Search Results (1,420)

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

Background/Objectives: Multi-strain Limosilactobacillus fermentum supplementation has been reported to promote weight loss outcomes in free-living conditions, but limited evidence exists on these probiotic strains added to an energy-restricted diet and walking program in overweight adults. Methods: In a double-blind, placebo-controlled, parallel-arm randomized trial, overweight adults (35.2 ± 13.2 years old, 167.6 ± 8.6 cm, 79.9 ± 11.8 kg, 28.4 ± 2.7 kg/m² body mass index, 36.1 ± 6.6% body fat) completed a 12-week weight loss program that included a 500 kcal/day energy deficit and walking 10 k steps/d. Participants ingested one daily capsule containing a three-strain probiotic blend (L. fermentum K7-Lb1, L. fermentum K8-Lb1, L. fermentum K11-Lb3; 6 billion CFU/day) (PRO) or maltodextrin placebo (PLA). Assessments were performed at baseline, week 6, and week 12 and included body composition, resting energy expenditure, substrate utilization, peak oxygen uptake, dietary intake, step counts, blood biomarkers, quality of life, and side effects. Data were analyzed using multivariate and univariate repeated-measures general linear models (GLM), with mean changes from baseline presented alongside 95% confidence intervals. Results: All participants significantly reduced body weight, fat mass, body fat percentage, and waist circumference. At 12 weeks, PRO reduced fat mass more than PL (−2680.7 ± 1276.7 g; p = 0.039). In PRO, android and gynoid fat percentage decreased at 6 weeks (p < 0.001; p = 0.008) and 12 weeks (p = 0.004; p < 0.001), respectively. Visceral adipose tissue mass, volume, and area were lower at 6 weeks and trended lower at 12 weeks. In PRO, bone mineral content and bone mineral area decreased at 12 weeks, while bone mineral density paradoxically increased (0.007 ± 0.003 g/cm²; p = 0.024). Conclusions: During a 12-week weight loss program, supplementation of a multi-strain L. fermentum probiotic significantly reduced body fat and central adiposity. Full article

Background/Objectives: Bariatric surgery is an effective intervention for severe obesity; however, long-term outcomes may be influenced by postoperative dietary behaviors, nutritional status, and complications. In Saudi Arabia, longitudinal evidence on weight trajectories and postoperative diet quality remains limited. The present study aimed at evaluating three-year weight status trends; assessing sociodemographic factors, baseline BMI, and postoperative diet quality; and examining nutrition-related complications following bariatric surgery. Methods: This retrospective longitudinal study included 189 adults who underwent sleeve gastrectomy at two tertiary hospitals in Jeddah, Saudi Arabia. Anthropometric data were obtained from medical records at six time points: preoperative, two weeks, six months, one year, two years, and three years postoperatively. Diet quality and postoperative complications were assessed via structured telephone interviews. Weight outcomes were expressed as percentage of total body weight loss (%TBWL), excess body weight loss (%EWL), excess body mass index loss (%EBMIL), and weight regain. Statistical analyses included Friedman’s test, Mann–Whitney U test, and multiple linear regression. Results: Significant improvements in all weight loss indicators were observed over three years (p < 0.001). Diet quality score was the only significant variable associated with weight loss at three years, with higher scores associated with greater %EWL and %EBMIL. Baseline BMI and DQS were significantly associated with %EWL (Beta = −0.17, 95% CI: −1.72 to −0.13 and Beta = 0.21, 95% CI: 1.37 to 7.12, respectively) and %EBMIL (Beta = −0.15, 95% CI: −1.68 to −0.07 and Beta = 0.24, 95% CI: 1.90 to 7.66, respectively). Age was significantly associated with weight regain (Beta = 0.20, 95% CI: 0.02 to 1.08). Conclusions: Bariatric surgery resulted in sustained weight reduction over three years. Postoperative baseline BMI and diet quality were significantly associated with %EWL and %EBMIL, underscoring the importance of structured nutritional follow-up and counseling. Full article

As global trends continue to embrace environmentally friendly, plant-based diets, food systems that are nutrient-dense, climate-resilient, and economically viable in addressing protein–energy malnutrition, micronutrient deficiencies, and food insecurity have increased. Although cereal–legume combinations are widely recognised to be highly nutritious, most studies have focused primarily on enhancing compositional efficiency and have overlooked their interactions with the food matrix and the processing-mediated transformations they undergo. This review combines recent findings examining cereal–legume food matrices as functional systems, with particular emphasis on nutritional complementarity, bioactive interactions, processing-induced modifications, and sensory acceptability. Studies indicate that cereals and legumes provide complementary amino acid profiles, dietary fibre, essential micronutrients, and phytochemicals within these composite matrices that influence digestibility, bioavailability, antioxidant activity, and glycaemic response. Processing methods, including fermentation, germination, roasting, and extrusion, modulate these interactions by releasing bound phenolics, reducing antinutritional factors, and altering starch–protein–phenolic complexes, thereby affecting health functionality and sensory quality. However, inadequately optimised processing can affect nutrient retention and consumer acceptability. Overall, this review emphasises the relevance of integrating food matrix science and processing optimisation for the production of functional, acceptable, and sustainable cereal–legume foods that promote product innovation, public health improvement, and the utilisation of underutilised crops for sustainable food systems. Full article

Cardiovascular disease (CVD) remains the leading global cause of death, with approximately 17.9 million mortalities annually. Studies have shown that adopting healthy behaviors, i.e., a balanced diet, regular physical activity, and weight management, can reduce CVD risk. However, evaluating their long-term impact requires extensive data collection and analysis, which are both time-consuming and challenging. This study developed a novel mathematical framework integrating an agent-based model (ABM) to simulate CVD risk progression and established clinical guidelines into synthetic training data for machine learning (ML) classification. The ML model was trained entirely on synthetic data generated from World Health Organization/International Society of Hypertension cardiac risk indications, and validated using outcomes from a NetLogo simulation. The workflow does not use real patient data; instead, the expected simulation results serve as a reference to assess the ML model and synthetic data. The ABM, designed in NetLogo, exchanges agent characteristics with a trained ML model to classify individuals into appropriate CVD risk levels based on lifestyle and clinical parameters. The simulation indicated measurable risk progression (5–12%) by year 20 in individuals with both smoking and diabetes. A combined effect of high dietary intake and low physical activity showed over 20% risk increase, demonstrating the model’s capacity to capture dynamic risk interactions. The relationship between CVD risk and systolic blood pressure was also effectively reproduced. Additional scenarios confirmed the alignment of model outcomes with real-world trends, showing model self-consistency, identifying critical thresholds and population-level risk shifts through detailed tabular analysis. Beyond confirming known associations, the findings support the internal consistency of the model, highlighting its potential as a simulation based tool for studying cardiovascular risk patterns and supporting risk monitoring within controlled settings. Full article

Background: The use of sports supplements among adolescents is rising globally, driven by fitness trends and social media influence, yet knowledge gaps persist. This study aimed to assess supplement usage patterns, knowledge, attitudes, information sources, and the impact of a social media educational intervention among Serbian secondary school students. Methods: A single-group pre–post educational intervention study was conducted in secondary school students (aged 14–18) in Vojvodina, Serbia. A 21-question anonymous questionnaire was distributed to 1000 students along with parental informed consent forms. Pre-intervention survey assessed sociodemographics, physical activity and social media habits, supplement use information sources, and awareness of risks and banned substances. Based on the initial findings, an educational campaign delivered 56 short videos (≈70 s each) on Instagram and TikTok covering most frequently used supplements (e.g., creatine, proteins, caffeine, energy drinks). After, the intervention survey was repeated. The data were analyzed using the McNemar–Bowker test of symmetry. Results: In this study, 65% of Serbian secondary school adolescents reported being physically active, engaging predominantly in gym workouts and team sports. The majority of participants initiate dietary supplement use independently, without consulting healthcare professionals or adults. The most commonly used supplements were vitamins and minerals, while energy drinks ranked notably high. Social media intervention had a limited impact due to its short duration; however, certain changes were detected. Conclusions: Serbian adolescents frequently use sports supplements without adequate professional guidance. Long-term TikTok/Instagram interventions could be used in the future in order to influence behaviors and improve knowledge about sport supplement use. Full article

Background/Objectives: Obesity remains difficult to treat effectively, not because weight loss cannot be achieved, but because it is difficult to sustain in the face of physiological adaptations to energy restriction, including reductions in resting metabolic rate and loss of fat-free mass. Dietary strategies that preserve favorable body composition while supporting long-term adherence are therefore needed. The purpose of this study was to compare continuous caloric restriction (CCR) with an intermittent approach incorporating structured diet refeeds and planned diet breaks (DRF) on body composition outcomes in adult women with obesity. Methods: Thirty adult females (18–65 years; BMI 30–45 kg·m⁻²) were randomized to 12 weeks of CCR or DRF following a two-week maintenance phase used to determine individualized caloric needs. Both groups were prescribed a 25% caloric deficit and protein intake of 1.2 g·kg⁻¹·day⁻¹. Body composition, including body fat percentage, fat mass, and fat-free mass, was assessed using air-displacement plethysmography at baseline and post-intervention. Results: Repeated-measures ANOVA revealed a significant main effect of time for body fat percentage (p < 0.001), which decreased by 6.7 ± 2.1% in the CCR group and 6.0 ± 1.9% in the DRF group, with no significant group × time interaction (p > 0.05). Fat mass significantly declined in both groups (p < 0.001), with reductions of 9.30 ± 2.77 kg (CCR) and 9.21 ± 2.63 kg (DRF); between-group differences were negligible (p > 0.05; Cohen’s d = 0.03). Fat-free mass increased over time (p < 0.05); although the interaction was not significant (p = 0.08), the DRF group demonstrated a moderate effect size advantage. Despite similar changes in body composition, analysis of energy balance revealed a significantly greater daily energy deficit in the CCR group compared with DRF (−1005 ± 515 vs. −690 ± 120 kcal·day⁻¹, p = 0.041), indicating a higher achieved level of caloric restriction in CCR. Conclusions: Both dietary strategies effectively reduced fat mass in females with obesity; however, incorporating diet breaks was associated with a nonsignificant trend toward greater preservation or accrual of fat-free mass without compromising fat loss. Future studies should investigate this potential association in larger, adequately powered trials before any conclusions regarding metabolic adaptation or practical advantage can be drawn. Full article

Background/Objectives: Plant-based dietary patterns like the Dietary Approaches to Stop Hypertension (DASH) reduce cardiovascular risk, which is a leading cause of mortality globally and in Spain. Diet is also a major environmental determinant, highlighting the need to evaluate public health alongside environmental sustainability. The aim of this study was to analyze the evolution of adherence to the DASH dietary pattern in Spain between 2006 and 2023 and evaluate its relationship with environmental sustainability indicators. Methods: This was an ecological epidemiological study. Food consumption data were harmonized into daily servings to calculate annual DASH scores using a standard 80-point methodology. Environmental impact was assessed by calculating the comprehensive Ecological Footprint (EF) using the Agribalyse^® 3.2 database. The study utilized open data from the Spanish Household Budget Surveys, capturing the consumption habits of approximately 24,000 randomly selected Spanish households annually from 2006 to 2023. The primary measures evaluated were the annual DASH adherence index score and the overall environmental Ecological Footprint. Temporal trends were evaluated using segmented regression models selected via the Akaike Information Criterion and Davies test. Pareto analysis determined individual food group environmental contributions, and correlations assessed the relationship between DASH scores and the EF. Results: DASH adherence increased by 8.26% over the study period, peaking in 2020. The EF demonstrated an overall decrease over time, largely driven by reduced consumption of meat, fish, and eggs. A strong inverse correlation was found between the DASH score and the EF (r = −0.8237 (95% CI: −0.932 to −0.580; p < 0.001)). Conclusions: A shift toward the DASH dietary pattern in Spain demonstrates potentially convergent health and environmental associations, promoting population cardiovascular health potential while simultaneously mitigating environmental impacts. Full article

Recently, the Japanese government has introduced ambitious policies for agricultural sustainability, specifically the MIDORI Strategy, aimed at reducing chemical fertilizer use, expanding organic farmland, and increasing calorie-based food self-sufficiency. To evaluate the feasibility of these goals, this study quantified nitrogen and phosphorus flows within the 2021 food and feed system using a normalized “Nutrient Index”. A scenario analysis was conducted using policy targets as parameters, where currently non-circulated waste streams were modeled as potential sources for domestic nutrient recovery. The results indicate that Scenario A (a 30% reduction of chemical fertilizers) is the most feasible, achieving significant improvements in circulation ratios through recovery of nutrients from sewage and livestock waste. While Scenario B (increasing organic farmland) shows similar trends, its success depends on technological advancements to mitigate the yield gap between organic and conventional systems. Scenario C (increasing calorie-based food self-sufficiency) presents the greatest challenge: maintaining current dietary patterns requires a great shift in nutrient recovery from waste. However, shifting dietary habits toward higher domestic rice consumption (Scenario C-2) significantly mitigates land and fertilizer demand. Achieving these targets requires a holistic approach that integrates technological infrastructure with socio-political shifts in land use planning and consumer behavior. Full article

Background/Objectives: Diet plays a crucial role in bone health; however, most studies have focused on individual nutrients or foods. The relationship between overall dietary quality and bone health in children and adolescents remains unclear. This study aimed to assess the association between diet quality scores and bone health in a pediatric population. Methods: A total of 3299 students aged 9–17 participated in this study. Dietary quality was assessed using the Chinese dietary guidelines index for Children and Adolescents (CDGI-Cs). Bone health was evaluated through calcaneal quantitative ultrasound (QUS), utilizing the speed of sound (SOS) as the key indicator. Generalized linear models and binary logistic models were used to analyze the association between CDGI-C scores and bone health outcomes (SOS Z scores and the risk of low SOS), respectively. Results: After full adjustment, CDGI-C scores showed a significant positive association with SOS. A 10-point increase in CDGI-C scores was associated with a 0.08-unit increase in SOS Z score (95% CI: 0.04, 0.11) and a 15% reduction in the risk of low SOS (OR = 0.85, 95% CI: 0.76, 0.94). Compared to participants in the lowest quartile of CDGI-C scores, those in the highest quartile exhibited significantly higher SOS Z scores (β = 0.18, 95% CI: 0.08, 0.29, p for trend < 0.001), and a 29% lower risk of low SOS (OR = 0.71, 95% CI: 0.50, 1.00, p for trend = 0.050). In dietary item analysis, higher intake of dairy and dairy products (β = 0.02, 95% CI: 0.00, 0.03) and seafood (β = 0.01, 95% CI: 0.00, 0.03) remained positively associated with SOS Z scores. Conclusions: Higher diet quality, as measured by CDGI-C, was significantly associated with better bone health in children and adolescents. Dairy, dairy products, and seafood emerged as key dietary components contributing to this positive association. Full article

Food trucks (FTs) are becoming increasingly popular in Saudi Arabia. However, inadequate food safety practices and limited consumer awareness of foodborne pathogens may increase the risk of foodborne illnesses associated with consumption from FTs. Therefore, we assessed consumer knowledge, attitudes, associations with sociodemographic characteristics, and dietary patterns among FT customers. A cross-sectional study was conducted in the Makkah region, Saudi Arabia, between March to October 2025. An online questionnaire was completed by 500 adults covering sociodemographic characteristics, food safety knowledge, attitudes, pathogen awareness, and dietary intake. Data were analyzed using the independent t-test, one-way analysis of variance, and linear regression. The mean scores for awareness, knowledge, and attitudes were 16.7 ± 3.8, 14.7 ± 3.3, and 30.8 ± 5.3, respectively. Women had considerably higher knowledge and awareness scores than men (p < 0.0001). Significant correlations were found between food safety knowledge and attitude scores (r  =  0.531, p  <  0.001), food safety knowledge and awareness scores (r  =  0.633, p  <  0.001), and attitude and awareness scores (r  =  0.429, p  <  0.001). A trend toward high fruit consumption was observed among participants with high knowledge and awareness scores. These findings highlight the need for targeted consumer education to improve pathogen awareness among FT customers. Full article

Background: Celiac disease (CeD) requires lifelong adherence to a strict gluten-free (GF) diet. During the COVID-19 pandemic, the prevailing clinical assumption was that food supply disruptions and dietary management difficulties would be the primary sources of patient distress. This exploratory cross-sectional study directly tested this assumption in an Italian CeD cohort. Methods: COVIMPACT is an exploratory observational, web-based study conducted in Italy (data collected: July–September 2024; participants retrospectively reported their experiences during the COVID-19 pandemic period 2020–2022). Participants with a confirmed CeD diagnosis were recruited through patient associations and online networks. A structured 26-item questionnaire addressed socio-demographic, nutritional, psychological, and healthcare-access domains. Descriptive statistics, chi-square bivariate analyses (Cramér’s V as effect size), and binary logistic regression were performed using R (v4.1) and Python. Results: Among 118 participants (78% female; median age 36 years; IQR 12–42), 27% reported self-perceived psychological distress. Against expectation, difficulties in accessing GF products and changes in gluten consumption showed no clear associations with distress. Instead, social exclusion showed the strongest association (Firth OR = 5.55, 95% CI: 1.80–17.09, p = 0.003), while reduced physical activity (Firth OR = 5.28, 95% CI: 1.86–14.99, p = 0.002, full model; Firth OR = 5.54, p = 0.001, reduced model) and negative economic impact (Firth OR = 3.77, 95% CI: 0.89–15.97, p = 0.071, trend) were additional associated factors. Female sex showed a non-significant trend (Firth OR = 4.21, p = 0.082). All estimates carry wide confidence intervals (EPV = 4.1) and should be treated as hypothesis-generating. Conclusions: These preliminary findings suggest that social exclusion and physical inactivity may be more strongly associated with self-perceived distress than dietary challenges in contexts where GF food access is structurally protected. Results are exploratory, hypothesis-generating, and should not be generalised beyond this selected Italian cohort. Full article

Background/Objectives: Nuts have been associated with various health benefits, yet the evidence regarding their relationship with dementia is inconclusive. This study aims to examine the association between nut consumption and long-term risk of dementia across three prospective cohort studies. Methods: We analyzed data from adults aged 45 and older who were free of dementia at baseline in the Health and Retirement Study (HRS, 2013–2020), the Framingham Offspring Study (FOS, 1998–2018), and the Whitehall II Study (WHII, 2002–2016). Nut consumption, including tree nuts and peanuts, was assessed using validated food frequency questionnaires (FFQs) once at baseline in the HRS and repeatedly across multiple waves in the FOS and WHII. Incident all-cause dementia was identified through a validated algorithm in the HRS, expert panel reviews in the FOS, and healthcare record linkages in the WHII. Cox proportional hazards models were used to estimate the cohort-specific association between nut consumption and incident dementia, which were subsequently pooled. Results: Over 190,914 person-years of follow-up, 992 incident dementia cases occurred among 17,349 participants across the three cohorts. After multivariable adjustments, higher nut consumption was associated with a lower risk of dementia, with pooled hazard ratios (HRs) of 0.80 (95% confidence interval [CI]: 0.69–0.94; I² = 0.0%) for 0.1–5.0 g/day vs. 0 g/day and 0.76 (95% CI: 0.58–0.99; I² = 40.4%) for >5.0 g/day vs. 0 g/day (p-trend = 0.015). Conclusions: Our findings suggest that higher nut consumption was associated with a lower risk of incident dementia among middle-aged and older adults, with evidence of a dose-response trend observed in pooled analyses. These preliminary results support its inclusion as part of an overall brain-healthy dietary pattern. Full article

Methionine (Met) and lysine (Lys), as primary limiting amino acids, play important roles in regulating muscle quality in aquatic animals. This study investigated the effects of dietary Met and Lys supplementation on the growth performance, antioxidant function, and muscle quality of Hefang crucian carp (HCC) using physiological and transcriptomic analyses. Fish were fed three diets for 8 weeks: a basal diet (LA) and two diets supplemented with DL-methionine at 1.7% (MA) and 3.4% (HA), respectively, while L-lysine supplementation was fixed at 3.4%. The results indicated that dietary Met and Lys supplementation had no significant effect on the growth performance of HCC (p > 0.05), but significantly reduced serum triglyceride (TG) and cholesterol levels (T-CHO) (p < 0.05). Additionally, serum total protein (TP) content was significantly increased in the MA group (p < 0.05). Analysis of serum antioxidant enzyme activities indicated that appropriate Met and Lys supplementation improved antioxidant capacity and upregulated the expression of antioxidant-related genes (Nrf2, GPX1a, GSTO1, GSTP1) in the muscle. Moreover, the MA group exhibited superior muscle hardness and gumminess, while the HA group had higher springiness and chewiness (p < 0.05). Muscle fiber density was significantly increased, whereas diameter and area showed opposite trends in fish fed 1.7% Met and 3.4% Lys (p < 0.05). Furthermore, appropriate Met and Lys supplementation significantly affected muscle fiber development genes (MyoD, MyoG, and MRF4), with MyoG highest in the HA group and MyoD and MRF4 highest in the MA group (p < 0.05). Comparative transcriptomic analysis of muscle tissue showed DEGs were mainly enriched in pathways correlated with muscle quality, involving cardiac muscle contraction, actin cytoskeleton regulation, PPAR signaling pathway and ECM–receptor interaction. Taken together, our findings enhance the understanding of the molecular mechanisms underlying the effects of dietary Met and Lys on muscle quality in HCC, providing valuable insights for the development of nutritional strategies in the aquaculture industry. Full article

Background: Aflatoxin B1 (AFB1) is a potent hepatocarcinogen commonly found in staple foods from tropical regions. Aim: This scoping review collated existing evidence on AFB1 contamination in rice, maize, and peanut-based products across ASEAN countries to estimate chronic dietary exposure, Margin of Exposure (MOE), and the associated liver cancer risk. Methods: A systematic search was performed in five databases. Estimated Daily Intake (EDI) and risk metrics were calculated using sample-size weighted mean concentrations, along with regional consumption data. Risk characterisation used the benchmark dose lower confidence limit (BMDL₁₀) of 400 ng/kg BW/day, while liver cancer potency levels were adjusted according to Hepatitis B virus (HBV) prevalence for each population. Results: Twenty studies from Malaysia, Thailand, Vietnam, and the Philippines met the inclusion criteria. Peanuts and maize had the highest AFB1 concentrations among all food groups. Peanuts showed the highest contamination in the Philippines, followed by Malaysia, Vietnam, and Thailand. Maize exhibited a similar trend, with the highest levels observed in the Philippines. Most MOE values calculated were below 10,000, indicating a major public health concern. An exception was peanuts in Thailand, where MOE values exceeded 10,000, thus indicating a lower genotoxic carcinogenicity risk. The estimated liver cancer burden due to dietary AFB1 varied widely among countries and commodities. Conclusions: These findings show significant differences in AFB1 exposure in the ASEAN region. There is a need for improved surveillance, better post-harvest management, and harmonised regional risk management strategies. Full article