Health promotion through healthy eating. Methods for quantifying anti-inflammatory effects using molecular epidemiology tools and subsequent web applications

This PhD thesis is framed within the exposome concept, which encompasses the totality of environmental and lifestyle exposures experienced throughout the life course and their role in shaping health outcomes. Moving beyond the traditional “one exposure–one disease” paradigm, the exposome approach allows the investigation of complex interactions between general external factors and specific external exposures driven by individual behaviours, with major implications for public health and disease prevention. Within this framework, diet is investigated as a key specific external exposure, acting both as a potential risk factor and as a component of the beneficial exposome. The thesis integrates three complementary study lines addressing diet quality, ultra-processed food (UPF) consumption, food literacy, and their biological and behavioural correlates. Study line 1 (Maternal Diet and Oxidative Stress during Pregnancy) focused on pregnancy as a critical window of susceptibility, evaluating the effects of two different nutritional information delivery methods, professional dietary counselling versus self-administered information, on gestational weight gain, dietary quality, and oxidative stress biomarkers. While no overall differences emerged between intervention groups, stratified analyses showed that dietary counselling was effective in attenuating gestational weight gain among women with obesity. Short-term improvements in specific nutrients, particularly protein and fibre, were observed following counselling, but these effects were not sustained throughout pregnancy. Oxidative stress biomarkers (15-Isoprostane F2t, Malondialdehyde, and total antioxidant power) followed physiological pregnancy-related trends, with only transient associations with dietary intake, suggesting that short-term interventions may be insufficient to induce lasting biological effects. Study line 2 (Ultra-Processed Food–Based Dietary Patterns and Their Association with Inflammation and Oxidative Stress) investigated dietary patterns and UPF consumption in a generally healthy alpine population, examining their associations with inflammation, oxidative stress, and anthropometric indices of cardiometabolic risk. UPF intake showed weak or inconsistent associations with urinary inflammatory and oxidative stress biomarkers, as well as with indices of central adiposity. In contrast, demographic and lifestyle factors (particularly age, sex, and education) emerged as stronger determinants of inflammation and cardiometabolic risk than UPF intake alone, supporting the notion that dietary exposures operate within a broader lifestyle and socioeconomic context. Study line 3 (Food Literacy) addressed food literacy as a modifiable determinant of dietary behaviour. The ABCibi study demonstrated that a multifactorial workplace intervention significantly improved food literacy among hospital employees, particularly in older and lower-educated groups. Complementary analyses from the SaperePer cohort highlighted the influence of socioeconomic, cultural, and demographic factors on food literacy during pregnancy, identifying vulnerable subgroups such as younger, foreign-born, and socioeconomically disadvantaged women. Overall, this thesis adopts an exposome-based approach to integrate dietary exposures, dietary patterns, food literacy, and biomarkers of inflammation and oxidative stress. The findings highlight that dietary interventions and nutrition education are most effective when tailored to nutritionally or socioeconomically at-risk populations and underscore the central role of diet-based strategies in health promotion, prevention, and the reduction of health inequalities across the life course