Tarini Shankar Ghosh and Ana Maria Valdes evaluate the evidence for clinical effects of microbiome altering interventions on cardiometabolic traits
### Key messages
Cardiometabolic diseases are one of the main causes of morbidity and mortality in western countries and are increasing in low and middle income countries.1 Dietary intake is one of the main determinants of cardiometabolic health1 and of microbiome composition.2 The gut microbiome is known to play an important part in the development of cardiometabolic diseases, including hypertension, diabetes, and obesity.2 This is thought to be linked with the ability of the gut microbiome to modulate inflammation, insulin sensitivity, and blood lipid levels, and is hypothesised to be mediated by specific microbially produced metabolites such as short chain fatty acids (SCFAs), secondary bile acids, phenylacetylglutamine, and trimethylamine-N-oxide.2
As well as their direct influence, gut microbes can also modulate the response of the
The narrative must shift away from individual choice on to structural factors
Over half of the global population will be living with overweight or obesity by 2035 if current trends continue, and more than 1.3 billion people worldwide will have diabetes by 20501; type 2 diabetes will account for most of the new cases, fuelled by changes in obesity and dietary risks.2 These trends are likely to have serious health, social, and economic effects, not least for low and middle income countries, which are forecast to bear the brunt of the increases. However, we already have evidence of the inequitable burden of obesity and type 2 diabetes, notably during the covid-19 pandemic when people with obesity and type 2 diabetes experienced poorer outcomes.3
In 2018, The BMJ launched Food for Thought, a collection exploring key questions around what we should eat to stay healthy and avoid disease.45 The collection showed how weak science, commercial influences, and conflicting media messages all co
Conceptualising ultra-processed foods high in carbohydrates and fats as addictive substances can contribute to efforts to improve health, argue Ashley Gearhardt and colleagues
The scientific understanding of addiction is evolving. Although addiction to certain foods is not included in diagnostic frameworks such as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), research on this topic has grown rapidly in the past 20 years. Much of this research uses the Yale Food Addiction Scale (YFAS), which was developed to measure food addiction by assessing DSM-5 criteria for substance use disorder in the context of food intake (box 1).14
Box 1
### Yale Food Addiction Scale (YFAS)RETURN TO TEXT
A recent analysis of two systematic reviews including 281 studies from 36 different countries found the overall pooled prevalence of food addiction using YFAS was 14% in adults and 12% in children.89 This reported prevalence is similar to the levels of addiction seen for other legal s