Iron deficiency (ID) represents the most prevalent nutritional disorder and a major public health concern. As part of the HYDRIA 2013-2014 National Health and Nutrition study, a cross-sectional survey of a nationally representative sample of adults in Greece, serum ferritin levels (SFL) were measured in participants aged ≥55 years and dietary intake was assessed using two nonconsecutive 24h dietary recalls per participant. The study aimed to evaluate SFL, determine the prevalence of ID among older adults and explore associations with dietary iron intake and adherence to Mediterranean diet(MD). Among individuals over 55 years, ID prevalence was 6.5% for SFL<15 ng/ml and 12.7% for SFL<30 ng/ml. SFL were significantly associated with sex and age (p<0.001), with men showing higher SFL than women. Advancing age, particularly among individuals over 74 years, increased the risk of ID. Dietary iron intake declined with age, and women had significantly lower intake than men (p<0.001). Overall, 57.2% of participants had inadequate daily iron intake. SFL were not associated with total or heme iron intake. High adherence to MD was associated with higher energy-adjusted total iron intake but lower heme-iron intake. Weighted logistic regression for SFL<15 ng/mL showed that MD adherence was significantly associated with reduced odds of ID (p=0.007), likely due to the protective effect of intermediate adherence (OR=0.10, p=0.002). Conclusively, while ID prevalence among older adults in Greece is low, over half of the population present inadequate daily iron intake, especially women. High adherence to MD may have a protective effect against ID.

Sepsis-related deaths remain prevalent in intensive care settings, with metabolic dysregulation as a key contributor. Although amino acid supplementation has shown promise, its clinical effectiveness in sepsis is unclear. This study evaluated the impact of intravenous amino acid administration on 28-d mortality in intensive care unit (ICU) sepsis patients using retrospective cohort analysis and Mendelian randomisation (MR). We analysed data from the Medical Information Mart for Intensive Care-IV database, matching 726 patients (363 per group) using propensity scores. The association between amino acid supplementation and mortality was assessed using logistic regression, Cox regression and targeted maximum likelihood estimation (TMLE). Two-sample MR was used to explore causal links between twenty common amino acids and sepsis mortality. In the cohort analysis, amino acid supplementation was consistently associated with significantly reduced 28-d mortality across all analytical methods (logistic regression: OR = 0·48, P < 0·01; Cox regression: HR = 0·48, P < 0·01; TMLE: average treatment effect = −0·102, P < 0·01). In contrast, the MR analysis did not find a significant causal association for any single amino acid after correction for multiple comparisons; although glycine showed a nominal protective signal, it did not remain significant after false discovery rate correction. This dual-method study demonstrates a strong association between compound amino acid infusions and reduced mortality in sepsis but did not identify any single amino acid as a robust causal mediator. These findings suggest the benefit may arise from a synergistic effect, highlighting the need for randomised controlled trials to validate these observational results and optimise nutritional strategies.

This study is a prospective observational study to systematically compare the effects of intermittent tube feeding and thickened feeding on dehydration status, thirst degree and quality of life in patients with dysphagia after stroke. A total of forty-eight patients with dysphagia after stroke were selected and divided into intermittent tube feeding group (twenty-four cases) and thickened feeding group (twenty-four cases). The grouping was based on the nutritional intake mode after clinical decision-making. Participants were selected from the Affiliated Brain Hospital of Nanjing Medical University and the First Affiliated Hospital of Nanjing Medical University. All enrolled patients received conventional treatment and nursing measures and were treated for 2 weeks. The dehydration status was evaluated by plasma osmotic pressure. The degree of thirst is evaluated by the Numerical Rate Scale. Total protein and Hb are used to assess nutritional status; The Functional Oral Intake Scale (FOIS) assesses swallowing function. The Swallowing Quality of Life Scale (SWAL-QOL) was used to assess the quality of life. After 2 weeks of treatment, the improvement in dehydration and thirst in intermittent tube feeding group was better than that in thickened feeding group (P < 0·05). The FOIS and SWAL-QOL scores of both groups of patients improved compared with those before treatment (P < 0·05). Intermittent tube feeding can improve the dehydration status of patients with dysphagia after stroke, relieve thirst and enhance swallowing function and quality of life. The study may provide a more comprehensive basis for the selection of clinical nutritional support plans.

Nutrition is crucial for the growth of children and adolescents. This study investigated multiple nutritional problems and influencing factors among 2423 students aged 6–17 years in Guizhou Province, using questionnaire surveys, physical examinations and blood tests. Multifactorial logistic and Poisson regression analyses were used to identify determinants of overnutrition and undernutrition. The results showed a distinct profile compared with national averages: wasting was more prevalent (9·6 %), while overweight (8·6 %) and obesity (5·0 %) were less common. Notably, hyperuricaemia (27·6 %) and Zn deficiency (17·9 %) were elevated, whereas classical metabolic syndrome (2·3 %) was lower, delineating a regional pattern that prioritises these emerging and micronutrient issues. Marginal vitamin A deficiency (17·2 %) and vitamin D inadequacy (50·9 %) remained significant. Older age (11–17 years) was a strong risk factor for overnutrition-related disorders and hyperuricaemia (All P < 0·001). Overweight/obesity increased risks of hyperuricaemia and metabolic syndrome (All P < 0·001). Being female was a major risk factor for undernutrition (prevalence ratio = 1·27, 95 % CI: 1·19, 1·35, P < 0·001) and vitamin D deficiency (adjusted OR = 2·51, 95 % CI: 2·10, 3·00, P < 0·001), but a protective factor against hyperuricaemia (adjusted OR = 0·34, 95 % CI: 0·27, 0·41, P < 0·001). Frequent sugary drink consumption (≥ 3/week) elevated hyperuricaemia risk (adjusted OR = 1·33, 95 % CI: 1·05, 1·69, P = 0·020). This study underscores a complex double burden of malnutrition in western China, characterised by specific priority areas, and necessitates tailored, multi-component interventions such as limiting sugary drinks and focusing nutrition support on adolescent girls.

This study aimed to evaluate the agreement between three body composition devices and dual-energy X-ray absorptiometry (DXA) in assessing segmental body composition among healthy Iranian adults. This comparative study recruited 62 healthy adults (33 men and 29 women) from Tehran, Iran, using a convenience sampling approach. Socio-demographic data were collected, and segmental body composition was assessed using several devices, including the InBody 770, Anea bioelectrical impedance analysis (BIA), Tanita BC-418 and DXA. Agreement between DXA and the BIA devices was evaluated using Lin’s concordance correlation coefficient (CCC). Additionally, Bland–Altman plots and mean percentage error were applied to assess the consistency between the two methods. The Anea, InBody 770 and Tanita BC-418 devices showed strong correlation with DXA for all segmental measurements (r ≥ 0·74, P < 0·05). Moderate agreement (CCC: 0·90 ≤ CCC < 0·95) with the DXA method was found for some segments using the Anea (trunk fat mass, arms fat-free mass, legs fat-free mass and trunk fat-free mass) and the InBody 770 (trunk lean body mass and trunk fat mass) devices. The estimation of legs fat mass was the least accurate across all BIA devices. Furthermore, subgroup analyses showed that the BIA devices provided more precise results in men and in individuals with a BMI < 25·00 kg/m2. The Anea BIA and InBody 770 devices show relatively acceptable validity for segmental body composition assessment. More research is needed to confirm these findings.

Monocrotaline (MCT) induces lung injury and pulmonary hypertension (PH) by a mechanism that is in part due to oxidative stress. The purpose of this study was to determine how MCT affected nutrient antioxidants retinol and alpha-tocopherol in a rat lung and liver. Rats were fed a purified diet (AIN-93G) one-week prior to a subcutaneous injection of MCT (60 mg/kg) and remained on the diet throughout the study. Three weeks after injection, the animals were euthanized, and the lungs and livers were analyzed for retinol, alpha-tocopherol, phospholipid (PL), and cholesterol content. Lung retinol concentrations were significantly lower in MCT-treated rats, 2.0 ± 1.2 (nmol/g lung) vs. vehicle control (VEH), 5.8 ± 1.4 (P < 0.01). However, liver retinol concentrations were not significantly different, 3.3 ± 1.3 vs. 2.5 ± 0.9 nmol/g liver. Alpha-tocopherol was significantly greater in MCT-treated rats in the lung, 145 ± 24 vs. 99 ± 13 nmol/g lung (P < 0.001), and liver, 107 ± 30 vs. 47.7 ± 4.8 nmol/g liver (P < 0.001). Phospholipid and cholesterol were significantly lower in the lung of the MCT-treated group, but not significantly different in the liver. In conclusion, retinol along with phospholipid, and cholesterol were decreased in the lungs whereas alpha-tocopherol was elevated in the lungs and liver in response to MCT. These findings along with others suggest a novel mechanistic link between MCT-induced oxidative stress, lung vitamin A depletion, inflammation and the impairment of alveolar cell proliferation and repair. Pulmonary retinol is important in the pathogenesis of MCT-induced lung injury.

The growing use of glucagon-like peptide-1 (GLP-1) receptor agonists and dual GIP/GLP-1 agonists has intensified debate over the role of pharmacotherapy in addressing obesity. While these drugs can support short-term weight loss, access remains limited, costly and unequal across health systems. Weight regain after cessation and recent price increases, such as for tirzepatide in the United Kingdom, underscore the fragility and inequity of drug-focused approaches. Reliance on medication risks diverts attention from structural drivers of obesity, including the widespread availability, marketing and placement of ultra-processed and high-fat, salt or sugar products and limited access to healthy, minimally processed foods. Population-level action, including mandatory reformulation, marketing restrictions, improved affordability and expanded access to nutritious foods, is essential. Medications may support individuals, but only comprehensive food-system reform can sustainably reduce obesity and diet-related disease.

The Mediterranean and a low carbohydrate diet are two popular dietary approaches recommended for cardiovascular and metabolic health, respectively. This trial will compare the combined effect of these diets to either approach alone for the treatment of the metabolic syndrome (MetS). Males and females (n=222), 30-75 years, with at least three MetS risk factors will be randomised to one of 3 diets: i) Traditional Mediterranean (∼55% of energy carbohydrate [CHO]:15% Protein [Pro]: 30% Fat), ii) Lower Carbohydrate (∼35%CHO:20%Pro:45%Fat), or iii) Lower Carbohydrate Mediterranean (∼35%CHO:20%Pro:45%Fat) diet for 12-weeks. The primary outcome measure is the MetS Severity Z Score (MetS-Z), a composite score of risk factors, sex and ethnicity. MetS-Z will be calculated pre and post intervention using fasted blood samples for plasma triglycerides, HDL-cholesterol and glucose, systolic blood pressure, body weight and waist circumference measures. The findings from this trial will offer new insights into the most effective dietary strategy for managing diabetes and reducing cardiovascular risk in individuals with metabolic syndrome.

Responsive feeding characterised by recognising and appropriately addressing children’s hunger and satiety signals, plays a key role in health. Despite children’s innate ability to self-regulate food intake, caregivers can override these cues, especially in child care settings. The study determined the effects of a 6-month coaching intervention on the responsive feeding environments of child care centres. CELEBRATE Feeding was a 6-month, coaching, pre-post intervention design conducted in eight child care centres across Nova Scotia and Prince Edward Island, Canada. Child care centres’ feeding environments and educator practices were observed using a modified Environment and Policy Assessment and Observation tool at baseline and follow-up in two rooms per centre (n = 16). Twenty-one responsive feeding components were scored from 0–3 (3 as best practice). The average centre scores were summed for an overall score ranging from 0–63 at each time point. Paired samples t-tests and Wilcoxon signed rank tests were conducted to assess the impact of the intervention on overall rooms’ and individual responsive feeding components’ scores. There was an increase in scores from baseline (M = 38.16, SD = 6.55) to follow-up (M = 45.75, SD = 5.87), t (15) = 4.91, P < 0.001. All but one score improved, where 3 of the 21 scores were significantly more responsive after the intervention after applying a Bonferroni correction (P < 0.002). The score with the greatest positive change was ‘Educators provide gentle comments or nudges towards feeding’, with a mean difference of 1.33, P < 0.001. The CELEBRATE Feeding coaching intervention was successful in improving responsive feeding practices and environments in child care settings.

The objective of this study was to develop and validate an educational comic book designed to promote healthy eating among caregivers of young children. The study was conducted in four phases: (1) literature review and script development; (2) creation of the initial version of the comic book, including illustrations, layout and design, and calculation of the Flesch Readability Index (FI); (3) expert validation of the initial version and calculation of the Content Validity Index (CVI); and (4) adaptation of the comic book based on expert suggestions, recalculation of the FI, and pilot testing (CVI) with a lay population. A total of 64 volunteers participated in the validation process, including 14 expert judges and 50 caregivers responsible for feeding children aged 0 to 5 years. Statistical analysis included descriptive measures and inferential testing using the Wilcoxon signed-rank test. The FI score for the initial version was 85.0%, indicating a reading level classified as “easy to understand.” After expert evaluation, the CVI reached 94%, reflecting high agreement among participants. In the revised version, the FI remained high at 84.7%, reinforcing the “easy to understand” reading level, while the CVI increased to 98% following the pilot test, demonstrating strong consensus among participants. A significant improvement in knowledge regarding healthy eating was observed after reading the comic book (p < 0.05). The comic book was validated for appearance, content and readability, showing a positive impact on caregivers’ knowledge about healthy eating practices. It represents an accessible and effective resource that can be integrated into community-based nutrition education programmes.

Prenatal exposure to PUFA has been associated with child weight at birth and may have a persistent effect on adiposity development across childhood. Fish is the richest dietary source of n-3 PUFA, albeit few studies have investigated associations between maternal fish consumption during pregnancy and child weight. This study examines associations between maternal fish consumption and prenatal PUFA status (n-3 and n-6), with longitudinal measures of child weight in the high fish-eating Seychelles Child Development Study Nutrition Cohort 2. Maternal fish consumption during pregnancy was assessed using a Fish Use Questionnaire administered at 28 weeks’ gestation. Serum PUFA were quantified in maternal blood collected at 28 weeks’ gestation and in cord blood collected at delivery. Birth weight was measured at delivery and classified according to WHO growth standards (n 1185). Child length/height (m) and weight (kg) were recorded at 20 months (n 1182), 7 (n 1167) and 13 (n 878) years. Child BMI was classified according to z-scores. Maternal total fish consumption (range: 0·0–584·71 g/d) was not associated with child weight at any age. At 7 and 13 years, maternal total n-6 PUFA were associated with increased risk of overweight/obesity (7 years; OR = 1·62, p = 0·037, 13 years; OR = 2·05, p = 0·005). Lower (<0·071 mg/ml) cord DHA concentrations were associated with a greater likelihood of being large for gestational age (LGA; >90th percentile) when compared with higher (>0·129 mg/ml) cord DHA concentrations (OR 4·17, p = 0·017). This study suggests that prenatal maternal n-3 and n-6 PUFA status may influence postnatal outcomes, including child adiposity from birth until adolescence.

The aim of this review is to examine why cultural food security and cultural food sovereignty should be prioritised and embedded within conventional food security frameworks. It demonstrates how culturally grounded, community-driven approaches foster more just, sustainable and empowering food systems for ethnically diverse, Indigenous and local communities, while highlighting the limitations of conventional metrics that overlook socio-cultural, political and ecological dimensions essential to resilience. Conventional food security focuses on access to sufficient, safe and nutritious food, often sidelining access to culturally appropriate and spiritually meaningful foods that are integral to cultural identity and tradition (cultural food security) and the authority and decision-making power held by local people over their foodways (cultural food sovereignty). Its market-based, individualistic measurement paradigms further neglect collectivist, traditional and spiritual food values, resulting in assessments that may conform to global standards yet produce flawed outcomes, misaligned interventions and continued marginalisation of ethnically diverse, Indigenous and local communities. Drawing on socio-cultural, political, economic and environmental frameworks, the review demonstrates how food sovereignty and cultural food security provide more sustainable, equitable and empowering pathways for communities. It underscores the need for community-driven, culturally grounded food policies.

Studies have linked lower birth weight to development of radiographic osteoarthritis (OA). We examined early life factors in relation to subsequent knee pain among individuals with radiographic OA. 143 participants from the UK Hertfordshire Cohort study were included. Birth weight and weight at one year (WA1) were ascertained from health ledgers and used to derive conditional infant weight gain (CIWG). At baseline and follow-up, heath questionnaires (including knee pain) and knee radiographs were collected. Only those with radiographic knee OA at baseline were analysed. Logistic regression was used to examine early life factors in relation to pain. Pain at follow-up was common (men 41.3%, women 50%). Greater WA1 and greater CIWG were related to reduced risk of knee pain at follow-up after adjustment for sex and follow-up time. CIWG was protective against knee pain at follow-up, with this association attenuated after adjustment for follow-up osteophyte score. Validation in larger studies is required.

Digital technologies provide a convenient and scalable approach to dietary assessment and personalised feedback, facilitating behaviour change. This is essential for reducing the prevalence of non-communicable diseases at a population level. However, the evaluation of the acceptability and feasibility of dietary feedback delivered via online platforms has not been thoroughly investigated. By utilising the term ‘system architecture’ to describe the essential components of the digital approach to capturing dietary feedback, this systematic review outlines the platform, dietary assessment methodology, reference values for assessing dietary intake, and elements of personalised dietary feedback. When reported, the acceptability and feasibility of personalised feedback were captured. OVID Medline, OVID Embase, Scopus via Elsevier, and Cinahl Plus via EBSCO identified 5,839 studies. Search terms included dietary assessment, feedback, and digital technologies. In total, 28 studies involving 301,271 participants were included. Food frequency questionnaires were the most commonly used dietary assessment method, accessed via web-based platforms. Dietary intake was commonly assessed using a diet quality index, and feedback was provided on food groups, often combined with a diet quality score or macronutrient analysis. While participant acceptance of personalised dietary feedback was generally high, the overall completion rates for acceptability questionnaires were low, and feasibility was seldom reported. Methods used to measure acceptability and feasibility varied, preventing comparisons across studies. Study quality was high; however, future research would benefit from the involvement of stakeholders and end-users in designing feedback messages.

This randomised controlled trial examined the effect of a 4-week, high-dose (Lf-High, 600 mg/d) or low-dose (Lf-Low, 200 mg/d) oral lactoferrin (Lf) intervention v. placebo on immune cell responses to respiratory virus, immune cell subsets and systemic inflammation. In healthy older adults (n 103, ≥50 years old), ex vivo cytokine release of interferon (IFN)-α2, IFN-γ, IL-6 and TNF-α from rhinovirus A-16 (RV-16) or influenza A virus (H1N1) stimulated peripheral blood mononuclear cells, circulating immune cell subsets, and plasma IL-6, C-reactive protein (CRP) and TNF-α were assessed. Ninety-seven participants completed the 4-week intervention (Lf-High n 32, Lf-Low n 31, placebo n 34, withdrawals n 6). There was no difference in RV-16 or H1N1-induced IFN-γ release between groups. RV-16-induced IL-6 was lower in Lf-High v. placebo (P = 0·001), and RV-16-induced IFN-α2 was higher in Lf-High v. Lf-Low (P = 0·04). Lf-High increased total T cells (P = 0·03) and CD4+ T cells (P = 0·03) v. placebo. Lf-Low reduced neutrophil (P = 0·04), natural killer cell (P = 0·045), activated CD8+ T cell (P = 0·03) and γδ T cell (P = 0·03) frequency v. placebo. Plasma IL-6 (P = 0·004) and CRP (P = 0·03) were lower following Lf-High v. Lf-Low, but not placebo. Both high- and low-dose Lf altered ex vivo immune cell responses after 4 weeks. High-dose increased T-cell subsets, promoting adaptive immunity, and reduced systemic inflammation, while low-dose reduced proinflammatory and cytotoxic immune cells. High- and low-dose Lf supplements may have immunoceutical benefits in older adults.

Lactotransferrin (LTF), a critical multifunctional glycoprotein, plays an essential role in the immune defence, growth and development, and milk quality of dairy cows. The regulatory mechanisms governing gene expression are intricate, with sequence variations in the promoter region potentially exerting a substantial impact on gene expression. In this study, sequencing analysis of the bovine lactotransferrin promoter region was conducted, leading to the identification of two linked single nucleotide polymorphism (SNP) sites. A significant association between these SNPs and lactotransferrin content was observed in a cohort of 301 Holstein cows. Subsequently, further investigation into the transcriptional activity of various lactotransferrin genotypes was performed by constructing promoter fragments encompassing different lactotransferrin genotypes. The findings reveal that the two SNPs significantly influence the activity of the lactotransferrin promoter, thereby affecting lactotransferrin expression. These results hold substantial implications for advancing our understanding of the regulatory mechanisms underlying lactotransferrin expression and for the genetic enhancement of dairy cows.

The current study was designed to examine the association between a composite Healthy Lifestyle Score (HLS) and thyroid function biomarkers among American adults. This cross-sectional study utilized data from 5,693 adults aged ≥18 years in the NHANES 2007–2012 cycles. A HLS (range 0–6) was constructed based on six modifiable factors: non-smoking, no heavy alcohol intake, normal BMI (18.5–24.9 kg/m²), high physical activity (upper tertile of MET-min/week), adequate sleep (7–9 h/night), and appropriate energy intake. Serum concentrations of thyroid-stimulating hormone (TSH), free and total thyroxine (FT4, TT4), free and total triiodothyronine (FT3, TT3), thyroglobulin (Tg), and thyroid antibodies (TPOAb, TgAb) were measured. Multivariable linear regression adjusted for sociodemographic factors was used to assess associations. In fully adjusted models, each one-point increase in HLS was associated with lower serum FT4 (β = −0.07 ng/dL; 95% CI: −0.10, −0.03; p < 0.001) and TT4 (β = −0.11 µg/dL; 95% CI: −0.15, −0.06; p < 0.001). Compared with participants with an HLS of 0–1, those with HLS 4–6 had lower FT4 (β = −0.20; 95% CI: −0.30, −0.09; p < 0.001) and TT4 (β = −0.36; 95% CI: −0.49, −0.22; p < 0.001). Associations for other thyroid markers were not statistically significant after correction for multiple comparisons (p > 0.05). A healthier lifestyle is inversely associated with serum FT4 and TT4 levels, highlighting potential links between modifiable behaviors and thyroid physiology.

No existing dietary metric simultaneously captures key dimensions of sustainable healthy diets (SHD): dietary variety, intake of animal products and extent of food processing. This methods and construct development study aimed to identify indicators of an SHD that can be used to inform a multidimensional diet quality score. A modified Delphi was used to gain expert consensus regarding the development of an SHD score. Three iterative surveys were conducted between November 2022 and May 2023. Surveys asked participants’ opinions regarding the measurement of the three dimensions of SHD (Dimension 1: variety of unprocessed and minimally processed foods; Dimension 2: intake of animal products; and Dimension 3: intake of ultra-processed foods (UPF)) and weighting and aggregation of a score that assesses these three dimensions. Thirteen international experts completed all three surveys. Consensus from experts led to the identification of food-based indicators of SHD. Experts agreed that Dimension 1 should be comprised of twelve food groups, with food groups and scoring ranges informed by the Global Diet Quality Score; Dimension 2 comprised of five food groups with scoring ranges informed by the EAT-Lancet planetary health diet; and Dimension 3 as one food group measured as a cut-off value of ≤10 % energy from UPF. There was consensus that each dimension should be equally weighted. Outcomes from this work have been used to inform the development and validation of a multidimensional diet quality score to assess the healthfulness and environmental sustainability of diets among healthy adult populations.