Public Health Nutrition

BackgroundAdherence to UK dietary guidelines is poor, yet no evidence exists regarding population-level knowledge of these guidelines, or the barriers and facilitators to adherence. This study aimed to characterise knowledge of UK dietary guidelines and perceived barriers and facilitators to adherence in a nationally representative UK sample. MethodsA cross-sectional survey was administered to 1003 adults recruited via Prolific, matched to the UK population by age, sex, and ethnicity. A 22-item knowledge questionnaire assessed awareness of the Eatwell Guide and broader Dietary Reference Values (DRVs), with both strict and liberal scoring applied. Perceived barriers and facilitators to adherence were assessed using custom questionnaire items informed by the COM-B model and TDF framework. ResultsKnowledge of Eatwell Guide recommendations was moderate under strict scoring (53.3%) and improved under liberal scoring (72.5%), despite nearly half of participants reporting no familiarity with the Eatwell Guide. Knowledge of broader DRVs was poor using strict scoring (17.9%) but moderate with liberal scoring (58.9%). The most commonly reported barriers were social (e.g. celebrations), environmental (e.g. access to unhealthy foods), and psychological (e.g., mood). The most strongly endorsed facilitators were economic (e.g. cheaper healthy foods) and health-related (e.g. motivated by weight and mental health). ConclusionsThese findings suggest that whilst knowledge of UK dietary guidelines is reasonable, individualised behaviour change approaches alone are unlikely to be sufficient. Meaningful population-level improvements will require complementary structural changes to the food environment.

IntroductionMinimum dietary diversity (MDD) is a key indicator of complementary feeding among children aged 6-23 months. This study examines the prevalence, trends, and determinants of MDD in Bangladesh over the period 2014 - 2022. DesignSecondary analysis of the Bangladesh Demographic and Health Survey (BDHS) data between 2014 and 2022. The primary outcome was MDD defined as consumption of at least 5 of 8 food groups (MDD-8). We included 6,080 children aged 6-23 months to assess trends over time. The pooled datasets were used to identify factors associated with MDD-8. Multiple logistic regression was performed to assess the association between different factors and MDD-8, accounting for the complex survey design. SettingBangladesh ResultsThe proportion of children achieving MDD-8 increased from 26.4% in 2014 to 38.7% in 2017, but plateaued at 37.1% in 2022, with an average annual increase of 4.3% between 2014 and 2022. MDD-8 improved with child age. Higher odds of achieving MDD-8 were observed among children surveyed in later years, from wealthier households, with mothers who had [≥]4 ANC visits, received PNC, had higher education, were employed, and had media exposure. Older age and higher birth order were also associated with achieving adequate MDD. Children in Chattogram and Sylhet were less likely to meet MDD-8 compared to Dhaka. ConclusionsWhile dietary diversity improved between 2014 and 2017, progress stalled thereafter. Targeted, multisectoral strategies focusing on womens empowerment, health service utilisation, media engagement, and disadvantaged regions are needed to improve child dietary diversity in Bangladesh.

BackgroundNo official correspondence table exists between the Japanese Standard Tables of Food Composition 2020 (8th edition; MEXT) and the USDA FoodData Central (FDC), despite their widespread use in nutritional research. This absence has hindered international comparison of food composition data for over six decades. MethodsWe developed a bidirectional matching pipeline using Claude Haiku (Anthropic), a large language model (LLM), combining food category mapping, 17-nutrient Euclidean distance ranking, and LLM-based conceptual judgment. Survey (FNDDS) data were excluded from FDC, yielding 8,158 items (Foundation Foods and SR Legacy). Matching was performed in both directions: MEXT[->]FDC and FDC[->]MEXT. ResultsOf 2,478 MEXT items, 1,927 (77.8%) were matched to FDC items, while 549 (22.2%) had no FDC equivalent (JP-only foods). Of 8,158 FDC items, 5,445 (66.7%) were matched to MEXT items, while 2,698 (33.1%) had no MEXT equivalent (US-only foods). Bidirectional consensus yielded 435 confirmed food pairs across 13 food categories. Notably, FDC items showed systematically higher calcium (+6.0 mg/100g) across 12 of 13 categories, while MEXT items showed systematically higher potassium (-3.7 mg/100g) across 9 of 13 categories and higher vitamin A as RAE (-3.7 g/100g) across 8 of 13 categories. ConclusionsThis study presents the first systematic bidirectional food correspondence table between MEXT and USDA FDC. The 435 confirmed pairs constitute a validated common vocabulary for international food composition research. The systematic cross-national differences in calcium, potassium, and vitamin A represent novel findings with direct implications for international dietary comparison studies. The complete correspondence table (Version 0.1) is openly available at https://github.com/shnkgw-rincom/jbfd-correspondence-table (DOI: 10.5281/zenodo.20103327).

To evaluate the international interoperability of food composition databases, we assessed the compatibility of seven national food composition tables with USDA FoodData Central (FDC) using the LLM-based matching method reported previously (Nakagawa and Yamamoto, 2026). Databases from four English-speaking countries (Canada, United Kingdom, Australia, and New Zealand), South Korea, and Japan were compared with 8,158 USDA FDC entries (SR Legacy and Foundation Foods, excluding Survey/FNDDS). Match rates varied by country (62.0-89.7%) and food category. After excluding six USDA categories unsuitable for cross-national comparison, 45.2% of the remaining 6,290 entries were not matched by any country. Canada showed the highest concordance, reflecting shared North American food supply. Japan and South Korea showed similar low coverage for vegetables and spices. These findings suggest that while USDA FDC represents a practical foundation for a globally comprehensive food composition database given its breadth, systematic incorporation of country-specific foods and classification schemes will be necessary to achieve true international interoperability.

Background/Objectives: Children aged 6-24 months are highly vulnerable to malnutrition during conflict because they depend on breastfeeding, complementary feeding and functioning nutrition services. This study assessed nutritional status, socioeconomic correlates, maternal knowledge and primary health care centre (PHCC) nutrition service gaps in Gaza. Subjects/Methods: This cross-sectional study was conducted at Al-Daraj Martyrs Health Centre, one of the remaining functioning PHCCs in Gaza City during the study period, between late August and October 2025. Mother-child pairs were recruited by convenience sampling. Of 276 approached, 200 were included after non-response and exclusion of questionnaires with missing anthropometric data. Data came from structured interviews and medical records; haemoglobin results were available for 55 children. Results: Stunting affected 12.5% of children, underweight 20.1%, wasting 20.8%, and anaemia 63.6% of the haemoglobin-tested subsample. Underweight was associated with household food shortage (p=0.013) and previous malnutrition treatment (p=0.002), wasting with child age category (p=0.0024), and anaemia with paternal unemployment (p=0.020). Maternal knowledge and practice scores were positively correlated (r=0.177, p=0.012), but neither was independently associated with stunting or underweight in adjusted models. PHCC nutrition support was limited, with 71.0% of mothers reporting nurse-provided nutrition advice and 52.5% reporting growth-chart review. Conclusions: In this clinic-based sample from conflict-affected Gaza, malnutrition among children aged 6-24 months was substantial. The overall pattern suggests that nutritional risk was shaped more by structural deprivation and weakened PHCC support than by maternal knowledge alone. These findings underline the need to restore essential nutrition services and improve access to adequate food for young children.

BackgroundPaediatric liquid medicines (PLMs) routinely contain sucrose to improve palatability, yet their cariogenic potential is well established. Healthcare professionals awareness and prescribing practices regarding sugar-free PLMs have received limited study in India, particularly in Uttarakhand. MethodsA descriptive cross-sectional study was conducted among 500 healthcare professionals aged [&ge;]25 years, using a pilot-tested structured questionnaire (Cronbachs = 0.85), administered online and in person across Uttarakhand districts (January-March 2024). After excluding 69 incomplete responses, 431 participants were analysed (response rate: 86.2%), comprising general medicine practitioners (49%, n = 211), paediatricians (27%, n = 116), and dental practitioners (24%, n = 104). Descriptive statistics and chi-square tests were applied (p < 0.05). ResultsPrescription decisions were primarily driven by childs age and weight (58%), cost (40%), and pharmaceutical brand (37%). While 88% recognised PLM sweetness and 67% were aware of pH-dental harm links, only 20% associated PLMs with dental caries. Overall awareness of hidden sugars was 73%. Eighty-three percent knew of sugar-free alternatives (50% local availability), yet 80% found them less palatable and 85% costlier. Only 48% routinely provided oral health advice. A statistically significant association was found between specialty and sugar-free PLM awareness (p = 0.03), with dental practitioners recording the highest awareness (90%). ConclusionsHealthcare professionals demonstrated variable levels of knowledge, attitudes, and practices regarding PLMs, with critical gaps in caries recognition (20%) and oral health counselling (48%). Despite high sugar-free PLM awareness, uptake is constrained by perceived cost and palatability barriers. Targeted continuing medical education and policy measures, including sucrose-free labelling promotion, are needed to improve paediatric oral health outcomes in Uttarakhand. KEY MESSAGESO_LIOnly 20% of healthcare professionals in Uttarakhand associated pediatric liquid medicines (PLMs) with dental caries, representing a critical knowledge gap despite 88% recognising their sweetness. C_LIO_LIOverall awareness of hidden sugars in PLMs was 73%, yet only 48% routinely provided post-prescription oral health counsellingsubstantially below international benchmarks. C_LIO_LIEighty-three percent were aware of sugar-free PLM alternatives, but adoption was constrained by perceived inferior palatability (80%) and higher cost ([~]10% premium, cited by 85%). C_LIO_LIDental practitioners demonstrated significantly higher sugar-free PLM awareness than general practitioners and pediatricians (p = 0.03), supporting the case for interprofessional oral health education in medical training. C_LIO_LITargeted continuing medical education (CME) and policy measuresincluding sucrose-free labelling mandates and institutional formulary inclusionare needed to convert awareness into prescribing practice change. C_LI

Introduction. Ultra-processed foods (UPFs), defined as foods in group 4 of the NOVA classification system, are a key contributor to chronic disease in the United States. Front-of-package warning labels ('warnings') offer a promising strategy to help Americans reduce consumption of UPFs. Requiring warning labels on UPFs could help reduce consumption of these foods. However, the effects of UPF warnings are largely unknown. The impact of warning labels on UPFs among Latino adults was examined. Study design. Online randomized trial. Setting/participants. 4,107 Latino adults (49% limited English proficiency) in the US. Intervention. Participants viewed one of three labels: control labels displaying barcodes; identity warnings stating 'WARNING: Ultra-processed food'; or health warnings stating 'WARNING: Consuming ultra-processed food and drinks can cause weight gain, which increases the risk of obesity and type 2 diabetes'. Main outcome measures. Participants viewed four UPF products displaying their randomly assigned labels. Participants indicated whether the product was UPF (primary outcome) and rated perceived healthfulness of the product, intentions to purchase the product, and perceived message effectiveness (secondary outcomes). Results. Identity warnings (70% correct) and health warnings (67% correct) both led to higher correct identification of UPF compared to control labels (54%, p<.001), with the identity warning having a larger impact than the health warning (p=.007). Compared to the control label, the identity warning and health warning both elicited higher perceived message effectiveness and lower perceptions of healthfulness and purchase intentions (p<.001 for all outcomes) with no significant differences between UPF labels. The impact of the health warning label (vs. the control label) on correct identification of UPF was greater for participants with high education (p=0.012) compared to those with low education, and participants with limited English proficiency (p=0.001). Conclusions: UPF warnings may help consumers identify UPFs and influence product perceptions and intentions.

Due to a high prevalence of obesity-related chronic diseases and an increasing use of injectable weight loss medications, a need for dietary consultations by registered dietitian nutritionists (RDNs) has been increasing. However, there is a paucity in RDNs who provide weight management services. The objective of this study is to gather insight on the dietary interventions and barriers in weight loss practice as reported by RDNs specializing in weight management. The survey contained 33 questions and four domains (current practice diet interventions and protocols, client demographics, practitioner demographics, and barriers). Descriptive statistics were used to evaluate results. Survey participants, RDNs (N=739), were recruited from Weight Management Dietetic Practice Group of the Academy of Nutrition and Dietetics. Weight management occupies most (69%) of surveyed RDNs work time. App use was the most common method of food record collection (n=299), and food record accuracy was the most prevalent cited barrier to weight loss magnitude (n=233). Most (n=253) RDNs reported seeing their typical client once a month with an average continued engagement of one month being the most prevalent (n=197). Lastly, most RDNs (81%, n=595) do not have a customary program or diet they refer clients to. In conclusion, improvements in technologically enhanced platforms for accurate diet record collection and patient education may benefit RDNs weight management practice and further research into reasons for patient attrition from weight loss counselling is warranted.

Introduction Acute malnutrition in children aged 6-23 months remains critical in Tigray, Ethiopia, where global acute malnutrition (GAM) rates have reached emergency levels. Small-quantity lipid-based nutrient supplements (SQ-LNS) show promise for prevention, but evidence from post-conflict settings is limited. Objective This study evaluated SQ-LNS effectiveness in preventing acute malnutrition and rightward shifting in the distribution of weight-for-height among young children in post-conflict Tigray, Ethiopia. Methods A non-randomized cluster trial enrolled 8,442 children aged 6-23 months across four districts. The intervention group (n=6,838) received daily 20g SQ-LNS sachets for six months plus behavior change communication; the control group (n=1,604) received standard nutrition programming. Primary outcomes were acute malnutrition prevalence (WHZ < -2 or MUAC < 12.5cm) and distribution of weight-for-height z-scores. Data were collected biweekly and analyzed using longitudinal comparisons and difference-in-differences (DiD) estimation. Results Acute malnutrition declined from 22.1% to 4.2% in the intervention group (17.9 percentage point reduction) versus 19.6% to 11.4% in controls (8.2-point reduction). Mean WHZ scores increased from -0.35 to +0.33 in the intervention group (gain of +0.68 z-scores), while controls improved from -0.79 to -0.63 (gain of +0.16). The net intervention effect (DiD) showed a 4.9 percentage point reduction in WHZ-defined GAM and a 9.7-point reduction in MUAC-defined GAM. Mean WHZ and MUAC increased significantly more in the intervention group (DiD: +0.52 z-scores and +3.88 mm, respectively). Critically, the entire WHZ distribution shifted rightward, indicating population-level nutritional improvement, not merely reduced caseloads. Conclusions Six months of daily SQ-LNS effectively prevented acute malnutrition and shifted the entire weight-for-height distribution rightward among young children in post-conflict Tigray. Benefits extended beyond treatment, lifting whole-population nutritional status and building resilience. Findings support SQ-LNS inclusion in post-conflict nutrition packages and highlight the importance of assessing distributional outcomes, not just prevalence, when evaluating nutritional interventions. Trial registration number This trial was registered as NCT06103084.

Produce prescription programs (PRx) targeting different populations and conditions have been found to be effective. However, few have focused on pregnant women. The objectives of this study were to assess the impact of the Food4Moms (F4M) PRx on 1) healthy eating stages of change 2) intake of fresh produce, and 3) household food security among pregnant Latina women. F4M recruited low-income Latinas living in Greater Hartford, Connecticut that received a "produce prescription" from a Registered Dietitian based at the community-based organization (CBO) where the program was implemented. Participants were offered $100 per month for 10 months through Fresh Connect debit cards to purchase fresh produce from two food retailers or the equivalent value in fresh produce delivered at home. To be fully enrolled in F4M, participants had to complete a baseline survey and the first nutrition education interactive session. Enrolled participants were offered additional nutrition education sessions at the CBO and received text messages with nutrition tips as well as reminders to spend their remaining benefit balances towards the end of each month. A single-group pre-post study design was used to assess the impact of F4M 10 months after the card activation. No attrition bias was detected when comparing the characteristics of those completing (N=113) vs. those not completing the endline survey (N=41). Pre-post Wilcoxon signed-test or paired t-test analyses showed that F4M had a positive impact on healthy eating readiness (p < 0.001), the consumption of fruits (p < 0.001) and vegetables (p < 0.001), and household food security (p = 0.034). F4M is a promising community-engaged PRx program that may improve readiness for healthy eating, produce intake, and household food security. Implementation research is needed to find out how to effectively scale out and sustain programs like F4M. The study was registered in ClinicalTrials.gov (identifier: NCT05907616).

IntroductionFood insecurity and mixed patterns of malnutrition coexist in rural Nigeria despite the countrys agricultural potential. There is a lack of precise data regarding the relationship between household food security and nutritional status of the mother-child pair in southwestern Nigeria. This study examined household food security and mother-child nutritional status in Irele and Okitipupa Local Government Areas (LGAs) of Ondo State. Methods and AnalysisA descriptive cross-sectional community-based survey was carried out with 358 mother-child pairs (children 6-59 months). The Household Food Insecurity Access Scale (HFIAS) was used to measure household food insecurity. Body Mass Index (BMI) was used to assess mothers and WHO Anthro Z-scores to assess childrens nutritional status. Descriptive statistics and Chi-square tests (p < 0.05) were used to examine the data. Results93.3% of households were food insecure. A striking double burden of malnutrition was observed: 58.4% of mothers were overweight or obese, and child malnutrition was widespread, with 39.3% stunting, 29.1% wasting and 42.1% underweight. Breastfeeding duration (p = 0.008) and introduction of complementary feeding (p = 0.032) were significant predictors of child wasting. Interestingly, maternal education and income were not significant predictors of child undernutrition (p > 0.05), suggesting that environmental and behavioral influences take precedence over individual socioeconomic status in these communities ConclusionThe simultaneous presence of severe child undernutrition and maternal overnutrition in rural Ondo State suggests a public health crisis in a state undergoing nutrition transition towards energy-dense, low-nutrient foods. These results suggest that national approaches are inadequate. We need interventions that focus on decentralized, LGA-level policies that integrate food security programs with education on Infant and Young Child Feeding (IYCF). What is already known on this topicHousehold food insecurity is a major driver of malnutrition among mothers and children under five in Nigerias rural communities. Evidence from southwestern Nigeria shows that over 88% of rural households are food insecure, with women and young children disproportionately affected. However, localized data from specific LGAs in Ondo State--particularly examining the mother-child dyad--remains scarce. What this study addsThis study provides the first localized evidence from Irele and Okitipupa LGAs, Ondo State, documenting a 93.3% household food insecurity rate and a dual burden of malnutrition (39.3% child stunting and 58.4% maternal overweight/obesity coexisting in the same communities). It demonstrates that IYCF practices--specifically breastfeeding duration and timing of complementary food introduction--are significant determinants of child wasting, and highlights the limitations of maternal socioeconomic variables alone as predictors of child nutritional outcomes. How this study might affect research, practice or policyFor research, this study establishes a dyadic methodological framework applicable to other Nigerian states. For practice, it underscores that nutrition education on IYCF practices must accompany food security programs. For policy, the findings call for decentralized, LGA-specific strategies addressing both rural food insecurity and the emerging nutrition transition--moving beyond one-size-fits-all national approaches to combat simultaneous undernutrition and overnutrition within the same households.

BackgroundAccurate dietary assessment is essential for precision nutrition and effective nutrition surveillance. However, portion size estimation remains a persistent challenge, particularly in culturally diverse regions such as Central Asia. Traditional self-reporting tools often yield inconsistent results due to communal eating practices and unfamiliarity with standard measures. ObjectiveTo address these limitations, this study aimed to compare three methods: unassisted human judgment, visual food atlas assistance, and an artificial intelligence (AI) model, using Central Asian food items. MethodsIn this cross-sectional study, 128 participants from Astana, Kazakhstan, visually estimated portion sizes of 51 foods and 8 beverages from standardized photographs. Participants were randomized into two groups: one using unassisted visual estimation and the other aided by a regionally tailored digital food atlas. Additionally, an AI model trained on Central Asian food images was evaluated. Actual food weights served as the reference standard. Accuracy was assessed using Mean Absolute Error (MAE) and Mean Absolute Percentage Error (MAPE) across food types and portion sizes. ResultsThe atlas-assisted group demonstrated the highest accuracy, with the lowest MAE (80.81g) and MAPE (44.76%) across all portions. The AI model showed promising results for average portions (MAE: 79.07g, MAPE: 67.91%) but underperformed on small portions, particularly for meat-based items. Unassisted estimates were the least accurate (MAE: 133.86g, MAPE: 79.40%). Across food categories, visual aids consistently improved accuracy, while AI demonstrated variability by texture and portion size. ConclusionsCulturally adapted visual atlases significantly enhance portion size estimation accuracy in non-Western, communal-eating contexts. While AI models hold promise for dietary assessments, particularly with standard portions and beverages, further refinement is needed for complex food items and small portion types. These findings support the integration of visual and AI-based tools into region-specific dietary monitoring strategies.

Child undernutrition remains a major public health challenge in Kenya. Suboptimal feeding practices contribute significantly to persistent underweight and stunting. This study evaluated the effect of a community-based Positive Deviance Hearth (PDH) intervention on feeding practices among children aged 6-59 months in Sub County within a County of study. The study adopted a two-group pretest-posttest randomized experimental study design conducted for six months period, among 84 caregiver-child pairs in intervention and control groups. A multi-stage sampling was employed to identify study settings and participants. Structured and pretested questionnaires, 24-hour food recall questionnaires and meal diversity questionnaires were used for data collection at pre-intervention and post-intervention periods. Data was analyzed using R software v.4.5.2. The differences between intervention and control groups at baseline and endline were assessed using difference-in-difference analysis, relevantly summarized using adjusted DID estimates, 95% confidence intervals and p-values, with p<0.05 considered significant. The PDH intervention significantly improved feeding practices among children 6-59 months. Meal frequency increased for 9-23 months (DiD = +1.4; 95% CI: 1.2-1.7; p = 0.034) and [&ge;]24 months (DiD = +1.2; 95% CI: 1.1-1.5; p = 0.017), and dietary diversity rose (DiD = +1.3; 95% CI: 1.1-1.9; p < 0.001). Nutrient-dense food consumption improved, including legumes (DiD = +32.6%; p < 0.001) and animal-source foods (DiD = +35.4%; p < 0.001). Energy and protein intake increased across all age groups (p < 0.05), and micronutrients--iron, vitamin A, vitamin C--also rose significantly (p < 0.05). The PDH intervention substantially improved caregiver feeding practices, increased dietary diversity, and enhanced macro- and micronutrient intake, demonstrating its effectiveness as a scalable, community-driven strategy for sustainably improving child nutrition in high-burden settings.

Introduction High consumption of ultra-processed foods (UPF) is associated with adverse health outcomes and weight gain. Despite increasing calls for behavioural strategies to reduce UPF intake, no theory-informed intervention targeting UPF reduction has been evaluated in UK adults in alignment with national dietary guidance. We assessed the feasibility, acceptability, and preliminary behavioural and clinical outcomes of a multi-component intervention designed to reduce UPF consumption (and increase physical activity (PA)/minimally processed food (MPF) intake). Methods In this exploratory single-arm pre-post study, adults (N=45) living with overweight or obesity and habitual UPF intake [&ge;]50% of total energy were offered a 6-month behavioural intervention following a controlled feeding phase (UPDATE trial, stage 1). The intervention was developed using the Behaviour Change Wheel and Capability, Opportunity, Motivation-Behaviour (COM-B) model and included one-to-one sessions with a behavioural scientist, tailored print and digital materials, peer-support meetings, and a moderated group chat. Feasibility outcomes included uptake, retention, and intervention fidelity. Secondary outcomes included COM-B constructs, dietary intake, PA, clinical and self-reported outcomes, and qualitative feedback. Results Uptake was 91% (41/45). Retention at 6 months was 68% (28/41), with 83% (34/41) providing follow-up data (intention-to-treat). Median attendance at one-to-one sessions was 86% (interquartile range (IQR): 57-100) with 56% (23/41) attending all sessions (per-protocol). Fidelity to core behaviour change techniques was high. At 6 months, COM-B scores improved for healthy eating (+7%, standard deviation (SD): 8; p<0.001) and physical activity (+5%, SD: 9; p=0.013). UPF intake decreased by 25% of total energy (95% confidence interval (95%CI): -32, -17), with a corresponding increase in minimally processed foods (+23%; 95%CI: 17, 29). Vigorous physical activity increased (+60 min/week, IQR: 0-180), weekday sitting time decreased (-61 min/day, SD: 110), and weight reduced by 3.8 kg (IQR: -8.5-1.0; p=0.001). Findings were similar in per-protocol analyses. Qualitative data indicated perceived improvements in wellbeing and habit formation. Conclusion This theory-informed intervention demonstrated good feasibility and acceptability and was associated with improvements in targeted behavioural mechanisms and health-related outcomes. A randomised controlled pilot trial is warranted to evaluate effectiveness and refine implementation.

Although the co-occurrence of diarrhea and malnutrition is well documented, research has largely focused on the acute management of diarrheal illness. Despite its importance, longitudinal evidence characterizing post-diarrheal recovery trajectories is sparse. We sought to characterize post-diarrheal nutritional recovery trajectories among children aged 6-35 months who were malnourished at enrollment using data from the Enterics for Global Health (EFGH) Shigella Surveillance study (2022-2024). EFGH enrolled children aged 6-35 months presenting with medically-attended diarrhea and followed them at 4 weeks and 3 months post-enrollment. This analysis included children with baseline wasting, stunting, or underweight (z-score < -2) and complete anthropometric follow-up. Latent class mixed-effects models were used to identify distinct post-diarrheal growth trajectories based on changes in anthropometric z-scores over time. Multinomial modified Poisson regression models examined associations between baseline factors and trajectory membership. Among 9,480 enrolled children, 16.5% (n=1,561) were wasted, 22.7% (n=2,155) stunted, and 21.0% (n=1,994) underweight at baseline. Wasting showed greater recovery potential (80.8%) compared with stunting (38.5%) and underweight (40.3%). Recovery was shaped by factors across multiple levels. Clinical severity markers ( prolonged diarrhea, dehydration, and hypoxemia) increased the risk of nutritional failure. Age also influenced outcomes: infants were more likely to worsen, whereas older toddlers more often experienced stagnation. Interventions including exclusive breastfeeding, oral rehydration therapy, appropriate antibiotics, and zinc supplementation, improved outcomes, while unimproved sanitation undermined recovery. These findings highlight the need for integrated strategies combining infection control, nutritional rehabilitation, and water, sanitation, and hygiene interventions tailored to the childrens developmental stage. Key MessagesO_LIPost-diarrheal nutritional recovery is highly heterogeneous, with wasting showing the greatest potential for improvement, while stunting and underweight often result in persistent growth stagnation. C_LIO_LIBaseline anthropometric deficits alone are insufficient to predict recovery, highlighting the need for dynamic monitoring and individualized management. C_LIO_LIInfants are particularly vulnerable to acute nutritional deterioration, while older toddlers frequently experience growth stagnation. C_LIO_LIModifiable protective factors including exclusive breastfeeding, ORS, zinc, and appropriate antibiotics, improved outcomes, whereas poor sanitation undermined recovery. C_LIO_LIIntegrated strategies, tailored to a childs developmental stage, combining clinical care, nutrition, and environmental interventions are critical to support sustained child growth and development. C_LI

Abstract Background Between 2021 and 2022, primary care obesity management was entering the early diffusion phase of newer anti obesity pharmacotherapy, as GLP1 based treatments began reshaping expectations. However, it was unclear whether primary care clinicians and practice environments were prepared to deliver comprehensive obesity care. (1,2) Methods In 2021 to 2022, we surveyed 276 clinicians from three cohorts: an opt-in national physician panel (Cohort A), clinicians from an integrated health system (Cohort B), and clinicians from a rural accountable care organization (Cohort C). The survey, informed by formative patient and physician focus groups conducted in 2021, assessed current and desired competence, attitudes, confidence, perceived forces for change, and barriers to obesity care. Analyses were descriptive (means and standard deviations). Results Across cohorts, desired competence exceeded current competence. The largest gaps involved recommending behavioral interventions, developing comprehensive care plans, and providing ongoing obesity management support. Attitudes toward obesity care were generally favorable, while confidence that current practices reflected best practice was only moderate. Professional and personal forces for change were moderate, patient driven motivators were moderate to high, whereas social (peer/organizational) reinforcement was weak. Reported barriers extended beyond knowledge deficits to include patient engagement, competing demands, cost, and practical constraints. Conclusions At the threshold of the GLP1 era, primary care clinicians were motivated to improve obesity care but lacked consistent support to deliver comprehensive management. The relative absence of peer and organizational reinforcement suggests that readiness for change reflected not only individual knowledge and attitudes, but also the degree of peer and organizational reinforcement that supports comprehensive obesity care in routine practice.

Understanding how nutritional interventions alter food evaluations may help clarify mechanisms of dietary behavior change; however, most studies focus on intake outcomes and rarely assess within-person changes in subjective food evaluation. We developed a brief, image-based rating tool that measures two core dimensions of food evaluation, liking and perceived healthiness, using standardized food images. The tool was piloted in adults with type 2 diabetes participating in a medically supervised intervention that included structured glucose monitoring and professional dietary guidance. Ratings were collected at baseline, post-monitoring, and follow-up. In line with the methodological aim of this study, we examined whether the tool demonstrates internal coherence, sensitivity to change, and external validity against expert ratings and physiological measures, and whether it can capture item-level patterns relevant to eating behavior. Results provide preliminary evidence that the tool is feasible, it is low-burden, and capable of detecting coherent relationships between food liking and health perceptions, including coordinated within-person changes over time and meaningful associations with external benchmarks. To support scalability and self-administration, we also developed an online smartphone-based demonstration version to exemplify the task structure and user experience. Overall, this pilot study suggests that a short, flexible rating task can serve as a practical measurement tool for tracking intervention-relevant changes in food evaluation and for informing the design of future nutritional interventions.

Background: Severe acute malnutrition (SAM) remains a major public health problem among under-five children, particularly in low-income countries. Comorbidity, especially pneumonia and diarrhea, significantly increases the risk of morbidity and mortality among affected children. Methods: An institutional-based cross-sectional study was conducted from April 20 to May 20, 2024, among children aged 6-59 months admitted with SAM to public hospitals in North Shoa Zone, Ethiopia. A total of 394 participants were included using systematic random sampling. Data were collected through caregiver interviews and medical record reviews using a structured, pre-tested questionnaire. Data were entered into Epi Info version 7 and analyzed using Stata version 16.1. Logistic regression analyses were performed to identify factors associated with comorbidity. Statistical significance was declared at p-value < 0.05. Results: The prevalence of comorbidity (pneumonia and diarrhea) among severely acutely malnourished children was 15.48% (95% CI: 11.89-19.06). Children with low dietary diversity (<5 food groups) were twice as likely to develop comorbidity (AOR = 2.00, 95% CI: 1.09-3.98). Children of single mothers had higher odds of comorbidity (AOR = 3.00, 95% CI: 1.21-7.65). Additionally, very low perceived birth weight was strongly associated with comorbidity (AOR = 7.11, 95% CI: 1.43-35.48). Conclusions: A substantial proportion of children with SAM had comorbid pneumonia and diarrhea. Key predictors included poor dietary diversity, maternal marital status, and low birth weight. Strengthening integrated child health and nutrition interventions is essential to reduce comorbidity and improve outcomes among vulnerable children.

This study examines the effects of rural out-migration and remittance inflows on food consumption outcomes among rural households in the Tigray region of Ethiopia. Utilizing household survey data collected from 521 rural households across three distinct Weredas (districts) (Tahtay Maichew, Kola Tembien, and Kilte-awlaelo). A Binary Probit model was employed to identify factors influencing migration decisions, while an Endogenous Switching Regression (ESR) model was used to estimate the impact of migration on food consumption outcomes while controlling for selection bias and unobserved heterogeneity. Food security was measured using the Food Consumption Score (FCS) and dietary diversity indicators. The empirical results reveal that severe food insecurity is widespread, with over 60% of all surveyed households falling into the "Poor" food consumption category. Descriptive baseline comparisons show that migration and remittance transfers marginally shift the raw average FCS upward from 23.86 to 25.48. However, this impact is profoundly nuanced: remittances serve as an immediate consumption-smoothing safety net but run parallel to a "labor-lost" constraint that reduces own-production capacities, forcing households to rely increasingly on market purchases for staple foods. The findings reveal that migration creates short-term labor shortages in agricultural production; however, remittance inflows substantially improve household food consumption frequencies, particularly for pulses, vegetables, and other nutrient-rich foods. After accounting for self-selection bias and unobserved traits, the rigorous ESR estimates indicate that migration increases the Food Consumption Score of participating households by an average Treatment Effect on the Treated (ATT) of 10.75 points, shifting them into more secure dietary tiers. Moreover, remittances help households mitigate the adverse effects of drought and other shocks by relaxing liquidity constraints and supporting both food purchases and agricultural investments. The study recommends establishing target food security safety nets for non-remittance households, promoting scale-appropriate labor-saving agricultural technologies, expanding traditional communal labor-sharing innovations, and boosting irrigation and agricultural input support programs to enhance rural food security and livelihood resilience.

OBJECTIVETo evaluate the return on investment (ROI) of a community-based Diabetes Self-Management Program (DSMP) enhanced with health-related social needs (HRSN) screening and referrals, implemented by the New York City (NYC) Department of Health and Mental Hygiene with three community-based organizations in highly-impacted, under-resourced neighborhoods. RESEARCH DESIGN AND METHODSA retrospective cost-benefit analysis from a public-sector payer perspective was conducted among 171 adults with type 2 diabetes who completed a six-week, peer-led DSMP delivered by community health workers (CHWs) in English, Spanish, and Korean during 2018-2019. A time-driven, activity-based costing model captured direct implementation costs, CHW workforce turnover, and administrative overhead. Monetized benefits included avoided diabetes-related complications, reductions in self-reported emergency department (ED) visits and hospitalizations, and quality-adjusted life year (QALY) gains from improved medication adherence. Univariate sensitivity analyses tested robustness under conservative assumptions. RESULTSTotal program costs were $179,224; monetized benefits totaled $1,824,213, yielding a net benefit of $1,644,989 and an ROI of 918%--approximately $10 returned per $1 invested. Excluding QALY gains, ROI remained 551%. Self-reported ED visits declined from 149 to 82 and hospitalizations from 93 to 24 in the six months following intervention. Over 80% of participants reported housing instability; 72% were Medicaid-covered and 16% uninsured. Sensitivity analyses confirmed a positive ROI under all conservative scenarios. CONCLUSIONSA CHW-led, community-based DSMP integrated with HRSN screening and referrals delivered substantial economic and public health value among adults facing housing instability and structural barriers to care. Findings support inclusion of DSMP as a covered benefit in Medicaid managed care, value-based payment arrangements, and housing access initiatives to advance equitable diabetes outcomes.