Dietetics

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article