Nutrition

Eating pattern

Nutrition largely determines how the body functions and a person's risk of chronic disease[1]. The diet describes the structure around eating: how often meals are freshly prepared, how often someone eats out or orders takeaway, what is eaten between meals, and whether meals are eaten at regular times and not too late. It is not about one product or nutrient but about the whole.

That whole weighs more than individual nutrients. In PREDIMED, a randomised trial in 7,447 people at high cardiovascular risk, a Mediterranean pattern with olive oil or nuts reduced major cardiovascular events by about 30%, mainly strokes; all-cause mortality did not fall significantly within the study period[2]. Of the behavioural characteristics in this score, the evidence is strongest for ultra-processed food: an umbrella review found convincing evidence of higher cardiovascular mortality and more type 2 diabetes with high intake[3].

Guidelines

There is no numerical guideline for the diet as a whole. Synapse's nutritional recommendations rest on those of the Belgian Superior Health Council[4], [5], which recommends a predominantly plant-based pattern with vegetables, fruit, whole grains, legumes and nuts, and less red and processed meat and sugary drinks. The AHA names circadian health, with regular and not-too-late meals, as a cardiometabolic factor[6].

How Synapse assesses this

Synapse maps eating behaviour on a weekly basis with a frequency questionnaire. The diet rests on two pillars. Self-sufficiency covers how often meals are freshly prepared (at home or by someone else), how often someone eats out, orders takeaway or eats ready meals, and how many unhealthy snacks are eaten. Timing covers regular meal times and heavy meals in the two hours before bedtime. The result is a composite score from 0 to 100 with the general zone classification:

Eating pattern score (0-100)Assessment
> 75Optimal
50 to 75Acceptable
25 to 50Watch
< 25Priority

For the individual rows (freshly prepared, eating out, snacks, regular meal times, late meals) Synapse shows no reference value: they are frequencies without a published norm.

Self-sufficiency

Cooking at home and preparing fresh meals go together with better diet quality and more favourable health outcomes. People who often cook at home eat more vegetables and fruit and have a lower risk of overweight and excess body fat. Home cooking is associated with patterns such as the Mediterranean and DASH diets and with higher micronutrient levels[7], and it reduces the consumption of ultra-processed food[8], [9]. Unhealthy snacks (biscuits, sweets, crisps) deliver a lot of added sugar, saturated fat and salt with little satiety; frequent consumption is associated with higher energy intake[10].

Timing

Meal timing plays a role in the regulation of energy intake and metabolism[11], [12]. A full first meal with enough protein (indicatively 25 to 30 g) can temper hunger peaks and snacking later in the day[13]; that evidence comes mainly from small experimental studies and is indicative. In controlled studies, an irregular meal pattern disrupts insulin sensitivity and appetite regulation[14]. Late or night-time eating is associated with weight gain, disturbed glucose metabolism and disruption of the circadian rhythm[15], [6].

The Mediterranean pattern as a reference point

In practice, a Mediterranean pattern means vegetables with every meal, olive oil as the main source of fat, legumes and fish instead of red meat, whole grains, a daily handful of nuts and fruit as dessert, with little processed meat, sweet drinks and pastry[2]. It is not a diet with rules but a way of shopping, which explains the adherence.

Fibre

Dietary fibre consists of indigestible carbohydrates, essential for a healthy gut flora and a stable blood sugar level. Viscous fibres slow gastric emptying and glucose absorption and bind bile acids, so that the liver draws cholesterol from the blood. In the colon, bacteria convert fermentable fibres into short-chain fatty acids, which strengthen the gut wall, dampen inflammation and support the immune system[16], [17].

A fibre-rich diet protects against cardiovascular disease, diabetes and cancer[18], has an anti-inflammatory effect[19] and lowers all-cause mortality[20]. In the Lancet series by Reynolds (185 cohorts, 58 trials), the highest fibre intake carried a 15 to 30% lower risk of mortality, coronary heart disease, stroke, type 2 diabetes and colorectal cancer; the greatest risk reduction lay at 25 to 29 g per day, with further gains above that[18]. A recent umbrella review of more than 17 million participants confirms that picture[21].

Guidelines

The Superior Health Council advises at least 25 g of fibre per day, with 30 g as the target for the prevention of cardiovascular disease and diabetes[5]. Only a minority of the Belgian population reaches that target[22].

How Synapse assesses this

Synapse translates the Superior Health Council's recommendation into an energy-scaled target of 30 g for men and 25 g for women, an operationalisation of its own in line with international reference values[23]. Synapse scores fibre intake on two axes: the absolute amount and the variety across five sources (vegetables, fruit, whole grains, legumes, and nuts and seeds). One strong axis makes up for a lot, but a weak axis remains visible; a maximum score is achievable without every source. The zones on the quantity axis:

Quantity axisMen (g/day)Women (g/day)
Optimal> 30> 25
Acceptable24 to 3020 to 25
Watch17 to 2415 to 20
Priority< 17< 15

Next to the member's values these references are shown:

ItemReference
Fibre≥ 30 g per day (men), ≥ 25 g per day (women)
Vegetables≥ 7 times per week
Fruit≥ 7 times per week
Whole grains≥ 7 times per week
Legumes≥ 2 times per week

For nuts and seeds Synapse shows no reference value. In irritable bowel syndrome the type of fibre matters: soluble fibres such as psyllium improve symptoms, coarse bran can worsen them[24].

Vegetables

Fresh or minimally processed vegetables deliver fibre, potassium, folate, β-carotene and vitamin C with virtually no fat. Prospective meta-analyses show an inverse dose-response relationship up to and beyond about 400 g per day for all-cause mortality and above all cardiovascular disease; the greatest marginal benefit lies around 300 g of vegetables plus two portions of fruit per day[4], [25], [26]. Cruciferous and dark green leafy vegetables in particular lower the incidence of coronary heart disease[27]. In Belgium the median intake is about 160 g per day[22].

Fruit

Fruit delivers readily available carbohydrates and nutrients such as pectin, vitamin C, folate, β-carotene, potassium and polyphenols[4], [28]. A daily intake of at least 250 g (about two pieces) is associated with less coronary heart disease, stroke and certain cancers, independently of vegetables[29]. The Superior Health Council therefore uses 250 g per day as the target[22]. Synapse scores fruit on weekly frequency. Fruit juice counts as a drink: it contains less fibre, satiates less and delivers a comparable amount of sugar and energy to a piece of fruit.

Whole grains

Whole-grain products contain all fractions of the grain kernel and deliver more fibre, B vitamins, magnesium, iron and phytonutrients than refined variants. Meta-analyses show an inverse dose-response relationship with coronary heart disease, stroke, type 2 diabetes and colorectal, pancreatic and gastric cancer, with about 90 to 125 g of whole grains per day as a well-founded target zone[18], [30]. The Superior Health Council advises at least 125 g of whole grains per day[22]. A product counts as whole grain when at least 50% of its dry weight consists of whole-grain ingredients[31].

Legumes

Legumes are a complete plant-based source of protein and deliver soluble and insoluble fibre, folate, potassium, magnesium, non-haem iron and zinc[32], [33]. Regular intake (at least two portions per week) is associated with lower LDL cholesterol and better glycaemic control[34], [35] and with lower all-cause mortality[36]; for coronary heart disease and type 2 diabetes the picture in recent meta-analyses is more neutral. Only one in three Belgian adults eats legumes weekly[22].

Nuts and seeds

Nuts and seeds are calorie-dense but nutrient-rich: they deliver mainly unsaturated fat, plant protein, fibre, magnesium, potassium, vitamin E, zinc and polyphenols[37]. An intake of around 28 g per day (a handful) is associated with a 21% lower risk of cardiovascular disease, 11% lower cancer mortality and 22% lower all-cause mortality[38], and with favourable effects on BMI, LDL cholesterol, glycaemia and systolic blood pressure[39], [40]. The Superior Health Council recommends a daily portion of unsalted nuts[22].

Protein

Proteins are the building blocks of muscles, enzymes, hormones and the immune system. The body constantly breaks down and renews proteins, and does not store protein the way it stores fat or glycogen; a sufficient daily intake is therefore necessary[41]. Muscle protein synthesis is dose-dependent and saturable, and older people show anabolic resistance: more protein per meal is then needed for the same response[42].

Guidelines

The Superior Health Council advises 0.83 g of protein per kilogram of body weight per day, rising to 1.2 g/kg for endurance athletes, for example; that norm is aimed mainly at preventing deficiency[5]. Recent evidence and guideline revisions indicate that intakes around 1.2 to 1.6 g/kg are more favourable for muscle mass, satiety and metabolic health, especially in older people, physically active people and during weight loss[43], [44], [45], [46]. The PROT-AGE study group advises 1.0 to 1.2 g/kg for healthy older people and 1.2 to 1.5 g/kg for active or ill older people[42]. In chronic kidney disease without dialysis the opposite applies: KDIGO 2024 advises about 0.8 g/kg and warns against more than 1.3 g/kg[47].

How Synapse assesses this

Synapse estimates protein intake from the frequency questionnaire and treats 1.2 to 1.6 g/kg per day as the optimal zone, with the classic recommendation as a minimum rather than an optimum. With reduced kidney function Synapse lowers the target, according to severity.

Protein intake (g/kg body weight/day)Assessment
> 1.2Optimal
0.8 to 1.2Acceptable
0.6 to 0.8Watch
< 0.6Priority
ItemReference
Protein≥ 1.2 g per kg body weight per day, shown in grams; lower with reduced kidney function

Distribution across the day

Because synthesis saturates per meal, the same daily intake yields more when spread over three meals, with about 20 to 30 g per meal. In practice, intake is usually low at breakfast and high at dinner, the distribution that yields the least[42]. During weight loss, sufficient protein and strength training together limit the loss of fat-free mass[44].

White meat and fish

Poultry delivers high-quality protein, selenium and B vitamins with a more favourable fatty-acid profile than red meat; cohort data show no consistent association between unprocessed white meat and cardiovascular disease or all-cause mortality[48], [49]. Fish delivers high-quality protein, vitamin D, B12, iodine and selenium, and oily fish also the omega-3 fatty acids EPA and DHA. One to two portions of fish per week, especially oily fish, lower cardiovascular risk[50].

Eggs

Eggs deliver high-quality protein and plenty of vitamin B12, vitamin D, selenium and choline. Their cholesterol content historically caused concern[51], but moderate egg consumption carries no significantly increased cardiovascular risk in the general population[52].

Red and processed meat

Unprocessed red meat delivers complete protein, haem iron and B vitamins; processed forms (ham, salami) additionally deliver extra sodium and saturated fat[53]. Large cohort meta-analyses show a dose-response relationship with coronary heart disease, stroke, type 2 diabetes and colorectal cancer[53], [54], [55]; the largest federated meta-analysis (1.97 million adults) reports about 15% more diabetes per 50 g per day of processed red meat[56]. Replacing processed red meat with nuts, legumes or whole grains is associated with less cardiovascular disease and lower mortality[57]. The Superior Health Council advises less than 300 g per week of unprocessed and less than 30 g per week of processed red meat[22].

Milk and dairy products

Dairy products deliver quality protein, calcium, vitamin B12, iodine, potassium and phosphorus. Full-fat and low-fat variants do not differ in their effect on BMI, waist circumference or fat mass[58]. An intake of 250 to 500 ml per day is associated with a lower risk of cardiovascular disease, stroke, colorectal cancer and type 2 diabetes[59], [60], and the Superior Health Council advises that amount[22].

Simple sugars

Simple sugars are the free sugars: added sugars plus the sugars in fruit juice and soft drinks. They deliver mainly energy without essential nutrients and, through their rapid absorption, cause peaks in blood sugar and insulin. High intake is associated with weight gain, insulin resistance, type 2 diabetes and an unfavourable lipid profile[61], [62]. Fructose is metabolised almost entirely in the liver and, at high intake, drives de novo lipogenesis, triglycerides and fatty liver[63].

Meta-analyses show a clear dose-response relationship between free sugars and cardiometabolic risks[64]. The strongest signal comes from sugar-sweetened drinks; for solid sources of sugar the evidence is weaker and less consistent[65].

Guidelines

The WHO advises limiting free sugars to less than 10% of energy, preferably less than 5%, which broadly amounts to less than 25 g per day[66]. The AHA uses an upper limit of around 25 g for women and 36 g for men[67].

How Synapse assesses this

Synapse estimates free sugars per day from the frequency questionnaire and anchors the optimum at 25 g per day. The intermediate cut-offs are pragmatic consensus anchors, not empirically validated breakpoints: 37.5 g approximates the AHA upper limit for men, 50 g the WHO ceiling of 10%. Fruit juice counts in full[68]; sugar in whole fruit does not count.

Free sugars (g/day)Assessment
≤ 25Optimal
25 to 37.5Acceptable
37.5 to 50Watch
> 50Priority
ItemReference
Simple sugars≤ 25 g per day

Whole fruit and fruit juice

Sugar in whole fruit comes with fibre, water and structure: absorption is slower and satiety greater. Avoiding fruit to lower sugar intake is therefore unnecessary. Fruit juice lacks that fibre and behaves metabolically more like a soft drink, although the association with mortality is less clear-cut than for soft drinks[68].

Unhealthy fats

Fats are essential for energy supply, cell structure, hormone production and the absorption of fat-soluble vitamins. Their health effect depends mainly on composition, more than on total amount[69]. Saturated fatty acids suppress LDL-receptor activity in the liver, so that LDL cholesterol and apoB rise. What matters is the replacement: polyunsaturated fat lowers LDL and coronary risk the most, refined carbohydrates yield nothing on balance[70]. In the Cochrane review, cardiovascular events fell by about 17% with at least two years of reduced saturated fat, without a clear effect on all-cause mortality[71].

Guidelines

The Superior Health Council advises a total fat intake of 20 to 35% of energy, saturated fat below 10%, trans fat avoided as far as possible (below 1%) and a preference for unsaturated sources[5], [69]. EFSA sets no target ratio between omega-6 and omega-3, but gives a recommended amount per fatty acid[72].

How Synapse assesses this

Synapse assesses fat quality on three axes: the share of saturated fat in total fat intake, the omega-6/omega-3 ratio and the share of fat in total energy intake. The ratio axis is a deliberate choice by Synapse: recent guidelines put the emphasis on absolute intakes per class of fatty acid rather than on the ratio. The zones per axis:

AssessmentSaturated fat (% of total fat)Omega-6/omega-3 ratioFat in energy (%)
Optimal< 28< 4< 37.5
Acceptable28 to 334 to 637.5 to 40
Watch33 to 436 to 1240 to 42.5
Priority> 43> 12> 42.5

Next to the member's values, references are shown in the unit of the row. The one for calories from fat is stricter than the scoring zone: a range of 30 to 35% of daily energy requirement.

ItemReference
Saturated fatspersonal maximum in grams, derived from the member's own fat intake
Omega-6 / omega-3 ratio≤ 4
Calories from fat30 to 35% of daily energy requirement, shown in kcal

Saturated fats and butter

Saturated fats occur mainly in animal products (butter, fatty meat, full-fat dairy) and in coconut and palm oil. High intake raises LDL cholesterol and cardiovascular risk[71], [70]. In recent large cohort analyses butter is associated with higher all-cause mortality[73], although older meta-analyses were more neutral[74]. Replacement with plant oils such as olive or rapeseed oil is beneficial[73]; soft, non-hydrogenated margarine is an acceptable alternative, hard or hydrogenated variants are discouraged[22], [75]. The AHA estimates the gain from swapping to unsaturated fat to be of the same order as that of statins[70].

Trans fat

Industrial trans fat forms when plant oil is hardened. It raises LDL and lowers HDL, and there is no safe amount[70]. In Europe its content is limited by law, but it still occurs in deep-fried products and some biscuits and pastries.

Fried food

Fried food is rich in energy and fat and, through preparation at high temperature, can contain harmful oxidation products and acrylamide[76]. Frequent consumption is associated with weight gain, type 2 diabetes and cardiovascular disease[77], [78]. Oven cooking, steaming and pan-frying are preferable.

Omega-3 supplements

Supplementation with EPA and DHA changes little about all-cause mortality or the number of cardiovascular events and mainly lowers triglycerides[79]. For the general population, oily fish once or twice a week remains the advice[50].

Healthy fats

Unsaturated fats occur in plant oils, nuts, seeds and oily fish. They lower LDL cholesterol and cardiovascular risk, especially when they replace saturated fats[70], [80]. Olive oil, as part of the Mediterranean pattern, is consistently linked to better cardiometabolic outcomes; higher intake is associated with lower all-cause and cardiovascular mortality[80].

Guidelines

The Superior Health Council advises plant oils as the standard source of fat[22], in line with the American heart guidelines[75]. One to two portions of fish per week, especially oily fish, lower cardiovascular risk[50].

How Synapse assesses this

Members who score sufficiently on the basic fats item are shown the supplementary healthy fats item, which looks more closely at the quality of the unsaturated fats. Synapse looks at the share of unsaturated fat in energy intake, at the balance between omega-6 and omega-3, and at a sufficient total fat intake. The result is a composite score from 0 to 100 with the general zone classification (Optimal above 75, Acceptable 50 to 75, Watch 25 to 50, Priority below 25).

ItemReference
Unsaturated fats≥ 10% of daily energy requirement, shown in grams
Omega-6 / omega-3 ratio≤ 4
Calories from fat30 to 35% of daily energy requirement, shown in kcal

Avoiding fat is not a goal

Eating patterns high in fat, such as the Mediterranean one, do well in research as long as that fat comes from olive oil, nuts and fish; low-fat patterns do not do better[2], [69]. Too low a fat intake also limits the absorption of fat-soluble vitamins.

Developed and reviewed with the Synapse medical advisory board.

References

  1. [1]Taylor, R. M. et al. Diet quality and cardiovascular outcomes: a systematic review and meta-analysis of cohort studies. Nutr Diet 81, 35–50 (2024). doi.org/10.1111/1747-0080.12860
  2. [2]Estruch, R. et al. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med 378, e34 (2018). doi.org/10.1056/NEJMoa1800389
  3. [3]Lane, M. M. et al. Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses. BMJ 384, e077310 (2024). doi.org/10.1136/bmj-2023-077310
  4. [4]Hoge Gezondheidsraad. Voedingsaanbevelingen voor de Belgische volwassen bevolking met een focus op voedingsmiddelen. HGR nr. 9284 (2019).
  5. [5]Hoge Gezondheidsraad. Voedingsaanbevelingen voor België. HGR nr. 9285 (2016).
  6. [6]Knutson, K. L. et al. Role of circadian health in cardiometabolic health and disease risk: a scientific statement from the American Heart Association. Circulation 152, e408–e419 (2025). doi.org/10.1161/CIR.0000000000001388
  7. [7]Mills, S. et al. Frequency of eating home cooked meals and potential benefits for diet and health: cross-sectional analysis of a population-based cohort study. Int J Behav Nutr Phys Act 14, 109 (2017). doi.org/10.1186/s12966-017-0567-y
  8. [8]Wolfson, J. A. et al. Greater frequency of cooking dinner at home and more time spent cooking are inversely associated with ultra-processed food consumption among US adults. J Acad Nutr Diet 124, 1590–1605 (2024). doi.org/10.1016/j.jand.2024.05.013
  9. [9]Di Costanzo, G. et al. Cross-sectional associations of home cooking with diet quality and food consumption by degree of processing in women from the Moli-sani Study. Int J Food Sci Nutr 76, 878–887 (2025). doi.org/10.1080/09637486.2025.2574087
  10. [10]Cooke, C. B. et al. The effect of discretionary snack consumption on overall energy intake, weight status, and diet quality: a systematic review. Obes Rev 25, e13693 (2024). doi.org/10.1111/obr.13693
  11. [11]Liu, H. Y. et al. Meal timing and anthropometric and metabolic outcomes: a systematic review and meta-analysis. JAMA Netw Open 7, e2442163 (2024). doi.org/10.1001/jamanetworkopen.2024.42163
  12. [12]Jacob, R. et al. Associations of timing of food intake with energy intake, eating behaviour traits and psychosocial factors in adults with overweight and obesity. Front Nutr 10, 1155971 (2023). doi.org/10.3389/fnut.2023.1155971
  13. [13]Gwin, J. A. et al. A review of the evidence surrounding the effects of breakfast consumption on mechanisms of weight management. Adv Nutr 9, 717–725 (2018). doi.org/10.1093/advances/nmy047
  14. [14]Alhussain, M. H. et al. Irregular meal-pattern effects on energy expenditure, metabolism, and appetite regulation: a randomized controlled trial in healthy normal-weight women. Am J Clin Nutr 104, 21–32 (2016). doi.org/10.3945/ajcn.115.125401
  15. [15]Wang, P. et al. Night eating in timing, frequency, and food quality and risks of all-cause, cancer, and diabetes mortality. Nutr Diabetes 14, 5 (2024). doi.org/10.1038/s41387-024-00266-6
  16. [16]Gill, S. K. et al. Dietary fibre in gastrointestinal health and disease. Nat Rev Gastroenterol Hepatol 18, 101–116 (2021). doi.org/10.1038/s41575-020-00375-4
  17. [17]O'Grady, J. et al. Review article: dietary fibre in the era of microbiome science. Aliment Pharmacol Ther 49, 506–515 (2019). doi.org/10.1111/apt.15129
  18. [18]Reynolds, A. et al. Carbohydrate quality and human health: a series of systematic reviews and meta-analyses. Lancet 393, 434–445 (2019). doi.org/10.1016/S0140-6736(18)31809-9
  19. [19]Qi, X. et al. The associations between dietary fibers intake and systemic immune and inflammatory biomarkers, a multi-cycle study of NHANES 2015–2020. Front Nutr 10, 1242115 (2023). doi.org/10.3389/fnut.2023.1242115
  20. [20]Veronese, N. et al. Dietary fiber and health outcomes: an umbrella review of systematic reviews and meta-analyses. Am J Clin Nutr 107, 436–444 (2018). doi.org/10.1093/ajcn/nqx082
  21. [21]Veronese, N. et al. The impact of dietary fiber consumption on human health: an umbrella review of evidence from 17,155,277 individuals. Clin Nutr 51, 325–333 (2025). doi.org/10.1016/j.clnu.2025.06.021
  22. [22]Hoge Gezondheidsraad. Voedingsaanbevelingen voor de Belgische bevolking. Advies nr. 9805-9807 (2025).
  23. [23]Vlaams Instituut Gezond Leven. Aanbevelingen HGR (voedingsdriehoek). gezondleven.be (geraadpleegd 2 september 2026).
  24. [24]El-Salhy, M. et al. Dietary fiber in irritable bowel syndrome. Int J Mol Med 40, 607–613 (2017). doi.org/10.3892/ijmm.2017.3072
  25. [25]Wallace, T. C. et al. Fruits, vegetables, and health: a comprehensive narrative, umbrella review of the science and recommendations for enhanced public policy to improve intake. Crit Rev Food Sci Nutr 60, 2174–2211 (2020). doi.org/10.1080/10408398.2019.1632258
  26. [26]Wang, D. D. et al. Fruit and vegetable intake and mortality. Circulation 143, 1642–1654 (2021). doi.org/10.1161/CIRCULATIONAHA.120.048996
  27. [27]Zurbau, A. et al. Relation of different fruit and vegetable sources with incident cardiovascular outcomes: a systematic review and meta-analysis of prospective cohort studies. J Am Heart Assoc 9, e017728 (2020). doi.org/10.1161/JAHA.120.017728
  28. [28]Konde, A. B. et al. Swedish dietary guidelines: risks and benefit management report. Livsmedelsverket (2015).
  29. [29]Aune, D. et al. Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality: a systematic review and dose-response meta-analysis of prospective studies. Int J Epidemiol 46, 1029–1056 (2017). doi.org/10.1093/ije/dyw319
  30. [30]Seal, C. J. et al. Health benefits of whole grain: effects on dietary carbohydrate quality, the gut microbiome, and consequences of processing. Compr Rev Food Sci Food Saf 20, 2742–2768 (2021). doi.org/10.1111/1541-4337.12728
  31. [31]McKeown, N. M. et al. Fibre intake for optimal health: how can healthcare professionals support people to reach dietary recommendations? BMJ 378, e054370 (2022). doi.org/10.1136/bmj-2020-054370
  32. [32]Hoge Gezondheidsraad. Vegetarische voeding (2021).
  33. [33]Torheim, L. E. et al. Legumes and pulses: a scoping review for Nordic Nutrition Recommendations 2023. Food Nutr Res 68 (2024). doi.org/10.29219/fnr.v68.10484
  34. [34]Mendes, V. et al. Intake of legumes and cardiovascular disease: a systematic review and dose-response meta-analysis. Nutr Metab Cardiovasc Dis 33, 22–37 (2023). doi.org/10.1016/j.numecd.2022.10.006
  35. [35]Thorisdottir, B. et al. Legume consumption in adults and risk of cardiovascular disease and type 2 diabetes: a systematic review and meta-analysis. Food Nutr Res 67 (2023). doi.org/10.29219/fnr.v67.9541
  36. [36]Zargarzadeh, N. et al. Legume consumption and risk of all-cause and cause-specific mortality: a systematic review and dose-response meta-analysis of prospective studies. Adv Nutr 14, 64–76 (2023). doi.org/10.1016/j.advnut.2022.10.009
  37. [37]Gonçalves, B. et al. Composition of nuts and their potential health benefits: an overview. Foods 12, 942 (2023). doi.org/10.3390/foods12050942
  38. [38]Balakrishna, R. et al. Consumption of nuts and seeds and health outcomes including cardiovascular disease, diabetes and metabolic disease, cancer, and mortality: an umbrella review. Adv Nutr 13, 2136–2148 (2022). doi.org/10.1093/advances/nmac077
  39. [39]Eslami, O. et al. Inverse association of long-term nut consumption with weight gain and risk of overweight/obesity: a systematic review. Nutr Res 68, 1–8 (2019). doi.org/10.1016/j.nutres.2019.04.001
  40. [40]Jalali, M. et al. The effects of cashew nut intake on lipid profile and blood pressure: a systematic review and meta-analysis of randomized controlled trials. Complement Ther Med 50, 102387 (2020). doi.org/10.1016/j.ctim.2020.102387
  41. [41]Lv, J. L. et al. Dietary protein and multiple health outcomes: an umbrella review of systematic reviews and meta-analyses of observational studies. Clin Nutr 41, 1759–1769 (2022). doi.org/10.1016/j.clnu.2022.06.005
  42. [42]Bauer, J. et al. Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. J Am Med Dir Assoc 14, 542–559 (2013). doi.org/10.1016/j.jamda.2013.05.021
  43. [43]Mozaffarian, D. The 2025–2030 Dietary Guidelines for Americans. JAMA (2026). doi.org/10.1001/jama.2026.0283
  44. [44]Nunes, E. A. et al. Systematic review and meta-analysis of protein intake to support muscle mass and function in healthy adults. J Cachexia Sarcopenia Muscle 13, 795–810 (2022). doi.org/10.1002/jcsm.12922
  45. [45]Wirth, J. et al. The role of protein intake and its timing on body composition and muscle function in healthy adults: a systematic review and meta-analysis of randomized controlled trials. J Nutr 150, 1443–1460 (2020). doi.org/10.1093/jn/nxaa049
  46. [46]Tagawa, R. et al. Dose-response relationship between protein intake and muscle mass increase: a systematic review and meta-analysis of randomized controlled trials. Nutr Rev 79, 66–75 (2021). doi.org/10.1093/nutrit/nuaa104
  47. [47]Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int 105, S117–S314 (2024). doi.org/10.1016/j.kint.2023.10.018
  48. [48]Lupoli, R. et al. White meat consumption, all-cause mortality, and cardiovascular events: a meta-analysis of prospective cohort studies. Nutrients 13, 676 (2021). doi.org/10.3390/nu13020676
  49. [49]Damigou, E. et al. White meat consumption and cardiometabolic risk factors: a review of recent prospective cohort studies. Nutrients 14, 5213 (2022). doi.org/10.3390/nu14245213
  50. [50]Jayedi, A. et al. Fish consumption and the risk of chronic disease: an umbrella review of meta-analyses of prospective cohort studies. Adv Nutr 11, 1123–1133 (2020). doi.org/10.1093/advances/nmaa029
  51. [51]Fernandez, M. L. The role of eggs in healthy diets. J Fam Pract 71, S54–S56 (2022). doi.org/10.12788/jfp.0330
  52. [52]Drouin-Chartier, J. P. et al. Egg consumption and risk of cardiovascular disease: three large prospective US cohort studies, systematic review, and updated meta-analysis. BMJ 368, m513 (2020). doi.org/10.1136/bmj.m513
  53. [53]Shi, W. et al. Red meat consumption, cardiovascular diseases, and diabetes: a systematic review and meta-analysis. Eur Heart J 44, 2626–2635 (2023). doi.org/10.1093/eurheartj/ehad336
  54. [54]Lescinsky, H. et al. Health effects associated with consumption of unprocessed red meat: a Burden of Proof study. Nat Med 28, 2075–2082 (2022). doi.org/10.1038/s41591-022-01968-z
  55. [55]Di, Y. et al. Association of meat consumption with the risk of gastrointestinal cancers: a systematic review and meta-analysis. BMC Cancer 23, 782 (2023). doi.org/10.1186/s12885-023-11218-1
  56. [56]Li, C. et al. Meat consumption and incident type 2 diabetes: an individual-participant federated meta-analysis of 1.97 million adults. Lancet Diabetes Endocrinol 12, 619–630 (2024). doi.org/10.1016/S2213-8587(24)00179-7
  57. [57]Neuenschwander, M. et al. Substitution of animal-based with plant-based foods on cardiometabolic health and all-cause mortality: a systematic review and meta-analysis of prospective studies. BMC Med 21, 404 (2023). doi.org/10.1186/s12916-023-03093-1
  58. [58]Kiesswetter, E. et al. Effects of dairy intake on markers of cardiometabolic health in adults: a systematic review with network meta-analysis. Adv Nutr 14, 438–450 (2023). doi.org/10.1016/j.advnut.2023.03.004
  59. [59]Zhang, X. et al. Milk consumption and multiple health outcomes: umbrella review of systematic reviews and meta-analyses in humans. Nutr Metab (Lond) 18, 7 (2021). doi.org/10.1186/s12986-020-00527-y
  60. [60]Chen, Z. et al. Dairy product consumption and cardiovascular health: a systematic review and meta-analysis of prospective cohort studies. Adv Nutr 13, 439–454 (2022). doi.org/10.1093/advances/nmab118
  61. [61]Qin, P. et al. Dietary carbohydrate quantity and quality and risk of cardiovascular disease, all-cause, cardiovascular and cancer mortality: a systematic review and meta-analysis. Clin Nutr 42, 148–165 (2023). doi.org/10.1016/j.clnu.2022.12.010
  62. [62]Te Morenga, L. et al. Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies. BMJ 346, e7492 (2013). doi.org/10.1136/bmj.e7492
  63. [63]Malik, V. S. et al. The role of sugar-sweetened beverages in the global epidemics of obesity and chronic diseases. Nat Rev Endocrinol 18, 205–218 (2022). doi.org/10.1038/s41574-021-00627-6
  64. [64]Huang, Y. et al. Dietary sugar consumption and health: umbrella review. BMJ 381, e071609 (2023). doi.org/10.1136/bmj-2022-071609
  65. [65]Lane, M. M. et al. Sugar-sweetened beverages and adverse human health outcomes: an umbrella review of meta-analyses of observational studies. Annu Rev Nutr 44, 383–404 (2024). doi.org/10.1146/annurev-nutr-062322-020650
  66. [66]World Health Organization. Guideline: sugars intake for adults and children (2015).
  67. [67]Van Horn, L. et al. Recommended dietary pattern to achieve adherence to the American Heart Association/American College of Cardiology (AHA/ACC) guidelines: a scientific statement from the American Heart Association. Circulation 134, e505–e529 (2016). doi.org/10.1161/CIR.0000000000000462
  68. [68]Pan, B. et al. Association of soft drink and 100% fruit juice consumption with all-cause, cardiovascular and cancer mortality. Crit Rev Food Sci Nutr 62, 8908–8919 (2022). doi.org/10.1080/10408398.2021.1937040
  69. [69]Schwingshackl, L. et al. Total dietary fat intake, fat quality, and health outcomes: a scoping review of systematic reviews of prospective studies. Ann Nutr Metab 77, 4–15 (2021). doi.org/10.1159/000515058
  70. [70]Sacks, F. M. et al. Dietary fats and cardiovascular disease: a presidential advisory from the American Heart Association. Circulation 136, e1–e23 (2017). doi.org/10.1161/CIR.0000000000000510
  71. [71]Hooper, L. et al. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev 8, CD011737 (2020). doi.org/10.1002/14651858.CD011737.pub3
  72. [72]EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA). Scientific Opinion on Dietary Reference Values for fats, including saturated fatty acids, polyunsaturated fatty acids, monounsaturated fatty acids, trans fatty acids, and cholesterol. EFSA J 8, 1461 (2010). doi.org/10.2903/j.efsa.2010.1461
  73. [73]Zhang, Y. et al. Butter and plant-based oils intake and mortality. JAMA Intern Med 185, 549–560 (2025). doi.org/10.1001/jamainternmed.2025.0205
  74. [74]Pimpin, L. et al. Is butter back? A systematic review and meta-analysis of butter consumption and risk of cardiovascular disease, diabetes, and total mortality. PLoS One 11, e0158118 (2016). doi.org/10.1371/journal.pone.0158118
  75. [75]Lichtenstein, A. H. et al. 2021 dietary guidance to improve cardiovascular health: a scientific statement from the American Heart Association. Circulation 144, e472–e487 (2021). doi.org/10.1161/CIR.0000000000001031
  76. [76]Qin, P. et al. Fried-food consumption and risk of cardiovascular disease and all-cause mortality: a meta-analysis of observational studies. Heart 107, 1567–1575 (2021). doi.org/10.1136/heartjnl-2020-317883
  77. [77]Qin, P. et al. Fried-food consumption and risk of overweight/obesity, type 2 diabetes mellitus, and hypertension in adults: a meta-analysis of observational studies. Crit Rev Food Sci Nutr 62, 6809–6820 (2022). doi.org/10.1080/10408398.2021.1906626
  78. [78]Sun, Y. et al. Association of fried food consumption with all cause, cardiovascular, and cancer mortality: prospective cohort study. BMJ 364, k5420 (2019). doi.org/10.1136/bmj.k5420
  79. [79]Abdelhamid, A. S. et al. Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev 3, CD003177 (2020). doi.org/10.1002/14651858.CD003177.pub5
  80. [80]Guasch-Ferré, M. et al. Consumption of olive oil and risk of total and cause-specific mortality among US adults. J Am Coll Cardiol 79, 101–112 (2022). doi.org/10.1016/j.jacc.2021.10.041

Put it into practice

Nutrition

Food

Fats