Dietetics doi: 10.3390/dietetics5020033

Authors: Anna Simonson Jacquelyn Zera Gregory Farnell

College students often maintain poor dietary habits, notably low fruit and vegetable intake. Common barriers include limited time, cost, and lack of nutritional knowledge. This study examined dietary behaviors, barriers, and factors influencing Healthy Eating Scores (HES) among college students. Participants (N = 224; age = 20.3 ± 2.5 years, BMI = 23.9 ± 4.1 kg/m2, 78.9% female, and 91.3% white) completed an online survey. Results indicate meat overconsumption with underconsumption of water, fruits, and vegetables. Limited time and healthy options were the primary perceived barriers. Tests of between-subject effects identified gender (F = 4.38, p = 0.04) and living situation (F = 4.42, p < 0.01) as independent HES predictors. Backward stepwise linear regression (adj. R2 = 0.22, p < 0.001) further indicated that being male, an athlete, living off-campus, and cooking at home were significantly associated with higher HES. Conversely, non-athlete females living on campus emerged as the most vulnerable group for low HES. These findings suggest that future interventions should target specific demographic vulnerabilities to improve dietary outcomes and mitigate barriers in the college population.

Dietetics doi: 10.3390/dietetics5020032

Authors: Alexandre Morais Nunes Andreia Matos João Ricardo Catarino Susana Sobral Sérgio Alves

Over the past decade, Portugal has increasingly focused on public policies that promote healthy eating, driven by growing concerns about the population’s health and its social, economic, and political effects. These policies aim to reduce unhealthy eating habits, which are major risk factors for disease, and to reduce the overall disease burden. Tax measures are specifically intended to curb the consumption of foods high in sugar, salt, and saturated fats to prevent chronic non-communicable diseases such as obesity, type 2 diabetes, and cardiovascular disease. This article analyzes the measures adopted in Portugal to reduce sugar consumption and examines their effects on tax revenue and consumption volume. Using document analysis, the results indicate a decrease of 3853 tons in sugar consumption and tax revenue of 432 million euros from taxing sugary drinks and sweeteners since 2017. Although significant progress has been made, including product reformulation to reduce sugar content, challenges remain. It is essential to continue and expand these policies to other products, along with ongoing impact assessments, to foster a healthier future in line with the World Health Organization’s guidelines for 2030.

Dietetics doi: 10.3390/dietetics5020031

Authors: Novia Shin Ying Chiew Emily Dow Hassan Ghasemzadeh Carol S. Johnston

Clinical trials suggest that daily vinegar ingestion improves fasting blood glucose concentrations, postprandial glucose excursions, and hemoglobin A1c levels in patients with prediabetes and type 2 diabetes. With the recent commercialization of continuous glucose monitoring (CGM) technologies, diabetes patients as well as other health-conscious individuals can evaluate the impact of food choices in real-time and make data-driven decisions to improve dietary behaviors. This 9-day, randomized crossover study documented CGM-derived glycemic patterns during vinegar ingestion in adults with prediabetes. Participants consumed two tablespoons of vinegar twice daily with meals for four days or a control tablet each morning for four days in random order. For each phase, fasting blood glucose on day four, average blood glucose across three days, and peak glucose excursion across three days were calculated. Fasting glucose concentrations of participants (n = 10 women; 36.6 ± 15.6 y; 33.9 ± 6.5 kg/m2) averaged 105.8 ± 20.6 mg/dL at baseline. Vinegar ingestion was associated with significant reductions in the mean glucose concentration (−4.4 mg/dL) and the frequency of blood glucose excursions > 140 mg/dL (−10%) in comparison to the control treatment, but fasting glucose concentrations were unaffected. These data suggest that vinegar-induced improvements in blood glucose can be observed in real-time using a CGM device in adults with prediabetes.

Dietetics doi: 10.3390/dietetics5020030

Authors: Georgia Tsakalou Kalliopi Georgakouli

Adherence to the Mediterranean Diet (MD) is a cornerstone in managing Type 2 Diabetes Mellitus (T2DM), with patients’ Nutrition Literacy (NL) playing a potential role in their dietary choices. This cross-sectional study investigated the association between NL and MD adherence in 81 patients with T2DM from two Greek hospitals. Participants completed the NLS-GR questionnaire to assess NL and the 14-MEDAS for MD adherence, while socio-demographic and clinical data, including glycated haemoglobin (HbA1c), BMI, and disease duration, were obtained through researcher-conducted interviews and medical records. Median HbA1c was 6.9%, duration of T2DM was 13 years, and BMI 26.9 kg/m2. A total of 71.6% had moderate MD adherence (median 14-MEDAS: 7), and 96.3% had adequate NL (median NLS-GR: 23). HbA1c showed a weak negative correlation (r = −0.238, p = 0.033) with the 14-MEDAS. Median duration of DM showed a low negative correlation with NL (NLS-GR: r = −0.323, p = 0.003). No statistically significant correlation was found between 14-MEDAS and NLS-GR (r = 0.032, p = 0.775). Although MD adherence was correlated with HbA1c, neither MD adherence nor nutrition literacy were independent predictors after adjustment for confounding factors. Further studies are needed to demonstrate the extent to which NL can influence adherence to a specific dietary pattern.

Dietetics doi: 10.3390/dietetics5020029

Authors: Carrie Knight Simone Camel Orlene Martens Kerrilyn Phillips Dawn Erickson

Background: Dysphagia is a medically complex condition that often necessitates modified food textures to ensure safe swallowing. As smoothies continue to grow in popularity, developing nutritionally balanced recipes that meet the International Dysphagia Diet Standardisation Initiative (IDDSI) Level 3 guidelines may offer practical, appealing options for caregivers and individuals managing dysphagia. Standardized recipes can potentially also support consistency in preparation. Purpose: The purpose of this research was to develop and evaluate palatable smoothie recipes that meet the IDDSI Level 3 consistency guidelines. Method: In this descriptive pilot study, using a pre-test/post-test design, 32 preprofessional students evaluated three smoothies prepared in a laboratory setting. Both fresh and frozen ingredients were used, and each smoothie was tested for IDDSI Level 3 consistency using the IDDSI funnel. Participants rated the smoothies on color, aroma, texture, flavor, appearance, palatability, and overall acceptability using a five-point Likert scale. Results: The results varied across evaluation criteria. Texture and color were the most influential factors in participants’ assessments. The strong impact of texture was an unexpected finding, as all smoothies met Level 3 standards according to the IDDSI funnel. Conversely, the influence of color was expected, as visual presentation is known to significantly affect food perception and acceptance. Conclusions: Given their nutritional value and ease of preparation, smoothies can be a practical addition to modified diets. While IDDSI Level 3 appears to be an appropriate consistency for this purpose, further research may be needed to evaluate the reliability of the IDDSI funnel in ensuring consistent texture outcomes.

Dietetics doi: 10.3390/dietetics5020028

Authors: Mohamad Motevalli Clemens Drenowatz Markus Schauer Susanne Mair Michael Kohlberger Gerhard Ruedl Katharina Wirnitzer

Micronutrient status is strongly influenced by dietary patterns; however, the extent to which plant-forward dietary patterns versus omnivorous diets shape micronutrient profiles and their associations with blood pressure, body composition, and cardiovascular health remains unclear. This cross-sectional study aimed to comprehensively assess associations between blood micronutrient profiles, blood pressure, and body composition in adults, with analyses stratified by dietary patterns to compare omnivorous and plant-forward dieters. Secondary cross-sectional analyses were conducted using data from an exploratory study of 488 Austrian adults (median age: 38 y [IQR 21]; 48% female, 52% male). Participants were classified as omnivores (n = 260) or plant-forward dieters (including 194 flexitarians, 25 vegetarians, and 9 vegans; n = 228). Blood pressure and anthropometric measurements were obtained alongside fasting venous blood sample analysis to quantify a comprehensive panel of micronutrient, hematological, lipid, and inflammatory biomarkers. Micronutrient concentrations were standardized (scaled −1 to +1, truncated ±3) and evaluated for deficiency or excess according to sex-specific reference ranges. Linear regression was used to analyze the association of micronutrients with BMI, including age and sex as covariates. Vitamin D showed the highest micronutrient deficiency, observed in 96% of omnivores and 93% of plant-forward dieters. Across both dietary subgroups, multiple micronutrients, together with age and sex, were significant correlates of body weight, body mass index, and blood pressure (p < 0.05). Significant differences between omnivores and plant-forward dieters were observed for blood pressure, lipid, hematological, and inflammatory markers, with participants adhering to plant-forward dietary habits exhibiting lower blood pressure and more favorable lipid profiles (p < 0.05). The findings highlight the potential of diet-type-specific strategies for personalized cardiometabolic risk management.

Dietetics doi: 10.3390/dietetics5020027

Authors: Jane Sylvestre Laura Byham-Gray Diane Rigassio Radler

Bariatric surgery (BS) is effective for treating obesity but carries significant nutritional risks. Patients often develop micronutrient deficiencies, loss of muscle mass, and other physiological complications. Standardized methods such as the Nutrition-Focused Physical Exam (NFPE) may not adequately capture physical findings specific to BS. This study aimed to develop an expanded and modified bariatric-specific NFPE tool and achieve expert consensus on its essential components using a modified Delphi methodology. A literature review identified clinical signs of malnutrition and nutritional complications unique to patients undergoing BS, which informed proposed BS-NFPE components. A three-round modified Delphi study with expert bariatric dietitians (n = 25) achieved consensus (≥75% agreement) on 43 BS-NFPE components, including physical signs of micronutrient deficiencies and toxicities, changes in muscle and fat stores, indicators of surgical complications, gastrointestinal symptoms, and mental health effects. Experts also supported incorporating functional considerations and social determinants of health. This study introduces the first evidence-informed modified BS-NFPE tool to address limitations of the standard NFPE in bariatric populations. Use of BS-specific features may help clinicians identify malnutrition earlier, tailor care, and improve long-term patient support. Future research should evaluate this tool in clinical practice.

Dietetics doi: 10.3390/dietetics5020026

Authors: Antonio Peracchia Cecilia Rustichelli Rossella Avallone

Obesity is currently recognized as a chronic and multifactorial disease. According to epidemiological data released by the World Health Organization in 2022, more than 2.5 billion adults were overweight and more than 890 million were affected by obesity. The aim of this narrative review is to clarify what leads to overweight and obesity, to explain the concept of energy balance, to address the limited effectiveness of dietary products marketed for weight reduction, to examine commonly promoted nutritional strategies for weight loss and to challenge claims of their superiority. The most recent, robust, and high-quality evidence available on the topic was selected, with particular emphasis on systematic reviews and meta-analyses. Overweight and obesity are characterized by an excessive accumulation of fat mass. At the basis of excessive adipose tissue accumulation lies a persistent positive energy balance. Energy balance is generally considered a central physiological determinant of body weight regulation. Approaches that do not explicitly incorporate this principle may be associated with variable or unsustained outcomes. Available evidence suggests that, when an equivalent caloric deficit is achieved, differences in the timing of energy intake or in dietary patterns—such as intermittent fasting or low-carbohydrate diets—are not consistently associated with greater weight loss compared with other guideline-based dietary strategies. Some supplements supporting weight loss, in selected cases, may offer marginal support; however, based on the current state of scientific knowledge, no product represents an effective shortcut for weight loss.

Dietetics doi: 10.3390/dietetics5020025

Authors: Tamara P. Mancilha Brad P. Yentzer Samira Deshpande Lisa Harnack Erika Helgeson Niki Oldenburg Lisa Senye Chow

Background: Assessing food and nutrient intake is an important yet challenging component of nutrition research, particularly in populations at higher risk for dietary underreporting. Objective: To evaluate the feasibility, acceptability, and preliminary measurement characteristics of augmenting interviewer-administered 24 h dietary recalls with a photo-based mobile food record application (mCC: my Circadian Clock). Design: This was a randomized cross-over feasibility study in which each participant completed two sets of three 24 h dietary recalls. One set consisted of standard interviewer-administered recalls, while the other incorporated dietary intake captured via the mCC app during the 24 h preceding the recall to guide the interview. Participants: Participants (n = 10) were adults aged 18–65 years with obesity (BMI > 30 kg/m2) and less than a college-level education, recruited from a general community setting. Main Outcome Measures: Primary feasibility outcomes included recall adherence, protocol completion, participant burden, and usability of the mobile application. Secondary and exploratory outcomes included average energy intake (kcal/day), number of food items and eating occasions reported, Healthy Eating Index (HEI)-2015 scores, and recall duration. Statistical Analyses: Descriptive statistics and paired t-tests were used to explore differences between methods; analyses were considered exploratory and hypothesis-generating. Results: All enrolled participants completed every scheduled recall, resulting in 100% adherence and protocol completion. Most participants (70%) rated the mCC app as easy or very easy to use, although 60% reported greater burden with the Augmented Recalls. Average energy intake was 274 kcal/day lower with the augmented method compared with Standard Recalls (95% CI: −597, 50; p = 0.09), with no clear differences observed in reported food items, eating occasions, HEI-2015 scores, or recall duration. Conclusions: Augmenting interviewer-administered 24 h dietary recalls with a photo-based mobile food record is feasible and acceptable in adults with obesity, though it did not demonstrate clear improvements in dietary intake capture in this small feasibility sample. These findings provide practical guidance for refining technology-assisted recall protocols and informing the design of future, adequately powered studies.

Dietetics doi: 10.3390/dietetics5020024

Authors: Maria Ioannidou Marios Skordis Ioannis Kavvadias Georgios I. Panoutsopoulos Evaggelia Fappa

Background: Given the limited evidence in the field, the present study aimed to explore the association of UPF intake with food literacy levels in an adult Mediterranean-based population. Methods: Self-reported demographic and anthropometric data were collected from 317 apparently healthy adults (52.5% males) Food literacy and dietary intake of this population were also assessed. Foods were classified as ultra-processed according to the NOVA system, and their contribution to total daily energy intake (%) was calculated. Then, participants were grouped into the (1) higher UPF intake (HUPFI), and (2) lower UPF intake (LUPFI) groups, based on the median value of this population as a cut-off. Results: Between-group analysis revealed that LUPFI scored statistically significantly higher than the HUPFI group in total food literacy (93.5 [84.0–104.0] vs. 86.0 [78.0–99.0], p < 0.001) and in three out of five food literacy sub-dimensions. Sub-analysis revealed no differences between LUPFI and HUPFI groups of individuals with normal weight. In participants with overweight or obesity, the LUPFI group scored lower than the HUPFI in the total food literacy score (95.0 [87.0–104.0] vs. 81.0 [70.0–94.0], p < 0.001) and in each sub-dimension. Conclusions: Higher UPF intake was associated, in adults with overweight or obesity, with lower levels of food literacy.

Dietetics doi: 10.3390/dietetics5020023

Authors: Rickelle Richards Anairany Zapata Daphne C. Hernandez

Higher rates of food insecurity have been observed among Hispanic immigrants, yet these individuals have traditionally been excluded from food insecurity survey development. The most common Spanish translated food insecurity scale—the Spanish Translation of the U.S. Household Food Security Survey Module (S-FSSM)—may not be capturing how Spanish-speaking immigrant parents conceptualize food insecurity. The purpose of this study was to gain insight into how Spanish-speaking immigrant parents with low English literacy conceptualize household food insecurity within the 18-item S-FSSM and to use this information to revise the S-FSSM instrument. Researchers conducted two rounds of cognitive interviews with Spanish-speaking adults at a community center in Houston, TX, USA (N = 19; Round 1: n = 9, October 2023; Round 2: n = 10, July 2024). Researchers used participants’ feedback to refine the S-FSSM. All participants were female (Rounds 1 and 2 = 100%) and most born in Mexico (Round 1 = 66.7%; Round 2 = 50%). In Round 1, eight items were combined to enhance cultural relevance and to add definitions. Follow-up questions were added to improve clarity. Two items were revised for relevancy, two items had no change, six items were deleted. In Round 2, modifications to wording occurred and one item was added. The revised scale, named Food Access Measure for Immigrant Latinos In America (FAMILIA), resulted in 17 survey items. Study findings suggested that the S-FSSM needed refinement to enhance relevancy for Spanish-speaking immigrant parents with low English literacy.

Dietetics doi: 10.3390/dietetics5020022

Authors: Rita Wegmüller Volkan Cakir Fabian Rohner Karim Koudougou Maguette F. Beye Regina Khassanova Ndèye Yaga Sy Sitor P. Ndour Jean Kaboré Zein Naber Nicolai Petry James P. Wirth Valeria Galetti

Accurate assessment of sodium intake and its dietary sources is essential for developing effective sodium reduction strategies. This study estimated total dietary sodium intake (DSI) and source-specific contributions using questionnaire-based methods, validated against urinary sodium excretion (USE). Two cross-sectional surveys were conducted in 2023 among adults aged 15–59 years in Burkina Faso (N = 749) and Senegal (N = 1340), selected through stratified sampling. USE was estimated from spot urine samples, calibrated using 24 h urine collections in a sub-sample (eUSE). DSI was assessed using three complementary methods: (1) household purchasing/adult male equivalent (AME) for small-commodity foods and discretionary salt, (2) 24 h recall for sodium-rich foods consumed in and outside the home, and (3) a food frequency questionnaire for composite dishes eaten outside the home. Median DSI from dietary methods (2.6 g/day) closely matched estimates from eUSE (2.7 g/day) in Burkina Faso but was overestimated in Senegal (5.4 vs. 3.1 g/day), mainly due to difficulty estimating discretionary salt use in households buying large quantities. The country-specific validation of spot urine showed good agreement with 24 h collections. Combining complementary dietary intake methods offers a feasible approach to estimating total and source-specific sodium intake in settings with frequent small salt purchases. In settings with large salt purchases and salt being used for purposes other than human consumption, the salt purchasing/AME method to quantify the use of discretionary salt at the household level should be replaced by the salt disappearance method.

Dietetics doi: 10.3390/dietetics5020021

Authors: Julia Navarro-Marroco Carmen Lucas-Abellán Ana María García-Muñoz Lucía Guardiola-García Rebeca González-Louzao Desirée Victoria-Montesinos Pilar Hernández-Sánchez

Background: Roux-en-Y gastric bypass (RYGB) is a highly effective treatment for severe obesity, achieving substantial weight loss and metabolic improvement. Beyond weight, assessing body composition and functional markers is essential. Phase angle (PA), obtained through bioelectrical impedance, is a relevant indicator of cellular integrity and nutritional status. The rise of glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide (GLP-1 and GLP-1/GIP) agonists makes comparison with surgical outcomes increasingly important. This study aimed to evaluate changes in fat mass, lean mass, hydration, and PA after RYGB and compare these findings with evidence from pharmacological therapies. Methods: A retrospective observational study was conducted in 15 patients (18–50 years, BMI > 35 kg/m2) at Quirón Salud Hospital Torrevieja. Body composition was assessed using multifrequency bioelectrical impedance (TANITA BC-980) before surgery and at 3 and 12 months. All patients received structured nutritional follow-up. Repeated-measures ANOVA and the Friedman test were applied. Results: After 12 months, weight decreased by 40.06 ± 11.86 kg; fat mass by 30.43 ± 10.81 kg; and fat-free mass by 9.64 ± 5.31 kg. PA declined 11% during the first 3 months and then stabilized. Women lost more fat mass; men lost more lean mass. Conclusions: RYGB combined with nutritional support produces high-quality weight loss with relative preservation of lean tissue and stabilization of PA, which proves valuable for postoperative monitoring.

Dietetics doi: 10.3390/dietetics5020020

Authors: Gulsun Akdemir Evrendilek

The global seafood industry generates millions of tons of by-products each year, creating environmental and economic challenges but also presenting a valuable opportunity for resource recovery. These by-products, rich in bioactive compounds such as proteins, omega-3 fatty acids, collagen, chitin, and antioxidants, have traditionally been underutilized due to inefficient and energy-intensive conventional extraction processes. Pulsed electric field (PEF) technology has emerged as a promising, non-thermal, and environmentally friendly method for valorizing seafood by-products by enhancing the permeability of biological membranes through electroporation, thereby facilitating the efficient extraction of high-value compounds. This manuscript critically reviews the scientific principles underpinning PEF, including dielectric breakdown and transmembrane potential generation, and explores its mechanisms for improving mass transfer during extraction and dehydration. Applications of PEF for recovering proteins, lipids, and antioxidants from diverse seafood side streams are comprehensively discussed, with emphasis on its advantages such as reduced energy consumption, preservation of thermolabile compounds, and improved product quality compared to conventional methods. Despite demonstrated laboratory-scale successes, industrial adoption of PEF remains limited due to challenges in process optimization, economic feasibility, and regulatory frameworks. This review synthesizes current knowledge and provides guidance for future research to advance the industrial implementation of PEF as a sustainable and efficient tool for seafood by-product valorization.

Dietetics doi: 10.3390/dietetics5020019

Authors: Dalia El Khoury Haleema Ashraf Ho Ching Nika Shiu Sawsan G. A. A. Mohammed Nader I. Al-Dewik M. Walid Qoronfleh

The reciprocal relationship between genes and nutrients, known as nutrigenetics and nutrigenomics, has been established in many studies. However, current investigations of maternal and neonatal nutrition using a precision nutrition approach focused on genomics are limited, especially in the Middle East and North Africa (MENA) region. This review aims to summarize the impacts of the dietary micronutrients, folic acid, thiamine, and cobalamin on optimal health outcomes during pregnancy, fetal development, lactation, and infant growth. In this review, the roles of folic acid, thiamine, and cobalamin are discussed in the context of various aspects of pregnancy, such as preconception, fetal development, and lactation, highlighting how genetic events occurring during developmental periods can have consequential impacts on health outcomes later in life. Deficiency rates and related health consequences as well as the prevalence of genetic mutations related to these nutrients of interest in the MENA region are also elaborated on. How to advance knowledge and applications of precision nutrition, how genes interact with the neurochemical changes during pregnancy, and how this interaction impacts maternal eating behaviors, and consequently fetal development and infant and child growth and health, should be further explored in future studies. This includes taking advantage of cutting-edge technologies and the role of artificial intelligence in this endeavor.

Dietetics doi: 10.3390/dietetics5010018

Authors: Maria Casale Kathryn L. Beck Cathryn A. Conlon Lisa A. Te Morenga Anne-Louise M. Heath Rachael W. Taylor Jill J. Haszard Lisa Daniels Neve H. McLean Alice M. Cox Emily A. Jones Ioanna Katiforis Kimberley J. Brown Madeleine Rowan Bailey R. Bruckner Rosario Jupiterwala Pamela R. von Hurst

Complementary feeding influences infant growth and health. Māori and Pacific infants in Aotearoa New Zealand experience disproportionate nutrition-related disease, yet complementary feeding data are limited. Caregivers of 625 infants (7–10 months) completed a questionnaire on timing of introduction, baby-led weaning (BLW), and baby food pouch use. Ethnicity was total response; infants not Māori or Pacific were classified as ‘other’. Complementary foods were introduced at around six months for 56.5% of Māori, 62.2% of Pacific, and 80.9% of others; before five months for 40.5%, 34.2%, and 17.3%. BLW prevalence was 29.2% (Māori), 17.1% (Pacific), and 27.3% (other). Although pouches were uncommon when complementary feeding began, by 7–10 months about two-thirds of Māori and Pacific infants were fed pouches sometimes or frequently. Frequent pouch use with mostly or always nozzle feeding occurred in 12.2% of Māori infants, 12.2% of Pacific infants, and 2.7% of other infants. Vegetables and purée were the most common first food and texture. By six months, over half consumed red meat and about half consumed iron-fortified baby rice. These feeding practices have implications for nutrition-related health inequities among Māori and Pacific infants, highlighting the need for culturally centered public health approaches to support whānau with feeding.

Dietetics doi: 10.3390/dietetics5010017

Authors: Daniela Ojeda-Mercado Maurizio Fadda Benedetta Beltrame Martina Tosi Amalia Bruno Carmen Di Scala Giancarlo Travaglia Assunta Vitale Rita Schiano di Cola Stefano Boschetti Federica Pessina Roberta Jaccheri Liisa Tolvanen

Background: Incretin-based therapies, including glucagon-like peptide-1 (GLP-1) receptor agonists and dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor co-agonists, advance obesity treatment by promoting weight loss and lowering the risk of type 2 diabetes and cardiovascular disease. Methods: This narrative review synthesizes clinical evidence to highlight the role of dietitians in obesity management when incretin-based therapies are used. Results: GLP-1 receptor agonists and dual GLP-1/GIP receptor co-agonists achieve 15–21% weight loss and reduce cardiometabolic risk. Their effectiveness and safety are optimized when integrated with medical nutrition therapy (MNT) and personalized nutrition strategies. In Italy’s aging population, the rising burden of sarcopenic obesity requires dietitian-led care to preserve fat-free mass while reducing fat mass. Dual GLP-1/GIP co-agonists show superior reductions in visceral adiposity, but effects on fat-free mass remain inconclusive, underscoring the need for dietitian oversight to prevent adverse body-composition changes. Sarcopenic obesity is associated with increased mortality and functional decline. Dietitians are uniquely qualified to ensure adequate protein intake and protect muscle during pharmacologic interventions. In Italy, role clarity in clinical nutrition remains limited; however, under national law (DM 744/94; Law 42/1999), dietitians are recognized as the professionals authorized to provide medical nutrition therapy (MNT). Conclusions: The dietitian’s expertise maximizes therapeutic efficacy, minimizes adverse effects, and safeguards long-term outcomes. Integrating dietitians into pharmacological treatment pathways is essential to optimize outcomes, ensure patient safety, and safeguard long-term metabolic health.

Dietetics doi: 10.3390/dietetics5010016

Authors: Afroditi Mouratidou Georgios Katsaras Ilias Chatziioannidis

Human breast milk evolves beyond simple nutrition to function as a complex signaling system that promotes neonatal development. This review analyzes the bioactive components, delineating how its specific constituents compensate for the physiological vulnerabilities of the neonate. Additionally, the distinct roles of colostral and mature milk are in fortifying the immature immune system and promoting gastrointestinal maturation. Focus is placed on the prevention of necrotizing enterocolitis, where milk oligosaccharides and microbiome function to maintain mucosal integrity and symbiosis, while preventing pathogens’ adhesion. Furthermore, how breastfeeding duration is linked to long-term metabolic and immunological programming is evaluated. MicroRNAs and bioactive lipids actively modulate gene expression and immune responses, thereby reducing the incidence of metabolic diseases and childhood malignancies. By integrating findings, this article underscores the irreplaceable role of breast milk in clinical dietetics and pediatric care.

Dietetics doi: 10.3390/dietetics5010015

Authors: Monica Stanton Koko Silvia del Cerro Alicia Chung

COVID-19 disrupted daily routines, altering eating patterns. However, it could encourage individuals to adopt healthier behaviors. While extensive research documented changes in dietary behaviors during the COVID-19 lockdown, few studies explored whether they persisted over time. This study aimed to identify the long-term effects of the pandemic on lifestyle and eating behaviors of families from a private primary school in Funes County, Rosario, Argentina. A total of 51 families (192 individuals) completed an anonymous survey on food intake and perceived dietary and lifestyle changes since the pandemic began. Multiple correspondence analysis revealed increased consumption of fast/processed foods, larger portion sizes, and snacking linked to eating from boredom, stress, or tiredness. Increased home-cooked meals, physical activity, interest in healthy habits, and leisure time enjoyment were also found. Dietary analysis revealed that higher intake of fruits, vegetables, legumes, and water was inversely associated with consumption of refined grains, cold cuts, pastries, and sugary drinks. Boredom, stress, or tiredness led to unfavorable changes. Interest in health, changes in home routines, spending more time together, and preparing meals with family resulted in healthier behaviors that remained present at the time of this study.

Dietetics doi: 10.3390/dietetics5010014

Authors: Joshua Frederick Richardson Joshua Brett Amanda Avery

Objective: To examine the proportion of drinks and snacks offered by the largest coffee shop chains in the UK that exceed the NHS and Public Health England maximum recommended intakes for energy and sugar. Design: Observational study design where nutritional information for drinks and snacks was gathered from the official coffee shop chain website. Data were compared with the maximum recommended intakes of 200 kcal per drink or snack and 30 g of free sugar per day. Direct comparisons between mean values were performed using analysis of variance (ANOVA). Subjects: A total of 2707 drinks and 434 snacks across eight leading coffee shop chains in the United Kingdom. Results: Overall, 47.0% of drinks and 66.8% of snacks exceed the recommended energy intake, while 32.5% of drinks and 45.3% of snacks surpass the recommended daily free sugar intake. ‘Hot chocolates and other speciality drinks’ contain the most energy (255.6 ± 5.78 kcal) of all drink categories. Snacks contain significantly more energy than drinks (p < 0.001), with all three snack categories exceeding the recommended intake of energy. Variations in nutritional content were observed in dairy-alternative milk options and specific chains. Conclusions: The high energy and sugar content of drinks and snacks in major UK coffee chains may contribute to excessive energy intake, with almost half of all drinks and snacks exceeding the maximum recommended levels. Healthier choices, such as avoiding flavoured drinks or limiting the consumption of snacks, may be necessary to help mitigate weight gain and combat obesity and T2DM rates in the UK.

Dietetics doi: 10.3390/dietetics5010013

Authors: Brayan Montoya-Torres Amandeep Kaur Benjamin Barr Emily Garrison Mindy M. Brashears Amanda M. V. Brown Lauren S. Gollahon

(1) Background: Acidogenic Western-style diets disrupt gut bacteria promoting obesity-related diseases. Here, we investigated whether long-term feeding of alkalinized dietary casein as a protein source (ammonium hydroxide enhancement, AHE) modulates microbiome structure/functions under high-fat conditions, and normal diets, and whether these responses are sex-dimorphic. (2) Methods: C3H/HeJ mice (N = 256; equal sex distribution) received either control casein (CC), AHE casein (CCN), high-fat casein (HFC), or AHE high-fat casein (HFCN) diets from 6 to 18 months. Body mass and survival were tracked; fecal samples collected at 16 months were sequenced and underwent shotgun metagenomics. (3) Results: Diet and sex jointly shaped host metrics. AHE diets taxonomically showed an abundance of Verrucomicrobiota phyla predominating in most cohorts, notably Akkermansia muciniphila. Within Pseudomonadota, Christensenella was identified, along with other taxa associated with beneficial health outcomes, including Lactococcus lactis, Lactococcus cremoris, Pediococcus acidilactici, and families Lachnospiraceae/Oscillospiraceae. Additionally, sex- and diet-dependent advantageous enriched functions associated with AHE that enhanced electron transport, B-vitamin cofactor pathways, and mucosal/redox support were observed. (4) Conclusions: In the long term, pH-directed protein chemistry is a tractable lever for gut ecology during high-fat feeding, enriching and promoting the balance of beneficial taxa, providing a mechanistic bridge between dietary acid load and microbiome remodeling.

Dietetics doi: 10.3390/dietetics5010012

Authors: Nikolaus Rittenau Klaus Günther

Choline is an essential nutrient whose physiological importance has not yet been sufficiently recognized by many European nutrition authorities. Despite convincing evidence of its crucial role in liver lipid export, one-carbon metabolism, cell membrane integrity, and nervous system development, explicit dietary recommendations for choline are still lacking in most European countries. In contrast, its importance has long been recognized in the national guidelines of the United States, Australia, China, and other regions. The current and rapidly spreading dietary shifts toward plant-based and vegan diets—characterized by a lower proportion of animal foods, the main sources of choline—increase the risk of suboptimal intake in broad segments of the population. Given the considerable interindividual differences in endogenous choline biosynthesis, which are influenced by sex hormones, physical activity, nutrient interactions, and genetic polymorphisms, adequate dietary intake is essential to meet physiological needs, especially during periods of increased demand such as pregnancy, lactation, and high-performance sports. This narrative review summarizes the evidence for the essentiality of choline, outlines the rationale for deriving intake recommendations for different life stages, and identifies an urgent need for coordinated action by European nutrition societies to address the growing risk of population-wide undersupply.

Dietetics doi: 10.3390/dietetics5010011

Authors: Kayo Kurotani Natsumi Morichika Sana Yamada Kazunori Ohkawara

Food insecurity is a considerable challenge for university students globally. While food pantries are a primary response, their impact on psychological well-being remains unclear. Here, we aimed to investigate effects of providing hot meals during community food-pantry events on participant satisfaction and self-reported loneliness among financially challenged university students in Tokyo. A non-randomized pre-post design was used to compare events with (n = 87) and without (n = 41) a hot meal. Participant satisfaction was assessed using a questionnaire; loneliness was measured using the University of California, Los Angeles (UCLA) Loneliness Scale. Hot-meal events had a 100% satisfaction rate. Notably, satisfaction with the café space was significantly higher in hot-meal events than in non-meal events (p = 0.003). However, analysis of covariance indicated that the adjusted mean difference in post-event loneliness scores was not statistically significant. Hot meals enhanced participant satisfaction and the perception of the venue, suggesting it is a key component of the food-utilization dimension of food security. Although a significant reduction in loneliness was not observed, the high appreciation of the dining environment suggests that future programs should integrate hot meals with strategies to maximize social interaction, aiming for a more holistic impact on student well-being.

Dietetics doi: 10.3390/dietetics5010010

Authors: Daniel J. Griffith Stephen Ardouin Laura Cramp Sheldon C. Cooper

Small-intestinal bacterial overgrowth (SIBO) is defined by an excessive microbial presence in the small intestine and is associated with a range of gastrointestinal symptoms. Its management remains complex due to diagnostic limitations and high recurrence rates following treatment. A narrative review was conducted using MEDLINE (PubMed) and Cochrane databases to identify relevant studies published between 1984 and 2024. Search terms included small intestinal bacterial overgrowth SIBO, FODMAP, probiotics, prebiotics, synbiotics, and low-carbohydrate diets. Reference lists were also screened for additional studies. Antibiotics, particularly rifaximin, are commonly used for SIBO treatment but recurrence is frequent. Dietary strategies, such as low-FODMAP and low-carbohydrate diets, may help reduce symptoms, especially in patients with complications like D-lactic acidosis. Evidence for biotic agents (probiotics, prebiotics, synbiotics) is mixed, with limited high-quality studies and inconsistent outcomes. Some probiotic strains show symptom improvement, but effects on breath-test results are variable. A tailored, multidisciplinary approach combining dietary and medical therapies may offer optimal symptom control in SIBO. However, heterogeneity in study designs and limited evidence highlight the need for further research to inform standardised, evidence-based clinical practice.

Dietetics doi: 10.3390/dietetics5010009

Authors: Francesca K. Martino Greta Redi Marco Bogo Elena Sgrò Alessandra Zattarin Giovanni Samassa Lucia Federica Stefanelli Anna Basso Federico Nalesso

Background: Hyperuricemia is a well-known problem in end-stage kidney disease. Currently, the end-stage kidney disease patients may be treated with comprehensive conservative management, hemodialysis, or peritoneal dialysis, which impact uric acid levels distinctly. We assessed the impact of these strategies on uric acid control and identified the factors that influence it. Methods: We conducted a preliminary case–control study comparing patients in comprehensive conservative management, hemodialysis and peritoneal dialysis. For each patient, we evaluated demographic characteristics, comorbidities, body mass index, protein intake, urine output and blood test results. Results: In the entire population, uric acid levels were slightly higher in the comprehensive conservative management group. Furthermore, uric acid control was influenced primarily by body mass index (β = −0.005, p = 0.03) and treatment modality (β = −0.0026, p = 0.05). In comprehensive conservative management, body mass index (β = −0.007, p = 0.02) and urine urea excretion (β = 0.014, p = 0.04) were independent predictors of uric acid level. Conversely, only the suggested protein intake (β = 0.16, p = 0.05), potassium levels (β = −0.046, p = 0.04) and allopurinol therapy (β = −0.073, p = 0.03) were independent predictors of uric acid in hemodialysis patients. Finally, only the recommended protein intake (B = −0.005, p = 0.03) was associated with uric acid levels in patients undergoing peritoneal dialysis. Conclusions: In our series, uric acid control correlates with the treatment modality used for end-stage kidney disease and dietary protein intake.

Dietetics doi: 10.3390/dietetics5010008

Authors: Bethany A. Roorda Megan Molnar Stephanie E. Cassin

Negative body image is a widespread phenomenon among women in Western cultures. Appearance-related social media trends such as “thinspiration” and “fitspiration” have been found to be related to poor body image, and recent research suggests that food-related social media may also impact women’s body dissatisfaction, though this literature is in its infancy. The current study examined the impact of diet- and food-related social media among undergraduate women. Participants (N = 256) were randomized to view either “What I Eat in a Day” (WIEIAD) or interior design TikTok videos, with or without a depiction of a “thin-ideal” body. They completed measures of body image before and immediately after viewing the video, and a measure of dieting intentions after viewing. Results indicated a worsened body image among those who watched WIEIAD videos depicting thin-ideal bodies, which was significantly greater than the change reported by those who viewed either interior design videos (with or without thin-ideal bodies depicted). This finding suggests a possible detrimental effect of WIEIAD videos on body image; however, they did not appear to affect dieting intentions, as no significant group differences were found in this outcome between WIEIAD and interior design video groups. Considering WIEIAD videos are common across social media platforms, it is important for young women to be aware of the potential adverse impact of the social media they are exposed to.

Dietetics doi: 10.3390/dietetics5010007

Authors: Emad Aldeen Alsayed Patricia A. Shewokis Jennifer Nasser Deeptha Sukumar

Background: Calcium (Ca) and magnesium (Mg) are essential micronutrients integral to metabolic processes and cardiovascular health. Emerging evidence suggests that the dietary Ca:Mg ratio may influence chronic disease risk, yet variability in this ratio across diverse demographic groups and its relationship to body composition and vitamin D status remain unclear. Methods: Dietary intakes of Ca and Mg were assessed using validated Food Frequency Questionnaires (FFQs) and body composition was quantified via Dual-energy X-ray Absorptiometry (DXA) scans. Relationships between dietary Ca:Mg ratios and demographics, body composition parameters (lean and fat mass), and vitamin D and parathyroid hormone (PTH) levels were examined statistically using SPSS ver. 29.0 and R ver. 4.5.1 (2025) employing Kruskal–Wallis, regression, and moderated mediation analyses. Results: We examined 155 healthy adults with a mean age of 36.6 ± 12.5 years. Only 16.8% had adequate intakes of Mg compared with 45.8% who had adequate dietary Ca intakes. Significant differences in the Ca:Mg ratio were observed across racial groups (p = 0.023) and age groups (p = 0.017). South Asian Indians exhibited the highest median Ca:Mg ratio (4.83), whereas African Americans exhibited the lowest (2.67). Interestingly, our moderated mediation analysis indicated that African Americans were the most sensitive to the impact of PTH changes on the balance of Ca:Mg (indirect effect = −0.762, 95% CI [−1.298, −0.234]), indicating that even slight shifts in their Ca:Mg balances cause significant elevation in the PTH, which, in turn, leads to lowering of their vitamin D levels. Young adults (ages 18–29) had the highest median Ca:Mg ratio (4.73). No statistically significant differences were detected based on Gender (p = 0.425 and BMI (p = 0.744) on Ca:Mg ratios. Additionally, dietary Ca:Mg ratios were positively associated with sPTH in males (r = 0.203, p < 0.05), but not with body composition. Conclusion: Important variations in dietary Ca:Mg ratios exist across racial and age demographics, notably among young adults, and specific ethnic groups exhibited elevated ratios. Tailored nutritional interventions may be necessary for these populations to optimize Ca:Mg balance and support metabolic and cardiovascular health outcomes in these populations.

Dietetics doi: 10.3390/dietetics5010006

Authors: Chanita Unhapipatpong Abeer Abbasi Cecillia Tang Carole-Anne Williams Sharvika Bharatselvam Johane P. Allard Katherine J. P. Schwenger

Worsening nutritional status in patients with pancreatic cancer may be associated with poorer tolerance to chemotherapy and increased complications. This retrospective cohort pilot study, conducted between October 2023 and March 2024, aimed to evaluate the association between nutritional status, weight loss, and clinical outcomes that included hospitalization, neutropenia, chemotherapy delay, and worsening laboratory changes. Patients were categorized into two groups: those with weight loss >5% of usual body weight and those with ≤5%. Of the 21 participants, 8 were male and 13 were female. Weight loss >5% was significantly associated with more patients requiring hospitalizations compared to weight loss ≤5% [6 (75%) vs. 3 (23.1%), p = 0.02], while no statistically significant differences were observed for other clinical outcomes. Risk factors associated with greater weight loss included age >72 years (crude odds ratio [COR] 9.17; 95% CI 1.15–73.24; p = 0.037), treatment with a paclitaxel plus gemcitabine regimen (COR 12.00; 95% CI 1.02–141.34; p = 0.048), and a history of hospitalization (COR 10.00; 95% CI 1.28–78.12; p = 0.028). Weight loss in pancreatic cancer is linked to poorer clinical outcomes, with older age, certain chemotherapy regimens, and hospitalization identified as risk factors. Early dietary counseling by registered dietitians may help mitigate this risk.

Dietetics doi: 10.3390/dietetics5010005

Authors: Vivian M. Drewelow Aleksandra S. Kristo Suzanne Phelan Alison K. Ventura

The present work aimed to assess associations between food insecurity, WIC participation, diversity of dietary exposures, and diet quality in infancy. A secondary analysis was conducted of the WIC Infant and Toddler Feeding Practices Study-2 (WIC ITFPS-2), a national longitudinal study of WIC participation, feeding practices, and children’s health outcomes. Food security at 13 and 24 months, WIC participation at 13 and 24 months, diversity of dietary exposures between 5 and 13 months, and diet quality at 24 months were assessed in 1246 participants who had complete data on all variables of interest. Multivariable linear regression using weighted cases was used. Among families participating in WIC at 13 months, infants in families with low or very low food security had a greater diversity of dietary exposures (mean ± SE: 8.9 ± 0.3) compared to families with high or marginal food security (8.6 ± 0.2); the magnitude of this effect was small but significant (p = 0.03). In both food-insecure and -secure families, greater diversity of dietary exposures (b = 0.30, 95% CI 0.15, 0.44) and WIC participation at 24 months (b = 2.35, 95% CI 1.29, 3.40) were associated with higher diet quality at 24 months. Greater diversity of dietary exposures and participation in WIC may support improved diet quality during the first 2 years.

Dietetics doi: 10.3390/dietetics5010004

Authors: Chen Bai Yuning Xie Danan Gu

Background: Identifying factors associated with cognitive impairment among older adults is critical. This study investigates both concurrent and longitudinal associations between sleep quality, sleep duration, and cognitive performance among older adults in China, with particular emphasis on the moderating role of fruit and/or vegetable intake (FVI), a factor rarely examined in previous research. Methods: We pooled five waves of a specially designed nationwide sample of adults aged 65 years or older (N = 64,690; mean age: 86.3 years; men: 43.5%) in 2005, 2008, 2011, 2014, and 2018 in China. Cognitive impairment was assessed by the Mini-Mental State Examination. Among the sample, 10.7% were cognitively impaired. FVI was dichotomized into frequent (almost daily) versus infrequent (other low frequencies). Sleep hours were grouped into short (≤6 h), normal (7–9 h), and long (≥10 h) durations. Both concurrent and cross-lagged analyses were performed after adjusting for a wide set of covariates (demographics, socioeconomic status, family/social connections, health practices, disability, self-rated health, and chronic conditions). Analyses were further stratified by gender, age group, and urban–rural residence. Results: When all covariates were present (the full model), good sleep quality was associated with 22% lower odds of the prevalence of cognitive impairment, whereas the long sleep duration was associated with 24% higher odds as compared with the normal sleep duration. Although the short sleep duration was not associated with the prevalence of cognitive impairment in the full model, it was associated with 8% higher odds of cognitive impairment when health condition was not controlled for. Interaction analyses revealed that frequent FVI buffered the adverse cognitive effects of poor sleep quality and both short and long sleep durations. Subgroup analyses further show similar patterns across subpopulations, with more pronounced protective associations in older women and the oldest-old. Conclusions: Good sleep quality, normal sleep durations, and frequent FVI jointly contribute to better cognitive functioning at older ages. While the observed relationships are largely concurrent rather than causal, promoting both healthy sleep and dietary habits may be important for cognitive health among older adults.

Dietetics doi: 10.3390/dietetics5010003

Authors: Titilope R. Komolafe Mary T. Olaleye Afolabi C. Akinmoladun Kayode Komolafe Akintunde A. Akindahunsi

Plantain (Musa paradisiaca L.) is a tropical monocotyledonous, succulent plant of the Musaceae family commonly grown for food in the tropical regions of the African, Asian, and South American continents, where its parts are also sought for ethnomedicinal purposes in the treatment of burns, inflammation, and diabetes, among others. In the present preliminary exploratory study, the ethanol extract of the underutilized Musa paradisiaca peel (MPE) was evaluated for its in vitro inhibitory effects on α-amylase and α-glucosidase, as well as its in vivo hypoglycemic activity and potential biochemical toxicity. MPE (100, 200, 400 mg/kg) was orally administered to normal experimental rats for 30 days, following which the lipid profile, antioxidant status, and serum/tissue indices of hepatic, renal, and cardiac functions were evaluated. MPE produced significant inhibition (p < 0.05) of α-amylase (37%) and α-glucosidase (46%) at 120 µg/mL in vitro. The effect was lower than that of acarbose (IC50 = 44.4 ± 1.14 and 15.60 ± 0.01 µg/mL, respectively). A modest blood glucose-lowering effect of MPE was observed at the highest tested dose (400 mg/kg) following subacute oral administration. During this treatment period, no biochemical alterations of toxicological importance were caused by MPE, as the organ–body weight ratio and serum/tissue indicators of organ function/damage were not adversely altered. In conclusion, MPE demonstrated inhibitory activity against both α-amylase and α-glucosidase, which may contribute to its potential hypoglycemic effects. Additionally, the findings indicate that the peel extract is non-toxic in rats following sub-acute administration at doses up to 400 mg/kg body weight. Further studies involving diabetic models and chronic exposure will substantiate and extend these preliminary observations.

Dietetics doi: 10.3390/dietetics5010002

Authors: Alicia S. Landry Candace F. Bolden Mercedes Babin Holly Huye

The national obesity prevalence for children between 2 and 5 years old was 12.7% from 2017 to 2020. These prevalence rates are concerning because as obesity in youth increases, so do long-term health and psychosocial risks. Preschool children can spend up to 50% of their day in childcare with their educators, consuming meals and snacks together. Therefore, the role modeling of healthy eating behaviors by these educators may have an impact on children’s eating behaviors and future weight status. The purpose of this paper is to examine the relationship between Head Start educators’ self-reported dietary intake patterns and BMI. Variables included BMI and 8 items from the Starting the Conversation brief dietary assessment screener. Data were collected at educators’ respective Head Start centers in the spring of 2019. Pearson correlations were calculated to examine the relationship between educators’ self-reported dietary intake patterns and BMI. Of 66 teachers and teacher assistants who completed all items and BMI assessment, significant relationships were found between consumption of snack chips or crackers and fast food (r = 0.33, p = 0.007 and r = 0.27, p = 0.031, respectively). This study’s findings call attention to the importance of supporting healthier diets among early childhood educators.

Dietetics doi: 10.3390/dietetics5010001

Authors: Elisa Zambetti Maura Crepaldi Francesca Orgiu Francesca Brivio Marina Colombi Aycannur Ince Paola Palestini Emanuela Cazzaniga Andrea Greco

Mothers’ behavior strongly influences children’s eating habits, with family attitudes and feeding practices playing a key role in dietary development. In accordance with the previous literature, this study examined these aspects, including also mothers’ use of social media to stay informed about nutrition as an innovative element. The main goal was to validate the Italian version of the PSEPAD scale (Parental Self-Efficacy for Promoting Healthy Physical Activity and Dietary Behaviors in Children), which is a valid and reliable tool for assessing parental self-efficacy in encouraging healthy lifestyles in children, through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The sample was composed of 217 mothers. Results were interpreted through groups comparisons (chi-square, ANOVA, and t-test). The findings confirmed the central role of mothers in managing children’s diets and using strategies against picky eating behaviors. The study also highlighted the growing use of social media among mothers, especially younger ones, as a source of nutritional information, meal planning, and peer support, despite a generally low level of satisfaction with the content available on pediatric nutrition. Finally, the results showed a positive link between maternal self-efficacy and healthier child behaviors: mothers with higher self-esteem and confidence were more effective in promoting healthy habits. These findings underscore the importance of targeted interventions to strengthen maternal self-efficacy and the development of digital tools to support healthy family lifestyles.

Dietetics doi: 10.3390/dietetics4040059

Authors: Mohamad Motevalli Derrick R. Tanous Clemens Drenowatz Markus Schauer Susanne Mair Michael Kohlberger Gerhard Ruedl Katharina Wirnitzer

Nutrition has been recognized as a major contributor to health and well-being. However, the association between nutritional status and cardiometabolic health across different stages of adulthood is not yet well understood. This cross-sectional study examined the association between health and micronutrient status among young and older Austrian adults. Specifically, the study investigated how blood micronutrients, blood lipid measures, and body composition are interrelated. A total of 488 adults who fulfilled the study criteria were categorized into young adults (n = 380; aged 20–49 years; 48% female) and older adults (n = 108; aged 50–64 years; 45% female). Blood analyses were performed to assess blood micronutrient levels and serum concentrations of a wide range of cardiometabolic health biomarkers, including blood lipids. Micronutrient deficiencies and excesses were determined using sex-based reference ranges. Significant differences were found between younger and older adults for 16 out of the 28 blood biomarkers of cardiometabolic health using group comparison tests (p < 0.05). There were significant age-based differences in the levels of magnesium, copper, zinc, molybdenum and vitamin D, but only copper and molybdenum deficiency/excess differed significantly between age groups (p < 0.05). Multivariate regression analysis showed that several micronutrients and demographic factors were associated with body weight, body mass index, and blood lipids (p < 0.05), with variation in associations observed between younger and older adults. These findings highlight that age-related differences in specific micronutrients, as well as their associations with blood lipids and body composition, should be considered when developing targeted nutritional and cardiometabolic health interventions for adults.

Dietetics doi: 10.3390/dietetics4040058

Authors: Anna Warias Anna Kurkiewicz-Piotrowska

The Olea europaea L., commonly known as the European olive, has been recognized for centuries as one of the most valuable species among useful plants. In contemporary applications, the olive tree provides a wide array of raw materials utilized in the food, pharmaceutical, and nutraceutical industries. Extracts derived from the leaves, bark, and fruits of O. europaea have also gained significant relevance in dermatological and cosmetic formulations. The aim of this paper was to review scientific studies published between 2019 and 2025 concerning the application of olive oil and other derivatives of the European olive in the care of skin, hair, and nails. The analysis underscores the role of olive-derived bioactives in wound healing, stretch mark management, and skin regeneration, highlighting compounds such as oleocanthal and oleuropein in hydration, elasticity, wrinkle reduction, and photoprotection relevant to skin aging. The evidence for olive oil in hair and nail care mainly highlights their moisturizing and strengthening effects, though studies remain limited. O. europaea derivatives show a favorable safety profile with low allergenic potential, and their availability and minimal sensitization risk support use in home cosmetics. The importance of the European olive and its products is expected to grow in the coming years. However, the availability of technologies for processing waste materials obtained from this plant, as well as the associated technological costs, remain significant limitations.

Dietetics doi: 10.3390/dietetics4040057

Authors: Nichole Cortez Barbara Gordon

This study examined the efficacy of pediatric Produce Prescription Programs (PPP) on food security status, dietary intake, and health outcomes among children, and aimed to determine the optimal prescription dosage and exposure duration required to promote beneficial outcomes. A systematic review of studies published within the past 10 years, reporting on discrete food security status, dietary quality, and health outcomes among children was conducted. Studies not reporting child-specific data or not published in the English language were excluded. Three databases were searched (PubMed, CINAHL Complete, and EBSCO), data was narratively compiled, and the Newcastle-Ottawa Quality Assessment was employed to assess risk of bias. Prescription monetary amounts (dosages) were standardized, facilitating comparison between programs and outcomes. Nine studies (n = 3808 at-risk children) conducted at 52 sites were retrieved. Program protocols varied. Participation improved food security and fruit/vegetable intake; some beneficial changes were similar regardless of produce dosage and exposure. Data suggest conjecturally that a minimum dosage of $70/month adjusted for locality, cost-of-living and implementation year and exposure of ≥6 months might promote achievement of FV recommended guidelines. The value of educational components emerged in the studies. The findings of this study are limited by the high risk of bias embedded in the included interventions, as well as high heterogeneity amongst the programs. More research on program designs, the impact of PPPs on health outcomes, and cost-benefit analyses are warranted. Rigorous study designs are needed to assess the health impacts and long-term efficacy of pediatric PPPs.

Dietetics doi: 10.3390/dietetics4040056

Authors: Dalia El Khoury Laura Kuszaj Ashley Goodliff

The market for gluten-free (GF) snack products has expanded, even among children without gluten-related disorders, but few studies have assessed their nutritional quality relative to gluten-containing (GC) counterparts. This study compared the macronutrient composition and fibre additive content of such snack bars marketed to children in Ontario. A total of 110 snack bars were identified using a standardized set of marketing-based criteria. Nutritional data, including macronutrient content and the presence of fibre additives such as inulin and fructooligosaccharides (FOSs), were collected. Data was standardized per 100 kcals and bar size, then analyzed using an independent sample t-test and chi-square. Results indicated that GF bars contained significantly higher levels of protein (1.7 ± 0.77 g vs. 1.3 ± 0.44 g; p = 0.002) and fibre (1.9 ± 0.95 g vs. 1.4 ± 0.98 g; p = 0.015). No significant differences were observed for sugar, carbohydrates, total fat, saturated fat, or trans fat content. Fibre additives were more common in GF bars (24.4% vs. 10.1%), though this association was not statistically significant (p = 0.079). Findings suggest that while GF bars show slight nutritional advantages, their similar overall profiles and greater use of fibre additives indicate room for improvement across both categories.

Dietetics doi: 10.3390/dietetics4040055

Authors: Xinran Xiong Manuel Martí-Vilar

Population aging has significantly increased the number of older adults in situations of dependency, where they are more vulnerable to mental health problems and a decline in quality of life. Several studies have suggested that nutritional support could play a key role in improving these aspects. This study aimed to analyze the current scientific findings regarding how nutritional interventions influence mental well-being and life quality in elderly individuals with dependency. Following PRISMA methodology, literature was retrieved from internationally recognized bibliographic databases, including Web of Science, PubMed, Scopus, and ProQuest. Experimental and quasi-experimental studies that analyzed nutritional interventions aimed at dependent older adults with results related to mental health and/or quality of life were included. A total of 23 studies satisfying all inclusion standards were selected for the analysis. Most reported positive effects of nutritional interventions on mood, depressive symptoms, and/or perceived quality of life, although there was heterogeneity in the designs and measures used. Nutritional support may represent an effective strategy for improving mental health and quality of life in dependent older adults. However, further research with robust designs and standardized measures is needed to strengthen the available evidence.

Dietetics doi: 10.3390/dietetics4040054

Authors: Rehan Jessa Farris Kassam Rachel A. Murphy Nadia A. Khan Tricia S. Tang

Vegetarianism has historically been associated with cardiometabolic benefits and reduced diabetes risk. Despite having the highest prevalence of vegetarians globally, the prevalence of type 2 diabetes in South Asians is amongst the highest globally. This review explores the relationship between vegetarianism and cardiometabolic measures in South Asian populations to clarify this paradoxical relationship. Five databases were searched to identify observational studies published between January 2000 and May 2025 that compared vegetarian diets with non-vegetarian diets and reported cardiometabolic measures. A total of 973 articles were identified, 590 articles were assessed, and 7 studies (n = 184,345) were ultimately included. Overall, each study utilized different dietary intake assessments and reported variable cardiometabolic measures. The three highest-quality studies found that vegetarian adherence was associated with a lower BMI, waist circumference, diastolic blood pressure, lipid levels, and fasting blood glucose compared with non-vegetarian diets. Conclusive findings were limited by the small number of studies, variability in dietary assessment methods, and heterogeneity in the reporting of cardiometabolic measures. These results underscore the importance of conducting more methodologically robust studies to assess cardiometabolic measures and demonstrate the need for culturally consistent dietary assessment tools to reduce inter-study variability and improve dietary reporting in South Asians.

Dietetics doi: 10.3390/dietetics4040053

Authors: Marwyn Sowden Monique van de Lagemaat Dana Yumani Evette van Niekerk Mirjam Maria van Weissenbruch

(1) Background: Preterm infants are deprived of crucial growth and development that occurs during the last trimester of pregnancy. Optimal nutrition after birth, including sufficient intakes of protein and energy, have been emphasized to improve postnatal growth and development of preterm infants. This study investigated the impact of routine nutritional strategies as used in a Neonatal Intensive Care Unit in South Africa and in the Netherlands, respectively, on the preterm infant’s postnatal growth; (2) Methods: This retrospective observational study included 100 preterm infants from a South African cohort and 86 preterm infants from a Dutch cohort. Over the first four postnatal weeks, total intravenous (IV) fluid volume (i.e., IV. glucose and/or parenteral nutrition (PN) and enteral nutrition (EN) were recorded, and total energy and protein intakes were calculated. Anthropometric measurements were taken and expressed as Z-scores per week; (3) Results: At birth, the South African cohort had a higher gestational age compared to the Dutch cohort; however, weight, length and head circumference Z-scores were lower. During the first four postnatal weeks, the Dutch cohort had a significant higher total energy and protein intakes by the combination of PN and EN than the South African cohort, that mostly received EN only. In addition, the South African cohort showed a more pronounced decline in Z-scores compared to the Dutch cohort; (4) Discussion: Over the 4-week study period, the South African cohort showed more pronounced growth faltering compared to the Dutch cohort preceded by lower total energy and protein intakes; (5) Conclusions: The use of PN, while EN is incremented daily, should be considered in the South African cohort to diminish postnatal growth faltering in preterm infants.

Dietetics doi: 10.3390/dietetics4040052

Authors: Safa Abdul Majeed Reema Tayyem

Background/Objectives: Qatar and other Gulf Cooperation Council (GCC) countries are experiencing a growing incidence of diet-related non-communicable diseases (NCDs). The lack of a culturally relevant food exchange list (FEL) for commonly consumed foods in Qatar and the GCC limits the application of cultural preferences in medical nutrition therapy (MNT) for managing diet-related NCDs, thereby reducing patient adherence and metabolic outcomes. Therefore, the primary objective of this study was to develop a culturally tailored FEL for 50 main course dishes widely consumed in the region. Methods: A four-phase approach was followed in this developmental study. First, common Qatari and GCC dishes were identified based on cultural practices and market availability. Second, nutrient composition was compiled from regional food composition tables and validated using dietary analysis software. Pearson correlation was conducted to compare macronutrient values, with significance set at p < 0.05. Third, standard serving sizes were determined using Wheeler et al.’s methodology and converted into household measures using a kitchen scale. Finally, we developed a macronutrient exchange list for the dishes based on the established Wheeler rounding-off criteria. Results: A culturally tailored FEL for 50 frequently consumed Qatari and GCC dishes was successfully developed. Significant correlations were observed between laboratory-derived and software-derived values for carbohydrates (r = 0.7) and protein (r = 0.9), with a weaker correlation for fat (r = 0.5). Macronutrient exchange analysis revealed substantial variation across dishes, with several carbohydrate-based dishes also contributing meaningful protein and fat exchanges. Findings indicated that visual assumptions about nutrient composition may not accurately reflect exchange values, highlighting the need for systematic analysis in diet planning. Conclusions: This study developed a novel culturally relevant FEL for commonly consumed composite dishes in Qatar and the GCC. The exchange list provides a practical tool for dietitians and healthcare professionals to support culturally tailored MNT and public health interventions in the region. It also serves as a valuable resource for researchers in nutritional epidemiology, enabling the analysis of dietary data by converting raw food intake information.

Dietetics doi: 10.3390/dietetics4040051

Authors: Andrea J. Lobene Annabel Biruete Seyedeh Nooshan Mirmohammadali Leah M. Ellis Dennis P. Cladis

Chronic kidney disease (CKD) affects over 850 million individuals globally and has no cure. The treatment of CKD centers on lifestyle interventions, including dietary changes, that slow disease progression. As emerging evidence suggests that fruit and vegetable-derived (poly)phenols may slow CKD, the goal of this narrative review is to synthesize current knowledge on the role of dietary (poly)phenols in CKD. To identify relevant articles, we searched databases including PubMed, Google Scholar, and Web of Science to identify relevant articles, using keywords including (poly)phenols, CKD, gut microbiome, and cardiovascular disease, among others. The relevant articles were synthesized into a summary of the evidence for (poly)phenols as a therapeutic strategy in CKD, though the paucity and heterogeneity of available research in this area precludes the identification of specific doses or types of (poly)phenols needed to slow CKD progression. The review is supplemented through our discussion of the gut microbiota and microbially derived metabolites as key targets in mediating the progression of CKD itself as well as subsequent cardiovascular outcomes. Finally, we discuss the integration of (poly)phenol-rich dietary patterns into CKD nutrition guidelines, highlighting future research directions to elucidate the potential therapeutic role of (poly)phenols in CKD.

Dietetics doi: 10.3390/dietetics4040050

Authors: Katie N. Kraus Stacy L. Bevan Sarah Moore Smith Maeci H. Armstrong Brooke Campbell Jeppesen Catherine Fish Heidi J. Wengreen

With the growing use of AI, it is important to know target audiences’ perceptions of its use. A convenience sample of students were invited to take an online survey in which they were randomly assigned to Group 1 (evaluated a student-generated blog; n = 456) or Group 2 (evaluated an AI-generated blog; n = 492). The results of independent t-tests and chi-squared tests indicated no group differences in ratings of ease of recipe preparation, time to prepare the recipe, utilization of common ingredients, and frequency of intended use of the blog. The student-generated blog was rated higher on budget friendliness (p = 0.025). A total of 42% indicated they would be less willing to use a blog if they knew it was AI-generated, while 43% indicated that it would make no difference and 4.4% indicated being more likely to view the AI-generated blog. Two researchers used a thematic analysis approach to evaluate participants’ free responses regarding the likelihood of using a recipe blog that was AI-generated. Participant perceptions of an AI-generated blog ranged from very positive to very negative. Some themes highlighted the potential benefits of AI or a more neutral stance indicating that “a recipe is a recipe”. The majority of themes highlighted the benefits of content that was created, verified, or tested by humans, or espoused a human touch. Students should be trained to cater to consumer preferences, and to add value in a world that includes AI-generated content.

Dietetics doi: 10.3390/dietetics4040049

Authors: Silvia Tedesco Nadia Campelli Stefano Lunetti Giulia Nicolai Cristina Marmorale Albano Nicolai Marina Taus

Bariatric surgery is a highly effective therapeutic strategy in the treatment of severe obesity, but it carries significant risks, both in the short and long terms. However, many of these complications can be avoided by appropriate patient selection, comprehensive assessment of clinical conditions, and structured follow-up including clinical, nutritional, and psychological monitoring. Achieving these objectives requires a meticulous program involving the entire multidisciplinary team and lays the foundations for proper patient compliance. Furthermore, recent studies have begun to explore the systemic effects of bariatric–metabolic surgery, with benefits extending far beyond simple weight loss and effects on both morbidity and mortality. Research has documented improvements in cardiovascular risk factors, insulin sensitivity, and hormonal balance, with substantial effects on the three main comorbidities of obesity: cardiovascular risk and hypertension, T2DM, and OSAS. In conclusion, bariatric surgery, while highly effective in treating severe obesity and its comorbidities, involves significant anatomical and physiological changes that alter nutrient absorption and digestion. These changes can lead to a number of short-, medium-, and long-term nutritional complications that require close monitoring and targeted dietary interventions.

Dietetics doi: 10.3390/dietetics4040048

Authors: Despina Chatziharalambous Antonios E. Koutelidakis

(1) Background: This research aims to determine the main factors that influence: (i) purchase decisions for flour and bakery products, (ii) consumer preferences, attitudes, and consumption frequency of those products, and (iii) the degree of knowledge and confidence in innovative functional food products. (2) Methods: Questionnaires were randomly distributed to 639 Greek citizens aged 18–75 years. The statistical analysis included Chi-Square, Kruskal–Walis H, and Mann–Whitney U tests, and Spearman correlations. (3) Results: Flour purchasing decisions were influenced by age, income, marital status, and education, while bakery products were widely regarded as nutritious. Women and older individuals were more knowledgeable regarding alternative flours. Trust in functional products increased with age, marital status, household minor and adult size, and income. (4) Conclusions: Several demographic characteristics may affect the purchasing decisions and attitude towards flour, bakery, and functional food products.

Dietetics doi: 10.3390/dietetics4040047

Authors: Aru Takaoka Suzuna Iwano Takahiro Tabuchi Yasutake Tomata

Background: Meat alternative products have gained attention in recent years. This study examined the factors associated with meat alternative purchase in Japan. Methods: This longitudinal study used data from nationwide surveys conducted in 2022 and 2023 with persons aged 15–79 years in Japan. In total, 11,476 participants were included in the analysis. The outcome indicators were changes in meat alternative purchase in 2022 and 2023, categorized into four groups: “no in both years,” “purchased only in 2022,” “purchased only in 2023,” and “purchased in both years.” A multinomial logistic regression model was used, with “no in both years” as the reference group. Potential factors included sex, age, household income, education, health check-up status, and population density in residential areas. Results: Factors that were significantly associated with meat alternative purchase in any year were being woman, being aged <65 years, not having a lower annual income (5–16 million yen), having a higher educational attainment, and having undergone/intended to undergo health check-up (p < 0.05). In particular, sex was significantly associated with “Purchased only in 2022,” “Purchased only in 2023,” and “Purchased in both years”; the multivariate-adjusted OR (95% CI) of “Purchased in both years” for women was 3.07 (2.16–4.34). Conclusion: This study suggests that sociodemographic characteristics may influence the consumption of meat alternatives, impacting the development of the meat alternative industry.

Dietetics doi: 10.3390/dietetics4040046

Authors: Madoka Kishino Azumi Hida Kazuko Ishikawa-Takata Yuki Tada Lucy Kariuki Patrick Maundu Hirotaka Matsuda Kenji Irie Yasuyuki Morimoto

Objectives: Few studies have examined maternal dietary intakes in relation to children’s malnutrition status. We examined variations in children stunting status and their association with maternal and child dietary intakes. Methods: This one-year prospective study (conducted from November 2021 to December 2022) consisted of up to four surveys carried out in rural Kenya. It included 135 pairs of children aged 12–59 months and their non-pregnant mothers, all of whom had received nutrition guidance during the study. Dietary intakes were assessed in four non-consecutive 24 h dietary recalls during the first two surveys. Anthropometric measurements were taken at most four times, and variations in children stunting status (not-stunted, recovered-from-stunting, or persistent/worsened stunting) were assessed. Maternal and child dietary intakes, based on variations in stunting status, were compared using one-way analysis of covariance adjusted for socio-demographic variables. Results: Of the 135 children studied, 40 (29.6%) were stunted at baseline, whereas 85, 20, and 30 had no stunting, recovered from stunting, or had persistent/worsened stunting. Children with persistent/worsened stunting had a significantly lower energy intake than other children; however, maternal energy intake did not differ by children’s stunting status. Milk intake was significantly lower among children with persistent/worsening stunting than other children. A similar difference based on variations in stunting was also observed for maternal milk intake. Conclusions for Practice: The mothers of rural Kenyan children who had recovered from stunting consumed the most milk, while the mothers of children with persistent/worsening consumed the least milk. Further research is needed to confirm the factors behind the observed intake differences.

Dietetics doi: 10.3390/dietetics4040045

Authors: Mohamad Motevalli Derrick R. Tanous Clemens Drenowatz Markus Schauer Susanne Mair Michael Kohlberger Gerhard Ruedl Katharina Wirnitzer

Sex differences are known to influence both micronutrient metabolism and cardiometabolic health outcomes. However, the extent to which these sex-specific factors interact, particularly in the relationship between micronutrient status and cardiometabolic risk, remains insufficiently understood. The present study aimed to investigate sex differences in health and micronutrient status, and their association with blood lipids, body mass index, and body weight. The final sample size included 488 Austrian adults (median age: 38 years; comprising 256 males and 232 females) who successfully met the inclusion criteria. Blood analyses were conducted to measure whole-blood micronutrients and serum levels of various cardiometabolic health biomarkers, including blood lipids. Micronutrient status (including deficiencies and excesses) was calculated using sex-specific reference ranges. There were significant differences between males and females for most (19 out of 28) blood biomarkers of cardiometabolic health (p < 0.05), with females generally showing a healthier cardiometabolic profile. Significant sex differences were also observed in the adjusted values of three micronutrients: copper was higher in females, while iron and vitamin B12 were higher in males (p < 0.05). Sex differences in micronutrient status indicated a higher prevalence of iron deficiency and copper excess among females (p < 0.05). Different patterns were observed between males and females in the association of blood lipids and body composition with micronutrients and demographic factors. These findings highlight the importance of individualized approaches in preventive and therapeutic health interventions based on differences between males and females.

Dietetics doi: 10.3390/dietetics4040044

Authors: Nikolaos-Orestis Retzepis Alexandra Avloniti Christos Kokkotis Theodoros Stampoulis Dimitrios Balampanos Dimitrios Draganidis Anastasia Gkachtsou Marietta Grammenou Anastasia Maria Karaiskou Danai Kelaraki Maria Protopapa Dimitrios Pantazis Maria Emmanouilidou Panagiotis Aggelakis Nikolaos Zaras Ilias Smilios Ioannis G. Fatouros Maria Michalopoulou Athanasios Chatzinikolaou

Background: Bone health in youth is influenced by both modifiable factors, such as nutrition and physical activity, and non-modifiable factors, such as biological maturation and heredity. Understanding how these elements interact to predict body composition may enhance the effectiveness of early interventions. Importantly, the integration of both supervised and unsupervised machine learning models enables a data-driven exploration of complex relationships, allowing for accurate prediction and subgroup discovery. Methods: This cross-sectional study examined 94 male athletes during the developmental period. Anthropometric, performance, and nutritional data were collected, and bone parameters were assessed using dual-energy X-ray absorptiometry (DXA). Three supervised machine learning models (Random Forest, Gradient Boosting, and Support Vector Regression) were trained to predict Total Body-Less Head (TBLH) values. Nested cross-validation assessed model performance. Unsupervised clustering (K-Means) was also applied to identify dietary intake profiles (calcium, protein, vitamin D). SHAP analysis was used for model interpretability. Results: The Random Forest model yielded the best predictive performance (R2 = 0.71, RMSE = 0.057). Weight, height, and handgrip strength were the most influential predictors. Clustering analysis revealed two distinct nutritional profiles; however, t-tests showed no significant differences in TBLH or regional BMD between the clusters. Conclusions: Machine learning, both supervised for accurate prediction and unsupervised for nutritional subgroup discovery, provides a robust, interpretable framework for assessing adolescent bone health. While dietary intake clusters did not align with significant differences in bone parameters, this finding underscores the multifactorial nature of skeletal development and highlights areas for further exploration.

Dietetics doi: 10.3390/dietetics4040043

Authors: Salsabila Khairunnisa Koutatsu Maruyama Saori Miyazaki Isao Saito Kiyohide Tomooka Takeshi Tanigawa Eri Eguchi Tamami Shiba Akiko Kooka Kazumi Fujimura Keiko Suyama Ryoichi Kawamura Yasunori Takata Haruhiko Osawa

Previous studies have shown that dietary fatty acid intake is associated with the risk of developing dementia. However, its association with mild cognitive impairment (MCI) remains controversial. Therefore, we aimed to examine the association between dietary fatty acid intake and MCI in an older Japanese population. We included 1144 participants aged 60 or older who participated in the Toon Health Study in 2014–2018 in the analysis. Dietary fatty acid intake was estimated using food frequency questionnaires (FFQs). MCI was assessed using the Montreal Cognitive Assessment in Japanese (MoCA-J) and defined as an MoCA-J score below 26. The multivariable-adjusted odds ratio (OR) and 95% confidence interval (CI) were calculated using logistic regression. We determined that 430 of the participants had MCI. Intake levels of polyunsaturated fatty acids (PUFAs), n-3 and n-6, fatty acids, and saturated fatty acid/PUFA ratio (SFA/PUFA) were not significantly associated with MCI. The multivariable-adjusted ORs (95%CI) for MCI in the highest quartile of PUFA, n-3 and n-6 fatty acid, and SFA/PUFA intake were 0.79 (0.55, 1.14, p for trend = 0.29), 0.96 (0.59, 1.54, p for trend = 0.85), 0.81 (0.56, 1.16, p for trend = 0.34), and 0.85 (0.59 1.22, p for trend = 0.24) compared with the lowest quartiles, respectively. SFA was significantly associated with lower odds of developing MCI. The multivariable-adjusted OR (95%CI) for MCI in the highest quartile of SFA intake compared with the lowest quartile was 0.63 (0.43, 0.93, p for trend = 0.03). Conclusions: SFA intake was inversely associated with MCI, while intake of PUFAs, including n-3 and n-6 fatty acids, was not associated with MCI. Further investigation is required to clarify these associations.

Dietetics doi: 10.3390/dietetics4040042

Authors: Jael Alfonso Hugo Melgar Quinonez Olga P. García Alex Brito Israel Ríos-Castillo

Food and water security are essential components for Panama’s advancement toward the Sustainable Development Goals. This study aimed to quantify the prevalence of household food insecurity and water insecurity, and to explore the association between them using standardized measurement tools. A cross-sectional survey was conducted between January and June 2024 using an online questionnaire administered via Google Forms. The survey collected sociodemographic data and applied the Food Insecurity Experience Scale (FIES) and the Household Water Insecurity Experiences (HWISE) scale to assess water and food insecurity, respectively. A total of 222 adult household heads were included (66.2% female), with a median age of 31.4 years. The prevalence of moderate and severe food insecurity was 29.7% (95% CI: 24.8–34.6%) and 6.1% severe food insecurity (95% CI: 3.7–8.4%), while water insecurity affected 27% of households (10.4% high; 16.7% moderate). Multiple linear regression showed that moderate to severe food insecurity was significantly associated with water insecurity (β = 0.19; 95% CI: 0.08–0.31) and lower income levels. Specifically, food insecurity was associated with households reporting no income (β = 0.25; 95% CI: 0.05–0.44) and those with monthly income between 501 and 1000 USD (β = 0.11; 95% CI: 0.01–0.22), compared to households with income above 1000 USD. The results suggest that food insecurity is significantly associated with water insecurity, supporting the need for integrated approaches in public policy to address basic resource access in vulnerable populations.

Dietetics doi: 10.3390/dietetics4030041

Authors: Jordy P. W. Burger Catherine Pijls Floris W. P. C. van Overveld Marc Jacobs Margreet M. S. Wessels Peter J. Wahab

Strict adherence to a gluten-free diet (GFD) is the cornerstone of treatment in coeliac disease, yet gluten cross-contamination in household settings poses a persistent challenge. Guidance from dieticians and patient organizations is often not evidence-based. This study quantified gluten contamination risks associated with common kitchen appliances and evaluated the effectiveness of various cleaning methods in typical Dutch households. We performed a two-phase analysis of 417 samples of 275 chopping boards, 34 toasters/sandwich makers, and 108 deep-fat fryers/air fryers. Gluten levels were assessed on appliances and food items under different cleaning protocols, with Bayesian modeling used to estimate contamination probabilities. Plastic chopping boards showed the highest risks, with probabilities up to 0.868 when rinsed with cold water, compared with 0.147 after dishwasher cleaning. Glass and wooden boards cleaned in dishwashers had the lowest probabilities (0.0102 and 0.0194). Toasters and sandwich makers tested positive in 1 of 34 samples; at the 20 ppm threshold, contamination probability was 0.00001. In fryers, probabilities were 0.125 for deep-fat fryers and 0.070 for air fryers at the 5 ppm threshold, decreasing to 0.0405 and 0.0326 at 20 ppm. Across all appliances, gluten levels seldom exceeded the clinically relevant threshold of 20 ppm. This study highlights the importance of dedicated cleaning protocols and appliance-specific recommendations to mitigate gluten exposure. While complete elimination of gluten is challenging, adopting rigorous practices can substantially mitigate exposure for coeliac patients, enhancing safety and quality of life.

Dietetics doi: 10.3390/dietetics4030040

Authors: Pauline Celine Raoul Marco Cintoni Chiara De Rossi Elena Leonardi Eleonora Ribaudi Emanuele Rinninella Antonio Giaquinto Carmen Nuzzo Antonio Gasbarrini Maria Cristina Mele

Background: Hospitalized patients often experience reduced dietary intake, leading to malnutrition and worsening clinical outcomes. This study evaluated their dietary intake and its associated factors, focusing on three diets provided by the hospital’s kitchen. Methods: An observational study was conducted from October 2024 to January 2025 at the Fondazione Policlinico Agostino Gemelli in Rome. Standard, minced, and soft diets were considered. A visual 5-point scale estimation method was used by trained dietitians to measure dietary intake. Face-to-face interviews also assessed food service quality. Results: A total of 631 patients were enrolled. The average calorie and protein intake were, respectively, 473.4 kcal and 30.9 g at lunch, regardless of diet type. Over 40% of the patients did not meet the minimum nutritional requirements in terms of meal calories and proteins consumed, regardless of diet type. Correlation analysis showed significant positive associations between dietary intake, breakfast palatability for all diets, and breakfast quantity for standard and soft diets (ORs > 2, p < 0.05). Other food service quality factors showed no significant associations with dietary intake. Conclusions: These preliminary findings highlight the need for regular dietary assessments to identify barriers to optimal meal consumption. Educating and assisting patients during mealtime could also promote awareness and diet acceptance.

Dietetics doi: 10.3390/dietetics4030039

Authors: Mi-Jeong Lee

Elevated oxidative stress and chronic inflammation are major pathological factors underlying numerous diseases, including cardiovascular and neurodegenerative diseases. Astaxanthin, an antioxidant carotenoid, and very long-chain omega-3 polyunsaturated fatty acids, such as eicosapentaenoic acid and docosahexaenoic acid, are commonly found in seafood and exhibit beneficial effects on a myriad of diseases. The two powerful nutrients often work together, and this interaction is particularly beneficial for various aspects of health, primarily due to their complementary antioxidant and anti-inflammatory properties. The current understanding of the molecular and cellular mechanisms by which powerful duos exhibit protective effects, and their potential interactive effects on cardiometabolic and neurodegenerative diseases, is discussed.

Dietetics doi: 10.3390/dietetics4030038

Authors: Letícia M. Conceição Sara S. P. Rodrigues

Cooking skills (CSs) encompass both physical and behavioral abilities, and their transmission has evolved due to social changes and the rise of fast food as a convenient but unhealthy option. Studies show that patients are more likely to follow dietary plans when the advice includes healthy, simple, and practical cooking tips. Intervention programs supporting this approach have been shown to improve CSs and encourage balanced diets in the community. CSs of health professionals, and their ability to teach and impart, can thus play a key role in these strategies. This systematic review aimed to identify studies that have already discussed CSs among health professionals. PRISMA guidelines were followed, and Scielo, Pubmed, Scoppus, and Web of Science databases were searched in January 2024. From the identified 527 potentially relevant studies, 9 met the inclusion criteria. The studies analyzed address topics such as the suitability of CS as a professional competency, professionals’ viewpoints regarding culinary aptitude, integrating CSs into training, and assessment of their impact on enhancing professionals’ competencies. Results suggest that developing CSs can improve professionals’ confidence, potentially benefiting community eating behaviors. Despite available validated tools, a clearer CS definition is needed for consistent evaluation and a better understanding of its role among health professionals.

Dietetics doi: 10.3390/dietetics4030037

Authors: Cristiane Vasconcelos Kamila Castro Rudimar dos Santos Riesgo

Background: Autism spectrum disorder (ASD) presents diverse challenges that significantly impact feeding, nutrition, growth, and development. The heterogeneity of ASD manifestations adds complexity to assessments due to the broad range of factors to be considered. Moreover, the literature lacks a comprehensive tool specifically addressing nutritional aspects in ASD. Methods: Conducted in two steps, this study first involved researchers selecting evidence-based elements related to ASD and nutrition to develop a preliminary tool. Content validation was subsequently undertaken using a modified Delphi method, whereby expert consensus was sought from 30 dietitians with experience in ASD, who evaluated the tool through a digital questionnaire. Four quality criteria were evaluated: functionality, organization, language and comprehensibility, and comprehensiveness. Results: Levels of strong agreement with the quality criteria ranged from 63.3% to 80%, specifically functionality (76.7%), organization (73.3%), language and comprehensibility (80%), and comprehensiveness (63.3%). Thematic analysis highlighted six key areas for improvement. The instrument assesses nutritional aspects across seven domains: life history, food-related aspects, feeding behavior, dietary intake, daily routines, clinical aspects, and anthropometry. Conclusions: This is the first known tool to comprehensively address the nutritional needs of individuals with ASD, offering a detailed framework for clinical application. It supports initial assessments, ongoing monitoring, and targeted interventions, supporting dietitians worldwide in clinical decision-making.

Dietetics doi: 10.3390/dietetics4030036

Authors: Fernando Blanco-Gomez Nerea Nogueira-Rio Veronica Mendez-Vilabrille Jose Manuel Miranda Julia María Cabo del Riego Aroa Lopez-Santamarina

Type 2 Diabetes (T2D) is a prevalent metabolic disease with a strong association with cardiovascular complications. This study evaluated glycemic control and lipid profiles (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides) in patients with T2D, based on glycated hemoglobin and fasting glucose levels, through a cross-sectional analysis of 4814 individuals (mean age: 66.2 ± 16.07 years with normal distribution; 51.5% male) from the Hospital Universitario Lucus Augusti in Northwest Spain. The aim was to assess the metabolic differences and potential influences of age, sex, and geographic setting. We observed that patients with T2D had lower low-density lipoprotein cholesterol, but higher triglycerides and high-density lipoprotein cholesterol levels compared to patients without T2D. A positive correlation was found between age and fasting glucose levels (r = 0.182; p < 0.05), with the highest glucose concentrations occurring in postmenopausal women. No significant differences were observed between rural and urban participants. These findings support the integration of targeted nutritional strategies and education programs in the clinical management of T2D, particularly in older adults.

Dietetics doi: 10.3390/dietetics4030035

Authors: Bradley Ridoutt Danielle Baird Gilly A. Hendrie

Protein-rich foods, such as meats, eggs, nuts, legumes, and dairy foods, can be important sources of micronutrients, especially those micronutrients that tend to be widely under-consumed. The source of dietary protein, animal or plant origin, is therefore a relevant consideration in the transition to healthier and sustainable diets. In this study, 1589 Australian adult diets with higher diet quality and lower environmental impact were isolated from Australian Health Survey data. These diets were primarily differentiated by lower intake of energy-dense/nutrient-poor discretionary foods. These diets were grouped according to the proportion of total protein obtained from animal and plant sources. On average, 55% of protein was from animal sources and 45% was plant derived. As the proportion of animal protein increased, total dietary protein intake also increased, and total energy intake decreased. Diets with between 60 and 80% of protein from animal sources met the greatest number of Estimated Average Requirements (EARs). Furthermore, diets with this ratio of animal protein were closest to benchmarks when assessed as a proportion of EAR met. That said, across all identified “sustainable healthy diets”, calcium, vitamins B6 and A, zinc, and magnesium were at risk of inadequate intake. This evidence suggests that a diet with around 60–80% of total protein coming from animal sources can reduce the risks of inadequate intake of micronutrients in a sustainable diet.

Dietetics doi: 10.3390/dietetics4030034

Authors: Ioannis Maisoglou Michalis Koureas Lamprini Dimitriou Ermioni Meleti Maria Alexandraki Vasiliki Kossyva Anastasia Tzereme Mariastela Vrontaki Vasileios Manouras Athanasios Manouras Eleni Malisisova

The growing demand for health-promoting and eco-friendly foods has driven interest in biofunctional dairy products. Goat milk yogurt, though nutritionally beneficial, faces sensory challenges, while antioxidant-rich spent coffee grounds (SCGs), a coffee by-product, offer sustainable enhancement potential. This study assessed the consumer acceptance of goat milk yogurt enriched with 2% and 3% SCG extract. A total of 137 untrained consumers evaluated six sensory attributes—appearance, aroma, taste, texture, coffee–yogurt balance, and aftertaste—on a five-point hedonic scale. Due to non-normal data, Wilcoxon rank-sum tests and Spearman correlations were applied. No significant differences emerged between formulations (p > 0.05). Taste, aftertaste, and aroma were strongly correlated (r > 0.65). All attributes significantly predicted purchase intent (p < 0.01), with taste as the strongest driver (OR = 2.24). Consumers aged 26–35, usually presenting health or environmental concerns, showed greater acceptance. The addition of SCG extract did not compromise sensory quality, supporting its viability as a sustainable functional ingredient. These findings present high acceptance of a newly developed eco-friendly and nutritionally beneficial product, responding to consumers’ current qualitative demands related to the food they consume.

Dietetics doi: 10.3390/dietetics4030033

Authors: Aziz Shoaib Saori Miyazaki Koutatsu Maruyama Kiyohide Tomooka Takeshi Tanigawa Ryoichi Kawamura Yasunori Takata Haruhiko Osawa Isao Saito

This study investigates the association between Low-Carbohydrate Diet (LCD) score and the incidence of hypertension in the Japanese population. This cohort study was conducted in an ongoing longitudinal study, the Toon Health Study. Hypertension was defined by measured blood pressure levels and self-reported treatment information, and dietary intake was measured through a validated food frequency questionnaire. Total, animal and plant-based LCD scores were calculated. Participants were divided into sex-specific tertiles of LCD scores. A multivariable-adjusted logistic regression model was used to calculate odds ratio (OR) and 95% confidence interval (95% CI) of incidence of hypertension. Total and plant-based LCD scores showed a borderline negative association with incidence of hypertension. The ORs (95% CI) for the highest versus lowest tertile of the total LCD score were 0.61(0.37–1.03, p for trend = 0.07) and 0.65(0.39–1.10, p for trend = 0.09) for the plant-based LCD score. Stratified analysis by drinking status showed significant negative association among alcohol drinkers, multivariable ORs (95% CI) for the highest versus lowest tertile of total LCD score was 0.38 (0.17–0.83, p for trend = 0.01) and for the plant-based LCD score was 0.39 (0.17–0.90, p for trend = 0.01). No significant association observed in non-drinkers. In conclusion, an increased LCD score was associated with the lower incidence of hypertension, especially in the drinking population.

Dietetics doi: 10.3390/dietetics4030032

Authors: Ronna Robbins Jason C. O’Connor Tiffany M. Cortes Monica C. Serra

This pilot, randomized, double-blind, placebo-controlled trial investigated the effects of branched-chain amino acids (BCAAs)—provided in a 2:1:1 ratio of leucine:isoleucine:valine—combined with exercise on fatigue, physical performance, and quality of life in older adults. Twenty participants (63% female; BMI: 35 ± 2 kg/m2; age: 70.5 ± 1.2 years) were randomized to 8 weeks of either exercise + BCAAs (100 mg/kg body weight/d) or exercise + placebo. The program included moderate aerobic and resistance training three times weekly. Physical function was assessed using handgrip strength, chair stands, gait speed, VO2 max, and a 400 m walk. Psychological health was evaluated using the CES-D, Fatigue Assessment Scale (FAS), Insomnia Severity Index (ISI), and global pain, fatigue, and quality of life using a visual analog scale (VAS). Significant group x time interactions were found for handgrip strength (p = 0.03), chair stands (p < 0.01), and 400 m walk time (p < 0.01). Compared to exercise + placebo, exercise + BCAAs showed greater improvements in strength, mobility, and endurance, along with reductions in fatigue (−45% vs. +92%) and depressive symptoms (−29% vs. +5%). Time effects were also observed for ISI (−30%), FAS (−21%), and VAS quality of life (16%) following exercise + BCAA supplementation. These preliminary results suggest that BCAAs combined with exercise may be an effective way to improve physical performance and reduce fatigue and depressive symptoms in older adults.

Dietetics doi: 10.3390/dietetics4030031

Authors: Emmanuel Psylinakis Nikolaos Thalassinos Alexios Manidis Maria Togia Vasileia Kounelaki Anastasia G. Markaki Aspasia Spyridaki

Introduction: Living with coeliac disease (CD) requires lifelong adherence to a strict gluten-free diet (GFD). This study assessed GFD adherence, symptom burden, autoimmune comorbidities, and dietetic support among Hellenic CD patients. Methods: A cross-sectional survey was completed by 272 adults with CD. Adherence was measured using the Hellenic version of the Celiac Dietary Adherence Test (H-CDAT). Results: The mean H-CDAT score was 13.5 ± 3.5. Good adherence was observed in 44.9% of participants, while 14.3% showed poor adherence. Symptom burden was high: 39.3% reported partial symptom resolution and 3.7% had ongoing symptoms. Among patients, 25.0% had multiple autoimmune conditions, ranging from two to four. Dietetic support was limited: 61.5% were not referred to a dietitian at diagnosis, and 75.4% had no regular follow-up. Higher H-CDAT scores, indicating poorer adherence, were significantly associated with younger age (p = 0.014), earlier diagnosis (p = 0.01), and ongoing symptoms (p < 0.01). Age at diagnosis was also positively associated with autoimmune comorbidity count. Conclusions: These findings highlight the need for earlier diagnosis, improved access to structured dietetic support, and individualized care to optimize GFD adherence and improve outcomes in patients with CD.

Dietetics doi: 10.3390/dietetics4030030

Authors: Fanny Cecília Dusa Tibor Vellai Miklós Sipos

Methylation is a biochemical process involving the addition of methyl groups to proteins, lipids, and nucleic acids (both DNA and RNA). DNA methylation predominantly occurs on cytosine and adenine nucleobases, and the resulting products—most frequently 5-methylcytosine and N6-methyladenine epigenetic marks—can significantly influence gene activity at the affected genomic sites without modifying the DNA sequence called nucleotide order. Various environmental factors can alter the DNA methylation pattern. Among these, methyl donor micronutrients, such as specific amino acids, choline, and several B vitamins (including folate, pyridoxine, thiamine, riboflavin, niacin, and cobalamin), primarily regulate one-carbon metabolism. This molecular pathway stimulates glutathione synthesis and recycles intracellular methionine. Glutathione plays a pivotal role during oocyte activation by protecting against oxidative stress, whereas methionine is crucial for the production of S-adenosyl-L-methionine, which serves as the universal direct methyl donor for cellular methylation reactions. Because local DNA methylation patterns at genes regulating fertility can be inherited by progeny for multiple generations even in the absence of the original disrupting factors to which the parent was exposed, and DNA methylation levels at specific genomic sites highly correlate with age and can also be passed to offspring, nutrition can influence reproduction and life span in a transgenerational manner.

Dietetics doi: 10.3390/dietetics4030029

Authors: Annie Lalande Stephanie Alexis Penelope M. A. Brasher Neha Gadhari Jiaying Zhao Andrea J. MacNeill

While hospital meals are designed to meet the nutritional requirements associated with illness or surgery, competing priorities often take precedence over food quality, contributing to poor patient satisfaction, in-hospital malnutrition, and high food waste. The environmental impacts of hospital food services are a less well-characterized dimension of this complex problem. A prospective cohort study of patients admitted for select abdominal surgeries between June and October 2021 was conducted at a tertiary care hospital in Canada. Greenhouse gas emissions and land-use impacts associated with all food items served were estimated, and patient food waste was weighed for each meal. Patients’ experience of hospital food was measured at discharge. Nutrition was assessed by comparing measured oral intake to minimum caloric and protein requirements. On average, food served in hospital resulted in 3.75 kg CO2e/patient/day and 6.44 m2/patient/day. Average food waste was 0.88–1.39 kg/patient/day (37.5–58.9% of food served). Patients met their caloric and protein requirements on 9.8% and 14.8% of days in hospital, respectively. For patient satisfaction, 75% of overall scores were lower than the industry benchmark, and food quality scores were inversely correlated with quantities of food wasted. Redesigning inpatient food offerings to feature high-quality, low-emissions meals could lessen their environmental impacts while improving patient nutritional status and experience.

Dietetics doi: 10.3390/dietetics4030028

Authors: Tameka I. Walls Alicia S. Landry Nichole A. Espineli Jessica L. Thomson

American adults struggle with accurately assessing the quality of their diet, with the majority overrating their diet quality. Thus, the objective of the study was to explore what individuals think about when asked to rate their diet quality. Virtual focus groups were conducted from October 2023 to April 2024, using a semi-structured interview with open-ended questions. Convenience samples of small-scale farmers, school food service directors, health clinic patients, and university students and staff in Mississippi and Arkansas participated (N = 27). Themes and subthemes from NVivo-transcribed discussions were identified and coded inductively. Four subthemes emerged for description of diet: balance, consideration for others, convenience, and location. Four subthemes emerged for quality of diet: availability/access, culture/tradition, health considerations, and making better choices. Three subthemes emerged for healthy food: composition/preparation, nourishing benefits, and taste/flavor. Three subthemes emerged for unhealthy food: addicting/overconsumption, composition/preparation, and undesirable effects. Three subthemes emerged for nutrition knowledge: audience specific, general knowledge, and ambivalence. Three subthemes emerged for food shopping: food types, family influence/preference, and planning. Factors shaping how individuals perceive their diet quality are complex with intertwining components. Understanding the complexity involved in self-perceptions of diet quality will help us better quantify perceptions and link them to measurable outcomes.

Dietetics doi: 10.3390/dietetics4030027

Authors: Zelda Luvha Vhuhwavho Tshipota Selekane Ananias Motadi Lavhelesani Negondeni Hlekani Vanessa Mbhatsani

In April 2018, South Africa became the first African country to implement a Health Promotion Levy (HPL) on sugar-sweetened beverages (SSBs). This study assessed sugar tax awareness among rural-based university students and involved 342 participants, with an additional 10% to account for attrition. However, only 257 students, randomly selected from six university residences at the University of Venda, reported consuming SSBs. Systematic sampling determined the room selection, and the data was collected through an interviewer-administered questionnaire (8–28 October 2022). A knowledge questionnaire assessed the students’ understanding of the sugar tax. The results showed that 65.8% purchased SSBs five to six times a week, while 41.2% spent over R200 monthly on these beverages. The results showed that students had limited awareness and little perception of the sugar tax, reflecting a broader knowledge gap. Their negative behaviors toward sugar-sweetened beverages indicated that changing their consumption patterns would be challenging. Raising public awareness through taxation is widely recognized as an effective obesity prevention strategy, but misinformation, negative perceptions, and pessimistic attitudes may contribute to continued high consumption.

Dietetics doi: 10.3390/dietetics4030026

Authors: Jasmina Hasanović Helena Križan Zvonimir Šatalić Sanja Musić Milanović

Background: While previous research on children’s diets has primarily focused on individual nutrients or foods, recent years have seen increasing attention to the analysis of dietary patterns. In school-aged children enrolled in the CroCOSI study, this research focused on identifying the dietary patterns and examining their potential links with childhood obesity. Methods: Data were collected from a nationally representative sample comprising 5608 children aged 7–10 years and their parents in this cross-sectional study. To evaluate the nutritional status of the children, BMI-for-age was assessed using z-score values. Results: A factor analysis using data from the FFQ revealed three dietary patterns: Western, Healthy, and Breakfast. Children who scored high for consumption of fruits, vegetables, fish, cheese, dairy products, and 100% fruit juice were categorized into the Healthy dietary pattern, whereas those with high scores for cereals and milk were assigned to the Breakfast dietary pattern. Conclusions: The Western dietary pattern did not show a significant relationship with obesity among school-aged children (OR = 1.00, 95% CI: 0.98–1.00; p = 0.11). The risk of obesity was lower among children following the Healthy (OR = 0.98, 95% CI: 0.98–0.99; p = 0.045) and Breakfast (OR = 0.96, 95% CI: 0.95–0.99; p = 0.001) dietary patterns.The results can help in creating food policies with the aim of reducing childhood obesity in Croatia.

Dietetics doi: 10.3390/dietetics4030025

Authors: Charistoula Chatzinikola Vasileios Papavasileiou Nikolaos Andreadakis Antonios E. Koutelidakis

Background: Nutrition literacy, defined as “the skills to comprehend and implement nutrition information into everyday practice”, is a new area of study. Preschool teachers affect children’s perception of nutrition and health and contribute to their nutrition literacy skills. Objective: This cross-sectional study aimed to assess the level of nutrition literacy (NLS-Gr) of preschool teachers. Methods: The research included two stages of cluster sampling in a sample of kindergarten teachers in Greece (Rhodes Island). Nutrition literacy was assessed with the NLS-Gr, the Greek version of the NLS, and adherence to a Mediterranean diet with the MedDiet score. Results: The mean NLS-Gr score was 25.87 (SD ± 2.2) and is considered adequate. The correct answers range from 65.1% to 100%. The MedDiet score was calculated at 33.94 (SD ± 3.8), and no correlation was found between the MedDiet score and the NLS-Gr. The NLS-Gr score of kindergarten teachers was adequate, higher than that of previous research on different populations. Conclusions: The study concluded that adherence to the Mediterranean diet requires improvement, and food waste needs to be reduced. Educators should be empowered through targeted educational interventions to improve their dietary habits and, therefore, enhance students’ health and nutritional behaviors. Further research is needed to contribute to formulating nutrition strategies and policies in kindergarten.

Dietetics doi: 10.3390/dietetics4020023

Authors: Bruno Almeida Marques Alexandre Morais Nunes João Ricardo Catarino

In Portugal, public policies promoting a healthy diet have gained prominence in recent years, reflecting a growing concern with the population’s health status and its individual, social, economic, and political impact. These policies aim to mitigate the impact of inadequate eating habits as a determinant of health and the population’s disease burden. Based on a document analysis, the main objective of this article is to explore public healthy diet policies in Portugal following the 2017 implementation of the Estratégia Integrada para a Promoção da Alimentação Saudável (Integrated Strategy for the Promotion of a Healthy Diet), which is the primary guiding instrument for these policies. Among the most impactful legislative measures found in this sector, we highlight the reformulation of food products, food taxation, food marketing regulation, food incentives, and food labeling. Despite significant progress in promoting healthy diets, some challenges still remain, particularly the growing prevalence of behavior-related chronic non-communicable diseases, like obesity, such as the maintenance of a set of health determinants related to inadequate nutrition. Thus, the continuity and deepening of such policies, combined with continuous impact assessments, are crucial to ensuring a healthier future.

Dietetics doi: 10.3390/dietetics4020024

Authors: Namhyun Kim Hajin Jang Marquis Hawkins

Introduction: Obesity is associated with cardiometabolic diseases, and chrononutrition has become a novel weight loss strategy. However, few have characterized chrononutrition patterns among people attempting weight loss. This study characterizes chrononutrition patterns in a nationally representative sample of U.S. adults who attempted weight loss in the past year through dietary modifications by weight change and adiposity. Methods: This cross-sectional analysis utilizes NHANES 2017–2020 data. Chrononutrition patterns were assessed using 24 h dietary recalls. Participants self-reported weight loss attempts in the past year and if they tried using diet modification. Weight change (loss, maintenance, and gain) was defined based on differences in current weight and weight one year prior. We used latent profile analysis and descriptive statistics. Results: The sample included 2107 participants who attempted weight loss in the past year through diet modification (median age 47; 58% women and 62% white). Individuals who gained weight (vs. loss) had longer hours between waketime and the first eating (1.78 vs. 1.62 h, p = 0.024), consumed a lower proportion of calories later in the day (43% vs. 52%, p < 0.001), and ate less frequently (5.20 vs. 5.43 episodes, p = 0.008). Participants with obesity had the shortest eating window (11.77 vs. 12.22 h, p = 0.02) despite a longer delay between waketime and the first eating (1.80 vs. 1.29 h, p < 0.001) and lower eating frequency (5.16 vs. 5.97, p < 0.001). Conclusions: Variations in eating timing, eating episodes, and caloric distribution suggest that chrononutrition may play a role in personalized weight management strategies.

Dietetics doi: 10.3390/dietetics4020022

Authors: Alexandra Bédard Camille Pitre Lucie-Maude Grégoire Julia Lévy-Ndejuru Sophie Desroches Véronique Provencher Ariane Bélanger-Gravel Catherine Bégin Simone Lemieux

The present research aimed to develop and validate a questionnaire examining French-speaking Québec adults’ perceptions of how the various dimensions of eating pleasure influence healthy eating habits. Items were developed based on dimensions of eating pleasure, identified through a literature review. Content validity was evaluated by an expert committee, followed by a pre-test among 30 participants to assess face validity. The questionnaire was then administered twice (2–4 weeks apart) to 298 participants. Exploratory factor analysis identified a six-factor structure reflecting the multidimensional nature of eating pleasure in relation to healthy eating: (1) emotional/situational eating and reward (eight items), (2) sensory experiences (six items), (3) ideologies/interest in food (eight items), (4) autonomy, freedom, and individual preferences (seven items), (5) social experiences (five items), and (6) mindful eating (three items). The results showed an adequate internal consistency, a good test–retest reliability, and a good construct validity. Participants perceived all factors except Factor 1, “emotional/situational eating and reward”, as supporting healthy eating. Overall, these findings indicate that the questionnaire assessing the perceived impact of eating pleasure on healthy eating is a suitable instrument for use among French-speaking adults of the province of Québec, in Canada.

Dietetics doi: 10.3390/dietetics4020021

Authors: Nagako Okuda Hiroko Kojima Tomomi Nagahata Akira Okayama

Salt intake, specifically NaCl, should be reduced to prevent hypertension. Ramen often contains high-NaCl soup in Japan, but there are no reports of the actual sodium (Na) or potassium (K) contents. We visited ramen restaurants in Kyoto that had received high ratings on review sites and sampled the soups and toppings (n = 52). The Na and K concentrations were measured using ion electrodes, and the NaCl and K contents per serving and Na/K ratio were calculated. The results were compared among different types of “tare” (thick seasonings) (salt, soy sauce, and miso) and different types of broth (chicken, pork bone, and fish). The average NaCl and K contents per serving were 6.53 ± 1.48 g and 448 ± 141 mg, respectively, and Na/K was 10.7 ± 4.3 mmol/mmol. Considering the different broths, the Na/K ratio was the lowest for fish (9.6 ± 5.2), followed by chicken (10.0 ± 3.1) and pork bone (13.2 ± 4.8). Ramen dishes were high in both Na and the Na/K ratio. The low Na/K of fish soup ramen was thought to be due to the higher K content extracted from dried fish. Depending on the broth, it is possible to reduce the Na/K ratio.

Dietetics doi: 10.3390/dietetics4020020

Authors: Evgenia Lazou Ioannis Vlastos Kalliopi Gkouskou Efstathios Skoufas Dimitrios Chaniotis

Background: Epidemiological studies on the effect of coffee intake on food consumption have yielded conflicting results. We sought to study the immediate and short-term effects of coffee consumption on food preferences, total calories, and macronutrient consumption within a specific, closely supervised experimental protocol. Methods: Twenty-one normal-weight volunteers completed this crossover, randomized, controlled study. Each volunteer took part in two trials consuming (a) 200 mL of instant coffee providing 5 mg of caffeine/kg body weight or (b) 200 mL of water (control). In both trials, participants were offered an ad libitum lunch meal from a buffet for 30 min. Proteins, lipids, and carbohydrates, as well as total caloric consumption were recorded during the initial 30 min period of the experiment (immediate period) as well as during the rest of the day (short-term period). Results: Coffee intake resulted in a statistically significant lower intake of immediate and short-term carbohydrate consumption (p = 0.012 and p = 0.047), of immediate protein consumption (p = 0.019), and of short-term lipid consumption (p = 0.04) versus water consumption. As a result, the calories consumed both immediately upon coffee administration and during the rest of the day of the experiment were significantly lower (p = 0.026 and p = 0.006) in the coffee group. Conclusions: Coffee intake seems to exert an anorexigenic result that last for several hours upon its consumption, particularly for carbohydrates and lipids.

Dietetics doi: 10.3390/dietetics4020019

Authors: Jane Bradbury Helen R. Martin Rachel Bamborough Janina Kitcher

Restricting food intake before consuming alcohol due to weight concerns or to increase alcohol’s intoxicating effects (food and alcohol disturbance, FAD) is a recognised problem in young American college students, but there is less evidence about whether middle-aged and older adults are also engaging in FAD behaviours. A cross-sectional survey of FAD and potential alcohol problems using validated measures (Compensatory Eating and Behaviours in Response to Alcohol Consumption, CEBRACS; Alcohol Use Disorders Identification Test, AUDIT-C) was administered online and in two universities in the north of England to adults aged ≥ 18 years old who had consumed ≥ one alcoholic beverage within the previous month. Most of the 488 participants were ≥25 years (73%) and not university students (72%). Overall, 69% of participants engaged in at least one FAD behaviour in the previous 3 months. The youngest age group (18–24 years) was significantly less likely than the oldest age group (53+ years) to never engage in FAD behaviours: alcohol effects OR (CI) 0.05 (0.02, 0.13); bulimia 0.08 (0.01, 0.67); and restriction 0.21 (0.08, 0.52). Nevertheless, 47% of the oldest age group engaged in at least one FAD-related behaviour, and student status was not associated with FAD behaviours, except for alcohol effects. FAD behaviours were engaged in by most alcohol consumers in this study, including middle- and older-aged adults, and non-students.

Dietetics doi: 10.3390/dietetics4020018

Authors: Luise V. Marino Rosan Meyer Sarah Veale Jennifer V. E. Brown

Healthcare organisations in the United Kingdom must comply with national standards for food and drink, including sustainable sourcing and minimisation, mitigation, and management of food waste. Despite this, an estimated one in six plates of food served in hospitals are wasted daily, producing 12% of the UK’s food waste, equating to 6% of carbon dioxide emissions (CO2e) nationally, and a waste-management cost of GBP 230 m per annum. Within healthcare, there is a move towards the implementation of “plant-based diets by default” to reduce the environmental impact, improve nutritional outcomes, and reduce costs. However, plant-based diets are often perceived as being difficult to prepare by caterers, less enjoyable, and potentially resulting in more food waste. We conducted a scoping review to examine the influence of the social, medical, and physical environment on food intake during inpatient admission to a mental health hospital. Fourteen studies were included. We identified five critical knowledge areas: (i) food and socio-cultural environment, (ii) evidence-based measures and strategies to reduce food waste, (iii) economic food environment, (iv) inevitability of weight gain, and (v) applications of theoretical models for behaviour change. Future research should explore the development of a behaviour-change framework inclusive of training, education, and goal-setting components for staff, patients, and visitors.

Dietetics doi: 10.3390/dietetics4020017

Authors: Lorenza Mistura Francisco Javier Comendador Azcarraga Laura D’Addezio Cinzia Le Donne Deborah Martone Raffaela Piccinelli Stefania Sette

The national food consumption surveys are crucial for monitoring the nutritional status of population but are also time and resource consuming. The growing use of technology and web-based platforms can help to reduce the logistical burden and cost of conventional methods. This study aims to compare self-administered 24 h recall to those obtained from interviewer-led 24 h recall by examining food items, food group and nutrient intakes using the online software FOODCONS 1.0 in both cases. The volunteers (39 adults) were randomized in A and B groups. On study days, they completed a self-administered 24 h recall and 3 h later, an interviewer-led 24 h recall. After 15 days, the same process was repeated in the opposite way. The difference in the two-day mean of energy and macro- and micronutrients intakes between the two methods was not statistically significant. The Bland–Altman analysis found a good agreement for energy, carbohydrates and fiber. At the level of food groups, the correlation coefficients indicated good concordance between the two methods. The self-administered 24 h recall through FOODCONS 1.0 software could be a suitable alternative to an interviewer-led interview, allowing a higher participation rate and less time-consuming food consumption studies.

Dietetics doi: 10.3390/dietetics4020016

Authors: Michelle O’Leary Elaine Mooney Amanda McCloat

This study aimed to provide an overview of published studies that assess the relationship between nutrition knowledge and dietary intake among university students. A scoping review was undertaken and articles assessing the relationship between nutrition knowledge and dietary intake among university students were identified. EMBASE, PsycINFO and Scopus were searched for peer-reviewed articles reporting primary research. The initial search generated 805 potentially relevant articles. After reviewing titles and abstracts and applying the exclusion criteria, 22 articles were deemed eligible for inclusion. Nutrition knowledge was measured in all studies and information was predominantly collected using adapted General Nutrition Knowledge Questionnaires (GNKQs). Dietary intake measurement methods varied across the studies, with the Food Frequency Questionnaire (FFQ) being commonly used. Findings identified that in most studies a positive relationship was found between nutrition knowledge and dietary intake. The ability to draw strong conclusions about the relationship between nutrition knowledge and dietary intake in university students is limited by the heterogeneity of the study design, the subpopulations considered, and the tools used. Notwithstanding this, findings indicate that the majority of studies reported a positive relationship between nutrition knowledge and dietary intake. Future studies should consider the use of validated assessment tools for both nutrition knowledge and dietary intake and the inclusion of more male student participants.

Dietetics doi: 10.3390/dietetics4020015

Authors: Cristina Palacios Elvira Alvarez Maria Gabriela Kallis Yari Valle Jeremy Pomeroy Maribel Campos

Introduction: This is a secondary cross-sectional analysis of participants’ baseline data from the Baby-Act Trial to compare energy and macronutrients intake by feeding type. This was a cluster-randomized clinical trial among pregnant women and their infants participating in the Puerto Rico WIC program to test the clinical effectiveness of an intervention that addressed various infant obesity risk factors during the first year of life. Methods: Participants completed at baseline a sociodemographic questionnaire and a validated infant food frequency questionnaire (FFQ). The FFQ was analyzed for type of feeding (exclusively fed breastmilk, fed breastmilk and formula, or exclusively fed infant formula) and for energy and macronutrient intake (protein, carbohydrate, and fat). Analysis of covariance was used to compare intake type of feeding, adjusting for maternal age. race, education, number of previous children, gestational length, and pre-pregnancy BMI. Results: The present analysis included 368 mother–infant pairs. Mean age of mothers was 26.7 years and of infants 0.7 months. Ten infants fed complementary foods were removed from the analyses. A total of 39.9% of infants were exclusively breastmilk-fed, 47.2% were fed breastmilk and infant formula, and 12.8% were exclusively formula-fed (n = 358). Intake of energy, protein, fat, and carbohydrates was significantly lower in infants fed only breastmilk compared to infants fed a combination of breastmilk and infant formula, and intake of protein and carbohydrates were lower in infants fed a combination of breastmilk and infant formula compared to infants fed only infant formula, after adjusting for important confounders. Conclusions: Very early infant feeding practices are associated with differences in dietary intake. The long-term health implications of this findings need to be further studied.

Dietetics doi: 10.3390/dietetics4020014

Authors: Lucia Maddaloni Lorenzo Maria Donini Laura Gobbi Luca Muzzioli Giuliana Vinci

Essential amino acids and essential fatty acids are vital nutrients that must be obtained from the diet. However, traditional sources face limitations amid increasing global food security and sustainability challenges. This study aims to evaluate the nutritional potential of novel foods, including microalgae (e.g., spirulina and chlorella), fungi (e.g., oyster and shiitake mushrooms), edible insects (e.g., mealworms and migratory locusts), and unconventional plants (e.g., water lentils and canihua). The study will compare their amino acid and fatty acid profiles with those of conventional animal and plant sources. The comparative analysis conducted in this study reveals that these innovative foods offer balanced and high-quality protein and lipid profiles, and contribute essential nutrients needed to prevent deficiencies and support metabolic health. Significantly, the integration of these novel foods into established dietary patterns, such as the Mediterranean diet, has the potential to enhance nutritional quality while promoting environmental sustainability. In conclusion, the adoption of these innovative food sources provides a viable strategy to meet nutritional demands and address global health and ecological challenges, paving the way toward a more resilient and sustainable food system.

Dietetics doi: 10.3390/dietetics4020013

Authors: Allison D. Sanchez D. Enette Larson-Meyer

Athletic individuals may intentionally aim to gain weight, primarily as lean body mass, to improve athletic performance or to better match opponents’ size. This study aimed to investigate the self-reported nutrition- and exercise-related behaviors of athletic individuals aiming to gain weight. Cross-sectional data were drawn from an online survey of athletic adults recruited locally, nationally, and internationally. In total, 168 athletic participants (24 ± 5 years; 29% female, 71% male) completed the survey and were actively attempting or had attempted weight gain in the last 12 months to gain muscle mass (87.5%), for aesthetic reasons (66.1%), or to improve athletic performance (63.7%). The most prevalent dietary strategies reported to increase weight gain were consuming more energy than usual (88.0%) from mainly protein foods (83.9%) and using protein powders (67.3%). In total, 9.6% of participants reported using anabolic hormones. The main exercise change was increased resistance training (81.5%). Our results confirm that both male and female athletic individuals intentionally attempt to gain weight. Nutrition and exercise professionals may use the findings to be aware of these common dietary and exercise strategies and to better educate their athletic clients on appropriate methods that are evidence-based and not detrimental to health.

Dietetics doi: 10.3390/dietetics4020012

Authors: Romilly O’Brien Denelle Cosier Kelly Lambert

Climate change is a global priority requiring immediate action. A thorough understanding of the source of greenhouse gas emissions is essential to inform reduction strategies. This study aimed to quantify the climate footprint of two therapeutic diets—one diet for an adult with coeliac disease and one diet for an adult with type 2 diabetes—and then compare the climate footprint of these diets with the standard Australian diet and the Australian adapted EAT Lancet Planetary Health Diet. In addition, potential areas for reductions in greenhouse gas emissions were explored. All diets were developed for a 71-year-old male reference person. The amount of carbon dioxide produced by each diet was determined using the GWP* calculator for the reference person. Both the gluten-free and diabetic diet had a measurable climate footprint and were not considered climate-neutral. The diabetic diet produced 1.35 kg of carbon dioxide equivalents [CO2e] per day, and the gluten-free diet produced 2.51 kg of CO2e per day. Meat, dairy, and discretionary foods were the major contributors to the climate footprint of the two therapeutic diets. Substituting lamb for beef and soy milk for cow milk in the Australian context resulted in a 25% reduction in the climate footprint for the diabetic diet and 29% reduction for the gluten-free diet. Dietetic advice to reduce the climate footprint of therapeutic diets for coeliac disease and type 2 diabetes should focus on adapting diets to reduce animal-based products.

Dietetics doi: 10.3390/dietetics4010011

Authors: Jennifer A. Jamieson Cayla Olynyk Ruth Harvie Sarah O’Brien

This study aimed to explore the occurrence of exercise-associated gastrointestinal symptoms (ExGIS) in collegiate athletes and identify related self-management practices. A sequential mixed methods design was used, consisting of an online survey followed by semi-structured interviews. Data were analyzed with descriptive statistics (survey) and thematic analysis (interviews). Survey respondents (n = 96) represented various individual and team sports but were primarily female (76%). ExGIS prevented or interrupted training and/or competition in 32%. Female athletes experienced gastrointestinal symptoms (GIS) more frequently at rest (60%) and during training (37%), compared to males (22% and 9%, respectively; p < 0.01). Only 12% sought health care for ExGIS. Four (13%) female runners with ExGIS agreed to an interview. Response rates and interview data provided evidence of stigma in discussing GIS. Self-imposed food restriction was a common self-management strategy. In summary, female collegiate athletes may experience a greater burden of GIS and ExGIS than males. The stigmatized topic of ExGIS is a potential barrier to seeking health care and support. Access to a sport dietitian could help to address barriers to ExGIS care and support self-management practices in these athletes.

Dietetics doi: 10.3390/dietetics4010010

Authors: Marie Fanelli Kuczmarski Nancy Cotugna Michele K. Evans Alan B. Zonderman

Health disparities have been associated with diet quality inequalities. Study objectives were to determine if race and/or income were associated with the diet quality of White and African American urban women and to compare core food and beverage categories consumed at eating occasions by diet quality within race and income groups. Two 24 h dietary recalls were collected on 1219 women interviewed in the Healthy Aging in Neighborhoods of Diversity across the Life Span study, 2013–2017. Healthy Eating Index (HEI)-2010 scores were calculated. Linear regression Model 1 included race, marital status, and age. Model 2 included Model 1 variables plus income, education, literacy, employment, enough money for food, and food security. Core food categories and most frequently consumed items were identified at five eating occasions within the first and third tertile HEI-2010. Diet quality was associated with age, education, literacy, and employment. More fruit and vegetable categories at meals and snacks, and more water as a top beverage, were observed for women whose diets were in the third HEI-2010 tertile. The majority of foods reported by women in the first HEI-2010 tertile would be considered ultra-processed. The health benefits of consuming more minimally processed foods and unsweetened beverages may reduce health disparity gaps.

Dietetics doi: 10.3390/dietetics4010009

Authors: José Manuel Pérez de la Lastra Sergio González-Acosta Andrea Otazo-Pérez Patricia Asensio-Calavia Víctor Manuel Rodríguez-Borges

Interest in natural biopreservatives has increased significantly due to growing consumer demand for safer and more environmentally friendly food preservation strategies. Antimicrobial peptides (AMPs), naturally occurring molecules (typically <10 kDa), have emerged as a promising alternative to synthetic chemical preservatives. Found in bacteria, fungi, plants, and animals, including humans, AMPs play a crucial role in innate immune defense. Their antibacterial and antioxidant effects enable them to prevent microbial spoilage and extend the shelf life of food, reducing the need for artificial additives. AMPs are biodegradable and environmentally friendly, and they specifically target harmful microorganisms, minimizing disruption to beneficial microorganisms. Despite their promising properties, challenges such as stability, cost and potential sensory impairment limit their wide application. Recent advances, such as encapsulation techniques and nanotechnology, have shown remarkable potential to improve the stability and functionality of AMPs in complex food systems. In addition, AMPs derived from edible mushrooms represent a sustainable and natural approach to food preservation and could offer effective solutions against foodborne pathogens and oxidative spoilage. This review examines the structural features, mechanisms of action and practical applications of AMPs in food protection, with a particular focus on their innovative integration with nanotechnology to address current food safety challenges.

Dietetics doi: 10.3390/dietetics4010008

Authors: Alberto Caballero-García David C. Noriega-González Aurora Caballero-Castillo Enrique Roche

Soccer is a widely practiced and highly mediatic sport discipline. For this reason, the incidence of injuries associated with the game is an active area of research. High-impact actions occur during the game, affecting the knee joint and resulting in osteoarthritis. In this line, knee osteoarthritis results from mechanical and biological stress due to lesions that are not adequately repaired, resulting in an inflammatory process. This occurs because the degradation of extracellular matrix predominates over synthesis by chondrocytes. Therefore, in soccer players, knee osteoarthritis results from joint traumatic actions, displaying a degenerative evolution. Osteoarthritis occurs in up to 32% of male soccer players, 3 times more than in the male general population. On the other hand, female soccer players are a main target population to suffer from knee osteoarthritis, with a higher significant incidence observed compared to men. In this context, certain diet supplements have an instrumental potential in the prevention and/or treatment of knee osteoarthritis. Therefore, the aim of this narrative review is to present possible research lines to implement treatments for knee osteoarthritis in female soccer players.

Dietetics doi: 10.3390/dietetics4010007

Authors: Peiqi Guo Guancheng Liu Xiaoling Xiang Ruopeng An

A balanced diet is crucial for preventing diseases and managing existing health conditions. ChatGPT as garnered attention from researchers, including nutrition scientists and dietitians, as an innovative tool for personalized meal planning and dietary recommendations. Objectives: The purpose of this study was to review scientific evidence on ChatGPT’s performance in providing personalized meal plans and generating dietary recommendations. Methods: This systematic review was conducted following the PRISMA guidelines. Keyword-based database searches were performed on PubMed, Web of Science, EBSCO, and Embase. Inclusion criteria included (1) empirical studies and (2) primary research on ChatGPT’s performance in personalized meal planning and dietary recommendations. Results: Twenty-three studies met the inclusion criteria, comprising fourteen validation studies, five comparative studies, and four qualitative studies. Most studies reported that ChatGPT achieved satisfactory accuracy and was often indistinguishable from human dietitians. One study even reported that ChatGPT outperformed human dietitians. However, limitations and risks, such as safety concerns and a lack of real-world implementation, were also identified. Conclusions: ChatGPT shows promise as a relatively reliable innovative tool for personalized meal planning and dietary recommendations, offering more accessible and cost-effective solutions. Nevertheless, further studies are needed to address its limitations and challenges.

Dietetics doi: 10.3390/dietetics4010006

Authors: Celia María Curieses Andrés José Manuel Pérez de la Lastra Elena Bustamante Munguira Celia Andrés Juan Eduardo Pérez-Lebeña

Selenium (Se) has important anti-inflammatory and antioxidant activities, plays an important role in the immune system through redox balance, and is part of selenoproteins. In patients who are critically ill, Se supplementation causes alterations in inflammatory markers such as procalcitonin, leukocyte count, albumin, prealbumin, C-reactive protein (CRP), inflammatory cytokines, and cholesterol. The decrease in Se levels leads to a reduction in the levels of various selenoenzymes, in particular glutathione peroxidase and selenoprotein P. These antioxidant selenoproteins play a protective role against the lipoperoxidation of cell membranes and also participate in the process of regulating the inflammatory response. Currently, there are no conclusive data that allow us to affirm the existence of a significant reduction in mortality with the use of Se in intensive care. Selenium nanoparticles (SeNPs) can be used as dietary supplements or therapeutic agents due to their low toxicity and better bioavailability compared to traditional Se supplementation. In this review, we focus on the current state of research on SeNPs and their anti-inflammatory and antioxidant properties as a therapy for patients who are seriously ill, without the toxic effects of other Se species.

Dietetics doi: 10.3390/dietetics4010005

Authors: Bradley Ridoutt

Evidence to inform the incorporation of environmental sustainability into public health nutrition policy and dietetics practice needs to be relevant to the local dietary, cultural, environmental, and food system context. Global recommendations and evidence from other countries may not be directly applicable. As this information is scattered across multiple research publications in Australia, a systematic review was undertaken to consolidate evidence and identify practical recommendations. Following the PRISMA 2020 guidelines, the search strategy sought to identify studies based on Australian dietary intake data obtained by surveys combined with an environmental assessment. Theoretical or conceptual studies were deemed out of scope. Included studies were grouped for synthesis based on content relating to total dietary energy intake, nutrient adequacy, foods and food groups, and dietary patterns. Out of 765 records, 14 studies met the eligibility criteria. These studies addressed a variety of research questions using a variety of modelling approaches and environmental indicators. Current evidence suggests encouraging consumption of nutrient-dense foods, especially those that enhance satiety, along with discouraging consumption of nutrient-poor processed foods that contribute little to satiety and can lead to excessive dietary energy intake. Limiting total intake or diversity of protein-rich foods can increase risks of inadequate intake of micronutrients. For lower environmental impact dietary patterns, intake of vitamins A, B6, and B12, and minerals Ca, Mg, Se, and Zn can be below estimated average requirements. The practical implication is that foods that are rich and bioavailable sources of these nutrients need to be prioritized in any strategy to reduce dietary environmental impacts.

Dietetics doi: 10.3390/dietetics4010004

Authors: Hardip Malhi Jane Fletcher Dorothy Balhatchet

Calorie information is often provided on food packaging and is a legal requirement in many countries. There is some evidence to suggest that attention to calorie counting can have a detrimental effect on those with eating disorders (EDs). The aim of this review is to summarise current research relating to the impact of restaurant menu calorie labelling on people with EDs. A search was carried out using the CINAHL Complete and Medline databases. Ten papers were included in the final review. Recent statistics show that the incidence of EDs is increasing. These studies assessed the impact of calorie information on people with EDs. Policies, such as calorie labelling on restaurant menus, could be a contributing factor. Studies exploring the effect the policy has had on obesity levels have not demonstrated a significant positive impact on reducing calorie intake. Qualitative studies conducted in England show the extent to which people with EDs are affected. Much of the data from the transcripts highlighted the negative thoughts that this policy has evoked. A review of the literature has demonstrated that this policy has had a negative impact on people with EDs and little benefit for those with obesity, who may also experience EDs.

Dietetics doi: 10.3390/dietetics4010003

Authors: Mariana Lares-Michel Fatima Ezzahra Housni Avilene Rodríguez-Lara Sofía Cecilia López-Salido María Guadalupe Castrejón-Barajas Nahid Ochoa Dalila Betsabee Meza-Rodriguez Jesús R. Huertas

The environmental impact of unhealthy diets and the obese population is becoming clearer. However, little is known about the impact of ‘healthy’ diets related to ‘fitness’ lifestyles, such as diets directed to gain muscle mass and lose body fat, or the diets of the physically active population. This paper aims to evaluate the Dietary Water Footprint (DWF) of a representative sample of the Guadalajara Metropolitan Area, Mexico, identifying differences according to body composition (levels of fat and muscle) and physical activity (type and intensity), with a focus on contrasting active, healthy lifestyles (i.e., fitness) with sedentary and obesogenic patterns and examining protein consumption. A validated and adapted Food Frequency Questionnaire (FFQ) was applied to 400 adults (18–74 years) from the Guadalajara Metropolitan Area. The participants were grouped according to their body fat and muscle mass levels and physical activity type and intensity. DWF, food and nutrient intake, and adequacy were calculated. The DWF of the sample with a low body fat, a high muscle mass, moderate to intense exercise, and anaerobic exercise (i.e., ‘fitness’ lifestyle) was up to 800 L per person per day (L/p/d) higher than the sedentary/obese populations. Risks of a high DWF were found as protein intake increases (OR = 6; p < 0.0001). Although unhealthy diets linked to obesity are a major environmental problem, ‘fitness’ lifestyles can have serious environmental implications.

Dietetics doi: 10.3390/dietetics4010002

Authors: Raquel Anny González-Santana Clara Gómez-Urios Jesús Blesa Clara Cortés María José Esteve Ana Frígola

Diets will likely play a crucial role in the Anthropocene to support the population’s health and safeguard environmental sustainability for future generations. Based on a cross-sectional–observational–descriptive design for evaluating an entire menu proposal, data on the type and composition of the menus offered by a university catering service during an academic year were collected. Each day during the meal service, 10 plates of the same option offered were weighed, and 10 photographs were taken. With these data, the nutritional value and carbon footprint were evaluated for all possible combinations of first and second courses, while including the average values of other components of the menu (garnishes, bread, desserts, and beverages). The annual menu proposal resulted in 6478 combinations of first and second courses plus the other components. The average caloric intake was 1194 kcal/menu with high consumption of proteins and lipids, and the average carbon footprint was 1.86 kg carbon dioxide equivalent (CO2eq)/menu, with the second course being the major contributor. Creating menus that consider these two essential parameters is the task of specialists. Achieving food consumption that balances nutrition and environmental sustainability is another issue of education and communication.

Dietetics doi: 10.3390/dietetics4010001

Authors: Daniel Messiha Miriam Rinke Adriana Schultz Moreira Amos Annika Tratnik Ulrike Barbara Hendgen-Cotta Julia Lortz Kristina Hogrebe Jan Kehrmann Jan Buer Tienush Rassaf Christos Rammos

Background: Inorganic nitrate is abundant in leafy green vegetables and has been shown to exert positive cardiovascular effects through nitric oxide-related pathways. The enteral microbiome is an emerging key player in cardiovascular diseases and depends on dietary habits. Whether dietary inorganic nitrate impacts on the microbiome and atherosclerosis-associated microbiome-dependent metabolites like short chain fatty acids (SCFA) and trimethylamine N-oxide (TMAO) is unknown. Methods: In a double-blind randomized controlled trial, 30 healthy volunteers were included who either received dietary nitrate (0.12 mmol/kg bodyweight) or placebo (equimolar amounts of sodium chloride) for 30 days. The microbiome metabolites TMAO and SCFA were analyzed. The enteral microbiome was analyzed by 16S-rRNA sequencing at baseline and follow-up. Results: Systolic blood pressure decreased after nitrate supplementation (baseline 124.73 mmHg vs. follow up 120 mmHg, p < 0.05) with no change in controls. Dietary nitrate supplementation increased TMAO levels (nitrate baseline 349.28 μ/L vs. nitrate follow-up 481.15 μ/L, p < 0.05), while SCFA levels remained unchanged. The relative abundance of Akkermansia and taxa of Clostridiales were higher in individuals with high compared to normal TMAO levels after nitrate supplementation, while Shannon diversity, richness and evenness did not differ between both groups. Conclusions: Our results indicate that dietary nitrate supplementation is associated with alterations to the enteral microbiome with an impact on proatherogenic metabolites. Further work is warranted to investigate the causal relationship between dietary nutrients, the microbiome and downstream metabolites.

Dietetics doi: 10.3390/dietetics3040041

Authors: Joseph E. Hilton William N. Setzer Prabodh Satyal Ambika Poudel Sawyer Ashcroft Rakesh Satyal

The dietary supplement industry is expanding, but it still remains far less regulated than the pharmaceutical industry, resulting in inconsistent quality control. Limited research has been performed in the U.S., particularly regarding the quantification of omega-3 fatty acids like eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). The aim of this study was to quantify the omega-3 fatty acid content in fish oil capsules and liquids purchased from major stores and a grocery chain and compare the results to their label claims. A total of 6 out of 15 were found to have EPA levels ±20% and 10 out of 15 were ±20% outside of the label claim for DHA. One product did not have a label claim for EPA and DHA, but did have a claim for total omega-3 content. These discrepancies indicate that consumers may unwittingly be consuming higher or lower quantities of omega-3 fatty acids than expected, potentially affecting their health outcomes.

Dietetics doi: 10.3390/dietetics3040040

Authors: Bonny Burns-Whitmore Erik Froyen Kellene Isom

Vitamin D is a conditionally essential fat-soluble vitamin found in foods such as fish; fish oil; egg yolks; animal fats; some mushroom varieties; and fortified foods such as cheese, margarine, milk, infant formula, and some ready-to-eat cereals. Calcium (Ca) is found in milk, cheese, canned fish, ready-to-eat cereals, milk substitutes, dark green leafy vegetables, and sports drinks. There are more than fifty metabolites of vitamin D. Vitamin D participates in immune regulation, apoptosis induction, insulin secretion, inflammation, cell differentiation, calcium balance and regulation, bone mineralization, and phosphorus homeostasis. Ca is an essential macro-mineral involved in bone and teeth matrices, strength, and hardness; muscle and cardiovascular movement; neurological messaging; and in the release of hormones. Peer-reviewed journal articles were accessed from the search engine PubMed. The authors reviewed the references in the peer-reviewed journal articles, websites, and review articles if the authors proposed a new theory or mechanism. Vitamin D and Ca have important relationships; therefore, many factors may impede or interfere with the body’s ability to absorb or utilize vitamin D and or Ca and may result in low or excessive levels of each. Additionally, genetic/medically related absorption issues and low intake may also result in deficiencies. This review discusses the introduction of each, their functions, absorption, somatic transportation, the relationship between vitamin D and Ca, and recommendations and supplementation strategies if available.

Dietetics doi: 10.3390/dietetics3040039

Authors: Sara Carnevale Assunta Vitale Monica Razzi Claudia Onori Gianna Cornacchia Ornella Grispo Elena Corsinovi Laura Rossl Elena Spinetti Martina Tosi Fabrizia Lisso Gianna Marchi

Background: Malnutrition is a major issue in hospitals, impacting over 25% of patients. It can arise from a range of factors, such as chronic underfeeding, diseases, aging, and inappropriate nutritional care. Unnecessary fasting and the use of incorrect dietary prescriptions can also contribute to malnutrition, regardless of a patient’s underlying health conditions. Methods: A search strategy was applied to identify pertinent articles on the prescription and management of therapeutic diets in hospital settings from the last 10 years (2014–2024) using the PubMed database. The following English terms and their combinations were used: hospital diet, non-evidence-based dietary restriction, hospital food service, and therapeutic diets. Only national or international guidelines published in English were considered. Results: The narrative review was developed through the analysis of two guidelines on the prescription and management of therapeutic diets in hospital settings. The main non-evidence-based therapeutic diets that should have limited prescriptions are low-calorie, low-carbohydrate, low-protein, and low-sodium diets because they inevitably lead to a reduction in caloric and/or protein content, limit menu choices, and make recipes less palatable. The preventive total elimination of lactose without diagnostic confirmation should be avoided in the prescription of hospital therapeutic diets for lactose intolerance without symptoms and confirmation of diagnosis. Fasting after surgery should be avoided. The two guidelines differ in part in terminology and the bromatological composition of the diet. Conclusions: The heterogeneity of terminologies and bromatological composition leads to further confusion in determining the correct procedure for managing and prescribing therapeutic diets. Deepening and increasing research in the field of management and prescription of therapeutic diets is necessary to overcome the problem of hospital malnutrition, as the food provided through hospital food service is a very effective medicine for providing calories, macronutrients, and micronutrients.

Dietetics doi: 10.3390/dietetics3040038

Authors: Oana-Liliana Atomei Monica Sânpălean Monica Tarcea

In the European context shaped by migration, it is necessary to adapt dietitians to cultural diversity for effective professional practice. The objectives of the research are to analyze the cultural and ethnic diversity in Romania, highlighting the possible influence of acculturation on the dietary behaviors of different ethnic groups, and to formulate ways to apply the stages of cultural competence. The research methodology included the collection and use of data from the population census and other statistical sources to analyze the ethnic, linguistic, and religious composition in different regions of Romania, and the use of a cultural competence model that could be applied in the Romanian medical context for the formulation of health recommendations tailored to eating habits and influenced by acculturation and sociocultural factors. The study reveals the cultural diversity of the Romanian population, with more than 1.7 million inhabitants having a native language other than Romanian and with a wide ethnic and religious variety. We adapted a cultural competence model including methods to assess dietary acculturation, understand food preferences, and respect ethnic, religious, and generational diversity, ensuring its applicability in various multicultural contexts. This study emphasizes the importance of cultural competence in dietetic practice in a diverse health care setting and tailoring nutrition services according to cultural diversity to improve health and patient satisfaction.

Dietetics doi: 10.3390/dietetics3040037

Authors: Jingyi Jess Bai Mariam Mandoh Yee Mei Yu Margaret Allman-Farinelli

Medical Nutrition Therapy (MNT) services have shifted from only in-person to digital consultations. This may present a challenge to older patients if they are not digitally literate. This scoping review aimed to identify and analyse tools for assessing digital health literacy to guide dietetic practice in screening patients for digital care needs and training. Publications that used or tested a digital health literacy tool with participants aged 45 years and older in clinical, community, or population settings were deemed eligible. Five scientific databases, reference lists of identified studies, and publications from key authors were searched for peer-reviewed articles published in English between 2014 and March 2024. Relevant data on participant characteristics, tool design, and validation were charted. The generalisability of studies and applicability of tools were assessed using 4-point scales. Searches yielded 1823 articles, of which 66 articles were included in the final analysis. Eight tools were identified, and the electronic Health Literacy Scale (eHEALS) was the most frequently used. After evaluating the validity and feasibility of these tools, the adapted eHEALS emerged as the most applicable for digitally delivered MNT. Future studies should explore effective educational programmes for less digitally literate populations to better connect them to online MNT healthcare services.

Dietetics doi: 10.3390/dietetics3040036

Authors: Sebastian Gimpfl Kseniia Steinle Kurt Gedrich

The increasing availability of direct-to-consumer personalized nutrition products has raised questions about their scope of personalization and added value compared to general dietary guidelines. This study evaluated eleven personalized nutrition products across six distinct methodologies, including DNA analysis, blood marker analysis, microbiome testing, blood glucose monitoring, questionnaire-based personalization, and consultation with a dietitian, comparatively evaluating their consistency and added value compared to general dietary guidelines. A 24-year-old obese male with no pre-existing illnesses was chosen as the case participant to represent a typical individual seeking personalized nutrition advice for weight loss. Significant variability and inconsistency were observed across and within the different methodologies, particularly in recommendations for energy intake and macronutrient distribution. Most advice was generic and aligned closely with existing dietary guidelines, with a notable lack of behavioral change strategies. This study underscores the challenges in personalized nutrition, highlighting the problem that current practices often fall short of delivering truly tailored recommendations. There is a critical need for clearer definitions, evidence-based guidelines, and more comprehensive approaches to fully realize the potential of personalized nutrition in improving individual health.

Dietetics doi: 10.3390/dietetics3040035

Authors: Nerea Nogueira-Rio Lucia Varela Vazquez Aroa Lopez-Santamarina Alicia Mondragon-Portocarrero Sercan Karav Jose Manuel Miranda

Mobile applications, websites and social media networks are now widely used communication tools. With the emergence of communication-related technologies in our lives and, consequently, the rise of social media networks and mobile applications, nutrition-related applications have become popular. Smartphones and other artificial intelligence technologies have become very useful tools for delivering nutrition-related interventions because they are very accessible and cost-effective. Digital interventions are also able to serve a larger number of communities than traditional interventions. Nutrition is not a field that has remained on the sidelines of these technological advances, and numerous mobile applications and technological tools have emerged that are intended to provide dietary advice or guidelines on the process of recovering from a disease. However, many of these applications have limitations and barriers that are important to consider. The aim of this review was to analyze the most current and widely used mobile applications related to nutrition, as well as their complementary tools (activity bracelets and smart scales, among others), highlighting their importance in improving lifestyle habits. In addition, their advantages and disadvantages are discussed and future directions are proposed.

Dietetics doi: 10.3390/dietetics3040034

Authors: Tai L. Guo Jarissa Navarro Maria Isabel Luna Hannah Shibo Xu

Dietary supplements are products taken orally, and they contain an ingredient intended to augment the diet. Many studies demonstrate clear alterations in microbe abundances and the production of microbiota-derived metabolites, such as short-chain fatty acids, following dietary changes. This review comprehensively explores the possible interactions among gut microbiota, lemon extracts, glycerin, and their mixture products. Lemon extracts/components are associated with a vast array of health benefits, including anti-inflammation, antioxidant, anti-atherosclerotic, and anti-diabetic effects. They are also associated with increased memory and decreased depression. Glycerin can reduce serum free fatty acids and mimic caloric restriction; its metabolites can function as a broad-spectrum antimicrobial. Additionally, glycerin has a dehydrating effect on the central nervous system and can reduce focal cerebral edema and improve performance by expanding plasma volume. However, it may also have side effects, such as hyperglycemia. Therefore, combined consumption of lemon extracts and glycerin may, in part, mitigate each other’s side effects while exerting their benefits. There is growing evidence that both lemon components and glycerin are metabolized by the gut microbiota and may modulate the intestinal microbiome composition. Therefore, gut microbiome alterations are also explored as an important mechanism in the gut–brain axis regulating various effects of these dietary supplements and their application in various noncommunicable neurological disorders.