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.

Within Public Health Nutrition, the preconception phase, has emerged as a particularly important window for promoting a healthy diet, as it affects both current and future health as well as health in the next generation. Different approaches are used to support dietary change in this phase, and digital interventions are viewed as particularly promising. In this review, we describe digital interventions addressing preconception diet, discuss challenges in targeting the preconception population and highlight issues related to digital designs and measuring intervention effects. We draw upon six digital interventions with dietary outcomes, in different target populations. Only two of the interventions were found to be effective in improving relevant aspects of the participants’ diet, and these targeted specific and narrow groups or a single dietary component. Most of the intervention studies faced considerable challenges with recruitment. High attrition further complicated evaluation. In addition, there were difficulties related to participant engagement with the digital interventions. Challenges with lack of engagement, recruitment and attrition are not new insights within public health research, and we need to acknowledge the need for new approaches to recruitment, intervention development and evaluation. Alternative approaches such as citizen science and participatory action research in which the researchers work closely with the target population and other stakeholders during the whole process, should be explored. Moreover, as the current behavioural interventions that rely heavily on individual agency seem largely unsuccessful, future interventions should consider targeting more upstream and structural determinants of diet, rather than individual behaviour alone.

Gestational weight gain (GWG) can be defined as the total weight gained throughout pregnancy and is required for healthy fetal growth; however, gaining excessive weight during pregnancy has been linked with several adverse effects. This review aims to consider the evidence on weight management during pregnancy, with a focus on the key challenges surrounding GWG and the practical considerations related to assessing weight changes. It is estimated that nearly 50% of women gain excessive weight during pregnancy; nevertheless, this can be difficult to quantify due to the lack of global consensus on recommended GWG guidelines. Currently, there are no GWG guidelines in the UK and Ireland, as reiterated in the recent National Institute for Health and Care Excellence guidelines, due to the lack of evidence about what the optimal total weight change in pregnancy should be. This is further complicated by the conflicting results of interventions aimed at preventing excessive GWG and their resultant inconsistent effects on adverse pregnancy outcomes. Accurate calculation of GWG requires measurement of pre-pregnancy weight and weight prior to the onset of labour. However, several practical considerations are associated with obtaining these weights, as in practice, estimated or self-recalled weights are often used as an alternate, thereby introducing variability into the measurement of GWG and the potential for inaccuracies in analysis. These limitations highlight the need for a more uniform approach in assessing GWG. The WHO is in the process of developing global GWG standards, and this could potentially establish a uniform gold standard for assessing GWG and reintroduce routine weighing.

Smoking has been confirmed to induce systemic inflammation and oxidative stress (OS) and is associated with higher odds of chronic obstructive pulmonary disease (COPD). Dietary antioxidants can reduce inflammation and OS. This study seeks to score the dietary antioxidant intake and then assess its impact on the association between smoking and COPD in adults. The data extracted from the 2007–2012 National Health and Nutrition Examination Survey database were used. The Dietary Antioxidant Quality Score (DAQS) was evaluated by the total intake of vitamins A, C and E, Se, Zn and Mg in the daily diet. Smoking was used as the exposure variable and COPD as the outcome variable. Weighted multivariable logistic regression was conducted to evaluate the associations of DAQS with smoking and COPD, as well as their joint effects on the odds of COPD. The relationships between dietary antioxidant quality score, smoking status and COPD were subsequently assessed. Subgroup analyses were performed to explore associations between relevant covariates and smoking and COPD across DAQS strata. Current smoking was found to be linked to COPD (OR = 4·06, 95 % CI = 3·14, 5·27) in comparison to never smoking. Among smokers, significant associations were observed in both the medium-quality DAQS group (OR = 3·48, 95 % CI: 2·34, 5·17) and the low-quality DAQS group (OR = 5·60, 95 % CI: 3·58, 8·76). In conclusion, high DAQS levels are inversely related to the odds of COPD in adult smokers. Our findings provide valuable insights for management strategies for COPD.

College students (those enrolled in two- and four-year postsecondary institutions) with caregiving responsibilities for children or other dependents face unique challenges balancing academic and caregiving duties. This scoping review aimed to describe the prevalence of food insecurity among United States college student caregivers and their experiences with food insecurity, dietary quality/intake, academic outcomes, and food security programming. A search of peer-reviewed and grey literature was conducted in four databases: CINAHL, Google Scholar, Embase, and Medline. Identified articles were evaluated against inclusion criteria. Of 162 articles identified, 61 articles met eligibility criteria and underwent data extraction and descriptive analysis. Forty-two articles (69%) reported the prevalence of food insecurity among college student caregivers, with prevalence ranging from 9% to 79%. Single parents, students of colour, LGBTQ+ individuals, and those with multiple dependents had increased food insecurity risk. Thirteen studies examined dietary patterns, finding caregiving students prioritised feeding their children, reduced their own meal sizes, and chose low-cost, low-nutrient foods due to budget constraints. Academic challenges included difficulties in time management and scheduling stress. No studies examined Grade Point Average (GPA) or academic performance. Thirteen studies identified the use of food assistance programmes. Food assistance programmes were underutilised due to limitations such as restricted pantry hours and availability. Housing insecurity frequently co-occurred with food insecurity. Food insecurity disproportionately affects college student caregivers compared to non-caregiving students. Comprehensive programming is needed to support food and nutrition security, including connections to government and university food assistance programmes, childcare services, and programme modifications to reduce barriers to academic success for caregiving students.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing in prevalence and is the leading cause of hepatic fibrosis and cirrhosis in the industrialised world. Despite growing evidence for lifestyle interventions, adherence to nutritional and physical activity recommendations and psychological behaviours among patients with MASLD has not been previously characterised in Canada. We conducted a cross-sectional analysis of baseline data from patients with MASLD. Lifestyle adherence, including dietary patterns, physical activity and psychological measures, was assessed at a single time point to describe prevalence and patterns among participants. Adults with MASLD and advanced fibrosis were older (median age 58·4 v. 45·3 years; P < 0·001), had a greater BMI (median 36·3 v. 31·2; P < 0·001) and have higher presence of metabolic risk factors including type 2 diabetes mellitus (P < 0·001), hypertension (P = 0·001), thyroid disease (P = 0·02) and were of White ethnicity (P = 0·002). The prevalence of mood disorder was 31 % for anxiety and 16 % for depressive symptoms based on HADS-A and HADS-D ≥ 8 indicating borderline/abnormal anxiety and depression, respectively. Twenty per cent of patients had a Binge Eating Score ≥ 18 indicating moderate/severe binge eating behaviour. Most had poor adherence to a Mediterranean diet with the energy-restricted Mediterranean Diet Adherence Screener (er-MEDAS) ≤ 7 (56 % with poor adherence, 34 % with moderate adherence), 42 % reported weekly alcohol consumption and one-third had low self-reported activity levels on the International Physical Activity Questionnaire Short Form (IPAQ-SF). Here, we identified barriers to risk reduction in patients with MASLD, including increased prevalence of anxiety and depressive symptoms, high frequency of binge eating behaviours, poor adherence to Mediterranean diet quality and sedentary self-reported activity levels.

Understanding trends in height and BMI, along with trajectories of weight status, is crucial to identifying the optimal timing for intervention. The objective of this study was to describe trends in height and BMI among children and adolescents and identify the trajectory of weight status over time. This was a longitudinal study with data collected annually (2013–2020). A total of 41 325 students aged 5–18 years from forty-seven schools participated in the study, and a subsample of 11 535 participants with at least five BMI measurements was used for the analyses. Mixed-effects analysis showed significant increases in height over the years for boys (0·19 cm, standard error 0·01, P < 0·001) and girls (0·15 cm, standard error 0·01, P < 0·001). Regarding BMI, an increasing trend over the years was also found in boys (0·04 kg/m2, se 0·01, P < 0·001) and girls (0·04 kg/m², se 0·01, P < 0·001). Analysing weight status trajectories, three groups were identified: consistently normal weight (males 63·7 %, females 64·5 %), increasingly overweight (males 21·8 %, females 20·7 %) and increasingly obese (males 14·5 %, females 14·8 %). We conclude that in adolescence, height was below expected, indicating that children are not reaching their maximum growth potential. Furthermore, the identification of increasing trajectories of overweight and obesity, starting in childhood, emphasises the progressive nature of excessive weight gain before adulthood. These findings highlight the early onset of nutritional deviations in this population, suggesting the need for interventions to promote healthy weight as children transition into adolescence to mitigate future health risks.

Little is known about the factors that influence inter-individual variability in the thermic effect of food (TEF). Factors such as age, physical activities, insulin resistance and body weight and composition have been proposed as potential predictors, but findings remain inconsistent. TEF may also be influenced by hormonal status in females. Therefore, this study aimed to explore potential physiological and dietary predictors of TEF in a well-phenotyped cohort of females approaching menopause. This study is a secondary analysis of the MONET study. Eighty-six females had complete data for all predictors included in the analyses: fat mass (kg), resting energy expenditure (REE), VO2peak, fasting glucose, follicle-stimulating hormone and habitual protein intake. Stepwise multiple linear regression analyses were conducted to identify predictors of TEF. Mean TEF over the 180-min measurement period was 33 (sd 8·7) kcal. Habitual daily protein intake was the only consistent significant predictor of TEF across regression models (B ≈ 0·12–0·14 kcal·g−1, β ≈ 0·23–0·24, P ≤ 0·04), explaining 6 % of the variance (R2 = 0·060). Inclusion of fat mass, REE, VO2peak, fasting glucose or follicle-stimulating hormone did not meaningfully improve model fit. These findings suggest that TEF may represent a relatively stable physiological trait, with modest contributions from habitual dietary protein intake, and that additional, unmeasured factors may contribute to inter-individual variability.

Maternal Hb and fetal growth change dynamically throughout pregnancy. We examined the associations of time-specific Hb levels and Hb trajectories with fetal biometrics and adverse birth outcomes. This prospective study included 6844 pregnant women (mean age 26·6 (sd 3·7) years) from the Tongji-Huaxi-Shuangliu Birth Cohort. Hb levels were measured at four periods: early (6–12 gestational weeks), middle (13–27), middle-late (28–32) and late pregnancy (33–37). Fetal biometrics were assessed by ultrasound from middle to late pregnancy. Birth outcomes were obtained from medical records, including small for gestational age (SGA), low birth weight (LBW) and preterm birth. Three Hb trajectories were identified: consistent decline (Trajectory 1), consistently low (Trajectory 2) and increase from middle-late pregnancy (Trajectory 3). Compared with Trajectory 1, Trajectory 3 was associated with lower estimated fetal weight (β, −0·54; 95 % CI −0·99, −0·09) and abdominal circumference (β, −0·21; 95 % CI −0·40, −0·01) in late pregnancy and higher umbilical artery resistance index across pregnancy (β, 0·65; 95 % CI 0·31, 1·00). Trajectory 3 was also associated with higher risk of LBW (OR, 1·57; 95 % CI 1·09, 2·26). In middle-late pregnancy, higher Hb (≥ 130 g/l) was associated with higher risks of LBW (OR, 2·26; 95 % CI 1·08, 4·25) and preterm birth (OR, 2·03; 95 % CI 1·12, 3·44) compared with the reference (110–129 g/l). Elevated maternal Hb from middle-late pregnancy onwards may be associated with lower fetal weight and increased risk of LBW. Dynamic monitoring of maternal Hb may facilitate targeted nutritional management in pregnant women.

Fasting during pregnancy is a widespread practice in Muslim communities, yet its health implications remain poorly understood. A lack of conceptual frameworks and limited understanding of the characteristics of women who fast during pregnancy have hindered research in this area. This study examines the differences in several nutritional biomarkers between women who fasted and those who did not and identifies factors associated with fasting behaviour. We analysed data from the Kuwait Birth Cohort in which information on fasting, sociodemographic characteristics and health behaviours was collected via structured interviews between 2017 and 2021. Clinical and laboratory data were extracted from medical records. Predictors of fasting were identified using Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression with 5-fold cross-validation, followed by Poisson regression with robust standard errors. Among 1087 women with available data, 581 (53·4 %; 95 % CI 50·4 %, 56·4 %) reported fasting during pregnancy (19·5 % in the first trimester, 25·1 % in the second and 10·1 % in the third). Women who fasted had significantly lower levels of ferritin (P = 0·048), vitamin B12 (P = 0·001), erythrocytes folate (P < 0·001), 25-hydroxyvitamin D (P = 0·002) and vitamin D binding protein (P = 0·011), but higher parathyroid hormone (P = 0·011). Predictive models based on sociodemographic and clinical factors showed limited predictive ability. This study indicates that fasting during pregnancy is a common practice among women in Kuwait and is associated with lower levels of key nutrients such as vitamin D, RBC folate and vitamin B12. Fasting during pregnancy appears to be driven more by personal, religious and cultural influences than by identifiable clinical or sociodemographic characteristics.

Existing studies suggest that foods rich in phytoestrogens could reduce mortality and protect against the shortening of telomere length (TL). However, the specific phytoestrogens responsible for this effect remain unidentified. We conducted a cross-sectional study using data from the 1999–2002 US National Health and Nutrition Examination Survey. Four metabolites of soya isoflavones (daidzein, equol, genistein, O-demethylangolensin) and two metabolites of lignans (enterodiol and enterolactone) were detected. Leukocyte TL was measured. After ln-transformed, the association of phytoestrogen metabolites and leukocyte TL was assessed using multivariable linear regression. Percentage change was calculated as (eβ–1) × 100 %. Of the 2607 participants, 48·52 % were male. A 1-sd increase in urinary equol was associated with a 1·50 % (95 % CI 0·51, 2·50) increase in TL, and TL was 4·26 % (95 % CI 1·07, 7·56) longer in the highest quintile of equol compared with the lowest. Similarly, a 1-sd increase in the equol:daidzein ratio was linked to a 1·87 % (95 % CI 0·91, 2·84) rise in TL, and TL was 4·83 % (95 % CI 1·71, 8·05) longer in the highest quintile of the equol:daidzein ratio compared with the lowest. No significant association of urinary daidzein, genistein, O-demethylangolensin, enterodiol and enterolactone with TL was observed. Our findings suggested that higher levels of urinary equol and its ratio with daidzein were associated with longer leukocyte TL, highlighting the need for further research into their relationship with ageing.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease worldwide. Flavonoids may offer protective benefits, but the role of overall diet quality in modulating this remains unclear. In this cross-sectional study, we analysed 2815 participants from the Framingham Heart Study. Hepatic steatosis was defined by liver:phantom ratio < 0·33 using multidetector computed tomography. Dietary intake was assessed using a validated FFQ, and intake of six flavonoid subclasses and total flavonoid was estimated using the USDA database. Logistic regression models evaluated associations between flavonoid intake quartiles and hepatic steatosis, adjusting for demographic and lifestyle covariates, followed by additional models adjusting for a priori dietary quality indexes: the Alternative Healthy Eating Index, the Mediterranean-style diet score and the Dietary Approaches to Stop Hypertension score. Higher intake of flavonols, flavan-3-ols, anthocyanidins, flavonoid polymers and total flavonoids is associated with lower odds of hepatic steatosis (Ptrend < 0·05), with up to 40 % reduced odds at the highest quartiles before adjustment for diet quality. After adjustments, associations attenuated and lost statistical significance. The attenuation does not rule out a potential protective role of flavonoids; it may indicate that higher flavonoid intake is an important element of a broader healthy diet. Alternatively, the associations could be confounded by other components of diet which may independently reduce steatosis risk. Nonetheless, these findings underscore the importance of promoting flavonoid-rich diets in the context of overall healthy diet and support further investigation in prospective and interventional studies targeting MASLD prevention.