The Journal of Nutrition

Background Maternal iron requirements increase substantially during pregnancy, and ferritin concentrations typically decline as gestation progresses. However, the physiologic significance of this decline remains uncertain, and whether reductions in maternal iron stores relate to birth outcomes is unclear. Objectives To examine associations between maternal ferritin trajectories during pregnancy and postpartum and infant anthropometric outcomes. Methods We conducted a secondary longitudinal analysis of 1,496 mother - infant pairs from the Alberta Pregnancy Outcomes and Nutrition cohort. Serum ferritin was measured longitudinally in the second and third trimesters and at three months postpartum, with limited first-trimester data available. Values below 15 g/L indicated iron deficiency. Multivariable linear regression assessed associations between inflammation-adjusted third-trimester serum ferritin and infant birthweight and length. Change in serum ferritin between the second and third trimesters ({delta} ferritin) was examined as a marker of late-gestation iron mobilization. Postpartum serum ferritin was modelled using restricted cubic splines to account for nonlinear associations with birth weight and length. Results Ferritin concentrations declined progressively across pregnancy, with 61% of women classified as iron deficient in the third trimester. Lower inflammation-adjusted third-trimester ferritin was associated with higher birthweight, corresponding to approximately 84g higher birthweight per 2.7 - fold decrease in ferritin (p < 0.001). Women experiencing the largest decline in ferritin between the second and third trimester delivered infants approximately 155 g heavier than those with minimal change (p = 0.001). Higher birthweight was associated with greater odds of postpartum iron deficiency (OR per 1 kg = 1.83; 95% CI: 1.12 - 2.99). Conclusions In this healthy cohort, maternal iron depletion in late pregnancy was associated with higher birthweight, consistent with preferential fetal iron transfer. Women delivering larger infants exhibited higher odds of iron deficiency, suggesting sustained maternal iron depletion following greater fetal iron accretion.

Dietary choice plays a critical role in metabolic and neurological health, yet the biological factors that shape macronutrient preference remain poorly understood. Evidence from both humans and rodents suggests potential sex differences in the attractiveness of specific nutrients, though findings have been inconsistent and often rely on self-report or diets with mixed macronutrient composition. The present study examined sex differences in macronutrient preference and food-directed behavior in mice using a controlled three-food choice paradigm. Adult male (n = 12) and female (n = 11) C57BL/6J mice were given simultaneous access to foods consisting of fat, sucrose, or a fat-carbohydrate combination across 14 days. Intake, latency to approach, and time spent near each food source were quantified, and estrous cycle stage was monitored in females. Female mice consumed significantly more food than males overall, driven by a selective increase in fat intake. Behavioral measures paralleled these results, with females spending more time in proximity to fat-associated food zones. In contrast, males preferentially consumed the fat-carbohydrate combination and showed weaker nutrient-specific engagement. Estrous cycle stage modestly influenced feeding behavior, with estrus associated with increased overall intake and greater consumption of combination diets, reflecting elevated carbohydrate intake. These findings demonstrate robust sex differences in macronutrient preference and suggest that hormonal state may selectively modulate nutrient-specific feeding behavior.

ContextVitamin B12 deficiency is common among vegans and vegetarians due to limited intake of animal-derived foods. Identifying safe, plant-based sources of vitamin B12 is essential to address this nutritional gap. AimsThis study evaluated the efficacy and safety of Chlorella vulgaris tablets in improving vitamin B12 deficiency. Settings and DesignA double-blind, randomized, placebo-controlled trial was conducted among 46 healthy adults with vitamin B12 deficiency (serum levels 107-210 pmol/L). Methods and MaterialParticipants were randomized (1:1) to receive C. vulgaris (1 g twice daily) or identical placebo for 12 weeks. Primary outcome was change in serum vitamin B12; secondary outcomes included folic acid, homocysteine, methylmalonic acid (MMA), and quality of life (WHO-QoL). Assessments were conducted at baseline and week 12, with safety monitored through liver and kidney function tests and adverse event reporting. Statistical Analysis UsedSample size (n=46) was calculated with 90% power and 10% dropout allowance. Data were analyzed using SPSS v22. Non-parametric tests were applied after normality assessment, with p<0.05 considered significant. ResultsOf 46 participants (mean age 35.5 {+/-} 11.2 years; 69.6% female), mean serum vitamin B12 levels were significantly higher in the C. vulgaris group than in the placebo group at 12 weeks (214.4 {+/-} 160.8 vs 55.9 {+/-} 15.0 ng/mL; P < .001). No significant differences were observed in folic acid, homocysteine, MMA, or QoL scores between groups. No adverse events were reported. ConclusionsSupplementation with Chlorella vulgaris significantly improved serum vitamin B12 levels, suggesting its potential as a safe, plant-based alternative for managing vitamin B12 deficiency. Key MessagesO_LIPlant-based Chlorella vulgaris improved vitamin B12 levels significantly C_LIO_LIRandomized trial in B12-deficient healthy adults over 12 weeks C_LIO_LINo adverse effects observed on liver or kidney function tests C_LIO_LIQuality of life improved across all domains in the intervention group C_LI

Background: Maternal micronutrient deficiencies (MNDs) and inflammation contribute to adverse birth outcomes While the individual effects of MNDs have been studied, the consequence of co-occurring MNDs remains unclear. Objectives: To examine the associations between maternal micronutrient deficiencies and inflammation with adverse birth outcomes (ABOs). Methods: Data from 5,408 pregnant women across 11 datasets from 10 countries were analyzed. Descriptive analyses explored the distribution of MNDs (iron, vitamin A, zinc, serum folate, vitamin D, and vitamin B12) and inflammation (c-reactive protein >5 mg/L or -(1)-acid glycoprotein > 1g/L) by maternal characteristics (age, height, education, socioeconomic status [SES]) using chi-square tests. Associations of 1) single MNDs and inflammation and 2) co-occurring MNDs (2 deficiencies at a time) with low birth weight (LBW, < 2500 g), preterm birth (PTB, < 37 wks), and small-for-gestational age (SGA, < 10th percentile for gestational age), were examined using modified Poisson regression to estimate relative risk (RR), adjusting for age, SES, and dataset. Results: Young maternal age and short height were associated with up to 9.7% and 25% higher prevalence of MNDs and inflammation, respectively. Lower education and SES level were associated with higher prevalence of Vitamin B12 deficiency. Women with folate deficiency had an increased risk of LBW (RR [95% CI]: 1.22 [1.06, 1.39]). Co-occurring MNDs for folate and vitamin B12 were also associated with increased LBW risk (1.38 [1,1.9]) as was folate deficiency without iron (1.28 [1.09, 1.51]) or vitamin B12 deficiency (1.67 [1.09, 2.56]) compared with mothers without either deficiency. Iron deficiency without vitamin B12 deficiency was associated with a reduced LBW risk (0.4 [0.2, 0.79]). Conclusion: Maternal MNDs, especially folate and vitamin B12, are linked to adverse birth outcomes. Complex nutrient interactions highlight the need to explore these relationships to improve maternal and neonatal health interventions.

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 [&ge;]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[-&gt;]FDC and FDC[-&gt;]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).

BackgroundAffecting 40% of infants and young children worldwide, anaemia in sub-Saharan Africa hampers cognitive and physical development, often in ways that cannot be reversed. Iron-based micronutrient powders (MNPs) are recommended to combat anaemia, but concerns remain about their safety and effectiveness in malaria-endemic areas. We evaluated the impact of iron-based MNPs on growth measurements and malaria-related anaemia among preschool children in Ghana. MethodsWe conducted a secondary analysis of a cluster-randomized, double-blind, placebo-controlled trial in the Bono Region, Ghana. Children aged 6-35 months (n=1,958) received daily MNP containing 12{middle dot}5mg elemental iron or placebo for five months. Anthropometric indices, haemoglobin, and malaria parasitaemia were assessed at baseline and endline. Adjusted analysis of covariance (ANCOVA) models estimated effects on height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height (WHZ) z scores. Binomial regression with identity link estimated risk differences for malaria-induced anaemia. Cluster-robust standard errors were applied at the compound level, and intracluster correlation coefficients (ICCs) were estimated. Results1,815 (92{middle dot}7%) children completed the endline survey, but 1,806 were included in the final analysis. Baseline characteristics were balanced between groups. Iron-containing MNP had no significant effect on endline HAZ ({beta}=0{middle dot}026, p=0{middle dot}609), WAZ ({beta}=-0{middle dot}015, p=0{middle dot}719), or WHZ ({beta}=-0{middle dot}035, p=0{middle dot}463). However, the intervention reduced the risk of malaria-induced anaemia (risk difference 0{middle dot}050, 95% CI 0{middle dot}004-0{middle dot}096; p=0{middle dot}032). Female sex was associated with higher HAZ ({beta}=0{middle dot}149, p=0{middle dot}005). ConclusionIron-containing MNP did not improve short-term growth but was associated with a modest reduction in malaria-induced anaemia. These findings support the safe use of iron fortification in malaria-endemic settings while underscoring the need for integrated strategies to address persistent growth faltering and gender specificity. TRIAL REGISTRATION clinicaltrials.gov IdentifierNCT01001871. Registered 27/10/2009, http://www.ClinicalTrials.gov/NCT01001871.

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.

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.

BackgroundAdequate maternal nutritional knowledge is essential for healthy pregnancy outcomes, yet many pregnant women lack good nutritional knowledge. This study assessed nutritional knowledge and associated factors among pregnant women in the Krowor Municipality of Ghana. MethodsA facility-based cross-sectional study was conducted among pregnant women attending antenatal clinics in two public health facilities. Structured questionnaires were used to collect data on sociodemographic characteristics and nutritional knowledge. Data were analysed using descriptive statistics and chi-square tests at a 5% significance level. ResultsMost respondents demonstrated moderate nutritional knowledge (mean score =11.24 {+/-} 2.48), with 45% classified as having moderate knowledge. Income level (p = 0.00), education (p = 0.007), gestational age (p = 0.042), employment status (p = 0.007), and religion (p = 0.005) were significantly associated with nutritional knowledge. ConclusionThe study highlights notable gaps in nutritional knowledge among pregnant women in Krowor Municipality. Socioeconomic and obstetric factors strongly influenced nutritional knowledge. Strengthening antenatal nutrition counselling and improving socioeconomic support may help improve the nutritional knowledge of pregnant women.

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.

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).

BackgroundDiets rich in monounsaturated fatty acids (MUFAs) and fiber support gastrointestinal health and the microbiome; however, the effect of whole foods relative to their isolated nutrients remains under-investigated. ObjectiveDetermine the impact of avocado consumption on gastrointestinal health and microbiome beyond the individual effects of MUFAs and fiber. MethodsAdults with overweight and obesity (n=43, mean age=41y, BMI=31.6kg/m2) completed a randomized, crossover, controlled feeding study with three 4-wk dietary interventions separated by 2-wk washouts: average American (AA), oleic acid + fiber (OF) nutrients, and avocado (AV). The base diet was supplemented with 209g avocado (AV), or isocaloric snacks high in MUFA/fiber (OF) or low in MUFA/fiber (AA). Outcomes included fecal microbiome (shotgun metagenomics), fecal microbial metabolites (short-chain [SCFA] and branched-chain [BCFA] fatty acids, phenols, indoles, and bile acids), intestinal permeability (24h urinary sweetener excretion), systemic (CRP, IL-6, LBP) and gut (fecal calprotectin and sIgA) inflammatory markers, and gastrointestinal tolerance symptoms. Statistical analysis included linear mixed models, Friedman tests, and multivariable association analysis. ResultsFecal acetate and total SCFAs were 28% and 18% higher in AV and OF conditions, compared to AA (p<0.001 & p=0.019, respectively). Total secondary bile acids in the AV condition were 34% and 24% lower compared to OF (p<0.001) and AA (p=0.011), respectively. Alistipes communis ({beta}=0.85, q=0.03) and Bacteroides uniformis ({beta}=0.50, q=0.14) were higher following AV, whereas Lachnospira eligens ({beta}=1.79, q <0.001) was higher following OF, compared to AA. Microbial genes involved in pectin, cellulose, and hemicellulose degradation were enriched in AV and OF. Fecal calprotectin was lower in AV (30%; p=0.03) and OF (26%; p=0.04) compared to AA, while sIgA was 34% lower following AV, compared to AA (p=0.01). ConclusionsAvocado and MUFA/fiber-matched control had similar fermentation, but distinct secondary bile acid and microbial profiles, emphasizing the food matrix and gut microbiome as key determinants of diet-health relations. Clinical Trial Registry number and website where it was obtainedhttps://clinicaltrials.gov/study/NCT05941728?intr=NCT05941728&rank=1

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.

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.

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.

ObjectiveThe average American consumes 55% of their daily energy from ultraprocessed foods (UPF) created through industrial processes and additives not used at home. We investigated if a high-UPF diet alters brain response to milkshake compared with a diet free-from UPF (NonUPF) in emerging adults, who are in a critical period for brain development and typically consume high amounts of UPF. MethodsIn a randomized controlled crossover trial participants aged 18-25 completed two, 2-week controlled feeding periods including a UPF (81% UPF) and nonUPF (0% UPF) diet. Before and after each diet intervention participants consumed milkshake concomitant with functional magnetic resonance imaging. ResultsIn the entire cohort, there were no differences between diet conditions in brain response. An exploratory analysis revealed orbitofrontal cortex (OFC) response to milkshake decreased after the UPF diet and increased following the NonUPF diet in adolescents (18-21 years) but not young adults (22-25 years). Habitual UPF intake (gs) was positively associated with OFC response to milkshake independent of diet intervention in all participants. ConclusionsAn acute UPF dietary intervention may only alter brain response in adolescents. Further work is needed to determine potential vulnerability of adolescents to changes in dietary UPF on brain response to rewards.

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.

Background & AimsHigh-fat diets (HFDs) are a major modifiable risk factor for intestinal health. Current research focuses primarily on palmitate (C16:0); however, myristate (C14:0, rich in dairy products) has been minimally investigated. HFDs increase ceramide generation which drives endoplasmic reticulum (ER) stress; with both sphingolipids and ER stress being key contributors to intestinal biology. Whether different fatty acids uniquely impact sphingolipid metabolism and ER stress in intestinal biology has not been well defined. MethodsHuman colon epithelial cells were utilized to determine the role of ceramide synthases (CerS) 5 and 6 on myristate-induced ER stress using pharmacologic inhibitors and siRNA. Intestinal epithelial cell specific CerS5 and/or CerS6 knockout mice of both sexes were fed a control, high milk-fat, or high lard-fat diet for 16 weeks. Cells and colon tissues were analyzed for lipids, mRNA, and protein. ResultsMyristate treatment increased C14:0-ceramide and induced IRE1-dependent ER stress. Inhibition of CerS suppressed these effects, yet knockdown of CerS5/6, the primary enzymes generating C14:0-ceramide, unexpectedly exacerbated IRE1 activation both in vitro and in vivo, potentially due to depletion of dihydro(dh)sphingosine. ConclusionsCerS are required for myristate-induced IRE1 activation and restoration of the sphingoid base pool provides partial protection from intestinal ER stress. SYNOPSISThis study identifies a new mechanism linking dietary fats to intestinal cell stress. Ceramide synthases drive ER stress triggered by myristate, a dairy-derived fat, while restoring sphingoid bases partially protects cells, revealing a new role for sphingolipids in shaping intestinal responses to diet. Graphical abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=193 SRC="FIGDIR/small/728542v1_ufig1.gif" ALT="Figure 1"> View larger version (44K): org.highwire.dtl.DTLVardef@a6e246org.highwire.dtl.DTLVardef@518c0eorg.highwire.dtl.DTLVardef@1c21140org.highwire.dtl.DTLVardef@1fa993e_HPS_FORMAT_FIGEXP M_FIG C_FIG

Introduction: Adults in Nigeria face a growing nutrition challenge: while some struggle with undernutrition, others are increasingly affected by overweight and obesity. This double burden of malnutrition reflects socioeconomic divides, where income, education, and household conditions shape food choices and health. This study examined how socioeconomic factors influence dietary diversity, nutritional knowledge, and nutritional status among adults in urban and rural communities of Ekiti State. Methods and Analysis: A descriptive cross-sectional survey was conducted among 350 adults selected via multistage sampling. Data were collected using structured questionnaires and anthropometric measurements. Dietary diversity was assessed using food group frequency, and nutritional status was determined by BMI. Associations were analyzed using chi-square tests (p < 0.05). Results: Significant urban-rural divides were identified: urban respondents were more educated (48.8% tertiary), while rural households were more dependent on farming (35.0%) and low-income (62.0% <70,000). Dietary patterns differed significantly: urban diets favored legumes (58.4%) and cereals (56.0%), while rural diets predominated in sugar/honey (90.0%) and roots/tubers (71.0%). Nutritional knowledge was higher in urban areas. Nutritional status revealed a dual burden: 20.4% of urban and 22.0% of rural respondents were underweight, while combined overweight/obesity affected 18.4% of urban and 25.0% of rural participants. Conclusion: Socioeconomic factors strongly dictate dietary choices and health in Ekiti State. Urban areas show greater diversity but rising obesity risks, while rural areas face persistent undernutrition. These findings highlight the need for tailored, state-specific interventions addressing both food insecurity and emerging diet-related chronic disease risks. Keywords: Socioeconomic factors, Dietary diversity, Nutritional knowledge, Double burden of malnutrition, Ekiti State, Nigeria.