Appetite

Background: Vision-language models (VLMs) are being considered for estimating energy intake from meal photographs. Prompt descriptions such as a Japanese-dietitian persona shift the estimates, suggesting their use for calibration; what the estimates rest on was unknown. Objective: We examined whether prompt descriptions can serve as calibration, at which training stage responses to a nationality persona and to an amount instruction arise, and whether estimates follow the visible amount or one associated with the identified dish. Methods: Eleven commercial and 15 open-weight models were evaluated on NutriImage (887 Japanese single-dish photographs) and SNAPMe (1,134 US meal photographs) under eight prompt conditions (no description, five personas, and smaller- or larger-portion instructions). With one model, images were cropped or replaced by the dish name. Before- and after-meal photographs of 804 meals (ACETADA) were estimated. Pre-trained and post-trained weights of Gemma 3 and InternVL3.5 8B were compared by likelihood scoring. Prompts were compared with numerical calibration. Results: Where the dish was named as in the full image, a 25% crop changed neither the median absolute percentage error (MedAPE; 33.8% vs 34.4%) nor the persona shift (-20 vs -20 kcal); dish names alone gave similar accuracy (MedAPE 31.7%); nearly empty trays still received 39%-75% of the before-meal estimate, often described as already eaten. Between models, the persona shift was related to baseline bias (r = -0.77) and less to instruction following (r = -0.36); the instruction shift showed the reverse (r = -0.14 and -0.95). In Gemma 3, the Japan-US contrast was 2-4 times larger before post-training, and the instruction response 2-4 times larger after it (InternVL3.5 8B: 3 and 1.4 times). Across images, the Japan-US contrast was uniform on US meals and, for Japanese dishes in the commercial models, Gemma 3, and Qwen3-VL 32B, larger where overestimated. In these models, the persona lowered MedAPE for Japanese dishes as much as, or slightly more than, subtracting the mean bias, and no more than dividing by a ratio; on US meals it did not; in open-weight families that responded little, only numerical calibration lowered error. The smaller-portion instruction raised MedAPE in models with little bias (eg, 30.0% to 50.2%). Conclusions: In the model examined most closely, the estimates behaved as if anchored on an amount associated with the identified dish and only partly corrected by the visible amount. Prompt descriptions moved them by amounts depending on model and cuisine, not on the correction needed; a persona is therefore not proposed as a general means of calibration. In a facility, the findings suggest showing the identified dish for correction, calibrating by a ratio measured on reference meals with the deployed model, keeping amount statements out of the prompt, and not deriving intake from before-after-meal differences.

Background: (Poly)phenol intake is associated with improved cognitive function in adults, with emerging evidence suggesting benefits in children. However, the role of prenatal (poly)phenol exposures in cognitive development remains a gap in early-life nutrition research. Objective: This analysis of a longitudinal cohort tested the associations between prenatal (poly)phenol intakes and cognitive outcomes in school-age children at age 5 and 8 years. Methods: Participants included mother-child pairs enrolled in a prospective, longitudinal study during pregnancy and completed 5- and 8-year follow-up visits (N = 129). 3-day food records were used to estimate prenatal and child intakes of energy and 18 (poly)phenol subclasses using a database developed from Phenol-Explorer (v3.6). The analytical sample included children (N = 111) with completed assessments for academic achievement, language skills, and intelligence quotient (IQ) scores (Mean = 100, SD = 15). Regression models estimated associations between (poly)phenol intakes and cognitive outcomes, adjusted for breastfeeding duration, maternal IQ, pre-pregnancy BMI, gestational age, and infant sex. Results: Average prenatal total (poly)phenol intake was 716 mg/d. Prenatal (poly)phenol intakes were not associated with child academic achievement scores. Higher prenatal flavone intakes were associated with higher language ({beta}: 4.36, p = 0.045) and IQ ({beta}: 9.43, p = 0.002) scores. Higher flavonol ({beta}: -4.67, p = 0.022) or hydroxybenzoic acid intakes ({beta}: -3.88, p = 0.026) were associated with lower language scores. Major sources of flavones and lignans included coffee, orange juice, and herbal tea. Coffee, cranberry, black tea, okra, and tomato sauce provided flavonols and hydroxybenzoic acids. Conclusions: Associations between prenatal (poly)phenol intake and child cognitive outcomes were mixed and differed by subclass. Further investigation is needed to explore the role of co-occurring nutrients and other dietary components. These findings suggest that (poly)phenol subclasses derived from healthier plant-based foods, including citrus fruit and herbal tea, may associate with improved child cognitive outcomes.

The post-ingestive dopamine response is an integral determinant of subsequent eating behavior in animals yet measurement of the post-ingestive response to nutrients in humans has been elusive when assessed in the early post-ingestive period (30 minutes postprandially). We conducted secondary analysis comparing dopamine D2 receptor binding potential (D2BP) measured using [18F]fallypride positron emission tomography in two inpatient controlled feeding cohorts consuming standardized diet (50% carbohydrate; 35% fat; 15% protein) with similar characteristics and procedures but differing in time since last meal: confirmed overnight fast (n=57; 66.7% female; BMI 29.6{+/-}7.6 kg/m2; 31.9{+/-}7.2 years old) and 2-hours after a standardized meal reflecting 20% of energy requirements (n=43; 48.8% female; BMI 28.8{+/-}7.8 kg/m2, 31.3{+/-}7.7 years old). Compared to the fasted cohort, the 2-hour postprandial cohort exhibited significantly reduced whole striatal D2BP (p<0.0001) as well as in clusters in insular cortex, prefrontal cortex which remained after adjustment for age, sex, and insulin sensitivity. Voxelwise comparisons of the relationship between D2BP and BMI in the fasted and fed cohorts reveals clusters within dorsolateral and ventral striatum where dopamine level is dependent on postprandial state and adiposity. Given the similarities between protocol procedures and participant characteristics, our results suggest that the post-ingestive dopamine response to nutrients may be prominent in the extended post-ingestive period and warrant investigation within-subject.

Background: Added sugars during early development may influence adiposity, but whether associations vary by developmental timing and child sex is unclear. Objectives: To determine whether child sex modifies associations of added sugars and fructose exposure from pregnancy through 24 months with body composition at 24 months. Methods: This secondary longitudinal analysis included 130 mother-child dyads. Maternal diet was assessed during mid-pregnancy and child diet at 2wk and 6mo (infancy), and 12mo and 24mo (toddlerhood). Multivariable regression tested sex-by-exposure interactions for anthropometric outcomes; 42 children had usable dual-energy X-ray absorptiometry (DXA) data. Results: Prenatal added sugars were more positively associated with percentage body fat and total and regional fat mass in girls than in boys. Prenatal fructose was more positively associated with waist circumference in boys. During infancy, added sugars were more positively associated with percentage body fat and total and regional fat mass in boys, whereas fructose was more positively associated with fat-free mass in girls. Conclusions: Associations of early-life sugars exposure with body composition varied by developmental timing and child sex. Findings from the smaller DXA subset are exploratory and require replication but suggest that susceptibility to early dietary sugars may differ across developmental windows.

Purpose: In high-income countries, lower socioeconomic position (SEP) is linked to higher childhood obesity prevalence but its association with cardiometabolic risk in those presenting in pediatric weight management services remain underexplored. Methods: In the Bern Obesity in Childhood and Adolescence Biorepository (BOCAB), we used the Swiss neighborhood index of SEP (0-100, 100=highest SEP) to assess cross-sectional associations with obesity severity and cardiometabolic risk factors, mediation by behavioral lifestyle factors and longitudinal associations between SEP and percentage of the 95th BMI percentile (%BMIp95) and waist circumference-to-height ratio (WHtR), adjusted for age and sex. Results: Among 886 participants (52% male, mean age 11.2 years [SD 3.1]), mean %BMIp95 was 124% (SD 17%). A 10-unit higher SEP was associated with lower %BMIp95 ({beta} -2.57; 95% CI -3.84 to -1.31) and lower WHtR ({beta} -0.006; -0.010 to -0.001), both partially mediated by weekly physical activity and screen time. Higher SEP was also associated with lower odds of insulin resistance (OR 0.80; 0.65 to 0.98), low HDL-cholesterol (OR 0.81; 0.67 to 0.98), elevated non-HDL-cholesterol (OR 0.74; 0.59 to 0.92) and elevated triglycerides (OR 0.83; 0.70 to 0.98). Among 419 participants with longitudinal data, annual reduction in %BMIp95 and WHtR did not differ by SEP. Conclusion: Lower SEP is associated with greater obesity severity and cardiometabolic risk among children and adolescents with obesity presenting at specialized tertiary care. Screening and early referral of lower-SEP children and adolescents with obesity should be encouraged, before cardiometabolic risk accumulates, particularly since treatment response did not differ once enrolled.

Obesity and metabolic diseases such as diabetes reflect long-term interactions between diet, lifestyle, and genetics, variables that are hard to control in humans but can be systematically varied in mice, though behavioral variables like long-term exercise remain harder to model. Having previously phenotyped ~50 BXD strains, we identified BXD40, BXD43, and BXD100 as predisposed to voluntary wheel-running (~6 km/day at 24 weeks) with variable susceptibility to diet-induced obesity and diabetes. We followed these strains from 8-32 weeks on a 60% kcal/fat high-fat (HF) diet, with or without access to running wheels. Wheel usage declined from ~9 km/day in the first two weeks to a steady ~5 km/day thereafter yet still improved oral glucose tolerance by 35% over sedentary controls by 24 weeks. Despite equivalent body weight, runners ate 20% more relative to body weight, indicating the glucose benefit was independent of caloric intake. We next asked whether the gut microbiome contributes to this benefit. Long-term exercise produced only modest, cohort-dependent shifts in cecal microbial composition, though functional profiling revealed exercise-associated differences in carbohydrate- and glucose-metabolism pathways. Reciprocal bedding exchange between sedentary and running BXD43 cages reduced microbial differentiation in a taxon-specific manner and coincided with marked attenuation of the glucose phenotype, despite unchanged running behavior. Together, these findings validate BXD40, BXD43, and BXD100, alongside the canonical C57BL/6, as a model for studying diet, exercise, and genetics in metabolic disease, and implicate gut microbial taxa in shaping exercise's metabolic effects during HF feeding.

Background: University life can influence food choice even among physically active students. This study examined nutritional awareness, emotional, external, and restrained eating, body mass index (BMI), and estimated resting metabolic rate (RMR) in physical education students, and assessed differences by sex and academic level. Methods: A descriptive, analytical and correlational design was used. The sample included 160 physical education students (95 women and 65 men; mean age 20.42 {+/-} 1.53 years) from An-Najah National University. Nutritional awareness was assessed with a 15-item scale, and eating behaviour with the 33-item Dutch Eating Behavior Questionnaire. BMI was calculated from measured height and body mass, and RMR was estimated using an equation developed for athletes. Correlations, group comparisons, robust interaction models, and hierarchical regression were applied. Results: Nutritional awareness was high (3.73 {+/-} 0.81), whereas emotional (3.11 {+/-} 1.18), external (3.20 {+/-} 0.95), and restrained eating (3.25 {+/-} 1.11) were moderate. Higher awareness was associated with less emotional (r = -0.617) and external eating (r = -0.652), but greater restrained eating (r = 0.644; all q < 0.001). These associations remained after adjustment. Men reported more external eating, while women reported more restrained eating. Eating patterns also varied by academic level. BMI and estimated RMR showed weaker and less consistent associations with eating behaviour. Conclusions: Nutritional awareness was closely associated with reported eating behaviour, whereas BMI and estimated RMR were less informative. Sex and academic-level differences suggest that nutrition education for physical education students may be more useful when adapted to specific behavioural patterns. The findings represent associations and group differences and do not establish causal relationships. Keywords: physical education students; nutritional awareness; eating behaviour; emotional eating; external eating; restrained eating; body mass index; resting metabolic rate

Background: Whether whole-body energy balance is associated with perceived stress in young adults is unclear. Aim: To examine associations of estimated free-living energy balance with physical and psychological stress during 28-day monitoring. Methods: This secondary analysis of an observational study included 18 Japanese male university students with at least 14 valid accelerometer days (at least 600 min/day). Energy intake was estimated using the Brief-type Self-administered Diet History Questionnaire; total energy expenditure was estimated from accelerometry plus resting metabolic rate. Physical and psychological stress were assessed before and after monitoring using 100-mm visual analog scales. Baseline-adjusted linear regression was used. Summary: Mean energy balance was -79 kcal/day (SD 531). Energy balance was not clearly associated with post-monitoring physical stress (B = 0.067 per 100 kcal/day, 95% CI -1.604 to 1.737; p = 0.933) or psychological stress (B = 0.314, 95% CI -2.571 to 3.199; p = 0.820). No clear association between estimated free-living energy balance and post-monitoring stress was detected.

Background: There is a growing availability of plant-based alternatives for bovine milk. However, plant-based drinks differ e.g. in protein quantity, protein quality and carbohydrate composition. Knowledge on the impact this has on digestion-related outcomes such as postprandial amino acid (AA) availability and gastric behavior is still limited. Additionally, data on milk alternatives with higher overall protein concentration are lacking. Objective: We aimed to compare the differences in postprandial AA profiles, glycemic response, and gastric behavior between bovine milk and plant-based drinks with or without added protein using representative commercial drinks. Methods: 12 healthy males participated in a randomized crossover study with three treatments. After an overnight fast, participants drank 750 ml of semi-skimmed milk (Milk), a standard oat-based drink (OBD) or an oat-based drink enriched with pea protein (OBD+Pea). Blood samples were taken for measurement of plasma AA, glucose, insulin and FGF21 over 5 hours. Gastric content changes were assessed using magnetic resonance imaging scans for Milk and OBD+Pea over 2 hours. Results: Compared with Milk, both oat-based drinks elicited lower 5-h total AA iAUC (OBD -169706; OBD+pea -139552 microM*min; both P<0.001) and EAA iAUC (OBD -91748; OBD+pea -78199; both P<0.001), with no differences between oat-based drinks. Gastric content volume was lower for OBD+Pea versus Milk from 60-120 min (range -48 - -84 ml, all P<0.001). Compared to Milk, OBD and OBD+Pea increased glucose more from 15-45 min (range 0.86 - 1.73 mmol/l, all P<0.001) and insulin from 30-60 min (1.84 - 2.14-fold, all P<0.001). Conclusions: Protein enrichment in plant-based milk alternatives can be a valuable strategy to increase protein content and improve amino acid composition. However, such products still show faster gastric emptying, lower postprandial essential amino acid and higher glycemic and insulinemic responses compared to bovine milk because of their different carbohydrate and protein content and quality.

Background & Aims Personalized nutrition has the potential to improve nutritional intake and clinical outcomes in hospitalized patients by adapting to individual dietary needs and preferences. Despite its promise, no personalized nutrition product (PNP) for hospitalized patients is currently available. This study aimed to assess the acceptability of PNPs among hospitalized patients and hospital staff. Methods A prospective, ten-days, proof-of-concept study was conducted among in-hospital adult patients ([&ge;]18y). Study patients received a freshly 3D printed PNP, customized to match individual taste preferences and health profiles. Patients could reorder the product daily if they remained hospitalized >24h after consumption. Consumption was assessed by weighing the PNP before and after consumption. Acceptability, sensory feedback, and overall experience were evaluated using questionnaires. Hospital staff also evaluated sensory feedback and acceptability. Factors influencing consumption and liking among patients were evaluated by testing within-group differences. Correlations between consumption rates, liking and patient characteristics were assessed. Results Eighty-seven patients received 137 PNPs during the study period. The average overall liking score was 5.7 ({+/-}2.1) on a 1-9 scale, and median consumption rate was 51% [Interquartile Range 19-100]. Consumption rates positively correlated with overall liking (R2 = 0.50, p < 0.001). Patients' willingness to reorder was 3.5 ({+/-}2.3) on a 1-7 scale, and reorder rate 63%. The perceived value of a PNP service in a hospital setting (scale 1-7) was scored 5.3 ({+/-}1.7) by patients and 4.5 ({+/-}1.1) by staff. Conclusions PNPs were evaluated as moderately positive in terms of acceptability and value by both patients and staff. However, further optimization of the product is needed before evaluating clinical efficacy.

Background: Real-world evidence on food-as-medicine programs for irritable bowel syndrome (IBS) is scarce, and single-arm evaluations overstate improvement because of regression to the mean (RTM). We estimated change in the IBS Symptom Severity Scale (IBS-SSS, 0-500) in a multi-omics personalized digital health food-as-medicine program, unadjusted and RTM-corrected. Methods: Retrospective single-arm cohort. Of 15,933 members with a valid baseline, 2,254 had a follow-up reading and 1,683 one at least 14 days after baseline. Change at 4, 12 (primary) and 26 weeks was estimated by baseline severity stratum, unadjusted and RTM-corrected by analysis of covariance. A responder fell by at least 50 points (the minimal clinically important difference benchmark). Sensitivity analyses covered equity, inverse-probability weighting and tipping-point analyses for members without a reading in each landmark window, a negative-control stratum and medication. The association of weight loss and dietary nutrient density with symptom change was evaluated within and between members. Results: At 12 weeks (n = 430) IBS-SSS fell by 43.88 points unadjusted (95% confidence interval [CI] -52.44 to -35.32; p < 0.001) and by 47.73 RTM-corrected (-55.48 to -39.98; p < 0.001); 720 of 1,339 symptomatic members (53.8%; 95% CI 51.1 to 56.4) fell by at least 50 points. Larger improvement in more severe members persisted after RTM correction (severe stratum, n = 37: unadjusted -127.43, RTM-corrected -60.71, 95% CI -97.75 to -23.68, p = 0.001). A higher meal nutrient density was associated with lower IBS-SSS within a member's own trajectory (p = 0.018) while weight change was not (p = 0.361). Improvement was similar across groups in spite of baseline differences by age and sex: RTM-corrected 12-week change did not differ by age (p = 0.458), body-mass index (p = 0.328), sex (p = 0.749), income (p = 0.486) or ethnicity (p = 0.170). Estimates were robust to weighting for members without a reading in the landmark window (RTM-corrected estimates moved by less than 2 points), and the change of those members would have had to be 39 to 73 points worse than observed before the mean change reached zero. Baseline medication use and starting a GLP-1 receptor agonist did not explain symptom changes. Conclusions: IBS-SSS fell significantly among program participants, with steeper improvement in the more severe group, even after RTM correction. The improvement was comparable across socioeconomic characteristics, age and sex and robust to the confounders and missing-data assumptions evaluated. These associations from a self-selected single-arm cohort warrant replication in independent studies.

Formula-fed infants have altered gut microbiota and immune development relative to breastfed infants. Human milk oligosaccharides (HMOs) and microbes able to ferment these, like Bifidobacterium infantis, promote healthy immune-microbiome interactions in breastfed infants. In this randomized trial, 240 healthy term infants in the Philippines received a synbiotic blend formula (SynF; seven HMOs, bovine milk oligosaccharides, and B. infantis LMG11588) or control formula (CtrlF) for 6 months. SynF supported growth non-inferior to CtrlF and near universal B. infantis colonization (vs <10% in CtrlF). Markers of intestinal inflammation were lower in children fed SynF while secretory IgA was higher. SynF fed infants showed lower markers of systemic inflammation in plasma, slower immune cell maturation, and fewer upper respiratory tract infections (URTI) during their first 6 months of life. These findings suggest that synbiotic formula can dampen inflammatory responses to colonizing microbes and mild infections in fully formula-fed, term infants. Trial registration: NCT06073652.

Epidemiological studies associate replacing animal-sourced with plant-sourced protein with lower colorectal cancer (CRC) risk, but controlled feeding studies have rarely tested how this substitution alters the gut microbiota and CRC-related biomarkers. In a 12-week randomized controlled feeding study, 136 healthy adults consumed diets providing 30 energy percent (E%), 50 E%, or 70 E% of protein from plant sources. Change in gut microbiota composition was the primary outcome; stool characteristics, fecal N-nitroso compounds (NOCs), and fecal and plasma bile acids (BAs) were secondary outcomes. The 70% plant-protein diet significantly restructured the gut microbiota, increasing fiber-associated Lachnospiraceae and Roseburia while reducing Methanobrevibacter and several asaccharolytic taxa. Microbial functional potential shifted toward plant-carbohydrate degradation, with lower amino acid degradation and methanogenesis. Fecal pH decreased, stool characteristics suggested faster colonic transit, and potentially carcinogenic total and haem-derived NOCs declined progressively with plant-protein replacement. The 70% plant-protein diet also reduced fecal secondary and taurine-conjugated BAs, including the CRC-associated BAs DCA and LCA. Plasma glucuronidated BAs increased, expanding the circulating pool of readily excreted BA conjugates. Higher insoluble fiber intake was associated with greater microbiota restructuring and lower fecal NOCs. Methanogen carriers had higher baseline fecal NOCs and features of slower colonic transit, and showed weaker microbiota and less favorable BA responses to the 70% plant-protein diet. Baseline methanogen carriage thus could be exploited for participant stratification in future dietary interventions.

Background: Incretin-based obesity medications (IOMs) produce substantial weight loss, but the incremental benefit of structured nutritional therapy when integrated with pharmacotherapy remains unclear. Objectives: To compare 12-month weight-loss outcomes between individualized carbohydrate-reduced nutritional therapy combined with IOMs (VINT+IOM) and IOM-based care without structured nutritional therapy (IOM only). Methods: This retrospective cohort study evaluated 4,269 adults enrolled in a comprehensive telemedicine obesity care program (VINT+IOM, n=1,658; IOM only, n=2,611). Both pathways included clinician-guided medication management and behavioral coaching. The primary analysis focused on GLP-1-naive participants receiving either semaglutide or tirzepatide without switching medications during follow-up. Adjusted weight changes were estimated using longitudinal linear mixed-effects models accounting for baseline demographic and clinical characteristics. Additional analyses evaluated weight-loss responders, prior GLP-1 exposure, and medication utilization. Results: Among GLP-1-naive semaglutide users, adjusted 12-month weight loss was greater with VINT+IOM than IOM only (30.7 vs. 24.1 lb; P=0.01), with corresponding observed weight loss of 13.3% versus 11.1%. Among tirzepatide users, adjusted weight loss was 45.9 versus 34.4 lb (P=0.003), with observed reductions of 19.7% versus 15.6%, respectively. Weight-loss responder rates consistently favored VINT+IOM. In the overall cohort, including GLP-1-naive participants, those with prior GLP-1 exposure, and participants with varying medication trajectories, adjusted weight loss was 29.4 versus 21.5 lb (P less than 0.001), with observed reductions of 12.7% versus 9.6%. Greater weight loss with VINT+IOM was also observed among participants with prior GLP-1 exposure. Weight loss continued between 6 and 12 months in both pathways. Medication coverage was high, with approximately 80% of participants achieving a proportion of days covered of at least 80% in both pathways. Conclusions: Integrating individualized carbohydrate-reduced nutritional therapy with IOM-based care was associated with greater 12-month weight loss than IOM-based care without structured nutritional therapy. These real-world findings support further evaluation of individualized nutritional approaches as an adjunct to incretin-based obesity pharmacotherapy.

Background: Thinness-oriented body ideals are well described among young Japanese women, but variation in visual and numerical ideals by sex, age, and current BMI remains unclear. Methods: We analysed an unweighted web-panel sample of 27,359 Japanese adolescents and adults aged 15-69 years from the Survey of Body Shape and Health Awareness in Japanese People, a cross-sectional web-based survey. Current and ideal BMI were derived from self-reported height and weight, and visual orientation from ideal versus perceived current silhouette. Adult BMI-stratified analyses included participants aged 20-69 years. Findings: Among 27,359 participants (10,094 men and 17,265 women), relative thinness-oriented indicators increased with current BMI in both sexes. Among normal-weight women, 74.7-83.7% selected a smaller ideal silhouette and 79.2-91.2% reported an ideal BMI lower than current BMI. These indicators were also present among underweight women aged 20-29 years (44.9% and 43.4%, respectively), but declined with age. Most underweight men reported weight-gain-oriented ideals. Fine stratification showed that thinness-oriented ideals among women were common in low-normal and mid-normal BMI strata. Interpretation: Body-size ideals differed by sex, age, and current BMI. Thinness-oriented ideals among women extended beyond obesity and young adulthood, whereas underweight men generally preferred a larger body. Longitudinal and behavioural studies are needed. Funding: Cabinet Office of Japan Strategic Innovation Promotion Program (SIP), "Inclusive Community Platform" (grant no. SIPCP23C02).

Growing evidence links ultra-processed food intake according to the Nova classification with poor health, yet no comprehensive database of additives and food substances of non-culinary use that are markers of ultra-processing exists for the UK. Building the database involved seven steps: (1) obtaining all approved additives in the UK, (2) retrieving all of their technical functions, (3) coding each technical function as cosmetic (marker of ultra-processing) or non-cosmetic (not a marker of ultra-processing), (4) adding 'flavour extracts', 'natural flavourings', and 'flavourings', (5) excluding additives as ultra-processing markers if they served fortification purposes, or were a herb/spice, and (6) adding food substances of non-culinary use defined as markers of ultra-processing in the Nova classification. Lastly, (7) two UPF definitions were constructed based on the ambiguity/overlap of additive technical functions from previous approaches. The database is freely accessible for researchers to improve consistency in using the Nova classification in the UK.

Thailand is experiencing a rapid rise in childhood obesity, increasing the risk of early-onset non-communicable diseases. Although whole grains support weight management and reduce non-communicable diseases risk, consumption remains low in Thailand and is insufficiently addressed in the Thai Food-Based Dietary Guidelines. Whole grains are also rarely included in the National School Lunch Program. Given its high participation rate, the school lunch program represents a strategic platform for increasing whole-grain intake and fostering lifelong healthy eating habits. This study aimed to identify facilitators and barriers to increasing whole-grain provision in Thai elementary schools from the perspectives of adult stakeholders We conducted in-depth interviews guided by the Integrated Behavioral Model with 19 teachers and contracted school cooks from two Thai elementary schools, and with 10 faculty and staff members at Mahidol University. Interviews explored perceived norms regarding student whole grain consumption, attitudes toward whole grain, and perceived facilitators and barriers to whole grain provision in schools. Data were analyzed using framework analysis, combining the Integrated Behavioral Model-informed thematic categorization with inductive coding. Transcripts were independently coded by two researchers to develop an Integrated Behavioral Model-grounded conceptual framework describing factors influencing intentions to increase whole grain provision in Thai elementary schools. Participants were predominantly female (93.1%) and highly educated (89.7% with a bachelors degree or higher). Most supported incorporating whole grains into school meals, citing their health benefits for schoolchildren. However, participants reported low WG intake among schoolchildren, attributable to limited availability at both schools and homes. Two primary barriers to whole grain provision were identified. The first was student-level resistance, including unfamiliarity and sensory aversions, particularly toward brown rice. The second involved systemic challenges, including the absence of regulatory guidance promoting whole grain inclusion and operational constraints related to contracted food services and inflexible menu systems. Multi-level engagement among schools, households, and government agencies was identified as a key facilitator of increased whole grain provision in school meals.? These findings indicate that although teachers and cooks are receptive to whole-grain provision in school meals, translating this support into practice will require coordinated, multisectoral action to address persistent structural barriers at the student, school, and policy levels. Future research should incorporate childrens perspectives and examine a broader range of school settings to inform the design of effective, sustainable strategies for whole grain integration.

Abstract Aim: To translate, culturally adapt, and psychometrically validate the Arabic version of the REAP-S among Arabic speaking young adults using Confirmatory Factor Analysis (CFA) and Rasch Measurement Theory (RMT). Design: A cross-sectional methodological psychometric validation study. Methods: The study included 500 undergraduate and postgraduate nursing students recruited from Saudi universities during the 2025-2026 academic year. The REAP-S was translated into Arabic using standardized forward backward translation procedures and cross-cultural adaptation guidelines. Participants completed the Arabic REAP-S through an online self-administered questionnaire. Construct validity was evaluated using CFA with robust estimators, assessing the Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Root Mean Square Error of Approximation (RMSEA), and Standardized Root Mean Square Residual (SRMR). Rasch Measurement Theory was applied to examine item fit, response category functioning, person item targeting, and person reliability. We assessed internal consistency using Cronbach's alpha and the Rasch Person Separation Index (PSI). Results: Psychometric analyses included 490 participants with a median age of 20 years (IQR = 19-22), of whom 54.1% were female. CFA supported the hypothesized one-factor structure and showed good model fit (CFI = 0.984, TLI = 0.978, RMSEA = 0.076, SRMR = 0.061). Standardized factor loadings ranged from 0.429 to 0.768, and internal consistency was good (Cronbach's = 0.863). Rasch analysis confirmed the scale's unidimensionality, with satisfactory person reliability (Expected A Posteriori [EAP] = 0.872; Weighted Likelihood Estimate [WLE] = 0.848). All items demonstrated acceptable infit and outfit mean square statistics (0.826-1.311 and 0.866-1.283, respectively), with ordered response thresholds and adequate person-item targeting. Overall, the Arabic REAP-S effectively discriminated between different levels of dietary behavior among Arabic-speaking young adults. Conclusion: The Arabic REAP-S demonstrated strong validity and reliability, supporting its unidimensional structure and appropriate psychometric performance. Evidence from both CFA and Rasch analysis confirmed acceptable model fit, good internal consistency, and adequate item functioning. The instrument provides a brief and practical tool for assessing dietary behaviors among Arabic-speaking young adults in clinical and research settings. Implications for the Profession and/or Patient Care: The Arabic REAP-S provides nurses and other healthcare professionals with a brief, standardized tool for rapidly assessing dietary behaviors and identifying individuals at nutritional risk. Its integration into routine clinical and community practice may support early dietary screening, guide nutrition education, and strengthen evidence based preventive care for diet related chronic diseases. Keywords: Arabic REAP-S; Dietary Screening; Confirmatory Factor Analysis; Rasch Measurement Theory; Construct Validity; Young Adults.

Synchrony between time-of-day and food intake is critical for maintaining homeostasis while desynchrony between these cues caused by repeated bouts of mistimed eating (ME) is profoundly disruptive to organismal health. However, it is unknown whether the same is true for a single bout of ME. While it is generally accepted that mammals recover quickly from acute alterations in feeding schedule and that chrono-disruption requires chronic, repeated changes, there have been no dedicated investigations of acute ME to suggest otherwise. Therefore, we exposed female and male C57Bl6/J mice to a single bout of ME or timed eating (TE) and continuously measured metabolic and behavioral responses for five days. A single bout of ME was sufficient to disrupt the daily rhythms of metabolic and behavioral outcomes for several days. Energy expenditure and wheel running activity were disrupted and light:dark variation in food intake and macronutrient utilization were altered for several days. Finally, ME changed the amount of time spent resting in for several days post-ME. The TE paradigm disrupted macronutrient utilization for two days but otherwise had no effect on metabolism or behavior. Our results demonstrate that one instance of ME alone has lasting impacts on daily rhythmicity and is an understudied source of circadian disruption.

Background: Erythritol and xylitol, naturally present in fruits and vegetables, are widely used as alternative sweeteners with minimal glycemic and insulinemic effects. Both are also produced endogenously, with elevated plasma concentrations reported in metabolic disorders and cardiovascular disease. Recently, two interventional studies reported enhanced platelet aggregation after acute oral intake of erythritol or xylitol, raising concerns about potential prothrombotic effects. We investigated whether acute exposure to erythritol or xylitol increases platelet reactivity in healthy individuals. Methods: We conducted a randomized, single-blind, crossover study in 14 healthy participants who received erythritol (50 g), xylitol (33.5 g), or water. Platelet aggregation was assessed ex vivo, together with circulating markers of platelet activation (P-selectin), endothelial activation (sVCAM-1), and coagulation (D-dimer), as well as plasma erythritol and xylitol concentrations. Complementary in vitro experiments were performed using platelet-rich plasma from 11 healthy participants exposed to increasing concentrations of erythritol or xylitol, followed by assessment of platelet aggregation. Results: Despite substantial increases in circulating erythritol and xylitol concentrations following oral intake, neither erythritol nor xylitol increased ex vivo platelet aggregation compared with water. Consistently, no relevant changes were observed in P-selectin, sVCAM-1, or D-dimer concentrations. Direct in vitro exposure of platelet-rich plasma to increasing concentrations of erythritol or xylitol likewise did not enhance platelet aggregation. Conclusions: In healthy individuals, acute oral intake of erythritol or xylitol did not increase platelet aggregation or circulating markers of platelet activation, endothelial activation, or coagulation. These findings were supported by in vitro experiments showing no direct effect of erythritol or xylitol on platelet aggregation. Our results do not support an acute platelet-activating effect of erythritol or xylitol under the conditions studied. Registration: URL: https://clinicaltrials.gov/study/NCT04966299; Unique identifier: NCT04966299.