Dietetics

Ultra-processed foods (UPFs) account for a substantial proportion of energy intake and are commonly characterized by being low in protein. The growing availability of protein-fortified UPFs may contribute considerably to dietary protein intake. This study examined associations between UPF consumption and protein intake and evaluated the effects of UPF reduction on protein intake. Fifty-two healthy adults were randomized to either minimize UPF consumption (MPF; n = 25) or maintain typical dietary patterns (UPF; n = 27) for six months. Dietary intake was assessed using three-day diet records at baseline and post-intervention, and foods were classified by the Nova Food Classification System. At baseline, UPF consumption was positively associated with UPF-derived protein intake and the proportion of protein obtained from UPFs (p’s < 0.0001), while demonstrating inverse associations with protein intake relative to body mass and the percentage of calories derived from protein. The MPF group significantly reduced UPF consumption and UPF-derived protein intake (p’s < 0.0001). Despite this, total protein intake, protein intake relative to body mass, and percentage of calories derived from protein were maintained. These findings suggest that dietary protein adequacy can be preserved during UPF reduction while decreasing reliance on UPF-derived protein sources. Full article

Advances in healthcare have led to substantial growth in the global population of cancer survivors, yet young adult cancer survivors (YACS) aged 18–39 years remain an underrepresented population in cancer survivorship research. This review examines the health challenges and psychosocial factors that shape nutritional status in YACS, with the aim of informing age-appropriate nutritional care. YACS face significant financial and psychosocial demands unique to this life stage, balancing education, early careers and family responsibilities. They report greater unmet nutritional and health needs than other age cohorts, in addition to concerns regarding long-term side effects, financial strain, fear of cancer recurrence and increased responsibility for managing their own care. Cancer treatment can cause nutrition impact symptoms (e.g., nausea, taste changes, fatigue, dysphagia and gastrointestinal (GI) disturbances) that may persist for years, and YACS are vulnerable to late effects such as endocrine dysfunction, cardiometabolic disease, chronic pain and osteoporosis, all of which can be influenced by diet. Poor dietary patterns have been observed in YACS, indicating low intakes of fruits, vegetables, fibre and dairy, and higher consumption of saturated fat, sodium and processed foods. This narrative review evaluated fourteen nutritional intervention studies targeting YACS aged 18–39. Most existing interventions demonstrate minimal recruitment and retention rates, small sample sizes, and a reliance on self-report methods rather than objective nutritional measures. These limitations highlight the need for a deeper understanding of YACS’ specific nutritional needs and more effective strategies to engage this cohort. Future research should prioritise larger, more representative samples, incorporate objective nutritional and clinical measures, and explicitly address psychosocial and age-related barriers to healthy eating in young adulthood. Full article

We conducted an online cross-sectional study to assess malnutrition risk, food and nutrition insecurity, and perceived barriers and facilitators to dietary management among adults (18–64 years old) with a self-reported clinical diagnosis of inflammatory bowel disease (IBD) in outpatient and community settings. We assessed malnutrition risk using the Saskatchewan IBD-Nutrition Risk screening tool, food security risk using the two-item Hunger Vital Signs questionnaire, and nutrition security risk using a validated four-item tool. Open-ended questions elucidated barriers and facilitators to dietary management of IBD. Among 57 participants who self-reported a clinical diagnosis of IBD, 52.6% (n = 30/57) had ulcerative colitis, and 47.4% (n = 27/57) had Crohn’s disease. Nutrition insecurity was higher among those at high risk of malnutrition than among those at low-to-medium risk (p = 0.018), and there were no differences in food security status (p = 0.081). Using univariate logistic regression, the odds of being classified as having a high risk of malnutrition were associated with being male, following a special diet or nutrition plan, experiencing IBD-related flare-ups, and nutrition insecurity. Furthermore, healthcare professionals and social support, as well as digital resources/nutrition-related apps, were identified as facilitators to dietary management, while barriers included food access and expense, limited nutrition knowledge and resources, and fear of IBD-related symptom flare-ups. Although self-reported malnutrition risk and food and nutrition insecurity are common, larger prospective studies incorporating validated disease-activity measures and comprehensive nutritional assessment are needed to clarify these relationships and evaluate integrated dietetic and social-support interventions. Full article

Individuals with overweight and obesity consistently demonstrate lower circulating concentrations of serum 25-hydroxyvitamin D (25OHD), the primary biomarker of vitamin D status. Additionally, they exhibit an attenuated response to conventional vitamin D supplementation and may require doses approximately 2–3 times higher than those recommended for individuals with normal body weight to achieve equivalent serum 25OHD concentrations. However, accumulating evidence from randomized controlled trials raises concerns regarding the safety of high-dose vitamin D supplementation, with some studies reporting increased risks of falls and fractures, as well as potential adverse effects on bone mineral density and cognitive outcomes. Magnesium is an essential cofactor in vitamin D metabolism, participating in enzymatic processes required for the hepatic and renal hydroxylation of vitamin D into its active forms. Inadequate Magnesium status may therefore influence vitamin D status and response to vitamin D treatment. Previous randomized clinical trials suggest that Magnesium supplementation, administered either alone or in combination with moderate doses of vitamin D, can effectively increase serum 25OHD concentrations, particularly among individuals with overweight or obesity. Collectively, these findings suggest that optimizing Magnesium status may improve the response to vitamin D supplementation and potentially reduce the need for high-dose vitamin D therapy in obese individuals. Physicians treating overweight or obese patients for vitamin D deficiency should consider co-supplementation with Magnesium and/or encourage intake of Magnesium-rich foods to improve vitamin D status and supplementation outcomes in this population. Full article

Excessive screen usage and exposure to emotionally charged content are public health concerns because they correlate with emotional eating and weight gain. This study investigated the relationship between emotionally charged screen content, emotional shifts, and subsequent food selection. Seventy-two students were randomized to watch happy, sad, or anxiety-eliciting videos. The Discrete Emotions Questionnaire and Wilcoxon signed-rank tests measured changes in emotion. Following the post-questionnaire, students were invited to select from pre-packaged food items. Correlation analysis examined relationships between emotional change and standardized food selection. Use of TikTok and video streaming platforms was associated with higher odds of overweight (p < 0.05). “Happy” screen content correlated with increases in happiness, satisfaction, liking (p < 0.01), enjoyment, calm, and relaxation (p < 0.05), and a reduction in sadness (p < 0.05) among students. “Sad” screen content was associated with increases in sadness (p < 0.001), grief, dread, and worry (p < 0.05). Positive emotions, such as easygoing, were negatively correlated with savory food selection (r = −0.95, p < 0.05). Loneliness positively correlated with sweet food selections (r = 0.99, p < 0.05). Emotive screen content is associated with emotional shifts that potentially influence food selection. These findings highlight the need for targeted interventions to address emotional eating among college students. Full article

More frequent consumption of home-cooked meals is associated with better diet quality, and food literacy questionnaires may be able to identify factors that influence cooking frequency. Eating and Food Literacy Behaviors Questionnaire (EFLBQ) factor scores and demographic characteristics were examined as predictors of home cooking in a group of women aged 18 to 30 years. Participants were recruited by a third-party provider. EFLBQ factor scores (F1: health and nutrition, F2: taste, F3: food preparation, F4: planning and decision making, and F5: convenience), demographic characteristics, and frequency of cooking were measured. Groups were compared using ANOVA and Games–Howell post hoc tests. Pearson’s r or point-biserial tests were used to examine relationships between variables. Significant predictors were entered into a structural equation model (SEM) to predict home cooking frequency. A total of 107 Asian, 113 Black, 108 Hispanic, and 111 White women participated. The F1 factor score (health and nutrition) was a positive mediator between age and cooking frequency, and the F5 score (convenience) was independently and negatively correlated with how often the women cooked. Nutrition educators should address these EFLBQ factor topics in interventions and use these factor scores to measure changes in participants’ behaviors after they participate in educational programs that promote cooking. Full article

While standard dietary frameworks and public health guidelines predominantly evaluate honey based on its high free-sugar content to regulate caloric intake, its comprehensive role as a complex and dense biological signaling matrix is often less characterized. This review integrates raw chemical profiling with physiological bioaccessibility to evaluate the effect of the floral source on the functional quality of monofloral honeys. Through a structured literature-based comparative synthesis, the specific enzymatic behaviors, gastrointestinal metabolic fates, and chemical biomarkers of four representative monofloral honeys—Manuka, Chestnut, Acacia, and Argan—were systematically mapped and contrasted. Honey bioactives undergo extensive metabolic transformation during gastrointestinal transit, actively communicating with the mucosal environment rather than acting as a static nutrient solution The synthesized literature highlights distinct botanical-specific mechanisms: Manuka honey matrices exhibit well-characterized topical antimicrobial kinetics, while data on Chestnut honey suggest a potential role in cellular redox homeostasis via the Nrf2 pathway and a highly specific, though preclinical, signaling axis through kynurenic acid–GPR35 interactions. Furthermore, in vitro profiles of Acacia honey support its potential to modulate digestive carbohydrate enzymes, providing a plausible framework for its lower postprandial glycemic responses. Conversely, Argan honey bioactivity remains restricted to preliminary baseline antioxidant screenings. We also note that sophisticated sugar adulteration and climate change create critical “phytochemical drift,” endangering the therapeutic consistency of honey. In summary, the identification of honey as a “functional interactome” offers a strong scientific foundation for evidence-based dietetics. The targeted use of verified medical-grade monofloral honeys must be supported by advanced authenticity testing, metabolomics, and in vivo pharmacokinetics in future clinical dietetic interventions. Full article

Though it has been well established that a subset of collegiate student-athletes in the United States (U.S.) are not food secure, efficacious solutions for mitigating this issue appear to be elusive. This study identified system-level barriers and enablers to food security among student-athletes through the lens of collegiate athletic professionals (athletic directors, athletic trainers, sports dietitians, and strength and conditioning coaches). Using a phenomenological-informed design and constructivist theoretical framework, researchers explored the experiences and insights of participants (n = 27, Division I, northwestern U.S.) via six online focus groups July–December 2023. Categorical themes for barriers to food security were finances, culture, and competing priorities; enablers were on-campus supplemental food assistance, referrals to community services, and educational programming. A gap analysis was performed; existing solutions enabling food security and aspirational solutions for addressing food insecurity were compared, and gaps identified. Based on the insights of athletic professionals, a lack of student-athlete-centric solutions to ensure food security emerged. The introduction of shared revenue programs in American college sports may address some of food security barriers; however, additional funds may not mitigate the contribution of competing priorities and scheduling issues experienced by student-athletes. System-level changes are required to enable food security among this population. Full article

Protein intake recommendations for patients with chronic kidney disease (CKD) stages 3–5 without kidney replacement therapy (KRT) remain controversial. This study investigated current practice trends related to the 2020 Kidney Disease Outcomes Quality Initiative (KDOQI) protein guidelines and dietitians’ perspectives on low-protein diets (LPDs) and plant-based diets in CKD. This mixed-methods explanatory sequential study included a secondary analysis of an online survey (N = 87), followed by a conventional content analysis of two virtual focus groups (N = 11). Most survey respondents reported prescribing the KDOQI-recommended protein amounts of 0.55–0.6 g/kg/d in patients without diabetes (65.9%) and 0.6–0.8 g/kg/d in patients with diabetes (81.5%). Use of keto-acid analogs (KAs) was low among survey participants (18.4%). Focus group participants described varied approaches for calculating protein goals but overwhelmingly stressed the importance of individualized care. Key factors influencing recommendations included nutritional status, food preferences, comorbidities, current intake, and knowledge, beliefs, attitudes, and motivations. In summary, most participants recommended LPDs consistent with the KDOQI guidelines; however, KA use was uncommon. Despite differences in decision-making, participants emphasized individualizing protein recommendations to each patient’s unique needs. Given the exploratory nature of this work and the small, self-selected sample, these results provide preliminary insights that warrant further investigation in more diverse samples. Full article

Registered dietitian nutritionists (RDNs) have an opportunity to play a central role in improving nutritional outcomes among Mexican American young adult college students by helping them make culturally relevant adaptations to their eating patterns. Previous research has suggested limited representation of Mexican Americans among RDNs; therefore, the cultural competence of RDNs as perceived by Mexican Americans is uncertain. The purpose of this study was to evaluate how young adult college-age Mexican Americans (defined as 18–30 years old) perceive the cultural competence of RDNs. A sample of Mexican American (n = 93) and non-Mexican American (n = 120) young adult college students completed a 19-item online survey, with researchers using a subset of 4 survey items related to perceived cultural competence of RDNs in the present study. Descriptive statistics, Fisher’s exact tests with adjusted standardized residuals, and ordinal regression models were used. Fisher’s exact tests indicated that Mexican American young adult college students, compared to non-Mexican American young adult college students, reported less agreement that RDNs were knowledgeable about a traditional Mexican diet, that RDNs would take time to know students’ food preferences, and that RDNs would take personal preferences into account during nutrition counseling (p < 0.05). These associations, however, became insignificant in adjusted regression models. Rather, results indicated that other variables, such as age and lack of prior experience with an RDN, were associated with poorer perceptions. Full article

Rotating shift work has been associated with impaired quality of life and changes in health behaviors among nurses. Although maintaining a healthy diet and engaging in physical activity may be associated with better quality of life, evidence in shift-working nurses remains limited. This pilot cross-sectional study explored associations between adherence to the Mediterranean diet, physical activity, and quality of life among nurses in Northern Greece from October 2025 to February 2026. A total of 100 nurses working rotating shifts participated in the study. Quality of life, adherence to the Mediterranean diet, and physical activity were assessed using the WHOQOL-BREF, MedDietScore, and IPAQ questionnaires, respectively. The mean MedDietScore was 22.56 ± 4.83, and the mean physical activity was 711.16 ± 576.05 MET-min/week. Adherence to the Mediterranean diet was positively associated with the Physical Health, Psychological Health, and Environment domains. In the multivariable model, physical activity remained positively and independently associated with Physical Health (β = 0.31, p = 0.002), whereas both physical activity and adherence to the Mediterranean diet were positively associated with the Environment domain. These findings suggest that lifestyle behaviors are associated with specific dimensions of quality of life among shift-working nurses and emphasize the need for larger studies. Full article

Underweight in pregnant women adversely affects the next generation. Although young female underweight has become an important issue even in developed countries, the precise mechanisms that induce an underweight status in young women remains unknown. To examine the influence of feeding timing in young women on the following underweight conditions, we examined the effects of chronic light–dark cycle-reversed feeding restriction on post-restriction dietary behaviors using adult and young adult female rats. Eight- and 24-week-aged female Wistar rats were classified into three groups: (1) the control group (without time or calorie restriction), (2) the night-time-fed group that was fed only during the active phase, and (3) the daytime-fed group that was fed only during the non-active phase. After a 4-week feeding restriction, all groups were additionally fed ad libitum for 7 weeks with daily food intake and weight gain measurements. After sacrifice, mRNA expressions of neuropeptide Y (NPY), agouti-related protein (AgRP), orexin-A, pro-opiomelanocortin (POMC), and thyrotropin-releasing hormone (TRH) in the hypothalamus and leptin in the fatty tissues were examined by real-time PCR. Daytime-fed groups decreased food intake during restriction. After stress relief, adult rats showed a rebound increase in food intake beyond the level of the control group, whereas young adult rats showed no significant rebound response. At the end of the non-restricted period, both adult and young adult rats in the daytime-fed group reduced NPY expression in the hypothalamus. These findings indicate that recovery responses in food intake against chronic light–dark cycle-reversed stress are different between adult and young adult rats. The lower response in young adult rats may provide clues to elucidating a new mechanism for underweight status in young females. Full article

Disordered eating has been identified as a concern among individuals with type 1 diabetes mellitus (T1DM) and is associated with poorer glycaemic control, which may result in vascular complications and increased morbidity and mortality. Despite this, there is a paucity of research examining disordered eating behaviour (DEB) among individuals with T1DM in Ireland. This study aimed to examine the prevalence of DEB among adults with T1DM attending an Irish hospital outpatient clinic. This cross-sectional study recruited 95 adults with T1DM attending an outpatient diabetes clinic at Sligo University Hospital. Screening for DEB was conducted using self-reported measures, including the Diabetes Eating Problem Survey–Revised (DEPS-R) and the Eating Disorder Examination Questionnaire (EDE-Q 6.0). DEB was identified in 16.3% (n = 15) of the participants using the DEPS-R and in 3.2% (n = 3) using the EDE-Q 6.0. Higher levels of DEB were observed among the female participants; however, a notable prevalence was also identified among the male participants. DEB demonstrated a weak positive correlation with body mass index (BMI) and a negative correlation with age and height. No association was found between DEB and glycated haemoglobin (HbA1c). The substantial prevalence of DEB among adults with T1DM, with nearly one in six participants affected, highlights the presence of clinically relevant disordered eating symptoms in this population. The findings suggest potential differences in case identification between diabetes-specific and generic screening tools. These results support further evaluation of diabetes-specific screening instruments such as the DEPS-R in adult T1DM populations within larger studies before routine clinical implementation. Full article

Background/Objectives: Household food insecurity is a modifiable social determinant of health with important implications for diet quality and health outcomes. Dietitians are well positioned to identify and respond to food insecurity; however, little is known about how this is addressed in routine dietetic practice across Europe. This exploratory study examined food insecurity screening and response practices among dietitians practicing in Europe and examined associated correlates using the Capability, Opportunity, and Motivation Model of Behaviour (COM-B). Methods: An online cross-sectional survey informed by the COM-B framework was distributed through the European Federation of Associations of Dietitians’ institutional communication channels between February and June 2024. Participants were recruited using a voluntary, convenience-based sampling strategy through professional networks and social media dissemination. A total of 148 dietitians practicing in European countries responded. The questionnaire assessed routine food insecurity screening practices, COM-B correlates, perceived barriers, actions taken following identification, and learning needs. Quantitative data were analysed descriptively, and open-ended responses were used illustratively to contextualise reported practices. Results: Food insecurity screening was not systematically embedded in routine dietetic practice, with 11.6% of respondents reporting routine screening and 30.2% not asking about food insecurity. Identification of food insecurity did not consistently translate into follow-up action, and responses were predominantly referral-based rather than involving direct material support. While capability and motivation to address food insecurity were generally high, opportunity-related factors—such as time constraints, limited organisational support, and unclear referral pathways—emerged as the main barriers shaping professional behaviour. Substantial heterogeneity was observed across practice settings. Conclusions: In this sample of dietitians practicing in Europe, food insecurity screening and response were variable and often constrained by organisational and contextual factors. These findings highlight the need for system-level support and practice-oriented training to facilitate the integration of food insecurity into routine dietetic care. Full article

Dietary emulsifiers, common in processed and ultra-processed foods, improve food texture and shelf life but may affect gut health by interacting with the microbiota and intestinal barrier. While emulsifiers have long been considered safe, growing evidence links their presence in ultra-processed foods to chronic disease risk. This review aims to evaluate the current understanding of the factors and mechanisms underlying individual differences in intestinal mucosal susceptibility to dietary emulsifiers. A search of PubMed and Embase through February 2026 identified eight relevant studies. Overall, the available evidence indicates a heterogeneous and highly individualized host response to dietary emulsifiers. These differences appear to be strongly influenced by the gut microbiota and its functional properties, while animal studies further suggest that host factors such as sex-related differences in microbial composition may also contribute to variability in response. Importantly, not all emulsifiers have the same effects, underscoring compound-specific impacts on gut physiology. The findings demonstrate that sensitivity to dietary emulsifiers varies substantially between individuals, challenging the long-standing assumption that these additives are universally safe. Given the multifactorial nature of this susceptibility, particularly the role of the gut microbiota, future research should adopt an integrative approach that combines microbial profiling with host genetics, immune responses, and early-life exposures. Such efforts will be essential to identify at-risk individuals and to inform more personalized dietary recommendations aimed at preserving intestinal health and reducing disease risk. Importantly, there is a clear need for larger, well-powered studies that can validate and expand upon these initial observations. Full article

Obesity prevalence has increased globally, and metabolic bariatric surgery (MBS) is the most effective treatment for severe obesity. However, the impact of postoperative dietary counselling (DC) on clinical outcomes including weight is unclear. This review aims to assess the nature and impact of postoperative DC delivered by dietitians on clinical outcomes in adults undergoing post-MBS, focusing on weight change as the primary outcome, and body composition, nutritional status, biochemical parameters, and complications as secondary outcomes. Five databases (Medline, Embase, Web of Science, CINAHL, and Cochrane Library) were searched for observational studies and randomised controlled trials (RCTs) assessing DC related to weight change. Thirteen studies met the inclusion criteria (five RCTs and eight observational studies), involving 4173 individuals. Eight studies reported no significant difference in weight outcomes between the groups receiving DC and comparison groups. However, secondary outcomes such as nutritional status, complications, and levels of transferrin saturation, vitamin B12, and vitamin D showed improvements with more frequent DC. The components of DC delivered by dietitians varied, including advice on micronutrient supplements, protein intake, physical activity, transition diets, healthy eating, and mindful eating. Evidence supporting the efficacy of postoperative DC in promoting weight loss is limited by short-term assessment and inconsistencies in reporting weight outcomes, highlighting the need for long-term RCTs to ascertain its effectiveness. Full article

College students often maintain poor dietary habits, notably low fruit and vegetable intake. Common barriers include limited time, cost, and lack of nutritional knowledge. This study examined dietary behaviors, barriers, and factors influencing Healthy Eating Scores (HES) among college students. Participants (N = 224; age = 20.3 ± 2.5 years, BMI = 23.9 ± 4.1 kg/m², 78.9% female, and 91.3% white) completed an online survey. Results indicate meat overconsumption with underconsumption of water, fruits, and vegetables. Limited time and healthy options were the primary perceived barriers. Tests of between-subject effects identified gender (F = 4.38, p = 0.04) and living situation (F = 4.42, p < 0.01) as independent HES predictors. Backward stepwise linear regression (adj. R² = 0.22, p < 0.001) further indicated that being male, an athlete, living off-campus, and cooking at home were significantly associated with higher HES. Conversely, non-athlete females living on campus emerged as the most vulnerable group for low HES. These findings suggest that future interventions should target specific demographic vulnerabilities to improve dietary outcomes and mitigate barriers in the college population. Full article

Over the past decade, Portugal has increasingly focused on public policies that promote healthy eating, driven by growing concerns about the population’s health and its social, economic, and political effects. These policies aim to reduce unhealthy eating habits, which are major risk factors for disease, and to reduce the overall disease burden. Tax measures are specifically intended to curb the consumption of foods high in sugar, salt, and saturated fats to prevent chronic non-communicable diseases such as obesity, type 2 diabetes, and cardiovascular disease. This article analyzes the measures adopted in Portugal to reduce sugar consumption and examines their effects on tax revenue and consumption volume. Using document analysis, the results indicate a decrease of 3853 tons in sugar consumption and tax revenue of 432 million euros from taxing sugary drinks and sweeteners since 2017. Although significant progress has been made, including product reformulation to reduce sugar content, challenges remain. It is essential to continue and expand these policies to other products, along with ongoing impact assessments, to foster a healthier future in line with the World Health Organization’s guidelines for 2030. Full article

Clinical trials suggest that daily vinegar ingestion improves fasting blood glucose concentrations, postprandial glucose excursions, and hemoglobin A1c levels in patients with prediabetes and type 2 diabetes. With the recent commercialization of continuous glucose monitoring (CGM) technologies, diabetes patients as well as other health-conscious individuals can evaluate the impact of food choices in real-time and make data-driven decisions to improve dietary behaviors. This 9-day, randomized crossover study documented CGM-derived glycemic patterns during vinegar ingestion in adults with prediabetes. Participants consumed two tablespoons of vinegar twice daily with meals for four days or a control tablet each morning for four days in random order. For each phase, fasting blood glucose on day four, average blood glucose across three days, and peak glucose excursion across three days were calculated. Fasting glucose concentrations of participants (n = 10 women; 36.6 ± 15.6 y; 33.9 ± 6.5 kg/m²) averaged 105.8 ± 20.6 mg/dL at baseline. Vinegar ingestion was associated with significant reductions in the mean glucose concentration (−4.4 mg/dL) and the frequency of blood glucose excursions > 140 mg/dL (−10%) in comparison to the control treatment, but fasting glucose concentrations were unaffected. These data suggest that vinegar-induced improvements in blood glucose can be observed in real-time using a CGM device in adults with prediabetes. Full article