. METHODS AND RESULTS We used the be...
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Background We aimed to systematically identify, standardise and disseminate individual-level dietary intake surveys from up to 207 countries for 54 foods, beverages and nutrients, including subnational intakes by age, sex, education and urban/rural residence, from 1980 to 2015. Methods Between 2008–2011 and 2014–2020, the Global Dietary Database (...
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Food systems lie squarely at the intersection of several over-arching goals of the United Nations and member states, as embodied in the Sustainable Development Goals, including, eliminating poverty, hunger and malnutrition in all its forms, achieving good health and well-being, while promoting environmental sustainability. The need for radical tran...
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Background Consumption of nuts improves cardio-metabolic risk factors in clinical trials and relates to lower risk of cardiovascular disease (CVD) in prospective observational studies. However, there has not been an adequately powered randomized controlled trial to test if nuts supplementation actually reduces incident CVD. In order to establish th...
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Importance It remains uncertain whether the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) reduce cardiovascular risk. Objective To determine the effects on cardiovascular outcomes of a carboxylic acid formulation of EPA and DHA (omega-3 CA) with documented favorable effects on lipid and inflammatory markers in pati...
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Purpose: Optimal metrics to assess healthfulness of carbohydrate-rich products are not well established. We investigated how the content per 10 g of carbohydrate of at least 1 g of fiber (≤ 10:1-ratio) related to nutritional quality in grain foods as well as cardiometabolic risk factors in São Paulo, Brazil. Methods: Data were from the cross-sec...