Appetite

Obesity is associated with low-grade inflammation, which - our prior work shows - causally and reversibly increases effort aversion and related brain responses during food-related decision-making. However, how these laboratory findings translate to daily-life (food) motivation remains unclear. This study investigated low-grade inflammation in more ecologically valid measures of (food-related) motivation in obesity. We conducted a cross-sectional study (N=145 women, BMI>27 kg/m2, 18-59 yrs) and a 12-week randomized controlled trial (N=57 women, BMI>30 kg/m2, 18-59 years, C-reactive protein (CPR)>3 mg/l) testing the anti-inflammatory drug colchicine versus placebo. We measured effort-related food intake using a bogus taste test, daily-life motivation using ecological momentary assessment (EMA), and dietary intake using a food frequency questionnaire (FFQ). INFLA-score (CRP, white blood cell count, neutrophil-to-lymphocyte ratio, platelets) related to lower intake of high-effort food items on the taste test ({beta} -0.26 SD, p=0.011), lower engagement in high-effort activities (OR 0.72, p<0.001), and negatively moderated the association between anticipation and activity completion in EMA (OR 0.89, p=0.032). On the FFQ, INFLA-score related to lower intake of legumes and fruits and more intake of processed meat (all p<0.05). Colchicine decreased overall caloric intake ({beta} -341 kcal, p=0.018). A decrease in inflammation related to healthier dietary choices (Spearman {rho}=0.37, p=0.013). Colchicine did not affect effort-related food intake on the taste test or EMA. These findings indicate that that obesity-related inflammation is associated with increased effort-related food intake and motivation in daily life, and that reducing inflammation decreases (unhealthy) food intake. Such effects may partly underlie the challenges of achieving and maintaining weight loss.

Background: Over half of UK adults eat food prepared out-of-home (OOH) weekly and the poor nutritional profile of OOH food contributes to ill health. Nutri-Score is a form of interpretative labelling which assigns food products a value of A (healthiest) to E (least healthy) based on nutritional quality, and inclusion on menus could be a public health policy option to reduce obesity. This is the first real-world Randomised Control Trial to test the effectiveness of Nutri-Score alongside calorie labelling on food menus in UK OOH settings. Methods: Adult participants (N=672), majority White (80%) female (63%), with a mean age of 47(SD18) years, were recruited from the local community to visit OOH food businesses to order, consume, and pay for meals. Data collection days were randomised to be control (calorie labelling) or Nutri-Score (calorie labelling with Nutri-Score). Linear mixed models assessed impacts of labelling condition on perceived effectiveness of menu labelling and nutritional quality of food orders. Findings: Scores for perceived effectiveness of labelling were significantly greater in the Nutri-Score condition compared to control (B = 0.21, p=0.010; 95% CI 0.05, 0.37) and food orders were significantly better nutritional quality, indicated by lower Nutrient Profiling Model scores in the Nutri-Score vs. control condition (B = -0.89, p=0.003; 95% CI -1.48, -0.31). Interpretation: Compared to providing calorie labelling alone, inclusion of Nutri-Score could be an effective policy approach to improve nutritional quality of diet and reduce diet-related disease.

Resolving the inner conflict between improving eating habits (change talk) and sticking to unhealthy ones (sustain talk) is a key target in communication-based behavioral change interventions such as motivational interviewing (MI). Recent work has shown that this inner conflict affects how tastiness and healthiness are traded off in dietary decision-making. The effect varied with body mass index (BMI). Here we aimed to identify why participants with higher BMI shifted toward healthier food choices after listening to change talk. An evidence accumulation model found that BMI affected health evidence sampling when listening to change talk, and taste evidence sampling when listening to sustain talk. A serial mediation analysis showed that the effect of BMI on change-talk-induced health evidence sampling was explained by stronger resting-state connectivity in the ventromedial prefrontal cortex within the default mode network (DMN), which in turn predicted greater motivation to change eating habits. These cross-sectional findings indicate that the intrinsic functional organization of valuation-related regions within the DMN is associated with motivation to change. They provide evidence that these neural and behavioral factors need to align with contextual cues, such as weight status (as reflected by BMI), and with reasons for behavioral change to promote healthier decision-making.

Objective: Circadian rhythms are frequently disrupted in patients in the intensive care unit (ICU), potentially worsening clinical outcomes. Continuous enteral nutrition throughout the day and night is common in the ICU, but eliminates feeding-fasting cycles that serve as important timing cues for the circadian system. The objective of this study was to determine the effect of providing enteral nutrition in a cyclic daytime pattern, compared with continuous administration, on circadian rhythmicity in critically ill patients in the ICU. Design: Single-center randomized controlled trial Setting: Mixed medical-surgical tertiary intensive care unit in the Netherlands Patients: Adult ICU patients ([&ge;]18 yr) receiving enteral nutrition. Intervention: Patients were randomized to receive either continuous, or cyclic daytime enteral feeding (08:00-20:00), initiated from the start of nutritional support. Measurements and Main Results: Sixty-two ICU patients were enrolled, of whom 51 were included in the per-protocol analysis. While the amplitude of the 24-hour rhythm in core body temperature did not differ significantly between the cyclic daytime and continuous feeding groups (0.17 [interquartile range: 0.09-0.24] vs. 0.20 [0.13-0.30], p=0.182), the 24-hour rhythm in heart rate was enhanced in patients receiving cyclic daytime feeding, as reflected by significantly higher amplitudes and more synchronized peak times. No significant differences in 24-hour rhythmicity were observed between groups for the other vital signs or melatonin. Conclusions: Our findings suggest that cyclic daytime feeding may strengthen circadian rhythms in critically ill patients. Further studies are warranted to evaluate its impact on clinical outcomes.

The satiety cascade includes post-prandial increases in plasma glucose and insulin, and changes in appetitive gut hormones, including decreases in orexigenic stomach-derived ghrelin, and increases in liver-foregut-derived LEAP2 hormone, a ghrelin antagonist. However, which contribute to post-prandial attenuation of eating behaviour with increasing preload meal size is unclear. In a randomised, single-blinded study, adults without obesity attended four visits, consuming 750mL liquid preloads 0, 600, 900, 1200 kcal, with assay of plasma glucose, acyl ghrelin (AG), LEAP2 and serum insulin over 0-3h with appetite ratings (n=17, 65 visits). At 2h a virtual portion size creation task measured desired food intake (n=15, 58 visits, after data exclusion), and at 3h an ad libitum meal measured actual food intake (n=11, 43 visits). The greater the pre-load meal size, the greater the post-prandial increase in plasma glucose and serum insulin, and greater the decrease in plasma AG and AG/LEAP2 ratio, associated with greater attenuation of eating behaviour (appetite ratings, desired/actual food intake). The strongest correlations of eating behaviour with blood measures were for serum insulin, plasma AG and AG/LEAP2 ratio, with weaker results for plasma glucose. Although there was a weak correlation of post-prandial plasma LEAP2 with pre-load meal size but not with eating behaviour. Post-prandial increases in serum insulin and decreases in plasma AG and AG/LEAP2 ratio appear part of the satiety cascade related to preload meal size in adults without obesity. Future studies should investigate potential mediation of satiety in this context via other appetitive gut hormones, and in obesity.

Objective: Observational studies have provided evidence for positive associations between inflammatory dietary patterns (IDP) and mental health, which might be mediated by immune activation. However, a causal relationship has not yet been established. Here we aim to investigate the causal nature of associations between IDP and mental health traits (depressed affect, mood swings, neuroticism, feed-up feelings, worry, irritability) using Mendelian Randomization (MR) analyses. Method: In the UK Biobank dataset, IDP was identified by conducting a partial least squares regression (PLSR) on the items of the food frequency questionnaire along with three inflammatory biomarkers as response variables: C-reactive protein, platelets, and white blood cell (WBC) counts. An individual-level genome-wide association study (GWAS) of IDP was performed within an unrelated European subsample from the UK Biobank (n=320,137) and summary-level GWAS data for mental health traits were utilized for bi-directional two-step MR to test the association between genetically predicted IDP and mental health traits. Result: The first PLSR component was retained for subsequent analysis, with a higher IDP score indicating a more frequent consumption of processed meat, beef, pork, lamb/mutton, and poultry. Genome-wide association analysis identified 101 independent genomic loci. MR analyses indicated a uni-directional positive relationship from IDP to neuroticism and a positive bi-directional relationships between IDP and depressed affect, mood swings, fed-up feelings, and irritability. The mediation effect of total white blood cell count on neuroticism score was also significant (adjusted P<0.05). Conclusion: Our findings identified genetic loci and functional properties of IDP and provided evidence for causal pathways with depressed affect, mood swings, irritability, and fed-up feelings. Implementing dietary advice and interventions should become part of a public mental health approach. Keywords: Inflammatory dietary pattern; Partial least squares regression; Genome-wide association study; Mendelian Randomization; Mental health.

Objectives: Estimate the prevalence and sociodemographic correlates of adolescent-reported food insecurity experiences from 2019-2021. Methods: Repeat cross-sectional data were collected in November-December 2019, 2020, and 2021 from adolescents aged 10-17 years living in the ten Canadian provinces (n = 11,057). The prevalence of ten items and five food insecurity subconstructs based on the 10-item Child Food Insecurity Experiences Scale was estimated. Weighted multinomial logistic regression assessed associations between sociodemographic characteristics and food insecurity experiences as a four-level (no, few, several, or many experiences) variable. Results: Across 2019-2021 among adolescents, the prevalence of worrying about food scarcity ranged between 18.4%-22.5%, worrying about parental/guardian ability to get food ranged between 22.8%-26.9%, and not being able to get the food they wanted ranged between 23.5%-26.1%. Close to or above one in four adolescents affirmed the uncertainty (range: 26.9%-29.9%) and compromised diet quality or preferences (range: 23.5%-26.1%) subconstructs. In 2021, adolescents identifying as Black had a higher relative risk ratio of few food insecurity experiences (adjusted relative risk ratio (ARRR): 2.04 [95% CI: 1.20, 3.47], p-value: <0.01) and adolescents identifying as Indigenous had a higher relative risk ratio of several food insecurity experiences (2.38 [1.10, 5.15], p-value 0.03) compared to adolescents identifying as White. The relative risk ratio of having few, several, or many food insecurity experiences also differed by age, sex-at-birth, perceived income adequacy, and region. Conclusion: The type and number of experiences reported underscores the value of directly measuring food insecurity. Interventions to mitigate food insecurity's adverse consequences are warranted.

Objective: Studies assessing the validity of screening measures for avoidant/restrictive food intake disorder (ARFID) remain scarce. We evaluated the diagnostic performance and validity of an online, parent-reported screening approach for ARFID in a population-based sample of children. Methods: Participants were drawn from the ARFID Initiative Sweden (ARIES) cohort and included 65 children aged 6-14 years. Parents completed three screening questionnaires (Pica, ARFID, and Rumination Disorder Interview-ARFID Questionnaire [PARDI-AR-Q], Nine-Item ARFID Screen [NIAS], and Parent Eating Disorder Examination Questionnaire [PEDE-Q]), followed by a diagnostic interview (PARDI). Diagnostic performance indices (sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]) were calculated. Convergent validity was assessed via correlations between questionnaire and interview dimensions. Results: The combined screening algorithm demonstrated perfect sensitivity and NPV, indicating accurate detection of all ARFID cases and exclusion of non-cases. Specificity was high (0.83), and PPVs ranged from 0.91 to 0.95, decreasing to 0.78 under a more conservative operationalization of ARFID Criterion A4 (psychosocial impairment). Diagnostic performance varied across ARFID criteria: PPVs were low for medically anchored Criteria A1-A3 but high for Criterion A4 (psychosocial impairment; PPV=0.95). Correlations between screening measures and corresponding interview dimensions were generally moderate to strong, supporting convergent validity. Children meeting threshold ARFID criteria showed significantly greater symptom severity than subthreshold cases at screening. Discussion: These findings support the use of a multi-instrument, parent-reported screening approach for ARFID in large-scale pediatric research and highlight the centrality of psychosocial impairment, underscoring the need for standardized operationalization of this criterion.

Considerable evidence suggests that the motivational control of instrumental action depends on incentive learning; i.e., on the opportunity to learn how the value of the consequences or outcome of an action, (e.g., a specific food) varies under different motivational conditions (e.g., under different degrees of hunger). The current study investigated whether learning the values of high-protein and high-carbohydrate rewards under different degrees of protein and carbohydrate appetite is also necessary for these nutrient-specific appetites to exert control over instrumental performance. Experiment 1 gave differing consummatory experience to whey protein and polycose carbohydrate outcomes under protein and carbohydrate appetite and found that, without the opportunity for incentive learning, the performance of actions earning these outcomes was insensitive to a shift in appetite. However, once the opportunity for incentive learning was provided, the rats increased their instrumental performance on a lever that earned the whey outcome relative to the polycose lever when protein hungry and on the polycose lever relative to the whey lever when carbohydrate hungry. Experiment 2 assessed how these nutrient-specific states exerted this control; whether, once learned, nutrient values were immediately controlled by nutrient appetite or whether this was based on conditional control acquired during experience with the outcomes under different nutrient appetites. We found that exposure to an outcome under a single nutrient-specific state was not sufficient to establish state-specific control. Instead, establishing the conditional control of outcome value required exposure to both the whey and polycose outcomes under both protein and carbohydrate appetites.

Disordered eating attitudes exist on a continuum that extends well below clinical diagnostic thresholds, yet the cognitive correlates of this non-clinical variation remain incompletely understood. Previous research linking executive functioning to disordered eating in non-clinical samples has relied almost exclusively on self-report questionnaire measures of executive function, which show weak correspondence with performance-based assessments. This methodological reliance leaves open the question of how objective executive performance relates to eating behavior across the spectrum. The present study addressed this gap by examining the association between performance-based measures of executive function and disordered eating attitudes in a non-clinical sample of 243 university students via an online experiment, using a dimensional approach consistent with the Research Domain Criteria framework. Participants completed established neurocognitive tasks covering three executive function domains: working memory was assessed with Digit Span and an N-back task, inhibitory control with a Go/No-Go task, and cognitive flexibility with the Card Sorting Task. Disordered eating attitudes were indexed using the EAT-26 total score and its subscales. A notable correlation was identified between cognitive flexibility and disordered eating attitudes, while working memory and inhibitory control exhibited no such association. Overall, our findings provide evidence for associations between executive functioning and disordered eating attitudes in a non-clinical sample.

The Healthy Eating Index (HEI-2020) is conventionally computed by aggregating intake across days before scoring. Digital food logging enables an alternative: scoring each day and averaging daily scores. These methods are not equivalent. The HEI's density-based structure and component caps cause aggregation to inflate adequacy scores when intake is irregular. Using Food & You data, we show daily HEI correlates more strongly with microbiome diversity, and recommend co-reporting both metrics.

Objective: This systematic review and meta-analysis examined 1) the effects of stress management interventions on changes in stress eating for women, and 2) the longevity of these effects, by summarizing and assessing evidence from controlled and non-equivalent pretest-posttest intervention studies. Method: Five databases (PsycINFO, PubMed, Medline, Web of Science, CINAHL), existing sources, and grey literature were searched (February - June 2025). Studies that assessed stress eating or emotional eating, included a stress management intervention, and comprised at least 70% women were included. The primary outcome was reduction in stress eating. Data were pooled in meta-analyses using multi-level random-effects models and subset by follow-up period. Risk of bias was assessed via funnel plots and sensitivity analyses. Results: Sixty studies with 119 effect size estimates were included in the primary analysis. Pooled estimates indicated that stress management interventions significantly reduced stress eating (Hedges g = -0.4174, p < 0.001), with pre-post designs having larger effects than controlled trials. Subgroup analyses of follow-up periods found small effects in the short-term (before 3 months; Hedges g = -0.4202, p < 0.0001) and moderate effects for mid-term (3-6 months; Hedges g = -0.5886, p < 0.0001). Effects beyond 6 months were small and nonsignificant (Hedges g = -0.4370, p = 0.0660). Conclusion and Relevance: Stress management interventions appear to be effective for reducing stress eating for women, suggesting the potential to incorporate stress management in interventions targeting obesity. Effects may be only sustained 6 months post-intervention, suggesting the need for strategies to bolster long-term effectiveness.

Objective: To examine changes in the neural valuation of high- versus low-calorie stimuli following bariatric surgery and determine whether these changes relate to weight loss at 24 months. Methods: Adults undergoing bariatric surgery completed fMRI scans before surgery and at 4, 12 and 24 months post-surgery while performing the Becker-DeGroot-Marschak auction task to assess willingness-to-pay (WTP) for food stimuli. Linear mixed-effect models tested longitudinal changes in WTP-related blood oxygen level-dependent (BOLD) associations and their interactions with total weight loss at 24 months. Results: WTP for high-calorie foods decreased significantly after surgery, whereas valuation of low-calorie foods remained stable. At 4 months, WTP-BOLD associations for high- versus low-calorie stimuli were enhanced within the frontoparietal control network and right lateral orbitofrontal cortex relative to pre-surgery. These early postoperative changes did not correlate with 24-month weight loss. Instead, greater 24-month weight loss correlated with both pre-surgical and long-term changes (24 months versus pre-surgery) in WTP-BOLD associations within the precuneus, inferior parietal cortex and visual cortex. Conclusion: Bariatric surgery induces early reductions in the valuation of high-calorie foods, potentially through enhanced cognitive control and aversive processing. However, long-term weight-loss success appears more strongly related to trait-like neural differences in self-referential and attentional processing.

Background/Objectives: Childhood appetitive traits are heritable behavioural phenotypes hypothesized to link genetic susceptibility to obesity risk. Yet their genetic architecture and role in mediating polygenic adiposity risk remain poorly understood. Methods: We conducted the largest survey of childhood eating behaviour to date, allowing us to perform genome-wide association studies of six appetitive domains derived from 18 items of the parent-reported Children's Eating Behaviour Questionnaire in up to 31,018 eight-year-old children from the Norwegian Mother, Father and Child Cohort Study (MoBa). A trio-based design enabled decomposition of direct and indirect genetic effects on appetite and BMI. Results: We identified ten independent genome-wide significant loci for childhood eating behaviour, primarily across Food Responsiveness, Satiety Responsiveness, and Food Fussiness, eight of which lie at established childhood or adult BMI loci. Food Responsiveness and Satiety Responsiveness showed both phenotypic and genetic correlations with BMI trajectories from early childhood through adolescence. Statistical mediation analyses indicated that 22.1% and 10.4% of the aggregated genetic association with BMI at age 8 could be decomposed through these traits, respectively. Locus-specific patterns further suggested mechanistic pathways, with the FTO locus acting predominantly via Food Responsiveness, and the ADCY3 locus via Satiety Responsiveness. Trio analyses demonstrated that both BMI and eating behaviour associations were predominantly explained by children's inherited alleles, with minimal contribution from indirect effect from parental adiposity, although parental genetic liability influenced reporting of Satiety Responsiveness. Conclusions: Childhood appetitive traits capture a substantial proportion of genetic susceptibility to adiposity through distinct eating behaviour pathways (under standard mediation assumptions). These effects are primarily driven by the child's own genotype rather than indirect parental influences, positioning appetite as a plausible, biologically grounded target for early obesity prevention.

Animals defend protein intake strongly, yet how protein status shapes moment-to-moment reward signalling in mesolimbic circuits remains unclear. Here, we examined how dietary protein restriction shapes nucleus accumbens (NAc) core dopamine signalling during operant feeding in the home-cage. C57BL/6 mice expressing the GRABDA sensor in NAc core performed 1 h fixed-ratio 1 (FR1) and progressive ratio (ProgRatio) sessions to earn grain or sucrose pellets across three dietary phases; an initial non-restricted phase (NR1), a protein-restricted phase (PR), and a return to the non-restricted diet (NR2). Home-cage food intake remained stable across phases, whereas bodyweight gain was markedly reduced during PR and partially recovered in NR2. Behaviourally, operant responding increased during PR under both FR1 and ProgRatio schedules, with the most robust enhancement observed for grain pellets. Fibre photometry revealed a more selective neural effect. During FR1, pellet delivery evoked a larger NAc dopamine response for grain than for sucrose specifically during PR, whereas no pellet-type difference was detected during NR1 or NR2. By contrast, under progressive ratio, dopamine responses at pellet delivery and pellet retrieval did not differ between pellet types in any dietary phase. Together, these findings show that protein restriction does not globally amplify reward-related behaviour or dopamine signalling, but instead selectively biases NAc dopamine encoding in a manner that depends on nutritional status of the animal, nutrient context, and task demands.

Background: Despite growing evidence that personalised nutrition (PN) can improve dietary behaviour and health outcomes, the implementation of PN food services in real-world settings remains largely unexplored. This study evaluated the feasibility of a comprehensive PN service for delivering personalised nutrition products (PNPs) in a military setting and assessed consumer acceptance following repeated consumption. Methods: A complete PN service was developed to design, produce, and distribute personalised nutrition products (PNPs). Twenty-five participants from the Royal Netherlands Army took part in a feasibility study, using a single-cohort pre-test post-test design. Each participant consumed a PNP on 10 consecutive days during a two-week combat training exercise. Product liking was assessed through daily questionnaires, while broader user experiences were assessed at baseline (t=0), one week follow-up (t=1) and two-week endline (t=2). Results: The PN service was succesfully implemented during a real-life military training exercise. In total, 229 PNPs were produced and distributed. Participants evaluated all aspects of the PN service from just below neutral to slightly positive (3.4 to 5.0 on 7 point scales). Across the different product combinations, mean overall liking and all sensory attributes were slightly positive (5.7 to 6.1 on 9 point scales). Overall liking did not change over time (F (9,194) = 1.242, p=0.27). Attitudes toward a PNP service in the army decreased over time, but remained just-above neutral at study end. Conclusions: This study demonstrates the feasibility of a personalised nutrition service in a military setting. Both the service and PNPs received modestly positive evaluations, while repeated exposure did not change overall liking of the products. Although further optimisation of the service is warranted, these findings support the potential for broader implementation of PN services in military and other high performance environments.

Globally, 75% of adolescents do not meet recommendations for fruits and vegetables (F&V) consumption. This study investigated drivers of F&V choices among adolescents in Benin and identified barriers and facilitators to modifying F&V consumption. We conducted 16 focus group discussions (FGDs) with 126 adolescents and 5 semi-structured school observations in December 2024. FGDs were purposively chosen to explore variation by region (north/south), school location (urban/rural), adolescent age (12 to 15 years/16-18 years) and gender (boys/girls). Inductive and deductive thematic content analysis was performed using Atlas.ti. Findings showed that adolescents perceived a healthy diet as one composed of meals providing nutrients and strength, and including F&V. At home, adolescents mentioned eating staples and other vegetables more than other food groups. The foods adolescents reported typically eating at school varied by age, gender, and location. The primary categories of factors that influenced adolescent F&V choices were: intrapersonal (knowledge related to healthy eating and the nutrition and health benefits of F&V, taste preferences, and health prioritisation), socio-cultural (family and peer influences), and food environment (low availability, low affordability, convenience, and desirability). DFC factors were consistent across adolescent age, gender, and location. Multiple, dynamic, and multilevel factors influence adolescent F&V choices. Interventions that simultaneously address multiple barriers and involve family and peers are likely to be more successful in promoting F&V consumption and healthy diets than interventions only addressing individual barriers.

Background: Childhood obesity is a prevalent public health concern, particularly among children from marginalized backgrounds. Epigenomic mechanisms, including DNA methylation (DNAm), offer insight into the biological embedding of metabolic risk, yet protective family-level factors remain understudied. This study examined whether participation in a positive parenting intervention was associated with reduced epigenetic cardiometabolic risk among preschool-aged children. Methods: Participants were 74 children (n = 35 intervention; n = 39 services-as-usual; mean age = 36 months). Using a secondary analysis of a randomized controlled trial, DNAm-derived body mass index (BMI) and anthropometric BMI were assessed at baseline and 12-month follow-up, and parenting practices were observed post-treatment. Results: Children in the intervention group demonstrated significantly lower DNAm BMI at 12 months relative to controls, adjusting for child sex, race and/or ethnicity, and anthropometric BMI. No treatment effect was observed for anthropometric BMI, and DNAm BMI was not associated with anthropometric BMI at 12 months. Although parenting practices improved, they did not mediate intervention effects on DNAm-derived BMI. Conclusions: Parenting interventions may influence biological pathways related to cardiometabolic risk, even before changes in anthropometric outcomes, underscoring the potential of family-centered approaches to promote early metabolic health.

Importance: Food and non-alcoholic beverage marketing drives children's dietary intake, yet updated evidence quantifying effects by marketing medium and sociodemographic factors is needed to inform policy. Objective: To quantify the effect of food marketing on dietary intake among children and adolescents (0-19 years) and examine variations by age, sex, socioeconomic position (SEP), weight status, marketing medium, and exposure duration. Data Sources: Nineteen electronic databases were searched for articles published from April 2020 to February 2026, complemented by World Health Organization-commissioned reviews covering 1970 to March 2020. Study Selection: Two reviewers independently selected peer-reviewed primary studies that assessed the association between food marketing and dietary intake, following PRISMA guidelines, with no language restrictions. Data Extraction and Synthesis: Two reviewers independently extracted data and assessed the risk of bias. Random-effects meta-analyses were conducted. The certainty of evidence was assessed using GRADE. Main Outcomes and Measures: Dietary intake (energy, quantity, or number of items consumed). Results: A total of 55 studies (N = 6,877; range 2-18 years) were included. Food marketing was associated with higher dietary intake (mean difference [MD], 34.8 kcal; 95% CI, 20.2-49.4) compared with no or less marketing. Unhealthy marketing via television (20 studies; MD, 44.5 kcal; 95% CI, 11.2-77.8), digital media (11 studies; MD, 37.5 kcal; 95% CI, 20.1-54.9), and packaging (11 studies; MD, 20.5 kcal; 95% CI, 0.7-40.3) all increased intake; the difference across media was significant (p < .001). Higher intake was observed in males (3 studies; MD, 51.9 kcal; 95% CI, 45.4-58.3) but not in females (MD, -6.8 kcal; 95% CI, -60.3-46.6); difference was not significant (p = .082). Differences by weight status (p = .012) were seen (5 studies; normal weight: MD, 55.6 kcal; 95% CI, -51.3-162.5; overweight/obese: 146.9 kcal; 95% CI, 34.1-259.7). Effects varied by age (p = .003) and by digital media exposure duration (p = .044). One study examined ethnicity; none studied SEP. Conclusions and Relevance: Food marketing is associated with increased dietary intake, with low certainty of evidence. Variations were observed across age, sex, weight status, and marketing medium. Further research is needed for adolescents and the role of SEP.

Adolescence is a sensitive period during which unhealthy diets may shape metabolic health and cognition. Diets high in fat and sugar have been linked to obesity, impaired glucose regulation and hippocampus-dependent deficits, but the exposure duration required to affect cognition remains unclear. This study examined whether adolescent-onset exposure to a high-fat high-sucrose (HFHS) diet induces metabolic dysfunction and impairs object-based memory, spatial working memory and spatial pattern separation in male Long Evans rats. Rats were assigned to a control or HFHS diet at four weeks of age and remained on this diet into adulthood. Basal blood glucose was assessed monthly and home-cage behaviour using 48-hour LABORAS recordings. Cognitive testing started after 10 weeks of diet exposure, when basal glucose was elevated in HFHS-fed rats. Object displacement and novel object recognition were used in short open-field test settings, whereas touchscreen-based trial-unique nonmatching-to-location testing (TUNL) assessed spatial working memory and pattern separation across repeated operant sessions. Finally, glucose (in)tolerance and tissue weights were measured. HFHS diet exposure produced a metabolic phenotype, including increased body weight, elevated basal glucose, impaired glucose tolerance and increased liver and gonadal white adipose tissue weights. The diet also altered the general behavioural repertoire, with increased immobility and grooming and reduced rearing. HFHS-fed rats did not differ from controls in object displacement or novel object recognition performance. In the touchscreen task, both groups acquired the task at a comparable rate. Long-delay and spatial separation challenges reduced performance as expected, confirming task sensitivity, but did not reveal diet-related impairments. These findings show that adolescent-onset HFHS diet exposure induces metabolic dysfunction but does not necessarily produce detectable cognitive impairment when behavioural testing starts after 10 weeks of exposure. Longer exposure or advanced diet-induced inflammatory or neurobiological alterations may be required to reveal cognitive consequences.