The American Journal of Clinical Nutrition

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.

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.

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.

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

Introduction Adults globally are experiencing increases in diseases attributable to overnutrition, yet child undernutrition persists at high levels. This "double burden of malnutrition" increases the risk of nutrition-related non-communicable diseases in mother and child. Evidence-based interventions promote optimal maternal weight or child growth, but gaps remain in implementing them as integrated, sustainable, and equity-focused solutions. Methods and analysis K'ASLEM is an individually randomized, parallel-group Hybrid Type 1 effectiveness-implementation trial in Indigenous Maya communities in Guatemala with high levels of the double burden of malnutrition. We will enroll 766 pregnant women aged [≥]16 years at less than 28 weeks' gestation, allocated 1:1 to intervention or comparator. The intervention integrates (a) food supplementation for pregnant and postpartum mothers and their infants and (b) behavioral counseling to optimize maternal weight and promote healthy nutrition, physical activity, and infant feeding practices. The comparator is enhanced usual care. Mother-child dyads will be followed until 12 months after birth. Co-primary outcomes are maternal weight and child length-for-age z-score at 12 months. Secondary outcomes are child stunting, child development, maternal overweight or obesity, and maternal hemoglobin. We will collect quantitative and qualitative implementation data, use Implementation Mapping to identify factors shaping implementation, and conduct an economic evaluation of costs and cost-effectiveness. Ethics and dissemination Ethics approval was obtained from the Institutional Review Boards of Mass General Brigham and Maya Health Alliance and the Institute of Nutrition of Central America and Panama Research Ethics Committee. Results will be published in peer-reviewed, open-access journals.

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 Few dietary screeners are available for use with Hispanic/Latino adults in clinical or research settings, despite this group having a disproportionate burden of diet-related chronic disease risk amenable to nutrition intervention and counseling. We previously developed the 36-item Penn Healthy Diet (PHD) screener, which correlates with the Healthy Eating Index (HEI), and adapted it culturally and linguistically for use among Hispanic/Latino adults as the Screener of Alimentary Behaviors and Eating (SABE). Objective We aimed to develop a scoring algorithm for the SABE screener using data from Hispanic/Latino adults in the National Health and Nutrition Examination Survey (NHANES). Methods We used NHANES 2017-2018 dietary recall data from 1,126 Hispanic/Latino adults to simulate responses to SABE screener items. Using Spearman rank correlations, we examined the association between simulated SABE items and HEI-2020 components and validation using the Alternative Healthy Eating Index (AHEI)-2010. Items achieving {rho} [≥] 0.3 with any HEI-2020 component were retained in a simple scoring algorithm. A regression-weighted algorithm was then derived using ordinary least squares regression of all screener items on HEI-2020 total score. Reproducibility was evaluated in an independent validation sample of 1,633 Hispanic/Latino adults from NHANES cycle 2015-2016. Results Twelve of 24 screener items were moderately or strongly associated with HEI-2020 components, forming a simple scoring algorithm with a range of 0-60 points. The simulated SABE score was strongly correlated with HEI-2020 ({rho} [≥] = 0.73-0.74) and moderately correlated with AHEI-2010 ({rho} [≥] = 0.64-0.67). The regression-weighted algorithm improved HEI-2020 correlations ({rho} [≥] = 0.80) but not for AHEI-2010 ({rho} [≥] = 0.62-0.65). Conclusions The SABE screener is a brief and feasible dietary screener with demonstrated strong validity and reproducibility for assessing diet quality in Hispanic/Latino adults. Further validation of this screener is needed in Hispanic/Latinos subgroups of diverse heritage and acculturation level, and in real-world populations.

The Dietary Approaches to Stop Hypertension (DASH) diet reduces blood pressure and cholesterol. However, the mechanisms underlying these effects are unclear, and no randomized studies have evaluated the long-term benefits on health outcomes such as coronary artery disease (CAD) or type 2 diabetes (T2D). We performed a series of Mendelian randomization analyses of 71 serum proteins perturbed by the DASH diet in previous randomized controlled feeding studies to understand their potential mechanistic role on health outcomes. Four proteins (ANGPTL3, INHBC, PCOLCE, PLXNB2) had causal evidence of beneficial effects on risk factors that aligned with diet-induced changes in protein levels. Missense variants in INHBC and PLXNB were associated with lower risks of CAD and T2D respectively, and these effects are directionally concordant with DASH diet-induced changes in protein levels, providing causal evidence that these proteins influence disease risk. Combining molecular phenotyping in randomized interventional studies with human genetics evidence identified molecular regulators of the long-term cardioprotective effects of the DASH diet.

Background: Iron deficiency (ID) and iron deficiency anaemia (IDA) have global and severe health implications, and disproportionately impact women of reproductive age. Current methods of supplementing diets with iron are challenged by poor adherence and palatability, reducing effectiveness of these treatment strategies. The aim of this study is to evaluate the efficacy of a novel home beverage fortification with a mineral-enriched powder, designed to enhance bioavailability and ease of use, for the treatment of ID in women of reproductive age. Methods: This single-centre, randomised, double-blinded placebo-controlled trial will enrol 150 eligible biologically female participants with ID. Participants will be randomly assigned to the active intervention (iron/zinc-enriched powder) or control group (placebo powder) over 6 months. Primary outcomes will include change in serum ferritin (SF) concentrations and proportion of participants who remain iron deficient at 6-months. Secondary outcomes will include change in SF and haemoglobin (Hb) concentrations across timepoints, and levels of metabolites and key circulating pro-inflammatory biomarkers, changes in dietary intakes, self-reported perceptions of health, barriers to use of the powder, adherence and palatability, safety outcomes, and cost-effectiveness. Exploratory outcomes will assess the gut microbial metagenome and metabolome. Discussion: Fortification, an effective approach for the prevention of ID/IDA, has advantages over some methods of supplementation because it uses low levels of iron, minimising unpleasant side effects, does not risk toxicity, and has high acceptability and compliance rates. This mineral-enriched powder uses electrolytic iron and zinc sulphate monohydrate of a small particle size, which is less irritating to the gut, and facilitates bioavailability. Findings from the study will be shared with those affected by and involved in treating these conditions, as a novel intervention that is both effective and acceptable among women of reproductive age would help to improve treatment compliance, and ultimately, reduce ID/IDA burden. Trial registration: This trial is registered at clinicaltrials.gov (NCT05990166): https://clinicaltrials.gov/study/NCT05990166, August 2023.

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

Background: 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.

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

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

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.

Background Lean mass is positively associated with bone mineral density (BMD), and this relationship may vary according to age and sex. Sedentary behavior has also been associated with BMD, although findings differ across populations and skeletal sites. However, it remains unclear whether sedentary time modifies the relationship between regional lean mass and BMD and whether such modification varies across sex and age. These relationships were explored using nationally representative U.S. data. Methods Adults aged 18-59 years from the 2017-2018 National Health and Nutrition Examination Survey (NHANES) were analyzed. Mean bilateral leg lean mass and mean bilateral leg BMD were derived from dual-energy X-ray absorptiometry measurements, and sedentary time was obtained from self-report. Survey-weighted regression models incorporated NHANES examination weights, strata, and primary sampling units. The primary model examined the four-way interaction among leg lean mass, sedentary time, sex, and continuous age, with adjustment for race/ethnicity and height. Quadratic lean-mass terms were examined in sensitivity analyses. Results The primary complete-case analysis included 2,543 adults (1,191 men and 1,352 women). Women showed a more apparent decline in both leg lean mass and leg BMD at ages 50-59 years, whereas sedentary time did not increase in parallel with these age-related changes. Leg lean mass was positively associated with leg BMD in both sexes, with modest nonlinearity, particularly among women. In the primary survey-weighted model, the four-way interaction among leg lean mass, sedentary time, sex, and age was positive (beta = 0.000111 per year, 95% CI 0.000039-0.000183; P = 0.0051), indicating increasing sex divergence in sedentary-time modification of the lean mass-BMD association with age. At younger ages, conditional interaction estimates were similar between sexes; at older ages, estimates became increasingly positive in women while remaining negative but imprecise in men. Quadratic sensitivity analyses attenuated the four-way interaction estimate by approximately 9-12% and reduced its statistical precision, while broadly preserving its direction and magnitude. Conclusions In this exploratory cross-sectional analysis, sedentary-time modification of the association between DXA-derived leg lean mass and leg BMD varied according to sex and age. The sex difference was small at younger ages and became progressively more apparent with increasing age. These findings suggest that behavioral and demographic context may contribute to variation in the muscle-bone relationship itself, although confirmation in independent and longitudinal datasets is needed.

The Global Leadership Initiative on Malnutrition (GLIM) consensus standardized malnutrition diagnosis, but incorporating low Body Mass Index (BMI) as a phenotypic criterion introduces a circularity bias in weight-stratified analyses and conceals "hidden hunger" in high obesity populations. Using nationally representative data from the U.S. NHANES 1999 2020 (N = 23,363 adults), we propose a "GLIM-adapted" framework that excludes BMI relying solely on weight loss and DXA-derived appendicular lean mass index (ALMI). Standard GLIM identified an 18.9% malnutrition prevalence, but low BMI was the sole indispensable phenotypic driver for only 233 individuals (5.2%). The GLIM-adapted framework maintained a highly comparable prevalence of 17.9% (n = 4,038). Thus, low BMI exhibits low diagnostic sensitivity in modern U.S. cohorts. Excluding BMI successfully bypasses circularity, unmasks qualitative muscle wasting under excess body weight, and establishes a robust, weight-independent standard for clinical and epidemiological research.

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.

Phosphatidylserine (PS) is a functional phospholipid widely studied for cognitive support, yet evidence in healthy adults with subjective cognitive decline remains limited. This 12-week randomized, double-blind, placebo-controlled trial evaluated the safety and cognitive effects of 300 mg/day of soybean-derived PS in 70 adults aged 35-65 years reporting subjective memory complaints. PS was well tolerated, with no adverse events or clinically significant changes in safety parameters. In the prespecified primary analysis, the primary endpoint of composite memory score did not differ significantly between groups at week 12. Exploratory secondary analyses suggested possible domain-specific effects, including favorable changes in working memory (p = 0.037) and motor speed (p = 0.005), with the latter appearing to vary according to blood fatty-acid profiles. These findings should be interpreted cautiously and require confirmation in future studies designed to evaluate these domains and potential nutritional moderators.

Gut dysbiosis poses a significant public health concern, and malnutrition plays a central role in its development. In our recent clinical trial, we explored the effects of regulated walnut intake on the levels of 11 fecal metabolites to determine whether (I) walnut consumption promotes changes in metabolite profiles consistent with reduced gut dysbiosis, and (II) whether these changes are associated with the levels of urolithin A, a bioactive metabolite produced by colonic microbes following walnut consumption. DNA was extracted from fecal samples using a DNeasy 96 PowerSoil Pro QIAcube HT for 16S rRNA sequencing, and fecal short-chain fatty acids (SCFAs) and p-cresol were extracted fecal specimens by liquid chromatography/mass spectrometry (LC/MS-MS). At baseline, obese individuals (BMI > 30) had lower alpha diversity, higher p-cresol and valeric acid levels, and a higher trending Firmicutes to Bacteroidetes (F/B) ratio compared to non-obese (BMI < 30) participants, indicating a level of inherent gut dysbiosis. Walnut intake was associated with an overall 2.8% increase in alpha diversity, a 17.6% reduction in estimated marginal mean F/B ratio, and an overall reduction in three luminal proteolytic metabolites associated with gut dysbiosis: isobutyric acid, valeric acid, and isovaleric acid. Interestingly, the effects on the gut metabolome were more pronounced in obese individuals, with significant decreases observed in the same three SCFAs, as well as p-cresol. Given the known associations between these luminal proteolytic metabolites and gut dysbiosis, these results suggest that walnut intake may help to attenuate overall gut dysbiosis, particularly in obese populations.

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.