Military veterans (ex-serving members of the Armed Services) experience unique physical and mental health challenges, with diet playing a critical role in chronic disease management and well-being. This review aimed to evaluate veterans’ dietary intake against nutrient reference values (NRV) relevant to age and sex. A systematic search of CINAHL, MedLine, Scopus, PubMed and AMED (January 2024, updated March 2025) identified 1268 records; thirty-three studies (n 654 323) met inclusion criteria. Eligible designs included cross-sectional, cohort, quasi-experimental and randomised controlled trials. Data were extracted using the Joanna Briggs critical appraisal checklist, indicating low risk of bias. Across studies, veterans’ intake of fibre, folate, vitamin D, Ca, potassium, fruits, vegetables, wholegrains and legumes was consistently inadequate, with overall diet quality rated poor to average. BMI ranged widely, and veterans reported high rates of mood disorders and low quality-of-life scores. These findings highlight key nutrients and dietary patterns that might be considered and targeted in dietary and lifestyle interventions for promoting the physical and mental health of veterans.

While chrono-nutrition behaviours are inter-related, few studies examined patterns of chrono-nutrition behaviours using a comprehensive set of these behaviours. This study aimed to identify chrono-nutrition behaviour patterns and examine their associations with sociodemographic characteristics, diet quality and obesity. This cross-sectional study included 1047 Japanese adults aged 20–69 years. Using 11-d diaries of eating, chrono-nutrition behaviours (such as frequency and timing of eating) were evaluated for workdays and non-workdays separately. Principal component analysis identified four patterns: ‘early, large breakfast on workdays’, ‘skipping breakfast on non-workdays’, ‘frequent snacking with small dinner’ and ‘early last eating with large lunch’. Female sex was associated with the ‘frequent snacking with small dinner’ and ‘early last eating with large lunch’ patterns; male sex was associated with the ‘skipping breakfast on non-workdays’ pattern. Age was positively associated with the ‘skipping breakfast on non-workdays’ and ‘early last eating with large lunch’ patterns. Having a full-time paid job was associated positively with the two patterns characterised mainly by breakfast but inversely with the remaining two patterns. After adjustment for potential confounders, none of the four patterns were significantly associated with diet quality (Healthy Eating Index-2020 score), general obesity (BMI ≥ 25 kg/m2) or abdominal obesity (waist circumference ≥ 90 cm for males; ≥ 80 cm for females). In conclusion, this study suggests that different chrono-nutrition behaviour patterns were differentially associated with sociodemographic characteristics, but not with diet quality or obesity. Further research is needed to clarify if the patterning approach is useful to comprehensively interrogate chrono-nutrition behaviours.

Disordered eating (DE) significantly affects both physical and mental health, contributing to morbidity, mortality, and considerable global healthcare costs. This cross-sectional study assessed the prevalence of high-risk DE and examined its associations with body composition, behavioural factors, diet quality, and perceived stress among university students in the United Arab Emirates. A total of 911 students were recruited using non-probability quota sampling (50.49% female). Body composition was measured using a TANITA BC-420MA body composition monitor. Usual dietary intake was assessed via a validated 65-item food frequency questionnaire. DE risk was assessed using the Eating Attitudes Test (EAT-26) and perceived stress using the PSS-10. Analysis included linear regression and independent-samples t-test (p < 0.05). High-risk DE (EAT-26 ≥ 20) prevalence was 30.3%. High-risk DE was significantly associated with higher body fat percentage (β = 0.121, p < 0.001), fat mass (β = 0.148, p < 0.001), fat-free mass (β = 0.079, p = 0.017), lean mass (β = 0.08, p = 0.016), total body water (β = 0.084, p = 0.011), and lower total body water percentage (β = −0.131, p < 0.001). High-risk students also reported higher intakes of fibre (β = 0.12, p = 0.018), beta-carotene (β = 0.14, p = 0.025), vitamin A (β = 0.13, p = 0.034), B12 (β = 0.15, p = 0.043), folate (β = 0.16, p = 0.006), and vitamin D (β = 0.16, p = 0.036). Compared with the low-risk group, high-risk DE was associated with higher adiposity markers and slightly higher perceived stress, and differed in selected nutrient intakes; sociodemographic characteristics were largely similar between groups except for smoking status. These findings support the implementation of targeted prevention strategies, including nutrition education, routine screening, and culturally tailored programmes, for young adults in the UAE.

Evidence-based diet quality screeners that can be completed within a few minutes are suitable tools for evaluating diet quality in time-limited settings; however, no such tool has yet been developed in Japan. This study aimed to develop a screener to assess adherence to the Diet Quality Score for Japanese (DQSJ) and to describe its development process. The DQSJ is a 10-component index that was previously developed. The present study developed questions and assigned scores based on dietary data analysis and evidence on diet-health associations. Dietary data from 392 Japanese adults were analysed to identify the intake of food groups in the DQSJ. The mean intakes of 4-non-consecutive-day dietary records were described for each food group across the consumption frequencies in dietary questionnaires. Questions about sodium intake were derived from a sodium screener. Consequently, the DQSJ screener comprised 12 questions: two for red and processed meat, two for sodium and one for each of the other eight food groups (fruits, vegetables, whole grains, nuts, legumes, dairy, fish and sugar-sweetened beverages). The screener asked about the number of servings consumed for vegetables, dairy and sugar-sweetened beverages and the consumption frequencies for the other food groups. The maximum scores were assigned with consideration of optimal and feasible consumption for health outcomes. The total DQSJ was calculated by summing all item scores, resulting in a range of 0–30. The DQSJ screener has the potential to facilitate the assessment of diet quality in time-limited settings in Japan; the next step is to examine its validity.

In 250 men (21·4 (sd 2·9) years; BMI 24·2 (sd 3·0) kg·m–2) commencing arduous military training during winter, we investigated the effect of 12 weeks of vitamin D supplementation on lower body (pelvic girdle, sacrum, coccyx and lower limb) overuse musculoskeletal injury risk in a randomised, placebo-controlled trial. Participants received either simulated sunlight (1·3 × standard erythemal dose in T-shirt and shorts, three times per week for 4 weeks and then once per week for 8 weeks), oral vitamin D3 (1000 IU · d–1 for 4 weeks and then 400 IU · d–1 for 8 weeks) or placebo for each intervention. Serum vitamin D metabolites and bone metabolism biomarkers were measured at baseline, week 5 and week 12. At baseline, 29 % of participants were vitamin D sufficient (25-hydroxyvitamin D ≥ 50 nmol·L–1). Vitamin D supplementation achieved vitamin D sufficiency in 95 % of participants after 4 weeks. During 6 months of training and subsequent 3 years of military service, 100 lower body overuse musculoskeletal injuries were diagnosed by clinicians. Frailty models indicated no difference in injury risk between vitamin D and placebo during military training (HRplacebo:vitamin D = 1·23 (95 % CI 0·57, 2·66), P = 0·597) or military service (HRplacebo:vitamin D = 0·94 (95 % CI 0·60, 1·46), P = 0·782). Both safe simulated sunlight and oral vitamin D3 were effective in achieving and maintaining vitamin D sufficiency in almost all. There was no clear evidence that vitamin D affects the risk of lower body overuse musculoskeletal injury during 6 months of military training or subsequent 3 years of military service.

The interaction between 25-hydroxyvitamin D [25(OH)D] and physical activity (PA) in influencing hypertension remains underexplored. This study aimed to examine their independent and joint associations with hypertension risk among 5327 participants aged ≥ 50 years from the English Longitudinal Study of Ageing. Participants were categorised by 25(OH)D status (sufficient, ≥ 50 nmol/l; insufficient, ≥ 30 to < 50 nmol/l; deficient, < 30 nmol/l) and self-reported PA levels. Multivariable logistic regression, adjusting for the season of measurement and sociodemographic confounders, showed that sufficient 25(OH)D (OR = 0·66, 95 % CI 0·56, 0·78) and higher PA (OR = 0·82, 95 % CI 0·71, 0·94) were independently associated with reduced hypertension prevalence. In joint analyses, the group combining higher PA and sufficient 25(OH)D exhibited the lowest odds of hypertension (OR = 0·55, 95 % CI 0·43, 0·70) compared with the lower PA and deficient group. A significant synergistic interaction was identified, indicating that the combined protective effect of these factors was greater than the sum of their individual associations. These results were corroborated by Mendelian randomisation analysis, which identified inverse causal associations between genetically predicted 25(OH)D, vigorous PA and hypertension risk across independent datasets. These findings emphasise that vitamin D sufficiency acts in synergy with an active lifestyle to enhance cardiovascular protection. This relationship underscores the critical importance in nutritional science of integrating micronutrient status with PA to develop more effective, multifaceted lifestyle-based strategies for hypertension management in middle-aged and older populations.

Metabolic dysfunction-associated fatty liver disease (MAFLD) is emerging as the leading cause of chronic liver disease worldwide, with a spectrum ranging from simple steatosis to advanced fibrosis and cirrhosis. Its pathogenesis is multifactorial and involves genetic, metabolic, and gut microbiota factors. Gut microbiota, through the gut-liver axis, plays a crucial role in the progression of MAFLD. Here, we investigated the association between DI-GM, a novel metric reflecting diet-microbiota interactions, MAFLD, and liver fibrosis, with a focus on the mediating role of vitamins. Using data from 13,498 participants across seven NHANES cycles (2007–2018), we found that higher DI-GM scores, indicative of a healthier gut microbiota-promoting diet, were associated with a reduced prevalence of MAFLD (OR = 0.93, 95% CI = 0.88–0.99) and high-risk liver fibrosis (OR = 0.94, 95% CI = 0.90–0.98) in fully adjusted models. Notably, the relationship between DI-GM and MAFLD and the risk of liver fibrosis is largely mediated by specific vitamins and carotenoids, with vitamin C and cis-β-carotene emerging as key mediators. These findings suggest that dietary interventions targeting the gut microbiota and vitamin supplementation could offer new strategies for the prevention and management of MAFLD. Our study provides the first comprehensive evidence linking DI-GM to MAFLD and the risk of liver fibrosis, highlighting the potential of diet and nutrition to modulate metabolic liver diseases. Future research should focus on elucidating the underlying mechanisms and validating these findings through prospective studies and clinical trials.

Individuals with type 2 diabetes are at increased risk for developing CVD. We assessed how dietary counselling on a high-quality, fibre-rich diet influenced cardiometabolic health of patients with type 2 diabetes. In this 6-month trial, 121 patients with type 2 diabetes (67 (sd 8·7) years, 68 % men, BMI 27·8 kg/m2) were assigned to dietary counselling (n 61) or standard care (n 60). Counselling included 4–7 individual sessions with a dietitian, aimed at increasing fibre intake to improve diet quality. The primary outcome was a composite risk score estimating 10-year CVD risk. Secondary outcomes included diet quality, assessed by the Dutch Healthy Eating Index-2015 (DHD15-index), HbA1c, LDL-cholesterol, blood pressure, body weight and medication use. Diet quality score at baseline was 115 (sd 26) and similar across groups. Over 6 months, DHD15-index scores improved by 4·5 points (95 % CI: −0·2, 9·1) in the intervention group v. control, but not significant. The change in 10-year CVD risk across the 6 months of the trial (primary outcome) did not differ between groups −0·1 %, 95 % CI: −0·2, 0·1. Changes over time in HbA1c (–1·1 mmol/mol, 95 % CI: −4·4, 2·3), LDL-cholesterol (0·0 mmol/l, 95 % CI: −0·2, 0·3), blood pressure (–1 mmHg, 95 % CI: −6, 4), body weight (–0·1 kg, 95 % CI: −1·2, 1·1) or medication use did not differ between groups. Dietary counselling for 6 months slightly improved adherence to a high-quality, fibre-rich diet in patients with type 2 diabetes but did not significantly impact cardiometabolic health or medication use.

Autism spectrum disorder (ASD) is a population-scale condition with life-course health consequences, yet nutrition support remains inconsistently embedded in routine pathways. Food selectivity is common in ASD and is associated with restricted dietary variety, nutritional imbalance, gastrointestinal morbidity and cardiometabolic vulnerability. Current responses are predominantly clinic-and family-centred and are difficult to scale equitably. This commentary argues that institutional food services (schools, day-care and residential settings) are an underused public health platform to improve inclusion and accountability through sensory-accessible, nutritionally adequate meals. Because these services are commissioned, standardised and audited, sensory accessibility can be operationalised via procurement specifications and quality indicators, enabling benchmarking across sites. Evidence from sensory-informed menu adaptation and implementation work suggests feasibility within routine operations and supports evaluation using system-relevant outcomes (acceptability, nutritional adequacy, waste, feasibility and maintenance). Three policy actions are proposed: embed sensory accessibility in institutional standards, integrate nutrition across sectors and fund scale-up using implementation science.