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 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.
Journal of nutritional scienceLeena Mohammad Ahmad, Nour Amin Elsahoryi, Omar Alhaj, Ola Al-Maseimi, Ahmad Al Athamneh, Fatena F Afaneh, Hana'a Khalaf, Ayman D Alsheikh, Qutaibah K Fraihat
This cross-sectional based market surveillance study examined the level of gluten contamination in commercially manufactured products labelled 'gluten-free' in Jordan and compared the results to the globally recognised 20 mg/kg gluten safety limit for people with coeliac disease and other gluten-related disorders. From August 2022 to November 2024, 182 goods from 25 different food categories were tested in retail locations in Jordan's main governorates. A validated monoclonal-based antibody-sandwich ELISA was used to determine the levels of gluten concentration, and a 95% CI was used to describe the prevalence of contamination. Overall, 47 of 182 products (25.8%; 95% CI: 19.7-32.6%) exceeded 20 mg/kg gluten. With maximum concentrations of 395.8 mg/kg, the highest non-compliance was found in rice-based goods (66.7%), milk products (50.0), and cookies (42.9). On the other hand, with the fact that several categories had rather small sample sizes, no violations were found in any of them. Jordan had a higher rate of contamination than a number of other places, including Europe (0.5%), India (10.8% of packaged items marketed as gluten-free), and Mexico (17.4%). The findings highlight clinically relevant issues with the quality of gluten-free products and support further monitoring, manufacturing supervision, and regulatory actions to better protect customers who depend on strict gluten avoidance guidelines.
The Proceedings of the Nutrition SocietyKaren E Charlton, Suzanne C Pickles, Katherine Kent
Food and nutrition insecurity in high‑income countries is increasingly persistent, driven by intersecting economic, social and environmental disruptions. In Australia, acute shocks such as the COVID‑19 pandemic, floods and bushfires, alongside chronic pressures including rising food prices, housing stress and concentrated corporate power, have exposed structural weaknesses in food access, governance and system resilience. This review examines how community‑led responses to food and nutrition insecurity function during disruption, whether they buffer short-term hardship or contribute to adaptive capacity and redistribution of agency. Guided by the six‑pillar food security framework and a socio-ecological model, responses are examined across household, community, organisational and governance levels. A continuum of responses is identified, ranging from downstream emergency food relief that buffers immediate hardship through to community and organisational food infrastructure that strengthens local resilience and governance‑level responses with greater transformative potential. Drawing on this synthesis, we propose the SEEDS (Socio-Ecological Enablers of Dietary Security) Model, which conceptualises how food system responses across socio-ecological levels and over time can progress from buffering (acute) to adaptation (medium‑term) and ultimately transformation (long‑term). Central to this framework is a shift in decision‑making power, accountability and participation. While many initiatives improve food access and short‑term stability during crises, the greatest potential for transformation lies where responses are embedded within governance structures, enable meaningful community participation and influence policy, procurement and resource allocation. Implications for public health nutrition practice include expanded roles in systems leadership, cross‑sector governance and advocacy for upstream policy reform.
Food and nutrition bulletinI Desak Ketut Dewi Satiawati Kurnianingsih
BackgroundEdible residues from Hindu offerings (lungsuran) may enter mixed waste streams despite retaining nutritional value. Although food rescue research has focused on household leftovers and supply-chain loss, less is known about how culturally governed norms and changing ritual economies shape post-ritual handling of edible offerings.ObjectiveTo examine how socio-religious norms, authority structures, and changing ritual economies shape lungsuran handling in urban Bali and identify culturally legitimate pathways for nutrition-sensitive recovery.MethodsWe conducted a qualitative study in Denpasar, Indonesia, from September to November 2025 using 20 in-depth interviews with key informants, 4 focus group discussions involving 40 participants, and structured observations across 8 household and temple ritual settings. Data were transcribed, coded, and analyzed thematically.ResultsParticipants described lungsuran as edible and blessed, yet discard occurred in both household and temple settings, especially after large or frequent ceremonies. Post-ritual handling was shaped by four interrelated mechanisms: ritual-temporal suitability, authority and ownership, social permission and hierarchy, and marketization with devotional abundance. Reuse was more likely when decision rights were clear, social permission was explicit, and sorting occurred within an acceptable safety window. In pooled temple settings, ownership ambiguity, reluctance to be seen taking food, and reliance on purchased offerings increased discard. Across settings, time, labor, containers, storage, and transport affected recovery.ConclusionsLungsuran is not ordinary leftover food but a culturally governed edible flow. Nutrition-sensitive recovery is more likely when it aligns with ritual timing, clarifies authority, reduces social hesitation, and integrates food safety into community governance.
Frontiers in public healthYu Wu, Zhengxiang Gao, Yu Gou, Lingyi Yan, Yifei Duan
BACKGROUND: Maternal nutritional status is considered essential for metabolic adaptation during pregnancy. Both malnutrition and obesity are associated with metabolic abnormalities; however, the link between these factors and metabolic syndrome (MetS) in pregnancy remains poorly studied from a public health perspective. AIM: The aim of the current study was to evaluate the association between nutritional status and the risk of metabolic syndrome in pregnant females. METHODS: In a retrospective observational study, data were collected from the medical records of 850 pregnant women from tertiary care hospitals between November 2023 and May 2025. Assessment of nutritional status was carried out using dietary and body mass index (BMI). MetS was diagnosed based on the presence of three or more metabolic conditions. Logistic regression was employed to identify significant risk factors, adjusting for various covariates. RESULTS: MetS was diagnosed in 24.7% of cases. Patients with MetS were found to have higher BMI, dietary calorie intake, fat, and sugar consumption, and lower fibre consumption (p < 0.001). Risk factors of MetS included poor nutritional habits (AOR = 2.45), insufficient fibre intake (AOR = 2.12), increased BMI (AOR = 2.76), and excessive dietary fat intake (AOR = 1.89). There appeared to be a dose-response effect between fibre intake and MetS. CONCLUSION: Nutrition status is significantly associated with the risk of MetS during pregnancy. Findings suggest that nutritional evaluation and intervention are important strategies in public health nutrition.
BACKGROUND/OBJECTIVES: Food insecurity remains a major public health challenge in Guamote Canton, Ecuador, particularly in areas characterized by high levels of poverty and limited educational attainment. This study examined the association between household income, educational level, and food insecurity in Guamote Canton. METHODS: A cross-sectional survey based on the Latin American and Caribbean Food Security Scale (ELCSA) was administered to 368 households, allowing food insecurity to be classified into four categories: food security, mild insecurity, moderate insecurity, and severe insecurity. An Ordinal Logistic model was applied to identify the socioeconomic factors associated with food insecurity. RESULTS: The results showed that household income and educational level were significantly associated with lower probabilities of food insecurity (β = -0.639, p = 0.001; β = -0.366, p = 0.008, respectively). Gender, Area of residence, and Access to nutrition information were also significantly associated with food insecurity. CONCLUSIONS: Households located in rural areas and those headed by women were more likely to experience moderate or severe food insecurity. Overall, the findings highlight the importance of improving income opportunities, educational attainment, and structural living conditions, which may contribute to lower levels of food insecurity.
Background/Objectives: Foods and beverages consumed during school lunch periods contribute substantially to children's dietary intake; however, Canadian evidence of their nutritional contribution and quality remains limited. This study assessed nutrient content, nutrient density, and contributions to dietary recommendations among Saskatchewan elementary students. Methods: A descriptive quantitative study was conducted among 379 students aged 5-13. Dietary intake during school lunch periods was assessed using a photography-assisted plate waste method. Nutrient content was estimated using standard nutrient databases, nutrient density was evaluated using the Nutrient-Rich Food (NRF) 9.3 Index, and contributions to dietary recommendations were examined. Results: Median lunch energy was 411.4 kcal (IQR: 296.7), and the mean NRF 9.3 score was 292.6 (SD: 130.7). Compared with home-packed and mixed lunches, school-provided lunches contained less energy, carbohydrate, fat, and sugar, while protein was similar across lunch types. Overall, lunches contributed <25% of daily requirements for key nutrients, including fibre, vitamin D, calcium, and potassium. Older students had lower proportional nutrient contributions relative to their higher nutritional requirements. Nutrient density differed by lunch provenance, but not by age or reported gender, with school-provided lunches achieving the highest NRF 9.3 scores. Conclusions: Lunches contributed modestly to daily nutrient requirements, particularly among older students. In this sample, school-provided lunches were associated with higher nutrient density than home-packed lunches, although their absolute contributions to several nutrients remained limited. These findings provide baseline evidence on lunches consumed during school lunch periods among Saskatchewan elementary students and may inform future evaluations of school food systems and policies.
Background/Objectives: Adults living alone are vulnerable to nutritional inadequacy and depressive symptoms; however, their combined influence remains poorly understood. This study examined the independent and joint associations of nutritional imbalance and oral functional limitation with depressive symptoms among adults living alone and explored potential indirect pathways involving metabolic syndrome (exploratory). Methods: This cross-sectional study used nationally representative data from the Korea National Health and Nutrition Examination Survey (KNHANES) 2022 and 2024, including 1572 adults aged ≥19 years living alone. Nutritional imbalance was assessed by the number of essential nutrients consumed below the Estimated Average Requirement (EAR; range 0-8). Oral functional limitation was defined as chewing or speaking difficulty. Depressive symptoms were evaluated using the Patient Health Questionnaire-9 (PHQ-9). Survey-weighted regression and bootstrapped indirect-effect analyses were performed. Results: Nutritional imbalance was associated with higher PHQ-9 scores (β = 0.216; 95% CI: 0.098-0.335). Oral functional limitation (β = 1.278; 95% CI: 0.739-1.816) and metabolic syndrome score (β = 0.156; 95% CI: 0.006-0.306) were independently associated with depressive severity. Participants with both high nutritional imbalance and oral functional limitation had substantially higher odds of clinical depression (PHQ-9 ≥ 10; OR = 4.268; 95% CI: 2.037-8.943) than the reference group. Exploratory analyses suggested that indirect effects via oral functional limitation and metabolic syndrome were directionally consistent but did not reach statistical significance. Conclusions: Nutritional imbalance and oral functional limitation were jointly associated with depressive symptoms among adults living alone. These findings highlight the importance of integrated strategies targeting dietary quality, oral health, and metabolic health in vulnerable single-person households.
BackgroundBody dysmorphic disorder (BDD) is a psychiatric condition that is not widely recognized, despite being prevalent worldwide. It involves obsessions related to one's physical appearance, and there is no appropriate screening tool for it in Turkey.AimThe aim is to adapt the Body Dysmorphic Disorder Screener (BDDS-5) for use in a Turkish cultural context, enabling the practical assessment of BDD.MethodsThis methodological study collected data between January and April 2025. The sample consisted of 405 young adults aged 19-29. Confirmatory factor analysis (CFA) was performed and examined using factor structure fit indices. Internal consistency was assessed using Cronbach's α coefficient, and the Eating Disorder Examination Questionnaire-13 (EDE-Q-13) was employed to evaluate convergent validity.ResultsAccording to the CFA results, the single-factor structure of the Turkish version of the BDDS-5 has been confirmed, and Cronbach's α has been determined as 0.88. A weak to moderate correlation was found between the EDE-Q-13 total score, the subfactors "shape and weight over-evaluation" and "body dissatisfaction," and the BDDS-5 total score.ConclusionThe BDDS-5 is a valid and reliable measurement tool that can be used to screen BDD in young adults. To the best of our knowledge, this is the first study in Turkey to adapt the BDDS-5 into Turkish, and the scale can serve as a valid and reliable guide for healthcare professionals and academic research.
Functional fermented foods are increasingly recognized in public health nutrition for their potential to reduce the burden of metabolic diseases through fermentation-derived bioactive biomolecules. Fermentation enhances the nutritional and functional properties of foods by generating peptides, short-chain fatty acids, organic acids, exopolysaccharides, enzymes, and transformed phytochemicals with antioxidant, anti-inflammatory, immunomodulatory, and metabolic regulatory activities. Despite growing interest, the biomolecular pathways linking these compounds to metabolic health, particularly through gut microbiota modulation, remain insufficiently clarified. This review focuses on representative functional fermented foods such as dairy, cereal, legume, vegetable, tea, and traditional mixed fermented foods and key fermentation-derived biomolecules, including bioactive peptides, short-chain fatty acids, polyphenols, exopolysaccharides and organic acids, with emphasis on their mechanistic roles in gut microbiota modulation and metabolic disease prevention. By linking biomolecular mechanisms with public health outcomes, it positions functional fermented foods as promising, sustainable tools for metabolic disease prevention and health promotion.
Implementation science communicationsKyung E Rhee, Sarah Hiller-Venegas, Clare Viglione, Michelle A Polich, Jeannie S Huang, Jane J Kim, Mandeep S Bajwa, Michelle Zive, Dawn M Eichen, David R Stro…
BACKGROUND: Food insecurity (FI) is associated with poorer physical and mental health outcomes, exacerbation of chronic diseases, and decreased access to healthcare. Children experiencing FI face additional risks, including lower psychosocial functioning and reduced academic achievement. Although national initiatives call for integrating nutrition support services into healthcare, clinical workflows for FI screening and referral remain inconsistently implemented and difficult to sustain. The goal of this study is to refine, adapt, and optimize a comprehensive FI screening and referral program, and identify effective implementation strategies for pediatric healthcare systems. METHODS: We will use a RollOut Implementation and Optimization (ROIO) trial design to iteratively implement and refine the implementation strategies for our FI screening and referral program (I-FRESH: Implementing Food Referrals for Equity and Sustained Health) across 4 pediatric clinics. I-FRESH includes: (1) FI screening; (2) assessment of family needs and readiness to access services; (3) referral and navigation support to community nutrition programs; and (4) follow-up to assess fit, utilization, and ongoing needs. The Pragmatic, Robust Implementation and Sustainability Model (PRISM) will guide adaptation and evaluation of contextual determinants, while RE-AIM will guide assessment of outcomes (implementation feasibility and acceptability, fidelity, adoption, reach, effectiveness, and maintenance). We will identify several implementation strategies to increase the likelihood that I-FRESH can be successfully implemented and sustained in a pediatric healthcare system. We will enroll 240 participants and assess preliminary effectiveness on family‑level food security and pediatric nutrition‑related health outcomes (e.g. weight status, blood pressure, lipids, HbA1c, liver function tests). The information gathered in this trial will be utilized in the development of a fully powered Type 2 Hybrid Effectiveness-Implementation Trial that will test the effectiveness of the identified implementation strategies and impact of the FI program on clinical outcomes. DISCUSSION: By integrating PRISM and RE-AIM within an iterative ROIO design, this study will generate a scalable, contextresponsive implementation model for addressing FI in pediatric healthcare settings. Findings will inform sustainable strategies that link families to highquality nutrition support programs and improve nutritionrelated health outcomes for lowincome children. TRIAL REGISTRATION: NCT06661538.
NutrientsGeorgios K Vasios, Maria Gialeli, Georgios Antasouras, Constantinos Giaginis
Background/Objectives: The increasing burden of non-communicable diseases, together with accelerating environmental degradation, highlights the urgent need for sustainable dietary patterns that promote both human and planetary health. The Mediterranean diet (MedDiet), traditionally followed in countries bordering the Mediterranean basin, has gained recognition as a model of sustainable nutrition due to its well-documented health benefits and relatively low environmental impact. However, its broader role within sustainable food systems requires comprehensive and interdisciplinary evaluation. The aim of this review is to provide a state-of-the-art synthesis of the evidence on the MedDiet as a sustainable dietary pattern, integrating its health, environmental, economic, and socio-cultural dimensions. Methods: This state-of-the-art narrative review synthesizes evidence from peer-reviewed literature on the MedDiet and sustainability. Relevant studies were identified through major scientific databases, focusing on publications addressing nutritional, environmental, economic, and socio-cultural dimensions. Both observational and interventional studies, as well as modeling and life cycle assessment analyses, were included. Additional sources from international organizations and policy reports were incorporated to contextualize global trends and challenges. Results: High adherence to the MedDiet is consistently associated with a reduced risk of cardiovascular disease, type 2 diabetes, cancer, and all-cause mortality. From an environmental perspective, the MedDiet is associated with lower greenhouse gas emissions, reduced land and water use, and enhanced biodiversity conservation compared with Western dietary patterns. Economically, it may represent a cost-effective dietary model and support local food systems when grounded in traditional practices, although affordability varies across contexts. Socio-culturally, the MedDiet promotes food heritage, culinary skills, and social cohesion. Nevertheless, globalization, urbanization, and the increasing consumption of ultra-processed foods have contributed to declining adherence, posing significant challenges to its sustainability and scalability. Moreover, the sustainability benefits of the MedDiet seem to be context-dependent rather than intrinsic, raising several challenges and limitations for its adoption. Conclusions: The MedDiet should be viewed not as a definitive solution to global food-system challenges but as a valuable reference model that illustrates how dietary practices can contribute simultaneously to human health, environmental sustainability, and cultural continuity. Modern sustainable dietary strategies should build upon the strengths of the MedDiet while recognizing its limitations, embracing contextual adaptation, and addressing the structural determinants that shape food choices.
Frontiers in public healthNicoló Scarsi, Abdelrahman Taha, Doriana Lacalaprice, Giorgia Perazzoni, Luisa Soru, Salvatore Di Grande, Daniele D'Anna, Andrea Staffieri, Marius Geantǎ, Robe…
INTRODUCTION: National nutrition policies play a pivotal role in promoting healthier dietary choices and reducing the consumption of unhealthy foods, thereby contributing to improved public health outcomes. Understanding their scope and implementation is essential for guiding regional health policies and strategies to improve food systems. METHODS: We conducted a scoping review to map national-level nutrition policies, legislation, and regulatory instruments related to food production, labeling, marketing, pricing, and consumption across 31 European countries. We systematically searched PubMed, Scopus, FAOLEX, Google, and the Global Database on the Implementation of Food and Nutrition Action for records published between 2014 and 2024. Policy actions were categorized according to the NOURISHING framework. RESULTS: Out of 6,299 screened records, we identified 379 national food and nutrition policy actions. Finland, France, Spain, and Sweden showed the broadest domain coverage, with policy actions identified in nine or more of the 10 NOURISHING policy areas, whereas Cyprus, Poland, and Latvia showed limited coverage, with five or fewer areas represented. The most regulated domain was food supply chain governance (32%), followed by nutritional quality of the whole food supply (19%) and labeling (15%). In contrast, the integration of nutrition services in healthcare settings (1%), and the use of economic incentives (1%), were underrepresented. CONCLUSION: European countries showed marked variation in the adoption of nutrition policies. While progress has been made in food safety and information provision, significant gaps remain in behavior-shaping policies. These disparities may reinforce existing health inequalities. Coordinated EU-level strategies, stronger enforcement mechanisms, and broader uptake of evidence-based interventions are needed to support a more equitable and effective transformation of food systems across the region.
Journal of family medicine and primary careArti Gupta, Joe Amalan, Sirisha Pulla, B Venkatashiva Reddy, Rajeev Aravindakshan, R Barath, Shanmukh Krishna Kopuru, Bhukya Kamal
BACKGROUND: Millets are nutrient-rich, ability to thrive in challenging climate were integral to traditional Indian diets. However, their intake has reduced in diet. This study aims to assess the prevalence of anemia among women in Andhra Pradesh and to determine the association between millet-based local recipe talk in the mother's kitchen and maternal anemia. METHODS: A community-based cohort study enrolled 345 mothers across three regions of Andhra Pradesh, India, in 2024-2025. Baseline data included sociodemographic characteristics, 24-hour dietary recalls (3 nonconsecutive days), anthropometry, and hemoglobin estimation of mothers. A 12-week intervention delivered weekly millet recipe talks in mothers' kitchens/Anganwadi centers, with hands-on cooking using nine millets and two pseudo millets. Endline assessments of 24-hour dietary recalls (3 nonconsecutive days), anthropometry, and hemoglobin estimation in mothers were conducted. RESULTS: Most mothers were predominantly aged 21-30 years. Tribal groups had higher rates of early marriage (under 18 years), reaching 18 (32.73%) in Uttar Andhra. Most mothers were housewives, and husbands were daily laborers. Rural participants had a medium standard of living, 159 (88.33%), whereas tribal participants had a low standard of living 41 (74.55%) in Coastal Andhra. Anemia was present among 266 (77.1%) mothers at baseline, with higher maternal/husband education linked to lower risk (P = 0.014, P = 0.047). Postintervention, mean daily intake increased significantly for protein (P = 0.009), energy (P = 0.007), calcium (P < 0.001), and iron (P < 0.001). Among the 265 mothers with anemia at baseline, excluding attrition, the prevalence of anemia decreased to 239 (90.2%) with P =<0.001. Severe anemia cases fell from 10 to 4 (P = 0.007), moderate from 46.9% to 34.2% (P < 0.001), and mild anemia also decreased (P < 0.001). CONCLUSION: Culturally tailored, hands-on millet recipe interventions significantly enhance nutrient intake and reduce anemia severity. Scaling such community-led approaches through Anganwadi networks offers a sustainable strategy to combat maternal anemia.