Search Results (553)

Background: Celiac disease (CeD) requires lifelong adherence to a gluten-free diet (GFD). However, there is evidence that a GFD may lead to an unhealthy cardiometabolic risk profile and potentially increase the risk of cardiovascular disease in some patients. Incorporating plant-based foods (primarily derived from plants) into a GFD may offer a solution to improve cardiometabolic health. Thus, this study aimed to identify the attitudes toward and barriers to adopting a more plant-dominant diet among Danish patients with CeD. Methods: A cross-sectional survey was distributed to 2861 members of the Danish Celiac Society. Data from 959 patients with confirmed CeD were included. Results: Most participants (58.5%) reported adapting their diet after diagnosis by combining gluten-free products with plant-based foods, while 31.2% relied solely on gluten-free replacements. Dietary adaptation was primarily shaped by the limited availability of gluten-free plant-based foods (64%), taste/texture (55%), and cost (51%). More than half of the patients (56.8%) considered ‘eating more plant-based foods’, with ‘health’ being the primary motivator (70%), followed by ‘climate’ (50%) and ‘taste’ (36%). However, several barriers to a more plant-dominant diet were identified. Most notably, ‘taste and texture’ (71%), ‘limited availability of gluten-free plant-based foods’ (68%), ‘nutritional concerns’ (56%), and ‘cost’ (54%) were reported as barriers. Conclusions: Most Danish patients with CeD were generally positive about increasing their intake of plant-based foods; however, barriers to such dietary changes remain. Ongoing follow-up, practical guidance from dietitians, and accessible evidence-based resources may help patients maintain a nutritionally balanced, plant-dominant GFD that supports long-term health. Full article

Objective: This scoping review aimed to map the methodological approaches used to assess disordered eating attitudes and behaviors in children and adolescents with celiac disease (CD). Methods: This review followed the Joanna Briggs Institute scoping review methodology and the PRISMA-ScR guidelines, including studies of children and adolescents with CD that used methodological approaches to assess disordered eating attitudes and behaviors in the context of the gluten-free diet (GFD). No restrictions were applied regarding geography, language, or year. Searches were conducted across 10 electronic databases. Data were descriptively analyzed and presented in tables or diagrams, with a narrative synthesis aligned to the review objective. Results: Studies from 13 countries were included and classified as quantitative (n = 16; 51.6%), qualitative (n = 11; 35.5%), or mixed-methods (n = 4; 12.9%). A total of 34 instruments were used, but only one was specifically designed to evaluate eating attitudes and behaviors in children and adolescents with CD. Conclusions: Analysis of disordered eating in children and adolescents with CD remains methodologically heterogeneous and evolving. Quantitative studies predominate but often rely on non-specific instruments that blur the distinction between adaptive dietary vigilance and disordered eating. Qualitative and mixed-methods approaches highlight lived experiences and reveal measurement gaps despite their higher costs. Progress depends on developing specific instruments for this population that better capture the complexity of GFD management across development. Full article

Background: Schools are widely recognized as key settings for promoting healthy eating behaviors and supporting childhood obesity prevention. In recent years, increasing attention has been devoted to experiential and interactive nutrition education strategies designed to actively engage children and adolescents in food-related learning processes. These approaches move beyond traditional didactic teaching and include practical and participatory formats, such as cooking activities, school gardening, digital or app-based learning tools, workshops and educational camps, and game-based learning interventions. Objective: This narrative review aims to provide an overview of experiential school-based nutrition education interventions, describing the main types of programs implemented in school settings and summarizing their reported effects on nutrition knowledge, attitudes, and eating behaviors among children and adolescents. Results: Across intervention studies and systematic reviews, hands-on and interactive educational models, including cooking classes, gardening programs, digital learning tools, workshops or camps, and board game-based interventions, frequently report improvements in nutrition knowledge, attitudes toward food, food-related skills, and self-efficacy. These programs seek to strengthen food literacy by combining experiential learning with educational content delivered within the school environment. Evidence regarding changes in dietary intake, diet quality, and anthropometric outcomes is more heterogeneous, with some studies reporting improvements in eating behaviors and others showing more modest or short-term effects. Program outcomes appear to be influenced by several contextual factors, including intervention duration, curriculum integration, teacher involvement, and the availability of resources supporting implementation. Conclusions: Experiential and interactive approaches represent an increasingly adopted strategy in school-based nutrition education. Their effectiveness appears to depend on the quality of implementation, the degree of integration within the school curriculum, and the broader educational context. Future research should further explore how different experiential formats can be optimally integrated into school systems to support the development of food literacy and sustainable healthy eating behaviors among children and adolescents. Full article

Background: Anorexia nervosa (AN) commonly emerges during adolescence and disproportionately affects girls. In recent years, problematic social media use (PSMU) has been identified as a potential sociocultural risk factor for eating disorder symptoms; however, the psychosocial pathways linking PSMU to AN symptomatology remain insufficiently understood. This study examined the associations between PSMU and AN symptoms in adolescent girls and explored the roles of perceived parenting style and childhood traumatic experiences as explanatory pathways. Methods: A cross-sectional, school-based survey was conducted with 463 adolescent girls aged 13–18 years in İstanbul, Türkiye. Participants completed validated self-report measures assessing AN symptoms (Eating Attitudes Test–26), problematic social media use (Social Media Disorder Scale), perceived parenting style (Parenting Styles and Dimensions Questionnaire), and childhood trauma (Childhood Trauma Questionnaire). Structural equation modeling was used to examine direct and indirect associations between PSMU and AN symptoms, controlling for age, body mass index, and socioeconomic indicators. Indirect effects were tested using bias-corrected bootstrapping. Results: Problematic social media use was directly associated with greater AN symptom severity (β = 0.18, p < 0.001). Significant indirect associations were also observed via perceived parenting style (β = 0.06, 95% CI [0.03, 0.11]) and childhood traumatic experiences (β = 0.07, 95% CI [0.04, 0.12]). Childhood trauma accounted for a larger proportion of the indirect association, while parenting style contributed a smaller but significant pathway. When both pathways were included simultaneously, the direct association between PSMU and AN symptoms remained significant, indicating partial mediation. Model fit indices indicated good overall fit. Conclusions: Problematic social media use is meaningfully associated with anorexia nervosa symptoms among adolescent girls, both directly and through indirect pathways involving parenting context and childhood trauma. Childhood trauma may be interpreted as a variable showing a significant indirect statistical association with both problematic social media use and anorexia nervosa symptoms, rather than a causal determinant within the present design. These findings underscore the importance of integrated, trauma-informed and family-sensitive prevention strategies that address adolescents’ digital environments alongside broader psychosocial vulnerabilities. Full article

Background/Objective: Ultra-processed foods (UPFs) have become deeply embedded in global dietary patterns. However, their widespread consumption conceals the dual hidden risks of delayed physiological health effects and long-overlooked environmental externalities. Prior research has largely centered on health-driven dietary behaviors, with insufficient understanding of how perceptions of the environmental burden shape consumer choices, particularly in highly convenient, eating-out-dominated food environments. To address this gap, this study extends the theory of planned behavior (TPB) to examine how dual-risk perceptions influence intentions to reduce UPF consumption. Methods: Drawing on survey data from 362 Taiwanese consumers, this study analyzed the proposed theoretical model using structural equation modeling. Results: The findings show that (1) both health and environmental risk perceptions significantly and positively shape attitudes toward reducing UPF intake; (2) attitude, subjective norms, and perceived behavioral control (PBC) significantly increase reduction intentions, with subjective norms and attitude emerging as the strongest predictors; and (3) environmental awareness produces a counterintuitive diminishing marginal effect, negatively moderating the relationship between environmental burden perception and behavioral intention. Conclusions: These results extend the empirical foundation of the “green TPB” by demonstrating that the internalization of environmental costs complements traditional health motivations. The findings offer actionable implications for public health policy, including the implementation of front-of-pack warning labels and the use of the NOVA food classification system to advance sustainable diets. Full article

Background: Inadequate management of emotional responses, limited access to emotion regulation strategies, and difficulties in emotion regulation may co-occur with alexithymic traits and interoceptive inaccuracy or confusion. These dimensions may influence lifetime eating disorder spectrum manifestations. Objective: To assess, in a general population sample without Axis I psychiatric disorders, alexithymic traits, interoceptive confusion/inaccuracy, and difficulties in emotion regulation, and to explore their associations with eating disorder spectrum manifestations. Method: In this cross-sectional observational study, fifty-two participants aged 18–30 years, recruited via a university bulletin board, were assessed online using the Toronto Alexithymia Scale (TAS-20), Interoceptive Accuracy Scale (IAS), Interoceptive Confusion Questionnaire (ICQ), Eating Attitude Test (EAT-26), and Difficulties in Emotion Regulation Scale (DERS) (protocol #01/2025). Results: Interoceptive confusion (ICQ) showed significant positive correlations with TAS-20, DERS, and EAT-26 total scores. ICQ scores were associated with TAS-20 subscales ‘difficulty identifying feelings’ (DIF) and ‘difficulty describing feelings’ (DDF). Participants with TAS-20 scores > 51 (n = 35; 67.3%) had significantly higher EAT-26 scores on ‘dieting’ (p = 0.043) and ‘bulimia’ (p = 0.017), as well as higher ICQ (p = 0.001) and DERS (p = 0.001) total scores, with smaller differences in the DERS ‘impulse’ subscale (p = 0.037). Conclusions: Preliminary findings suggest a pattern of co-occurring traits characterized by alexithymia, interoceptive confusion, emotional dysregulation, impulsivity, and eating disorder spectrum features, supporting the study hypothesis. Full article

Background/Objectives: Diet and mental health constitute two significant modifiable factors affecting Inflammatory Bowel Disease (IBD). The present exploratory study explores potential interrelationships between mental health and eating patterns in IBD patients in Greece. Methods: A mixed-methods approach was followed. Two hundred and eighty-three individuals living with IBD in Greece (n = 110 UC, n = 173 CD) participated in an online questionnaire survey examining demographic characteristics, anxiety, depression, and dietary attitudes. Fourteen semi-structured interviews explored the lived experiences of diet, mental health, and disease among IBD patients. Results: Quantitative study revealed that 45.77% of patients scored above the clinical cutoff for anxiety (GAD-7 ≥ 10) and 48.37% for depression (PHQ-9 ≥ 10). Patients with UC exhibited a significantly higher prevalence of moderate to severe anxiety (54.5% vs. 37.0%, p = 0.004) and depression (54.5% vs. 42.2%, p = 0.042) compared to CD. Disordered eating attitudes were present in 27.22% of the total sample, with no significant differences between diagnostic groups (p = 0.985). Thematic analysis revealed three overarching themes, namely (a) ‘life in two phases: IBD impact on health’, (b) ‘mental health and diet interplay—their perceived impact on IBD’ and (c) ‘coping strategies for managing IBD’. Conclusions: Our findings highlight the dynamic interplay among diet, mental health, and IBD experience. The study underscores the importance of developing holistic biopsychosocial interventions integrating medical, dietary, and psychological components for IBD management. Full article

In Latin America, the double burden of malnutrition is the region’s single most important public health concern for the incoming decade. Latin America’s burden of disease has distinct features in comparison to high-income countries: nearly 20 percent of NCDs are diagnosed in people under 60 years of age in Latin America, whereas only about 13 percent of people under 60 years of age in North America and Europe are diagnosed with these diseases. We aimed to better understand decision-making processes, preferences, and norms around food choices to provide input for future programming and policy suggestions at national and regional levels. We included key informant interviews and focus group discussions with parents and adolescents from urban and rural communities in three regions in Colombia and in Mexico. Results showed that food choices considered to be affordable, acceptable, accessible, and aspirational are driven by environmental and social factors that influence individual cognitive decisions. Across the study groups, cognitive biases influenced food decision-making in relation to eating out, natural, homemade, and “moderation”. At the sociological level, conversations, and social influences at home and in communities were strong indicators of dietary practices, health beliefs, and body size attitudes. Full article

Background/Objectives: Dieting is a widespread behavior that is associated with psychological distress, body dissatisfaction, and eating disorders. Recent research suggests that a body-positive attitude and mindful approach to eating may influence individuals’ experiences with dieting; however, their combined role has been insufficiently explored. Methods: A two-phase study was conducted among voluntary adults using online data collection. In Phase 1, a cross-sectional survey was completed by 180 participants (71.7% women), assessing dieting behavior, body appreciation, nutritional awareness, psychological distress, well-being, and eating disorders. Correlation analyses, group comparisons, and regression models were performed. In Phase 2, 90 participants entered the pilot and received a brief psychoeducational digital material promoting mindful eating and positive body image. The follow-up assessment was completed by 59, after one month of engagement. Results: Body appreciation and nutritional awareness were positively associated with mental well-being and inversely related to psychological distress (p < 0.001 for all) and to eating disorder screening scores (p < 0.001 and p = 0.046, respectively). More frequent dieting was associated with lower body appreciation (p < 0.001). According to the observed pattern of correlations, body appreciation may play a role in the relationship between dieting and psychological distress. In the intervention phase, greater engagement with the psychoeducational material was associated with higher reported levels of nutritional awareness (p = 0.003) and greater perceived body awareness (p = 0.026) at follow-up; however, due to the exploratory design, findings are preliminary. Conclusions: The results suggest that dieting, as a behavior, may be embedded in broader psychological processes that include body-related attitudes and nutritional awareness. Taking these factors into account may have potential implications for preventive measures aimed at promoting healthier dietary habits, a more positive relationship with one’s body, and mental well-being. Full article

Background and objectives: Intolerance of uncertainty (IU) is a well-established transdiagnostic process in anxiety (ANX) and major depressive disorder (MDD), and has been increasingly implicated in anorexia nervosa (AN). However, most previous research including patients with AN has relied on total or subscale scores from eating disorder measures, which obscures how specific eating attitudes and body dissatisfaction symptoms relate to distinct facets of IU. The primary objective of the present study was to characterize item-level networks linking eating attitudes, body dissatisfaction, and IU in a pooled clinical mental health sample, alongside a control group (CG). Methods: Data were drawn from a sample including individuals with symptoms related to AN (N = 105), MDD (N = 97), and ANX (N = 240), a comorbid group (N = 84) with symptoms of two or more of these conditions, and a CG (N = 842). Separate item-level networks were estimated for clinical and control groups, and network structure and centrality indices were compared. Results: Network analyses revealed distinct organizational patterns between the clinical and control subsamples. Although both networks showed identical diameters, the clinical network exhibited a shorter average path length and higher clustering, indicating stronger local connectivity, whereas the control network showed higher modularity. In the clinical subsample, nodes related to binge eating, post-eating guilt, and IU emerged as the most central and acted as key connectors between clusters. In contrast, the control network displayed a more distributed centrality pattern, suggesting a more integrated and homogeneous network organization. Conclusions: This study provides new evidence to refine our understanding of how IU relates to eating attitudes and body dissatisfaction across diagnostic mental health boundaries. Identifying highly influential psychopathological symptoms across eating, mood, and anxiety disorders, as well as bridge nodes linking these mental health domains, is important for understanding transdiagnostic symptom dynamics. These insights may inform the development of more sensitive screening and diagnostic tools, as well as targeted intervention points to support more personalized and mechanism-focused treatments. Full article

Background/Objectives: Psychological variables such as body image, self-esteem, and life satisfaction have become important research topics in recent years, particularly in their relationships with individuals’ eating attitudes. The purpose of this study is to examine the predictive effect of body image and self-esteem on eating attitudes in emerging adults and to evaluate the mediating role of life satisfaction in this relationship. Method: The study included 402 participants aged 18–30. Data were collected using the Eating Attitudes Test (EAT-26), the Rosenberg Self-Esteem Scale (RSS), the Body Image Scale (BIS), and the Life Satisfaction Scale (LSS). The analyses included correlational analyses to examine relationships among eating attitudes, body image, self-esteem, and life satisfaction; multivariate regression to test the predictive roles of body image, self-esteem, and life satisfaction on eating attitudes; and structural equation modeling to evaluate the mediating role of life satisfaction in the relationships between body image, self-esteem, and eating attitudes. Result: The correlational analysis revealed that eating attitudes are associated with body image, life satisfaction, and self-esteem. Body image was identified as the most influential predictor of eating attitudes. Structural equation modeling indicated that life satisfaction mediates the relationship between self-esteem and eating attitudes. Conclusions: Body image, self-esteem, and life satisfaction play a crucial role in shaping eating attitudes among emerging adults. The mediating effect of life satisfaction underscores psychological well-being as a key regulatory factor rather than solely an outcome. Promoting positive body image, strengthening self-esteem, and enhancing life satisfaction through preventive and psychoeducational programs may help protect against disordered eating attitudes in this population. Full article

Background/Objectives: Sustainable food habits are essential for reducing the environmental impacts of a food system. We investigated food sustainability knowledge, attitudes, and food waste-related behaviours among Saudi adults and assessed their associations with socio-demographic characteristics and dietary choices, which are subjects that remain under-researched. Methods: A cross-sectional study was conducted among 855 Saudi adults (≥18 years) using convenience sampling. Data were collected using a validated online questionnaire assessing sustainability knowledge, attitudes, food waste behaviours, dietary choices, and socio-demographic characteristics. Descriptive statistics, chi-square tests, and linear regression analyses were performed using SPSS version 29. Results: Overall, 32% of the study population demonstrated adequate sustainability knowledge, 61% expressed positive attitudes towards food sustainability, and 45% demonstrated favourable food waste management. Women were more knowledgeable than men. Participants who possessed a better understanding of food sustainability consumed more vegetables, fruits, and bread and less processed meat. Those with a positive attitude towards food sustainability exhibited higher consumption of red meat, white meat, eggs, milk, yogurt, cheese, vegetables, fruits, bread, and sweet or savoury snacks. Meanwhile, individuals with better food waste behaviours demonstrated significantly lower consumption of legumes, fish, pasta, red meat, white meat, processed meat, eggs, milk, yogurt, cheese, fruits, bread, and sweet or savoury snacks. Conclusions: Saudi adults possess limited knowledge of sustainability and suboptimal food waste behaviours despite having relatively positive attitudes. These findings highlight opportunities for intervention. Public education, targeted campaigns, and media communication could enhance sustainability awareness and promote healthier, environmentally sustainable dietary patterns. Full article

Background: This study investigated the relationship between weekly structured physical exercise (PE) volume and type and the risk of eating disorders (EDs), with particular attention to age and sex differences. Methods: A total of 417 healthy adults (mean weekly PE: 256.19 ± 133.03 min) completed a self-report questionnaire covering personal information, weekly PE characteristics, and the Eating Attitudes Test-26 (EAT-26). Binary logistic regression was performed with the EAT-26 score as the dependent variable and PE volume, exercise type, age, and sex set as predictors. Results: The results of the binary logistic regression model were statistically significant (χ² = 16.784, p = 0.003). Sex emerged as the strongest independent predictor of ED risk (p = 0.003). Cross-tabulation confirmed a significant sex disparity, with females showing a threefold higher prevalence of at-risk EAT-26 scores (17.6%) compared to males (5.2%). No significant correlation was found between EAT-26 score and PE volume, nor were significant differences in ED risk observed across different types of structured exercise. Conclusions: When controlling for age, neither exercise volume nor type serves as a direct linear predictor of ED risk. Sex remains the strongest demographic predictor. Full article

Background/Objectives: Schools, as structured social environments, are important settings for shaping lifelong eating habits, and teachers play a mediating role in nutrition education. This study aimed to assess nutrition knowledge among public school teachers, examine their perceptions of the school food environment, and identify factors associated with knowledge scores. Methods: A stratified cross-sectional survey was conducted among 736 teachers from 12 public schools during the fall of 2025. A structured questionnaire based on the Knowledge–Attitudes–Practice model was used to evaluate nutrition knowledge, teaching practices, perceived school food environment, and teachers’ observations of student food-related behaviors. Group differences were examined using t-tests and ANOVA, and multivariable logistic regression was applied to identify factors associated with low nutrition knowledge. Results: The mean knowledge score was 6.26 ± 2.64 out of 12, with 23.6% of teachers classified as having low knowledge, 59.9% satisfactory, and 16.4% good. Primary school teachers scored significantly higher than subject teachers (7.27 vs. 5.64; p < 0.001). Regular conduct of nutrition classes was associated with lower odds of low knowledge (adjusted OR 0.10, 95% CI 0.05–0.23, p < 0.001). A sensitivity analysis using continuous knowledge scores confirmed this pattern, with the absence of nutrition teaching predicting a 1.40-point reduction in scores (95% CI −1.86 to −0.94, p < 0.001). Teachers rated school meal quality moderately high, and frequently observed student refusal of canteen food and purchase of sweets or fast food outside school. Conclusions: This study found that public school teachers in Karaganda, Kazakhstan showed satisfactory overall nutrition knowledge, with gaps in applied understanding and common dietary myths. Primary teachers and those actively teaching nutrition had higher knowledge scores, indicating an association between pedagogical engagement and content knowledge. To help optimize the school food environment, educational policies would benefit from the development of cross-curricular instructional materials fitted specifically for secondary school subject teachers. Full article

Background/Objectives: This study aimed to explore perceived changes in the eating behavior of children with overweight and obesity following a nutritional intervention, considering the perspectives of children and their families participating in a specialized health promotion program. Methods: This qualitative study included five children aged 7 to 12 years and four family members enrolled in the ProSaúde Kids Program in southern Brazil. The study comprised three stages: initial semi-structured interviews; nine interactive nutritional workshops conducted from July to November 2024 with active family participation; and final interviews after the intervention. Recordings were transcribed and analyzed in ATLAS.TI^® using the collective subject discourse approach, guided by Bronfenbrenner’s Ecological Systems Theory. Results: The intervention was associated with reported changes in perceptions and eating practices. Families described greater involvement of children in food decisions, perceived reductions in consumption of ultra-processed foods, and reported reorganization of eating routines. Children expressed increased critical awareness of food-related media content and greater appreciation of body diversity. Improvements in the quality of homemade school snacks suggested meaningful family engagement, even in the absence of direct school involvement. Conclusions: The workshops were described as encouraging reflection and supporting changes in attitudes and practices. Overall, the findings indicate potential positive shifts in eating behavior, greater awareness of food choices, and enhanced family participation in the behavior-change process. Full article