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.

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.

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 utilised data from 5693 adults aged ≥ 18 years in the National Health and Nutrition Examination Survey 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 metabolic equivalent-min/week), adequate sleep (7–9 h/night) and appropriate energy intake. Serum concentrations of thyroid-stimulating hormone, 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 behaviours 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.

International studies show that school food programmes (SFP) can improve children’s diets but evidence from Canada is nascent. We examined whether SFP are linked to better dietary intake and diet quality among Canadian elementary schoolchildren. This cross-sectional study surveyed 2366 grade 4–8 students (age 9–14 years; 48·9 % girls) from 32 schools in socioeconomically disadvantaged communities in Alberta and Ontario, Canada. Students completed a 24-hour diet recall, recording foods and beverages consumed during school hours (breakfast, morning snack, lunch, afternoon snack), and their source (school, other). Multivariable linear models examined the association of accessing SFP (≥1 meal/snack provided by school) with student daily intakes of vegetables and fruit, grains and grain products, milk and alternatives, meat and alternatives, free sugars, sodium and diet quality, adjusting for relevant confounders. Only 293 (12·4 %) students accessed SFP. Overall, accessing SFP was associated with higher intake of vegetables and fruit (β = 0·4, 95 % CI = 0·1; 0·7) and better diet quality score (β = 1·8, 95 % CI = 0·7; 3·0). Specifically, morning snacks provided by schools were associated with lower intake of free sugars (β = –8·9, 95 % CI = –16·5; −1·4), while school-provided lunches were associated with higher intake of milk and alternatives (β = 0·5, 95 % CI = 0·2; 0·8). Further, school-provided afternoon snacks were associated with higher intake of vegetables and fruit (β = 1·1, 95 % CI = 0·6; 1·6), lower sodium intake (β = –258·4, 95 % CI = –506·7; −10·0) and better diet quality (β = 3·1, 95 % CI = 1·1; 5·1). One in eight elementary schoolchildren accessed SFP. Students who accessed SFP had better diets, highlighting the potential of SFP (particularly snacks) in improving children’s diets.

Vitamin B6 is implicated in multiple mental disorders, and accumulating evidence suggests an inverse relationship with depression; however, important aspects of the underlying dose–response patterns and the roles of individual circulating vitamin B6 metabolites remain incompletely understood. We analysed data from the National Health and Nutrition Examination Survey 2005–2010. Depression was defined as a Patient Health Questionnaire-9 score ≥10. Vitamin B6 status was assessed using serum pyridoxal 5′-phosphate (PLP), the biologically active coenzyme form, and 4-pyridoxic acid (PA), the principal catabolic and urinary excretion product of vitamin B6. Among 12 620 participants, 1070 (8·5 %) met criteria for depression. After adjusting for relevant covariates, multiple logistic regression revealed that individuals in higher quartiles of serum PLP and PA (Q2–Q4) had significantly lower odds of depression compared with those in the lowest quartile (Q1). Restricted cubic spline analyses identified nonlinear relationships: L-shaped for PLP (P-nonlinearity = 0·001) and U-shaped for PA (P-nonlinearity = 0·017). Below the inflection points (90·7 nmol/L for PLP; 73·9 nmol/L for PA), both metabolites showed significant inverse associations with depression (PLP: OR = 0·992, 95 % CI: 0·988–0·996, P < 0·001; PA: OR = 0·994, 95 % CI: 0·993–0·996, P < 0·001). Above these thresholds, the association became non-significant for PLP (P = 0·353), while PA demonstrated a positive association with depression (OR = 1·008, 95 % CI: 1·002–1·013, P < 0·01). Subgroup analyses confirmed the robustness of these inverse associations across demographic categories. Serum vitamin B6 metabolites, PLP and its excretion product PA, exhibit non-linear associations with depression, with distinct threshold effects and metabolite-specific patterns that likely reflect both vitamin B6 availability and turnover.

Childhood undernutrition is a global public health challenge, affecting children unevenly within the same household. This study assessed the behavioural and genetic correlates of malnutrition among children aged 1–3 years in a district of the Greater Accra Region, Ghana. A cross-sectional study involving 262 child-caregiver pairs was conducted. Children were classified as wasted, stunted or healthy based on anthropometric indices. Feeding behaviours – including appetite, food refusal, force feeding and maternal feeding anxiety, were assessed using the International Complementary Feeding Evaluation Tool. Saliva samples were used to genotype nine SNP associated with appetite and energy regulation and a polygenic risk score (PGRS) was generated. Wasted children had significantly lower appetite z-scores (mean difference MD (CI): –0·37 (–0·65, –0·09) and higher z-scores for food refusal (0·30 (0·03, 0·58)) and caregiver feeding anxiety (0·67 (0·39, 0·94)) compared with healthy children. Maternal feeding anxiety attenuated the association between appetite and weight for height z-score while remaining a strong independent predictor. No associations were found between feeding behaviour and stunting. Although force feeding was common (33 % of children), it did not differ by nutritional status. The SNP rs2274333 showed a higher frequency of homozygosity for the AA genotype in wasted children. The PGRS was significantly associated with low appetite (p = 0·046) but not with food refusal or nutritional status. Children with wasting had a lower appetite and a higher food refusal. This is associated with high levels of maternal feeding anxiety, but does not seem to have a strong genetic basis.