Search Results (667)

Background/Objectives: Social determinants of health are implicated in metabolic dysfunction–associated steatotic liver disease (MASLD), yet longitudinal evidence on incident disease is scarce, and whether individual- and community-level determinants act independently remains unclear. The objective of this study was to examine whether individual food insecurity and neighborhood deprivation are independently associated with incident MASLD. Methods: In this retrospective cohort of 40,693 U.S. adults without baseline MASLD in the diverse NIH All of Us Research Program, food insecurity (two-item Hunger Vital Sign) and neighborhood deprivation (validated five-domain composite) were co-primary exposures, with incident MASLD ascertained from validated diagnostic codes. Proportional hazards models were adjusted for demographic, socioeconomic, and metabolic factors, including obesity. Results: Over 116,220 person-years, 1240 (3.0%) participants developed MASLD. Both associations remained significant after adjustment for demographic, socioeconomic, and major metabolic risk factors, including obesity (food insecurity adjusted hazard ratio [aHR] 1.32, 95% CI 1.13–1.53; neighborhood deprivation aHR 1.20, 95% CI 1.05–1.37). Unadjusted cumulative incidence was highest among participants with both exposures and lowest among those with neither. Findings were consistent across sensitivity analyses; the food-insecurity association remained when neighborhood disadvantage was specified with a census-based index. Conclusions: Food insecurity and neighborhood deprivation were independently associated with higher incidence of MASLD. Nutrition-focused, equity-oriented interventions warrant evaluation to reduce MASLD burden and advance health equity. Full article

Background/Objectives: Online food purchasing may be associated with health-related, environmental, economic, and technological factors. However, limited evidence exists on whether these factors are associated with online food purchase frequency in similar ways across generational groups. This study examined whether self-reported healthy eating, environmental concern, and economic decision indicators were associated with online food purchase frequency among Polish consumers who had previously purchased food online and whether these associations differed across birth-cohort groups. Methods: Data were collected in Poland in 2025 in a cross-sectional study using Computer-Assisted Web Interviewing. The analytical sample comprised 669 respondents who declared having purchased food online. Online food purchasing was measured both as a binary distinction between frequent and occasional purchasing and as an eight-category ordinal frequency variable. Pearson’s chi-square tests, Mann–Whitney U tests, binary logistic regression, and ordinal logistic regression were applied. Moderation was assessed through predictor-by-generation interaction terms. The Benjamini–Hochberg procedure was used to control the false discovery rate, and seven economic decision-making indicators were additionally examined in mutually adjusted multivariable models. Ordinal models were interpreted as sensitivity analyses because the proportional-odds assumption was not fully satisfied. Results: Healthy eating was not directly associated with online food purchasing frequency and did not interact significantly with generation. Environmental concern showed a significant interaction with generation in both binary and ordinal models. It was associated with more frequent online food purchasing among Baby Boomers but with less frequent purchasing among Generation Z. In separate models, price comparison and careful product choice were associated with more frequent online purchasing. Saving orientation also showed an exploratory interaction with opposite directions across generational groups: it was associated with more frequent purchasing in Generation X and less frequent purchasing in Generation Z. However, these economic decision indicators did not remain robust after correction for multiple testing and simultaneous adjustment. Conclusions: Online food purchasing frequency was not uniformly associated with health, environmental, or economic tendencies across generations. In this cross-sectional sample, generation moderated the association between environmental concern and online food purchase frequency, although this pattern should not be interpreted as evidence of a distinct causal cohort effect. The findings suggest that similar declared tendencies may be associated with different patterns of online food purchase frequency across generational groups. Full article

Background/Objectives: Ultra-processed food (UPF) consumption is increasingly recognized as part of broader adverse behavioral and health-related patterns in young people, yet evidence integrating dietary, sleep-related, behavioral, and health characteristics within the same adolescent population remains limited. The relationship between UPF-related dietary patterns and tinnitus is particularly understudied. This study examined factors associated with the highest category of a frequency-based proxy UPF score among adolescents in Belgrade, Serbia. Methods: A school-based cross-sectional study included 1285 students aged 15–19 years from 12 four-year secondary schools selected using a stratified multistage cluster probability sampling design. A frequency-based proxy UPF score was constructed from seven questionnaire-based food categories broadly consistent with UPF-related consumption patterns in the Serbian context. Participants were grouped into three categories using empirical tertile cut-points, and the highest category was modeled as the binary outcome in univariable and multivariable logistic regression analyses. Results: Lower academic achievement (aOR = 2.10; 95% CI: 1.38–3.21), alcohol consumption (aOR = 1.34; 95% CI: 1.04–1.74), and waking tired compared with waking rested (aOR = 1.58; 95% CI: 1.06–2.35) were associated with higher odds of being in the highest proxy-score category after adjustment for the measured covariates. Energy drink consumption frequency was also associated with the outcome after adjustment for the measured covariates (overall p < 0.001). Constant tinnitus showed one of the strongest adjusted associations (aOR = 2.55; 95% CI: 1.77–3.67). Conclusions: Adolescents in the highest category of the frequency-based proxy UPF score exhibited a broader pattern of academic, sleep-related, behavioral, and health characteristics, including a particularly strong association with constant tinnitus. These cross-sectional findings warrant longitudinal research to clarify temporal relationships and underlying determinants. Full article

Background: Cultured meat (CM) has emerged as a promising, albeit controversial, alternative to conventional livestock production, offering potential benefits in terms of sustainability, animal welfare, and resource efficiency. Despite these potential advantages, consumer acceptance remains uncertain, particularly in countries where CM is not yet commercially available. Objectives: this study investigates the determinants of willingness to try (WTT) cultured meat among Italian university students (n = 335), with particular attention to the role of product-related perceptions and personal values and motivations. Methods: data were collected through an online survey and analyzed using binary logistic regression to identify the main drivers of respondents’ willingness to try CM. Results: the findings suggest that acceptance of CM among university students is driven primarily by familiarity, perceived safety, and ethical considerations, particularly those related to animal welfare, rather than by demographic characteristics or resistance to novel food technologies. Conclusions: these findings offer practical implications for policymakers and industry stakeholders, highlighting the importance of transparent communication strategies emphasizing product safety and animal welfare benefits as a means of increasing familiarity with and acceptance of CM among younger consumers. Full article

Background/Objectives: Food system assessments in Sub-Saharan Africa have predominantly focused on caloric availability, often overlooking the structural and nutritional quality of the food supply. This study examines what drives and constrains food system transformation in Sub-Saharan Africa under different development pathways, using long-term changes in caloric availability, adjusted protein density, the balance between animal and plant proteins, and the diversification of animal protein sources as the empirical basis for this assessment. Methods: The analysis is based on data from the Food and Agriculture Organization of the United Nations for the period 1961–2023, covering Nigeria, the Republic of the Congo, the Democratic Republic of the Congo, Kenya, South Africa and Ethiopia. A longitudinal approach was applied where data were available, complemented by a recent comparative analysis (2010–2023). Derived indicators include total protein supply, adjusted protein density, the share of animal and plant proteins and the Herfindahl–Hirschman index (HHI) to assess the diversification of animal protein sources. Results: Findings show that increases in caloric availability are not consistently associated with improvements in adjusted protein density or nutritional quality. Significant differences are observed across countries in protein supply levels, structural composition, and diversification patterns. Results reveal heterogeneous trajectories of food systems, from diversified to structurally constrained or highly concentrated systems. Conclusions: Beyond caloric availability, the structure and quality of the food supply are essential for assessing food system performance. Quantitative gains alone do not ensure improved nutritional or sustainable outcomes. The study highlights the importance of considering protein supply structure, diversification and nutritional efficiency in the context of SDG 2 (Zero Hunger) and broader food system transformation. Full article

Background: With accelerated population aging, depressive symptoms in later life have become a major public health issue. The Chinese version of the MIND (cMIND) diet is a neuroprotective dietary pattern adapted to Chinese dietary habits. Previous studies have found that adherence to the cMIND diet is associated with lower levels of depressive symptoms, but the underlying statistical association patterns remain unclear. This study adopted a statistical moderated mediation framework to characterize cross-sectional associations, to examine the direct association between cMIND diet adherence and depressive symptoms, the statistical associational mediating pattern of social participation, and the exploratory moderating effect of exercise on the first segment of the statistical mediation chain. Methods: Data were drawn from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), including 8578 adults aged 65 years and older. Cross-sectional mediation and moderated mediation analyses were conducted using Model 4 and Model 7 of the PROCESS macro, with 5000 bootstrap resamples to test the significance of cross-sectional statistical indirect effects. Results: cMIND diet adherence was negatively associated with depressive symptoms (B = −0.414, p < 0.01). Social participation showed a statistical partial mediation pattern in this association, with the statistical indirect effect accounting for 14.02% of the total effect. Exploratory moderated mediation analysis showed that exercise moderated the first segment of the statistical mediation chain (B = 0.283, p < 0.01). The positive association between cMIND diet adherence and social participation was stronger among exercisers (simple slope = 0.635, p < 0.01) than among non-exercisers (simple slope = 0.352, p < 0.01). Correspondingly, the indirect association between cMIND diet adherence and depressive symptoms through social participation was stronger in the exercise group (indirect effect = −0.064, 95% CI [−0.079, −0.050]) than in the non-exercise group (indirect effect = −0.036, 95% CI [−0.045, −0.026]). Conclusions: Among Chinese older adults, higher adherence to the cMIND diet is significantly associated with lower levels of depressive symptoms, and this association shows a partial statistical mediation pattern linked to higher social participation. The positive association between cMIND diet adherence and social participation is more pronounced among adults who engage in regular exercise, which corresponds to a more pronounced statistical indirect association with depressive symptoms through social participation. As these findings are based on cross-sectional data and reflect only associational patterns, and given the limited effect magnitude, they provide only preliminary theoretical reference for the development of intervention strategies integrating dietary improvement and social participation promotion for late-life depressive symptoms. Full article

Background/Objectives: The aim of this study was to examine the discrepancy between nutrition-related knowledge (NRK) and nutrition-related practice (NRP) among 1440 Polish school-aged students (10–18 years), according to BMI status, and to identify factors associated with this discrepancy. Methods: This cross-sectional study was conducted via the CAWI method using an author-developed, non-validated questionnaire. Questions assessing NRK and NRP were thematically aligned and referred to the recommendations of the Polish Healthy Eating and Lifestyle Pyramid for Children and Adolescents (aged 4–18 years). Results: Students with excess weight scored significantly lower in nutritional knowledge (NRK: 46%) and practices (NRP: 30%) than those with underweight or normal weight (NRK: 52–53%, NRP: 33–34%). Higher NRK was associated with older age, female sex, larger urban residence (for students with overweight and obesity), and higher maternal/legal guardian education level (for students with normal/underweight body weight). Better NRP was associated with higher NRK and higher physical activity, while rural or small-town living was positively associated with healthier dietary practices and maintenance of normal BMI. Conclusions: The present study confirms that nutritional knowledge is a necessary but insufficient condition for shaping appropriate dietary behaviors among adolescents with different BMI statuses; lifestyle factors, practical food-related skills—including self-assessment of knowledge and adherence to dietary recommendations—and the broader environmental context plays a crucial role. These findings highlight the need for targeted nutrition education programs that expand not only knowledge but also practical skills among students. Full article

Background/Objectives: Healthy eating and regular physical activity support chronic disease prevention and healthy aging, while smoking, sugar-sweetened soft drink consumption, and excess weight remain important public health concerns in Europe. Nutritional status and lifestyle behaviors are also relevant to the progression and management of obesity-related metabolic and degenerative diseases, which justify a broader, systems-oriented analysis of lifestyle–health profiles. This study examines the associations between lifestyle behaviors, excess weight, and population health outcomes across European Union Member States and explores whether Member States exhibit distinct lifestyle–health profiles. Methods: The analysis uses cross-sectional data from the European Health Interview Survey for the 27 European Union Member States, along with related Eurostat indicators. Healthy dietary behavior is measured through daily fruit and vegetable consumption. The study also includes health-enhancing physical activity, daily smoking, sugar-sweetened soft drink consumption, overweight and obesity prevalence, life expectancy, and healthy life years. Pearson and Spearman correlations, reduced linear regression models, hierarchical clustering, K-means clustering, and cluster-based comparisons are used. Results: Healthy dietary behavior was positively associated with life expectancy (r = 0.459, p = 0.016), as was health-enhancing physical activity (r = 0.435, p = 0.023), while overweight prevalence was negatively associated with life expectancy (r = −0.505, p = 0.007). The reduced regression model, including healthy dietary behavior, physical activity, and overweight prevalence, explained 47.4% of the variance in life expectancy. Cluster analysis identified three distinct lifestyle–health profiles: a healthy-diet, low-excess-weight and high-longevity profile; a lower-diet-quality, higher-smoking and lower-health-outcome profile; and a mixed profile characterized by low smoking, higher excess weight, and relatively favorable health outcomes. Conclusions: The study supports a systems-oriented view of lifestyle and population health in Europe. Its findings may inform more targeted nutrition, obesity prevention, and public health policies across EU countries. Full article

Background: Food insecurity remains a major public health challenge in many low- and middle-income countries, where environmental and socioeconomic conditions influence household access to adequate, safe, and nutritious food. Objectives: This study aimed to evaluate the associations between environmental and socioeconomic factors and household food security in Riobamba, Ecuador. Methods: A cross-sectional survey was conducted among 382 households using the Latin American and Caribbean Food Security Scale (ELCSA), complemented by structured and Likert-scale questions addressing agricultural production practices, food handling, waste management, and food choice and dietary diversity. Household food security status was classified according to the standard ELCSA scoring procedure and subsequently grouped into categories representing adequate or inadequate household food access and consumption. Binary Logit and Probit models were estimated to identify factors associated with household food security. Results: The Probit model showed slightly better predictive performance (classification accuracy = 73.56%; Pseudo R² = 0.2729; LR χ² = 143.94; p < 0.01). Household income was the strongest predictor of food security status (Logit coefficient = 1.1977; p < 0.01). Among the environmental variables, agricultural production practices (β = 0.8649; p < 0.01), food handling practices (β = 0.3714; p < 0.05), and food choice and dietary diversity (β = 0.6479; p < 0.01) were positively associated with adequate household food access and consumption, whereas waste management practices were not significantly associated. Household size and gender were also significantly associated with food security outcomes. Conclusions: These findings indicate that household food security in urban Ecuadorian settings is associated with both environmental and socioeconomic conditions. Policies promoting sustainable agricultural practices, safe food handling, dietary diversity, and socioeconomic well-being may contribute to strengthening household food security and nutrition. Full article

Background/Objectives: Although food literacy is extensively studied in schools, the concept is less explored in the context of summer camps, which are also interesting learning environments. This qualitative study aimed to explore the clarity, usefulness and relevance of an adapted food literacy model for summer camps with camp counselors, camp managers and registered dietitians (RDs). Methods: Six semi-structured focus groups with counselors (n = 28) were conducted at summer camps located in the provinces of Quebec and Ontario, Canada. Semi-structured individual interviews were carried out online with camp managers (n = 5) and RDs (n = 6). Through an inductive approach, a thematic content analysis of transcribed verbatim was performed. Using a bottom-up approach, second and third final versions of the adapted food literacy model were developed. Results: Counselors and managers showed their intention to use an easy-to-use food literacy model. To improve their understanding, they proposed clarifying who will use the model and adding pictures. They expressed the need to be supported by incorporating concrete activity ideas and training to enhance the model’s usefulness. RDs highlighted that the model covered essential themes of food literacy. They expressed the need to clarify certain model components to make them easier to understand and more applicable to youth. Conclusions: This study contributed to the co-creation with participants of a clear, useful and relevant food literacy model tailored to the context of summer camps. Such a model will help camp counselors to implement relevant healthy eating actions and multiply opportunities to promote healthy habits among youth. Full article

Background/Objectives: Nutrition during childhood and adolescence is a key determinant of long-term health, influencing metabolic homeostasis, neurocognitive development, and immune system maturation. Globalization and technological advances have reshaped food production and consumption, increasing the availability of ultra-processed foods (UPF) of low nutritional quality. This study aimed to investigate the relationship between parental factors, namely food literacy, perceived barriers and enablers, dietary attitudes, and healthy eating behaviors, and the consumption of discretionary UPF among children and adolescents living in 5 Mediterranean countries. Methods: This cross-sectional study was based on a survey completed by 2011 parents of children and adolescents aged 6–17 years from 5 Mediterranean countries, who reported on their children’s dietary and lifestyle habits. Adherence to the Mediterranean diet was assessed through the KIDMED index. Parental food literacy was measured using the Short Food Literacy Questionnaire (SFLQ). Perceived barriers and enablers were assessed based on the Theory of Planned Behavior, and parents’ attitudes toward their child’s diet were evaluated using the Healthy-Eating Attitudes Questionnaire (HEAQ). Finally, the Theory of Internet Use Related to Health (TIUH) questionnaire was used to assess parents’ tendencies related to health information use online. Results: Higher perceived barriers and enablers were significantly associated with lower discretionary UPF consumption across all models. Parental food literacy (SFLQ) showed a positive association with discretionary UPF consumption, remaining significant in the fully adjusted model, although with reduced magnitude. Healthy-eating attitudes (HEAQ) were initially positively associated with discretionary UPF intake but lost statistical significance after full adjustment. Regarding health-related internet use (TIUH), the Health Information dimension showed a strong positive association with discretionary UPF consumption, while other dimensions (Consciousness and Beliefs) showed inconsistent and non-significant associations in the fully adjusted model. Conclusions: Children’s consumption of discretionary UPF is shaped by several interrelated factors, such as family environment, eating patterns, and parents’ perceptions, rather than solely by knowledge or attitudes. Full article

Ultra-processed foods (UPFs) have recently been associated with an increased risk of chronic diseases. However, this association remains controversial. The present commentary aims to clarify some of these controversies by summarizing the hypotheses linking UPFs to chronic diseases and critically examining the evidence regarding specific components of UPFs—such as saturated fat, added sugars, salt, and food additives—and their relationships with disease risk. Finally, the commentary discusses the implications of these findings for the development of dietary guidelines and public health policies at both global and national levels. Full article

Background/Objectives: Due to the rise in chronic disease in the United States, several policies, guidelines, and programs have focused on promoting healthy eating. This includes those aimed at service members, who may struggle to find nutritious food options on military bases. The Military Nutrition Environment Assessment Tool (mNEAT) assesses the access, availability, and promotion of nutritious foods and beverages on military bases. Military services vary in their policies related to the food environment, including the use of mNEAT, on their installations. The aim of this article is to examine the difference in mNEAT scores for those military services with a comprehensive mNEAT policy compared to those with a partial policy. Methods: Installations with mNEAT scores from October 2021 to September 2024 were separated into two groups: full-policy group (Air Force, Space Force, n_f = 76) and partial-policy group (Army, Navy, Marine Corps, n_p = 69). Food venue types assessed include: commissary (n_f = 67, n_p = 44); fast-food (n_f = 63, n_p = 48); vending (n_f = 42, n_p = 18); express stores (n_f = 65, n_p = 50); food truck (n_f = 42, n_p = 24); dining facility/galley (n_f = 51, n_p = 40); Morale, Welfare, and Recreation (MWR) food service venues (n_f = 56, n_p = 38). Installation-level venue types assessed include community (n_f = 56, n_p = 24) and worksite (n_f = 49, n_p = 20). Installations were separated into venue-type variety groups according to how many different venue types they assessed: low (1–4 venue types, n = 47), moderate (5–7 venue types, n = 48), and high (8–9 venue types, n = 50). Results: The full-policy group had higher total installation mNEAT scores on average than the partial-policy group (54.6% vs 50.4%, p = 0.034), but results were no longer significant when venue type assessment variety was added as a covariate (p = 0.074). In addition, the full-policy group had higher scores (p ≤ 0.05) for the following venue types: dining facility/galley, MWR, fast-food, express, and community. In the moderate (p = 0.012) and high (p = 0.022) venue-type variety groups, the full-policy group had significantly higher mNEAT scores, but not for the low venue-type variety group (p = 0.547). Conclusions: Higher mNEAT scores for full-policy installations may indicate a more supportive food environment than those in the partial-policy group, when ≥5 food venue types were assessed. Military services without a comprehensive mNEAT policy can consider modifying or implementing one to support easier access and availability of nutritious options. This public health strategy can support service members’ health and performance and can be applied to similar settings, such as universities and worksites. Full article

Background/Objectives: The increasing burden of non-communicable diseases, together with accelerating environmental degradation, highlights the urgent need for sustainable dietary patterns that promote both human and planetary health. The Mediterranean diet (MedDiet), traditionally followed in countries bordering the Mediterranean basin, has gained recognition as a model of sustainable nutrition due to its well-documented health benefits and relatively low environmental impact. However, its broader role within sustainable food systems requires comprehensive and interdisciplinary evaluation. The aim of this review is to provide a state-of-the-art synthesis of the evidence on the MedDiet as a sustainable dietary pattern, integrating its health, environmental, economic, and socio-cultural dimensions. Methods: This state-of-the-art narrative review synthesizes evidence from peer-reviewed literature on the MedDiet and sustainability. Relevant studies were identified through major scientific databases, focusing on publications addressing nutritional, environmental, economic, and socio-cultural dimensions. Both observational and interventional studies, as well as modeling and life cycle assessment analyses, were included. Additional sources from international organizations and policy reports were incorporated to contextualize global trends and challenges. Results: High adherence to the MedDiet is consistently associated with a reduced risk of cardiovascular disease, type 2 diabetes, cancer, and all-cause mortality. From an environmental perspective, the MedDiet is associated with lower greenhouse gas emissions, reduced land and water use, and enhanced biodiversity conservation compared with Western dietary patterns. Economically, it may represent a cost-effective dietary model and support local food systems when grounded in traditional practices, although affordability varies across contexts. Socio-culturally, the MedDiet promotes food heritage, culinary skills, and social cohesion. Nevertheless, globalization, urbanization, and the increasing consumption of ultra-processed foods have contributed to declining adherence, posing significant challenges to its sustainability and scalability. Moreover, the sustainability benefits of the MedDiet seem to be context-dependent rather than intrinsic, raising several challenges and limitations for its adoption. Conclusions: The MedDiet should be viewed not as a definitive solution to global food-system challenges but as a valuable reference model that illustrates how dietary practices can contribute simultaneously to human health, environmental sustainability, and cultural continuity. Modern sustainable dietary strategies should build upon the strengths of the MedDiet while recognizing its limitations, embracing contextual adaptation, and addressing the structural determinants that shape food choices. Full article