Search Results (492)

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

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

This study investigates consumer acceptance of insect-based foods, focusing on changes in visual evaluation after information disclosure and the influence of sociodemographic, attitudinal, and knowledge-related factors. An online survey among Italian consumers (n = 350) assessed the visual attractiveness of a cupcake containing 10% w/w Tenebrio molitor flour before (PRE) and after (POST) disclosure of the insect ingredient. Attractiveness decreased from 2.6 to 2.0, with 79% of POST evaluations in the lowest appeal categories. Women expressed more negative POST ratings and experienced a larger decline in attractiveness (Δ = POST − PRE), indicating greater sensitivity to information disclosure than men. The change in attractiveness (Δ) was linked to psychological variables: negative attitudes showed moderate negative correlations with Δ (r ≈ −0.3 to −0.6), whereas higher knowledge of regulatory, nutritional, and environmental aspects showed positive correlations (r ≈ +0.3 to +0.7), mitigating the decrease. Principal Component Analysis revealed two latent dimensions: PC1 (61.6%), representing an attitudinal continuum from aversion to acceptance, and PC2 (33.3%), reflecting differences in awareness. Respondents with higher PC1 and PC2 scores showed attenuated Δ values, indicating greater resilience to the disclosure effect. Overall, findings highlight a gap between visual familiarity and acceptance, shaped by emotions, knowledge, and gender-specific sensitivities. Full article

Background/Objectives: Beyond health benefits, plant-based diets are increasingly recognized for their contribution to environmental sustainability. This study aimed to evaluate knowledge of the health benefits of fruits, vegetables, and antioxidants, adherence to the Mediterranean Diet (MD), and propensity toward sustainable food purchasing in an adult population from Southern Italy, and to explore the relationships among these factors. Methods: A cross-sectional online survey was conducted among 311 adults living in the Campania region. Data were collected on knowledge of fruit and vegetable health benefits, antioxidant knowledge, adherence to the MD assessed using the Medi-Lite score, and attitudes toward sustainable food purchasing. Differences were examined according to gender, age, and educational level. Pearson’s correlation analyses and multiple logistic regression models were used to investigate associations between nutrition knowledge, dietary adherence, and sustainability-related behaviors. Results: Participants showed a medium–high level of knowledge regarding the health benefits of fruits and vegetables, while knowledge of antioxidants was moderate and significantly higher among older adults. Overall adherence to the MD was moderate, with lower consumption of vegetables, legumes, and fish. Most participants reported limited attention to sustainability when purchasing food. Both knowledge of fruit and vegetable health benefits and antioxidant knowledge were positively associated with sustainable food purchasing. In regression analyses, lower nutrition knowledge was independently associated with reduced odds of sustainable purchasing, whereas adherence to the MD was not a significant predictor. Conclusions: Although nutrition knowledge was generally adequate, its translation into sustainable food choices remained limited. These findings support the need for integrated public health strategies to encourage healthier and more environmentally responsible dietary behaviors. Full article

Background/Objectives: Artificial Nutrition and Hydration (ANH) at the end of life remains a clinically and ethically complex intervention. Although international guidelines exist, data regarding the awareness of them and their perceived applicability across different population groups remain limited. This study aimed to evaluate and compare perceptions and attitudes regarding ANH among healthcare professionals, medical students, and lay respondents. Methods: A cross-sectional, questionnaire-based comparative survey was conducted between July 2025 and March 2026, including 470 respondents (338 healthcare professionals, 46 medical students, and 86 lay respondents). The survey assessed perceptions of ANH, factors influencing decision-making, and familiarity with clinical guidelines and legislation. Results: General perceptions regarding ANH were broadly similar across groups. Significant differences were observed for the importance assigned to estimated life expectancy (p < 0.001) and family opinion (p = 0.017). Associations were identified between study group and opinions on clinical guidelines (χ²(6) = 16.366, p = 0.012) and legislation (χ²(6) = 14.712, p = 0.023), with lack of knowledge more frequent among lay respondents and students. Within healthcare professionals, physicians and nurses showed significantly different responses regarding guidelines (p < 0.001). Conclusions: In this cross-sectional survey, perceptions of ANH at the end of life were largely shared, but differed in relation to prognostic factors, family involvement, and awareness of guidelines and legislation, suggesting the presence of relevant knowledge gaps in end-of-life decision-making. 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

Diet quality, nutrition knowledge, and psychosomatic literacy—defined as the understanding of the interactions between diet, gut microbiota, and mental well-being—may shape weight-related behaviours in youth. This study used a cross-sectional design to integrate these domains with digital information pathways in Central–Eastern Europe. This study assessed diet quality, nutrition, and psychosomatic knowledge, supplement use, and health-information sources among Polish adolescents and young adults, with emphasis on age-related differences and the role of social media. A cross-sectional, anonymous online survey (October 2025–January 2026) was conducted in Poland (final analytical sample: n = 478; adolescents 15–19 years vs. young adults 20–30 years). Of 591 individuals who accessed the survey, 478 were included in the final analytical sample. Diet quality was estimated from FFQ data using KomPAN-derived indices (pHDI-10, nHDI-14, DQI). Nutrition knowledge (0–25 points), psychosomatic/gut–brain indicators, supplementation, and information sources were analysed using χ²/Fisher tests and Mann–Whitney U tests with effect sizes. The primary outcomes measured were dietary supplement use and excess body weight (BMI ≥ 25 kg/m²). Multivariable logistic regression examined predictors of supplement use and BMI ≥ 25 kg/m². Overall diet quality was low to moderate, with limited intake of whole grains, legumes, and fish, and common nutrition misconceptions. Social media was the most frequently indicated source of diet/supplement information and was independently associated with more frequent supplement use (OR = 2.29; 95% CI: 1.43–3.64). Adolescents reported lower whole-grain intake and more misconceptions than young adults. Predictors of BMI ≥ 25 kg/m² included male sex (OR = 2.46; 95% CI: 1.46–4.15), lower education, and lower nutrition knowledge, while age showed a non-linear positive association with excess body weight. Polish adolescents and young adults show gaps between declared pro-health attitudes and actual diet quality/competencies. Social media reliance appears particularly linked to product-oriented behaviours (supplementation). Prevention should strengthen nutrition and food safety education, digital health literacy, and professional guidance on supplementation, especially in adolescents. Our findings suggest that social media is a primary driver for dietary supplementation among Polish youth, more so than objective nutrition knowledge. While diet quality is linked to weight status, the relationship is complex. These results may inform future public health interventions targeting digital health literacy to promote balanced nutrition and safe supplementation practices. Full article

Background/Objectives: The presented study aimed to understand the relationship between knowledge, attitudes, and practices, as well as consumers’ preferences for the consumption of Spirulina-enriched fruit and vegetable juices. Methods: A survey about the consumers’ attitudes towards consumption of algae in general and especially Spirulina was conducted to better understand the target groups and marketing strategies for this novel non-alcoholic beverage product. Knowledge–Attitude–Practice (KAP) model in combination with structural equation modelling (SEM) was applied to test the hypothesised relationships between the variables. Additionally, consumers’ preference test was done using a seven-point hedonic scale and ranking of the six juice samples: plain sour cherry juice (SC1), sour cherry juice with 0.8% (SC2) and 1.6% (SC3) of blue Spirulina powder; plain tomato juice (T1), tomato juice with 0.8% (T2) and 1.6% (T3) of blue Spirulina powder. Results: The SEM results showed that there is a limited direct impact of knowledge on social motivation, while personal behaviour strongly predicts social motivation. Namely, perceived nutritional value and health benefits were shown to be the main factors for consumers’ willingness to drink Spirulina-enriched juice. Conclusions: The result of the consumer preference evaluation exposed that the juices containing sour cherry and Spirulina achieved better sensory acceptance and ranking than those containing tomato, pointing out the importance of the product matrix for achieving consumer acceptance. Full article

Farm-to-school initiatives, including school gardens, are an increasingly popular strategy to increase student access to healthy produce and nutrition education opportunities. While studies show school garden programs and garden-enhanced nutrition education can positively impact student consumption of fruits and vegetables, there is a gap in evaluation tools that can be used by practitioners across varied school sites, grades, and communities, to assess outcomes of their garden programs. This effort piloted the Student Garden Retrospective Survey (SGR) for grades 4+ in four classrooms in two counties in California. The instrument included items to measure program exposure, garden skill experiences, changes in students’ behaviors, preferences, and attitudes, as well as their perceptions of the program. Student and teacher feedback on the evaluation tool was gathered to determine if students understood the questions being asked, were able to complete the survey, and whether the evaluation questions were pertinent to their school gardening experiences. The results demonstrate that the SGR is suitable for evaluating school garden and garden-enhanced nutrition education programming. In the future, the evaluation tool can be used by practitioners to iteratively improve garden-based education to enhance students’ nutrition and health outcomes. Full article

Background: Probiotics have emerged as an effective therapeutic intervention in critically ill patients receiving enteral nutrition, yet their use remains inconsistent across intensive care units (ICUs). Understanding knowledge, attitudes, and practices (KAP) among healthcare professionals (HCPs) is essential for optimizing evidence-based probiotic administration in enteral nutrition, identifying perceived implementation barriers, and examining associations between KAP scores and study variables. Methods: A multicenter, cross-sectional online survey was administered to ICU physicians, nurses, clinical dietitians, pharmacists, and respiratory therapists. Participants completed a self-reported questionnaire assessing their knowledge of probiotic mechanisms, indications, and safety; attitudes toward probiotic therapy; and current practices in probiotic administration during enteral feeding. Results: A total of 935 ICU HCPs participated. Overall knowledge was insufficient, with only 33.2% achieving high knowledge scores (mean: 12.4/18 points), whereas attitudes were moderately favorable, with 35.5% demonstrating positive attitudes (mean: 23.9/30 points). A majority of respondents (58.7%) reported recommending or prescribing probiotics, most frequently clinical dietitians (84.5%). KAP varied significantly by profession, age group, and years of experience (p < 0.01). The most reported barriers were a lack of information about available probiotic products (73.2%), limited knowledge (41.2%), limited availability of clinically proven products (37.8%), and cost concerns (29.7%). Conclusions: Although ICU HCPs show interest and cautious acceptance of probiotics in enteral feeding, knowledge gaps, attitudinal variability, and practice inconsistencies persist across disciplines. These findings highlight the critical need for targeted, multidisciplinary educational interventions and the development of standardized, evidence-based institutional protocols to optimize probiotic use and improve patient outcomes. Full article

Purpose: Anemia remains a major public health concern among vulnerable rural adolescent girls in many countries, including India. This study aimed to assess the prevalence of anemia, nutritional status, and anemia-related knowledge, attitudes, and practices (KAP) among school-going rural adolescent girls, along with predictors of KAP score, complemented by stakeholder perspectives. Methods: A mixed-methods cross-sectional study was conducted among 553 school-going adolescent girls aged 14–19, selected through a multi-stage stratified random sampling technique from three rural districts of Andhra Pradesh, India. Quantitative data were collected using a structured questionnaire assessing KAP, anthropometric measurements to collect Body Mass Index (BMI) and middle upper arm circumference (MUAC), dietary assessments using a dietary diversity score, and hemoglobin estimation using standardized procedures. Qualitative insights were obtained through focus group discussions (FGDs) with teachers, parents, frontline health workers, and community leaders and analyzed thematically. Logistic regression analysis was performed to identify predictors of KAP. Results: The prevalence of anemia among the participants was 55.3%, and 30.7% were underweight. Although over half of the girls demonstrated adequate knowledge of anemia, only 39.6% reported good anemia-preventive practices, indicating a significant gap between knowledge and practice. Dietary scores indicated micronutrient-deficient diet consumption by participants (36.2%), which might be contributing to anemia. Multivariable analysis revealed that maternal education, hemoglobin status, diet patterns, and type of school attended were significantly associated with KAP scores. Qualitative findings highlighted challenges related to health-seeking behavior, cultural misconceptions, gaps in awareness and implementation of existing adolescent health programs. Conclusions: Anemia remains highly prevalent among rural school-going adolescent girls in Andhra Pradesh, with suboptimal anemia-preventive practices despite moderate levels of knowledge. Strengthening school-based nutritional education, improving dietary diversity, and enhancing the reach and effectiveness of adolescent health programs through community engagement may help combat anemia. Full article

Background/Objective: Dizziness is managed using various therapies, including lifestyle changes, nutritional supplementation, pharmaceutical therapies, and physical therapy, each offering differing efficacy. With legalization of cannabis in Canada, patients are exploring its use in treating their dizziness and related symptoms. Limited knowledge exists regarding usage patterns, forms, doses, and effects on these symptoms. The current study aims to examine cannabis use in patients experiencing dizziness. Methods: We conducted a cross-sectional study at the Ottawa Hospital outpatient neuro-otology clinic. Eligible participants included new patients presenting with a primary complaint of dizziness and follow-up patients reporting new-onset dizziness. Participants completed a questionnaire capturing demographic data, dizziness and related symptoms, attitudes toward cannabis use, consumption patterns, and its perceived effects on their symptoms. Results: Of 154 participants, 118 (77%) expressed willingness to consider cannabis for dizziness and 78 (51%) reported previous cannabis use. Of those patients, 44 (56%) consumed it recreationally, largely via smoking (29/78, 37%). Approximately 21% of these patients reported a moderate–large subjective relief from dizziness after use of cannabis. The most common diagnoses amongst cannabis users were migraine/vestibular migraine (24%), persistent postural perceptive dizziness (22%), and benign paroxysmal positional vertigo (17%). Other related symptoms relieved by cannabis included sleep (28/78, 36%), emotional difficulties (17/78, 22%), neck pain/stiffness (14/78, 18%) and headaches/migraines (9/78, 12%). Conclusions: There is generally a positive attitude towards cannabis use in treating dizziness amongst patients, with a subset of patients reporting a subjective improvement of dizziness and its related symptoms, such as sleep and emotional difficulties. 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

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