Kids SIPsmartER is a school-based behavioural intervention for rural Appalachia middle school students with an integrated two-way short message service (SMS) strategy for caregivers. When tested in a cluster randomized controlled trial, the intervention led to significant improvements in sugar-sweetened beverage (SSB) consumption among students and caregivers. This study explores changes in secondary caregiver outcomes, including changes in caregiver SSB-related theory of planned behaviour constructs (affective attitudes, instrumental attitudes, subjective norms, perceived behavioural control, and intentions), parenting practices, and the home environment. Participants included 220 caregivers (93% female, 88% White, 95% non-Hispanic, mean age 40.6) in Virginia and West Virginia at baseline and 7 months post-intervention. Relative to control caregivers (n = 102), intervention caregivers (n = 118) showed statistically significant improvements in instrumental attitudes (Coef.= 0.53, 95% CI [0.04, 1.01], p = 0.033), behavioural intentions (Coef.=0.46, 95% CI [0.05, 0.88], p = 0.027), parenting practices (Coef. = 0.22, 95% CI [0.11, 0.33], p < 0.001), and total home SSB availability (Coef. = –0.25, 95% CI [–0.39, –0.11], p < 0.001), with specific improvements for sweetened juice drinks (Coef. = –0.18, 95% CI [–0.35, –0.01], p = 0.043) and regular soda/soft drinks (Coef. = –0.31, 95% CI [–0.55, –0.07], p = 0.010). In contrast, there were no significant between group changes for affective attitudes, subjective norms, or perceived behavioural control. Our findings highlight future research areas and fill gaps in intervention literature. This study is among the few to develop and evaluate a scalable, theory-based caregiver SMS component in a rural, school-based intervention. Combined with evidence that Kids SIPsmartER improved SSB behaviours, our results emphasize the potential of theory-guided SMS interventions to impact SSB-related outcomes.

Trial registration: Clincialtrials.gov: NCT03740113.

Despite the multiple advantages of 25-hydroxyvitamin D (calcifediol or 25(OH)D) compared to cholecalciferol, it is used sparingly. This study was planned to assess the safety and efficacy of supplementing daily 25 µg of calcifediol capsules vis-a-vis 100 µg (4000 IU) of cholecalciferol sachets in apparently healthy individuals with vitamin D deficiency in Chandigarh, India (latitude 30.7° North, 76.8° East). It was a prospective, interventional study to evaluate the effects of calcifediol vis-a-vis cholecalciferol. Following initial screening of 70 subjects in each group, 62 were included in the calcifediol and 41 in the cholecalciferol group. Forty-six from calcifediol and 37 from cholecalciferol group completed the 6-month follow up. There was a significant increase in serum 25(OH)D (355% in cholecalciferol & 574% in calcifediol groups, respectively, p < 0.001) and 1,25 (OH)2D (p < 0.001) with a marked decrease in iPTH (p < 0.001) and ALP (p = 0.016) in both groups. Though serum ALP decreased significantly more in the calcifediol group than the cholecalciferol group, no appreciable difference in other biochemical parameters was noted between the groups. No episodes of hypercalcaemia or incidence of new renal stone disease were observed during follow-up. However, hypercalciuria (spot urine calcium creatinine > 0.2 mg/mg) was noted in 8/46 individuals in the calcifediol group and 5/37 individuals in the cholecalciferol group at final visit with no significant difference between two groups. This study establishes the efficacy and safety of correcting vitamin D deficiency with daily 25 µg calcifediol capsules as an alternative to 4000 IU (100 µg) cholecalciferol sachets.

Maintaining appetite in older adults is important for preventing malnutrition. Previous studies have shown seasonal variations in dietary intake, suggesting that appetite itself may vary with the seasons. Nevertheless, few studies have directly examined seasonal changes in appetite in older adults, particularly those living alone, who are at higher risk of malnutrition. Thus, the purpose of the present study was to identify when appetite declines throughout the year in older adults living alone and with others. Of the 60 adults aged 65 and older who participated in the study, 57 completed the longitudinal study over four seasons. Appetite for each season was assessed using the Simple Nutritional Appetite Questionnaire (SNAQ) and the visual analogue scale for hunger, satiety, and expectation of food intake. Nutritional status was assessed using the Mini Nutritional Assessment and the Food Frequency Questionnaire. The living arrangements of the participants were determined based on whether they were living alone or with others. The stratified analysis revealed seasonal changes in SNAQ scores exclusively among individuals living alone (p = 0.029, effect size = 0.280), who exhibited diminished appetite during summer compared to winter (p = 0.026, 95% CI: 0.076–1.258). No seasonal variation in appetite or nutritional status was observed in those living with others (p > 0.05). These findings highlight the importance of an approach that considers living arrangement and seasonality to ensure that older people maintain adequate appetite status throughout the year.

Alpha-ketoglutarate (AKG) is a well-known intermediate of the tricarboxylic acid cycle and plays an important role in the catabolism of branched-chain amino acids (BCAAs: leucine, isoleucine, and valine). While previous study suggested that AKG enhances glucose metabolism, its effect on the adaptation of muscles and adipocytes has not been well studied in diabetic condition. This study aimed to determine whether AKG improves glucose metabolism in the skeletal muscles and adipose tissues in diabetic mice. Male institute of cancer research mice were divided into control, diabetic, and diabetic + AKG groups. Diabetes (DM) was induced by a high fat diet consumption and streptozotocin (STZ) injection. Mice in the DM + AKG group were administered 1% AKG in drinking water for 6 weeks. The non-fasting plasma glucose level was significantly higher in the diabetic group than that in the control and DM + AKG groups (P < 0.05). No significant difference was observed in glucose transporter 4 (GLUT4) protein levels in the muscles between the DM and DM + AKG groups. AKG supplementation attenuated the decrease in peroxisome proliferator-activated receptor γ coactivator 1 alpha and GLUT4 protein levels in inguinal and epididymal adipose tissues in diabetic condition. In conclusion, the study findings suggested that AKG supplementation increased protein levels related to mitochondrial biogenesis and glucose transporters in adipocyte tissue accompanied with improved whole-body glucose metabolism in STZ and high-fat diet-induced diabetic mice.

Promoting fruit and vegetable (F&V) consumption is a public health priority. This study assessed compliance with the international recommendation of consuming at least 400g of F&V daily among Mexican adults and analysed its association with the five stages of behaviour change from the Transtheoretical Model (Precontemplation, Contemplation, Preparation for action, Action, and Maintenance). Using data from 5203 adults (ages 20–59) in the 2016 National Health and Nutrition Survey, dietary intake was collected via a food frequency questionnaire. Compliance was defined dichotomously (Yes/No), and readiness to change was assessed using a specific survey module. Multiple logistic regression models examined the association between stages of change and compliance, adjusting for demographic, socioeconomic, and health characteristics, as well as perceived barriers and self-efficacy. Nationally, 26.3% of adults met the F&V recommendation. Compliance was significantly higher among individuals in the Preparation for action (OR 3.62, 95% CI: 1.82–7.19), Action (OR 4.50, 95% CI: 1.8–11.25), and Maintenance (OR 9.54, 95% CI: 4.76–19.13) than those in the Precontemplation stage. Higher compliance was also significantly associated with greater self-efficacy (OR 1.86, 95% CI: 1.4–2.47), being in the highest socioeconomic tertile (OR 1.71, 95% CI: 1.25–2.33), and living in the central region (OR 1.70, 95% CI: 1.18–2.45). Conversely, individuals reporting a dislike for vegetables were less likely to meet recommendations (OR 0.67, 95% CI: 0.48–0.94). These findings highlight the value of developing stage-tailored interventions that consider both psychological and structural barriers to improve F&V consumption.

A growing body of evidence shows an association between in utero Ramadan exposure and negative long-term consequences. Nonetheless, there is a scarcity of studies utilizing clinical measures in adults. This study investigates a possible association between in utero Ramadan exposure and mean arterial pressure (MAP) as well as random blood glucose (RBG) measures in the adult offspring. Using cross-sectional data from the Southeast Asia community observatory health and demographic surveillance system (SEACO) in Malaysia for two survey rounds (year 2013 and 2018), we compared MAP and RBG of in utero Ramadan-exposed Muslims with unexposed Muslims and non-Muslims. In utero Ramadan exposure was estimated based on the overlap between pregnancy (estimated from birth dates) and Ramadan periods. We conducted difference-in-differences analyses adjusted for age and birth months (seasonal effects). A total of 20,575 participants aged 35 or older were included in the analysis, comprising 12,696 Muslims and 7,879 non-Muslims. Difference-in-differences analyses revealed no statistically significant association between in utero Ramadan exposure and MAP, or between in utero Ramadan and RBG. These findings persisted in additional analyses examining the timing of Ramadan exposure during pregnancy.

The weekly iron and folic acid supplementation (WIFAS) programme is a school-based initiative designed to reduce iron and folate deficiency anaemia among adolescent girls. In Ethiopia, donor-supported pilot programmes are implementing WIFAS in schools, but evaluations of its demand- and supply-side barriers and facilitators remain limited. This study aimed to explore these barriers and facilitators in the Sidama Region of Ethiopia. An exploratory qualitative study collected data from ten WIFAS-targeted schools using key informant interviews (KIIs) and focus group discussions (FGDs). Participants included purposively selected school directors, WIFAS-trained teachers, health centre heads, district health and education office nutrition focal points, and regional health and education bureau delegates. Ten FGDs were conducted with adolescent girls and their mothers. Thematic analysis was performed using Open Code software to identify emerging themes. This study identified low awareness of iron and folic acid (IFA) tablets, negative community perceptions, fear of side effects, supplementation interruptions due to school closures, and inadequate coverage as key barriers. Structural barriers included poor programme coordination, weak supply chain management, and water scarcity. Facilitators included free IFA tablet distribution, health extension workers’ involvement in awareness campaigns, positive testimonials, local leader support, training, and regular supervision. The WIFAS programme implemented in schools of the Sidama Region faces programmatic and structural barriers. However, facilitators like free IFA distribution, health extension worker involvement, and community support offer opportunities for improvement. These findings highlight the need for addressing barriers while leveraging existing facilitators for enhancing programme success.

Saturated fatty acids, particularly palmitic acid (PA), promote inflammation and contribute to chronic diseases such as type 2 diabetes and cardiovascular disease. PA induces interleukin-1 beta (IL-1β) production in lipopolysaccharide (LPS)-primed macrophages via NLRP3 inflammasome activation; but the underlying mechanism remains unclear. This study investigates whether PA-induced IL-1β production involves cytosolic potassium (K+) depletion. In LPS-primed macrophages, treatment with PA conjugated to bovine serum albumin (PA-BSA) significantly reduced cytosolic K+ levels and increased IL-1β production 2.4-fold. Stearic acid-BSA produced similar effects, whereas BSA-bound oleic, linoleic and docosahexaenoic acids had minimal impact. Voltage-gated potassium (Kv) channel blockers, 4-aminopyridine and tetraethylammonium chloride, attenuated PA-BSA-induced K+ efflux and IL-1β production in LPS-primed macrophages, implicating Kv channels as key mediators. These findings reveal a novel inflammatory pathway in which PA-BSA promotes IL-1β production via Kv channel-dependent K+ efflux, highlighting a mechanistic link between saturated fatty acid exposure and inflammatory signalling.

Consumers tend to perceive certain foods as more natural and in turn as more nutritious. Thus, this study aimed to evaluate the nutritional quality, the degree of naturalness, and their association with animal-based and plant-based food products. A total of 1275 food products were collected by the Food Quality Observatory in Québec (Canada) between 2018 and 2022. These products were divided into five categories: sliced processed meats (n = 477), yogurts and dairy desserts (n = 344), sausages (n = 266), processed cheese products (n = 96) and plant-based alternatives (n = 92) within these four categories. The overall nutritional quality was evaluated using the Nutri-Score and the front-of-package (FOP) nutrition symbol recently implemented in Canada, while the degree of naturalness was measured using the Food Naturalness Index (FNI). Yogurts and dairy desserts as well as plant-based alternatives had lower Nutri-Score and thus, higher nutritional quality compared to other food categories. The FOP symbol for foods high in saturated fat or sodium was more common in sliced processed meats and sausages. FNI scores were higher in processed cheese products than in other categories, indicating a greater degree of naturalness. Correlations between nutritional quality and food naturalness varied depending on the food category and the nutrient profiling model, with Spearman coefficients being positive or negative and ranging from weak to moderate. This study supports the idea that food naturalness and nutritional quality offer complementary information depending on the food category. Further research in other food categories would help to better understand the associations between the two concepts.

This scoping review provides an overview of the impact of fruit and vegetable (FAV) consumption on cognitive function in adolescents and young adults between January 2014 and February 2024. A comprehensive search across six databases, CINAHL, PubMed-MEDLINE, ProQuest, Web of Science, Scopus, and Embase, identified 5,181 articles, of which six met the inclusion criteria after deduplication and screening. This scoping review focused on individuals aged 11–35 years in schools, colleges, universities, and communities. Following a descriptive and narrative synthesis of the data, tables and figures were used to present the findings. Across the six included studies, most consistently demonstrated a positive association between higher fruit and vegetable (FAV) intake and improved cognitive performance among adolescents and young adults. This association was evident in both cross-sectional and longitudinal studies, with stronger effects observed for whole fruits and vegetables high in fibre and polyphenols. Cognitive domains positively impacted included psychomotor speed, memory, attention, and mood. However, findings varied by type of food and cognitive domain; while whole FAVs were generally beneficial, results for fruit juice were mixed—some studies showed acute benefits. Differences in study designs, dietary assessment tools, and cognitive measures contributed to variability. Despite these inconsistencies, the overall trend supports a beneficial role of FAV consumption in promoting cognitive health during adolescence and early adulthood. This review demonstrates that increased fruit and vegetable consumption is consistently linked to improved cognitive function in adolescents and young adults. However, further research is needed to establish its long-term effects on cognitive ageing and disease prevention

This study aimed to develop and validate a questionnaire that investigates sugar-related eating behaviour, excessive consumption, and addictive-like eating. This questionnaire was validated using a rigorous process assessing content validity, face validity, reliability testing, feasibility testing, and construct validity. Spearman’s correlation coefficients and Cronbach’s alpha were used to assess reliability. Feasibility testing was used to further validate and confirm the scoring/categorisation of ‘low’, ‘medium’, and ‘high’ scorers for use in future research. Exploratory factor analysis and reliability analysis were used to determine underlying latent factors and assess construct validity. Content validity was assessed by health professionals (n = 16), face validity was assessed by the lay public who had no expertise in nutrition or addiction (n = 20). Reliability (n = 54), repeat reliability (n = 50), and feasibility (n = 113) testing were assessed with a sample from the lay public. Spearman’s correlation coefficients were in the range of 0.58–0.91 and were statistically significant (P < 0.001), indicating good temporal stability within the questionnaire. Cronbach’s alpha coefficients were in the range of 0.62–0.93, indicating good internal consistency. Feasibility testing confirmed the use of calculating an ‘average total score’ from the data set and splitting the data set into tertiles: low, medium, and high scorers. Exploratory factor analysis confirmed three latent factors: F1: Compulsive Eating; F2: Comfort Eating; and F3: Withdrawal. Results suggest the questionnaire is highly reliable and was successfully validated. This questionnaire can be used in research to investigate problematic and addictive-like eating behaviour and its effects on ill health.

Accurate assessment of an individual’s diet is vital to study the effect of diet on health. Image-based methods, which use images as input, may improve the reliability of dietary assessment. We developed an iOS application that uses computer vision to identify food from images. This study aimed to assess the accuracy of energy intake (EIapp) estimates from the application by comparing them to estimated energy expenditure (EE) and to the EI estimates from a validated dietary assessment tool, the 24-h recall (EIrecall). Participants were recruited from a randomised controlled trial called He Rourou Whai Painga. Participants recorded all intake over 7 d using the application, which provided a mean daily EI; this was compared to the EI estimated by two 24-h recalls. The EI from the application and the recalls were compared to EE, estimated using indirect calorimetry and wrist-worn accelerometry. EI estimates from the application and the 24-h recalls were lower than EE, with a mean bias of -1814 kJ (95% CI -3012 to -615, p = 0.005) and -1715 kJ (95% CI -3237 to -193, p = 0.029), respectively. The mean bias between EI from the application and the 24-h recall was 783 kJ (95% CI -875 to 2441, p = 0.33). This suggests that the EI estimates from the application are comparable to the 24-h recall method, a validated and widely used tool in nutritional research.

Dietary fibre can modify colostrum and milk composition in sows. Bile acids (BA) aid in fat digestion and lipid absorption and are important signalling molecules for the digestive tract. The aim of this study was to determine BA concentration in colostrum from sows fed two different sources of dietary fibre during gestation and lactation and from the intestinal digesta of their 4-6-days-old suckling offspring. Twenty sows were fed diets enriched with either 15% high-fermentable sugar beet pulp (SBP, n = 10) or 15% low-fermentable lignocellulose (LNC, n = 10). Sow colostrum, piglet gallbladder content, ileum and colon digesta were assessed for BA using high-performance liquid chromatography coupled to triple-quadrupole mass spectrometry. In colostrum, lithocholic acid and oxolithocholic acid were higher in sows fed SBP vs. LNC (p = 0.005 and p = 0.003, respectively), while 3α,7α,12α-trihydroxycholestanoic acid and glycohyodeoxycholic acid were higher in colostrum from sows fed LNC vs. SBP (p = 0.039, p = 0.002, respectively). In the piglet bile, cholic acid and taurodeoxycholic acid were higher in SBP vs. LNC group (p = 0.02, p = 0.001, respectively), while taurochenodeoxycholic acid was higher in LNC vs. SBP group (p = 0.035). In the piglet ileum digesta, lithocholic acid was higher in SBP vs. LNC (p = 0.015). In the piglet colon digesta, lithocholic acid and ursodeoxycholic acid were higher in SBP vs. LNC (p = 0.001 and p = 0.007, respectively). Addition of specific dietary fibres to sow diets differentially influences the BA in colostrum. Dietary fibres in sow diets can impact on the intestinal BA composition in piglets with a possible consequence on the digestive physiology and health in the offspring.

The multilevel dimensions of sustainable diets associating food systems, public health, environmental sustainability, and culture are presented in this paper. It begins by defining sustainable diets as those that are healthful, have low environmental impacts, are affordable, and culturally acceptable. The discussion includes the history of research on sustainable diets, from initial studies focused on environmental impacts to more recent, comprehensive frameworks that integrate affordability, cultural relevance, and nutritional adequacy as key dimensions of diet sustainability. In addition, the paper highlights recent innovations, such as the Planetary Health Diet of EAT–Lancet and the SHARP model, and the conflicts and optimum trade-offs between sustainability and nutrition, particularly within low- and middle-income countries. Case descriptions of Mediterranean Diet with a focus on Traditional Lebanese Diet, and African Indigenous Foods demonstrate culturally confined dietary patterns associated with sustainability objectives. These examples show that sustainable diets are not a single set of prescriptions, but a series of multiple pathways that are shaped by local food environments, ecological belts, and sociocultural heritages. The paper also describes major policy and governance activities necessary to promote sustainable diets. Finally, the paper addresses measurement challenges and advocates for better indicator options to measure sustainable food systems in all their facets and for participatory and context-specific approaches. The discussion concludes that fairer and culturally diverse inclusion strategies, system change, and political determination are imperative in achieving sustainable diets. Diets able to sustain are posited as agents capable of driving the 2030 agenda, enhancing planetary health and social integrity.

This paper examines associations between maternal exposure to a radio programme, Bhanchhin Aama (Mother Knows Best), and the programme’s most promoted maternal and child nutrition-related practices, using the Nepal Demographic and Health Survey (NDHS) from 2022. We limited our sample to mothers of children less than 2 years (n = 1,933). The primary exposure variable was whether the mother listened to the Bhanchhin Aama radio programme. The five primary outcomes were: maternal dietary diversity, maternal use of modern family planning methods, exclusive breastfeeding (EBF) of children less than 6 months, dietary diversity among children 6 to 24 months, and participation in growth monitoring and promotion among children 0 to 24 months. Descriptive analyses followed by logistic regression models, adjusted for potentially confounding factors and clustering, were conducted. Maternal exposure to Bhanchhin Aama was associated with nearly 70% higher odds of meeting both maternal (OR: 1.67; p: <0.001; CI: 1.26–2.21) and child minimum dietary diversity (OR: 1.70; p: 0.005; CI: 1.18–2.45), as well as 83% higher odds of a child participating in growth monitoring and promotion (OR: 1.83; p: 0.001; CI: 1.28–2.63). No associations were found for use of modern family planning methods and EBF. These findings suggests that radio programmes may be an effective tool to improve some maternal and child nutrition-related practices. Further research is needed to understand why certain behaviours are modifiable from this type of intervention versus others that are not and for which population groups this intervention would be most effective.

Food insecurity is a global issue. The objective is to summarise the literature identifying the main outcomes related to out-of-school hours interventions that provide food for low-income families with school-aged children, how they impact school-aged children and their families, and to identify gaps in knowledge. This review covered the main types and dimensions proposed in the literature. One author independently selected the studies, and an independent reviewer randomly reviewed them. Any paper meeting the inclusion criteria was considered regardless of geographical location. Papers were predominantly from the US, UK and Australia, including school-aged children from low-income families. Ninety-four articles were included relating to holiday clubs (n = 38), breakfast clubs (n = 45) and after-school clubs (n = 11). Key outcomes were healthy eating, academic, social, physical activity, nutritional education and financial outcomes. Clubs were consistent regarding the positive social and financial outcomes. There was variation in the primary aim, either to improve healthy eating or to feed children, regardless of nutritional quality. None of the studies reported children’s health outcomes. This review identified the key outcomes of interventions for low-income families outside of school hours in the literature. It highlights the consistent positive social outcomes across the three intervention types and the discrepancy in the nutritional value of the food provided. Few studies examined the attainment impact of holiday clubs, with no evidence on how they could impact term-time attendance. This highlights the need to analyse secondary data to understand further the attainment and attendance impact on children attending these interventions over time.

Male volleyball athletes may be at risk of inadequate energy and carbohydrate intake. This may increase their risk of relative energy deficiency in sport (REDs) and impair a variety of physiological and psychological systems involved with performance and health. This study explored the eating behaviours and diet quality of international elite volleyball male athletes and their association on hormones associated with acute energy deficit and primary serum REDs indicators outlined in the International Olympic Committee REDs Clinical Assessment Tool 2. Methods: Using a retrospective design, 30 male athletes from a national indoor volleyball programme were assessed using DXA bone mineral density, hematological analysis, anthropometry, restrained eating behaviour via the Three-Factor Eating Questionnaire-R18 and the Athlete Diet Index (ADI) questionnaire. Results: All participants met or exceeded dietary recommendations for health and sport with ADI mean score of 95.2/125 ± 10.5. Restraint eating was inversely associated with insulin (r = − 0.37; p  < 0.05). Both the ADI total and core nutrition sub-scores were inversely associated with free-triiodothyronine (r = − 0.58; p < 0.01) but not with total testosterone, insulin or leptin. Conclusion: Male volleyball athletes at risk of inadequate energy intake may not necessarily demonstrate signs of poor diet quality.

There is increased interest in self-selected exclusionary diet patterns, specifically vegetarian, vegan, and gluten-free (GF) diets, but there is a lack of research exploring the beliefs and behaviours surrounding these diets in Canadians capable of bearing children (CCBC). The goal of this study was to explore the beliefs and behaviours of CCBC who follow vegetarian, vegan, and/or GF diets using mixed methods. A self-administered online Qualtrics™ survey containing 102 questions was conducted using open text and closed format questions. Continuous variables were summarized using mean and standard deviation while percentages were used to summarize categorical variables. Qualitative data was analysed using thematic analysis. A total of 271 CCBC between 18–45 years of age were analysed, with 27%, 22%, and 3.7% indicating they followed a vegan, vegetarian, and/or GF diet, respectively. Three main themes emerged that influenced CCBC beliefs about their chosen diet. The belief that these diets are healthy or could impart health in some way, was the main reason for following their chosen diet, especially in those who identified as vegetarian. Ethical/moral concerns, primarily around animal welfare and the environment, was the second theme for following their chosen dietary pattern, especially amongst those who identified as vegan. Perception of social judgement in the forms of criticism, guilt, and isolation were noted by some CCBC, with family, friends, and colleagues interacting differently with them because of their dietary choices. These findings serve to enhance our understanding of the beliefs and behaviours of CCBC who choose to follow exclusionary diets.