Dietetics

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

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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. Full article

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