BMJ Nutrition, Prevention & Health

ObjectiveWeight restoration is an integral part of managing anorexia nervosa patients and has been found to be associated with electrolyte and fluid abnormalities gathered under the umbrella term refeeding syndrome, which has led to cautious initiation of caloric regimes. This study looks at how a sample of severe anorexia nervosa patients were managed using higher rates of refeeding than the ones currently recommended. Designretrospective cohort study of consecutive patients with severe eating disorders admitted to an UK specialist tertiary centre. The treatment programme uses a weight restoration regime starting at 1000 kcal/day, increased to 1500 kcal/day after two days and to 2000 kcal/day after seven days. The main outcome was the rate of hypophosphatemia, hypokalemia and hypomagnesemia within the first two weeks of weight restoration. The secondary outcomes included rate of weight gain and tendency of electrolyte shift. Results83% of the patient sample were categorised as extreme anorexia nervosa (BMI <15). 11.3% of patients developed hypophosphatemia, 11.3% had hypomagnesemia, 42% had hypokalaemia. The lowest levels were found between the 5-6 days after starting refeeding. The vast majority of electrolyte abnormalities fell into the mild category. Electrolyte abnormalities were easily corrected by oral supplementation, and only 5% required iv replacement. The only significant predictor for hypophosphatemia was a BMI below 13. ConclusionsThe majority of extremely ill patients with anorexia nervosa tolerate refeeding starting at 25-30kcal/kg. Oral supplementation is effective, so overcautious refeeding is unnecessary, provided that the patient is carefully monitored.

IntroductionVitamin D supplements are recommended for elderly care home residents with little sunlight exposure. However, their use in care homes is limited and vitamin D deficiency in residents is widespread. This study aimed to understand perceived responsibility for the vitamin D status of residents and the determinants of current practice around supplementation. MethodsThirteen semi-structured interviews were conducted with key informants in two areas of Southern England including care home managers, general practitioners (GPs) and public health professionals. Interviews were audio recorded and transcribed verbatim. ResultsInductive thematic analysis identified four themes - medical framing; professional and sector boundaries; awareness of national guidance; and ethical and practical issues. Vitamin D supplements were not routinely given to residents, and most participants, including the GPs, believed the vitamin D status of residents was the responsibility of the GP. Care home managers felt unable to make decisions about vitamin D and vulnerable to suggestions of wrongdoing in administering over-the-counter vitamin tablets. This results in vitamin D requiring prescription by medical professionals and few care home residents receiving vitamin D supplements. ConclusionThe medical framing of vitamin D supplements in care homes is a practical barrier to residents receiving them and is out of step with public health recommendations. Vitamin D levels in care home residents could be improved through universal supplementation. This requires a paradigm shift so that vitamin D is understood as a protective nutrient as well as a medicine, and a public health as well as a medical responsibility. The failure to ensure vitamin D adequacy of residents may emerge as a factor in the spread and severity of COVID-19 in care homes and gives increased urgency to addressing this issue. KEY MESSAGESO_ST_ABSWhat is already known about the subject?C_ST_ABSNutrition guidelines recommend elderly care home residents take vitamin D supplements as a preventative measure. This is rarely implemented in practice and vitamin D inadequacy is widespread. What are the new findings?Medical framing of vitamin D in the care sector puts elderly residents at risk of vitamin D deficiency. Vitamin D supplements are perceived as medicines requiring an individual prescription and diagnosis by a medical professional. This is out of step with public health recommendations. The systems failure to protect the vitamin D status of the elderly in care homes may have implications in the context of COVID-19. How might these results change the focus of research or practice?Prompt a review of current guidelines and regulations in England to establish responsibility for implementing public health recommendations on vitamin D supplementation in care homes. Further research on feasibility of implementation strategies is needed.

PurposeAdequate hydration is vital for health, yet many people do not meet fluid recommendations. This study aimed to characterise the role of water and sugar-sweetened beverages in hydration across different levels of socioeconomic status (SES) in the UK. MethodsIn a pre-registered cross-sectional study, participants (N = 1,112) recalled beverages consumed on the previous day and reported urine colour as an indicator of their hydration status. We analysed water intake (H1), sugar-sweetened beverage (SSB) intake (H2), and SES (education; H3) as predictors of hydration status using stepwise binomial logistic regression adjusted for health, demographic, and lifestyle covariates. ResultsForty percent of participants were classified as underhydrated. Higher water intake was associated with a greater likelihood of adequate hydration: Drinking one extra glass of water per day (250 ml) increased the odds of being adequately hydrated by about 16%. However, SSB intake was not associated with hydration unless intake from other drink sources was held constant. Having a higher versus lower level of education was not significantly associated with hydration status, although finer-grained and income-based analyses suggested modest socioeconomic differences. ConclusionWater intake--rather than SSB intake--is the primary correlate of adequate hydration in this UK sample. Public health initiatives should emphasise the importance of water for hydration, invest in ways to make water more appealing, and promote the use of urine colour as a marker of hydration status.

ObjectivesTo estimate the proportion of female university students reporting overeating (EO) in response to emotions during the COVID-19 university closures, and to investigate social and psychological factors associated with this response to stress. DesignOnline survey gathered sociodemographic data, alcohol/drugs use disorders, boredom proneness and impulsivity using validated questionnaires, and EO using the Emotional Overeating Questionnaire (EOQ) assessing eating in response to six emotions (anxiety, sadness, loneliness, anger, fatigue, happiness), whose structure remains to be determined. ParticipantsSample of 302 female students from Rennes University, France. Main Outcome MeasureFrequencies of emotional overeating. AnalysisThe frequency of emotional overeating was expressed for each emotion as percentages. Exploratory Factor analyses (EFA) were used to determine EOQ structure and provide an index of all EOQ items used for further analysis. Linear regression models were used to explore relationships between EO and others covariates. ResultsNine in ten participants reported intermittent EO in the last 28 days, mostly during 6 to 12 days, in response to Anxiety (75.5%), Sadness (64.5%), Happiness (59.9%), Loneliness (57.9%), Tiredness (51.7%), and to a lesser extent to Anger (31.1%). EFA evidenced a one-factor latent variable reflecting "Distress-Induced Overeating" positively correlated with internal boredom proneness, tobacco use, attentional impulsivity, inability to resist emotional cues, and loss of control over food intake, and negatively with age and well-being. EO was unrelated to body mass index or substance abuse. Conclusion and ImplicationsNine in ten female students reported emotional overeating during the COVID-19 university closure. This response to stress was related to eating tendencies typical of young women, but also to personality/behavioral patterns such as boredom and impulsivity proneness. Better understanding of the mechanisms underlying EO in response to stress and lack of external/social stimulation would improve preventive interventions.

BackgroundThe COVID-19 pandemic has caused people to shelter-at-home for an extended period, resulting in a sudden rise in unstructured time. This unexpected disruption in everyday life has raised concerns about weight management, especially in high-risk populations of women and individuals with overweight and obesity. This study aimed to investigate the changes in behaviors that may impact energy intake and/or energy expenditure in U.S. adults during the home confinement. MethodsCross-sectional data from 1,779 adults were collected using an online Qualtrics survey between April 24th and May 4th, 2020. Self-reported data on demographics, eating behaviors, physical activity, sleep, screen time, takeout food intake, and food purchasing behaviors were collected. Chi-Square analyses were conducted to evaluate differences in the percent of participants reporting increasing, decreasing, or staying the same in each health behavior since the COVID-19 outbreak in their area. Each analysis was followed by comparing whether increases or decreases were more likely for each health behavior. Similar comparisons were made between male and female participants and between body mass index (BMI) categories. ResultsWe observed an increase in the intake of both healthy and energy-dense unhealthy foods and snacks during the home confinement. Participants also reported increases in sedentary activities and decrease in physical activity, alcohol intake, and consumption of takeout meals during this time. In women, several behavioral changes support greater energy intake and less energy expenditure than men. No clear difference in patterns was observed across BMI status. ConclusionAcute changes in behaviors underscore the significance of a sudden increase in unstructured time at home on potential weight gain. Our findings support the need to implement and support measures that promote strategies to maintain body weight and establish a methodology to collect body weight data at multiple time points to longitudinally assess the dynamic relationship between behaviors and body weight change.

Background and AimsPeople living with motor neuron disease (MND) frequently struggle to consume an optimal caloric intake. Often compounded by hypermetabolism, this can lead to dysregulated energy homeostasis, prompting the onset of malnutrition and associated weight loss. This is associated with a poorer prognosis and reduced survival. It is therefore important to establish appropriate nutritional goals to ensure adequate energy intake. This is best done by measuring resting energy expenditure (mREE) using indirect calorimetry. However, indirect calorimetry is not widely available in clinical practice, thus dietitians caring for people living with MND frequently use energy equations to predict resting energy expenditure (pREE) and estimate caloric requirements. Energy prediction equations have previously been shown to underestimate resting energy expenditure in over two-thirds of people living with MND. Hypermetabolism has previously been identified using the metabolic index. The metabolic index is a ratio of mREE to pREE, whereby an increase of mREE by [&ge;] 110% indicates hypermetabolism. We propose that the use of energy prediction equations to inform a metabolic index to indicate hypermetabolism in people living with MND is inappropriate and results in a biased identification of hypermetabolism in lighter individuals. MethodsmREE was derived using VO2 and VCO2 measurements from a GEMNutrition indirect calorimeter. pREE was estimated by Harris-Benedict (HB) (1919), Henry (2005) and kcal/kg/day predictive energy equations. The REE variation, described as the percentage difference between mREE and pREE, determined the accuracy of pREE ([pREE-mREE]/mREE) x 100), with accuracy defined as [&le;] {+/-} 10%. A metabolic index threshold of [&ge;] 110% was used to classify hypermetabolism. All resting energy expenditure data are presented as kcal/24hr. ResultsSixteen people living with MND were included in the analysis. The mean mREE was 1642 kcal/24hr ranging between 1110 and 2015 kcal/24hr. When REE variation was analysed for the entire cohort, the HB, Henry and kcal/kg/day equations all overestimated REE, but remained within the accuracy threshold (mean values were 2.81% for HB, 4.51% for Henry and 8.00% for kcal/kg/day). Conversely, inter-individual REE variation within the cohort revealed HB and Henry equations both inaccurately reflected mREE for 68.7% of participants, with kcal/kg/day inaccurately reflecting 41.7% of participants. Whilst the overall cohort was not classified as hypermetabolic (mean values were 101.04% for HB, 98.62% for Henry and 95.64% for kcal/kg/day), the metabolic index ranges within the cohort were 70.75% - 141.58% for HB, 72.82% - 127.69% for Henry and 66.09% - 131.58% for kcal/kg/day, indicating both over- and under-estimation of REE by these equations. We have shown that pREE correlates with body weight (kg), whereby the lighter the individual, the greater the underprediction of REE. When applied to the metabolic index, this underprediction biases towards the classification of hypermetabolism in lighter individuals. ConclusionWhilst predicting resting energy expenditure using the HB, Henry or kcal/kg/day equations accurately reflects derived mREE at group level, these equations are not suitable for informing resting energy expenditure and classification of hypermetabolism when applied to individuals in clinical practice.

BackgroundOverweight and obesity are causing growing public health, economic and clinical burden, particularly within under-resourced communities. There is an urgent need to develop an in-depth understanding of experiences of weight management, and preferences for support within under-resourced communities, with a view to developing more effective weight management interventions. MethodsFocus groups were run in under-resourced communities using storyboarding; a method to facilitate inclusive communication (n=37). Thematic analysis was applied to textual and visual data, and a realist lens applied to provide in-depth insight into weight management experiences and needs. We believe this is the first study to use this combined methodology to explore weight management experiences and needs. ResultsCombining storyboarding with a realist lens, generated four themes. Living circumstances indicated that mental health, individual needs, and cost of weight management services were key contextual factors. Mechanisms of weight management identified emotional eating and portion control to be central to individual weight management. Yo-yo dieting centred on participants experiences of weight regain after attempting weight loss. Weight management intervention needs indicated psychological support was perceived as severely lacking, and the only route to attain sustained weight management. Offering both in-person and online support for weight management was considered important to reach more people. ConclusionMoving weight management support from short- to long-term and incorporating more robust psychological support would better serve the needs of people living in under-resourced communities who are overweight or obese. Ideally interventions should be multicomponent and tailored to individual needs and circumstances.

Vitamin D is essential for bone and metabolic health. Deficiency remains a global health issue, particularly among older adults and ethnic minorities with darker skin pigmentation. Data on circannual variation these groups remain sparse. This study reports vitamin D status in older adults ([&ge;]65 years) and ethnic adults ([&ge;]18 years, Fitzpatrick classes IV-VI) in northern Britain during the screening phase of a supplementation trial. Participants were screened for inclusion between December 2024 and August 2025. Serum 25-hydroxyvitamin D (25(OH)D) was assessed in dried blood spots followed by LC-MS/MS analysis. 299 participants were screened. Vitamin D insufficiency or deficiency (<50 nmol/L) was noted in 54.8% of older adults and 72.1% of ethnic individuals. These rates did not decline during summer months. These findings highlight persistently high rates of vitamin D insufficiency across high-risk groups in northern Britain and underscore the inadequacy of sunlight exposure as a corrective measure.

BackgroundThe 2019 coronavirus disease (COVID-19) is a global public health emergency resulting in lockdowns, associated diet and lifestyle changes and constraint public health delivery. ObjectiveTo investigate the impacts of the COVID-19 induced lockdown in Zimbabwe on nutrition, physical activity, alcohol consumption and smoking among Zimbabwean population aged [&ge;]18years. MethodsA cross-sectional online survey was conducted using a structured questionnaire to collect information on demographics (age, gender, place of residence, current employment), food system dimensions, diet and physical activity patterns, stress and anxiety, body image perceptions, lifestyle behaviours like smoking, alcohol intake, screen time, and ease of access to health services. The study obtained ethical clearance from the Medical Research Council of Zimbabwe (MRCZ/B/1920). ResultsThe participants (n=507) were mostly female (63.0%) between the ages of 31-40 years (48.1%) and had tertiary education (91.3%). The lockdown resulted in increase in food prices (94.8%) and decrease in availability of nutritious foods (64%). Most (62.5%) of the participants reported a reduction in their physical activity levels. The prevalence of Generalised Anxiety Disorder (GAD) was 40.4% and mostly affecting females [63.5%, P=0.909), 31-40 years age group (49.6%, P=0.886). Based on the BMI-based Silhouette Matching Test (BMI-SMT) 44.5% gained weight, 24.3% lost weight and 31.2% did not have weight change. The paired samples T test showed that there was a significant increase in perceived body weight (P<0.001). More than half (59.6%) reported having difficulties accessing medicinal drugs and 37.8% growth monitoring services. ConclusionsThe lockdown period was associated with increase in food prices, decrease in dietary diversification, elevated stress, disrupted diet and consumption patterns. There were low levels of physical activity and perceived weight gained during the lockdown period, thus increasing the risk of overweight and obesity. Further studies incorporating participants of different socio-economic status are warranted to get more conclusive results. What this paper adds?O_LIFirst diet and lifestyle survey in Zimbabwe documenting negative effects of lockdown on the urban elite on diets and lifestyles; C_LIO_LIThe COVID-19 induced lockdown was associated with elevated anxiety, disruptions of food supply chains and consumption patterns; C_LIO_LIMost of the participants were less active and gained weight in the lockdown period, thus increasing the risk of overweight and obesity an emerging risk factor for severe COVID-19 complications. C_LI

BackgroundExcessive consumption of Sugar Sweetened Beverages (SSBs) in adolescents has become a global issue. As its link to obesity and non-communicable diseases is clear, it is imperative to understand SSB consumption behaviours in the future healthcare professionals. ObjectiveTo document the prevalence, patterns and clinic-social and behavioural factors predicting high intake of SSBs among medical students. MethodsThis cross-sectional study was conducted using a self-reported, web-based, questionnaire. All the students and interns who were part of a publicly funded premiere teaching hospital during October and November 2019 were included. The semi-structured questionnaire enquired regarding socio-demographic, clinical details, amount, behavioural patterns and money spent in connection with SSB consumption. Data were analysed using IBM SPSS version 24. ResultsThe mean (SD) age of participants was 19.3 (1.6) years, 71.7% being males. The current prevalence of SSB consumption was 90.5 %. Also, 49.9% and 29.1% participants preferred soft drinks and sweetened fruit juice respectively. Multivariable analysis showed that male gender (aOR 1.83, 95% CI 1.03-3.25), current alcohol consumption (aOR 4.09, 95% CI 1.25-13.42), and recent (last week) consumption of a SSB predicted high intake of SSBs (aOR 7.36, 95% CI 3.41-15.87) whereas, preference of energy/sports category of drinks predicted low intake of SSBs (aOR 0.10, 95% CI 0.02-0.47). ConclusionThe consumption of SSBs among medical students was high. Targeted health education and behaviour change interventions should be provided to males, alcohol users and frequent consumers.

BackgroundSkeletal muscle wasting is a major determinant of physical functional disability in critical illness survivors, and contributes to post-intensive care syndrome. As yet, no therapies exist to address this major public health issue. Intramuscular bioenergetic failure and inflammation are understood to be the underpinning mechanisms, and carbohydrate and lipid oxidation are impaired. This systematic review synthesises the evidence that peroxisome proliferator-activated receptor gamma agonists may be a therapeutic option to optimise clinical nutrition in critically ill patients. MethodSystematic review and meta-analysis. ResultsFourteen studies over 19 publications were included. Lean body mass was unaffected (n=174). Pioglitazone treatment resulted in periperal insulin sensitivity increasing 30-71% (Standardised mean change 0.97 (95%CI 0.36-1.58; n=213). Intramuscular Tumour Necrosis Factor Alpha concentrations decreased in treatement arms (n=29) as did circulating interlukin-6 and Tumour Necrosis Factor Alpha (n=53). Intramyocellular Lipid concentrations decreased by 34-40% with pioglitazone therapy (n=60). Treatment increased intramuscular markers of Oxidative Phosphorylation (n=55), mitochondrial biogenesis(PGC1 and PGC1{beta}; n=26) and {beta}-oxidation (n=29) ConclusionsPioglitazone therapy increases skeletal muscle insulin sensitivity, decreases intramyocellular lipid accumulation and systemic and intramuscular inflammation. Where lean body mass was measured, this was seen to increase. Pioglitazone may be an adjunctive therapy to optimise clinical nutrition in acutely unwell patients. Clinical relevancy statementPioglitazone may optimise clinical nutrition therapy in critically ill patients by normalising carbohydrate and lipid metabolism.

IntroductionExcessive body weight and problematic eating behaviours, such as emotional and binge eating, have become major public health concerns. Mindful eating and intuitive eating offer alternative approaches to traditional dieting by encouraging individuals to focus on internal hunger and satiety cues. This study aims to analyse research trends and metrics related to mindful eating and intuitive eating publications over the past twenty years. MethodsWe used Scopus to identify mindful and intuitive eating related studies from 2004 to 2024. VOSviewer and Bibliometrix were used to extract relevant data and run the bibliometric analysis. ResultsA total of 1922 articles and reviews published in English were identified. After screening titles and abstract for relevance, 1064 documents were left for analysis. The number of studies on mindful and intuitive eating increased most years, with 2023 (n=143, 13.44%) and 2024 (n=146, 13.72%) producing the most articles, and a total citation count of 32,245 over the twenty-year period. High-income countries such as the United States (n=497), United Kingdom (n=131), and Canada (n=88) produced the most scientific articles. Leading researchers were Mantzios, M. (n=26) and Tylka, T. L. (n=25). The most cited articles focused on mindfulness or meditation-based therapies in managing psychological stress and the influence of taste on food choices. Keyword and trend analyses highlight emerging research areas such as mindfulness and intuitive eating. ConclusionThis bibliometric analysis provides valuable insights to the research trends in the mindful and intuitive eating fields. Strengthening interdisciplinary research and expanding collaborations between countries and authors could enhance the research impact in these fields as well as exploring emerging topics such as body perceptions (e.g., body image, body positivity, body dissatisfaction).

Beta-hydroxybutyrate (D-BHB) is a metabolite with intrinsic signalling activity that has gained attention as a potentially clinically useful supplement. There are available supplements for inducing ketosis: ketone salts, ketone esters, and medium-chain triglycerides. Even when all of them raise the beta-hydroxybutyrate in the blood and all are safe and well tolerated, they significantly differ in their safety profile, their palatability, and their price. A fourth and potentially interesting option is to use biologically identical beta-hydroxybutyrate, while it is already commercially available in the United States (American Ketone LLC) and Greater China (MedPHA Ltd). However, its safety and tolerability had not yet been documented in the scientific literature. We evaluated the safety and tolerability of orally administered Free D-BHB in a gender and age-balanced sample of 24 asymptomatic and overtly healthy adults. No participant showed acid-base abnormalities or electrolyte abnormalities. Secondary symptoms were reported after only 6.2% of all drink takes and none of the reports described the symptom as "severe". The most frequently reported secondary effects (19/720 or 2.6%) were gastrointestinal discomfort, headache (7/720 or 1%), and loss of appetite (7/720 or 1%). No correlation between weight-adjusted dose and frequency of secondary symptoms was observed. Free D-BHB was a safe and well-tolerated intervention for inducing sustained exogenous ketosis. Being bio-identical, salt-free, and lacking intermediate metabolites, this form of supplementation could have a larger safety spectrum than salt or alcohol-based exogenous ketones. More research is warranted to assess its clinical efficacy in those clinical scenarios in which achieving ketosis rapidly could be beneficial. KEY MESSAGESO_ST_ABSWhat is already known on this topicC_ST_ABS- Ketogenic supplements could be useful therapeutic tools in certain time-sensitive circumstances. A previously unexplored but attractive option is using bio-identical D-BHB. What this study adds- Diluted Free D-BHB is a safe and well-tolerated intervention for inducing sustained exogenous ketosis. How this study might affect research, practice, or policy- Being bio-identical, salt-free, further research is warranted on the potential clinical uses of Free-BHB.

BackgroundHypo-hydration is a major health concern that affects performance and is associated with increasing morbidity and growing health care costs. There is an emerging interest in optimum hydration and identifying how factors such as ingestion rate and beverage composition affect hydration. This study examined three beverages with varying ingestion rates and measured markers of hydration. MethodsThirty healthy, active participants between ages 18-45 years were given three different beverages on three separate days. The beverages were of identical volumes (1 Liter), but differed in the rate of ingestion, carbohydrate content and electrolyte content. Beverage 1 (Buoy, San Diego, CA) and water-alone were both consumed at a metered rate of one liter over four hours, whereas Beverage 2 was used as a positive control and consumed at a bolus rate of one liter in 30 minutes. FindingsAfter six hours Beverage 1 significantly improved markers of hydration compared to water-alone or Beverage 2. Beverage 1 decreased cumulative urine output vs water-alone by 32% (absolute difference -0.33L; CI {+/-} -0.16 to -0.51) and vs Beverage 2 by 26% (absolute difference - 0.26L; CI {+/-} -0.13 to -0.38). Beverage 1 increased the beverage hydration index vs water-alone by 64% (absolute difference +0.64L; CI {+/-} 0.36 to 0.92) and vs Beverage 2 by 48% (absolute difference +0.53L; CI {+/-} 0.30 to 0.76) InterpretationBeverage 1 is superior to water-alone at improving hydration when ingested at similar rates. Moreover, metered ingestion of Beverage 1 improved hydration compared to a bolus ingestion of Beverage 2, this could be due to the dissimilar ingestion rates and/or beverage composition. RESEARCH IN CONTEXTDespite the overwhelming number of commercial hydration beverages on the market, there are only a very limited number of studies that address whether these beverages are actually effective at improving hydration. Using PubMed and Google Scholar using the search term "Beverage Hydration Index" with the search date from 2016-2024 (2016 was when the Beverage Hydration Index was established) we found less than 10 articles on this topic that used the beverage hydration index to assess the efficacy of popular beverages and supplements, and none of them have previously evaluated the efficacy of Beverage 1 (Buoy). Additionally, only one other study assessed how that rate of beverage ingestion can influence the beverage hydration index. This current study has found Beverage 1 increased the beverage hydration index vs water-alone by 64% (absolute difference +0.64L; CI {+/-} 0.36 to 0.92). We propose that Beverage 1 increases the beverage hydration index due to its abundance of electrolytes including sodium and chloride, as it does not contain carbohydrates, protein, or artificial sweeteners that are common in other commercial hydration beverages. Identifying beverages that improve hydration compared to water-alone can play an important role in preventing severe hypohydration and dehydration, including renal failure, seizures, arrythmia, and altered mental status. It has been estimated that over half a million hospitalizations per year are due to dehydration with a cost of over 5.5 billion United States dollars(1). Thus, there are both clinical and economic reasons to identify simple, cost-effective methods to promote euhydration.

ObjectiveMonitoring time trends in salt consumption is important for evaluating the impact of salt reduction initiatives on public health outcomes. There has so far not been available data to indicate if salt consumption in Norway has changed during the previous decade. We aimed to assess whether average 24-hour salt intake estimated from spot urine samples in the adult population of mid-Norway changed from 2006-08 to 2017-19, and to describe variations by sex, age, and educational level. DesignRepeated cross-sectional studies. SettingThe population-based HUNT Study. ParticipantsIn each of two consecutive waves (HUNT3: 2006-08 and HUNT4: 2017-19), spot urine samples were collected from 500 men and women aged 25-64 years, in addition to 250 men and women aged 70-79 years in HUNT4. Based on spot urine concentrations of sodium, potassium and creatinine, age, sex, and body mass index, we estimated 24-hour sodium intake using the INTERSALT equation for the Northern European region. ResultsMean (95% confidence interval (CI)) estimated 24-hour salt intakes in men were 11.1 (95% CI 10.8, 11.3) g in HUNT3 and 10.9 (95% CI 10.6, 11.1) g in HUNT4, p=0.25. Corresponding values in women were 7.7 (95% CI 7.5, 7.9) g and 7.7 (95% CI 7.5, 7.9) g, p=0.88. Mean estimated salt intake in HUNT4 decreased with increasing age in women, but not in men, and it did not differ significantly across educational level in either sex. ConclusionsEstimated 24-hour salt intake in adult men and women in mid-Norway did not change from 2006-08 to 2017-19.

BackgroundWeight loss is a common endeavor taken by millions of residents annually in the U.S.--a country with a 31% overweight and 42% obesity rate. Weight loss is associated with numerous physical health benefits, such as better cardiovascular health. However, unhealthy weight loss strategies can cause adverse mental health effects. Past research has focused on how weight loss strategies affect the mental health of a general population--rather than those who are trying to lose weight--or has investigated a diverse array of weight loss strategies. This paper explores how dietary changes for weight loss are associated with mental health, specifically through several variables used in the Patient Health Questionnaire-9 (PHQ9), which measures depression severity. We hypothesize that eating less and skipping meals will be associated with poorer mental health status, while eating fewer carbohydrates, eating less fat, and drinking more water will be associated with better mental health status. Methods and FindingsThis study uses the U.S. 2005-2006 National Health and Nutrition Examination Survey (NHANES) 2005. Univariate (descriptive statistics), bivariate (correlation coefficient), and multivariate (ordinal logistic regression) analyses were performed. The main results show that skipped meals was positively associated with feeling bad about yourself, feeling down, depressed, or hopeless, and little interest in doing things. Ate fewer carbohydrates was negatively associated with the little interest in doing things. ConclusionDiffering dietary changes used for weight loss, particularly skipping meals and eating fewer carbohydrates, are associated with differences in mental health status. Health care professionals providing weight loss guidance should be cognizant of patients baseline mental health and the potential for changes in mental health with different dietary strategies. Future research employing a longitudinal approach to determine whether there is evidence of a causal relationship between these and other dietary strategies and subsequent mental health outcomes.

Background & AimsMetabolic disorders are tightly linked to sleep disturbances. First evidence showed that time-restricted eating (TRE), a growingly popular approach to combat cardiometabolic diseases, can also affect sleep quality. Recommendations for a preferable eating time window are pending. Our aim was to investigate the effects von early and late TRE on sleep quality in women with overweight and obesity. MethodsA total of 31 women with overweight and obesity were included in the controlled randomized crossover study ChronoFast. After a 2-4-week baseline period, participants were randomly allocated to two-weeks early time-restricted eating (eTRE) or late time-restricted eating (lTRE). The phases were switched after a washout phase. During dietary interventions participants were only allowed to consume caloric foods and drinks in the restricted eating window (eTRE: 8 am toTRE 4 pm; lTRE: 1 pm to 9 pm). Assessment of sleep metrics was performed subjectively, using Pittsburgh Sleep Quality Index (PSQI) and self-report of sleep quality, and objectively, by blinded actigraphy. Hunger and satiety scores were examined using a visual analogue scale (VAS). ResultsWhile subjective sleep quality (PSQI and self-reported sleep quality) remained unchanged, an improvement of sleep efficiency (p = 0.047) and sleep fragmentation index (SFI) (p = 0.029) was observed in eTRE intervention compared to baseline as estimated by actigraphy. There were no correlations between hunger and satiety and sleep quality, with no differences of hunger and satiety scores between eTRE and lTRE assessed in the evening on the last day of each intervention. ConclusionseTRE but not lTRE improved objective sleep-quality, which was not related to the feeling of hunger and satiety. eTRE might be more effective strategy for well-being and sleep-related metabolic health outcomes. ClincialTrials.gov number, NCT04351672 (registered on April 17, 2020).

ObjectiveTo understand the extent and nature of the available research on gastric modulation of food reward, olfaction, and taste in people with obesity or those who have undergone bariatric surgery. IntroductionBariatric surgery-induced weight loss is partially attributed to shifts in food preferences resulting from alterations in sensory perceptions and changes in reward system. The stomachs innervation and mechanical function have been theorized to play a significant role in these modifications, as suggested by numerous preclinical studies. However, the extent and nature of these connections in clinical settings require further elucidation. Inclusion criteriaThis review will examine studies on the influence of gastric innervation and/or mechanical function on food reward, olfaction, and taste. Selected studies will include participants of all ages with obesity or bariatric surgery. Both observational studies and controlled experiments will be considered, while study protocols, opinion articles, letters to the editor, book chapters, oral communication or poster abstracts and systematic reviews will be excluded. MethodsThe search will be undertaken in MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, Google Scholar, and gray literature. No date parameters will be set, and all languages will be considered. Citations will be uploaded into EndNote 20.0 and duplicates removed using Covidence. The remaining studies will be analyzed by 3 reviewers using a two-stage procedure with the ASReview python package. The full-text screening and the data extraction will be conducted by 2 reviewers on Covidence. An additional reviewer will be consulted in the event of disagreement. Tabulated results will be accompanied by a narrative summary.

Poor sleep is linked to consumption of sugary foods/beverages and high neural responsivity to palatable food cues. Yet, whether hedonic liking for sweet taste explains these associations remains unclear. We examined cross-sectional associations of five sleep traits (chronotype, sleep duration, insomnia frequency, snoring, daytime dozing) and a composite sleep score with sweet food liking, and total and free sugar intake in 76,734 UK Biobank participants (39-72 years, 56.3% female). Models adjusted for age, sex, ethnicity, socioeconomic deprivation, and body mass index (Bonferroni-corrected =0.0025). Evening chronotype, more frequent insomnia and daytime dozing, and lower composite sleep score were associated with higher sweet food liking. Associations with intake were stronger for free than total sugar. Evening chronotype was associated with higher free sugar intake (g/day: {beta}=1.523, 1.309-1.737; g/1000 kcal: {beta}=0.450, 0.361-0.538), and daytime dozing showed a dose-response (dozing often vs never/rarely: g/day {beta}=6.307, 4.631-7.983). Snoring was associated with higher absolute (but not energy-adjusted) free sugar intake. A healthier sleep score was associated with lower free sugar intake (g/day {beta}=-2.193 [-2.464 to -1.922]; g/1000 kcal {beta}=-0.691 [-0.804 to -0.579]) but higher energy-adjusted total sugar intake ({beta}=0.633 [0.485-0.781]). Mediation analyses indicated sweet liking accounted for 15%-91% of several sleep trait and free sugar intake associations (indirect effects p<0.001). Poorer sleep health, particularly evening chronotype and daytime sleepiness, was associated with greater sweet liking and higher free sugar intake, with sweet liking partially mediating associations between sleep traits and sugar consumption. Sweet-taste liking may represent an underexamined pathway linking sleep/circadian disruption to free sugar intake.

BackgroundSince December 2019, the coronavirus disease (COVID-19) has massively spread, with overwhelming of health care systems and numerous deaths worldwide. To remedy this, several countries, including France, have taken strict lockdown measures, requiring the closure of all but essential places. This unprecedented disruption of daily routines has a strong potential for disrupting nutritional behaviours. Nutrition being one of the main modifiable risk factors for chronic disease risk, this may have further consequences for public health. Our objective was therefore to describe nutritional behaviours during the lockdown period and to put them in light of individual characteristics. Methods37,252 French adults from the web-based NutriNet-Sante cohort filled lockdown-specific questionnaires in April-May 2020 (nutritional behaviours, body weight, physical activity, 24h-dietary records). Nutritional behaviours were compared before and during lockdown using Student paired t-tests and associated to individual characteristics using multivariable logistic or linear regression models. Clusters of nutritional behaviours were derived from multiple correspondence analysis and ascending hierarchical classification. ResultsDuring the lockdown, trends for unfavourable nutritional behaviours were observed: weight gain (for 35%; +1.8kg on average), decreased physical activity (53%), increased sedentary time (63%), increased snacking, decreased consumption of fresh food products (especially fruit and fish), increased consumption of sweets, biscuits and cakes. Yet, opposite trends were also observed: weight loss (for 23%, -2kg on average), increased home-made cooking (40%), increased physical activity (19%). These behavioural trends related to sociodemographic and economic position, professional situation during the lockdown (teleworking or not), initial weight status, having children at home, anxiety and depressive symptoms, as well as diet quality before the lockdown. Modifications of nutritional practices mainly related to routine change, food supply, emotional reasons but also to voluntary changes to adjust to the current situation. ConclusionThese results suggest that the lockdown led, in a substantial part of the population, to unhealthy nutritional behaviours that, if maintained in the long term, may increase the nutrition-related burden of disease and also impact immunity. Yet, the lockdown situation also created an opportunity for some people to improve their nutritional behaviours, with high stakes to understand the leverages to put these on a long-term footing.