BMJ Nutrition, Prevention & Health

Introduction People with severe mental illness (SMI) and learning disabilities (LD) experience significant health inequalities, with diet-related conditions contributing substantially to early and preventable death. Despite high levels of nutritional risk, the presence and effectiveness of nutritional screening in mental health (MH) and LD settings remains under-researched. This study aimed to investigate nutritional screening practices in UK inpatient MH and LD services from the perspectives of dietitians. Methods A cross-sectional mixed-methods study was conducted using a novel 22-question online survey. Data was collected via the British Dietetic Association Mental Health Specialist Group (April-June 2025). Quantitative data was analysed descriptively and qualitative data by reflexive thematic analysis. Findings were integrated and presented thematically. Ethical approval was granted by Teesside University (2025Mar26544). Results Forty-seven dietitians participated, most with substantial dietetic experience, from a range of MH settings. Screening practices were widely established and supported by policy and audit. However, participants reported low confidence in screening translating into meaningful patient care. Barriers to screening included appropriateness of available tools, time constraints, difficulty engaging distressed patients and poor prioritisation of physical health. Digital integration and wider infrastructure were also important. Dietitians rarely undertook screening directly, instead holding secondary or leadership roles, while screening was most often completed by nursing staff who were often perceived to place limited importance on the process. Existing tools, particularly the Malnutrition Universal Screening Tool (MUST), were viewed as insufficiently capturing the broader nutritional risks relevant to MH/LD populations, leading some services to adopt bespoke, unvalidated tools. Conclusion Concerns regarding the suitability of existing nutritional screening tools in MH/LD settings are consistent with previous literature. However, we suggest cautious use of unvalidated bespoke tools. Whilst there was no clear front runner, MH specific tools such as the St Andrews Nutrition Screening Instrument (SANSI) and the NutriMental Screener warrant further evaluation. Importantly, findings indicate that optimising tool choice alone is unlikely to improve screening effectiveness. Nutritional screening must be embedded within clear care pathways, supported by organisational leadership, digital infrastructure, and multiprofessional engagement to move beyond procedural completion and support meaningful clinical action to improve patient care.

PurposeTo identify dietary patterns among adult childhood cancer survivors (CCSs), examine their determinants, and assess whether they differ according to cardiovascular disease (CVD) risk profiles. MethodsCCSs from the Swiss Childhood Cancer Survivor Study diagnosed before age 21 years (1976-2005), surviving [≥]5 years and aged [≥]18 years in 2017, completed a food frequency questionnaire (SCCSS-Nutrition). Factor and hierarchical cluster analyses of 52 food groups identified dietary patterns. We categorised CCSs as having CVD, CVD risk factors (obesity, hypertension, diabetes, high cholesterol), or being CVD risk-free. Multinomial logistic regression assessed associations between dietary patterns and CVD risk profiles. ResultsAmong 802 CCSs (median age: 35 years; IQR: 29-41; 50% male), we identified five dietary patterns: Mediterranean-inspired diet (22%), Western indulgence diet (38%), Western sweet & fatty diet (26%), restrained indulgence diet (9%), plant-based & alcohol-rich diet (6%). Male sex, younger age, German-speaking region, smoking, and living with others were associated with Western indulgence, Western sweet & fatty, and restrained indulgence diets. Higher Swiss socioeconomic position (Swiss-SEP) and education, and not having children, were associated with the plant-based & alcohol-rich diet, higher Swiss-SEP was also associated with the Western indulgence diet. No associations were observed between dietary patterns and CVD risk profiles. ConclusionsDietary patterns among adult CCSs were socially patterned and differed according to sociodemographic and lifestyle characteristics, but were not associated with CVD risk profiles. Implications for Cancer SurvivorsDietary counselling and broader lifestyle support should be considered as part of long-term survivorship care for CCSs.

Background & objectives: Malnutrition risk is common among hospitalized patients and is associated with adverse clinical outcomes. However, implementation of routine nutritional screening remains heterogeneous. This study assessed the distribution and implementation of Nutritional Risk Screening 2002 (NRS-2002) and examined associations between malnutrition risk and clinical outcomes in a tertiary university hospital. Methods: We conducted a retrospective cohort study using routinely collected electronic health record data from adult hospitalizations at the University of Leipzig Medical Center, Germany, between 2013 and 2023. The implementation of the NRS-2002 in 2017 enabled comparison of a main cohort with potential NRS assessment (2017-2023) and a pre-implementation comparison cohort (2013-2016). In the main cohort, hospitalizations were categorized according to screening results as no elevated malnutrition risk, NRS [≥]3 points, or positive initial screening without a documented final NRS assessment. Clinical outcomes included 30-day hospital readmission, intensive care unit (ICU) admission, mechanical ventilation, in-hospital mortality, and length of hospital stay (LOS). Associations were assessed using unadjusted and age- and sex-adjusted logistic regression. Length of hospital stay was analyzed using Gamma regression. Time to readmission was additionally assessed using Kaplan-Meier and Cox regression. Results: After data preprocessing, 178,607 hospitalizations were included in the main cohort and 52,044 in the comparison cohort. In the main cohort, 5,460 hospitalizations (3.1%) had an NRS [≥]3 points, while 21,842 (12.2%) had a positive initial screening without a documented final assessment. Patients with NRS [≥]3 points had higher rates of 30-day readmission, ICU admission, and in-hospital mortality and longer LOS than patients without elevated malnutrition risk. After adjustment for age and sex, NRS [≥]3 points remained associated with higher odds of 30-day readmission (OR 1.57, 95% CI 1.39-1.77), ICU admission (OR 1.85, 95% CI 1.63-2.11), in-hospital mortality (OR 3.62, 95% CI 2.69-4.99), and mechanical ventilation (OR 2.07, 95% CI 1.08-4.38). Hospitalizations with a positive initial screening but without a documented final assessment also showed increased odds of several adverse outcomes, including 30-day readmission and in-hospital mortality. The proportion of positive initial screenings and completion of the final NRS assessment varied substantially across clinical departments. Conclusion: Elevated malnutrition risk was associated with adverse clinical outcomes in this large real-world cohort. The substantial proportion of positive initial screenings without subsequent final assessment highlights important challenges in implementing a complete nutritional screening pathway in routine hospital care.

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.

Background & aims Food- and nutrient-based inflammatory scores may capture different dietary features. We compared the Food Inflammation Score for Individuals (FISI) and Dietary Inflammatory Index (DII) in relation to cognitive performance and incremental discrimination. Methods This cross-sectional analysis included 2,455 adults aged [&ge;]60 years in NHANES 2011-2014 with four cognitive tests and two reliable 24-h recalls. Daily FISI summed [(food FII per 100 g) x grams/100] across foods; two days were averaged. DII used 33 parameters averaged across the same days. Survey-weighted linear and logistic models incorporated strata, primary sampling units, and WTDR2D/2. Discrimination used survey-weighted AUROCs and 500 stratified primary-sampling-unit bootstrap replicates. Results After full adjustment, a 1-SD higher DII was associated with a 0.091 lower global cognitive Z-score ({beta} = -0.091; 95% CI, -0.143 to -0.040; P = 0.005), whereas FISI was not ({beta} = -0.019; 95% CI, -0.064 to 0.026; P = 0.341). The DII quartile trend was significant (P = 0.007), but nominal domain associations did not survive false-discovery-rate correction. Neither score was associated with low cognitive performance. The base AUROC was 0.8242; adding FISI changed it by <0.0001 (95% bootstrap CI, -0.0002 to 0.0007), and adding DII changed it by 0.0005 (-0.0003 to 0.0021). Conclusions Higher DII, but not FISI, was associated with lower global cognitive performance. Neither score materially improved discrimination for low cognitive performance. The two scores should not be assumed equivalent or interchangeable.

Background: Data from National Health and Nutrition Examination Survey (NHANES) cycles 1988-1994 and 1999-2004 show a declining trend in the adherence to Dietary Approaches to Stop Hypertension (DASH) among adults. Since then, DASH evidence, dietary guidelines, and public-facing dietary resources have advanced, but whether national DASH adherence has improved is uncertain. Methods: We extended the Mellen et al. NHANES analysis among 14,163 adults with self-reported hypertension (N=6,914, 2003-2010, N=7,249, 2011-2018). DASH score included 9 nutrient components: total fat, saturated fat, protein, cholesterol, fiber, calcium, magnesium, potassium, and sodium, with adherence defined as a score 4.5. Survey-weighted multivariable models compared DASH score, adherence, and nutrient-threshold attainment across periods. Results: In 2011-2018, U.S. adults with self-reported hypertension represented 76.2 million individuals (33.8%). Multivariable-adjusted DASH adherence declined from 22.1% in 2003-2010 to 18.6% in 2011-2018 (p=0.003), and mean DASH score declined from 2.98 to 2.85 (p=0.007). Adjusted odds of adherence were lower in 2011-2018 compared with 2003-2010 (OR, 0.78; 95% CI, 0.67-0.91; p=0.002). Adherence was lower among non-Hispanic Black adults (OR, 0.70; 95% CI, 0.59-0.84), adults with BMI 30 kg/m2 (OR, 0.61; 95% CI, 0.51-0.73), and adults with prior stroke (OR, 0.71; 95% CI, 0.56-0.89). Total fat and sodium threshold attainment declined from 20.9% to 18.7% and 13.8% to 11.8%, respectively. Conclusions: DASH adherence among U.S. adults with self-reported hypertension declined from 2003-2011 to 2011-2018. Implementation strategies should identify barriers to adoption and address the full DASH dietary pattern.

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.

We conducted a pilot study in adults with and without type 2 diabetes (T2D), measuring whole-blood thiamine diphosphate (TDP) concentrations alongside erythrocyte transketolase activity (TKT) and activity coefficients (ETKAC), and evaluated these findings alongside dietary and ETKAC data from the U.K. National Diet and Nutrition Survey (NDNS). In the pilot cohort, circulating TDP concentrations did not differ between T2D and control groups, and ETKACs were largely sufficient, yet absolute TKT activities varied approximately sixfold among participants. Magnesium supplementation of erythrocyte lysates increased TKT activity, demonstrating that cofactor availability beyond TDP can influence functional measurements. Discordance between circulating TDP and functional status was also observed, including ETKAC-defined deficiency despite a TDP concentration within the reference range. Among participants with T2D, TDP was positively associated with fasting glucose and HbA1c, a relationship absent in controls. In NDNS analyses, higher thiamine intake and dietary density were strongly associated with lower ETKAC-defined non-sufficiency, although substantial non-sufficiency persisted despite adequate intake. Dietary thiamine density, ethnicity, age, and magnesium intake were independently associated with ETKAC status. Collectively, these findings support the conclusion that circulating TDP, dietary intake, and ETKAC provide related, but non-equivalent measures and support integrating both direct and functional assessments of thiamine status.

Importance: Dyslipidemia, hypertension, and diabetes are highly prevalent conditions for which medical nutrition therapy (MNT) is guideline-recommended, yet access remains limited, and real-world evidence on technology-enabled MNT models at scale is sparse. Objective: To characterize lipid, blood pressure, and glycemic outcomes among adults receiving virtual MNT (vMNT) across three cardiometabolic conditions. Design: Retrospective cohort study of adults with a first Nourish appointment before November 2025, followed for 6 months. Setting: National vMNT platform. Participants: Adults meeting enrollment criteria for dyslipidemia, hypertension, or diabetes and remaining engaged in care with [&ge;]1 follow-up measurement at 3 or 6 months. Final cohorts: dyslipidemia (n=6,501), hypertension (n=13,704), diabetes (n=2,444); 18,965 unique patients overall. Exposure: vMNT delivered by a registered dietitian via telehealth visits, with technology-enabled support between visits. Main Outcomes and Measures: Outcomes were LDL cholesterol, total cholesterol, HDL cholesterol, and triglycerides (dyslipidemia); systolic and diastolic blood pressure (SBP, DBP) (hypertension); and HbA1c (diabetes), assessed at enrollment, 3, and 6 months. Weight was a secondary outcome. The proportion achieving guideline-recommended targets (HbA1c <7.0%, SBP <130 mmHg) was also assessed. Results: Among 18,965 patients (mean [SD] age, 42.9 [11.6] years; 15,770 [83.2%] female), significant changes from baseline to 6 months included: LDL cholesterol (-14.0 mg/dL [SE, 0.56]); total cholesterol (-19.4 mg/dL [SE, 0.61]); HDL cholesterol (-0.5 mg/dL [SE, 0.15]); triglycerides (-28.6 mg/dL [SE, 1.06]); SBP (-5.5 mmHg [SE, 0.16]); DBP (-4.5 mmHg [SE, 0.11]); and HbA1c (-1.37 percentage points [SE, 0.04]) (all P<.001). Among those with elevated SBP, 57.3% achieved <130 mmHg by 6 months; among those with elevated HbA1c, 54.7% achieved <7.0%. Outcomes among patients with stable medication regimens were similar to the full cohort. Conclusions and Relevance: In this study of 18,965 patients, vMNT delivered through a technology-enabled care model was associated with clinically meaningful improvement across three prevalent cardiometabolic conditions. These findings support technology-enabled virtual care as a scalable approach to delivering effective MNT.

AO_SCPLOWBSTRACTC_SCPLOWO_ST_ABSIntroductionC_ST_ABSPolyunsaturated fatty acid (PUFA) status is an important marker of metabolic health across the lifespan, and omega-3 (n-3) PUFA were shown to have anti-inflammatory and cardioprotective effects. The omega-3 index, a composite of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), is widely used to assess n-3 PUFA supplementation status, and product-to-precursor fatty acid ratios are used as proxy indices of desaturation and elongation. Previous data indicate a higher proportion of n-3 PUFA with age. Whether the same pattern can be found in an NHANES cohort, and whether long-chain n-3 status relates to phenotypic age (PhenoAge), a composite measure of biological age, has not been established. MethodsWe analyzed erythrocyte fatty acid profiles measured by electron capture negative-ion mass spectrometry in erythrocytes of participants of the National Health and Nutrition Examination Survey (NHANES) 2021-2023. Adults aged 20-79 years with a complete 21-fatty-acid panel were included (n = 4,863) and stratified into five age groups (20-34, 35-44, 45-54, 55-64, 65-79 years). In the fasting subsample with a measured fasting glucose (n = 2,822) we additionally computed PhenoAge according to Levine and assessed PhenoAge acceleration (PhenoAge regressed on chronological age) in relation to EPA and DHA. ResultsPercentage of summarized PUFA and n-6 PUFA decreased with age while percentage of n-3 PUFA and EPA + DHA increased. In contrast, total saturated fatty acids did not differ across age groups. EPA and DHA rose with age, whereas linoleic acid (LA), dihomo-{gamma}-linolenic acid (DGLA) and -linolenic acid (ALA) declined. The delta-5-desaturase (D5D) index (AA/DGLA) and the AA/LA ratio were positively associated with age, while elongation-related proxies ELOVL2 (DTA/AA, DPA/EPA) and ELOVL5 (DGLA/GLA) were inversely associated. Higher EPA + DHA was associated with lower PhenoAge acceleration with the most pronounced effect of - 4,7 years in the group with highest ([&ge;]8%) EPA+DHA content. DiscussionAge-related shifts in erythrocyte PUFA composition and in desaturase and elongase proxy indices reported previously in a clinical cohort from Germany are reproduced in a large US population. In addition, long-chain n-3 status was inversely associated with PhenoAge acceleration.

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.

Returning individual results to research participants is increasingly expected in genomic studies. Yet, genomic dietary data have unique characteristics. New DNA sequencing techniques reconstruct diet from the residual plant and animal DNA recoverable in stool, reporting not nutrients or calories but a list of the species a person ate. Turning that list into something a participant can understand does not yet have an established framework. The Everyone EATS (Edible Atlas Through Sequencing) study returned personalized genomic dietary profiles to a non-clinical pilot cohort. Participants collected a stool sample at home, samples were processed with FoodSeq, and each participant received an interactive Diet Data Return Report that translated detected taxa into familiar food groups and benchmarked them against prior FoodSeq cohorts. No monetary compensation was offered, and the Diet Data Return Report was the sole incentive. Of 111 kits mailed, 80 were returned (72.1%) and sequenced (100% sequencing success for plant DNA; 98.7% for animal). Among report recipients with engagement data (n = 73), all accessed their report and 74% engaged interactively with its content. Among 16 feedback survey completers, 13/16 (81.2%) found the report easy to understand, 13/16 (81.2%) reported improved understanding of their dietary variety, and 5/16 (31.2%) reported a dietary behavior change. Curiosity about personal dietary data and supporting broader research goals were the most common reasons for enrolling (79.8%, respectively). Notably, the foods participants flagged as missing or unexpected clustered among herbs, spices, seafood, and processed items, the foods most easily forgotten in self-report and least readily assigned from sequence. Overall, our results suggest that genomic dietary data can be returned in a form participants find understandable and engaging, and that curiosity alone can motivate participation without payment.

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.

Objective To develop and evaluate an automated large language model (LLM)-based framework for conducting meta-analyses of nutrition-related exposures and the risk of breast, ovarian, and uterine cancers. Design We developed MetaFemina, an automated evidence-synthesis pipeline for women's cancers that integrates keyword-based literature retrieval, LLM-assisted evidence extraction, and random-effects meta-analysis. We evaluated its performance against two recently published peer-reviewed meta-analyses and compared exposure-outcome associations across the three cancer types. Data sources PubMed articles identified through keyword-based searches of titles and abstracts. Methods MetaFemina was developed as a web platform that identifies relevant scientific articles, automatically extracts relevant information using LLMs, and synthesizes extracted evidence using random-effects meta-analysis. Additional analyses included assessment of heterogeneity, publication bias, and leave-one-out sensitivity analyses. The platform also provides sample size calculations based on synthesized effect sizes and generates visual summaries and plain-language interpretations. Results Compared with two recent peer-reviewed meta-analyses of folate and vitamin E intake in relation to breast cancer risk, MetaFemina demonstrated high sensitivity (81.82% and 80%, respectively) in identifying eligible studies and additionally retrieved relevant articles that had been missed by manual screening (27 and 13, respectively). Among 226 exposures considered, lutein and beta-carotene were significantly associated with lower risks of breast, ovarian, and uterine cancers. Vitamin D, antioxidants, and soy were significantly associated with lower risks of both breast and ovarian cancers, whereas calcium and folic acid were significantly associated with lower risks of both breast and uterine cancers. In contrast, iron, red meat, and copper were significantly associated with higher risks of both breast and uterine cancers. omega-6 fatty acids showed contrasting associations, being significantly associated with higher breast cancer risk but lower ovarian cancer risk. After restriction to dietary-intake studies, these cross-cancer significant associations remained statistically significant except for copper, which no longer met the two-study threshold for either breast or uterine cancer. Additionally, calcium became significantly associated with lower ovarian cancer risk, resulting in significant negative associations across all three cancer types, while vitamin E became significantly associated with lower breast cancer risk and remained significantly associated with lower ovarian cancer risk. Conclusions MetaFemina demonstrated high sensitivity for identifying relevant scientific literature, extracts key evidence, and performs statistically rigorous automated meta-analyses. The framework may facilitate more rapid evidence synthesis in nutritional epidemiology and may support researchers in study design, hypothesis generation, and interpretation of emerging evidence.

Background: Aging is associated with physiological, biological, socioeconomic and psychological changes that may increase vulnerability to poor dietary intake, reduced muscle strength and elevated blood pressure. In Ghana, evidence on dietary intake in relation to functional and cardiometabolic health among community-dwelling older adults remains limited. This cross-sectional study assessed dietary intake, handgrip strength (HGS) and elevated blood pressure (BP), and examined associations between diet quality indicators and these health outcomes among older adults in five peri-urban communities in the La Nkwantanang-Madina Municipality, Ghana. Methods: Data were collected from 200 community-dwelling adults aged 60 years and above. Dietary intake was assessed using a multiple-pass 24-hour dietary recall, while physical activity, HGS and BP were measured using standardized procedures. Categorical variables were summarized as frequencies and percentages. Non-normally distributed dietary variables were compared between health outcome groups using the Mann-Whitney U test. Adjusted binary logistic regression was used to examine associations between diet quality indicators and HGS or elevated BP. Results: The mean age of participants was 69.8 {+/-} 7.3 years. More than half did not meet the dietary reference intake for protein, fat, fiber, magnesium, potassium and vitamin E, and no participant met the dietary reference intake for calcium. The prevalence of inadequate minimum dietary diversity (MDD) and inadequate mean adequacy ratio (MAR) exceeded 50%. Energy, protein, carbohydrate and selenium intake differed significantly by HGS status (p < 0.05). Mean adequacy ratio differed significantly by HGS status (p = 0.021) and BP status (p = 0.016). In adjusted models, each one-unit increase in MDD was associated with lower odds of elevated BP (AOR = 0.68; 95% CI: 0.46-1.00; p = 0.05), while each one-unit increase in MAR was associated with higher odds of normal HGS (AOR = 8.77; 95% CI: 1.33-64.08; p = 0.034). Conclusions: Dietary inadequacy was common among older adults in this peri-urban Ghanaian setting. Better diet quality indicators were associated with normal HGS and lower odds of elevated BP. These findings support the need for nutrition-focused strategies and further longitudinal or intervention studies to clarify the role of dietary intake in functional and cardiometabolic health among older adults.

Background: Many epidemiological studies rely on dietary exposures taken from baseline only. This limits our understanding of diet-disease associations because it requires assuming a level of temporal stability, either by individuals or dietary pattern composition. Objectives: This study aimed to evaluate these analytic assumptions of pattern structure consistency and baseline adherence using a cohort of US Black women with repeated measures of food frequency questionnaires (FFQ). Methods: Data from 6151 Black women aged 21-69 from the Black Women's Health Study with complete FFQ data in 1995, 2001, 2013, and 2021 were evaluated for temporal stability. Baseline dietary patterns were derived using an overfitted latent class model. Parameter estimates from the baseline model were then applied to subsequent waves to track individual transitions between existing patterns. Dietary patterns were also derived at each time point using an overfitted latent class model and assessed for changes in pattern composition over time. Results: Five baseline dietary patterns were identified in 1995. Only 18% of participants remained in the same baseline dietary pattern across all four time points, while all others transitioned to a different baseline-derived pattern. Dietary patterns derived independently at subsequent time points, yielded a different number of dietary patterns at each time point (2001: 6 patterns, 2013: 5 patterns, 2021: 4 patterns). Correlation strength of subsequent derived patterns and baseline patterns significantly weakened in strength after 2001 (40% pairings > 0.5), with no patterns correlated greater than 0.5 in 2021. Conclusion: Prospective studies that rely on baseline dietary exposure data cannot assume stability of pattern composition or individual pattern adherence over time, as it ignores changes in dietary habits and may bias our understanding of the diet-disease pathway.

Background: Omega-3 polyunsaturated fatty acids may modulate lipid-mediated inflammatory pathways implicated in migraine, yet pediatric trial methodologies evaluating biologic target engagement remain limited. This study evaluated the feasibility of conducting a pediatric nutrition-based migraine intervention trial integrating longitudinal dried blood spot biomarker collection, validated patient-reported outcome measures, dietary assessment, and caregiver-reported acceptability measures. Methods: A quasi-randomized, double-blind, placebo-controlled feasibility trial was conducted at two academic pediatric neurology clinics. Children and adolescents aged 10-17 years with migraine were assigned 1:1 using sequential alternating allocation to daily omega-3 supplementation (850 mg eicosapentaenoic acid + docosahexaenoic acid) or matched coconut oil placebo for 12 weeks. Feasibility outcomes included recruitment yield, participant retention, caregiver-reported supplement adherence, dried blood spot biospecimen completion, 24-hour dietary recall completion, and intervention acceptability assessed via caregiver exit questionnaire. Feasibility benchmarks were established post hoc based on published pediatric trial literature: recruitment >70% of target sample, retention [&ge;]70%, supplement adherence [&ge;]70% of caregivers reporting administration on most days, biospecimen completion [&ge;]90%, dietary recall completion [&ge;]80%, and acceptability rated favorably by [&ge;]70% of caregivers. Clinical efficacy outcomes will be reported separately. Results: Of 58 individuals assessed for eligibility, 57 were enrolled and allocated (29 intervention, 28 placebo). Forty-four participants (77%) completed the 12-week follow-up (22 per group), meeting the retention benchmark. Dried blood spot collection was completed at both time points for all participants who attended study visits (100%). All 44 study completers finished all four planned dietary recalls (100% completion). Caregiver-reported acceptability was high, with the majority rating daily supplement administration as acceptable and reporting openness to future dietary supplement use for migraine management. Thirteen participants discontinued: five withdrew, five were lost to follow-up, two discontinued due to supplement palatability, and one no longer met inclusion criteria. Structured telephone follow-up at weeks 4 and 8 supported retention and adherence monitoring. Conclusions: This feasibility trial demonstrated that a pediatric nutrition-based migraine intervention integrating dried blood spot biomarker collection, repeated dietary recalls, validated patient-reported outcomes, and structured remote follow-up is feasible and acceptable to families. All six post-hoc feasibility benchmarks were met. Findings support progression to a larger-scale randomized controlled trial with modifications including concealed randomization, prospective daily headache diaries, and longer intervention duration. Trial registration: ClinicalTrials.gov, NCT06899074. Registered 20 March 2025.

Introduction: Research has documented that obesity and morbidity are associated. Black persons in the United States (U.S.) incur higher financial costs of obesity-related multimorbidity (ORM). However, lifetime healthcare costs (LHCs) remain underexamined for these populations. Objective: We quantified racial differences in 1) LHCs and 2) lifetime healthcare cost differential (LCD) associated with ORM for ages > 40 years. Methods: We used the 2008- 2012 Medical Expenditure Panel Survey Household Component to examine unique obesity-related diseases (ORDs): high blood sugar, hypertension, coronary heart disease, and stroke. We used a prior published Markov model to simulate a person's life history of ORDs and compute LHCs among ages > 40 years. We computed LCD-associated ORM as the difference in LHC for those with ORM and LHC for members without ORDs. We quantified differences in race as the difference between LHC or LCD among White and Black men and women. Results: Our analytic sample included 53,035 Black and White persons representing 97,229,611 (S.E., 2,104,365), 12.4% as Black and 87.6% as White persons. ORM was more prevalent in the Black (21.2%) than the White group (13.4%). LHCs by race (Black/White) for women/men with ORM and LCDs associated with ORM (2012$) were $3 1,035/43,595 and $11,350/26,948 for age 40-49, $2 1,567/25,6 115 and $3,846/9,808 for 50-59, $9,863/18,515 and -$2,566/7,426 for 60-69, -$8,220/16,285 and -$11,524/3,865 for 70-79. Conclusions: Racial Differences in LHCs and LCDs related to ORM persist and vary across subpopulations. Future interventions designed to prevent/manage ORM are crucial for prioritizing populations with high LHCs and advancing health equity.

Healthcare workers face substantial occupational demands and exposure to respiratory infections during winter, but evidence that probiotics improve their health and wellbeing remains limited. This exploratory, double-blind, randomised, placebo-controlled trial assessed whether daily Lab4 supplementation affected upper respiratory tract infection (URTI) frequency and supported wellbeing in 104 healthcare workers. Daily diaries recorded symptoms defining URTI episodes, general-practitioner visits, illness-related work absence and antibiotic use. Wellbeing was assessed at baseline and weeks 8 and 16, and faecal microbiota were assessed using 16S rRNA gene sequencing. Participants receiving Lab4 reported better wellbeing than those receiving placebo. For probiotic versus placebo, the risk ratio (RR) for URTI occurrence was 0.60 (95% confidence interval [CI]: 0.30-1.20; p=0.1477), the incidence rate ratio (IRR) for episodes was 0.58 (95% CI: 0.27-1.23; p=0.1581), and the mean ratio for episode duration was 0.98 (95% CI: 0.72-1.32; p=0.8776). For general-practitioner visits, the RR for at least one visit was 0.48 (95% CI: 0.21-1.07; p=0.0737) and the IRR was 0.44 (95% CI: 0.18-1.06; p=0.0677). For illness-related work absence, the RR for at least one day absent was 0.75 (95% CI: 0.18-3.22; p=0.6991) and the IRR for absence days was 0.74 (95% CI: 0.16-3.32; p=0.6914). For antibiotic use, the RR for any use was 0.48 (95% CI: 0.20-1.18; p=0.1111) and the IRR for antibiotic-use days was 0.42 (95% CI: 0.16-1.12; p=0.0820). No significant between-group differences in gut microbiota were detected in the subset providing faecal samples. Illness-related estimates generally favoured Lab4, although between-group differences were not statistically significant. These exploratory findings support evaluation in a larger, prospectively powered trial.

Abstract Background: Maternal disability can reduce the ability to provide adequate care and increase the likelihood of undernutrition among children. In Malawi, over one third of under-five children are affected by stunting. There has been no study that assessed the association between maternal functional difficulty and undernutrition among children in Malawi. The objective was to assess if maternal functional difficulty is associated with stunting, underweight, and wasting in children in Malawi. Methods: Data were extracted from the nationally representative cross-sectional Malawi 2024 Demographic and Health Survey (MDHS). Mother-child dyads were included for mothers aged 15-49 years and children aged [&le;] 59 months, with valid anthropometric z-scores. Maternal functional difficulty was assessed using the Washington Group Short Set on six domains (seeing, hearing, walking, cognition, self-care, communication) and classified as severe vs. no difficulty. Child undernutrition was defined as height-for-age z-score (HAZ) < -2 (stunting), weight-for-age z-score (WAZ) < -2 (underweight), and weight-for-height z-score (WHZ) < -2 (wasting). Survey-adjusted multivariable logistic regression models were fitted, accounting for complex sampling design whilst population attributable fraction was calculated. Results: A total of 4,361 mother-child dyads were analyzed for this study. The overall weighted prevalence of maternal functional difficulty was 3.74% (SE 0.35). There was a reported 36.4% prevalence for child stunting, 8.7% for underweight and 1.7% for wasting. Maternal functional difficulty was not associated with child stunting (AOR 0.85, 95% CI: 0.55-1.33), underweight (AOR 1.06, 95% CI: 0.55-2.02) and wasting (AOR 0.96, 95% CI: 0.26-3.53) after adjustments for confounders. The population-attributable fractions were also found to be negligible for all three nutrition outcomes. Maternal height [&ge;] 150 cm showed strong protective effect against child stunting (AOR 0.29, 95% CI: 0.16-0.54) as well as belonging to the richest wealth quintile (AOR 0.61, 95% CI: 0.42-0.89). In conclusion, there was no statistically significant association between maternal functional difficulty and child undernutrition in Malawi. The family and community support networks in Malawi may be buffering the nutritional effects of maternal disability on children. To reduce child undernutrition in Malawi, efforts should focus on maternal height, household wealth and the first 1,000 days interventions.