Search Results (168)

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

Background: Childhood obesity is a complex public health issue in which parental perceptions and family dietary behaviors are pivotal. This study assessed the feasibility of the Smart Family lifestyle counseling intervention in Greek primary care. It explored changes in children’s dietary behaviors relative to parental weight perception and Mediterranean diet adherence. Methods: A single-arm pretest–posttest pilot study was conducted in Patras, Greece, from Health4EUKids Joint Action. The intervention consisted of four monthly face-to-face counseling sessions using the Smart Family methodology. In total, 49 parent–child dyads (aged 2–12 years) completed the program. Data collection included child anthropometric measurements, validated food frequency questionnaires, parental perception of child weight status, and parental Mediterranean diet adherence. Results: Parents who underestimated their child’s weight status had significantly higher Mediterranean diet scores than those who overestimated (p = 0.032); those with low adherence tended to overestimate and those with moderate adherence to underestimate. The largest reduction was observed for sweets and desserts (median −2.35 servings/week), with significant reductions in sugar-sweetened beverages, grains and cereals, whole wheat products, and dairy. Fish and vegetable intake increased significantly, but fruit intake did not change. Changes in fast food and red meat differed significantly across Mediterranean diet score tertiles, with larger decreases in the lower tertiles. Conclusions: Smart Family counseling was feasible to deliver through trained healthcare professionals in Greek primary care over four months, with reductions in selected discretionary foods observed alongside the intervention. Parental weight perception and Mediterranean diet adherence emerged as potential barriers to change although the findings are exploratory and require confirmation in a future controlled trial. Full article

Accurate assessment of sodium intake and its dietary sources is essential for developing effective sodium reduction strategies. This study estimated total dietary sodium intake (DSI) and source-specific contributions using questionnaire-based methods, validated against urinary sodium excretion (USE). Two cross-sectional surveys were conducted in 2023 among adults aged 15–59 years in Burkina Faso (N = 749) and Senegal (N = 1340), selected through stratified sampling. USE was estimated from spot urine samples, calibrated using 24 h urine collections in a sub-sample (eUSE). DSI was assessed using three complementary methods: (1) household purchasing/adult male equivalent (AME) for small-commodity foods and discretionary salt, (2) 24 h recall for sodium-rich foods consumed in and outside the home, and (3) a food frequency questionnaire for composite dishes eaten outside the home. Median DSI from dietary methods (2.6 g/day) closely matched estimates from eUSE (2.7 g/day) in Burkina Faso but was overestimated in Senegal (5.4 vs. 3.1 g/day), mainly due to difficulty estimating discretionary salt use in households buying large quantities. The country-specific validation of spot urine showed good agreement with 24 h collections. Combining complementary dietary intake methods offers a feasible approach to estimating total and source-specific sodium intake in settings with frequent small salt purchases. In settings with large salt purchases and salt being used for purposes other than human consumption, the salt purchasing/AME method to quantify the use of discretionary salt at the household level should be replaced by the salt disappearance method. Full article

The highly competitive nature of the online food delivery (OFD) market faces a serious retention problem, with acquiring new users typically being much more expensive than retaining existing users. Traditional prediction methods that rely primarily upon static transactional metrics such as recency and frequency are often unable to capture the psychological ‘disconfirmation’ which occurs prior to churn. To fill this gap, this study proposes a framework based on Expectation-Confirmation Theory (ECT). Unsupervised K-Means clustering was employed to classify a simulated and filtered dataset with 1500 customer records containing behaviour, geography, etc. This framework also couples sentiment analysis from BERT, allowing it to identify psychological “silent” attrition. Heterogeneous cohorts, which exhibit different psychological antecedents (utilitarian versus hedonic), were identified. The empirical results of our analyses demonstrated that Random Forest Classifiers with segment-specific features outperform baseline transactional models (F1 = 0.76) with an F1 Score of 0.89. The visual analytic interface developed provides a holistic view of the consumption process than traditional prediction models, including prescriptive, automated segment-based mitigation strategies. Our findings contradict the assumption that the “frequency–loyalty” model applies to all users. High-frequency discretionary users are found to be elastic in terms of retention and will experience significant churn. By utilising the automated action log, managers can plan targeted, highly efficient retention strategies rather than blanket discounting approaches. Full article

Background: Adults with inflammatory bowel disease (IBD) have a high prevalence of modifiable cardiometabolic risk factors. This study investigates the impact of a personalised diet and physical activity intervention versus usual care on the risk factors. Methods: A 6-month randomised controlled trial was conducted at three hospitals in New Zealand (NZ) from 2023 to 2024. Adults with IBD in remission, a body mass index > 25 kg/m², and a low fibre intake < 25 g/day were recruited. Participants were randomised to receive either generic healthy eating and physical activity education or personalised heart-healthy eating education based on the NZ Heart Foundation and a self-led physical activity program. The primary outcome was change in body fat, and secondary outcomes included disease activity, biomarkers, quality of life, physical activity, and dietary intake. Between-group differences were analysed using multivariable regression. Results: Sixty-four participants were randomised, and 51 (80%) completed the intervention. The median age was 47 years (LQ, UQ: 37, 55), 59% participants were female, 61% had Crohn’s disease, and 85% had faecal calprotectin < 150 µg/g. Common cardiometabolic risks were high waist circumference (88%) and abnormal lipid profile (56%). There were no significant differences in primary or secondary outcomes except for dietary intakes: increased fruit (0.5 serves/day; 95% CI: 0.1, 1.0) and dietary fibre (3.1 g/1000 kcal/day; 95% CI: 1.1, 5.1); reduced discretionary food and drink (−1.7 serves/day; 95% CI: −3.0, −0.3), and sodium (−911 mg/day; 95% CI: −1783, −40). Conclusions: Personalised dietitian advice led to meaningful dietary changes without exacerbating disease activity. More intensive activity modalities can be recommended to support body composition improvements. Full article

Packaged discretionary foods that are energy-dense and nutrient-poor are widely available in the current food environment, potentially contributing to overconsumption and excessive energy intake over time. Factors such as on-pack visual cues (for example, front-of-pack image and food units per serving) and structural features (for example, package transparency) have an important role in nudging consumers towards better portion control. As little is known regarding the presence of these features on packaged discretionary foods in the current retail context, this study aimed to examine the presence of such cues on packaged discretionary foods in Australian supermarkets. Six common packaged snacks were selected: ice-cream, chocolate, lollies, sweet biscuits, savoury biscuits and crisps. Data were collected by in-store visits and using retail websites. A total of 1930 products were included; the majority were share packs (n = 1419, 73.5%), followed by multipacks (n = 385, 19.9%) and single packs (n = 126, 6.5%). Less than half of the share pack products (47%) had front-of-pack images aligned with the manufacturer-suggested serving sizes on the Nutrition Information Panel. Structural features, including transparency, partitioning and resealability, were less common and identified in less than 30% of packaged snacks. Overall, the findings showed that on-pack visual cues and structural features are not commonly used for portion control in packaged discretionary foods in Australian retail settings. Opportunities exist to improve on-pack cues and guides to support better portion size decisions. Full article

Background/Objectives: Poor dietary habits are a major contributor to non-communicable diseases (NCDs), the leading cause of mortality worldwide. To promote healthier eating, governments and stakeholders have implemented various nutrition policies, including front-of-pack nutrition labeling (FOPNL). The Choices International Foundation (Choices), through its criteria, supports these efforts through its standardized nutrient profiling system (NPS). Originally developed to underpin a positive FOPNL logo, in 2021, the criteria were expanded into a globally oriented five-level profiling system covering 23 basic and 10 discretionary food groups, addressing key nutrients such as trans-fatty acids, saturated fat, sodium, sugar, fiber, and energy. To ensure continued scientific relevance, the Choices criteria are periodically reviewed by an independent International Scientific Committee (ISC). Methods: This paper presents the 2025 revision of the Choices criteria, focusing on priority areas identified through stakeholder consultation and recent scientific developments. Results: Key updates include the introduction of nutrient-based equivalence criteria for plant-based alternatives to meat and dairy, based on protein and selected micronutrient thresholds. Non-sugar sweeteners (NSSs) were newly included as a factor that lowers a product’s health classification and makes it ineligible for a positive FOPNL. Additionally, the industrially produced trans-fatty acid (iTFA) criteria were revised and aligned with the latest World Health Organization (WHO) recommendations, improving both technical feasibility and policy coherence. While options for incorporating whole-grain and micronutrient criteria were explored, these were not included in the current revision. Conclusions: The 2025 update system enhances the scientific rigor, policy alignment, and global applicability of the Choices system. By providing a harmonized and evidence-based tool, it aims to support national policies that foster healthier food environments and, ultimately, improve public health outcomes worldwide. Full article

Background/Objectives: Under the urban–rural dual structure, rural children’s health security faces multiple challenges. These stem from geographical disadvantages, inadequate resources, and systemic flaws in medical insurance design. The outpatient cost-sharing policy is a key design to address these issues. Methods: Using data from the 2018 China Household Income Project (CHIP), this study employs Propensity Score Matching, Ordered Probit, Logit, and a Two-Part Model to examine the association between the policy and the health and economic outcomes of rural children. Conclusions: The results show that the policy is significantly associated with better child health scores and a higher probability of reimbursement. These positive associations appear to be connected to three potential factors: higher use of outpatient services, better mother’s health, and greater school-related food and accommodation expenses. In contrast to adult populations, no significant substitution between outpatient and inpatient services was observed for children, suggesting the non-discretionary and rigid nature of pediatric hospitalization decisions. This research provides robust empirical evidence for the policy’s potential benefits, offering important implications for optimizing the child medical security system. Full article

The assessment of food system sustainability requires a profound understanding of the evolution of food production and consumption. Monitoring the transition towards healthier and sustainable diets is crucial for supporting future interventions. This study explores market sales data as an input to investigate and compare current dietary trends in the European Union Member States over 14 years. By analysing consumption trends of major food product categories, including animal-based and plant-based foods, we identified two distinct clusters of countries with opposite dietary patterns. Our analysis explored not only major food product categories essential for healthy living but also superfluous foods (i.e., discretionary) to provide a broader understanding of dietary habits. In particular, our results show that countries reducing consumption of animal-based foods also exhibit a reduction in consumption of discretionary products, such as alcoholic beverages and soft drinks, highlighting opportunities for synergies between environmental and health policies. This research provides valuable insights for policymakers and stakeholders aiming to promote the uptake of healthy and sustainable diets and supports the development of targeted strategies to support the transition towards more environmentally friendly and healthy food systems. Full article

Protein-rich foods, such as meats, eggs, nuts, legumes, and dairy foods, can be important sources of micronutrients, especially those micronutrients that tend to be widely under-consumed. The source of dietary protein, animal or plant origin, is therefore a relevant consideration in the transition to healthier and sustainable diets. In this study, 1589 Australian adult diets with higher diet quality and lower environmental impact were isolated from Australian Health Survey data. These diets were primarily differentiated by lower intake of energy-dense/nutrient-poor discretionary foods. These diets were grouped according to the proportion of total protein obtained from animal and plant sources. On average, 55% of protein was from animal sources and 45% was plant derived. As the proportion of animal protein increased, total dietary protein intake also increased, and total energy intake decreased. Diets with between 60 and 80% of protein from animal sources met the greatest number of Estimated Average Requirements (EARs). Furthermore, diets with this ratio of animal protein were closest to benchmarks when assessed as a proportion of EAR met. That said, across all identified “sustainable healthy diets”, calcium, vitamins B6 and A, zinc, and magnesium were at risk of inadequate intake. This evidence suggests that a diet with around 60–80% of total protein coming from animal sources can reduce the risks of inadequate intake of micronutrients in a sustainable diet. Full article

Background: Dietary intake during the first year of life is a key determinant of a child’s growth and development. ORIGINS is a longitudinal birth cohort study investigating factors that contribute to a ‘healthy start to life’ and the prevention of non-communicable diseases. Methods: This descriptive cross-sectional study aims to describe the dietary intakes of one-year-old children participating in ORIGINS and compare these to the Australian Dietary Guidelines and Nutrient Reference Values (NRVs). Between 2020 and 2023, dietary intake data were collected on 779 one-year-old children using a Food Frequency Questionnaire (FFQ). The analysis explored milk intake (breastmilk, infant formula, and cow’s milk), the introduction to solids, macronutrient, micronutrient, and food group intakes. Results: The results indicated that 41.5% were still being breastfed at one year of age, while 58.0% continued to receive formula milk. While the cohort met NRV cut-offs for most micronutrients, iodine intake fell below requirements, and sodium intake exceeded recommendations. Diet quality, based on the food group intake, did not meet recommendations, with children over-consuming fruit and discretionary foods, while under-consuming vegetables and cereals and grains foods. Conclusions: These findings highlight areas for improvement in the dietary intake of one-year-old children. Full article

Background: Discretionary foods are not necessary for a healthy diet and are too high in saturated fat and/or added sugars, added salt, or alcohol and are low in fiber. The aim of this study was to identify patterns of discretionary food (DF) consumption in Polish adolescents in relation to anthropometric, socio-demographic, and lifestyle factors. It is important to learn about discretionary food consumption habits to identify health risks and plan strategies to reduce DF consumption. Methods: The cross-sectional study was conducted among 2849 primary school students aged 10–12 from Poland. Socio-demographic data, eating habits, lifestyle factors, and nutritional knowledge of children were assessed using questionnaires: KomPAN^® and SF-FFQ4PolishChildren^®. Body composition testing was performed by bioelectrical impedance analysis (BIA) using a TANITA MC-780 S MA multi-frequency segmented analyzer. Results: Four dietary patterns were identified with different frequencies of discretionary food consumption: LowDF, MediumDF, HighDF, and HighSweet pattern. Children from the LowDF and MediumDF patterns had higher BMI and body fat content than children from the HighDF and HighSweets patterns (p < 0.0001). The majority of children (68.4%) were of normal weight, 22.3% were overweight or obese, and 9.4% were underweight. Children in the LowDF and MediumDF patterns had higher body fat (24% and 23.5%, respectively) than children in the HighDF and HighSweetDF patterns (22.4% and 22.4%, respectively). Most of the children showed adherence to the MediumDF pattern, and they were mainly boys (38 vs. 32.5%). Girls predominate in LowDF, HighDF, and HighSweets patterns (33.5, 18.4, and 15.5%, respectively). Children in the LowDF and MediumDF patterns tended to be more physically active in their leisure time (OR = 1.758 (CI:1.32 2.34) p < 0.0001; OR = 1.354 (CI:1.04; 1.76) p = 0.0227) and the opposite relationship was observed in the HighDF pattern (OR = 0.495 (CI:0.38; 0.65) p < 0.0001). Children in the HighSweets pattern had low adherence to high physical activity (OR = 0.666 (CI:0.48; 0.92) p = 0.0132), but high adherence to moderate (OR = 1.29 (CI:1.01; 1.65) p = 0.0443) and high (OR = 1.54 (CI:1.04; 2.38) p = 0.0428) nutrition knowledge. Conclusions: Consumption of discretionary foods by Polish adolescents is related to body composition, socio-demographic, and lifestyle factors. Given the global emphasis on improving the daily diet, it seems necessary to implement intervention programs in Poland that would, among other things, clarify recommendations for the consumption of discretionary foods, following the example of other countries that have already achieved results in this regard. From a public health perspective, interventions to increase nutritional knowledge and improve lifestyles should be implemented with both adolescents and their parents in coordination with the school. Full article

Climate change is a global priority requiring immediate action. A thorough understanding of the source of greenhouse gas emissions is essential to inform reduction strategies. This study aimed to quantify the climate footprint of two therapeutic diets—one diet for an adult with coeliac disease and one diet for an adult with type 2 diabetes—and then compare the climate footprint of these diets with the standard Australian diet and the Australian adapted EAT Lancet Planetary Health Diet. In addition, potential areas for reductions in greenhouse gas emissions were explored. All diets were developed for a 71-year-old male reference person. The amount of carbon dioxide produced by each diet was determined using the GWP* calculator for the reference person. Both the gluten-free and diabetic diet had a measurable climate footprint and were not considered climate-neutral. The diabetic diet produced 1.35 kg of carbon dioxide equivalents [CO₂e] per day, and the gluten-free diet produced 2.51 kg of CO₂e per day. Meat, dairy, and discretionary foods were the major contributors to the climate footprint of the two therapeutic diets. Substituting lamb for beef and soy milk for cow milk in the Australian context resulted in a 25% reduction in the climate footprint for the diabetic diet and 29% reduction for the gluten-free diet. Dietetic advice to reduce the climate footprint of therapeutic diets for coeliac disease and type 2 diabetes should focus on adapting diets to reduce animal-based products. Full article

Background/Objectives: Food matching aligns food consumption and food composition data to quantify intakes of a food component or category. A systematic approach to food matching is required to obtain the highest quality match and, therefore, most accurately quantify the intake of the food component under investigation. This study aims to provide a tool to assess adherence with the Australian Dietary Guideline food group recommendations by the development of a food matching method that links dietary intake data from a food frequency questionnaire to food group data in the Australian Dietary Guideline database. Methods: Two researchers trained in food composition independently applied a stepwise approach to link the Dietary Questionnaire for Epidemiological Studies Version 2 food frequency questionnaire and the Australian Dietary Guideline database. Food preparation methods, mixed dishes and Australian Dietary Guideline database representative foods were considered to ensure the highest quality result. Average values were calculated for foods for which multiple items were matched. Results: The Australian Dietary Guideline Adherence Tool (ADG-AT) was produced, providing the number of servings of the five Australian Dietary Guideline food groups and discretionary foods per 100 g of food for 5742 food items. Conclusions: The ADG-AT produced in this study allows convenient evaluation of Australian Dietary Guideline adherence in studies using the Dietary Questionnaire for Epidemiological Studies food frequency questionnaire to collect dietary intake data. This informs the identification of dietary risk factors for nutritional inadequacy and chronic disease. The systematic methods used in this study can be reapplied to different dietary intake collection tools and food composition databases. Full article

A balanced diet and regular physical activity are essential for maintaining musculoskeletal health. Key nutrients such as calcium, vitamin D, and protein are especially important for preventing falls and fractures. While the benefits of these nutrients are well-established, other dietary components have not been studied as extensively. For instance, vegetables, which are rich in nutrients vital for muscle and bone health, play a crucial role in preventing falls and fractures. Over recent decades, a great emphasis has been given to the combinations of nutrients and foods in dietary patterns that may have synergistic or antagonistic effects. Despite the challenges in researching the impact of nutrition and physical activity on musculoskeletal health due to the extensive heterogeneity of the results, healthcare professionals should continue to promote healthy eating and regular physical activity, and these principles should be emphasized in public health initiatives. Ultimately, a sufficient and balanced diet, abundant in plant-based foods and low in processed or discretionary foods, along with consistent physical activity, remains the most effective strategy for the prevention of musculoskeletal issues. This article aims to review the updated literature of recent years on the links between nutrition and physical activity with bone and skeletal muscle health. Full article