Dietetics

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

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

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

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

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

Saturated fats are widely seen as undesirable components of a healthy diet, as a result of their illusory association with elevated serum cholesterol. The regulation of serum cholesterol is now better understood and a lack of polyunsaturated fatty acids, rather than an abundance of saturated fatty acids, is responsible. Palmitic acid was shown to incite inflammation at unnaturally high concentrations in tissue culture, but later was found to play an auxiliary role as a precursor to ceramide biosynthesis and possibly in the palmitoylation of membrane receptors involved in the initiation of inflammation. Studies of arthritic inflammation in lab animals showed that dietary saturated fats are anti-inflammatory, whereas polyunsaturated oils are pro-inflammatory. Inflammation plays a role in numerous metabolic diseases, including insulin resistance, fatty liver disease and metabolic syndrome, among others. Fat, as triglycerides in adipose tissue, is an efficient way for living organisms to store energy and reduce the toxicity of other macronutrients. Macronutrients, such as excess carbohydrates and polyunsaturated fatty acids, are converted to saturated and monounsaturated fatty acids for storage as triglycerides in adipose tissue. Fatty acids are released from adipose tissue during fasting and as a result of some metabolic disorders, where elevated levels of nonesterified fatty acids in blood can lead to hepatic lipid accumulation, inflammation and insulin resistance. Although most serum nonesterified fatty acids may be saturated fatty acids, they are not necessarily derived from the diet. This paper will attempt to clarify the role of saturated fatty acids, and palmitic acid in particular, with regard to certain adverse health conditions. Full article

Lactation support from health professionals is a crucial social determinant of health. Registered dietitians (RDs) and registered nurses (RNs) can play an important role in supporting breastfeeding, yet most have minimal formal lactation education and training. This study seeks to explore the correlates of professional breastfeeding perceived role, perceived influence, and confidence in providing lactation support among RDs and RNs. Using a cross-sectional design, a convenience sample of 111 credentialed providers completed an online survey assessing their breastfeeding-related training, experiences, knowledge, attitudes, and practices. We also examined perceptions of social support, intentions for future breastfeeding, professional roles, and confidence in lactation support. We tested for relationships between variables using chi-square, Fisher’s exact, and Mann–Whitney U tests and identified which correlates were associated with the dependent variables using bivariate logistic regression. Respondents who were breastfed as infants were 3.4 times more likely to agree that it is their responsibility to highlight health problems associated with infant formula when giving breastfeeding advice (p = 0.009). Those agreeing that people around them support breastfeeding were 8.0 times more likely to believe they can influence a woman’s breastfeeding decision and duration (p = 0.05). Respondents working in maternal/child/family health were 14.3 times more likely to feel confident in their ability to provide lactation counseling, guidance, and recommendations (p = 0.03). Educational institutions and employers should provide all RDs and RNs with opportunities for personal reflection and lactation training while strengthening breastfeeding social norms. Full article

Those with a cancer diagnosis report experiencing a wide range of nutrition impact symptoms, the prevalence of which varies by study, group, and cancer type. We aimed to identify groups of cancer survivors with specific patterns of nutrition impact symptoms. Two hundred and twenty-nine individuals attending oncology day ward and outpatient clinics completed a series of questionnaires and physical measurements. A latent class analysis was performed to identify subgroups based on 13 nutrition impact symptoms taken from the Patient Generated Subjective Global Assessment short form. The identified classes were subsequently compared using analysis of variance and chi-square tests, by sociodemographic, clinical and nutritional variables, and by the Global Health Status (GHS) and five functioning scales determined using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Three latent subtypes were identified: (1) Fatigue (n = 58, 28%); (2) Low Symptom Burden (n = 146, 64%), and (3) High Symptom Burden (n = 25, 11%). Those in the High Symptom Burden group were more likely to be female, were currently receiving some form of treatment, were diagnosed ≥two years, and had consumed less food than usual in the last month compared to those in the Low Symptom Burden group. Those in the Fatigue group were less likely to have reported their food intake to be unchanged and more likely to be diagnosed ≥two years than those in the Low Symptom Burden group. The EORTC-QLQ-C30 functioning and GHS scores were all significantly different between the three nutrition impact symptoms classes (p < 0.001). This is the first study to examine heterogeneity of nutrition impact symptoms in Irish cancer survivors. The findings of this work will inform and allow for more individualised nutrition care. By tailoring interventions to these specific groups, we can enhance the precision of care, improve prognostic accuracy, and significantly elevate the quality of life of survivors. This work underscores the critical importance of symptom management in the continuum of cancer care, ensuring that every survivor receives comprehensive support tailored to their unique journey. Full article

Accurate estimation of food intake is necessary to clarify the relationship between dietary intake and particular health conditions; however, self-reported assessments often result in estimation errors. In addition, increasing evidence indicates an association between a higher intake of fruits and vegetables and a lower risk of some diseases, and many countries are encouraging their consumption. Biomarkers of vegetable and fruit intake are important tools for objectively estimating dietary intake in nutritional epidemiological studies. To determine the association between vegetable and fruit intake and blood biomarkers, we systematically reviewed relevant literature on Asians. Databases, PubMed, and CiNii Articles were searched for English and Japanese articles. Of the 91 articles retrieved, 4 were selected for review, including 2 cross-sectional studies, 1 longitudinal study, and 1 randomized trial. Our literature review showed that vegetable consumption is positively associated with plasma concentrations of γ-tocopherol, β-cryptoxanthin, α-carotene, β-carotene, lutein, threonate, galactarate, creatine, and ascorbic acid. In comparison, fruit consumption is positively associated with blood concentrations of α-tocopherol, β-cryptoxanthin, α-carotene, β-carotene, lycopene, retinyl palmitate, ascorbic acid, proline betaine, threonate, and galactarate. Therefore, blood β-carotene, β-cryptoxanthin, and ascorbic acid concentrations may be useful biomarkers for predicting vegetable and fruit intake in Asian population. Full article

Background: Campus food pantries can address food insecurity among college students, but little is known about how to create a model at a Hispanic-Serving Institution (HSI). This study evaluated a food pantry, which was part of a learning community for dietetics and nutrition students at an HSI. Methods: The Bobcat Bounty food pantry was created and evaluated using a mixed-methods approach, including food inventories before and after each pantry, observations of operations (written by volunteers at each pantry, n = 27), new client intake (n = 947) and client satisfaction surveys (n = 267)), and stakeholder interviews (n = 16 after the first year of implementation). Descriptive statistics and t-tests were used for quantitative analyses, and qualitative analyses included interview transcript coding and peer debriefing. Results: Here, 2 faculty members and a team of 19 students/dietetic interns operated the weekly campus food pantry, which served 3567 students and distributed 33,000 pounds of food. Client satisfaction surveys provided evidence for addressing food insecurity for college students. Volunteers and stakeholders generated insights for operational evolution and sustainability of the food pantry. Conclusions: Results highlighted key factors for initial efficacy and strategies for long-term success. Findings may be incorporated by dietetic education and training programs to provide research-focused and culturally relevant experiential learning. Full article

This study aimed to develop the ‘Healthy Eating Index for Older People’ (the index), based on New Zealand dietary guidelines, and measures the validity and reproducibility of a food frequency questionnaire (FFQ) to derive the index scores in older adults. In Auckland, New Zealand, participants (community-dwelling adults aged 65–74 years, [n = 273, 36% male]) completed a 109-item FFQ administered one month apart (FFQ1, FFQ2), with a four-day food record (4-DFR) collected in between. Adherence to the guidelines was scored using the index, comprising a total score (maximum = 100) and two sub-scores: adequacy (maximum = 60) and moderation (maximum = 40). A comparison of FFQ1 and FFQ2 determined reproducibility, and FFQ1 and 4-DFR determined validity. Higher index scores (from FFQ1) were associated with higher intakes of protein, fibre, vitamins and minerals and lower intakes of alcohol and saturated fats (nutrients from 4-DFR) after adjusting for age and sex (all p < 0.001). Total index and sub-indices correlation coefficients ranged from 0.42 to 0.77 (all p < 0.001); weighted kappa values ranged from 0.35 to 0.67; and mean differences were all <10% of FFQ1 for reproducibility and validity. The Bland–Altman analysis showed no bias for the total index score for reproducibility and validity. However, with validation, the sub-index scores became less reliable as food intake increased (p < 0.05). The index applied to the FFQ demonstrated good construct validity and reproducibility. Relative and absolute validity were acceptable, though caution is required when using the absolute sub-index scores. The index is suitable for measuring total diet quality in older New Zealand adults. Full article

Sustainability is an important aspect of all areas of life, including nutrition and dietetic practice. The Sustainability Development Goals are 17 goals set by the United Nations as a guideline on how the global population can be more sustainable moving into the future. Opportunities are available for nutrition and dietetic professionals to be involved in making changes and supporting the SDGs. Yet, there are limited studies exploring Irish dietitians’ perceptions and experiences of sustainability. An online survey consisting of 16 questions exploring familiarity with, as well as personal and professional perceptions of, sustainability was circulated to Irish dietitians by the Irish Nutrition and Dietetic Institute and promoted online through social media platforms (Twitter and Facebook). The survey was open for four weeks (18 October–16 November 2021) and was housed in Qualtrics and analysed using SPSS. A total of 102 Irish dietitians completed the survey (n = 100, 98% female). Most (96.1%) reported that sustainability is very important or important and 81.4% felt that it was very important or important in dietetic practice. Overall, participants were more familiar with environmental sustainability, e.g., widespread availability (79.4%), climate change (89.2%) and some concepts under economic, social, and general sustainability. They were most unfamiliar with agricultural sustainability concepts, e.g., use of food and agricultural policies (36.2% were familiar). This study illustrates the importance that Irish dietitians place on sustainability, aspects they feel confident in and areas for future education and support. Full article

(1) Background: Patient education materials are frequently used by dietitians to support counselling and reinforce key concepts. No studies have examined the quality of dietetic patient education materials for diabetes and common gastrointestinal conditions. (2) Methods: Materials relating to the dietary management of diabetes and gastrointestinal conditions (IBD, IBS, lactose intolerance, coeliac disease and low-FODMAP diets) were evaluated by three dietitian raters. Readability was assessed, and materials with a reading grade level ≤ 7 were considered readable. The PEMAT was used to assess understandability and actionability. Clarity was determined using the CDCCCI. (3) Results: Overall readability scores were satisfactory with a median grade level of 6 (IQR: 5–8). Readability scores did not differ between material types (p = 0.09). The health literacy demand of materials was suboptimal, with a mean understandability score of 65.9 ± 15.1% and an actionability score 49.6% ± 20.8%. Both scores fell below the benchmark of ≥70%. These did not differ between material types (p = 0.06 and p = 0.15, respectively). Clarity scores were below the benchmark of ≥90% (mean score 64.2 ± 14.8%). Only 6.6% of materials achieved a score of ≥90. (4) Conclusions: Improvements to the health literacy demand and clarity of dietetic patient education materials are required. Areas for future improvement have been identified. Full article

Recently, there has been increased scientific and clinical interest in the potential harms associated with ultra-processed foods, including poor mental health, aggression, and antisocial behavior. Research spanning epidemiology, mechanistic pre-clinical work, addiction science, microbiome and exposome science, and human intervention trials has underscored that nutrition is of relevance along the criminal justice continuum. As such, the emerging dietetics research is salient to the thousands of international psychologists and allied mental health professionals that are engaged in justice work, including forensics, prevention, and intervention. In addition, relationships between nutrition and behavior relate to “food crime”, an emergent area unifying criminal justice researchers with psychology, public health, and other interdisciplinary sectors. Food crime scrutinizes the vast harms, including non-communicable diseases and adverse behavioral outcomes, as influenced by the distribution of addictive ultra-processed food products. Here, we examine the emergent research, including biophysiological mechanisms, and evidence indicating that dietary patterns/components intersect with psychosocial vulnerabilities linked with risks of antisocial behavior and justice involvement. Viewed through a prevention lens, the study of nutrition and aggressive behavior should be prioritized, especially if the outcomes emerge as externalities of the global consumption of ultra-processed food. In the context of criminal justice and behavior, there is a need for forensic examination of how industry influence and power structures can undermine matters of food justice. Full article

While homocysteine is produced as an intermediate metabolite during methionine metabolism, increased blood homocysteine levels are associated with various diseases. In a previous cross-sectional study, we reported a significant negative association between the serum concentrations of homocysteine in 227 young women and their dietary fiber intake. In the present study, we examined the relationship between dietary fiber intake from food sources and serum levels of homocysteine and its metabolites. Homocysteine and its metabolites 5-methyltetrahydrofolate (5MTHF), cystathionine, glycine, methionine, and S-adenosyl-methionine were measured using LC-MS/MS. The soluble, insoluble, and total fiber intake from fruits and mushrooms was significantly inversely correlated with the homocysteine concentrations. Furthermore, the soluble, insoluble, and total fiber intake from fruits was significantly positively associated with the serum 5MTHF concentrations, while the fiber intake from mushrooms was positively correlated with the cystathionine concentration and negatively correlated with the methionine and glycine concentrations. These results suggest that ingesting dietary fiber in the form of fruits and mushrooms maintains a low concentration of homocysteine by activating two different homocysteine-scavenging metabolic pathways. Full article

Neurological disorders are increasing globally due to their complex nature, influenced by genetics and environmental factors. Effective treatments remain limited, and early diagnosis is challenging. Recent evidence indicates that metabolic activities play a crucial role in the onset of neural defects. Molecular changes offer new diagnostic markers and dietary targets for disease management. Diets such as MIND, DASH, omega-3 fatty acids, and polyphenols show promise in protecting brain metabolism through their anti-inflammatory properties. Personalized dietary interventions could mitigate neurodegenerative diseases. This review highlights the effects of various dietary interventions, including calorie restriction, fasting, and ketogenic diets, on neurological disorders. Additionally, it emphasizes the nutritional impacts on immunomodulation and the underlying mechanisms, including the influence of gut microbiota on brain function. Dietary interventions could serve as adjunctive therapies in disease management. Full article

Mindful eating is the direct application of mindfulness to eating related issues. This approach has been developed to reduce suffering due to food and body image, to improve the capacity to follow the stimuli of hunger and satiety and to minimize the use of food as psychological compensation. The aim of this review is to analyze the results of clinical trials adopting a mindful eating approach to address cardiometabolic risk factors partly related to dysfunctional eating behavior. The selection of literature included articles published until 31 December 2023. The inclusion criteria were controlled randomized clinical trials, an intervention duration ≥4 weeks and indication of a clinical outcome. Fourteen studies were included. The sample sizes ranged from 18 to 194 participants, and the interventions lasted between 4 and 24 weeks. Their effects on body weight, BMI, waist circumference, serum glucose, glycated hemoglobin and C-reactive protein were assessed using a meta-analysis. Mindful eating was as effective as other recognized types of interventions regarding the clinical outcomes examined, but in many cases, they were more effective in terms of factors which may lead to improvement over a longer period. In particular, our analysis showed that mindful eating effectively reduced suffering related to food and body image. Full article

Neurocognitive deficits in children could be irreversible and detrimental to the overall wellbeing of children. Typically, children with this illness live lives below their mental and intellectual potential. The aim of this paper was to review primary evidence on the association between inflammatory biomarkers on neurocognition in children. Electronic databases such as Scopus, Cochrane Library, and PubMed were systematically searched to include all published data from 2000 to October 2023. The keywords included serum biomarker, cognition, executive function, intellectual ability, brain-derived neurotrophic factor, neurocognitive deficits, tau proteins, and children. A total of 8512 journal publications were obtained, but after the removal of duplicates, commentaries, and review papers, 9 papers were accepted for review. C-reactive protein, brain-derived neurotrophic factor (BDNF) tumor necrosis factor alpha (TNF-α), fibrinogen, plasma leptin, soluble tumor necrosis factor receptor 1 (sTNFR1), and copper were associated with neurocognition in the subjects. This review revealed that there is no research published in sub-Saharan Africa and most of the sample sizes in the studies were small. Full article

Caries is very common in the elderly as there are several aggravating factors, such as a decrease of the ability to self-care and, by extension, insufficient oral hygiene, a carious diet, limited exposure to fluoride, xerostomia, gingival recession, and limited access to dental care. This study aimed to review the dietary risk factors for root caries prevalence in older adults, from socially active people to frail patients. A comprehensive search strategy was used to select studies from PubMed and Scopus databases. Two evaluators performed data extraction, screening, and quality assessment independently. Only studies written in English were included. Root caries is prevalent in the elderly due to gingival recession and root exposure to the oral environment. Dietary risk factors significantly affect root caries prevalence in older adults, including a high intake of sugars and an alteration of their composition preference in this age group. Caries risk appears more significant in frail, institutionalized patients fed softer food or supplements. Full article