Dietetics

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. Full article

(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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article