Search Results (792)

Background/Objectives: Chrononutrition—the temporal organization of food intake relative to circadian rhythms—has emerged as an important factor in cardiometabolic health. While meal timing is typically analyzed as an isolated variable, limited research has examined integrated meal timing patterns, and no study has systematically compared clustering approaches for their identification. This cross-sectional study compared four clustering techniques—traditional (K-means, Hierarchical) and non-traditional (Gaussian Mixture Models (GMM), Spectral)—to identify meal timing patterns from habitual breakfast, lunch, and dinner times. Methods: The sample included 388 Mexican university students (72.8% female). Patterns were characterized using sociodemographic, anthropometric, food intake quality, and chronotype data. Clustering method concordance was assessed via Adjusted Rand Index (ARI). Results: We identified five patterns (Early, Early–Intermediate, Late–Intermediate, Late, and Late with early breakfast). No differences were observed in BMI, waist circumference, or age among clusters. Chronotype aligned with patterns (morning types overrepresented in early clusters). Food intake quality differed significantly, with more early eaters showing healthy intake than late eaters. Concordance across clustering methods was moderate (mean ARI = 0.376), with the highest agreement between the traditional and non-traditional techniques (Hierarchical–Spectral = 0.485 and K-means-GMM = 0.408). Conclusions: These findings suggest that, while traditional and non-traditional clustering techniques did not identify identical patterns, they identified similar core structures, supporting complementary pattern detection across algorithmic families. These results highlight the importance of comparing multiple methods and transparently reporting clustering approaches in chrononutrition research. Future studies should generate meal timing patterns in university students from other contexts and investigate whether these patterns are associated with eating patterns and cardiometabolic outcomes. Full article

Background/Objectives: The Mediterranean diet (MD) constitutes one of the most broadly studied dietary patterns, which has been linked to the prevention of non-communicable diseases and mental health disorders. University students, a population exposed to significant psychosocial stressors and lifestyle changes, may particularly benefit from healthy eating patterns such as the MD. This study was designed to examine the potential associations of MD adherence with symptoms of depression and anxiety among Greek university students. Methods: A cross-sectional study was initially conducted among 7160 active university students from ten diverse geographic regions in Greece. After the enrollment procedure and the application of relevant exclusion criteria, 5191 university students (52.0% female; mean age: 21.3 ± 2.4 years) constituted the study population. MD adherence was assessed using the KIDMED index, while depressive and anxiety symptoms were evaluated using the Beck Depression Inventory-II (BDI-II) and State–Trait Anxiety Inventory (STAI-6), respectively. Sociodemographic and anthropometric data were collected for all the enrolled university students. All the questionnaires were completed by face-to-face interviews with expert personnel. Results: Students with low adherence to the MD were significantly more likely to report symptoms of depression (OR = 2.12; p ˂ 0.001) and anxiety (OR = 2.27; p ˂ 0.001) and to be overweight or obese (OR = 2.45; p ˂ 0.001) after adjustment for multiple confounding factors. Low MD adherence was also associated with male gender (OR = 0.73; p ˂ 0.01), living alone (OR = 0.78; p ˂ 0.01), smoking (OR = 0.75; p ˂ 0.01), low physical activity (OR = 1.84; p = 0.001), and poorer academic performance (OR = 0.83; p ˂ 0.01). Conclusions: Low adherence to the MD is significantly associated with increased likelihood of depression, anxiety, and excess body weight among university students in Greece. These findings underscore the importance of promoting healthy dietary habits and related lifestyle behaviors in young adult populations as a potential strategy for mental health prevention and intervention. Due to the presence of several limitations in the present study, future longitudinal and interventional studies should be performed to confirm the present findings. Full article

Background: Healthier between-meal snacks can improve diet quality in the US and globally. Objectives: To assess the impact on diet quality of replacing solid snacks with almonds or adding almonds (30 g) to the diet. Methods: Dietary data for 4333 children (4–19 y) and 10,925 adults (>19 y) came from the National Health and Nutrition Examination Survey (NHANES 2017–23). Nutrient composition data came from the Food and Nutrient Databases for Dietary Studies (FNDDS). Substitution Model 1 replaced all solid snacks with almonds on a per-calorie basis. Model 2 exempted “healthy” snacks. Model 3 added almonds to the observed diet. The Healthy Eating Index (HEI-2020), Nutrient Rich Food Index (NRF), Mean Adequacy Ratio (MAR), and Mean Excess Ratio (MER) were measures of diet quality. Results: Solid snacks provided 329 kcal/day (15.6% of dietary energy), of which 58 kcal came from healthy snacks (2.9%). The 4–13 y age group consumed the most energy from snacks. Diets with almonds replacing solid snacks were lower in added sugar, sodium, and saturated (solid) fat but higher in protein, fiber, mono- and polyunsaturated fats, and magnesium. MAR dietary nutrient density scores were significantly higher, and MER scores were lower. Total HEI-2020 scores rose from 52.4 (observed) to 59.6 (Model 1) and to 60.6 in Model 2_100. The addition of almonds (30 g or 50 g) increased HEI-2020 values to 59.2 and to 61.4, respectively. Several HEI-2020 sub-scores increased as well. The greatest dietary benefits were obtained for children and young adults. Conclusions: Replacing solid snacks with small amounts of almonds led to higher quality modeled food patterns, especially for younger age groups. The DGA 2025–30 should address the inclusion of healthy energy-dense snacks into everyday diets. Full article

Poor diet is the leading preventable risk factor for death worldwide, associated with over 10 million premature deaths and USD 8 trillion related costs every year. Artificial intelligence or AI is rapidly emerging as the most historically disruptive, innovatively dynamic, rapidly scaled, cost-efficient, and economically productive technology (which is increasingly providing transformative countermeasures to these negative health trends, especially in low- and middle-income countries (LMICs) and underserved communities which bear the greatest burden from them). Yet widespread confusion persists among healthcare systems and policymakers on how to best identify, integrate, and evolve the safe, trusted, effective, affordable, and equitable AI solutions that are right for their communities, especially in public health nutrition. We therefore provide here the first known global, comprehensive, and actionable narrative review of the state of the art of AI-accelerated nutrition assessment and healthy eating for healthcare systems, generated by the first automated end-to-end empirical index for responsible health AI readiness and maturity: the Responsible Health AI readiness and Maturity Index (RHAMI). The index is built and the analysis and review conducted by a multi-national team spanning the Global North and South, consisting of front-line clinicians, ethicists, engineers, executives, administrators, public health practitioners, and policymakers. RHAMI analysis identified the top-performing healthcare systems and their nutrition AI, along with leading use cases including multimodal edge AI nutrition assessments as ambient intelligence, the strategic scaling of practical embedded precision nutrition platforms, and sovereign swarm agentic AI social networks for sustainable healthy diets. This index-based review is meant to facilitate standardized, continuous, automated, and real-time multi-disciplinary and multi-dimensional strategic planning, implementation, and optimization of AI capabilities and functionalities worldwide, aligned with healthcare systems’ strategic objectives, practical constraints, and local cultural values. The ultimate strategic objectives of the RHAMI’s application for AI-accelerated public health nutrition are to improve population health, financial efficiency, and societal equity through the global cooperation of the public and private sectors stretching across the Global North and South. Full article

Background: Socioeconomic disparities may drive cancer inequities in Hispanic/Latino populations. We examined associations of perceived access to healthy foods (AHF) and food insecurity (FI) with diet and body mass index (BMI) changes in Latina breast cancer (BC) survivors. Methods: Latina BC survivors in a 12-month intervention trial aiming to increase fruit/vegetable intake and physical activity were analyzed. AHF was from a modified, validated neighborhood environment scale and dichotomized (low–medium vs. high). FI was defined as eating less and/or going hungry due to a lack of money. AHF and FI surveys were self-reported. Outcomes included dietary intake, diet quality, and BMI. Fruit/vegetable intake was log-transformed. Relationships between AHF and FI and changes in diet and BMI were evaluated using generalized estimating equations. Results: Of women with AHF data (n = 86), 58% reported low–medium access and 42% reported high access. Fruit/vegetable (FV) intake declined overall from baseline to 12 months, with greater reductions among low–medium AHF women (−32%, 95% CI: −51%, −7%) compared with high AHF women (−17%, 95% CI: −40%, +13%). Statistically significant 12-month decreases in total calories, carbohydrates, sugars, and fat occurred in low–medium AHF women but not high AHF women, and changes in total energy density, carbohydrates, sugars, and BMI at 12 months were statistically significantly different between women with low–medium AHF and women with high AHF, p ≤ 0.05. Among 157 women, 23% reported FI. Reductions in fruit/vegetable intake were larger in women with FI (−39%, 95% CI: −57%, −14%) than in women without FI (−10% reductions, 95% CI: −25%, +8%) and between-group differences were significant at both 6 and 12 months, p ≤ 0.05. Most diet measures decreased for both FI and non-FI women, with greater decreases among those with FI. Conclusions: Latina BC survivors with FI or perceived limited AHF experienced greater declines in indicators of healthy diets including FV intake. Future interventions should integrate strategies to measure AHF and FI to address disparate access to healthy food options. Full article

Background: Adolescence involves physical and psychological changes that often conflict with body ideals, potentially increasing body image (BI) dissatisfaction and unhealthy diet. The main objective was to analyze cross-sectional and longitudinal associations between BI satisfaction (BIS) and nutritional status, dietary habits (DH), and emotional management (EM) in adolescents. Methods: 1315 adolescents from the SI! Program for Secondary Schools trial reported their BIS, DH, and EM at ages 12, 14 and 16. Linear and logistic mixed models estimated the associations between BIS, food intake, diet quality, and EM. Linear and logistic mixed-effect models for repeated measures assessed mean change estimates from baseline to 2- and 4-year follow-up in food intake and EM, stratified by gender. Results: A large proportion of adolescents without excess weight were dissatisfied with their BI. BIS was significantly associated with DH, especially in boys. Body-satisfied adolescents at baseline tended to have healthier DH (diet quality index: boys 56.7 ± 13.0; girls 58.8 ± 12.7) and showed a greater improvement in diet quality at 16 years (boys 3.44 (1.50, 5.37); girls 1.85 (0.18, 3.52)). Adolescents who desired to lose weight decreased their intake of sugar-sweetened beverages, sweets, and snacks, whereas boys who desired to gain weight consumed more frequently fast food, sweets, snacks, and processed meat. Body-satisfied adolescents had higher self-esteem, and girls desiring to gain weight presented higher emotional eating. Conclusions: BIS was associated with nutritional status, and EM, showing gender differences. Overall, the desire to gain weight was associated with unhealthier DH. Educational interventions should promote self-esteem and BIS by focusing messages on healthy eating instead of body weight. Full article

Objectives: This paper illustrates the use of the National Cancer Institute (NCI) Markov Chain Monte Carlo (MCMC) method for usual intake (UI) analyses of 5-year-old children’s diets by comparing results from the MCMC method with results from other estimation methods. Methods: This study involves secondary analysis of data from the Infant and Toddler Feeding Practices Study-2 (ITFPS-2), a nationally representative prospective cohort study that followed children from around birth through age 9. Dietary data analyzed were collected between April 2018 and August 2019. All study participants in the longitudinal cohort (n = 1030) had 1 day of dietary recall data, and 122 participants had 2 days of recall. We compare differences in intake distributions for sodium, added sugars, whole grains, energy, and Healthy Eating Index (HEI) scores using the NCI UI methods, as well as single-day and two-day methods. We use regression analysis to assess associations by intake estimation method. Results: Across the methods examined, means for daily consumed nutrients differed by less than 2 percentage points and mean HEI component scores differed by less than half a point. However, for episodically consumed whole grains, the NCI UI methods yielded mean intake estimates that differed by 37%, with the univariate method indicating higher mean intake than the MCMC method. Conclusions: For the daily consumed nutrients examined, the NCI MCMC method is a useful alternative to the univariate method. However, for episodically consumed whole grains, the NCI UI methods yield notably different mean estimates. For episodically consumed dietary constituents, abandoning the NCI univariate method may exacerbate differences between recommended and estimated population mean intake levels for young children. Full article

Background: Daily energy intake from snacking behaviors has increased over the past few decades, during which the prevalence of obesity and metabolic syndrome has risen to epidemic proportions. There remains considerable room for improvement in the overall quality of dietary intakes of the U.S. population when compared to national recommendations. Food cravings may contribute to the types of snacks chosen for consumption, and thus, the frequency of foods and food groups consumed, and the overall nutritional quality of the diet. Methods: Eighty-four young (28.5 ± 4.3 years) adults with at least one metabolic syndrome risk factor participated in a parallel-arm single-blind randomized trial designed to compare effects of consuming a mix of tree nuts versus typical high-carbohydrate food items as between-meal snacks for 16 weeks. Cravings for 28 common foods via the Food Craving Inventory, short-term dietary intakes via 24 h multi-pass methodology, food group frequency via the Rapid Eating Assessment for Participants, usual hunger and fullness via visual analog scales, appetite-regulating hormones, and diet quality via the Healthy Eating Index—2015 were measured at baseline and end of study. Results: Participants in the TNsnack group had significant decreases in cravings for high sweet items and fast-food items, which were associated with decreased frequency of desserts and salty foods along with increased intake of higher protein items. In contrast, no significant reductions in food cravings or preference for sweets were observed in the CHOsnack group. Decreased cravings for sweets by TNsnack participants were associated with increased total GLP-1 levels: cake (r = −0.35, p = 0.03), brownies (r = −0.44, p = 0.02), candy (r = −0.36, p = 0.03) and ice cream (r = −0.33, p = 0.04). Overall, the total diet quality score improved by 19% among TNsnack participants. Conclusions: Replacing more typical between-meal snacks with tree nuts may reduce food cravings, particularly for sweeter food items that are likely to be nutrient poor and energy dense. By reducing cravings and frequency of intake, consuming tree nuts as snacks could facilitate having a higher quality, more nutrient-dense diet and mitigate potential negative effects of snacking on metabolic health in young adults. Full article

Background/Objectives: Dietary quality is a driver of metabolic dysfunction-associated steatotic liver disease (MASLD). Men and women often have different levels of adherence to medical advice, but the effect of gender on adherence to dietary advice as a function of awareness of MASLD is understudied. We aim to investigate the differences in diet quality between men and women who are aware of their diagnosis of MASLD compared to their undiagnosed counterparts. Methods: We utilized the National Health and Nutrition Examination Survey 2017–2020 to identify a nationally representative sample of subjects with MASLD, 127 of whom reported a diagnosis of MASLD (diagnosed MASLD), and 1703 of whom did not report an existing diagnosis of MASLD but met criteria of the disease based on vibration-controlled transient elastography results and cardiometabolic criteria (undiagnosed MASLD). Results: In a gender-stratified analysis of diet quality as a function of reported MASLD diagnosis, women with diagnosed MASLD were more likely than women with undiagnosed MASLD to consume less added sugar and more total and whole fruits. Women with diagnosed MASLD had a 3.06 higher healthy eating index score than undiagnosed women, after adjusting for confounders such as demographics, comorbidities, lifestyle behaviors, and metabolic risk factors. In men, total diet quality did not differ based on awareness of MASLD diagnosis. Conclusions: Women with diagnosed MASLD have superior diets compared to their undiagnosed counterparts. Gender-specific approaches to counseling and prospective studies that investigate causes of gender-driven differences in dietary behavior in the context of MASLD are needed. Full article

Obesity remains a dominant risk factor for cardiovascular disease, yet its classification continues to rely heavily on body mass index (BMI)—a metric that fails to capture individual variability in fat distribution, metabolic health, and cardiometabolic risk. This narrative review analyzes 35 articles published between 2018 and 2025 to explore the limitations of BMI and outlines emerging strategies for obesity redefinition through a precision medicine lens. Drawing from recent advances in imaging, metabolomics, and genomic profiling, we highlight alternative metrics such as visceral adipose tissue (VAT), epicardial adipose tissue (EAT), waist-to-hip ratio (WHR), and multi-omic phenotyping that provide superior predictive value for cardiovascular outcomes. The review synthesizes data on metabolically healthy and unhealthy phenotypes, emphasizes the pathophysiological role of EAT in heart failure and arrhythmogenesis, and discusses the cardioprotective effects of pharmacologic agents such as glucagon-like peptide-1 (GLP-1) receptor agonists. Clinical implications include improved risk stratification, earlier disease detection, and individualized therapeutic targeting. Despite current barriers to widespread implementation—such as imaging cost, access to omics, and lack of guideline integration—this paradigm shift holds promise for refining cardiovascular prevention strategies. Redefining obesity using biologically informed, phenotype-based models is indispensable for aligning clinical practice with the complexities of modern cardiometabolic disease. Full article

Background: Although Türkiye hosts the largest population of Syrian refugees in the world, research on the vulnerability factors contributing to food insecurity among Syrian refugee mothers remains scarce. The aim of this study was to investigate the relationships between maternal food insecurity, diet quality, and mental health outcomes among Syrian refugee mothers with young children living in Türkiye. Methods: This cross-sectional study involved 285 Syrian mothers living in Türkiye with children under five years of age. Maternal food insecurity was assessed via the Food Insecurity Experience Scale (FIES), diet quality was evaluated via the Healthy Eating Index-2020 (HEI-2020), and the Patient Health Questionnaire-9 (PHQ-9) was used to evaluate mental health conditions. Data were collected through face-to-face surveys conducted by two native Arabic translators, and the analyses included sociodemographic characteristics, anthropometric measurements, diet quality, food insecurity status, and mental health status. Results: The prevalence of moderate/severe food insecurity and poor diet quality among refugee mothers amounted to 30% and 59.3%, respectively. Mothers experiencing food insecurity presented significantly lower levels of mental health and diet quality (p < 0.05). A one-unit increase in the food insecurity score was associated with an increase of 1.031 units in the total Patient Health Questionnaire-9 (PHQ-9) score. The model demonstrated that food insecurity accounted for 30.2% of the variance in PHQ scores (R² = 0.302). Low income, lack of institutional aid, short length of stay, and number of children significantly increase the likelihood of poor dietary quality among refugee mothers. Conclusions: Food insecurity was found to be a widespread problem for mothers who are refugees from Syria. It was significantly associated with poorer nutritional quality and mental health issues in mothers. These findings suggest the need for expanding social support programs, implementing effective public health interventions for food security, and securing an overall improvement of maternal health. Full article

Background/Objectives: Breastfeeding has positive effects on both maternal and offspring health. This study examined the association between egg consumption (total eggs and specific egg foods) and breastfeeding duration and initiation. Methods: Data from a U.S. cohort of 1039 mother–infant dyads in the Infant Feeding Practices Study II and its 6-year follow-up (2005–2012) were analyzed. In late pregnancy, mothers reported the frequency and serving size of their consumption of egg-related products in the past month, including total eggs, whole eggs, egg whites, egg substitutes, egg with fat, and egg salad. Multivariable logistic and linear regression models were used to examine associations of egg consumption with breastfeeding initiation and duration, respectively, adjusting for socio-demographics, pregnancy-related characteristics, and the Healthy Eating Index. Results: Mothers who consumed eggs 3+ times/week had higher odds of breastfeeding initiation (93.8% vs. 81.1%; confounder-adjusted OR, 3.34 [95% CI, 1.51–7.39]), compared to non-consumers. Similar associations were seen with whole eggs 2+ times/week (91.5% vs. 83.4%; 2.21 [95% CI, 1.20–4.04]), and eggs with fat 2+ times per week (91.4% vs. 86.8%; 2.19 [95% CI, 1.16–4.13]). Compared to non-consumers, mothers who consumed total eggs or whole eggs 1+ times per month had about 5 weeks longer breastfeeding duration, and those who consumed total eggs or whole eggs 1+ times per week had about 3 weeks longer exclusive breastfeeding duration. No significant associations were found for egg whites, egg salad, or egg substitutes. Conclusions: High consumption of total eggs, whole eggs, or eggs with fat may help support favorable breastfeeding practice outcomes. Full article

Background/Objectives: Childhood obesity and nutritional inequalities remain major public health challenges, particularly in socioeconomically disadvantaged settings. In Spain, these disparities are reflected in unequal access to healthy food and differing health outcomes among the young population. This study aimed to explore how social vulnerability influences dietary patterns, body composition, and food insecurity among children and adolescents, with a particular focus on sex differences. Methods: A descriptive cross-sectional study was conducted with 280 participants aged 6 to 15 years old, recruited from urban areas across Spain. Two groups were evaluated, a socioeconomically vulnerable group (VG) (n = 175) and a non-vulnerable group (NVG) (n = 105), classified according to socioeconomic and social established criteria. Validated tools were used to assess diet quality, adherence to the Mediterranean Diet (MD), consumption of ultra-processed foods (UPF), and household food insecurity. Anthropometric measurements were also collected, and body mass index (BMI) was calculated using both national and international reference standards. Results: Vulnerable children and adolescents showed higher prevalence of food insecurity, less favorable body composition indicators, and lower global dietary quality, characterized by lower adherence to the MD and higher consumption of UPF. Multivariate analysis confirmed that socioeconomic vulnerability was significantly associated with female sex, higher BMI, lower adherence to the MD, and greater consumption of UPF. Conclusions: Our findings highlight a concerning pattern of health and nutritional inequality among children and adolescents based on socioeconomic status. There is a clear and urgent need for effective public health strategies with an equity focus that promote healthy and affordable eating habits from early life, especially in the most disadvantaged environments and targeted by gender. Full article

Background/Objectives: Adherence to national dietary guidelines is essential for promoting healthy eating and preventing chronic diseases. In Chile, the 2022 update introduced new evidence-based recommendations, but no validated tool is currently available to assess adherence. The aim of this study was to develop and validate a tool to assess adherence to the updated Chilean dietary guidelines. Methods: For this purpose, five expert judges evaluated the content validity using Aiken’s V (V ≥ 0.80). Reliability was assessed through a 21-day test–retest in 30 participants (≥18 years, mean age 38.9 years; 63.3% women) using the Intraclass Correlation Coefficient (ICC(3,1)), a two-way mixed-effects model to assess the absolute agreement of individual measurements, Standard Error of Measurement (SEM), and Minimal Detectable Change (MDC95) at the 95% confidence level. Internal consistency was assessed in 152 participants (≥18 years) examined via McDonald’s ω, and construct validity through confirmatory factor analysis (CFA) using the WLSMV estimator. Results: The GABAS-Index 17 showed high content validity (Aiken’s V = 0.93–1.00), good internal consistency (ω = 0.64–0.71), and accurate reliability (ICC = 0.905; SEM < 1; MDC95 = 2.1). Confirmatory factor analysis supported the proposed four-dimensional structure (CFI = 1.00; TLI = 1.02; RMSEA = 0.00), confirming strong factorial validity and internal coherence. Conclusions: These findings support the GABAS-Index 17 as an adequate and reliable tool for assessing adherence to the updated Chilean dietary guidelines. Although some psychometric aspects, such as the factorial structure, could be improved, the instrument performs well for its intended purpose of providing an overall adherence score. Its use can facilitate monitoring dietary patterns, support nutrition research, and inform public health strategies to improve diet quality in the Chilean population. Full article

In contrast to several high-income nations, childhood obesity prevalence is rising in low/middle-income countries. Our objective was to study risk factors and complications of childhood overweight/obesity in an urban lower middle-income country setting. This was an observational study. Children aged 2–18 years at a pediatric clinic in Chennai, India were enrolled over a 12-month period. The definition of overweight was >23rd and obesity >27th adult equivalent percentile Body Mass Index. Parents and children completed a risk-factor questionnaire. Children with obesity/overweight were evaluated for complications. Of 103 children enrolled, 61% were obese/overweight and 39% healthy weight. Independent predictors of absence of overweight/obesity were as follows: never/rarely consuming sugar-sweetened beverages, never/rarely eating out, and sleep duration > 11 h. Exercise performed rarely/never independently predicted overweight/obesity. No significant difference was observed with screen time or a vegetarian diet. Complications in 54 obese/overweight children included prediabetes (15%), hypertension (11%), dyslipidemia (22%), nonalcoholic fatty liver disease (22%), acanthosis nigricans (24%), and anxiety/depression (17%). In conclusion, differences were observed in behaviors associated with childhood obesity in an urban lower middle-income environment compared to those in high-income nations. Behaviors associated with childhood obesity in an urban lower middle-income environment are similar to those reported from high-income nations, with some differences. Complications of overweight/obesity are common in this setting. Full article