Urinary metabolic biomarkers of diet quality in European children are associated with metabolic health

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    Evaluation Summary:

    This well-executed study looks at the association of urinary metabolites to the types of diets consumed by European children. Using NMR they find four metabolites that are predictive of a Mediterranean diet. This presents both an approach additional to traditional dietary questionnaire methods and potential insights into biological pathways and will be of interest to nutritionists and epidemiologists.

    (This preprint has been reviewed by eLife. We include the public reviews from the reviewers here; the authors also receive private feedback with suggested changes to the manuscript. The reviewer remained anonymous to the authors.)

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Abstract

Urinary metabolic profiling is a promising powerful tool to reflect dietary intake and can help understand metabolic alterations in response to diet quality. Here, we used 1 H NMR spectroscopy in a multicountry study in European children (1147 children from 6 different cohorts) and identified a common panel of 4 urinary metabolites (hippurate, N -methylnicotinic acid, urea, and sucrose) that was predictive of Mediterranean diet adherence (KIDMED) and ultra-processed food consumption and also had higher capacity in discriminating children’s diet quality than that of established sociodemographic determinants. Further, we showed that the identified metabolite panel also reflected the associations of these diet quality indicators with C-peptide, a stable and accurate marker of insulin resistance and future risk of metabolic disease. This methodology enables objective assessment of dietary patterns in European child populations, complementary to traditional questionary methods, and can be used in future studies to evaluate diet quality. Moreover, this knowledge can provide mechanistic evidence of common biological pathways that characterize healthy and unhealthy dietary patterns, and diet-related molecular alterations that could associate to metabolic disease.

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  1. Author Response:

    Reviewer #1 (Public Review):

    This is a well-executed study looking at the association of urinary metabolites to the types of diets consumed by European children. They focus on four analytes that have opposing patterns from a "good" KIDMED Mediterranean style diet versus a "bad" diet with processed foods and high sugars. They then create an association with levels of C-peptide, which has in turn been linked to health outcomes.

    Overall there is extensive data provided in the supplementary data to justify their findings. The one omission is the effects of activity levels and total caloric consumption. There is an attempt to link body weight to C-peptide associations, but in a minor revision, it would be nice to also include MBI as a parameter for the concentrations of metabolites.

    We thank the reviewer for his/her …

  2. Evaluation Summary:

    This well-executed study looks at the association of urinary metabolites to the types of diets consumed by European children. Using NMR they find four metabolites that are predictive of a Mediterranean diet. This presents both an approach additional to traditional dietary questionnaire methods and potential insights into biological pathways and will be of interest to nutritionists and epidemiologists.

    (This preprint has been reviewed by eLife. We include the public reviews from the reviewers here; the authors also receive private feedback with suggested changes to the manuscript. The reviewer remained anonymous to the authors.)

  3. Public Review:

    This is a well-executed study looking at the association of urinary metabolites to the types of diets consumed by European children. They focus on four analytes that have opposing patterns from a "good" KIDMED Mediterranean style diet versus a "bad" diet with processed foods and high sugars. They then create an association with levels of C-peptide, which has in turn been linked to health outcomes.

    Overall there is extensive data provided in the supplementary data to justify their findings. The one omission is the effects of activity levels and total caloric consumption. There is an attempt to link body weight to C-peptide associations, but in a minor revision, it would be nice to also include MBI as a parameter for the concentrations of metabolites.