We examined differences in characteristics between dietary supplement (DS) users and non-users in three age groups of Japanese women, including younger women (dietetic students), middle-aged women (their mothers), and older women (their grandmothers). In total, 3952 younger women (aged 18 years), 3780 middle-aged women (aged 34–60 years), and 2192 older women (aged 61–94 years) participated in this cross-sectional study in 2011 and 2012. DS use and other characteristics were self-reported using a questionnaire, and dietary intake from foods was assessed using a validated, self-administered diet history questionnaire. DS users were defined as participants who reported using DS at least once in the past month. We calculated the percentage of participants with nutrient intakes below the Estimated Average Requirement (EAR) from the Japanese Dietary Reference Intakes. The proportion of DS users was 5.7% in younger women, 24.3% in middle-aged women, and 27.7% in older women. In younger and older women, DS users were more likely to live in a city with a population of ≥ 1 million. In middle-aged women, DS users were more likely to have an education level more than high school or to be former smokers. In older women, DS users tended to have shorter sleep duration. Among the 15 nutrients examined, DS users were less likely to have intake levels below the EAR for 10 nutrients in younger women, 9 nutrients in middle-aged women, and 4 nutrients in older women. Some characteristics of Japanese female DS users differed from non-users depending on the age group.

The Healthy Eating Index (HEI) is widely used to assess diet quality, but certain contexts (e.g., pregnancy) may benefit from tailored versions. We evaluated whether the HEI’s current approach of assigning approximately equal weights to all components to compute the total score is appropriate when studying diet quality around conception. Data were from a U.S. prospective cohort of individuals who had not delivered a previous pregnancy past 20 weeks’ gestation (2010–2013, n=7882). Usual dietary intake around conception was estimated from food frequency questionnaires. Select adverse pregnancy outcomes (gestational diabetes, preeclampsia, preterm delivery, and small-for-gestational age birth) were abstracted from the medical record. We regressed each outcome on the 13 HEI-2015 component scores using SuperLearner, an ensemble machine learning method that combines predictions from multiple algorithms and avoids relying on parametric assumptions that characterize standard regression. We assessed the relative importance of each component using two permutation-based metrics: change in negative log likelihood (global influence) and absolute difference in the predicted probabilities (individual-level influence). Six of the 13 components (Greens and Beans, Saturated Fats, Total Protein Foods, Seafood and Plant Proteins, Fatty Acids, and Added Sugars) were important according to at least one metric for at least two of the four outcomes. In contrast, the Refined Grains component was not appreciably important for any outcome. These findings suggest that equal weighting of the HEI components may not be appropriate when evaluating diet quality for studies of pregnancy.

In the early history of vitamin D research most of the studies on its chemistry and function were performed with vitamin D2 which was readily obtained by UV irradiation of ergosterol from yeast. Yet, in the physiological economy of vitamin D for most vertebrates, including humans, fish and especially for birds, vitamin D3 produced in skin by solar irradiation of 7-dehydrocholesterol, is the natural form of vitamin D. Vitamin D2, as a dietary supplement, while of comparable potency to vitamin D3 in most mammals, has been found in nature only when ergosterol in fungi is inadvertently exposed to solar UV radiation. Nevertheless, some herbivorous animals, horses and elephants, seem to maintain adequate vitamin D status with vitamin D2 rather than vitamin D3. The source of that vitamin D2 has been assumed to be the traces derived from ergosterol in endophytic fungi exposed to the sun on grass being consumed. However, outdoor grazing sheep in winter maintained adequate vitamin D status with vitamin D2, yet no vitamin D2 could be detected on the grass they were consuming. Bovine rumen contents, fermenting in an artificial rumen, had an increase in vitamin D2 concentration, particularly when cellulose fibre was added as a fermentation substrate. Furthermore, mice being raised from weaning on a vitamin D-free diet had vitamin D2 in their colon contents. This review examines anaerobic microbial production of vitamin D2 in the alimentary tract, in the dark, and describes a natural function for vitamin D2 in microorganisms and potentially for gut health.

This study evaluated the psychometric properties of the Turkish version of the Comprehensive Emotional Eating Scale (CEES) and examined its associations with emotion regulation, cognitive control, cognitive flexibility, and perceived stress in adults. A cross-sectional design was conducted with 1,521 adults aged 18–74 (68% female). The CEES was adapted following standard cross-cultural guidelines, including translation, back-translation, and approval by the original scale developer. Participants also completed the Emotional Appetite Questionnaire (EMAQ), Difficulties in Emotion Regulation Scale (DERS-16), Cognitive Control and Flexibility Questionnaire (CCFQ), and Perceived Stress Scale (PSS). Confirmatory factor analysis (CFA) assessed construct validity, while internal consistency, convergent validity, and multiple linear regression analyses explored predictors of emotional eating. CFA supported a four-factor structure representing Undereating–Positive Emotions, Undereating–Negative Emotions, Overeating–Positive Emotions, and Overeating–Negative Emotions, with item loadings of 0.48–0.77; one item was removed due to low loading. Internal consistency was high (α = .88–.91), and convergent validity was confirmed via EMAQ correlations. Multiple regression analyses indicated that greater difficulties in emotion regulation, higher perceived stress, lower cognitive control and flexibility, smoking, higher Body Mass Index (BMI), and chronic disease significantly increased emotional eating. Women showed higher undereating-negative emotion and total emotional eating scores, while smoking, higher BMI, and chronic disease elevated scores on specific subscales. The Turkish CEES demonstrates robust psychometric properties and reliably captures multidimensional emotional eating in adults. Psychological and demographic factors increase emotional eating subscales and total scores, supporting the scale’s use in research and clinical settings in Türkiye.

Obtaining accurate estimates of children’s dietary intake is important because these estimates are used to characterize diet-disease relationships and inform nutrition interventions. This systematic review synthesized findings from validation studies of dietary assessment tools for children (aged 1-10 years), in which parents were proxy-reporters. Database searches (Ovid Medline, Embase, Web of Science, Cochrane) in January 2026 for validation studies of dietary assessment tools used for estimating daily intake of macronutrients and micronutrients yielded 4,545 citations. Articles were uploaded to Covidence for screening. Sixty-six articles met the inclusion criteria. Median sample size was 103. Eighty-six percent of studies (n=57) validated a food frequency questionnaire; the remainder validated dietary recalls (11%, n=8) or food diaries (2%, n=1). Many studies (67%, n=44) used another parent-proxy report tool as the reference method. For most nutrients, over a quarter of the 66 studies failed to find a significant correlation between the assessment tool and reference method. Among the 69% of analyses that did show a significant correlation, the median correlation for each nutrient ranged from 0.37 to 0.40 for macronutrients and 0.29 to 0.55 for micronutrients. Studies were limited by lack of generalizability, use of reference methods prone to error, and misalignment between the assessment tool and reference method. Overall, this review found no correlation or low-to-moderate correlations between dietary assessments and the reference method. The studies had significant methodological limitations. Future studies should validate parent-proxy report dietary assessments against objective measures, such as biomarkers. The development of novel assessment tools may also be warranted.

Honoring a patient’s wishes for end-of-life care can be challenging if the patient loses decision-making capacity and the identified alternate decision-maker will not respect the patient’s wishes. This article discusses how to proceed ethically and legally when the alternate decision-maker and care team disagree about respecting a patient’s end-of-life preferences.

The nosological status and psychopathology of delusional disorder have been a subject of debate since Kraepelin distinguished it from schizophrenia and affective psychoses. Contemporary diagnostic manuals define delusional disorder primarily by the presence of delusions, offering limited guidance for its differentiation from schizophrenia. Notably, DSM-5 introduced a major, seemingly unexplained change by allowing bizarre delusions in delusional disorder, contrary to ICD-11, prior DSM editions, and classical descriptions. This narrative review revisits the seminal works of six classical authors (Kraepelin, Jaspers, Kretschmer, Sérieux and Capgras, and De Clérambault), who shaped the concept of delusional disorder (paranoia), and their detailed clinical cases of the disorder. All considered delusional disorder to be an independent psychotic disorder, characterized by chronic, systematized, nonbizarre delusions, preservation of personality, and minimal hallucinations, with a largely intact experiential framework outside of the delusional theme. Additional features such as delusional misinterpretations, illusions, and false memories were also emphasized in the classical literature. We examined these authors’ clinical cases of delusional disorder for the presence of delusional features characteristic of schizophrenia (delusional mood, first-rank symptoms, autistic-solipsistic delusions, and double bookkeeping), which index alterations in the structure of experience rather than mere delusional content. Such delusions were rarely found in the classical clinical cases of delusional disorder. Our findings highlight psychopathological distinctions between delusional disorder and schizophrenia, suggesting that schizophrenia involves a qualitative alteration of the experiential framework that is absent in delusional disorder. These findings raise concerns about the validity of the DSM-5 change, allowing bizarre delusions in delusional disorder.