BACKGROUND: Undernutrition remains a leading driver of child mortality and morbidity in low- and middle-income countries, yet surveillance and case management in Pakistan still rely largely on infrequent surveys and paper-based registers that cannot track nutritional status in real time. The private sector, where most Pakistani households seek care, has been largely excluded from nutrition programming. We describe the development and early implementation of Mazboot Bunyad, a digital nutrition registry embedded within an integrated nutrition-immunization programme at private provider clinics in high-risk, low-income settlements of Karachi. METHODS: The Android application and web dashboard used in this implementation study were designed through a participatory process using the AHEAD framework, in consultation with provincial health authorities, immunization staff, and community nutrition worker. The system used QR-linked child records, an embedded digital decision-support system that classified children by mid-upper arm circumference and has automated follow-up reminders. The tool was deployed across 33 clinics, and routinely collected programme data, a preliminary analysis of data from 1 July to 31 December 2024 were retrospectively reviewed. RESULTS: During the period of 6 months, the Mazboot Bunyad application was used to screen and enroll 8,406 children aged 6-59 months. Field teams used the embedded Digital Decision Support System (DDSS) to classify children aged 6-59 months in real-time. Of these, 71.4% were classified as normal, 22.3% as moderately acutely malnourished (MAM), and 6.2% as severely acutely malnourished (SAM). The largest share of enrollments was among children aged 13-24 months (40.5%). Male children represented a slightly larger share of total enrollments (52.2%), but SAM burden was higher among females (7.3%) compared to males (5.3%). Supervisory teams used the dashboard to identify defaulters, monitor stock availability, and follow case recovery timelines. CONCLUSIONS: Early implementation of Mazboot Bunyad highlighted opportunities for enhanced nutritional surveillance using real-time tracking, but also challenges such as supply chain gaps that could affect the overall implementation. These offer valuable lessons for scaling digital tools in real world settings across Pakistan and other LMICs. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at https://doi.org/10.1186/s44247-026-00303-7.
Journal of human nutrition and dietetics : the official journal of the British Dietetic AssociationEsra Tansu Sarıyer, Elvan Yılmaz Akyüz, Sahin Yesildag
BACKGROUND: This study aimed to evaluate the levels of muscle appearance satisfaction and ergogenic aid use among adult male amateur bodybuilders. METHODS: In this descriptive cross-sectional study, a questionnaire containing demographic information, the "Nutrition Ergogenic Supplement Attitude Measurement (NESAM)" for ergogenic aid use, and the "Muscle Appearance Satisfaction Scale (MASS)", and anthropometric measurements were taken using a BIA analysis device (Tanita DC360). Data were analyzed using the SPSS v27 software package (IBM Corp., Armonk, NY, USA). RESULTS: The participants' mean BMI was 25.37 ± 2.53 kg/m2, while the mean body fat percentage was 14.60 ± 5.61%. While 54.8% of participants used ergogenic supplements, the majority (72.9%) did so on their own initiative. According to NESAM results, the highest average score was observed in the "Benefit" subscale, the total MASS score showed positive correlations with benefit (r = 0.207, p < 0.05), natural nutrition (r = 0.231, p < 0.05), and total NESAM scores (r = 0.196, p < 0.05). In multiple linear regression analysis, the NESAM total score remained an independent predictor of the MASS total score (β = 0.312, p = 0.002). Additionally, while BMI was negatively associated with muscle dissatisfaction (r = -0.213, p < 0.05), upper arm circumference was positively correlated with bodybuilding dependence (r = 0.323, p < 0.01). CONCLUSION: Among male bodybuilders, attitudes toward ergogenic supplements were independently associated with muscle appearance satisfaction.
Applied psychology. Health and well-beingLaura M König, Maren C Podszun, Wolfgang Gaissmaier, Helge Giese
Artificial intelligence (AI) is becoming increasingly common for health information seeking, yet many people are still skeptical of its performance. This between-subjects online experiment tested whether informing readers that a text was produced by AI influenced their ratings in 774 participants. They were randomly assigned to read one of six brief texts and rated trustworthiness, interest, and perceived understanding, as well as intention to act upon the received information and willingness to share the information with others. Source information did not influence ratings, but only 41.5% of participants in the AI source condition noticed the source. Source awareness was associated with higher education and greater nutrition knowledge. Nutrition information produced by AI chatbots is generally seen as trustworthy, although source information is often ignored. Our research highlights critical implications for public health messaging in the digital age as consumers may not differentiate between information generated by AI versus other sources, although future research is required to assess source perceptions in AI-generated texts in more detail.
European journal of nutritionYenisleidys Fernández-Guerrero, Ociel Muñoz-Fariña, Olga García, María Cristina Ravanal, Luisbel González
Purpose To quantify seven dietary vitamins and estimate their mean daily intakes and major food sources among Cuban adults through the country's first Total Diet Study.Methods Standardized 24-hour dietary recalls were collected from 450 adults across Western, Central, and Eastern Cuba between October 2020 and March 2021. Foods were classified into 16 groups, prepared as consumed, homogenized, and analyzed using validated high-performance liquid chromatography with ultraviolet and fluorescence detection. Vitamin concentrations were combined with mean food consumption to estimate daily intakes, which were compared with nutritional reference values.Results Estimated mean daily intakes were 831 µg retinol equivalents for vitamin A, 6.8 mg α-tocopherol equivalents for vitamin E, 1.6 mg thiamine, 1.8 mg riboflavin, 32 mg niacin equivalents, 2.7 mg pyridoxine, and 220 µg dietary folate equivalents. Mean intakes of thiamine, riboflavin, niacin, and pyridoxine exceeded the adult reference values used in the study, whereas vitamin E and folate reached 68% and 55% of their respective benchmarks. Dairy products, vegetables, fruits, and fish were major vitamin A sources; meats and legumes contributed substantially to thiamine intake, and vegetables and legumes were the leading folate sources.Conclusion The reported mean intake estimates identify vitamin E and folate as priorities for dietary improvement in Cuba. Promoting nutrient-rich foods and evaluating selective fortification could help address these gaps. These population mean estimates do not establish individual nutritional adequacy or deficiency prevalence; further assessment of usual intake distributions and nutritional biomarkers is warranted.
Oxford open digital healthRajabu Simba, Gilbert Charles, John B Uiso, Jacqueline Wetson, Hyasinta Jaka, Leonard Katalambula
Malnutrition remains a major public health problem in Tanzania, worsened by limited access to personalized, culturally relevant nutrition information. Existing gaps in community nutrition education across sub-Saharan Africa, combined with conventional approaches ignoring individual dietary needs, contribute to undernutrition and chronic disease. However, while AI-powered chatbots have shown global effectiveness in scalable health education, evidence from low-resource, Swahili-speaking settings is scarce. This study, aligned with Sustainable Development Goals (SDGs) 2, 3, and 4, developed Lishe Yetu, a culturally localized digital nutrition tool aimed at bridging these gaps. A pre-post quasi-experimental mixed-methods design evaluated Lishe Yetu among 400 Tanzanian residents between January and April 2025. Built on retrieval-augmented generation using GPT-3.5-turbo, the platform drew from over 2500 expert-reviewed sources including World Health Organization (WHO), Food and Agriculture Organization of the United Nations (FAO), Tanzania Food and Nutrition Centre, and validated Swahili materials. Nutritional knowledge was measured using a validated 20-item questionnaire, with engagement tracked via server logs and satisfaction assessed through Likert-scale surveys and thematic analysis of qualitative feedback. Results showed strong engagement, with average sessions lasting 12 minutes and 15.2 messages exchanged; 87% completed at least one full session. Satisfaction averaged 4.3/5.0, and 88% found the tool easy to use. Knowledge scores improved significantly from 52% to 73%, a 21 percentage-point gain with a large effect size (Cohen's d = 1.57, P < 0.001). Additionally, 65% reported intentions to adopt healthier diets. These findings provide strong preliminary evidence that a Swahili-language AI chatbot can improve nutrition literacy in low-resource African settings, though randomized controlled trials are needed to confirm sustained behaviour change.
Advances in nutrition (Bethesda, Md.)Karen A Della Corte, Anette E Buyken, Carlo La Vecchia, Marie-Ann Vanginkel, Jordi Salas-Salvadó, Gabriele Riccardi, Antonia Trichopoulou, Joanne Slavin, Anton…
Dietary guidelines shape food policy, education, and food systems worldwide. Recent controversies in dietary guideline development, together with rising burdens of diet-related chronic disease and increasing environmental pressures, highlight the need for globally relevant dietary guidance aligned with both human and planetary health. We developed an evidence-informed International Food Guide Pyramid emphasizing optimal carbohydrate-containing staple foods. The International Carbohydrate Quality Consortium (ICQC) developed the proposed framework using a four-step evidence-review process involving comparison of major national and regional dietary guideline systems, integration of evidence syntheses and selected primary studies, and expert consensus. Quantitative intake ranges from the EAT-Lancet Commission reference diet informed the relative visual proportions of food groups, while the guiding principles were derived from convergence across dietary guideline systems and complementary evidence syntheses. The resulting pyramid depicts a plant-forward omnivorous dietary pattern supported by epidemiological and clinical evidence indicating benefits for cardiometabolic health and chronic disease prevention. Vegetables, fruits, whole grains, and legumes constitute foundational components of the pyramid. Nuts, seeds, and unsaturated plant oils are emphasized as primary fat sources, while foods high in saturated fat are generally limited. Animal-source foods are included in modest amounts, with plant protein sources emphasized, poultry and fish preferred over red meat, and dairy incorporated in modest amounts, consistent with dietary patterns associated with lower environmental impacts. Carbohydrate quality is emphasized through prioritization of whole-grain foods alongside traditional low-glycemic index grain staples, favoring carbohydrate sources rich in dietary fiber, intact plant cells, and micronutrients while limiting sugars consumed in low-nutrient forms, particularly sugar-sweetened beverages. The framework also accommodates vegan and other primarily plant-based dietary patterns. This evidence-informed International Food Guide Pyramid integrates quantitative modeling and qualitative evidence synthesis to provide a coherent, flexible, and globally adaptable dietary framework aligned with both human and planetary health. STATEMENT OF SIGNIFICANCE: This work presents an evidence-informed International Food Guide Pyramid developed through a structured synthesis of major national and regional dietary guideline systems, quantitative modeling from the EAT-Lancet Commission, and complementary evidence syntheses. By translating areas of convergence across these independent evidence-based sources into a practical visual framework, it provides a globally adaptable approach to dietary guidance that explicitly incorporates carbohydrate quality and both human and planetary health.
Journal of public health policyHelene Power, Yuezhong Li, Yutong Chen
Packaged foods are a major source of dietary sodium worldwide. Nutrition labels often report sodium content in milligrams and a percent daily value; however, these measures are not sufficiently intuitive for comparing sodium content across packaged foods. We propose a new way to use sodium density (mg/kcal) in a serving to bypass nutrition label units. Because the WHO recommended sodium limit for adults (2000 mg/day) and the reference energy intake used on nutrition labels (2000 kcal/day) are numerically identical, a sodium-to-calorie ratio of 1 mg/kcal could serve as a practical guidepost to compare sodium content and support packaged food selection, rather than to provide an individual-level recommendation for daily sodium intake. Sodium density, applied to food log entries, could help consumers identify lower-sodium options among packaged foods, support healthcare professionals in nutrition education design personalized strategies to reduce sodium consumption, and inform developments of nutrition dashboards and AI-driven tracking tools.
Nature reviews. EndocrinologyHala B AlEssa, Vasanti S Malik, Frank B Hu
Obesity and type 2 diabetes mellitus (T2DM) are global epidemics, but their burden is particularly pronounced in the Middle East and North Africa (MENA) region. This Review provides a comprehensive overview of their epidemiological landscape among adults in the MENA region, encompassing disease burden, temporal trends, intersecting risk factors and key gaps in research, policy and practice, while highlighting regional heterogeneity. Despite worsening trends, the broader landscape, including disease burden and its drivers, remains insufficiently addressed. Contributing risk factors include poor diet quality, physical inactivity, genetic predisposition, obesogenic food environments and socioeconomic and cultural influences. While high-income places in the Gulf region have undergone earlier and more advanced nutrition transitions, with some of the highest prevalences of obesity and T2DM globally, places in North Africa are experiencing rapid shifts, with some of the steepest increases in high BMI and elevated fasting plasma levels of glucose. Although places share common drivers such as urbanization and sedentary lifestyles, the magnitude and distribution of risk vary widely owing to differences in economic development, healthcare infrastructure, cultural norms and public health nutrition policies. These epidemics impose a substantial and under-recognized economic burden. Prevention and management efforts remain fragmented, highlighting the need for stronger regional collaboration, improved evidence generation and culturally tailored interventions.
Frontiers in public healthAbdul Momin Rizwan Ahmad, Zoha Imtiaz Malik, Saira Zafar, Syed Hassan Bin Umsan Shah, Rida Fatima Saeed, Umar Farooq, Juweria Abid, Sehar Iqbal, Muhammad Irfan…
INTRODUCTION: Overweight and obesity have emerged as a public health concern, particularly among university students. This increasing prevalence is linked with unhealthy lifestyles consisting of poor dietary choices, and physical inactivity, most commonly reported among students. OBJECTIVE: The current study aimed to determine the prevalence of both overweight and obesity, and their socio-demographic correlates within the twin cities (Islamabad and Rawalpindi), Pakistan. METHODS: A cross-sectional study was conducted among 502 students, selected via convenience sampling, enrolled in public and private universities in the twin cities. Data was collected on socio-demographic correlates and lifestyle factors, using a structured questionnaire. Data was analyzed using Statistical Package for the Social Sciences (SPSS) version 27, and chi-square test, binary logistic regression, and adjusted odds ratio, were used to determine associations between sociodemographic variables, lifestyle factors and obesity. RESULTS: The mean age was 21.87 ± 2.27 years, while 80.7% were females. Based on Asian cut-offs for Body Mass Index (BMI), 25.5% were underweight (<18.5 kg/m2), 15.3% were overweight (23.0 to 27.4 kg/m2), and 12.9% were obese (27.5 kg/m2 and above). Gender (p < 0.001), monthly household income (p = 0.043), maternal education (p = 0.030) and having a medical condition (p = 0.025) were all significantly associated with obesity. However, once adjusted, only gender (adjusted odds ratio (aOR = 0.428), CI: 0.236-0.776, p = 0.005) remained significantly associated with obesity, with female sex depicting lower odds of obesity compared with male sex. CONCLUSION: Our study found a significant proportion of the study participants to be overweight (15.3%) and obese (12.9%). Gender, household income, maternal education, and having a prior medical condition, all emerged as significant associated factors of obesity in the current study. Primary prevention interventions aimed at university settings are vital to prevent and manage obesity risk factors and hence combat the increasing overweight and obesity trends among university students.
The 2025-2030 Dietary Guidelines for Americans include vegetarian and vegan dietary patterns as potential options for meeting nutrient needs across the lifespan, while also identifying several nutrients of potential concern within these patterns. These conclusions have important implications for dietetic practice, public communication, and policy development. However, estimates of nutrient adequacy derived from food pattern modeling are inherently shaped by the assumptions used to construct dietary scenarios, including decisions related to food substitution, energy balance, and the treatment of fortification and supplementation. This article provides a balanced examination of the strengths and limitations of the current modeling framework as applied to vegetarian and vegan dietary patterns. The protective intent of the conservative approach and its value for public health guidance are outlined, alongside alternative analytical strategies that address complementary questions regarding nutrient source composition under fixed energy conditions.
Current opinion in clinical nutrition and metabolic careMurielle Bochud, Mette M Berger
PURPOSE OF REVIEW: Zinc deficiency is a major modifiable nutritional and public health burden worldwide. Because zinc participates in a wide range of biochemical functions, the physiological consequences of deficiency are diverse and nonspecific, complicating the identification of reliable biomarkers of zinc status. The present review summarizes recent evidence regarding zinc status biomarkers, while integrating the impact of novel findings on the genetics of zinc homeostasis. RECENT FINDINGS: Updated assessment of available zinc biomarkers shows that plasma/serum and urinary zinc excretion respond to changes in zinc intake in humans. Despite the impact of inflammation, plasma/serum zinc remains a good indicator of status. Numerous other putative biomarkers do not meet biomarker efficiency criteria. Zinc homeostasis is tightly controlled through the action of more than 20 membrane transporters belonging to two large families (SLC30 and SLC39). SLC30A2 genetic variants play a key role in controlling urinary zinc excretion, with high geographic variation in allele frequency. The observation from genetic studies that urinary and blood zinc levels are regulated through largely distinct biological pathways suggests that urinary zinc levels may provide relevant complementary information to serum/plasma levels pointing towards urinary-to-plasma ratio as a novel biomarker of human zinc status. SUMMARY: The combined assessment of serum (or plasma) zinc concentration and urinary zinc excretion appears to be the most sensitive and specific approach for evaluating zinc status in humans.
Current developments in nutritionDaniela C Avelino, Ock K Chun, Michael J Puglisi, Ran Xu, Valerie B Duffy
BACKGROUND: Using digital tools to support healthy food choices and access may counteract the negative effects of living in underresourced communities on diet quality. OBJECTIVES: This study aims to develop and evaluate the psychometric properties of a Digital Food and Nutrition Literacy (DFNL) survey and its association with diet quality for informing future tailored interventions to improve diet quality. METHODS: The DFNL survey was theory-informed by the Information-Motivation-Behavioral Skills model and a multidimensional model for making healthy food choices online. In this cross-sectional study, 196 adults from a low-income, low-food access community in Northeast Connecticut completed an online survey. Principal component analysis was used to identify a DFNL index and components for multivariable linear regression analyses with diet quality, an external variable theoretically expected to be associated with DFNL. Diet quality was assessed using the Short Healthy Eating Index and liking-based Diet Quality Index. RESULTS: The 10-item DFNL index was internally reliable and explained 53.8% of total variance through 3 interpretable components-online grocery shopping, online nutrition information, and online communication. Associations between DFNL and diet quality varied by DFNL component and diet quality measure; the strongest associations were observed for online nutrition information and online grocery shopping components, particularly with adequacy scores of both diet quality measures. CONCLUSIONS: These preliminary findings support the construct validity of the DFNL index. Assessing DFNL may help identify modifiable behavioral skills in community nutrition interventions that can be tailored to participants' knowledge gaps and motivation to support diet quality in underresourced populations.
Nutrition and healthMary M Murphy, Maribeth M Anderson, Kelly A Higgins
BackgroundSugar-sweetened beverages (SSB) are a key source of energy and sugars in the American diet.AimThis assessment examined trends in SSB and sugar-sweetened carbonated soft drink (ssCSD) consumption.MethodsIntake estimates were generated using NHANES 2003-2020 and August 2021-August 2023 and temporal trends were examined using linear and logistic regression.SummaryThe percentage of individuals ≥2 years consuming SSB or ssCSD declined significantly from 2003 to 2023. The percentage of youth consuming SSB or ssCSD dropped from 2003 to 2023 (76%-44% and 56% to 22%, respectively), as did the percentage of adults consuming SSB or ssCSD (52%-32% and 42%-22%, respectively). Per capita energy intake from SSB or ssCSD declined among youth (-135 and -96 kcal/day, respectively) and adults (-89 and -75 kcal/day, respectively). The downward trends in SSB or ssCSD consumption among the US population suggest trends consistent with dietary recommendations.
Journal of dental educationAmira Mahomed, Teresa A Marshall, Vinodh Bhoopathi
PURPOSE: Nutrition and diet are vital for oral and systemic health. It is unclear how well US predoctoral dental programs prepare students in nutrition screening and counseling. This study analyzed US dental school curricula on these topics. METHODS: A cross-sectional online survey was sent to the publicly available email addresses of 67 of 72 academic dental deans at US Commission on Dental Accreditation-accredited dental schools. Items assessed availability, modes and hours of instruction, curricular topics, clinical integration, and instructors. Descriptive statistics summarized responses. RESULTS: A total of 21 academic deans responded, for an overall response rate of 29%. Most (85%) of responding academic dental deans reported that nutrition and diet education was mandatory, with none treating it as optional. Of these schools, 83% offered both classroom and clinical training, while 17% provided only didactic teaching. Didactic hours varied; 42% reported 10 or fewer hours. Foundational nutrition topics were common, although dietary guidelines such as MyPlate were reported less often (66%). Oral health-related nutrition content was broadly covered, with all respondents reporting instruction related to caries, erosion, periodontal disease, and oral dysfunction. Counseling content was less consistent, particularly public health nutrition (67%) and the impact of oral dysfunction on diet and nutrition (72%). CONCLUSION(S): Most responding academic dental deans report including nutrition and diet education in their curricula. However, it remains uncertain whether these topics are incorporated at schools that did not participate in the survey. Variability in curricular time, counseling, and teaching highlights the need for clearer competencies and more clinical training. Improving this could better prepare future dentists for common dietary risks affecting oral and systemic health.
Frontiers in public healthMiao Wang, Qian Wang, Bin Chen, Jianguo Liu
BACKGROUND: Oral diseases affect over 3.5 billion people globally, with dental caries and periodontitis being the most common. Previous studies suggest that dairy products may protect against these conditions through enamel remineralization and antimicrobial effects, but a comprehensive synthesis integrating component profiles, molecular mechanisms, and translational applications has been lacking. This systematic review synthesizes evidence on dairy products and their bioactive components in oral health, clarifies functional mechanisms, current applications, and future directions. METHODS: PubMed, Cochrane Library, and China National Knowledge Infrastructure (CNKI) were searched from database inception to April 2026. Studies linking dairy products to oral health were included. A narrative synthesis covered dairy product categories, bioactive components (proteins and peptides, minerals, probiotics), mechanisms (microecological regulation, caries prevention, periodontal management, antifungal effects, mucosal protection), current applications, and future challenges. RESULTS: Processing characteristics and compositional differences of liquid milk, fermented dairy products, and cheese determine their distinct roles in oral care. Dairy-derived proteins, minerals, and probiotics act synergistically through multiple mechanisms: maintenance of oral microbial homeostasis; enamel remineralization, inhibition of cariogenic bacterial adhesion and acid production (caries prevention); attenuation of inflammatory responses (periodontal support); inhibition of Candida albicans (opportunistic infection control); and protection of mucosal barrier integrity. A three-tiered application model-natural dietary intervention, oral care product development, and clinical adjunctive therapy-has emerged. This review adds an integrated "components-mechanisms-effects" framework demonstrating how casein phosphopeptides, lactoferrin, probiotics, calcium, and phosphorus synergistically maintain oral microbiota homeostasis, promote remineralization, reduce inflammation, inhibit opportunistic infections, and protect the mucosal barrier. CONCLUSION: Dairy products can preserve oral health via multiple pathways and have clear public health value. Future research should focus on probiotic strain specificity, synergistic mechanisms of active ingredients, and long-term clinical effects to promote an integrated "nutrition + oral care" health management strategy. This review provides a theoretical reference for precise application, product innovation, and interdisciplinary integration of dairy products in oral health, with positive implications for improving global oral health status.
Frontiers in nutritionLeonard R Ndibalema, Joseph Kalonga
Tanzania faces a complex nutrition and public health challenge characterized by persistent undernutrition, micronutrient deficiencies, and an increasing burden of diet-related non-communicable diseases. At the same time, traditional farming systems that historically supplied diverse, nutrient-dense foods are being weakened by urbanization, climate variability, market pressures, and dietary transitions. This narrative review examines farming as food as medicine in Tanzania by synthesizing literature on indigenous crops, agroecology, agrobiodiversity, dietary diversity, public health nutrition, and sustainable food systems. The review highlights how traditional crops such as lablab, cowpea, sorghum, millet, cassava leaves, and indigenous vegetables contribute to dietary quality, preventive health, climate resilience, and cultural continuity. It further discusses the roles of social determinants, gender, public health professionals, nutrition-sensitive agriculture, and policy integration in strengthening food-based health strategies. The review argues that smallholder farming systems should be understood not only as sources of food and income, but also as preventive public health infrastructure. Revitalizing traditional food systems and agroecological farming can contribute to improved nutrition, reduced disease risk, environmental sustainability, and more resilient livelihoods in Tanzania.
Public health actionP Kotni, G Ramaswamy, S Cheela, S Patil, P Chinnakali, J P Tripathy, M Khandale, D Kamban, C Konguvel, M Manohar
SETTING: Primary care settings in a rural district of Telangana, India, under an anaemia control programme. OBJECTIVE: To explore the facilitators and barriers to parenteral iron therapy for moderate and severe anaemia, and possible solutions from the perspective of health care providers and pregnant women. DESIGN: A qualitative descriptive study. Twenty in-depth interviews and four focus group discussions were conducted with health care providers (primary care and district hospital) and postnatal mothers who had moderate or severe anaemia. Manual content analysis with inductive coding was done to identify themes and sub-themes. RESULTS: Facilitators included availability of IV iron at higher-level facilities, support from ASHAs (community health volunteers), community nutrition schemes, and growing access to digital health information. Barriers clustered around medicine stock-outs at lower-level facilities, transport difficulties, out-of-pocket costs, wage loss, need for escorts to hospitals, and strong fears and misconceptions about injections. Suggested solutions focused on uninterrupted IV iron supply, decentralised service delivery, capacity-building of frontline workers, digital and community-led communication strategies, and social support mechanisms. CONCLUSION: Strengthening supply chains, decentralising parenteral iron therapy, and enhancing culturally sensitive counselling and community support are essential to improve uptake and completion of parenteral therapy in primary care settings.
NutrientsAna Presa-Carrera, Eva Luyufeng Yáñez-Izquierdo, Carlos Enrique Adán-Failde, Juan Manuel Vázquez-Lago
Background/Objectives: Nutrition is an important component of disease prevention and clinical care, yet nutrition training in medical education is often limited and may not adequately prepare future physicians for dietary counselling. Valid assessment tools are therefore needed to identify specific educational gaps and guide curriculum improvement. Unlike general nutrition knowledge instruments, the present questionnaire was specifically developed for medical students and integrates factual nutrition knowledge, applied food composition knowledge, and dietary habits within a multidimensional assessment framework. This study aimed to develop and preliminarily validate a multidimensional questionnaire assessing nutrition knowledge, food composition knowledge, and dietary habits in medical students. Methods: A cross-sectional psychometric validation study with a mixed-methods approach was conducted at the University of Santiago de Compostela, Spain. The instrument was developed by the research team using the revised General Nutrition Knowledge Questionnaire by Kliemann et al. as a conceptual reference and was subsequently adapted to the educational context and expected baseline knowledge of medical students. Face validity was examined through student focus groups, and content validity was established by an expert panel. The initial questionnaire included 61 analyzable items across three domains. Internal consistency was evaluated using Cronbach's alpha, construct validity by exploratory factor analysis with Promax rotation, and sensitivity analysis was performed to refine the scale. Results: A total of 150 medical students from all six academic years participated (mean age 21.26 years). The initial instrument showed high overall internal consistency with a Cronbach's alpha = 0.824. After excluding 15 low-performing items, the final 46-item version demonstrated improved reliability (alpha = 0.849). Domain-specific reliability was moderate for general nutrition knowledge (alpha = 0.632) and acceptable for food composition knowledge (alpha = 0.751) and dietary habits (alpha = 0.776). The revised structure produced interpretable components with potential utility for educational diagnosis. Conclusions: The refined questionnaire showed preliminary psychometric validity as a multidimensional assessment tool for medical students. Its potential value lies in providing a framework for future assessment of nutrition-related educational needs rather than in directly producing curricular or behavioral change. Independent multicenter and cross-cultural validation is required before broader use can be recommended.
Nutrition bulletinKashfia Farah Promy, Nick Smith, Louise Bennett, Warren McNabb, Margaret Murray
Information about the dietary intake of the Australian population is vital for informing nutrition policies; however, national dietary surveys are not frequently conducted, with the most recent data for Australia, at the time of analysis, collected in 2011-2013. Food supply data, from Food Balance Sheets (FBS), is updated annually, with data for Australia available for 2010 to 2022. This study compared nutrient intake data from the 2011-2013 Australian Health Survey with nutrient supply data (2011-2013) calculated from FBS, to determine whether nutrient supply data may be used as a surrogate measure of population nutrient intake to complement infrequent nationally representative dietary surveys. Relative nutrient intake and relative nutrient supply were calculated as a percentage of the target nutrient intake value per person, per day. The nutrient supply data were adjusted for consumer food waste, which is not taken into consideration in the FBS. Relative nutrient intake and unadjusted relative nutrient supply were statistically comparable (p > 0.002) for 10 out of 23 nutrients. This increased to 12 out of 23 nutrients when the supply data was adjusted for consumer food waste. Nutrient supply and nutrient intake were comparable for some, but not all, nutrients, and adjusting the supply data for consumer food waste increased the number of nutrients for which supply was comparable with intake. Therefore, national nutrient supply data may be a useful surrogate measure for national nutrient intake for some, but not all, nutrients. These two datasets can complement one another but should not be used interchangeably.
NutrientsAlexandru Mischie, Viorel Jinga, Aniela-Roxana Nodiți-Cuc, Ramona Amina Popovici, Diana Marian, Gabriela Elena Strete, Andreea Mihaela Kis, Alexandra Enache, L…
BACKGROUND/OBJECTIVES: Disordered eating behaviours are increasingly common among young adults, yet nutrition-focused, region-specific data from Romania and Central and Eastern Europe (CEE) remain scarce. We characterised nutritional patterns, weight-control practices, disordered-eating indicators, body image, and psychosocial factors among Romanian young adults and tested how these differed across body mass index (BMI) categories. METHODS: In a cross-sectional online survey (March-April 2026), 753 Romanian adults aged 18-30 years (93.5% female) completed a 30-item questionnaire. Self-reported anthropometric measurements were classified using WHO BMI cutoffs. Prevalences (with Wilson 95% confidence intervals [CIs]) were compared across BMI categories using the chi-square test, and multivariable logistic regression, adjusted for age and sex, estimated odds ratios (ORs). RESULTS: Most participants were normal weight (59.1%); 11.6% were underweight, 29.3% were overweight or obese, and 86.3% were omnivorous. Dietary restriction (57.4%) and physical exercise (46.7%) were the leading weight-control methods; self-induced vomiting (6.4%) and medication (4.5%) were less frequent. Lifetime compulsive/emotional eating was reported by 50.1%, current stress-related eating by 49.1%, and guilt after eating by 66.1%. Lifetime night eating reached 31.9% (current, 12.9%). Body dissatisfaction (36.1% "not at all satisfied"), difficulty looking in the mirror (66.7%) and self-reported stress (82.2%) were widespread. In adjusted models, dietary restriction, emotional eating and guilt after eating rose steeply and monotonically with BMI (overweight/obesity vs. normal weight: aOR 2.34, 2.49 and 2.73, respectively; all p < 0.001), whereas current night eating and frequent self-weighing did not differ across BMI categories (p = 0.92 and p = 0.82). Dietary restriction increased from 24.1% in underweight to 55.5% in normal-weight and 74.2% in overweight/obesity participants; corresponding gradients were also observed for emotional eating and food-related guilt. CONCLUSIONS: In this predominantly female, largely urban online convenience sample of Romanian young adults, self-reported behavioural risk indicators related to disordered eating were common. Restriction, emotional eating and food-related guilt increased with BMI, whereas night eating and self-weighing showed no clear BMI gradient. These findings should be interpreted cautiously and should not be generalised to Romanian young men or rural populations without confirmation in more representative samples.
Frontiers in nutritionYongkang Hou, Aocheng Zhou, Junqing Xu, Shaopeng Che
BACKGROUND: Front-of-package labeling (FoPL) has been increasingly implemented as a public health nutrition strategy to promote healthier dietary choices and reduce the burden of diet-related chronic diseases. However, the effectiveness of different FoPL formats and the cognitive pathways associated with consumers' food perceptions and choices remain unclear. This study aimed to examine how different FoPL types influence consumers' health perceptions, food choices, and cognitive pathway patterns. METHODS: Two experimental studies were conducted. Study 1 employed a 2 × 2 between-subjects online experiment comparing FoPL type (summary vs. nutrient-specific) and color coding (absent vs. present) among 237 participants. Two-way ANCOVA was used to examine the effects of FoPL design on health perception changes and food choice changes while controlling for health food interest and functional health literacy. Study 2 expanded the stimuli to multiple low-health food categories and compared three experimental conditions among 138 participants: a Health Star Rating summary label, a Multiple Traffic Light-style color-coded nutrient-specific label, and a No-FoPL control condition. Partial least squares structural equation modeling (PLS-SEM) was used to examine indirect associations involving nutrition accuracy, food health perception, and intentions to purchase low-health foods. RESULTS: In Study 1, a significant interaction effect between FoPL type and color coding was observed for health perception changes (F = 11.08, p < 0.001). Specifically, nutrient-specific labels with color coding generated significantly higher perceived healthfulness than nutrient-specific labels without color coding. However, no significant main or interaction effects were found for food choice changes. In Study 2, the summary-label condition showed a significant indirect association with lower intentions to purchase low-health foods through food health perception (β = -0.326, p = 0.028). In contrast, the color-coded nutrient-specific-label condition showed a significant sequential indirect association involving nutrition accuracy and food health perception (β = -0.119, p = 0.044). The two models explained substantial variance in intentions to purchase low-health foods, with R2 values of 0.504 for the summary-label model and 0.404 for the nutrient-specific-label model. CONCLUSION: Different FoPL designs were associated with distinct cognitive pathway patterns. Summary labels were more closely linked to food health perception, whereas nutrient-specific labels, especially when combined with color coding, were linked to nutrition accuracy and subsequent health perception. These findings provide practical implications for optimizing FoPL policies and designing more effective nutrition communication strategies to promote healthier dietary behaviors.
INTRODUCTION: This systematic review and meta-analysis aimed to evaluate the effects of nutritional interventions during pregnancy on maternal and neonatal outcomes. METHODS: The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered in PROSPERO (CRD42024528918). Randomized controlled trials published between 2014 and 2024 were identified through systematic searches conducted between May and July 2024. Methodological quality was assessed using the Revised Cochrane Risk of Bias tool, version 2, and the certainty of evidence was rated with Grading of Recommendations Assessment, Development and Evaluation. Pooled estimates were calculated using a random-effects model. RESULTS: Twenty-three trials involving 9389 participants were included. Nutritional interventions significantly increased birth weight within healthy limits and reduced the risks of low birth weight, small for gestational age, preterm birth, and gestational diabetes mellitus. No significant effects were observed for macrosomia, large for gestational age, birth length, head circumference, gestational hypertension, preeclampsia, maternal anemia, cesarean birth, or neonatal intensive care unit admission. Subgroup analyses showed stronger effects for personalized counseling, interventions with 4 or more sessions, and programs including food supply. DISCUSSION: Nutritional interventions during pregnancy are crucial for reducing major adverse outcomes such as gestational diabetes mellitus and preterm birth. Integrating structured nutritional counseling into antenatal care may contribute to improved population-level maternal and child health.
BMC public healthDominic Bassah, Emilie McClintic, Amy R Sharn, Suela Sulo, Erick Agure, Grace Wothaya Kihagi, Erick M O Muok, Oscar Kambona Ayoma, Ina Danquah, Raissa Sorgho
BACKGROUND: In many remote and low-resource regions, standard methods for assessing the nutritional status of children are hindered by inadequate access to equipment, inaccurate equipment, high costs of screening, and under-resourced health facilities for malnutrition risk screening. Mid-upper arm circumference (MUAC) is a relatively simple, inexpensive, and established method for malnutrition risk screening in children, but monitoring of nutritional risk status over time can be challenging. MUAC tapes that instantly display age-specific MUAC z-scores in addition to absolute MUAC have become available. However, there are limited studies exploring the penetration and adoption of MUAC z-score tapes' use and implementation by community health volunteers (CHVs) in community settings. METHODS: As part of the ALIMUS cluster-randomized controlled trial, 15 CHVs were trained on the use of MUAC z-score tapes. The CHVs then applied the tapes during routine home visits to screen for malnutrition risk among children < 5 years of age living in Siaya County, Kenya. The study comprised 4 screenings over 1 year at 2-3 month intervals. The proportions of executed MUAC z-score screenings and nutritional risk status at each home visit were determined. RESULTS: Of the 575 children (mean age, 15 months; SD, 5.08 months at enrollment) from 575 households, at least 85% (488/575) were screened using the MUAC z-score tape during each of the 4 screening periods. The overall proportion of malnutrition risk (overnutrition and undernutrition) declined from 18.2% in the first round to 14.1% in the fourth round of screening, increasing the proportion with normal nutritional status from 82% to 86%. Among the 451 children who completed all four screenings, 12% improved their nutritional risk status, while 7% experienced a deterioration in nutritional risk status. CONCLUSIONS: MUAC z-score tapes were repeatedly applied for nutrition risk screening in the ALIMUS study, supporting the penetration and adoption of their use by CHVs working in remote and low-resource community settings. TRIAL REGISTRATION: German Clinical Trials Register (DRKS) DRKS00019076. Registered on 27 July 2021.
Annals of nutrition & metabolismSedat Arslan, Merve Kiyar, İpek Akyüz, Oumaima Afailal, Rumeysa Nur Sari, Moutessim Hassan Zİber, Ayça Aydin
BACKGROUND: Carrageenan, a sulfated polysaccharide extracted from red seaweeds, is widely used in the food, pharmaceutical, and cosmetic industries due to its gelling, thickening, and stabilizing properties. SUMMARY: Its widespread use in the Western diet and processed foods has raised scientific interest regarding its health effects. Evidence remains contradictory: some studies report antioxidant, antiviral, antitumor, and immunomodulatory benefits, whereas others suggest potential adverse outcomes, including impaired glucose metabolism, intestinal inflammation, and immune dysregulation. These effects appear to depend on carrageenan type, molecular weight, purity, dosage, and host-related factors. Regulatory bodies such as the FDA and EFSA generally consider carrageenan safe, although concerns remain regarding infant formulas and long-term exposure. KEY MESSAGES: Carrageenan cannot be uniformly classified as beneficial or harmful. Its biological effects are context-specific, and further well-designed clinical and mechanistic studies are needed to clarify dose-response relationships, safety in vulnerable populations, and implications for industry and public health nutrition.
Public health nutritionPrecious Adade Duodu, Joshua Okyere, Ransford Akrong, Caroline Barker, Gill Waring, Warren Gillibrand
OBJECTIVE: To explore how key stakeholders contribute to dietary self-care support for adults with type 2 diabetes receiving outpatient care in diabetes clinics in the Ashanti Region of Ghana. DESIGN: Descriptive phenomenological study. Purposive sampling technique was used to recruit the participants. A total of 31 interviews were conducted using a semi-structured interview guide. Reflexive thematic analytical framework was followed to analyse the data. SETTING: Diabetes clinics in the Ashanti region of Ghana: Komfo Anokye Teaching Hospital, Manhyia District Hospital, Ejisu Government Hospital, and Juaben Government Hospital. PARTICIPANTS: healthcare providers, family caregivers, and officials of health directorates. RESULTS: Healthcare professionals contributed to dietary self-care by framing and interpreting dietary knowledge, offering psychological care and support, and preparing family caregivers for their caregiving responsibilities. Family caregivers supported adherence by providing emotional reinforcement and behavioural motivation, assuming responsibility for managing the daily realities of dietary self-care, and mobilising material and financial resources. Directors and officers at the health directorate contributed through supervision and quality control, and through capacity building. CONCLUSION: The study underscores a need for continuous professional development programmes for healthcare providers, equipping them with updated knowledge on dietary counselling, psychological support, and caregiver training. Additionally, the role of health directorates in supervising healthcare facilities and facilitating training programmes underscores the importance of strengthening institutional frameworks that ensure adherence to evidence-based dietary guidelines. Furthermore, the study highlights a need for healthcare facilities to strengthen the recognition and formalisation of the role of family caregivers in diabetes self-care practices.
Climate change is increasing the frequency, intensity, and duration of heatwaves, making extreme heat a recurrent public health challenge with important nutritional implications. High ambient temperatures affect human health through thermoregulatory strain, sweating, dehydration, electrolyte imbalance, cardiovascular and renal stress, impaired cognitive and physical performance, and exacerbation of chronic diseases. Diet and hydration may therefore represent modifiable, although still underinvestigated, components of heat-health prevention. This narrative review synthesizes evidence on hydration, electrolyte balance, meal composition, dietary quality, vulnerable populations, Mediterranean dietary patterns, seasonality, environmental sustainability, and public health strategies for reducing heat-related health risks. Evidence from climate-health research, physiology, nutrition science, occupational and sports medicine, geriatrics, pediatrics, and public health guidance was integrated. Particular attention was given to distinguishing direct heat-health evidence from recommendations based on indirect evidence, physiological plausibility, or expert consensus. Regular water intake, water-rich foods, avoidance of alcohol, moderation of sugar-sweetened beverages, and individualized electrolyte replacement during prolonged or intense sweating are supported by physiological rationale and public health guidance, although direct heatwave-specific intervention studies remain limited. Dietary recommendations should prioritize smaller, digestible, nutrient-dense meals that preserve nutritional adequacy while reducing unnecessary digestive and metabolic burden. However, evidence on meal size, macronutrient composition, and heat-related outcomes remains largely indirect. Vulnerable groups, including older adults, children, pregnant women, individuals with chronic diseases, outdoor workers, athletes, and socioeconomically disadvantaged populations, require tailored strategies. The Mediterranean diet may provide a useful regional model because it emphasizes seasonal plant foods, fruits and vegetables with high water content, legumes, whole grains, olive oil, culinary simplicity, and environmental sustainability; however, its specific role in heat adaptation requires further study. Integrating nutrition and hydration into heat-health action plans may improve preparedness and support climate-resilient food systems. Future studies should evaluate hydration protocols, meal patterns, Mediterranean diet adherence, biomarkers of nutritional heat resilience, and nutrition-sensitive interventions in real-world heat exposure settings.
Frontiers in nutritionWance Wang, Lei Yan, Bowen Xu, Xiangwei Pang, Qianqian Li, Ke Chen, Renkai Ge
BACKGROUND: Childhood overweight and obesity are pressing global health challenges with rising prevalence in China. Shandong Province, as a populous and economically developed region, provides a critical context for understanding regional patterns and determinants. METHODS: A cross-sectional survey was conducted among 83,436 children aged 9-12 years from 155 schools in 16 cities (September-November 2025). Anthropometric measurements and validated questionnaires were used to assess weight status, demographics, family environment, and lifestyle factors. Overweight/obesity was classified using International Obesity Task Force (IOTF) cut-offs. Logistic regression identified associated risk and protective factors. RESULTS: The prevalence of overweight/obesity was 19.0%. Rates were higher in boys than girls (19.9% vs. 18.2%, p < 0.001) and increased with age (11-year-olds 20.4% vs. 9-year-olds 18.0%, p < 0.001). Urban children had slightly higher prevalence than rural peers (19.6% vs. 18.7%, p = 0.002). Factors independently associated with overweight/obesity included parental overweight/obesity (OR = 1.18, 95% CI: 1.10-1.26), maternal gestational diabetes (OR = 1.53, 95% CI: 1.36-1.71), and high birth weight (OR = 1.16, 95% CI: 1.09-1.24). Lifestyle behaviors were strongly associated: <1 h/day physical activity increased risk, while >1.5 h/day was protective (OR = 0.83, 95% CI: 0.79-0.87); >8 h sleep reduced risk (OR = 0.66, 95% CI: 0.60-0.72); >3 h/day screen time (OR = 1.10, 95% CI: 1.02-1.20) and >3 h/day homework (OR = 1.49, 95% CI: 1.38-1.62) elevated risk; frequent fruit/vegetable intake was protective, whereas fast-food consumption >3 times/week increased risk (OR = 1.12, 95% CI: 1.05-1.20). CONCLUSION: Childhood overweight/obesity in Shandong Province is influenced by demographic, familial, and lifestyle factors. Findings highlight the importance of multilevel interventions-targeting family health behaviors, maternal metabolic management, school-based physical activity promotion, and community nutrition policies-to curb the rising burden of obesity.
Journal of nutrition education and behaviorKatherine E Soule, Cassandra J Nguyen
OBJECTIVE: To assess nutrition educators' perceptions of community nutrition education programs' capacity to address the needs of neurodivergent and physically disabled program participants. METHODS: Personnel with nutrition education programs in California participated in a cross-sectional multimethod study. Measured variables included agreement with the current capacity, future needs, and personal competence in providing programming for neurodivergent and physically disabled program participants. Open-answer items provided an opportunity to contribute qualitative contextualizing comments. Quantitative items were summarized, and qualitative data were analyzed with a basic inductive content approach. RESULTS: A total of 60 individuals responded to the survey. Perceptions about current capacity and competence to provide programming varied across population groups. Approximately half of the respondents felt programming was inclusive for both population groups. Simultaneously, more than 85% felt that programming should be more inclusive for both population groups. Cross-cutting qualitative comments were organized into 3 themes: (1) risk awareness and mitigation, (2) training for nutrition education personnel, and (3) nutrition education program improvements. CONCLUSIONS AND IMPLICATIONS: Nutrition education personnel perceived gaps in the program capacity for neurodivergent and physically disabled participants. Training for nutrition education personnel, curricula development, program delivery, and evaluation improvements represent the primary opportunities identified by participants to increase program accessibility for these populations.
Journal of human nutrition and dietetics : the official journal of the British Dietetic AssociationKrystal L Hodge, Caitlin Kownacki, Kaitlyn Streitmatter, Rebecca L Hagedorn-Hatfield, Karah Mantinan, Jennifer McCaffrey
BACKGROUND: As community nutrition education programs have expanded to include policy, systems, and environmental (PSE) initiatives to increase access to nutritious food and safe physical activity, the impact of these efforts on the consumption of healthier foods and physical activity levels is not clear. Research shows the effectiveness of PSE changes on individual-level behavior in controlled environments and in other public health disciplines. However, more evidence and guidance is needed to show the impact of PSE interventions in practice on individual-level nutrition and physical activity behaviors. The PSE Intervention and Evaluation Framework (PSE-IEF) was developed to explain the process by which implemented PSE activities may result in behavior changes within the priority audience. METHODS: Framework development involved a review and Theory of Change mapping process of a list of PSE changes used in the Supplemental Nutrition Assistance Program- Education (SNAP-Ed) Program, an environmental literature scan to identify relevant theories and related factors, and an expert review. The environmental scan examined how PSE changes are conceptualized as drivers of behavior change and how their impacts are measured at the individual level. Sources were identified through database searches, grey literature review, and citation tracking, with inclusion limited to U.S.-based, English-language documents published in the past 10 years. Twelve frameworks or theories were reviewed for their focus on individual behavior, ability to capture behavior change over time, and recognition of individual choice in when or whether change occurs. The PSE changes theory of change mapping results were reviewed for alignment with the selected framework and applied to a logic model for PSE implementers. Forty-five practitioners reviewed the framework for relevance, comprehensiveness, and comprehensibility, with revisions made iteratively until no substantial changes to structure or content were received. RESULTS: The final PSE-IEF describes how PSE programs are implemented at the organizational level and how they might impact the target audience at the individual level. To see outcomes at the individual level, organizational level activities must be completed, including staff awareness, engagement, action and maintenance activities to produce PSE outputs available for target audience use. Precaution Adoption Process Model stages of awareness, engagement, decision, action, and maintenance describe the responses at both the organizational and individual level over time. CONCLUSIONS: The resultant framework can be used to guide PSE intervention and evaluation in community-based programs and to increase the evidence base illustrating the impact of PSE interventions on individual behavior and health.
Journal of nutritional scienceJ Alfredo Martínez, Jacques Delarue
This special issue of the JNS presents a selection of abstracts and outputs from the 23rd edition of the IUNS International Congress of Nutrition (IUNS-ICN Paris 2025), held in Paris from 24 to 29 August 2025. The Congress, themed 'Sustainable Food for Global Health', brought together students, researchers, academics, practitioners, and policy stakeholders from across the globe to share advances in nutritional science and address contemporary challenges in nutrition and health. A total of 3,805 delegates from 123 countries participated. This wide international participation reflected the global nature of the IUNS-ICN Paris 2025 and supported the exchange of perspectives across all areas of nutritional science.
Food insecurity among international graduate students in the United States is a nutrition equity challenge that remains largely unaddressed by the nutrition science community. Prevalence estimates range from 22% to 46% across institutions, substantially exceeding the national household average, driven by converging financial constraints, restricted employment opportunities, and limited access to culturally appropriate foods. These conditions promote rapid dietary acculturation toward energy-dense, low-nutrient food patterns with well-established associations with insulin resistance, hypertension, and cardiometabolic risk. Despite a growing empirical base, longitudinal evidence on dietary quality and health outcomes in this population is virtually absent, and university nutrition support systems are poorly adapted to the cultural dietary needs of an internationally diverse student body. This commentary calls on nutrition researchers, dietitians, and universities to recognize food insecurity among international graduate students as a substantive public health nutrition concern warranting targeted research and culturally responsive institutional action.
Indian journal of ophthalmologySheeladevi Sethu, Bhavesh Sharma, Shalinder Sabherwal, Kamna Shroff, Shivani Saini, Parvindra Tyagi, Suma Ganesh, Rishi Borah
PURPOSE: Understanding parental and community perceptions is crucial for designing context-specific interventions that enhance awareness, promote timely care-seeking, and reduce avoidable childhood visual impairment. This study explored awareness and perceptions of child eye health among parents and community stakeholders in rural Uttar Pradesh, India. METHODS: In-depth interviews were conducted with five key stakeholder groups engaged in community eye health: Parents, Anganwadi (community nutrition center) workers, community eye health workers, schoolteachers, and vision technicians from vision centers. The interviews aimed to capture stakeholder perspectives on barriers and enablers related to accessing and delivering children's eye health services. All interviews were conducted in the local language, audio-recorded, transcribed, and thematically analyzed using the theoretical domains framework (TDF), which integrates multiple behavioral theories. RESULTS: The analysis identified three TDF domains as major barriers common across stakeholder groups: Social influences , Knowledge , and Environmental context and resources . Reported enablers fell within three domains- Knowledge , Environmental context and resources , and Behavioral regulation -reflecting the importance of community awareness, availability of services, and consistent follow-up practices. This comprehensive application of the TDF provided valuable insights into how behavioral, social, and contextual factors shape community responses to childhood eye health. CONCLUSION: The findings underscore that improving pediatric eye care requires not only expanding service delivery and outreach programs but also addressing community attitudes, beliefs, and emotional engagement. Sustainable progress in childhood eye health will depend on strategies that simultaneously strengthen healthcare provision and transform social norms and understanding within the community.
Journal of primary care & community healthOscar H Del Brutto, Denisse A Rumbea, Carlos Ríos, Emilio E Arias, Robertino M Mera
ObjectivesMicrovascular health is increasingly recognized as a determinant of functional aging and cardiometabolic risk in aging populations. Marine omega-3 polyunsaturated fatty acids (ω-3 PUFAs), primarily obtained from oily fish, have endothelial-stabilizing and anti-inflammatory properties that may preserve microvascular structure. This pilot cross-sectional study evaluated whether habitual oily fish intake - a modifiable dietary behavior relevant to primary care and public health - is associated with microvascular integrity in older adults.MethodsIn this community-based study, 306 older adults underwent high-resolution nailfold capillaroscopy (NFC). Images were analyzed using AI-assisted quantification with expert validation to assess capillary morphology and density. Dietary exposure was estimated from five consecutive annual surveys to capture habitual oily fish intake patterns. Multivariable linear models adjusted for demographics and cardiovascular risk factors examined associations between tertiles of oily fish intake and NFC parameters.ResultsHigher oily fish intake was independently associated with fewer tortuous capillaries (β: -1.74; 95% CI: -2.01 to -0.74), fewer dilated capillaries (β: -2.69; 95% CI: -5.27 to -0.11), and greater capillary density (β: 0.43; 95% CI: 0.07 to 0.78). Associations remained robust after adjustment for lifestyle and vascular risk factors.ConclusionSustained consumption of oily fish was associated with fewer structural microvascular abnormalities. Given the pilot nature of this study, these hypothesis-generating findings will guide a planned longitudinal follow-up to determine whether oily fish intake influences the progression of microvascular damage. Insights from this work may help shape dietary counseling strategies in primary care aimed at supporting microvascular health in older adults.
Frontiers in nutritionWolfgang Huber-Schneider, Karl-Heinz Wagner, Ingrid Kiefer
BACKGROUND: Vegan diets during pregnancy are commonly discussed regarding nutritional risks, often without differentiating between heterogeneous vegan populations. Empirical evidence on clearly defined subgroups who maintain a vegan diet throughout pregnancy remains scarce. OBJECTIVES: This study characterized a highly selected subgroup of pregnant women adhering to a vegan diet, focusing on supplement use, information sources, counseling experiences, and perceived risks of micronutrient deficiency and overdosing. METHODS: An explorative, cross-sectional online survey was conducted as part of the Vegan Diet and Dietary Supplements Study (VedieS). The questionnaire was developed from a scientific literature review, pilot-tested, and distributed via vegan, nutrition-related, and health-focused organizations and social media across German-speaking regions. Individuals adhering to a vegan diet (defined as a strictly plant-based diet excluding all animal-derived products) participated. The analysis was restricted to those reporting a vegan diet during at least one pregnancy. Supplement use, information seeking, and counseling adequacy were analyzed descriptively. RESULTS: In total, 801 individuals participated. Participants were highly educated and predominantly from urban areas (76.3% tertiary education; 79.6% urban). Adherence during pregnancy was largely consistent (90.5%), and supplement use was nearly universal (99.1%) with high compliance (79.1%), targeting micronutrients critical in vegan pregnancies, including vitamin B12 (77.8%), omega-3 fatty acids (76.9%), folic acid (73.8%), and vitamin D (67.8%). Scientific literature, self-identified by participants, was the primary information source (80.3%), whereas professional counseling was less frequent and often perceived as insufficient. Although 74.7% informed their gynecologist, only 16.1% reported comprehensive counseling. Despite high motivation and self-directed information seeking, considerable uncertainty persisted regarding micronutrient dosage, particularly overdosing, with 40.4% perceiving dosage guidance as insufficient. External influences, including the social environment (46.3%) and physicians (34.2%), were relevant sources of uncertainty. CONCLUSION: Rather than a uniformly high-risk population, pregnant individuals following a vegan diet represent a highly informed and responsible subgroup whose main challenges relate less to dietary behavior than to structural gaps in professional counseling and access to consistent, evidence-based supplementation guidance. These findings underline the public health relevance of expanding nutrition training and counseling capacities among healthcare professionals and the need for clinical research using objective measures of nutritional status in vegan pregnancies.
Proceedings of the National Academy of Sciences of the United States of AmericaMengyi Dong, Thomas Joseph Clerkin, Sharon Jiang, Nolan Ives, Olivia W Osborne, Michelle Kirtley, Anna E Bauer, Katherine Y Anderson, Martin D Smith, Rachel T …
Public health nutrition lacks scalable, objective tools for real-time dietary surveillance. We developed FoodSeq-FLOW (Food Landscape Observation in Wastewater), a genomic platform that sequences chloroplast trnL and mitochondrial 12SV5 DNA in municipal wastewater. Across 183 samples from 21 North Carolina wastewater treatment plants serving 2.1 million people, we detected 184 plant and 116 animal food taxa at a cost of <US $0.01 per person. Wastewater-derived dietary profiles correlated with paired individual stool dietary data (Spearman ρ = 0.64), and 98% of animal-derived sequences mapped to known food taxa. Temporal sampling revealed seasonal shifts in food taxa consistent with regional food availability patterns. Spatial analysis revealed community-level dietary signatures associated with per capita income and education, beer ingredient abundance with discretionary income, tropical fruits and pulses with foreign-born population size, and local seafood with coastal geography. FoodSeq-FLOW extends wastewater-based epidemiology from pathogens to diet, providing a scalable platform that existing global wastewater surveillance networks can deploy to inform nutrition policy and market analytics.
Current developments in nutritionFanny Salesse, Rebecca Finlay, Samara Jones, Alison L Eldridge, Eileen R Gibney
BACKGROUND: Shifting to more sustainable diets can reduce environmental impact and improve population health. Food-based dietary guidelines (FBDGs) offer an opportunity to incorporate sustainability into nutritional recommendations. OBJECTIVES: This study primarily examined the inclusion of environmental sustainability messaging across European FBDGs. A secondary analysis assessed how such messaging was associated with recommendations for 2 key food groups relevant to the transition toward sustainable healthy diets, namely meats and pulses. METHODS: Three FBDG document types were reviewed: consumer-facing guidelines, resources for health care professionals, and scientific background reports. Eighteen sustainability criteria derived from Food and Agriculture Organization/World Health Organization (FAO/WHO) and the British Dietetic Association's recommendations were examined. Criteria were coded as explicitly linked to sustainability, included without sustainability reference, or missing. Recommended daily intakes for total, red and processed meat, and pulses were extracted from consumer-facing documents where available. RESULTS: FBDGs from 36 countries were analyzed. Guidelines referencing sustainability were generally more recently published, with explicit sustainability messaging most commonly found in scientific background documents. Across document types, criteria related to reducing animal-based foods, increasing plant-based foods, and minimizing environmental impact were most frequently included. Guidance related to locally produced or seasonal foods was included in consumer-facing materials, whereas recommendations regarding food waste were rarely mentioned. FBDGs that included messages promoting plant-based foods generally recommended lower meat and higher pulse intakes, although trends between messages and recommended amounts were not always consistent. For example, messages related to reducing animal foods, animal protein, or red meat were not consistently associated with lower recommended intakes of total meat. However, FBDGs specifically addressing red or processed meat intake generally recommended lower red and processed meat consumption and higher pulse intakes. CONCLUSIONS: Overall, European FBDGs increasingly incorporate environmental sustainability, but gaps remain. Consumer-facing guidance remains largely health-focused. Greater coherence is needed in the translation of sustainability principles into FBDGs.
The Journal of nutritionRosanne Blanchet, Natalie Doan, Sara Nejatinamini, Camilo E Valderrama, David Hammond, Lana Vanderlee, Dana Lee Olstad
BACKGROUND: Suboptimal diet quality contributes to poor health. Numerous factors at all levels of the socioecological model intersect to influence individuals' diet quality. A precision public health nutrition framework can be used to understand how these factors jointly shape diet quality across several subgroups in the population. This is, however, very challenging to operationalize. OBJECTIVE: The purpose of this study was to assess whether machine learning can be leveraged to operationalize a precision public health nutrition approach by more precisely identifying subgroups with the highest proportion of adults with poor diet quality and the most important predictors of diet quality. METHODS: We conducted a secondary analysis of cross-sectional data from the 2018 and 2019 International Food Policy Study in Canada (n=5,093). A total of 42 candidate predictors within four domains (sociodemographic characteristics and socioeconomic position; food policies and environments; food literacy; health-related practices and indicators) were used. The Healthy Eating Index-2015 (HEI-2015) was used to assess diet quality; tertiles of HEI-2015 scores were defined as the outcome. Conditional inference tree (CIT) and conditional random forest (CRF) analyses were conducted. RESULTS: The CIT partitioned the sample into seven subgroups with different proportions of adults with lower, moderate or higher diet quality using six predictors. The probability of lower diet quality ranged from 16.9% to 49.9% across subgroups. The subgroup with the highest proportion of adults with lower diet quality was characterised by individuals confident in using ≤4 cooking techniques. Based on the CRF model and conditional variable importance, the five most important predictors of diet quality in were: frequency of food label use, confidence in using cooking techniques, perceived general health, household food insecurity status, and health literacy. CONCLUSIONS: This study provides evidence that machine learning approaches can be leveraged to operationalize a precision public health nutrition approach.
Journal of medical Internet researchChang Ying Li, Zhen Zhu Jiao, Li Qin Zhang, Hang Li, Meng Yao Wang, Wen Hui Guo, Yu Xin Wang, Yang Wang
BACKGROUND: Just-in-time adaptive interventions (JITAIs) use real-time data to deliver personalized support at moments of heightened need and may improve dietary behaviors in real-world settings. OBJECTIVE: The aim of this study is to systematically review the application, characteristics, and effectiveness of JITAIs in dietary health management. METHODS: We included human studies evaluating JITAIs-based dietary interventions delivered through digital platforms that used real-time or near-real-time data to tailor intervention content, timing, or intensity. Eligible studies reported at least one behavioral, engagement, physiological, or clinical outcome; reviews, protocols, editorials, commentaries, and studies without outcome data were excluded. We searched PubMed, Embase, Scopus, CINAHL, Web of Science, ClinicalTrials.gov, WHO ICTRP (International Clinical Trials Registry Platform), and ISRCTN (International Standard Randomized Controlled Trial Number) from inception. The initial search was conducted on August 20, 2025, and updated on March 16, 2026; reference lists were also screened manually. Two reviewers independently screened studies and extracted data. Methodological quality was assessed using the 2018 Mixed Methods Appraisal Tool, and reporting quality was assessed using the Mobile Health Evidence Reporting and Assessment checklist. Because of substantial heterogeneity, findings were synthesized narratively. The review was registered in PROSPERO (International Prospective Register of Systematic Reviews; CRD420261285292). RESULTS: Twenty studies involving 2948 participants were included. Target populations comprised individuals with overweight or obesity, chronic conditions, and eating disorders and the general population engaged in dietary management. Interventions were mainly delivered via smartphone apps, SMS text messaging, wearable-device feedback, and context-triggered notifications. More consistent benefits were observed for proximal behavioral and process outcomes, including fruit and vegetable intake, sodium-restriction behaviors, drinking automaticity, self-monitoring, eating-related behaviors, and responsiveness to prompts. Some studies also reported improvements in distal clinical outcomes, such as body weight, BMI, waist circumference, blood pressure, blood glucose, and selected biochemical indicators. However, these findings were inconsistent, and most studies did not show clear between-group advantages. Common implementation barriers included device incompatibility, variability in digital literacy, geolocation or signal limitations, and burden from frequent prompts. CONCLUSIONS: JITAIs-based dietary interventions appear promising for supporting timely and individualized dietary behavior change, particularly for proximal behavioral outcomes, although evidence for sustained clinical effects remains inconsistent. This review contributes to the JITAIs literature by examining dietary health management as a distinct application domain and by synthesizing evidence that has otherwise been dispersed across broader reviews of digital behavior change and weight management. By integrating intervention characteristics, delivery approaches, triggering mechanisms, and effects across diverse populations, it clarifies methodological and implementation gaps and informs more standardized intervention design and reporting. These findings support the development of scalable, context-sensitive digital dietary interventions for clinical care, chronic disease self-management, weight management, and public health nutrition.
Journal of nutrition education and behaviorAmanda Elkins, Reuby Staviss, Vishnudas Sarda, Lana Vanderlee, David Hammond, S Bryn Austin, Amanda Raffoul
OBJECTIVE: Examine relationships between self-reported nutrition knowledge, seeking nutrition information online, and disordered eating. METHODS: Cross-sectional data were drawn from online surveys in 2021 among adults from Australia, Canada, Mexico, the United Kingdom, and the United States (N = 21,138). Adjusted logistic models generated odds ratios to assess relationships between self-reported nutrition knowledge (ordinal) and online sources of nutrition information (dichotomous) with disordered eating. RESULTS: Higher self-reported nutrition knowledge was associated with elevated odds of binge eating, preoccupation with thinness, and self-induced vomiting. Seeking nutrition information online was associated with higher odds of binge eating in Australia and Mexico; lower odds of self-induced vomiting in Australia, Canada, Mexico, and the United States; and higher odds of preoccupation with thinness in Canada, the United Kingdom, and the United States. CONCLUSIONS AND IMPLICATIONS: Disordered eating is cross-sectionally associated with self-reported nutrition knowledge and seeking nutrition information from online sources. Results indicate a greater need for public health nutrition research and education.
BMC nutritionFrancine Sinzinkayo, Julien Soliba Manga, Jean-Claude Moubarac, Thomas Druetz
BACKGROUND: Non-communicable diseases (NCDs) are the leading cause of premature mortality in Africa, with Burundi facing a growing double burden of malnutrition effects: undernutrition and rising obesity rates. Despite recent policy efforts, including national strategies and increased health spending, the country's health system remains under-resourced and vulnerable to nutrition-related health challenges. OBJECTIVE: This study aimed to assess the extent of implementation of public policies aimed at creating healthy food environments in Burundi using the Food Environment Policy Index (Food-EPI), and to identify policy gaps and priorities for addressing the double burden of malnutrition. METHODS: From December 2022 to February 2024, the Healthy Food Environment Policy Index (Food-EPI) tool was used to benchmark 56 policy and infrastructure indicators against Good Practice Statements. Documentation was reviewed, and evidence was validated by a panel of 24 experts from government, academia, and civil society through two workshops. Experts scored the level of policy implementation using a five-point Likert scale and prioritized future actions based on importance, achievability, and effectiveness. RESULTS: Of the 56 indicators assessed, 27% were rated as "very little or no implementation" and 37% as "low implementation." Only 13% were rated as "high." Infrastructure support indicators generally scored higher than policy components. Thirteen indicators were not addressed in any existing policy documents. Experts identified 13 priority actions, seven of which aligned with WHO "double-duty actions." Inter-rater reliability was moderate (Gwet AC2 = 0.46). CONCLUSIONS: Significant policy gaps remain in Burundi's approach to improving food environments. There is an urgent need for comprehensive, multisectoral strategies to strengthen public health nutrition and reduce the impact of diet-related NCDs.