Lifestyle choices influence 20–40 % of adult peak bone mass. Therefore, optimization of lifestyle factors known to influence peak bone mass and strength is an important strategy aimed at reducing risk of osteoporosis or low bone mass later in life. The National Osteoporosis Foundation has issued this scientific statement to provide evidence-based guidance and a national implementation strategy for the purpose of helping individuals achieve maximal peak bone mass early in life. In this scientific statement, we (1) report the results of an evidence-based review of the literature since 2000 on factors that influence achieving the full genetic potential for skeletal mass; (2) recommend lifestyle choices that promote maximal bone health throughout the lifespan; (3) outline a research agenda to address current gaps; and (4) identify implementation strategies. We conducted a systematic review of the role of individual nutrients, food patterns, special issues, contraceptives, and physical activity on bone mass and strength development in youth. An evidence grading system was applied to describe the strength of available evidence on these individual modifiable lifestyle factors that may (or may not) influence the development of peak bone mass (Table 1). A summary of the grades for each of these factors is given below. We describe the underpinning biology of these relationships as well as other factors for which a systematic review approach was not possible. Articles published since 2000, all of which followed the report by Heaney et al. [1] published in that year, were considered for this scientific statement. This current review is a systematic update of the previous review conducted by the National Osteoporosis Foundation [1]. Lifestyle Factor Grade Macronutrients Fat D Protein C Micronutrients Calcium A Vitamin D B Micronutrients other than calcium and vitamin D D Food Patterns Dairy B Fiber C Fruits and vegetables C Detriment of cola and caffeinated beverages C Infant Nutrition Duration of breastfeeding D Breastfeeding versus formula feeding D Enriched formula feeding D Adolescent Special Issues Detriment of oral contraceptives D Detriment of DMPA injections B Detriment of alcohol D Detriment of smoking C Physical Activity and Exercise Effect on bone mass and density A Effect on bone structural outcomes B Considering the evidence-based literature review, we recommend lifestyle choices that promote maximal bone health from childhood through young to late adolescence and outline a research agenda to address current gaps in knowledge. The best evidence (grade A) is available for positive effects of calcium intake and physical activity, especially during the late childhood and peripubertal years—a critical period for bone accretion. Good evidence is also available for a role of vitamin D and dairy consumption and a detriment of DMPA injections. However, more rigorous trial data on many other lifestyle choices are needed and this need is outlined in our research agenda. Implementation strategies for lifestyle modifications to promote development of peak bone mass and strength within one’s genetic potential require a multisectored (i.e., family, schools, healthcare systems) approach.

Fruit and vegetables (F&V) have been a cornerstone of healthy dietary recommendations; the 2015–2020 U.S. Dietary Guidelines for Americans recommend that F&V constitute one-half of the plate at each meal. F&V include a diverse collection of plant foods that vary in their energy, nutrient, and dietary bioactive contents. F&V have potential health-promoting effects beyond providing basic nutrition needs in humans, including their role in reducing inflammation and their potential preventive effects on various chronic disease states leading to decreases in years lost due to premature mortality and years lived with disability/morbidity. Current global intakes of F&V are well below recommendations. Given the importance of F&V for health, public policies that promote dietary interventions to help increase F&V intake are warranted. This externally commissioned expert comprehensive narrative, umbrella review summarizes up-to-date clinical and observational evidence on current intakes of F&V, discusses the available evidence on the potential health benefits of F&V, and offers implementation strategies to help ensure that public health messaging is reflective of current science. This review demonstrates that F&V provide benefits beyond helping to achieve basic nutrient requirements in humans. The scientific evidence for providing public health recommendations to increase F&V consumption for prevention of disease is strong. Current evidence suggests that F&V have the strongest effects in relation to prevention of CVDs, noting a nonlinear threshold effect of 800 g per day (i.e., about 5 servings a day). A growing body of clinical evidence (mostly small RCTs) demonstrates effects of specific F&V on certain chronic disease states; however, more research on the role of individual F&V for specific disease prevention strategies is still needed in many areas. Data from the systematic reviews and mostly observational studies cited in this report also support intake of certain types of F&V, particularly cruciferous vegetables, dark-green leafy vegetables, citrus fruits, and dark-colored berries, which have superior effects on biomarkers, surrogate endpoints, and outcomes of chronic disease.

Anthocyanins are a group of abundant and widely consumed flavonoid constituents that occur ubiquitously in the plant kingdom, providing the bright red-orange to blue-violet colors present in many fruit- and vegetable-based food products. Their intake has been estimated to be up to 9-fold higher than that of other dietary flavonoids. Anthocyanins have become increasingly important to the food industry as their use as natural alternatives to artificial colors has become widespread and knowledge of their health-promoting properties has become more evident. Epidemiological studies suggest that increased consumption of anthocyanins lowers the risk of cardiovascular disease (CVD), the most common cause of mortality among men and women. Anthocyanins frequently interact with other phytochemicals, exhibiting synergistic biological effects but making contributions from individual components difficult to decipher. Over the past 2 decades, many peer-reviewed publications have demonstrated that in addition to their noted in vitro antioxidant activity, anthocyanins may regulate different signaling pathways involved in the development of CVD. This review summarizes the latest developments on the bioavailability/bioactivity and CVD preventative activities of anthocyanins, including results from in vitro cell culture and in vivo animal model systems as related to their multiple proposed mechanisms of action. Limited yet promising data from epidemiological studies and human clinical trials are also presented. Future studies aimed at enhancing the absorption of anthocyanins and characterizing their metabolic and/or breakdown products are necessary to ultimately evaluate their use for protection/prevention against the development of CVD.

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Background: Considerable attention has recently focused on dietary protein’s role in the mature skeleton, prompted partly by an interest in nonpharmacologic approaches to maintain skeletal health in adult life.

The 2015–2020 Dietary Guidelines for Americans advocate for increasing vegetable intake and replacing energy-dense foods with those that are nutrient-dense. Most Americans do not eat enough vegetables, and particularly legumes, each day, despite their well-established benefits for health. Traditional hummus is a nutrient-dense dip or spread made from cooked, mashed chickpeas, blended with tahini, olive oil, lemon juice, and spices. Consumers of chickpeas and/or hummus have been shown to have higher nutrient intakes of dietary fiber, polyunsaturated fatty acids, vitamin A, vitamin E, vitamin C, folate, magnesium, potassium, and iron as compared to non-consumers. Hummus consumers have also been shown to have higher Healthy Eating Index 2005 (HEI-2005) scores. This may be, in part, due to hummus’ higher Naturally Nutrient Rich (NNR) score as compared to other dips and spreads. Emerging research suggests that chickpeas and hummus may play a beneficial role in weight management and glucose and insulin regulation, as well as have a positive impact on some markers of cardiovascular disease (CVD). Raw or cooked chickpeas and hummus also contain dietary bioactives such as phytic acid, sterols, tannins, carotenoids, and other polyphenols such as isoflavones, whose benefits may extend beyond basic nutrition requirements of humans. With chickpeas as its primary ingredient, hummus—and especially when paired with vegetables and/or whole grains—is a nutritious way for Americans to obtain their recommended servings of legumes. This manuscript reviews the nutritional value and health benefits of chickpeas and hummus and explores how these foods may help improve the nutrient profiles of meals.