Search Results (899)

Objective: This study aimed to assess quality of life (QoL) and its determinants among Saudi adults diagnosed with type 2 diabetes mellitus (T2DM). Methods: A cross-sectional study was conducted among 200 (45% male and 55% female) Saudi adults with T2DM aged 30–65 years. Data were collected using the Audit of Diabetes–Dependent Quality of Life (ADDQoL) and the Personal Diabetes Questionnaire (PDQ). Anthropometric and clinical measures included weight, height, body mass index (BMI), blood pressure, and glycated hemoglobin (HbA1c). Results: Most participants (73.5%) were ≤50 years of age, and the majority were obese (56.0%) or overweight (28.0%). Nearly half (54.5%) had HbA1c levels ≥ 8.0%, while (50.5%) were hypertensive. Overall, 96% of participants reported a poor to extremely poor QoL. Female sex (p = 0.003), higher BMI (p = 0.034), diet type (p = 0.039), and satisfaction with glucose control (p < 0.001) were significantly associated with the QoL. Conclusions: T2DM substantially impairs the QoL of affected Saudi adults. Psychosocial and lifestyle-related factors, particularly obesity, gender, dietary practices, and perceived glucose control, are more influential than traditional clinical markers. Culturally tailored interventions targeting these determinants may improve patient outcomes. Full article

Background/Objectives: This study examines cross-sectional associations between dietary patterns, weight loss, and handgrip strength (HGS) among adults with a history of bariatric surgery. Methods: We analyzed data of 1888 adults (62.3% women; mean age 38.8 years) who attended the Qatar Biobank study. Dietary patterns were identified using factor analysis of data from a food frequency questionnaire. HGS was measured using dynamometry, and relative HGS (RHGS) was calculated as HGS/BMI. Results: The mean weight loss after bariatric surgery was 27.6 kg (23.4%), and the mean HGS was 30.1 (SD 11.2) kg. The mean duration after bariatric surgery was 3.6 years. Greater weight loss was associated with lower HGS (Q4 vs. Q1: −1.29 (95%CI −2.26 to −0.33)) but higher RHGS (Q4 vs. Q1: 0.10 (0.06 to 0.13)). Higher adherence to a “prudent diet” with high intake of fruits and vegetables was associated with stronger HGS (Q4 vs Q1: 1.07 (0.18 to 1.96)). In contrast, a “traditional diet” (high intake of mixed dishes, e.g., biryani, croissants, zaatar fatayer, lasagna, white rice, and Arabic bread) was inversely associated with HGS (Q4 vs. Q1: −1.27 (−2.19 to −0.35)). Conclusions: In conclusion, greater weight loss was associated with improved relative muscle strength, while adherence to a traditional diet was linked to weaker HGS. These findings highlight the importance of diet quality in maintaining muscle function after bariatric surgery. Full article

Background/Objectives: Preterm birth (PTB) is a major public health concern worldwide, which may lead to detrimental maternal and neonatal outcomes. Maternal nutritional status, gestational weight gain (GWG), and lifestyle factors are potentially modifiable determinants of adverse pregnancy outcomes. This study examined the association between PTB and maternal GWG and assessed whether maternal dietary habits and lifestyle factors were related to GWG in women delivering preterm versus at term. Methods: A retrospective case–control study was conducted at a tertiary center in Hungary (MANOR Study, 2019). The case group included n = 100 women with PTB, while n = 200 matched term deliveries served as controls (1:2 ratio). Data were collected using a self-administered questionnaire and medical records. Pre-pregnancy body mass index (BMI) was categorized using standard definitions, while GWG was classified as inadequate, recommended, or excessive according to the US 2009 Institute of Medicine guidelines. A 7-item dietary index score was calculated based on gestational dietary habits. Results: Pre-pregnancy BMI distribution did not considerably differ between groups (p > 0.05); over one-third of women in both groups were overweight or had obesity (38.7% vs. 36.7%). Previous PTB (p < 0.001) and gestational hypertension (GHT) (p = 0.003) were more common among current PTB cases, while smoking, alcohol consumption, and gestational diabetes mellitus (GDM) showed negligible differences (p > 0.05)—28.0% of cases, and 34.5% of controls were classified as having healthy dietary habits, based on the dietary index score calculated. Inadequate GWG was more prevalent among PTB cases (49.0% vs. 26.8%), whereas excessive GWG was less frequent among cases (21.9% vs. 38.4%). Being within the recommended GWG range and the manifestation of gestational hypertension were associated with lower (aOR: 0.39; 95% CI: 0.18–0.87; p = 0.020) and higher (aOR: 3.43; 95% CI: 1.44–8.19; p = 0.005) odds of PTB, respectively. Conclusions: Inadequate GWG was more common in PTB, while excessive GWG was more frequent in term pregnancies. Fast-food consumption was associated with excessive GWG among term births. Optimizing GWG and improving maternal diet quality should be included as key, cross-cutting interventions targeting the improvement of antenatal care. Full article

Diet quality, nutrition knowledge, and psychosomatic literacy—defined as the understanding of the interactions between diet, gut microbiota, and mental well-being—may shape weight-related behaviours in youth. This study used a cross-sectional design to integrate these domains with digital information pathways in Central–Eastern Europe. This study assessed diet quality, nutrition, and psychosomatic knowledge, supplement use, and health-information sources among Polish adolescents and young adults, with emphasis on age-related differences and the role of social media. A cross-sectional, anonymous online survey (October 2025–January 2026) was conducted in Poland (final analytical sample: n = 478; adolescents 15–19 years vs. young adults 20–30 years). Of 591 individuals who accessed the survey, 478 were included in the final analytical sample. Diet quality was estimated from FFQ data using KomPAN-derived indices (pHDI-10, nHDI-14, DQI). Nutrition knowledge (0–25 points), psychosomatic/gut–brain indicators, supplementation, and information sources were analysed using χ²/Fisher tests and Mann–Whitney U tests with effect sizes. The primary outcomes measured were dietary supplement use and excess body weight (BMI ≥ 25 kg/m²). Multivariable logistic regression examined predictors of supplement use and BMI ≥ 25 kg/m². Overall diet quality was low to moderate, with limited intake of whole grains, legumes, and fish, and common nutrition misconceptions. Social media was the most frequently indicated source of diet/supplement information and was independently associated with more frequent supplement use (OR = 2.29; 95% CI: 1.43–3.64). Adolescents reported lower whole-grain intake and more misconceptions than young adults. Predictors of BMI ≥ 25 kg/m² included male sex (OR = 2.46; 95% CI: 1.46–4.15), lower education, and lower nutrition knowledge, while age showed a non-linear positive association with excess body weight. Polish adolescents and young adults show gaps between declared pro-health attitudes and actual diet quality/competencies. Social media reliance appears particularly linked to product-oriented behaviours (supplementation). Prevention should strengthen nutrition and food safety education, digital health literacy, and professional guidance on supplementation, especially in adolescents. Our findings suggest that social media is a primary driver for dietary supplementation among Polish youth, more so than objective nutrition knowledge. While diet quality is linked to weight status, the relationship is complex. These results may inform future public health interventions targeting digital health literacy to promote balanced nutrition and safe supplementation practices. Full article

Background/Objectives: Elevated central adiposity (ECA) in childhood is associated with early cardiometabolic risk and hemodynamic alterations. However, evidence in Spanish schoolchildren regarding the relationship between eating behavior traits and central adiposity is limited, particularly across developmental stages. This study aimed to examine the association between Children’s Eating Behaviour Questionnaire (CEBQ) subscales and ECA, and to explore potential differences by age group. Methods: A cross-sectional study was conducted in 496 rural schoolchildren aged 6–15 years. ECA was defined using the waist-to-height ratio (WHtR) and sex-specific cut-offs validated for the Spanish pediatric population. Eating behavior was assessed with the CEBQ (Z-scores), and diet quality was measured using the KIDMED index. Multivariable logistic regression models were adjusted for sex, KIDMED score, and maternal education. Analyses were subsequently stratified by age (6–9 and 10–15 years). Results: The prevalence of ECA was 45.90%. In fully adjusted models, higher Food Responsiveness (FR) was associated with increased odds of ECA, while Satiety Responsiveness (SR) acted as a protective factor; sex also showed an independent association. After stratification, sex remained the only significant predictor in children aged 6–9 years. Among those aged 10–15 years, FR was significantly associated with ECA (p = 0.008), while Slowness in Eating (SE) showed a borderline positive association in the adjusted model (p = 0.049) and was therefore interpreted cautiously. SR and Emotional Undereating (EU) showed protective trends near significance (p = 0.081 and p = 0.082, respectively). Conclusions: The association between eating behavior traits and ECA varies by age. In older children, FR showed a robust association with ECA, whereas no behavioral predictors were observed in younger children. The protective role of SR in the global model and the emergence of behavioral predictors in older participants highlight the importance of targeted interventions during late childhood. Full article

Background: Surgical palatal techniques are established alternatives to continuous positive airway pressure (CPAP) in selective patients with obstructive sleep apnea (OSA) with retropalatal airway collapse. Anterior palatoplasty (AP) stiffens and advances the soft palate, whereas radiofrequency-assisted uvulopalatoplasty (RF-UPP) uses thermal ablation to reduce palatal tissue. This study aimed to compare the 6-month efficacy and morbidity of AP vs. RF-UPP in treating mild-to-moderate OSA. Materials and Methods: We conducted a single-center retrospective cohort study (March 2023–March 2025) of 86 adults (mean age ~42 years; 69.8% male) with mild-moderate OSA (apnea–hypopnea index [AHI] 5–30) due to palatal obstruction; 43 patients underwent AP and 43 patients underwent RF-UPP. Polysomnographic AHI, Epworth sleepiness scale (ESS), snoring severity (0–10 visual analog scale, VAS) and sleep-related quality of life (functional outcomes of sleep questionnaire, FOSQ) were analyzed at baseline and 6 months postoperatively. Postoperative pain (0–10 VAS), recovery time, and bleeding events were also assessed. Results: Baseline characteristics were similar between groups (AHI ~22 vs. 21 events/h; ESS ~11 vs. 10; snoring VAS ~8.4 vs. 8.2 in AP vs. RF-UPP, all p > 0.1). At 6 months, the AP group achieved a greater mean AHI reduction than the RF-UPP group (−13.5 ± 7.5 vs. −8.0 ± 7.2, p < 0.001), with post-treatment AHI averaging 8.5 ± 6.0 vs. 13.2 ± 6.5 events/h (AP vs. RF-UPP). AP yielded a higher surgical success rate (34/43 (79.1%) vs. 23/43 (53.5%), p = 0.012), meeting the criteria of ≥50% AHI reduction to <15; p = 0.01. Subjective outcomes improved in both groups, but AP showed greater mean reductions in ESS (−5.5 vs. −3.1 points, p = 0.001) and snoring VAS (−5.7 vs. −3.1, p = 0.002). The improvements in ESS, snoring VAS, and FOSQ scores were observed in both groups, with significantly greater gains after AP. Postoperative pain and time to resumption of normal diet were higher in the AP group. No major complications occurred in either group. Conclusions: Anterior palatoplasty demonstrated superior efficacy to RF-UPP in mild-moderate OSA at the expense of increased postoperative pain and a longer recovery period. AP may offer a greater therapeutic benefit in appropriately selected patients with palatal obstruction. Full article

Background: Tirzepatide is a novel therapeutic option for the management of metabolic disorders which has started to be implemented in routine practice. The study aimed to analyze the effectiveness of tirzepatide use and patient education in the field of healthy eating and weight loss, based on real-life data from the practice of a primary care physician, in metabolic syndrome (MetSyn) patients during a one-year follow-up period. Methods: This is a retrospective study based on real-life data of 118 MetSyn patients who were under the supervision of a general practitioner (GP). Analysis was conducted on 62 patients supported by trizepatide (2.5 mg for 4 weeks, then 5 mg for 4 weeks and 7 mg for 46 weeks) with dietary education and 56 patients that underwent dietary education with motivation only. Lipid profile, glucose level and blood pressure were assessed. Body Mass Index (BMI), waist-to-height ratio (WHtR), A Body Shape Index (ABSI), Lipid Accumulation Product (LAP), Visceral Adiposity Index (VAI) and Body Roundness Index (BRI) were calculated. The KomPAN^® questionnaire was used for dietary assessment and WHO Quality of Life-BREF for the quality of life assessment at 52 weeks. Results: Patients from both groups significantly reduced their body weight and WC and the values of the following indices: BMI, WHtR, ABSI, LAP and BRI. A significant increase in LDL cholesterol and triglyceride values was observed in both groups and a significant decrease in glucose level only in the group with tirzepatide combined with dietary modification. Energy value, energy density of food and nutrient intake did not differ between groups, while the intensity of beneficial nutritional features (pHDI-10) was low. Significant differences in patients’ QoL were observed, especially in the domain related to mental health (higher in trizepatide + diet group). Conclusions: Support in primary care by a physician was successful from a long-term perspective in the group using tirzepatide in combination with diet modification as well as in the group based on dietary modification only. The data do not indicate a significant advantage of any one approach for patients, prioritizing an individualized approach to treatment. Full article

Background/Objectives: Poor diet quality is common among young Saudi adults, characterised by high fast-food intake and low fruit and vegetable consumption. This study investigated the association between diet quality and lifestyle factors using a validated short Healthy Eating Index (sHEI). Methods: This study adopted a cross-sectional design, gathering responses through a self-completed online questionnaire. Demographic data were collected. Diet quality was assessed using the Arabic version of the sHEI, physical activity was evaluated with the Arabic short form of the International Physical Activity Questionnaire (IPAQ), and sleep quality was measured using the Athens Insomnia Scale (AIS). Saudi residents aged 18–25 years were eligible; pregnant or lactating individuals and those with chronic conditions affecting dietary intake were excluded. Results: Among 478 participants (mean age 21.1 ± 1.9 years), 88.1% were female, 24.7% were overweight or obese, and half reported poor diet quality. Moderation scores were slightly higher (54.2% high), whereas adequacy scores were nearly equal (49.8% high and 50.2% low). Most participants reported low physical-activity levels (78.5%) and poor sleep quality (55.2%). Sleep quality was significantly associated with all diet quality measures, increasing the odds of good total sHEI (OR = 1.74, p = 0.003), adequacy (OR = 1.49, p = 0.034), and moderation (OR = 1.54, p = 0.021). Conclusions: Sleep quality is significantly associated with diet quality among young Saudi adults. While body mass index and physical activity showed no significant associations, improving sleep quality may promote healthier dietary behaviours. Future studies should explore pathways linking sleep and diet. Full article

Background: Celiac disease (CD) is a chronic immune-mediated disorder requiring lifelong adherence to a strict gluten-free diet (GFD). Similar to chronic pediatric disorders, primary caregivers are susceptible to significant psychosocial burden, as CD management relies heavily on them. However, evidence regarding their psychological well-being in Jordan remains limited. Objective: This study aimed to investigate the psychosocial burden on Jordanian caregivers of pediatric CD patients and examine associations with clinical and sociodemographic factors. Methods: This cross-sectional study recruited Jordanian caregivers of pediatric CD patients with biopsy-confirmed diagnosis from September to December 2025, and all patients had followed a GFD for at least six months. The Arabic version of the Celiac Disease Parent/Caregiver Quality of Life Questionnaire (CDPCA-QoL) was distributed online, alongside questions on child and caregiver sociodemographic factors. Descriptive and inferential analyses, including t-tests, ANOVA, correlation, and multiple linear regression, were performed. Results: A total of 198 caregivers participated (mean age 39.5 ± 9.8 years; 85.9% female). Overall burden ranged from moderate to moderately high. Parental worries had the highest mean score (3.95 ± 0.66), followed by emotional (3.48 ± 0.73) and social functioning (2.96 ± 0.99). Younger age, lower education, and lower income were significantly associated with greater burden (p < 0.05). Caring for more than one affected child increased emotional and social strain, whereas longer disease duration was linked to lower parental worry. No associations were found with caregiver gender, marital status, employment, or child characteristics. Conclusions: Jordanian caregivers experience considerable psychosocial burden, emphasizing the need for targeted psychosocial and family-centered support. Full article

Background: Recent research has highlighted the potential of postbiotics for addressing obesity and associated metabolic disorders. In this randomized, double-blind clinical trial, the efficacy of a postbiotic product in managing overweight and associated parameters was assessed. Methods: Sixty individuals were randomized into two groups: one group (n = 30) received the Postbiotic (heat-killed L. fermentum strain K8-Lb1) and the other (n = 30) a Placebo control. Body weight, waist circumference, body composition, vital signs, blood biomarkers and questionnaires for quality of life, eating behavior, eating control and gastrointestinal symptoms were assessed. Results: After a 12-week intervention, body fat mass (primary parameter) was significantly (p = 0.016) reduced in the Postbiotic group (98.15 ± 3.32% of baseline) compared to the Placebo group (100.41 ± 3.39%). In line with this, body weight (p = 0.047) and waist circumference (p = 0.034) were significantly reduced and visceral fat tended to be reduced (p = 0.053). Accordingly, the Postbiotic group tended (p = 0.066) to feel more in control of their body weight. Despite weight loss, muscle mass tended (p = 0.062) to increase. ALT, AST and GGT tended to be reduced, which may indicate an improvement in liver steatosis. Estimated average glucose (eAG) differed significantly between the groups in individuals with normal fasting glucose levels. The ability to concentrate significantly (p = 0.014) improved. Conclusions: Under an ad libitum diet, the postbiotic L. fermentum strain K8-Lb1 reduced body fat mass, body weight, and waist circumference, improved the ability to concentrate, and showed a trend towards an increase in muscle mass. The results of this pilot trial need confirmation by a pivotal trial. Full article

Background/Objectives: The Diet Quality Questionnaire (DQQ) is a brief, food group–based instrument designed for globally comparable population surveillance of diet quality. We culturally adapted the DQQ for Poland and evaluated its internal structure and reliability in an adult cohort. Methods: Following forward–backward translation and expert review, the Polish DQQ was administered online to adult females. Internal structure was explored and test–retest reliability was assessed for total DQQ scores. Diet quality indicators (Dietary Diversity Score [DDS], NCD-protect, NCD-risk, and Global Dietary Recommendations score [GDR]) were summarized descriptively. Results: The average age in the cohort was 29.4 ± 13.6 years. A total of 296 respondents completed the survey; 100 completed the retest. Item-level test–retest reliability was good to excellent (Cohen’s kappa 0.72–1.00). Agreement for total scores was high with minimal bias (Bland–Altman bias 0.2, >95% of observations within limits of agreement) and there was no heteroscedasticity; Passing–Bablok regression indicated equivalence between the test and retest. Median (IQR) diet quality indicators were: DDS 6.0 (5.0; 7.0), NCD-protect 2.5 (1.5; 4.0), NCD-risk 2.5 (1.0; 4.0), and GDR 9.0 (7.5; 10.5). Eighty percent met DDS ≥ 5, while one-third consumed all five recommended food groups. Conclusions: DQQ-PL demonstrates high item-level stability and strong agreement for total scores, with structural findings aligning with its design as a non-latent, food group checklist for population monitoring. The Polish adaptation is feasible and reliable in the studied population (young adult women), supporting its potential use for rapid dietary surveillance pending broader validation. Full article

Background/Objectives: In recent years, the migrant population has been increasing. Migrants are at risk for malnutrition, mental disorders and related health problems. In this study, we aimed to examine the relationships among diet quality, eating behavior, posttraumatic stress disorders and sleep quality in Syrian migrants. Methods: This study included 78 female and 72 male Syrian adult migrants. The participants completed a questionnaire including demographic information, the Pittsburgh Sleep Quality Index, the Posttraumatic Stress Disorder Short Scale, and a three-factor eating questionnaire. For the diet quality calculation, a 24 h retrospective food consumption record was taken. Results: A total of 94.0% of the participants had mild to moderate risk of posttraumatic stress disorder. It was determined that 90.7% of Syrian migrants had low or moderate diet quality. There was a positive correlation between the PTSD score and age (r = 0.244) and the Pittsburgh sleep quality index score (r = 0.244) and between the Pittsburgh sleep quality index score and uncontrolled eating (r = 0.171) (p < 0.05). The probability of impaired sleep quality increased in individuals with PTSD scores in the T2 (11–19 points) (OR: 1.342; 95% CI: 1.073–1.678) and T3 (20–31 points) (OR: 1.485; 95% CI:1.157–1.905) groups, whereas the probability of improved diet quality increased in individuals in the T2 (11–19 points) (OR: 1.042; 95% CI: 1.000–1.086) group. Conclusions: Poor diet quality, risk of posttraumatic stress disorder and poor sleep quality are very common among Syrian migrants. In this respect, evaluating Syrian migrants and taking necessary precautions may help reduce the risk of chronic diseases related to nutrient deficiencies and mental problems. There is a need for policies and programs to manage PTSD among Syrian refugees. Full article

Background: Childhood nutrition is essential for development and disease prevention. Parental dietary practices and sociodemographic factors shape children’s eating habits. Objective: To assess the association between parental diet quality, children’s diet, and nutritional status, as well as the influence of caregiver sociodemographic factors. Design: Cross-sectional analyses were conducted using data from two waves of the PASOS study (2019–2020 and 2022–2023), which are nationally representative multicentre observational surveys. The analyses were restricted to participants with complete information on parental diet quality, children’s diet quality, and relevant covariates. Methods: Participants aged 8–16 years from the PASOS 2019–2020 (n = 1028) and 2022–2023 (n = 572) studies were included. Caregivers provided sociodemographic information and completed the Short Diet Quality Screener (SDQS), a validated questionnaire to assess parental diet quality. Children’s diet quality was assessed using the validated KIDMED index. Based on parental SDQS scores, participants were classified into low (≤50th percentile) or adequate/high (>50th percentile) diet quality groups. Associations were analysed using logistic regression and Pearson correlation. Results: Higher parental diet quality was consistently associated with greater adherence to the Mediterranean diet and higher consumption of fruit, breakfast cereals, and fish among children in both study waves. Children whose caregivers had better diet quality also showed a lower prevalence of abdominal obesity. Parental diet quality was positively associated with children’s diet quality and inversely related to several adiposity indicators, although associations with anthropometric measures were generally weak. Conclusions: Family-based approaches are essential for improving diet quality and preventing childhood obesity. Full article

Background: Misperception of body weight has been found to negatively impact both diet and physical activity levels, particularly in youth with overweight and obesity. Objectives: This study assessed consistency between actual and perceived weight status and lifestyle factors in a sample of 455 children and adolescents (55% males, 8–13 years) attending a summer camp in Northern Italy. Methods: Weight status was defined applying Body Mass Index (BMI) cut-offs. Adherence to the Mediterranean Diet (MD), physical activity level, sleep duration, and sleep quality were assessed through validated questionnaires. Self-perception was evaluated through 5-point Likert scales, with graphical representations. Results: Comparison between self-perceived and assessed parameters revealed a poor concordance across all types of variables. Approximately half of participants (43–55%) correctly rated their weight status (κ = 0.12; 95% CI: 0.05–0.19), diet quality (κ = 0.09; 95% CI: 0.02–0.15), physical activity level (κ = 0.18; 95% CI: 0.11–0.26), sleep time (κ = 0.10; 95% CI: 0.03–0.17), and sleep quality (κ = 0.18; 95% CI: 0.12–0.24). Participants 12–13 years old were more likely to have a greater weight status perception compared to younger subjects (OR = 2.13; 95% CI: 1.08–4.21). Being in a condition of overweight or obesity significantly decreased the odds of correct weight perception (OR = 0.13; 95% CI: 0.08–0.21). Similarly, subjects with higher adherence to the MD, adequate sleep time, and low sleep quality were more conscious about their diet and sleep patterns. Conclusions: Overall, these findings highlight a certain degree of misclassification, especially in subjects who need to improve their lifestyles, highlighting the potential relevance of fostering accurate self-perception during developmental age. Full article

Background: Parental knowledge and perceptions towards Functional Foods (FFs) play a critical role in shaping children’s dietary behaviors. This study aimed to investigate dietary habits, FFs knowledge and perceptions among Greek primary school children and their parents and to evaluate the feasibility of a one-month pilot asynchronous nutrition education program. Methods: A cross-sectional study included 374 children aged 9–11 years and 159 parents from urban (Thessaloniki) and rural (Lemnos) areas. Children completed questionnaires on dietary habits, FFs knowledge and Mediterranean Diet (MD) adherence (KIDMED score), while parents provided sociodemographic information, BMI, dietary habits, FFs knowledge and perceptions. A pilot asynchronous nutrition education intervention was delivered via pre-recorded videos on FFs, the MD, portion sizes and food label interpretation, with participation tracked and program evaluation conducted among parents. Data was analyzed using IBM SPSS Statistics (version 28). Descriptive statistics were calculated, group differences were assessed with t-tests and ANOVA and associations between variables were examined using chi-square tests and Pearson correlations (p < 0.06). Results: Children showed moderate MD adherence, frequent fast-food and soft drinks consumption and low FF knowledge, with a substantial gap between perceived and actual understanding. Parental FF knowledge was uneven, higher among normal-weight participants and largely limited to fortified products. Positive associations were found between children’s and parents’ diet quality and natural FF consumption, as well as between parental and child physical activity. The asynchronous intervention was positively rated; substantial attrition was observed across sessions and follow-up, which limited the ability to assess the intervention’s effects on behavioral change. Conclusions: This study highlights critical gaps in FFs knowledge among families and demonstrates that asynchronous, family-based nutrition education is feasible but challenged by engagement attrition. Targeted interventions are needed to clarify FF concepts and promote healthier family dietary behaviors. Full article