Public Health Nutrition

Background: Nutrition education and physical activity support are important components of type 1 diabetes mellitus (T1DM) care, but their association with body composition outcomes in routine Ugandan diabetes services remains uncertain. We evaluated a culturally tailored health promotion programme among adolescents and young adults living with T1DM. Methods: We conducted a trial study in Wakiso Health Centre IV, Uganda. Sixty participants aged 13 to 26 years were allocated through an alternating clinic-week schedule to an intervention group or usual-care control group, with 30 participants per group. The eight-week Active Hearts, Healthy Lives programme combined nutrition education, personalised dietetic counselling, physical activity support, and practical self-management activities. Anthropometric and bioelectrical impedance measurements were obtained at baseline and six months after baseline. Separate linear regression models compared follow-up outcomes, adjusting for the corresponding baseline measurement, age, and sex. Results: Participants had a mean age of 19.45 years (SD 3.02), and 33 (55.0%) were female. Compared with controls, the intervention group had lower adjusted fat mass and BMI and higher fat-free mass and muscle mass. These differences reflected modest changes among intervention participants alongside increased fat mass and decreased fat-free mass and muscle mass among controls. Conclusion: Participation in the programme was associated with differences in estimated body composition at six months. Larger randomised evaluations incorporating clinical and functional outcomes are needed to establish whether the programme provides meaningful health benefits.

Aim: This study aimed to estimate the prevalence and distribution of minimum dietary diversity for women (MDD-W) and underweight/thinness and examine sociodemographic and dietary factors associated with underweight/thinness among Cambodian women aged 15-49 years. Methods: We conducted a cross-sectional analysis of 9,181 women aged 15-49 years (9,262.5 weighted) from the 2021-22 Cambodia Demographic and Health Survey. Survey-weighted descriptive statistics and provincial mapping were used to describe MDD-W, food-group consumption and underweight/thinness. Rao-Scott chi-square tests assessed group differences, and survey-weighted logistic regression estimated factors associated with underweight/thinness. MDD-W and household wealth were retained a priori in the adjusted model, while other covariates with an overall crude Wald P value <0.20 were included. Results: The analysis included 9,181 women (9,262.5 weighted). Overall, 57.2% achieved MDD-W, and 6.7% had underweight/thinness; 22.8% were overweight, and 5.7% had obesity. Underweight/thinness was highest among women aged 20-24 years (17.7%). Achieving MDD-W was not associated with underweight/thinness in crude analysis (OR 0.93, 95% CI 0.74 to 1.17; P=0.545). In the adjusted analysis, the association remained imprecise (aOR 0.86, 95% CI 0.67 to 1.09; P=0.219). Provincial estimates showed geographic variation in both MDD-W and underweight/thinness. Conclusion: More than half of Cambodian women achieved MDD-W, while underweight/thinness coexisted with overweight and obesity. MDD-W was not clearly associated with underweight/thinness. These findings support monitoring dietary diversity, anthropometric status, and socioeconomic inequalities together in women's nutrition.

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

Background Micronutrient deficiencies are a major public health problem for women of reproductive age (WRA), especially in conflict settings, such as Yemen. However, there is little information on knowledge, attitudes and practices (KAP) toward micronutrient-rich foods among WRA in Aden Governorate. This study aimed to assess knowledge, attitude and practices of WRA toward micronutrient rich foods attending health facilities in Aden Governorate, Yemen. Methods A facility based descriptive cross-sectional study was conducted among 348 WRA aged 15-49 years who visited selected primary health care and maternal and child health facilities in the eight districts of Aden governorate, Yemen. Data were collected using structured interviewer administered questionnaire which was adapted from guidelines of Food and Agriculture Organization and World Health Organization. Chi-square test and Pearson correlation were used to assess the association between the KAP indicators and sociodemographic characteristics. Results The mean age of the participants was 26.3 {+/-} 8.8 years and 73.9% had high-grade education. In general, 77.9% identified micronutrients as essential for health and 92.8% correctly identified liver/red meat as micronutrient-rich food. However, only 29.6% identified iodized salt as a source of iodine. Although 95.7% perceived supplementation as important, only 9.8% reported regular supplement use. The most commonly reported barrier to access to nutritious food was high food cost (43.4%) and 70.6% perceived healthy foods as too expensive. Restriction in daily consumption was observed for eggs (36.2%), meat/poultry/fish (32.2%) and fruits (13.2%). Education was moderately positively correlated with micronutrient knowledge (r = 0.514, p < 0.001) and age was weakly positively correlated (r = 0.162, p = 0.002). Conclusion WRA in Aden had good knowledge and positive perceptions about micronutrients and supplementation but major gaps in dietary practices and access to affordable nutritious foods. Integrated, culturally appropriate interventions that include nutrition education and improved access to affordable micronutrient-rich foods and appropriate supplementation are needed.

Background Street food vending is a major source of food supply in Nepal. Poor food hygiene practices among street food vendors pose a health risk by increasing the risk of foodborne diseases. Studies regarding food hygiene knowledge and practices are needed to improve public awareness. Therefore, this study aimed to assess food hygiene knowledge and practice among street food vendors and their associated factors in selected districts of Bagamati Province. Methods A community-based cross-sectional analytical study was carried out among 186 street food vendors of Districts located in central Nepal. Face-to-face interviews were conducted using a semi-structured questionnaire and an observation checklist. Knowledge and practice levels were categorized as good and poor. Chi-square test, Fisher's exact test, odds ratio, and Mann-Whitney U test were applied for data analysis. Results Less than half (39.8%) of the vendors had good food hygiene knowledge, while 91.4% of the respondents reported good food safety and hygiene practices. The education level of street food vendors was significantly associated with food hygiene knowledge (p = 0.001) and food safety and hygiene practices (p = 0.042). Significant association was not seen between overall food hygiene knowledge and overall food safety and hygiene practices levels. Conclusion The study identified a gap between food hygiene knowledge and self-reported food hygiene practices among street food vendors. Education, infrastructure, and regulations among street food vendors play a key role in good food hygiene practices more than knowledge alone. Policymakers should focus on training of food vendors, regular supervision, and monitoring of vending sites to enhance food safety.

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 [&ge;]5 years and aged [&ge;]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.

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

High calorie intake of unhealthy foods are the main factor of overweight and obesity. In food environment, food retailers are the biggest player in shapping consumers purchase pattern. In this South East Asia Obesogenic Food Environment (SEAOFE) study, we aimed to to explore retailer perspectives on stocking decisions and barriers to stocking healthy food products in urban poor areas of Kuala Lumpur, Malaysia. The study was conducted using purposive sampling at three parliaments which have the highest urban poor population. 35 retailers who involved in procurement, retail operations, and product placement, with at least one year of experience, were selected as participants of this study. The interview were conducted face-to-face and been transcribed verbatim for data analysis. Nine key themes emerged regarding factors affecting stocking decisions: 1) consumer demand, 2) consumer satisfaction and feedback, 3) profitability, 4) forecast software, 5) fast-moving products, 6) product healthiness, 7) availability, 8) seasonality, and 9) e-commerce; while four key barriers in stocking healthy food products included 1) price, 2) shelf life, 3) consumer demand and preferences, and 4) availability of supply. This study showed that the urgency of targeted interventions to improve healthy food supply through collaboration from retailers, suppliers and policymakers. By addresing the issue will help to increase consumption of healthy foods and improve the health of the residents within the urban poor areas of Kuala Lumpur.

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.

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

Background and objective. The WHO growth reference judges a child's height against the population at one age, without using the child's own earlier growth. This study built and validated a quantile regression based conditional growth reference predicting a child's future height for age distribution from early growth status. Methods. Using deidentified longitudinal annual school children health check data from three major cities in Vietnam, this study linked a baseline height and BMI for age Z score near age 6 to outcome visits near age 12 or 15 in 4,857 children. A linear quantile regression and a pooled quantile generalized additive model, fit by sex, were compared against a linear benchmark and a naive persistence model on a held out test set, using pinball loss, interval coverage, and width against the WHO 90% band. This study also tested adding growth phenotype and checked generalization across the three cities. Results. The pooled model outperformed the discrete quantile regression in every group. Every individualized 90% interval was narrower than the WHO band, by 34.6 to 54.5%. Growth phenotype improved accuracy in most groups. The model generalized well to a held out Hanoi or Haiphong but poorly to a held out Ho Chi Minh City, where coverage fell to between 0.35 and 0.52, though the all-city model stayed well calibrated for Ho Chi Minh City itself. Conclusion. Conditional quantile modeling gives individualized growth predictions markedly narrower than a fixed population reference and gains further from growth phenotype, but needs local validation before use at an unrepresented site.

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

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

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 Concurrent wasting and stunting (WaSt) is a severe form of child undernutrition, linked to higher mortality and long-term negative health outcomes. Malnutrition is a significant challenge in Yemen, where the country is experiencing a long-standing conflict, food insecurity, and socioeconomic deprivation. But there is still limited evidence on the burden and determinants of WaSt in Yemen on a national level. This study aimed to estimate the prevalence and identify factors associated with WaSt among children under 5 years in Yemen. Methods We conducted a cross-sectional analysis using nationally representative data from the 2022-2023 Yemen Multiple Indicator Cluster Survey (MICS). A significantly large dataset of 17,734 children aged 0-59 months from all the 22 governorates of Yemen was analyzed. Concurrent wasting and stunting (WaSt) was defined as the coexistence of a weight-for-height z-score (WHZ) below -2 standard deviations and a height-for-age z-score (HAZ) below -2 standard deviations from the WHO Child Growth Standards in the same child. Survey-weighted logistic regression was performed to analyze the factors associated with WaSt among the under 5 children in Yemen. Results The national prevalence of WaSt was 8.4% (95% CI: 7.6-9.2). The highest prevalence of WaSt was found in children aged 12-23 months (12.0%) and in the Western Coastal region (11.6%). After adjustment, male sex (AOR 1.52, 95% CI: 1.30-1.80), residence in the Western Coastal (AOR 2.00, 95% CI: 1.60-2.40), Eastern (AOR 2.00, 95% CI: 1.50-2.70), and Southern regions (AOR 1.60, 95% CI: 1.20-2.10), poorest household wealth (AOR 1.96, 95% CI: 1.30-2.90), moderate (AOR 1.51, 95% CI: 1.13-1.94) and severe food insecurity (AOR 1.94, 95% CI: 1.40-2.60), and recent diarrhoea (AOR 1.22, 95% CI: 1.02-1.44) were associated with higher odds of WaSt. Having a handwashing facility and improved sanitation were protective. Conclusion At least 1 in every 12 under-five children in Yemen was affected by WaSt, and there were significant socioeconomic, geographic, food-security and WASH-related factors influencing this devastating outcome. Instead of simple, one-dimensional approaches, multi-sectoral interventions are needed to address this adversity. And those efforts must be integrated into the system, interconnected with each other and specifically targeted to vulnerable children and households.

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

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

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

Background: 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.