Public Health Nutrition

Objectives: To characterize prevalence and secular trends in stunting, thinness, overweight, obesity, and the double burden of malnutrition (DBM) in urban Vietnamese children. Methods: We analyzed 249,745 annual health check visits from 97,111 children aged 18 months to 18 years attending a private school system in Hanoi, Ho Chi Minh City, and Haiphong from 2018 to 2025. Temporal trends in stunting, thinness, and obesity were modelled using generalized estimating equation (GEE) logistic regression. Results: A total of 51,034 males and 46,077 females were included. Stunting prevalence was low but rose significantly in both sexes (males: 0.7% to 1.3%, p=0.006, females: 0.7% to 1.7%, p<0.001), concentrated in children under 10 years (GEE OR/year=1.076 and 1.089, both p<0.05), females exceeded males by 2025. Obesity declined overall in males (21.4% to 17.0%) and females (6.2% to 5.0%, both p<0.001), but rose significantly among males aged 15-18 years (OR=1.055, p=0.021). Overweight increased in males (19.7% to 20.5%, p=0.010) but declined in females (18.0% to 14.8%, p<0.001). Individual-level DBM (concurrent stunting with overweight/obesity) was uncommon (<0.2%). City-level heterogeneity was marked, with Haiphong showing the highest male obesity (22.7% in 2025) and individual-level DBM. Conclusion: Vietnamese urban schoolchildren experienced simultaneous, divergent nutritional burdens from 2018-2025: rising stunting and thinness under age 10, declining early childhood obesity, and rising adolescent male obesity. Individual-level DBM was rare, but a population-level double burden was evident across age groups. City, age, and sex specific nutrition and school health policies are needed to address this complex malnutrition transition.

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

Low dietary diversity is a risk factor for micronutrient deficiencies. Agricultural interventions that support crop production and livestock rearing may promote dietary diversity and achieve better nutritional outcomes, particularly among low-income households. Their effectiveness may be strengthened when integrated within microfinance platforms. The objective of this study was to estimate the association between an agricultural intervention delivered within a group-based microfinance program and dietary diversity in rural Western Kenya, and determined effect modification by sex. We conducted a cross-sectional design from June to August 2025 in two village wards of Webuye sub-County in rural Western Kenya, using a validated dietary diversity scale to assess the total number of food groups consumed in the previous 24 hours. We interviewed 312 microfinance participants, 156 of whom were in agricultural intervention comprised of farm input subsidies and training, while 156 were not in the intervention. We specified modified Poisson models to estimate the association between intervention receipt and dietary diversity, and tested whether the estimated association differed by sex. Participation in the agricultural intervention was associated with higher diversity among microfinance program members [adjusted PR (95% CI): 1.46 (1.02, 2.06)]. We did not find evidence that the association differed by sex (Wald p-value for interaction term=0.83). Participation in an agricultural intervention was associated with improved dietary diversity. Future prospective using large samples studies should build on these findings to establish temporal ordering, and assess the feasibility and sustainability of integrating agricultural support into microfinance platforms to improve dietary diversity in low-resource settings.

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

Background and aims: Maternal overweight and obesity are increasing worldwide, including Nepal. This study assessed BMI trajectories from early pregnancy to one year postpartum and trends in overweight and obesity over the past two decades in Bhaktapur, Nepal. Methods: In the most recent study, BMI was measured in 800 Nepalese women at three time points: at early pregnancy, 6 and 12 months postpartum (2017-2021). The prevalence of undernutrition, overweight, and obesity was estimated using the World Health Organization and the Asian specific cut-offs. Long-term trends were assessed by comparing these findings with three population-based studies conducted in Bhaktapur between 2001 and 2021 among 2400 women at similar life stages. Results: Mean (SD) BMI increased from 23.7 (3.0) kg/m^2 in early pregnancy to 26.1 (3.3) kg/meter squre at 6 and 25.2 (3.3) kg/m^2 and 12 months. The prevalence of overweight increased from 32.9% in early pregnancy to 48% at 6 months. Using the Asia-specific cut-offs, the prevalences were higher. Results from the three previous population-based studies demonstrated an upward trend where postpartum overweight increased from 11.4% in 2001- 2002 to 44.6% in 2017- 2021. The obesity prevalence rose from 1.8% to 10.9% during this period. Conclusion: Overweight and obesity among Nepalese women have risen dramatically over the past two decades, with postpartum overweight increasing nearly fourfold and obesity more than sixfold. These findings highlight the need for interventions to prevent excessive weight retention and reduce adverse health outcomes.

Background Indias maternal nutrition profile is undergoing a dual-direction shift, with persistent undernutrition coexisting alongside rising overweight and micronutrient deficiencies. Despite national efforts through Integrated Child Development Services (ICDS) and the National Health Mission (NHM), maternal dietary diversity remains suboptimal in India. Frontline health workers (FLWs) play a central role in delivering nutrition counselling; however, gaps remain between knowledge and its translation into practice, highlighting the need to strengthen training, applied competencies, and health system support within primary care settings. Objective To assess knowledge, attitudes, and practices (KAP) regarding maternal nutrition counselling among FLWs and to explore contextual factors influencing counselling delivery. Methods A sequential explanatory mixed-methods study was conducted in Udupi, Karnataka, India. In phase one, 46 FLWs- Accredited Social Health Activists (ASHA), Community Health Officers (CHO), and Primary Health Care Officers (PHCO) completed a validated Knowledge, Attitudes, and Practices (KAP) questionnaire. Data were analysed using descriptive statistics, Kruskal-Wallis test, Spearman correlation, and exploratory multiple linear regression. In phase two, one focus group discussion with 21 participants was conducted and analysed using reflexive thematic analysis. Results FLWs demonstrated moderate KAP scores (37.50 {+/-} 5.09), with lower scores observed in dietary diversity knowledge and counselling practices. CHOs and PHCOs had significantly higher knowledge (p < 0.001) and practice scores (p = 0.002) compared to ASHAs, while attitudes were similar across cadres. Knowledge was positively associated with practice ({rho} = 0.389, p = 0.008). Exploratory regression indicated that cadre and knowledge were associated with practice, while attitude was not statistically significant. Qualitative findings suggested that counselling was largely protocol-based and constrained by workload, limited counselling tools, economic barriers, and cultural food practices. Conclusion Despite positive attitudes towards maternal nutrition counselling, frontline health workers demonstrated gaps in knowledge and counselling practices. Mixed-methods findings suggest that counselling delivery is shaped by both provider competencies and health-system constraints, highlighting the need for implementation-focused strategies to strengthen maternal nutrition counselling in routine antenatal care.

Background: Indonesia, as an upper-middle-income country, is undergoing a nutrition transition. The persistent problem of undernutrition is now accompanied by rising overnutrition, creating a double burden of malnutrition. The Human Development Index (HDI) that measures socio-economic development, has shown steady improvements in Indonesia, yet nutritional disparities remain across provinces with varying HDI levels. Objective: This study aims to map the relationship between HDI and nutritional status by analyzing the prevalence of stunting, wasting, underweight, and overweight across different HDI categories and provinces in Indonesia. Additionally, this study explores the determinants of malnutrition to provide a deeper understanding of the factors influencing child nutrition status. Methods: This ecological study utilizes data from 2023 Indonesian Nutrition Status Study, Central Bureau of Statistics and Indonesian Demographic and Health Survey and creates provincial level dataset with malnutrition prevalence, HDI, and other health indicators. The analysis employs spatial relationship, descriptive statistics, and correlation analysis to assess the determinants of malnutrition. This ecological study used 2023 provincial-level data from the Indonesian Health Survey (SKI) and the Human Development Index (HDI) published by the Central Bureau of Statistics. Nutritional indicators (stunting, underweight, wasting, and overweight) were analyzed in relation to HDI and other determinants. Spearmans correlation and Mann-Whitney U tests were used for statistical analysis. Spatial patterns were visualized through GIS mapping to explore geographic relationships between HDI levels and nutritional status. Results: Provinces with high to very high HDI had significantly lower prevalence of stunting (21.36% vs. 31.80%), underweight (16.60% vs. 21.89%), and wasting (9.49% vs. 13.00%) compared to those with low to medium HDI (p < 0.05). No significant difference was found for overweight. Significant negative correlations were observed between stunting, underweight, and wasting with several key determinants, including exclusive breastfeeding, proper infant and young child feeding practices, adequate vitamin A intake, proper handwashing and sanitation practices, parental education, immunization coverage, and HDI. However, no significant correlations were found between these determinants and overweight. Conclusion: This study highlights the complex relationship between HDI and nutritional status, emphasizing the need for region-specific interventions. While improving HDI can help to reduce undernutrition, rising overweight prevalence requires targeted public health strategies. These findings offer valuable insights for policymakers to design holistic, multi-dimensional approaches to combat malnutrition in Indonesia. Keywords: Human Development Index, Nutritional Status, Spatial Analysis, Malnutrition, Indonesia

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.

Child-targeted marketing on packaged foods can shape children's food preferences and parents' purchasing decisions, yet many products with child-targeted marketing are ultra-processed foods (UPFs) and contain cosmetic additives such as food colorings, which have raised concerns about adverse effects on children's health and behavior. This mixed-methods study examined the prevalence of food colorings in child-directed UPFs and explored parents' perceptions and knowledge of these additives in beverages commonly consumed by children. Quantitative data were obtained from the Mintel Global New Products Database to identify child-directed products launched in Brazil between 2018 and 2021, measured as having at least one child-targeted marketing strategy in the food package, and whether they contained food colorings. Qualitative data came from seven focus groups with parents of children aged 2-5 and 6-11 years in Brazil, alongside a brief survey assessing participants' ability to identify food colorings on product labels. Among 5,078 UPFs launched during the study period, 23.0% contained child-targeted marketing, and 40.3% of these had food colorings. The highest prevalence was observed in carbonated beverages, candies, and ice creams, in which more than half of products contained food colorings. Parents generally understood that food colorings are used to make products more attractive to children and associated them with potential health risks, but reported difficulties avoiding them. These findings highlight the widespread presence of food colorings in child-targeted UPFs in Brazil and underscore the need for stronger regulatory measures to restrict the use of food colorings and improve labelling on food packages.

Background For children at risk of acute malnutrition, being able to predict and forecast dietary intakes and/or nutritional evolution would support decision-making, particularly in crisis settings where ground data collection is unfeasible or scant. We explored whether statistical models could offer accurate predictions of caloric intake or anthropometric (weight-for-height Z score, WHZ) changes, given intake, household food insecurity and other plausible predictors. Methods We reanalysed data from the Malnutrition and Enteric Disease (MAL-ED) multi-country (Bangladesh, Brazil, India, Nepal, Pakistan, Peru, South Africa, Tanzania) birth cohort (2009-2014), which consistently tracked household food insecurity experience, dietary intake, anthropometry, infectious disease symptoms, breastfeeding and other variables among children 9 to 35 months old. We quantified the performance on cross-validation of three models: (M1) change in WHZ as a function of household food insecurity; (M2) change in WHZ as a function of caloric intake; (M3) caloric intake as a function of household food insecurity. We compared random forests, lasso regressions, additive models and generalised boosted regressions. All models included age, sex, birth weight, urban versus rural residence, breastfeeding status and the longitudinal prevalence of diarrhoea, acute respiratory infection and fever as additional predictors. Results Altogether, M1, M2 and M3 leveraged 2957, 23,651 and 2013 longitudinal child observations, respectively. Both at country and individual level, there was low correlation among the key variables of interest. All three models featured low performance and moderate to extreme regression dilution, even when fitted to each country cohort separately. Discussion This secondary analysis based on data from a rigorous observational study suggests that statistical prediction of key variables along the causal pathway to childhood acute malnutrition may not be feasible. These negative findings may in part be explained by error in predictor measurement and the narrow range of both predictor and outcome values in the MAL-ED cohort, relative to the more extreme scenarios common to crisis settings. They also imply that mechanistic models requiring caloric intake as an input cannot rely on a statistical shortcut of this kind and must instead depend on empirical data or scenario assumptions.

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: Diabetes is a major global public health challenge, associated with substantial medical, economic, and social burden worldwide. As clinicians working at the intersection of medicine and nutrition, we observed that despite advances in pharmacologic therapy, many individual, particularly those living in underserved urban communitie, continue to experience suboptimal diabetes control due to persistent barriers related to food insecurity, cultural food practices, and limited access to practical nutrition education. In response, we implemented a community-based pilot study in an underserved urban area that focused on dietitian-led nutrition education grounded in Food Is Medicine principles. Aims: The intervention emphasized culturally responsive, cost-conscious, and client-centred approaches designed to make healthy eating simple and intuitive, with the goal of complementing standard diabetic medical therapy. Methods: We used conventional diabetic marker responses, fasting blood sugar (FBS), HgbA1c (percentage of glycosylated hemoglobin, subsequently documented as A1c), and urinary albumin:creatinine ratio (UACR) in a dual cohort design study measuring whether groups receiving dietitian-led nutrition education in addition to conventional therapy would show improvements in diabetic markers relative to groups receiving conventional therapy alone. Summary: Our pilot study summed over both cohorts support the hypothesis that additional dietitian-led nutrition education synergizes with conventional pharmaceutical therapy to improve diabetic control as gauged by improved FBS, A1c and UACR, implying a significant role for this combined approach to community based diabetic health care.

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.

Background: Since 2025, US states have rapidly adopted waivers to restrict the purchase of "non-nutritious items" like soda and candy with Supplemental Nutrition Assistance Program (SNAP) benefits. States have proposed various approaches in terms of food categories restricted and implementation strategies, which may influence the downstream effects of waivers on program participation and participants diets and health. Objective: To examine and describe contextual information related to the adoption and implementation of state-level SNAP food restriction waivers. Design: A content analysis was conducted including publicly available state-level: (1) bills introduced related to SNAP food restriction waivers (2025 to early 2026), (2) waiver requests, and (3) waiver approvals (up to June 2026). Codebooks that captured key elements, such as food and beverage group restrictions and definitions, rationale for restrictions, implementation supports, and evaluation plans, were applied independently by two coders, and discrepancies were resolved through consensus. Participants/setting: United States Intervention: N/A Main outcome measures: N/A Statistical analyses performed: Descriptive statistics were used to summarize the presence of coded elements in documents. Results: Seventy-one bills, 22 waiver requests, and 23 waiver approvals were included. Bills mostly proposed restricting candy (65%) and soft drinks (59%). Of the approved waivers, all restrict the purchase of specific beverage groups with SNAP benefits and 65% restrict the purchase of specific food groups with SNAP benefits. There is a high level of variability in how the same food or beverage groups (e.g., soda) are defined across states. States varied in the implementation supports described in waiver requests, describing strategies like communications plans, nutrition education, and staff training. Conclusions: The current state of SNAP food restriction waivers is highly variable and shifting rapidly. Understanding characteristics of early-adopting states can inform future impact and implementation evaluations of waivers and efforts of additional states that may pursue SNAP food restriction waivers.

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.

Abstract Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is linked to obesity and cardiometabolic dysfunction, yet local prevalence data from Mexican first-level care units are scarce. We estimated the prevalence of MASLD by B-mode ultrasonography and characterized the clinical profile of obese adults in a family medicine unit in Leon, Mexico. Methods: Cross-sectional study of 55 adults with obesity (body mass index [BMI] >=30 kg/m2) registered at one medical office of a Mexican Social Security Institute family medicine unit (April-October 2024). Hepatic steatosis was graded by B-mode ultrasonography; MASLD was defined as ultrasonographic steatosis plus at least one cardiometabolic criterion (all participants met the obesity criterion). Prevalence was reported with Wilson 95% confidence intervals (CIs); associations with obesity grade were assessed by Cochran-Armitage trend and Fisher exact tests. Results: MASLD was present in 37 of 55 participants (67.3%; 95% CI, 54.1-78.2). Mild (grade 1) steatosis predominated (45.5%). Prevalence increased across obesity grades: 59.0%, 75.0%, and 100% for grades 1, 2, and 3, respectively (trend P=0.022). Type 2 diabetes and hypertension each affected 50.9% of participants; the sample was predominantly female (74.5%). Conclusion: Two of every three obese adults screened in primary care had ultrasonographic MASLD, with a significant rise across obesity grades. Opportunistic ultrasonography in obese primary-care patients may enable earlier MASLD detection. Keywords: Non-alcoholic Fatty Liver Disease; Fatty Liver; Obesity; Ultrasonography; Primary Health Care; Prevalence

Micronutrient deficiencies are prevalent in Madagascar, where diets rely heavily on starchy staples and access to animal-source foods is limited. Small dried fish (SDF) are widely available, yet their nutritional value and health risks remain poorly documented. We combined market surveys, taxonomic identification, and micronutrient and heavy metal analyses of nine SDF types collected along National Road 7. The samples encompassed 33 fish families, were dominated by small pelagic species (Clupeidae and Engraulidae), and were appreciated by consumers. A daily portion (5 g for infants; 10 g for young children and women of childbearing age) contributed substantially to Recommended Nutrient Intakes (RNIs). Across samples and groups, SDF were rich (>30% of RNI) in selenium and, for infants and young children, in calcium. All samples were a source of (>15% of RNI), or rich in, phosphorus, whereas iron contributions were more variable but often substantial. Several samples exceeded 100% of RNIs for selenium, calcium, iron, or manganese in infants and young children, and some were also sources of magnesium and, less frequently, zinc. Vitamin A was absent from sun-dried samples but detected in a smoked freshwater type. Heavy metal concentrations varied markedly, and portions of several types led to estimated exposures to inorganic arsenic or cadmium exceeding reference values, whereas freshwater species and some pelagic types showed a more favorable nutrition-risk balance. Overall, SDF are affordable, nutrient-dense foods with strong potential to alleviate micronutrient deficiencies in Madagascar, while highlighting the need for type-specific guidance to balance nutritional benefits and contamination risks.

Background: Evidence regarding the double burden of malnutrition (DBM) among hospitalized patients in Vietnam remains limited. This study examined nutritional status at admission and its association with length of hospital stay among adults in Hanoi. Methods: This prospective observational cohort study was conducted in eight public hospitals in Hanoi between September 2018 and November 2019. Adults aged 18-60 years were assessed within 48 hours of admission using interviews, physical examination, anthropometric measurements, and medical records. Nutritional status was classified using the Subjective Global Assessment (SGA) and body mass index (BMI): undernourished (SGA-B or SGA-C or BMI <18.5 kg/m2) and overnourished (SGA-A and BMI [&ge;]25.0 kg/m2). Length of stay was compared across nutritional-status groups using the Kruskal-Wallis test. Results: Among 1,183 registered patients, 1,115 had sufficient data for analysis. Overall, 24% were undernourished and 16% overnourished. Weight loss during the preceding six months was reported by 54%, although most losses were <5%. SGA-B or SGA-C was identified in 20%, whereas 11% had BMI <18.5 kg/m2. The median hospital stay was 8 days, with no significant difference across nutritional status groups. Conclusions DBM was prevalent among hospitalized adults in Hanoi. Indicators of recent nutritional deterioration were more common than low BMI, suggesting that BMI alone may overlook early disease-related nutritional decline. Nutritional status was not associated with length of stay in this relatively young, predominantly mild-to-moderate patient population. Hospital nutritional screening should therefore assess recent nutritional changes across the full BMI spectrum.

Introduction: Understanding of absolute and relative estimates (i.e., effect size), and certainty of evidence corresponding to those estimates, is a fundamental evidence-based practice competency to promote informed clinical decision-making. While research has been conducted in the medical profession, there is no published research on these competencies in the nutrition and dietetics profession. Methods: Among registered dietitians, our main objectives were to assess (1) their understanding and perceived usefulness of three absolute and two relative estimate approaches to assess effect size, (2) their perceived usefulness of certainty of evidence, and (3) factors influencing their understanding and perceived usefulness. We conducted a web-based, cross-sectional survey among dietitians recruited from the Academy of Nutrition and Dietetics (United States). Participants received effect estimates based on hypothetical dietary interventions vs. usual diet for reducing myocardial infarction risk. Results: Of the 11,050 dietitians who received the survey link, 210 participated (2.0% response rate), and only completers (n=114) were included in the analysis. Participants demonstrated a similar understanding of the relative (27.6%) and absolute (27.5%) estimates, with Risk Difference (30.7% correct responses) being the best understood approach and Number Needed to Treat (24.6%) being the least. The understanding of five approaches was not different than random guessing (p>0.05). While perceived usefulness scores were similar between five approaches, they were highest when data was presented as Relative Risk [mean (SD): 4.82 (1.50)]. Dietitians rated the usefulness of certainty of evidence favorably [mean (SD): 5.07 (1.83), on a 7-point scale), and no factors were associated with correct understanding. Conclusion: Dietitians may have limited understanding of how to interpret effect sizes, a finding consistent with surveys of other health professionals. To optimize informed decision-making between dietitians and clients, dietetic programs and continuing education platforms should consider additional training on interpreting effect sizes and certainty of evidence for effect sizes.

Background: The growing burden of lifestyle-related chronic diseases has increased the need for clinically interpretable decision-support tools capable of integrating artificial intelligence with evidence-based preventive nutrition. Although machine learning has shown considerable potential for health risk prediction, most existing approaches remain limited to isolated predictive models or conventional nutritional software, with little integration of multidimensional clinical assessment and personalized recommendations. Objective: To develop and internally validate NutrIA, a hybrid web-based Clinical Decision Support System (CDSS) that combines machine learning, validated clinical assessment, structured clinical reasoning and personalized nutritional recommendations for preventive medicine. Methods: NutrIA was developed using harmonized data from the National Health and Nutrition Examination Survey (NHANES, 1988 to 2018). A supervised machine learning model was trained to estimate 5-, 10- and 20-year all-cause mortality risk and subsequently integrated with an adaptive clinical questionnaire, validated screening instruments, nutritional indicators, dietary clustering, clinical phenotyping and a transparent rule-based recommendation engine within a unified web-based platform. Results: The predictive model achieved ROC-AUC values of 0.894, 0.914 and 0.923 for 5-, 10- and 20-year mortality prediction, respectively. The implemented CDSS incorporates an adaptive questionnaire (151 items), 39 validated clinical assessment instruments, 17 clinical phenotypes and 31 dietary clustering modules to generate individualized nutritional and lifestyle recommendations together with an automated clinical report. The integrated framework translates probabilistic risk estimates into clinically interpretable decision support for personalized preventive nutrition. Conclusions: NutrIA demonstrates the technical feasibility of integrating machine learning with knowledge-based clinical reasoning within a single web-based CDSS for preventive nutrition. Although external validation and prospective clinical evaluation are required before routine implementation, the proposed architecture represents a promising step toward clinically interpretable artificial intelligence for personalized nutritional care.