Search Results (245)

Food insecurity has been associated with poorer diet quality; however, limited evidence exists on the association between food insecurity and adherence to the Mediterranean diet in Saudi Arabia. This cross-sectional study, conducted among 577 Saudi adults between February and June 2025, examined the association between food security status and adherence to the Mediterranean diet in this region. Data were collected through a self-administered questionnaire that included sociodemographic characteristics, the Food Insecurity Experience Scale, and the Mediterranean diet adherence score. Most participants were food secure (73.0%), and only 12.7% demonstrated high adherence to the Mediterranean diet. The food insecurity score was inversely related to Mediterranean diet adherence (B = −0.107, 95% CI −0.191 to −0.024; p = 0.012); however, the magnitude of the association was small. Age, marital status, and monthly income were also significantly associated with food security status (p < 0.005). Although most of the participants were food secure, overall adherence to the Mediterranean diet was low, with only a small proportion demonstrating high adherence. These findings suggest that socioeconomic factors, particularly income, may be associated with both food access and diet quality. Further research is needed to inform strategies aimed at improving access to affordable healthy foods and promoting healthier dietary patterns, especially among young adults and low-income individuals. Full article

Diet affordability is a critical determinant of food security, health and wellbeing. However, the cost and affordability of diets have not been routinely measured in Queensland (Australia) in over a decade. This study assessed the cost and affordability of healthy (based on national healthy eating guidelines) and habitual (less healthy, based on national reported intake) diets across six Queensland regions. Data were collected in 35 communities, over two years (2023 and 2024), using the evidence-based Healthy Diets Australian Standardised Affordability and Pricing protocol. Data were analyzed relative to a six-person intergenerational Aboriginal and Torres Strait Islander reference household. Results indicate that, across Queensland, healthy diet costs are above the threshold for food stress in Aboriginal and Torres Strait Islander households. On average, healthy diets were 30% cheaper than the habitual diet (which include alcohol and takeaway foods) but cost at least 26% of household income (above the 25% threshold for food stress). In 2023, healthy diets were on average 31% more expensive in remote communities compared to urban and regional centers. In 2024, the cost of a healthy diet in remote communities decreased significantly by 24%, narrowing diet cost differences between remote and non-remote regions. This shift could be associated with the implementation of a freight subsidy in remote Queensland, or other influences on remote food pricing. Findings highlight diet-related cost-of-living challenges for Aboriginal and Torres Strait Islander families, underscore the need for ongoing monitoring and provide insight for policy interventions (such as targeted subsidies) to improve diet affordability and reduce nutrition-related health inequity. Full article

Objectives: To describe the utilization patterns and patient perceptions of individual dietary consultations among people with type 2 diabetes in Israel, and to examine the association between dietary consultation attendance and adherence to the Mediterranean diet. Methods: This cross-sectional study enrolled adults with type 2 diabetes from a specialty diabetes clinic in Israel between July 2022 and May 2023. Participants completed structured interviews in which they were asked to report their perceptions of various diabetes management components, their sources of dietary information, and—among those who had previously attended dietary consultations—their satisfaction with specific aspects of the consultation experience. Medical records were reviewed to determine attendance at dietary consultations. Adherence to the Mediterranean diet was measured using the validated I-MEDAS 17-item questionnaire. Multivariable logistic regression was used to examine the association between attendance at dietary consultation within the past 12 months and adherence to the Mediterranean diet, adjusting for age, sex, socioeconomic status, and obesity (BMI ≥ 30 kg/m²). Results: Overall, 134 patients were interviewed. Their mean age was 69.8 ± 10.7 years, mean diabetes duration was 19.1 ± 9.7 years, and 96.3% were Jewish. Only 29.1% attended a dietary consultation within the past 12 months, and 52.2% had at least one consultation over the preceding 5 years. While 79.9% of participants rated maintaining normal weight and 78.4% rated taking medications as “very helpful” for diabetes control, only 29.9% reported that regular dietitian visits would be “very helpful.” Most participants (74.6%) were unable to name a specific dietary pattern they were following. Among those who recalled ever attending dietary consultations, most reported in interviews that recommendations were culturally aligned with their preferences. No association was found between recent attendance at dietary consultations and adherence to the Mediterranean diet (adjusted OR 1.03, 95% CI 0.39–2.74). Conclusions: Despite having accessible and affordable individual dietary consultations, the utilization of this service remains low, and patient-reported benefit limited. These exploratory findings point to perception-based barriers to engagement that warrant further investigation. Full article

Energy thriftiness and metabolic adaptations have had a crucial role in the emergence and spreading of the Homo lineage in the world. A higher-energy demand was required not only for the growing body mass, encephalization and human proliferation, but also for the survival adaptations to the environmental stresses. Because lean body mass lacks the energy-storage capacity required to supply the body’s demands, dedicated fat-storing cells originated. To feed such fat stores, the hominid evolution developed “meat-adaptive” genes to detect, digest and metabolize higher fat diets, and body-fat stores can be affected by lifestyle through hormonal-controlled daily energy balance. In energy surplus conditions, hypertrophy and hyperplasia of adipocytes can occur, with hypertrophic adipocyte signaling both a neo-adipocyte differentiation (leading to hyperplasia) and a local macrophage density (resident + infiltrated macrophages) for fat surplus scavenging. Adiposity-induced inflammation is caused by fat-overstored (hypertrophied) adipocytes that may operate as an overactive endocrine organ secreting an array of pro-inflammatory adipokines that, in combination with resident-macrophage activity and infiltrated blood-recruited, monocyte-derived macrophages, amplify the inflammatory process by spurting pro-inflammatory cytokines into the bloodstream. From an evolutionary perspective, obese humans represent a natural selection overexpressing the “thrifty” genes evolved for efficient food collection and fat deposition intended to help in survival in prolonged periods of famine. However, genetically speaking, obesity is a polygenic multifactorial disorder. Considering the rapidity of obesity-epidemic growth worldwide, epigenetic sets forth the key assumption of the mismatch between our human genome molded over thousands of generations, coping with the unprecedented dietary and physical conditions. Consequently, obesity would be due to our evolutionary-adapted polygenic-charge expressed by a deteriorated lifestyle characterized by high energy-dense food intake coupled with a reduction in caloric expenditure stemming from new mobility-reducing technologies. As a model of lifestyle change (LiSM), our 28-year on-going longitudinal study (“Moving for Health”) has shown effectiveness in the reduction not only of obesity but especially of its comorbidities, in a (10 week to 3 year) length-dependent LiSM. However, a disappointing progressive decrease in compliance with the study has been observed and attributed to the resistance of people to change their actual “obesogenic” lifestyle, basically represented by the individuals’ demand for labor-saving technologies and convenient, affordable, palatable foods. Full article

Background/Objectives: Cardiovascular diseases (CVD) in Chile are profoundly shaped by place-based determinants of diet. This study examines the association between food deserts—areas with structurally limited access to nutritious, affordable food—and population-level cardiovascular risk across Chile’s three largest metropolitan areas (Santiago, Valparaíso, Concepción). Methods: We constructed a geospatial food desert index combining OpenStreetMap-derived retail accessibility with census information, and linked it to georeferenced cardiovascular health records. To overcome the limitations of global models that assume spatial stationarity, we applied Multiscale Geographically Weighted Regression (MGWR) to allow coefficients to vary across space and to recover variable-specific process scales. Results: The MGWR results indicate pronounced spatial non-stationarity in the food desert–CVD association. The relationship is predominantly positive across Gran Valparaíso, predominantly negative in Gran Concepción, and highly mixed within Gran Santiago, evidencing divergent local mechanisms rather than a single national pattern. Conclusions: The observed heterogeneity undermines “one-size-fits-all” national interventions and supports place-sensitive, equity-oriented strategies. Policy implications include territorially tailored food-retail regulation and primary-care outreach, co-designed with local actors, with MGWR providing a critical analytic basis for actionable, context-specific public health planning. Full article

This study aims to explore the relationship between the Diet Sustainability Score (DSS) and health outcomes, specifically body mass index (BMI) and waist-to-height ratio (WHtR). Using data from 2287 Portuguese adults in the National Food, Nutrition, and Physical Activity Survey (IAN-AF 2015–2016), DSS was calculated based on four dimensions: health-related nutritional attributes, environmental impact, economic affordability, and sociocultural acceptability. Logistic regression models were used to analyse associations between DSS and general adiposity (BMI classes: under/normal weight vs. overweight/obesity) and central adiposity (WHtR classes: healthy vs. unhealthy central adiposity). Models were adjusted for sex, age, education and physical activity level to control for potential confounders. Higher DSS is associated with reduced odds of overweight/obesity (OR = 0.91, 95%CI: 0.88, 0.94), and unhealthy central adiposity (OR = 0.91, 95%CI: 0.87, 0.95), suggesting that more sustainable dietary patterns are associated with more favourable adiposity profiles. This study highlights the importance of promoting sustainable diets as part of public health strategies aimed at addressing obesity and integrating health, environmental, economic, and sociocultural dimensions for more comprehensive, long-term population health improvements. Full article

Nutritional strategies based on sourdough fermented breads with wholemeal ancient grains and legumes are emerging as promising modulators of (neuro)immune processes. This study investigated whether prolonged consumption of a sourdough bread enriched with a mixture of ancient cereals and legumes, commercially available in Italy (Primus^® bread, P^®B), modulates neuroimmune systemic responses to repeated lipopolysaccharide (LPS) challenge in mice. For this study, male C57BL/6J mice were fed for 14 days with either a standard diet (SD) or P^®B. Animals then received intraperitoneal LPS (3 mg/kg/day for 3 days) or vehicle. Body weight and food intake were monitored throughout. Pain-like behaviours were assessed by von Frey, plantar and tail flick tests, and plasma cytokine (32-plex panel), splenocyte and peritoneal macrophage cytokine expression, and expression of pro-inflammatory cytokines in sciatic nerves, dorsal root ganglia (DRG) and the spinal cord were analyzed by Reverse Transcription–quantitative Polymerase Chain Reaction (RT-qPCR). P^®B prevented LPS-induced body weight loss and reduced splenomegaly. Unlike SD mice, which exhibited widespread plasmatic cytokine upregulation, P^®B-fed mice displayed only limited increases Interleukin (IL)-1β, IL-12p40 and Tumor Necrosis Factor (TNF)α. Ex vivo cultures of splenocytes and macrophages confirmed attenuated cytokine overexpression. LPS-induced hypersensitivity to mechanical, thermal and nociceptive stimuli was significantly reduced in P^®B mice. Molecular analyses revealed that the P^®B diet blunted the pro-inflammatory cytokine expression present after LPS challenge in the sciatic nerves and DRG, with partial attenuation in the spinal cord. Our findings highlight the great potential of functional foods as affordable dietary strategies to mitigate systemic immune and neuroimmune dysregulation. Full article

Aeromonas hydrophila infection is typically linked to outbreaks of diseases and its pathogenicity seems to be connected to environmental stress in hosts whose immune systems are compromised. Fish diseases have long been treated using synthetic antibiotics, but there are environmental and health concerns regarding their use due to the development of bacterial resistance. It has been suggested that essential oils (EOs), which are alternative antibacterial agents, could be applied in the aquaculture industry. Their biodegradability, affordability, efficiency, and quick metabolism minimize the likelihood of them building up in bodily tissues and provoking bacterial resistance. EOs can directly influence bacteria, altering the lipid composition and structure of bacterial cell membranes, enhancing their permeability, and disrupting their structure. In addition, they can boost fish immunity and increase resistance to contagious bacteria. EOs can be incorporated into fish diets as nutritional additives and/or applied in baths. This review discusses the in vitro and in vivo methodologies used to study the effects of EOs on A. hydrophila and the results obtained so far, as well as perspectives for new studies. Full article

Background: There are conflicting reports on the association of socioeconomic (SES) characteristics and lifestyle with salt and potassium intake as well as with the sodium-to-potassium (Na/K) ratio. This paper examined how SES status and lifestyle habits affect salt, potassium intake, and the Na/K ratio in adults. Methods: Adults subjects (random sample) from the EH-UH 2 nationwide study with valid 24 h urine samples were included in these analyses. We used a questionnaire which included SES and questions related to lifestyle. Salt and potassium levels were measured using a 24 h urine collection. Results: A low level of professional qualification and education are important predictors of high salt and low potassium intake. SES affects salt intake more than potassium intake. Processed meat was the most important determinant of high salt intake. It significantly affected potassium intake, but this was not relevant due to a poor Na/K ratio. Non-smoking status was related to high daily salt and potassium intake, but with no significantly positive impact on Na/K ratio. Former smokers swapped one unhealthy habit for another, such as overeating or consuming too much salt. The Adriatic/Mediterranean diet, represented in this study with frequent olive oil and fish consumption, was related to more favourable salt and potassium intake and a better Na/K ratio. Targets of daily salt and potassium intake, as well as of Na/K ratio were achieved in a very low proportion of the population regardless of SES, lifestyle and behaviour. Conclusions: Our results emphasize the need for public-health strategies that consider both diet and individual characteristics to address nutritional inequalities and promote healthier eating habits. Targeted nutrition programmes for lower SES groups should emphasize salt reduction and encourage potassium-rich diets, thus reducing health imparities and the burden of diet-related chronic diseases. The prevention strategy should be more proactive and specifically designed for the food (meat) industry. A more holistic approach should be taken for smokers when quitting smoking is necessary, the whole population should be educated to change habits toward the Adriatic diet pattern, and the government should make olive oil and fish more affordable to all citizens, particularly to those with poor SES. Full article

Background: Childhood obesity is on the rise in South Africa and adolescents spend a substantial amount of time in the school food environment (SFE), which plays a role in shaping their food choices and provides a critical setting to improve diets. Objective: To investigate South African adolescent school-going learners’ knowledge and understanding of healthy and unhealthy foods and the drivers of their food choices in their (SFE). Design: Qualitative participatory research methods including workshops, photovoice and focus group discussions (FGDs). Setting: Two urban public high schools, one non-metropolitan and one metropolitan, in two separate provinces (Eastern Cape and Gauteng) in South Africa. Participants: Adolescents 14–18 years (n = 42). Results: Unhealthy ultra-processed foods (UPFs) were found to be rampant in the SFE, and healthy foods were scarce, limiting learners’ choices. Taste preference was a major driver of adolescent food choices as were satiety, value for money, affordability, convenience, visual appeal and seeming “cool or “rich” by purchasing branded franchise fast foods. Learners had some general nutrition knowledge, but this did not translate into healthy food choices. Banning unhealthy foods in the SFE and providing affordable and satiating healthy foods were proposed as solutions. Conclusions: UPFs such as packaged foods and fast food were considered tasty but unhealthy, yet were preferred. Interventions are needed to promote healthy diets by changing the SFE, and eventually adolescent food choices. This will require government regulation banning the sale of unhealthy food and beverages (F&Bs) in the SFE and subsidising healthy satiating foods to change dietary behaviour. Full article

Food insecurity is not merely an outcome of individual deprivation but a place-based expression of how urban food systems operate within unequal socio-spatial contexts. Using the Drivers–Pressures–State–Impacts–Responses (DPSIR) framework as a policy-relevant analytical lens, this study examines the Metropolitan Region of Rome to show how structural inequalities and uneven food infrastructures shape exposure to food-related risks. The results show that vulnerability is amplified by food price inflation, the rising cost of a healthy diet, and spatial gaps in retail provision—captured through the combined presence of food deserts and food blackouts—disproportionately affecting peripheral municipalities. State indicators, including the Food Insecurity Experience Scale (FIES), the Food Affordability Index (FAI), and the spatial distribution of FEAD beneficiaries, reveal a markedly uneven geography of food poverty, mirroring a higher prevalence of overweight, obesity, and diabetes. These spatial configurations point to obesogenic environments in which constrained affordability and limited accessibility restrict the capacity to maintain healthy diets, generating hidden social and health costs that disproportionately burden peripheral areas. Overall, food insecurity in Rome follows a pronounced centre–periphery gradient rooted in structural and institutional arrangements rather than incidental variation. Addressing this condition requires place-based, justice-oriented interventions that strengthen food infrastructures, improve coordination across governance scales, and place food security at the core of an integrated metropolitan Food Policy. Full article

Remote Indigenous communities experience persistent inequities in access to fresh and nutritious foods due to the fragility of perishable food supply chains (PFSCs). Disruptions across procurement, transportation, storage, retail, and limited local production restrict access to perishable foods, contributing to food insecurity and diet-related health risks. This scoping literature review synthesizes evidence from 84 peer-reviewed, grey, and unpublished sources across fourteen countries to map PFSC management (PFSCM) challenges affecting food access in remote Indigenous communities worldwide and to synthesize reported practices implemented to address these challenges. PFSCM challenges were identified across all supply chain levels, and five categories of reported practices emerged: PFSC redesign strategies, forecasting and decision-support models, technological innovations, collaboration and coordination mechanisms, and targeted investments. These findings informed the development of a multi-scalar conceptual framework comprising seven interconnected PFSCM clusters that organize how reported practices are associated with multiple food access dimensions, including quantity, affordability, quality, safety, variety, and cultural acceptability. This review contributes an integrative, system-oriented synthesis of PFSCM research and provides a conceptual basis to support future scholarly inquiry, comparative inquiry, and policy-relevant discussion of food access and health equity in remote Indigenous communities. 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

What people consume for breakfast and why they do so have not been widely studied, especially in developing-economy countries. This study aimed to determine the breakfast food habits and their drivers of adults in South Africa, a multiethnic middle-income country. An online cross-sectional survey was conducted among 1000 representative consumers of moderate to higher living standard (Living Standard Measure [LSM] range ≥ 5). Data from 842 respondents (mean age 41 years, 51.7% females and 48.3% males) was analyzed. Of 21 different food types in descending order, the most frequently consumed were bread, ready-to-eat (RTE) cereals, fruits/nuts, high-fibre cereal, yoghurt, and leftovers, all consumed weekly by 42–65% of respondents. Principal component analysis revealed that three components had eigenvalues > 1 characterized as “On-the-go”, “Traditional”, and “Ready-to-eat and functional cereals”. They explained 49% of the data. Decision tree analysis revealed that, for example, Black respondents were more likely to consume foods in the “traditional” category. Quick-and-easy options, notably bread, RTE cereals, fruits/nuts, and leftovers, were dominant, especially among lower LSM respondents. Tasty and filling, and value for money, as exemplified by leftovers and vetkoek (fried dough), were important considerations, particularly among these respondents. These drivers can lead to unhealthy choices, a major concern in South Africa with its high level of diet-related diseases. This study, however, indicates that South African consumers, irrespective of age, ethnicity, and living standard, rated healthfulness and nutritional value highly as a benefit, the highest for choosing 13 of the 21 foods. Additionally, aspects of wellness, e.g., feeling energized/recharged, rated very highly. Thus, it is concluded that the opportunity exists to support consumer needs of nutrition and wellness together with affordability, taste, and satiety. Full article