Search Results (711)

The demand for functional foods, particularly probiotics, has increased substantially in recent years. The search for plant-based milk alternatives (PBMA) has also risen, influenced by factors such as lactose intolerance, allergies, veganism, and environmental sustainability. Cashew nut kernels have high nutritional value, and are a suitable alternative for preparing plant-based beverages. Therefore, this study aimed to develop a potentially probiotic cashew nut-based beverage fermented by Lacticaseibacillus casei NRRL B-442. The fermented cashew nut-based beverage was prepared, and its stability was evaluated over a 42-day refrigerated storage period (4 °C). Various parameters were monitored, including pH, viability, and concentration of lactic acid, in addition to sugars. The survival rate of microorganisms following simulated gastrointestinal digestion was also determined. Sensory analysis included word association, hedonic scale, and CATA tests. During fermentation, the microorganism consumed glucose, leading to the production of lactic acid. The fermented drink was stable throughout the refrigerated storage period, with a final viable cell count greater than 12 log CFU/mL. After in vitro digestion, probiotic survival rates were higher than 73% in all the samples analyzed. The sensory analysis showed positive consumer acceptance. No statistically significant difference in overall hedonic acceptance was observed between the CNB sweetened with sucrose and sucralose, although both differed from the commercial fermented milk control in several sensory attributes. These results suggest that the cashew nut-based matrix is a promising alternative for developing functional plant products. This study effectively produced a probiotic beverage from cashew nut kernels with functional potential, providing a new product option for interested consumers. Full article

Background: Lifestyle factors such as diet and physical activity significantly impact on the risk of obesity in individuals with Down syndrome (DS). However, in the absence of national nutritional guidelines in individuals with DS, further work is needed to understand their dietary and physical activity patterns. In this work we retrieved caregivers’ responses on those aspects. Methods: We analyzed data from a cross-sectional online survey of caregivers of individuals with DS conducted as part of the GO-DS21 project and reported in the accompanying paper (nutrients-4216283) (n = 764). We explored physical activity patterns, dietary habits, beliefs around weight-loss interventions and caregiver confidence that family members with DS would engage in a healthier lifestyle. Associations were examined using correlation analysis, and cumulative and binary logistic regression models. Results: Caregivers reported that most individuals with DS exercised 1–3 times per week, with frequency declining with age. Males were more likely to exercise daily than females. Caregiver exercise frequency was positively correlated with that of their DS family member (ρ = 0.521, p < 0.001), suggesting clustering of shared health behaviors within households. In adjusted models, caregivers who exercised regularly had up to thirteen-fold higher odds of having a physically active family member with DS (aOR = 13.02, 95% CI: 7.40–24.06, p < 0.001). Fried food consumption and higher snack frequency were independently associated with perceived obesity status, while sugar-sweetened beverage consumption was not. Caregivers favored exercise as a weight-loss strategy, while anti-obesity drugs were endorsed by only 11% of caregivers primarily and were more likely to be endorsed when obesity was perceived (aOR = 4.21, 95% CI: 2.44–7.39, p < 0.001). Finally, caregiver confidence that their family member with DS would engage in healthier behaviors was associated with perceived obesity status and strongly associated with higher physical activity levels (aOR 14.68, 95% CI: 6.59–33.40, p < 0.001). Conclusions: In this large European caregiver survey, reported consumption of selected energy-dense foods was generally low, although fried food intake and higher snack frequency were associated with perceived obesity. Physical activity patterns were closely aligned between caregivers and individuals with DS, suggesting shared household health behaviors. These findings highlight the importance of involving caregivers and family environments in lifestyle interventions aimed at supporting physical activity and weight management in individuals with DS. Full article

Background: Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental condition with psychosocial impact. Dietary carbohydrates, particularly added sugars, refined starches, and high-glycemic index/load (GI/GL) patterns, have been proposed as modifiable exposures that may relate to attention and behavioral regulation. This systematic review synthesized evidence linking carbohydrate quantity and quality to ADHD-related outcomes. Methods: Following PRISMA 2020, PubMed, Scopus, and Web of Science were searched for English-language studies published from January 2015 to December 2025. Eligible studies included observational and interventional designs in children, adolescents, or adults with a clinical ADHD diagnosis or validated symptom assessment. Risk of bias was assessed using NOS/NOS-adapted criteria, RoB 2, and ROBINS-I. Findings were synthesized narratively by exposure domain. Results: Of 1174 records identified, 48 studies were included: 38 observational and 10 interventional. Sugar-related exposures showed the most consistent pattern: 15 of 16 studies examining added sugars, sugar-sweetened beverages, sweets, candy, or sweet dietary patterns reported positive associations with ADHD diagnosis, symptom severity, hyperactivity, or less favorable ADHD-related outcomes. Findings for total carbohydrate intake were inconsistent. GI/GL-specific evidence was limited but generally adverse in direction. Among intervention studies, symptom improvement after modification was reported in 6 of 10 studies, whereas 4 studies showed mixed, preliminary, non-significant, or non-superior findings. Most observational studies showed moderate to high risk of bias, while interventional studies showed variable risk across domains. Conclusions: Poorer carbohydrate quality may be associated with greater ADHD-related symptom burden, whereas total carbohydrate intake showed inconsistent associations. Certainty remains limited by heterogeneity, residual confounding, risk of bias, and limited carbohydrate-specific intervention evidence. Full article

Background/Objectives: Adherence to the Mediterranean diet (MD) is associated with reduced risk of non-communicable diseases but has declined among children, even in traditionally high-adherence settings such as Greece. As parental lifestyle behaviors strongly influence children’s dietary patterns, this study examined the associations between parental lifestyle factors and children’s MD adherence in Crete, Greece. Methods: A total of 760 parent–child dyads participated in this cross-sectional study. Children’s adherence to the MD was assessed using the KIDMED index. Parents completed validated instruments, including the MEDAS (MD adherence), IPAQ (physical activity), PSQI (sleep quality), and NLS (nutrition literacy), along with questions on dietary habits and screen time behaviors. ANOVA/Kruskal–Wallis tests and multivariable linear regression identified predictors of KIDMED scores. Results: Mean KIDMED score was 5.95 ± 2.65; 32% achieved optimal adherence. Younger children showed higher adherence. Higher children’s adherence to MD was positively associated with parental MD adherence (β = 0.493), urban residence (β = 0.544), higher parental education (β = 0.493), consistent daily meal routines (breakfast and mid-morning and mid-afternoon snacks), higher water intake, and fresh juice consumption (all p < 0.05) were positively associated with parental MD adherence. Conversely, lower adherence was associated with parental age ≥ 45 years (β = 0.987), higher parental BMI (β = 0.072), consumption of sugar-sweetened (β = 0.390) or artificially sweetened beverages (β = 0.497), and weekend screen time ≥ 3 h/day (β = 0.383) (all p < 0.05). Conclusions: Children’s adherence to the MD is strongly associated with parental dietary behaviors and structured meal routines. These findings support family-focused interventions that emphasize parental dietary role modeling to counter declining MD adherence among Mediterranean youth. Full article

Background: Adolescence is a critical period for the development of beverage-related behaviors; however, the role of digital interventions in addressing sugar-sweetened beverage and energy drink consumption remains insufficiently characterized. Methods: This study examined the literature on digital interventions aimed at modifying beverage-related behaviors among adolescents through a structured search in Scopus, PubMed, and Web of Science. Eligible studies were analyzed descriptively and classified according to intervention focus, digital delivery mode, behavior change strategy, ecological level of delivery, and beverage outcome specificity. Results: Twenty-two studies were included. Most studies have focused on sugar-sweetened beverage outcomes, whereas energy drink consumption has rarely been addressed directly. The identified interventions were predominantly mobile- or web-based and were often embedded within broader multicomponent, school-based, or lifestyle-oriented approaches. Beverage-related outcomes varied substantially across studies. Conclusions: Digital interventions targeting beverage-related behaviors in adolescents represent a promising but fragmented field. These findings offer a structured analytical foundation for designing and implementing future digital interventions targeting beverage consumption in adolescents. Full article

Background/Objectives: Adolescence is a critical developmental stage during which lifestyle and dietary habits are established, influencing both general and oral health outcomes. Territorial disparities between rural and urban environments may contribute to nutritional inequalities and health vulnerabilities. The aim of this study was to analyze differences between rural and urban environments in terms of lifestyle behaviors, dietary patterns, and oral health outcomes among adolescents in Mallorca, Spain. Methods: A cross-sectional study was conducted among 463 adolescents corresponding to the WHO index ages (12 and 15 years). Data were collected through questionnaires assessing dietary habits, oral hygiene behaviors and lifestyle characteristics. Clinical oral examinations were performed following the World Health Organization Pathfinder methodology. Statistical analyses included descriptive statistics and comparative analyses between rural and urban populations. Results: Urban adolescents reported higher consumption of sugar-sweetened beverages and ultra-processed foods (p < 0.001), whereas rural adolescents showed higher weekly physical activity (4.45 ± 2.34 vs. 3.62 ± 2.41 h/week; p < 0.001). Caries prevalence was higher in rural students (45.0% vs. 28.6%; p < 0.001), who however demonstrated better periodontal indicators. Conclusions: Geographic environment is associated with differences in dietary patterns, physical activity levels, lifestyle behaviors, and oral health outcomes among adolescents. These findings highlight the importance of targeted public health interventions adapted to geographic context and support the role of broader social and environmental determinants in adolescent oral health. Full article

Background/objectives: Mental health challenges are increasing worldwide. Identifying preventable factors for such challenges is important and will have the greatest impact if identified in young children. In this study we aimed to explore the association between aspects of diet and child mental health at the age of 4 years. Methods: This is a secondary analysis of data from the Early Food for Future health study in Norway, a randomized controlled trial aiming to improve diet at ages 6–12 months. Cross-sectional data from 363 children aged 4 years and their mothers are used. Diet was assessed using food frequency questions. Five food scores were developed: vegetables, fruits, fruit and vegetables, sweet/salty snack score, and soft drink score. The Child Behavioral Checklist (CBCL) was used to assess internalizing and externalizing behaviors. Crude and multivariable linear regression models are presented. Results: We found that frequency of consumption of vegetables and total frequency of consumption of fruit and vegetables in 4-year-old children were inversely associated with internalizing behavior (β −0.207, 95% CI: 0.351, −0.063), while frequency of consumption of sweet and salty snacks was positively associated (β 1.807, 95% CI: 0.276, 3.337) with externalizing behavior and frequency of consumption of fruit and vegetables was inversely associated (β −0.188, 95% −0.336, −0.041). All were independent of maternal education, measures of financial difficulties and maternal mental health. Conclusion: An inverse association was observed between child frequency of consumption of fruit and vegetables and internalizing and externalizing behaviors, whereas frequency of consumption of sweet/salty snacks was positively associated with externalizing behavior. A varied and healthy diet early in life may promote child mental health, with potential large returns for society. Given the observational nature of the data, causal inference is limited and intervention studies are needed. Full article

Sub-Saharan African health systems face critical funding challenges due to declining foreign aid, mounting debt and increasing disease burdens. Traditional financing mechanisms have proven inadequate, necessitating the exploration of innovative domestic revenue mobilization (DRM) strategies. This paper contributes to the health economics literature by examining the use of innovative tax models as DRM strategies for sustainable health financing in Sub-Saharan Africa, using the fiscal space for health framework. This narrative review synthesizes peer-reviewed articles, policy documents, and grey literature published between 2010 and 2025. The review identifies four promising innovative models: health taxes (tobacco, alcohol, sugar-sweetened beverages), environmental levies (pollution, carbon, plastic), digital taxation (digital services taxes, mobile money taxes, Value Added Tax (VAT) on digital services) and resource extraction taxes. The evidence demonstrates significant revenue generation potential while achieving public health and environmental co-benefits. However, critical implementation challenges persist: weak administrative capacity, poor governance quality, equity concerns and extensive informality and economic diversity. The paper recommends strengthening tax administration through digital infrastructure investment and capacity building, implementing progressive tax design with targeted exemptions, enhancing transparency and linking tax revenue to health service delivery, and tailoring reforms to country-specific contexts while learning from regional experience. Full article

Background/Objectives: Insufficient hydration and high consumption of sugar-sweetened beverages (SSBs) is a significant public health challenge among adolescents. The aim of the presented study was to assess the beverage intake, in terms of quantity and choices, in a national-based population of Polish adolescents within the PLACE-19 Study. Methods: Within the PLACE-19 Study, the population of n = 1027 secondary school adolescents (age 15–20 years) was recruited based on a quota sampling of Polish secondary schools and n = 984 individuals (n = 674 female, n = 310 male) were included in the analysis. The study assessed beverages intake using the National Youth Physical Activity and Nutrition Study (NYPANS) survey questionnaire and data were gathered using the Computer-Assisted Web Interview (CAWI) technique. The beverages were assessed in the following groups: water, milk beverages, 100% fruit juices, coffee/tea, regular carbonated soft drinks (CSDs), diet CSDs, other sugar-sweetened beverages (SSBs); additionally, total SSBs were summarized. The total beverage intake was compared with 80% of the Adequate Intake (AI) level. Results: The highest intake was observed for water (250 mL per day), and tea beverages (178.1 mL per day). However, in combining SSBs, the total daily intake for this group was 394.4 mL per day. The highest share of the daily intake of beverages was attributed to water intake (23.81%), and tea beverages (11.45%), followed by 100% fruit juices (7.14%), fruit drinks (6.67%), and milk (6.45%); however, the intake of total combined SSBs was even higher than for water (32.47%). Male individuals were characterized by a higher share of milk beverages, regular CSDs, diet CSDs, and other SSBs than female ones, while female individuals were characterized by a higher share of water, and coffee/tea in their total daily beverage intake than male ones (p < 0.001). Younger individuals were characterized by a higher share of other SSBs in their total daily beverage intake than older ones (p = 0.034). For the vast majority of the studied group, the inadequate intake of beverages was observed, as over 70% of the studied sub-groups did not meet the AI value. Conclusions: The inadequate beverage intake in a population of adolescents may be a problem, especially considering high intake of SSBs, and relatively low intake of water. Especially in male and younger individuals, due to a higher intake of SSBs, than for female and older individuals, education is necessary to promote adequate intake and choices of beverages. Further research is needed in the area of beverage consumption to understand the determinants of beverage consumption and develop opportunities to improve it. Full article

Water kefir production requires the fermentation of sweetened water with polysaccharide starter culture embedded with bacteria and yeast, which determines the finished product’s sensory, microbial, and chemical profile. The culture self-propagates, producing a new culture biomass used to inoculate subsequent raw materials. This study evaluated the effect of sequential culture transfers (across batches) and prolonged storage (within batches) on the microbial and chemical composition of finished beverages. Six commercial cultures were used in 20 sequential fermentations. The beverages were analyzed immediately after fermentation and then were stored at 4 °C for analysis every 2 weeks for 12 weeks. Microbial populations, including aerobic plate count (APC), lactic acid bacteria (LAB), acetic acid bacteria (AAB), and yeast, were enumerated; major organic acids, sugars, and alcohols were quantified chromatographically. Sequential culture transfers and storage resulted in minimal microbial and chemical component changes. The initial microbial counts were similar across brewing cycles and culture systems with high counts of LAB. The culture transfers resulted in a decrease in initial ethanol levels to a negligible level. Microbial viability and sucrose content decreased with prolonged beverage storage. Overall, this study revealed that water kefir cultures were resistant to temporal changes and beverages’ microbial and chemical constituents were statistically stable (p > 0.05) during refrigeration. Full article

Background/Objectives: Excess consumption of energy-dense foods (EDF; ultra-processed snacks, sweets, and sugar-sweetened beverages) among preschool-aged children is a public health concern, particularly in low-income families. Caregiver parenting style, psychological stress, and food-parenting practices (FPP) may shape children’s EDF consumption, yet little is known about how these factors operate in real time. This exploratory pilot study examined (1) associations between baseline characteristics and EDF feeding episodes across 1 week and (2) whether caregivers’ momentary stress during EDF episodes related to FPP used. Methods: In total, 22 caregivers of Head Start children (ages 3–5) completed baseline measures and 7 days of ecological momentary assessment (up to seven prompts/day). At each prompt, caregivers reported child EDF consumption in the past hour; if confirmed, they reported FPP used and rated momentary stress. Aim 1 used Poisson regression to model caregiver-level EDF episode counts. Aim 2 tested momentary stress–practice associations during EDF episodes using GEE, with within-person and between-person stress modeled separately. Results: Authoritarian parenting was associated with a higher weekly rate of EDF episodes (RR = 1.43, 95% CI 1.23–1.66, p < 0.001); authoritative parenting trended lower (RR = 0.90, p = 0.065). Higher baseline stress was associated with more EDF episodes (RR = 1.25, p = 0.001). Momentarily, elevated stress above a caregiver’s own average increased odds of using food as a reward (OR = 1.08 per +10 points, p = 0.011), while higher average momentary stress was associated with co-eating (OR = 1.59, p = 0.042). Domain-level FPP composites showed no association with momentary stress. Conclusions: Authoritarian parenting and higher caregiver stress were associated with increased EDF feeding, and momentary stress was linked to reward-based feeding during those episodes. These hypothesis-generating findings suggest potential behavioral targets for just-in-time adaptive intervention, pending replication in adequately powered studies. Full article

Background/Objectives: This secondary and exploratory meta-analysis re-evaluated 30 randomized controlled trials on free and added sugars (FS) detailed in the European Food Safety Authority’s (EFSA) report on the tolerable upper intake level for dietary sugars, focusing on the influence of food source (beverages, foods, or mixed) on cardiometabolic and anthropometric health. Methods: The EFSA’s method of analyzing the relative FS intake (difference between treatment and comparator arms, Δ%E^fs) was used, with further adjustment for the reported intake of all sources of FS and energy. The EFSA’s “high vs. low” random-effects meta-analysis comparing groups with the highest and lowest FS intake was replicated, and additional exploratory dose–response meta-regressions (linear and non-linear) were performed, stratified by food source. Given the secondary and observational nature of the analysis, all source-stratified findings should be interpreted as hypothesis-generating, rather than causal. Results: There were no interactions between Δ%E^fs and food source for any outcome, and within a source there were linearly positive and statistically significant regressions for body weight (mixed), low-density lipoprotein cholesterol (LDL-C, foods), and uric acid (beverages). Across 13 outcomes, Δ%E^fs was positively and linearly related to greater fasting glucose, high-density lipoprotein cholesterol (HDL-C), and LDL-C, and non-linearly to body weight. However, the data were limited in their representation of FS intake at typical population levels, and there were insufficient data to investigate the effect of FS from foods on most anthropometric outcomes. Conclusions: Meta-regressive dose–responses revealed little relationship between Δ%E^fs from specific food sources and health outcomes, but such effects might be masked by confounding factors. Future trials that test realistic intakes of FS across diverse food matrices and account for dietary compensation would help to overcome limitations in the body of evidence. Full article

Flocs, visible particles formed in sugar-sweetened beverages, reduce clarity and consumer acceptance of products. Their presence can be caused not only by different types of trace impurities in the sugar but also by interactions among beverage components. In this review, scientific reports on acid beverage flocs (ABFs) and alcohol flocs are summarized, the main pathways for their formation are described, and practical options for detecting them and preventing their formation in beverages are compiled. Using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 and related guidance, literature searches of Scopus, Web of Science (WoS), PubMed, Food Science and Technology Abstracts (FSTA), CAB Abstracts, and International Commission for Uniform Methods of Sugar Analysis (ICUMSA) resulted in the inclusion of 56 studies. In various types of beverages, complexes formed between proteins (Ps) and polyphenols (PPs) often initiate haze and floc formation, while polysaccharides (dextran, pectin, and starch), silica or silicates, and inorganic ions influence charge balance, particle bridging, and floc growth rate. Ethanol in alcohol beverages can further destabilize colloids and promote aggregation. For beet sugars, saponin–protein interactions are a likely pathway for the formation of ABF, but the available evidence is not consistent. In cane sugars, the reported roles of proteins, polysaccharides, silica, and starch in floc formation vary considerably between studies. For quality assurance, ICUMSA floc tests (GS2-40 and GS2-44) should be complemented by turbidity or haze measurement and colloid characterization such as light scattering, ζ–potential, and infrared IR-based analytical methods supported by chemometrics. Risk mitigation works best as a two-level strategy that combines impurity removal during sugar production and stabilization steps in beverage formulation and storage, including the use of clarification agents and control of pH, temperature, ionic strength, and oxygen exposure. Standardized reporting and validation of rapid predictors against ICUMSA benchmarks remain essential. Full article

Purpose: We hypothesised that cognition following consumption of an isomaltulose beverage would be comparable to that of an isoenergetic sucrose-based beverage, but the latter would attenuate post-ingestive metabolic responses. Methods: Thirty adults (15 males, 15 females) aged 21–44 years completed three experimental sessions, following at least 3 h fasting. Plasma insulin and glucose were measured in arterialised capillary blood 30 min after beverage consumption. Cognitive functions were assessed 45 min after beverage consumption using a computerised test battery; the primary cognitive performance outcome was a composite neurocognitive index score. Subjective symptoms were measured using questionnaires. Data are presented as the mean [95% confidence interval]. Results: Circulating glucose was greater after ingesting sucrose compared to isomaltulose and placebo beverages (sucrose: 7.3 [6.9, 7.7] mmol·L⁻¹; isomaltulose: 6.3 [6.1, 6.6] mmol·L⁻¹; and placebo: 5.3 [5.2, 5.4] mmol·L⁻¹). Insulin rose to a greater degree with sucrose compared to isomaltulose (mean difference = 8.5 [2.4, 14.6] µU·mL⁻¹, p = 0.005). Non-inferiority was shown between isomaltulose and sucrose for the composite neurocognitive index score (isomaltulose mean score = 0.931 [−2.3, 4.2]; sucrose mean score = 0.414 [−2.6, 3.5]). However, performance with the sucrose and placebo beverages was similar, limiting broader interpretation. The sensation of postprandial tiredness for isomaltulose was non-inferior to sucrose (isomaltulose mean score = −3.8 [−15.8, 8.2]; sucrose mean score = 0.1 [−10.9, 11.1]). Conclusions: A commercial stimulant beverage with isomaltulose as the energy substrate elicits substantial reductions in glycaemic and insulinaemic responses compared with an isoenergetic sucrose-based beverage, without compromising cognitive performance. Full article

Excessive intake of sugar-sweetened beverages is a major source of dietary free sugars and is strongly associated with an increased risk of type 2 diabetes mellitus. Sweetened tea beverages, which are widely consumed across many Asian countries including Indonesia, represent an important target for sugar reduction. However, reducing sugar content often results in lower perceived sweetness and diminished consumer acceptance. This study examined the potential of floral aroma cues to support sugar reduction in sweetened green tea beverages. Formulations containing jasmine, rose, or lavender aroma were prepared at 100%, 80%, and 70% of the reference sugar level and evaluated by 182 panelists using hedonic rating, Just-About-Right (JAR) scaling with penalty analysis, and Rate-All-That-Apply (RATA) profiling combined with principal component analysis (PCA). Sugar reduction led to decreased perceived sweetness and liking in control samples, whereas jasmine and rose aromas significantly enhanced sweetness perception at reduced sugar levels. Notably, jasmine and rose maintained sweetness perception and overall liking at up to 30% and 20% sugar reduction, respectively. In contrast, lavender aroma provided limited sweetness enhancement and was associated with increased bitterness and astringency. Overall, these findings indicate that culturally congruent floral aromas, particularly jasmine and rose, can be strategically applied to support sugar reduction in sweetened tea beverages while maintaining consumer acceptance, contributing to sensory-driven reformulation strategies for supporting public health. Full article