Search Results (330)

Background/Objectives: The field of dietary supplements is changing and evolving quickly. Registered Dietitian Nutritionists are recognized as experts in nutrition and familiarity with the usage of dietary supplements is expected. However, education on the use of dietary supplements is not equal across accredited dietetic education programs, which can lead to disparities in dietitians’ feelings of preparedness, attitudes, and consequently experience of comfort regarding dietary supplements. The purpose of this study was to create the D-SCOPE Questionnaire (Dietitians’ Survey of Comfort, Opinions, and Preparedness in Education in Supplements) and validate it. This questionnaire assesses Registered Dietitian Nutritionists’ feelings of preparedness, comfort with use, and general attitudes in the field of dietary supplements. Methods: Face and content validity was established with dietitian, nutritionist, and statistician input. For recruitment, 2000 national randomly selected emails were obtained from the Commission on Dietetic Registration. Registered Dietitian Nutritionists (n = 248) responded to the survey email request. Descriptive statistics (reported as means ± standard deviation), principal axis factoring (exploratory factor analysis) with a direct oblimin rotation and Cronbach’s a reliability analysis were used for validation techniques. Results: Five factors were created, which explained about 63% of the variance in the questionnaire. The questionnaire was generally reliable, but the factor structure could change with a non-US population. Conclusions: As a unit, the D-SCOPE Questionnaire shows validity and reliability in assessing Registered Dietitian Nutritionists’ perceptions of preparedness and attitudes in the area related to dietary supplements. Full article

Prenatal and postnatal skeletal muscle development in ruminants is coordinated by interactions between genetic, nutritional, epigenetic, and endocrine factors. This review focuses on the influence of maternal nutrition during gestation on fetal myogenesis, satellite cell dynamics, and myogenic regulatory factors expression, including MYF5, MYOD1, and MYOG. Studies in sheep and cattle indicate that nutrient restriction or overnutrition alters muscle fiber number, the cross-sectional area, and the transcriptional regulation of myogenic genes in offspring. Postnatally, muscle hypertrophy is primarily mediated by satellite cells, which are activated via PAX7, MYOD, and MYF5, and regulated through mechanisms such as CARM1-induced chromatin remodeling and miR-31-mediated mRNA expression. Hormonal signaling via the GH–IGF1 axis and thyroid hormones further modulate satellite cell proliferation and protein accretion. Genetic variants, such as myostatin mutations in Texel sheep and Belgian Blue cattle, enhance muscle mass but may compromise reproductive efficiency. Nutritional interventions, including the plane of nutrition, supplementation strategies, and environmental stressors such as heat and stocking density, significantly influence muscle fiber composition and carcass traits. This review provides a comprehensive overview of skeletal muscle programming in ruminants, tracing the developmental trajectory from progenitor cell differentiation to postnatal growth and maturation. These insights underscore the need for integrated approaches combining maternal diet optimization, molecular breeding, and precision livestock management to enhance muscle growth, meat quality, and production sustainability in ruminant systems. Full article

Background: Sarcopenic obesity, characterized by reduced skeletal muscle mass and excess adiposity, is strongly associated with chronic pain and functional decline in older adults. Objective: This prospective controlled trial without randomization investigated the effects of a structured, three-phase rehabilitation program on physical performance, pain, and sarcopenia-specific quality of life in elderly patients with sarcopenic obesity and chronic pain. Methods: In this study, 82 participants were enrolled and allocated to a study group (SG, n = 40), receiving supervised rehabilitation, nutritional counseling, and supplementation, or to a control group (CG, n = 42), which did not receive rehabilitation. The final analysis included 35 patients in SG and 36 in CG. Outcomes were assessed at baseline and six months using the Sarcopenia Quality of Life Questionnaire (SarQoL), Short Physical Performance Battery (SPPB), Numeric Rating Scale (NRS), and Pressure Pain Threshold (PPT). Results: The SG showed significant improvements in all outcomes: SarQoL increased from 57.02 to 63.98, SPPB increased from 7.14 to 8.4, PPT increased from 69.31 to 78.05, and NRS decreased from 6.94 to 4.65 (all p < 0.001). The CG showed no significant changes. Conclusions: The implementation of a structured, three-phase rehabilitation program resulted in clinically and statistically significant improvements in physical performance, pain perception, and sarcopenia-related quality of life in older adults with sarcopenic obesity and chronic pain. Full article

Nutrition education, framed within Supplemental Nutrition Assistance Program Education (SNAP-Ed) guidance, was provided to SNAP-eligible shoppers at community supported agriculture (CSA) sites in Michigan where SNAP nutrition incentives were accepted. An evaluation was conducted on data sources from sites where the CSA Food Navigator program was implemented to assess the delivery of nutrition education, understand the needs and experiences of SNAP-eligible shoppers, and measure behavioral outcomes. A multi-phase, mixed-methods design incorporated (1) outcome surveys with SNAP-eligible shoppers at participating CSA sites; (2) open-ended feedback surveys from CSA site staff; (3) nutrition educator activity logs; (4) a semi-structured nutrition educator focus group; and (5) semi-structured focus groups with SNAP-eligible shoppers. In phase one, descriptive analysis was completed on the quantitative data and constant comparative analysis was completed on the qualitative data. In phase two, these data were collated into case reports for respective CSA sites; then, a cross-case analysis was performed. In phase three, statistical tests were performed on SNAP-eligible shoppers’ survey data to assess outcomes against a nationally representative sample of nutrition incentive program participants. Results indicate significantly higher fruit and vegetable consumption among shoppers relative to SNAP incentive participants nationally. Key qualitative themes were (1) relating over transacting: investing in multi-level relationships, (2) personalizing engagement and experiential nutrition education, (3) activating social–ecological spheres to promote changes in access, and (4) enhancing education support and resources for accessibility. The findings have practical implications to enhance the delivery and impact of CSA-based nutrition education. Full article

The intrauterine environment is increasingly recognised as a critical period for the emergence of mental health vulnerabilities. This review explores how adverse maternal exposures, such as psychological stress, infection, malnutrition, and environmental toxins, can disrupt foetal neurodevelopment via epigenetic mechanisms, contributing to the risk of psychiatric and neurodevelopmental disorders. Focusing primarily on human studies, we synthesise evidence on DNA methylation, histone modifications, and non-coding RNAs as key pathways through which the intrauterine environment influences gene regulation in the developing brain. We examine how timing of exposure, foetal sex, and gene–environment interactions modulate these effects, with particular attention to disorders such as schizophrenia, autism spectrum disorder, depression, and anxiety. The placenta emerges as a central mediator, both reflecting and shaping epigenetic changes in response to maternal signals. We also discuss the reversibility of epigenetic marks and highlight emerging interventions, including nutritional supplementation and maternal mental health support, that may buffer or reverse prenatal epigenetic programming. Methodological challenges are addressed, including tissue specificity and causal inference, and future directions are proposed toward integrating epigenetic biomarkers into early risk assessment and precision mental health and psychiatry. This review emphasises the importance of the prenatal period as a window of vulnerability and opportunity for shaping lifelong mental health. Full article

Background/Objectives: Despite high breastfeeding initiation rates nationwide, disparities in breastfeeding continuation among Black mothers remain a public health issue. The BreastFeed Iowa Black Immigrant Project aimed to improve breastfeeding rates among low-income Black immigrant mother-infant dyads in Johnson County, Iowa by exploring factors influencing breastfeeding retention and developing a framework for culturally sensitive breastfeeding interventions. Methods: Using a descriptive cross-sectional study design, we employed a convergent, parallel mixed-methods approach to explore factors that influence breastfeeding duration among Black immigrant mothers with children 0–2 years old. Nine focus group discussions (FGDs) were conducted on Zoom among 40 participants with a semi-structured guide on breastfeeding beliefs, experiences, and feeding practices. Additionally, a 22-item survey was administered to 33 participants. Results: Based on the survey, one out of five participants indicated that they were unable to breastfeed for as long as they had planned. The top five reasons why mothers stopped breastfeeding included having received formula from the Supplemental Nutrition Program for Women, Infants and Children; being sick and having to take medicine; the baby was hungry too often; the baby was sick and could not breastfeed; and not producing enough milk. The top five themes that emerged from FGDs as barriers to breastfeeding included lack of lactation support, knowledge gaps on breastfeeding benefits, perception of inadequate milk supply, lack of comfort with breast milk expression, and work-related barriers. Conclusions: The community needs assessment identified the elements needed to develop a culturally sensitive framework with targeted interventions to address breastfeeding barriers in the Black immigrant community. Full article

Background: There is limited knowledge about nutritional intake and energy needs during the post-intensive care unit (ICU) period and their relationship with clinical outcomes and physical recovery. Aims and Methods: Thus, this observational multicenter study (Azienda Ospedaliero-Universitaria “Santa Maria”, Terni and “Madonna del Soccorso” General hospital, San Benedetto del Tronto, Italy) aimed, firstly, to measure energy expenditure via indirect calorimetry (IC) (Q-NRG+^® Metabolic Monitor, Cosmed, Rome, Italy), derived respiratory quotient (R/Q1) and, malnutrition risk via Mini Nutritional Assessment (MNA) test and body composition through bioimpedance vector analysis (BIVA-Akern, Pontassieve, Italy); secondly, to assess their effect on energy needs, body composition and physical rehabilitation steps in critically ill adults after ICU discharge. The provision of nutrients (PIS test) was also recorded. Oral nutritional supplementation was used to reach the optimal nutritional intake. All patients followed a standardized rehabilitation program. Results: A total of 43 patients were enrolled from January 2024 until February 2025 at the beginning of their post-ICU period. The mean age was 65.7 ± 1.0 years, the mean BMI was 20.73 ± 0.8 kg/m² at the recovery ward, and 60.4% (n = 26) were male. The mean admission period was 19.5 ± 1.7 days. The resting energy expenditure (mREE) was 1591 ± 71.2 at the admission and 1.856 ± 62.7 kcal/kg/d at the discharge (p < 0.05). The median phase angle value was 4.33 ± 0.15 at the admission and 5.05 ± 0.17° at the discharge (p < 0.05); R/Q1 at the admission was 0.7 ± 0.1 and 1.086± 0.11 at the discharge (p < 0.05). Improved energy expenditure significantly correlated with R/Q1 and phase angle (r = 0.81 and r = 0.72, respectively). Interestingly, there was no significant correlation between improved metabolism and improved PIS test scores (r = 0.18). Improved metabolism and nutritional status showed a tendency to correlate with shorter post-ICU courses and earlier physical recovery, without reaching statistical significance. Conclusions: Measurement of energy expenditure and caloric intake, along with the assessment of body composition is feasible and provides an objective tool to guide and possibly enhance the functional recovery in patients during the post-ICU period. Full article

Background: Exercise and nutritional interventions are often recommended to help manage risk related to metabolic syndrome (MetSyn). The co-ingestion of Phyllanthus emblica (PE) with trivalent chromium (Cr) has been purported to improve the bioavailability of chromium and enhance endothelial function, reduce platelet aggregation, and help manage blood glucose as well as lipid levels. Shilajit (SJ) has been reported to have anti-inflammatory, adaptogenic, immunomodulatory, and lipid-lowering properties. This study evaluated whether dietary supplementation with Cr, PE, and SJ, or PE alone, during an exercise and diet intervention may help individuals with risk factors to MetSyn experience greater benefits. Methods: In total, 166 sedentary men and women with at least two markers of metabolic syndrome participated in a randomized, placebo-controlled, parallel-arm, and repeated-measure intervention study, of which 109 completed the study (48.6 ± 10 yrs., 34.2 ± 6 kg/m², 41.3 ± 7% fat). All volunteers participated in a 12-week exercise program (supervised resistance and endurance exercise 3 days/week with walking 10,000 steps/day on non-training days) and were instructed to reduce energy intake by −5 kcals/kg/d. Participants were matched by age, sex, BMI, and body mass for the double-blind and randomized supplementation of a placebo (PLA), 500 mg of PE (PE-500), 1000 mg/d of PE (PE-1000), 400 µg of trivalent chromium (Cr) with 6 mg of PE and 6 mg of SJ (Cr-400), or 800 µg of trivalent chromium with 12 mg of PE and 12 mg of SJ (Cr-800) once a day for 12 weeks. Data were obtained at 0, 6, and 12 weeks of supplementation, and analyzed using general linear model multivariate and univariate analyses with repeated measures, pairwise comparisons, and mean changes from the baseline with 95% confidence intervals (CIs). Results: Compared to PLA responses, there was some evidence (p < 0.05 or approaching significance, p > 0.05 to p < 0.10) that PE and/or Cr with PE and SJ supplementation improved pulse wave velocity, flow-mediated dilation, platelet aggregation, insulin sensitivity, and blood lipid profiles while promoting more optimal changes in body composition, strength, and aerobic capacity. Differences among groups were more consistently seen at 6 weeks rather than 12 weeks. While some benefits were seen at both dosages, greater benefits were more consistently observed with PE-1000 and Cr-800 ingestion. Conclusions: The results suggest that PE and Cr with PE and SJ supplementation may enhance some exercise- and diet-induced changes in markers of health in overweight individuals with at least two risk factors to MetSyn. Registered clinical trial #NCT06641596. Full article

Background: The positive effects of oral nutritional supplements (ONS) on postoperative outcomes have been well recognized in several previous studies. However, to date, little data has been available with respect to determining the best immune modulating supplement to use and what its impact might be in thoracic surgery. The aim of this study was to evaluate the role of preoperative immune-nutritional supplement intake as predictor of postoperative cardiopulmonary complications (CPCs) in patients undergoing uniportal video-assisted thoracoscopic (uVATS) lung resection. Methods: This is a retrospective, observational study enrolling consecutive patients who underwent uVATS lung resections for cancer from January 2022 to December 2024 in the context of the Enhanced Pathway of Care (EPC) Program. All patients were evaluated by a nutritionist and dietetics team during the preoperative phase. The nutritional protocol consisted of 250 mL ONS rich in arginine, omega-3-fatty acids, and nucleotides to be taken twice a day for 5–7 days before surgery. Results: Four hundred ninety-one patients were enrolled: 277 patients underwent anatomic lung resection and 214 underwent wedge resection (WR). Utilizing the univariate analysis, we found that in patients undergoing anatomic lung resection, not-ONS-intake, high Body Mass Index (BMI), and arrythmia were correlated with a higher CPCs rate compared to the patients without nutritional supplementation (7.2% ONS vs. 15% not-ONS, p = 0.04; BMI 28.4 kg/m² vs. BMI 26.4 kg/m², p = 0.03; 31.2% arrythmia vs. 9.4% no-arrythmia, p < 0.01). These correlations, except for BMI, were confirmed after stepwise logistic regression. Alternately, in patients undergoing WR, hypertension and low-FEV1% were associated with a higher CPCs rate (5.1% hypertension vs. 0.4% no-hypertension, p = 0.02; FEV1% 79.7% vs. 95%, p = 0.01). Conclusions: Our results demonstrated that preoperative ONS after uVATS anatomic lung resection, in the context of an EPC program, influences the postoperative period, reducing the CPCs rate. Full article

Objectives: The global rise in dementia prevalence is escalating the socioeconomic burden, prompting efforts in prevention and treatment. This study aimed to evaluate the effects of an 8-week oral nutrition supplement (ONS) program with or without a multi-domain intervention program (MIP) in patients with mild cognitive impairment. Methods: Forty-nine patients with mild cognitive impairment were divided into three groups: (1) ONS (ONS), (2) ONS+MIP (ONS+MIP), and (3) control (CON). Korean-style dementia prevention MIP was used in the ONS+MIP group. Two packs of ONS per day were provided to the ONS group during the intervention period. Cognitive function, nutritional evaluation, body composition analysis, and physical performance were measured. The paired t-test and one-way analysis of variance were used for statistical analyses. Results: A final analysis was performed on the final 46 participants. After intervention, the cognitive function test (Repeatable Battery for the Assessment of Neuropsychological Status, RBANS) scores of the ONS+MIP group were significantly increased compared to the baseline scores. However, no significant changes were observed in the ONS and CON groups. Eating behavior and food quality also improved in the ONS+MIP group, with a significant difference among the three groups. There was no significant change in body composition in all groups; however, grip strength (left hand), muscular endurance, and the total SPPB score improved in the ONS+MIP group. The total SPPB score decreased in the CON group. Conclusions: Along with ONS intake, intensive education and continuous monitoring through multi-domain interventions are important to improve cognitive function. Trial registration: Clinical Research Information Service identifier: KCT0007253. Full article

Objectives: Dietary conditions are closely related to maternal health. This study aims to investigate the causal relationship between the first–second-trimester Dietary Inflammatory Index (DII) and developing anemia in the third trimester. Methods: This prospective cohort study comprised 545 pregnant women, with dietary data assessed via a semi-quantitative food frequency questionnaire (FFQ). Hemoglobin levels were obtained by hospital laboratory tests and used to diagnose anemia. Multivariable logistic regression models—adjusted for baseline serum iron, age, pre-pregnancy body mass index (BMI), occupation, education, history of adverse pregnancy outcomes, parity, serum iron, passive smoking exposure, and iron supplementation use during pregnancy—were employed to evaluate the relationships between the first-trimester DII, second-trimester DII, first–second-trimester average DII, and third-trimester anemia. Results: After multivariable adjustment, the first–second-trimester average DII in the pro-inflammatory diet group demonstrated a 3.73-fold elevated risk of third-trimester anemia compared to the anti-inflammatory diet group (Odds Ratio [OR] = 3.73, 95% Confidence Interval [CI]: 1.50–9.25). Conclusions: Pro-inflammatory dietary patterns during pregnancy exhibit a significant correlation with developing third-trimester anemia. This study demonstrates that reducing dietary pro-inflammatory components through prenatal nutrition programs may lower third-trimester anemia risk. Notably, this study carries potential risks of bias, including self-reporting bias in dietary data and incompletely controlled confounding factors (such as unmeasured biomarkers). Full article

Maternal overnutrition and targeted supplements during pregnancy strongly affect fetal development in beef cattle, influencing gene expression, tissue development, and productivity after birth. As modern feeding practices often result in cows receiving energy and protein above requirements, understanding the balance between adequate nutrition and overconditioning is critical for sustainable beef production. This review synthesizes findings from recent studies on maternal overnutrition and supplementation, focusing on macronutrients (energy, protein, methionine) and key micronutrients (e.g., selenium, zinc). It evaluates the timing and impact of supplementation during different gestational stages, with emphasis on fetal muscle and adipose tissue development, immune function, and metabolic programming. The role of epigenetic mechanisms, such as DNA methylation and non-coding RNAs, is also discussed in relation to maternal dietary inputs. Mid-gestation supplementation promotes muscle growth by activating muscle-specific genes, whereas late-gestation diets enhance marbling and carcass traits. However, maternal overnutrition may impair mitochondrial efficiency, encourage fat deposition over muscle, and promote collagen synthesis, reducing meat tenderness. Recent evidence highlights sex-specific fetal programming differences, the significant impact of maternal diets on offspring gut microbiomes, and breed-specific nutritional responses, and multi-OMICs integration reveals metabolic reprogramming mechanisms. Targeted trace mineral and methionine supplementation enhance antioxidant capacity, immune function, and reproductive performance. Precision feeding strategies aligned with gestational requirements improve feed efficiency and minimize overfeeding risks. Early interventions, including protein and vitamin supplementation, optimize placental function and fetal development, supporting stronger postnatal growth, immunity, and fertility. Balancing nutritional adequacy without excessive feeding supports animal welfare, profitability, and sustainability in beef cattle systems. Full article

Background/Objectives: Safety-net health centers are increasingly screening for food insecurity and providing patients with referrals to public assistance programs—e.g., the Supplemental Nutrition Assistance Program (SNAP). However, not all individuals actively participate in or are eligible for these programs. Onsite distributions of free produce at health center sites represent a promising complementary option for addressing this need. This study examines free produce events at these sites and their associations with attendees’ food and vegetable consumption, household food insecurity, and SNAP participation (study outcomes). Methods: In 2024, an intercept survey was conducted with 497 adults attending produce events at 16 safety-net health center sites in Los Angeles County, California, USA. Descriptive analyses profiled these food events, gathering information on attendee characteristics. Multivariable regressions examined associations between event attendance and study outcomes. Results: Over 80% of attendees lived in food-insecure households. Among those who were patients of the event site, 68% and 28%, respectively, indicated they received information about Medicaid and SNAP from the clinic staff. Compared to first-time attendees, those who attended produce events frequently consumed, on average, one additional serving of fruit and vegetables a day (p < 0.000). Conclusions: Offering free produce events at health center sites, where many attendees receive usual care, is a promising strategy for increasing healthy food access among safety-net populations. This underutilized approach is a viable intervention for improving access to healthy food, especially in circumstances where patients are not eligible for public assistance or nutrition incentive and/or food pharmacy programs are not readily available. Full article

Background: The prevalence of malnutrition is high in post-intensive care unit (ICU) coronavirus disease 2019 (COVID-19) patients during hospitalization and after hospital discharge. This paper presents prospective results from the NutriEcoMuscle study, a multicenter observational study. The study aimed to evaluate changes in nutritional and functional status in post-ICU COVID-19 patients following nutritional and physical rehabilitation interventions. Secondary aims included assessing adherence to and tolerance of the oral nutritional supplement (ONS) used in the nutritional intervention. Methods: The study enrolled adults who had been admitted to the ICU due to severe COVID-19. At hospital discharge, the patients underwent a nutritional intervention based on oral nutritional supplements (ONSs) with 100% serum lactoprotein enriched with leucine and vitamin D and a physical rehabilitation program. They were followed up during three months. Performed assessments included Subjective Global Assessment (SGA), Global Leadership Initiative on Malnutrition (GLIM) criteria, Barthel index (BI), handgrip strength and Timed Up and Go test, bioelectrical impedance analysis (BIA), nutritional ultrasound (US), and tolerance and adherence to ONS. Sample size was calculated based on handgrip strength, and parametric and non-parametric tests were used to assess differences between the baseline and three-month outcomes. Results: The study included 96 patients (71.9% male, mean age 58.8 years, mean body mass index (BMI) of 28.8 kg/m², 36.5% obese). A total of 85 patients (62 men and 23 women) completed the 90-day follow-up. The mean weight gain after the intervention was 6.8 (SD 5.2) kg (similar in men and women; p = 0.263). The proportion of patients with malnutrition according to the SGA or GLIM criteria decreased from 100% to 11.8% and 36.4%, respectively (p < 0.00001 in both cases). The proportion of patients with functional limitations by BI decreased from 66.7% to 27.0% (p < 0.0001). Handgrip strength increased more than 40% in both men and women (p < 0.00001). The time to perform the Timed Up and Go (TUG) test decreased more than 40% in both men and women (p < 0.00001). According to BIA, the mean fat mass did not increase significantly in either men or women. The mean fat-free mass index (FFMI) increased significantly in both men and women. There were also significant increases in body cell mass, skeletal muscle mass index, and appendicular skeletal muscle mass index. The phase angle (PhA) increased significantly in both men (26.5%) and women (17.4%). In a multivariate analysis, age and baseline PhA were related to the PhA increase (adjusted R² = 0.5573). The US study showed a significant increase in the mean measurements of muscle area, muscle circumference, X-axis, and Y-axis in the rectus femoris. Regarding abdominal fat, there were no significant increases in total, superficial, or preperitoneal adipose tissue by US. Participants engaged in a median interquartile range (IQR) of 70 (0–120) min/week of strength exercise and 60 (0–120) min/week of moderate physical exercise. The supplement was well tolerated, and poor adherence (less than 50%) was low (4% of the participants). Conclusions: A three-month intervention, including ONS and physical rehabilitation, is associated with a significant improvement in nutritional and functional status. Patients gained weight primarily by increasing their muscle mass. There was no significant increase in fat mass, as measured by BIA or US. The intervention was well tolerated and had good adherence. Full article

Background/Objectives: Nutrition plays a key role in gynecologic conditions, pregnancy, and perinatal outcomes; therefore, nutritional counseling is essential in obstetric and gynecologic care. The present study aimed to delineate Italian Obstetrics and Gynecology (ObGyn) residents’ awareness of women’s nutrition and supplementation in different stages of life. Methods: We conducted a cross-sectional online survey about women’s nutrition and supplementation use throughout their lifetime. A 31-item survey questionnaire was distributed to Italian ObGyn Residents. Results: 258 Italian ObGyn Residents completed the online survey. About 40% of the responders considered their knowledge of women’s nutritional needs poor or very poor. A total of 226 residents (88%) declared that there is not enough time dedicated to women’s nutrition during their specialty program, and almost all the trainees would consider training in this area helpful for achieving a better professional profile. A total of 128 participants (49.6%) demonstrated insufficient knowledge in this field. Most (97.1%) of the responding trainees recommend supplementation during different stages of women’s lives. Conclusions: Italian ObGyn residents are not very skilled in women’s nutrition. There is an urgent need to develop specific training and interventions to educate our ObGyn residents about the importance of improving nutritional habits in patient care. Full article