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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

This study aimed to evaluate adherence to the Mediterranean diet, a recognised healthy eating pattern, and the tendency towards orthorexia nervosa in professional athletes, and to examine their relationship with physical activity levels. The study was conducted with athletes (n 134) at the Turkish Olympic Preparation Center (TOHM). Data were collected using a questionnaire covering sociodemographic information, dietary habits, anthropometric measurements, the Mediterranean Diet Quality Index (KIDMED), the International Physical Activity Questionnaire-Short Form (IPAQ-SF) and the Orthorexia-11 (ORTO-11) scale assessing orthorexic tendencies. Of the participants, 17·2 % had poor dietary quality, 60·4 % moderate and 22·4 % good dietary quality. According to the ORTO-11 (cut-off ≤ 25 points), 30·6 % of athletes exhibited orthorexic tendencies. Athletes adhering to a diet had significantly higher orthorexia tendencies compared with non-dieters (P < 0·05). A significant association was found between athletic experience and orthorexic tendencies, particularly among those with 4–8 years and ≥8 years of experience (P < 0·05). Moreover, athletes consuming three main meals had significantly higher KIDMED and ORTO-11 scores than those consuming two meals (P < 0·05). No statistically significant correlation was found between the KIDMED score, ORTO-11 score and physical activity level (P > 0·05). Professional athletes showed moderate adherence to the Mediterranean diet, while certain groups displayed higher orthorexia tendencies. Diet quality and orthorexic tendencies differed significantly with eating habits such as athletic experience and meal patterns, whereas physical activity level had no effect. These findings highlight the importance of multidisciplinary nutrition strategies focusing on both performance and sustainable healthy eating behaviours.

The planetary health diet (PHD) is a mostly plant-based diet that aims to optimise human health while minimising the environmental impact of food production. Limited data exist on whether the PHD fulfils key nutritional requirements during pregnancy. This research aimed to examine the PHD in early pregnancy and how it aligns with daily nutrient intake and European Food Safety Authority (EFSA) dietary guidelines. Pregnant women (n 678) from two Irish cohorts (ROLO and MicrobeMom) were analysed, and PHD index (PHDI) scores were assigned based on data from 3-d food diaries. Women were dichotomised by the median score to create a ‘High PHDI’ (> 88·99) and a ‘Low PHDI’ group (≤ 88·99). Differences in nutrient intakes and adherence to dietary guidelines between ‘High’ and ‘Low’ PHDI groups were explored. Compared with those with a ‘Low’ score, those with a ‘High’ PHDI score reported higher intakes of dietary fibre (g/d) (17·32 (13·39, 21·08) v. 21·74 (18·28, 25·88), P < 0·001), Fe (mg/d) (10·48 (8·48, 12·82) v. 12·06 (9·48, 14·60), P < 0·001), folate (µg dietary folate equivalent per d) (250·73 (193·88, 312·45) v. 279·57 (219·43, 356·81), P < 0·001) and Ca (mg/d) (837·75 (695·36, 1056·72) v. 956·57 (751·84, 1155·03), P < 0·001). A greater proportion of women in the ‘High PHDI’ group met EFSA recommendations for dietary fibre intake (10·3 % v. 28·9 %, P < 0·001). The PHD may support maternal nutritional adequacy in pregnancy while promoting environmental sustainability. Our findings provide valuable insights that can inform future dietary recommendations for pregnancy, contributing to both maternal health and planetary well-being.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading chronic liver disease worldwide. While total SFA intake has been linked to MASLD, the contribution of specific SFA and the mechanism underlying the SFA-MASLD association remain unclear. This study evaluated the associations of individual SFA with MASLD and the mediating roles of insulin resistance (IR) and serum albumin. We used data from seven National Health and Nutrition Examination Survey (NHANES) cycles (2005–2018) in a cross-sectional analysis. Associations between individual SFA and MASLD were estimated via logistic regression with restricted cubic splines (RCS). Weighted quantile sum (WQS) and quantile g-computation (QGC) models assessed the mixture associations. Mediation analysis evaluated the proportions of these associations accounted for by serum albumin and IR. Compared with the reference group, the highest tertile of intake was associated with increased odds of MASLD for C4:0 (OR = 1·12, 95 % CI 1·01, 1·25), C6:0 (OR = 1·15, 95 % CI 1·04, 1·28), C14:0 (OR = 1·20, 95 % CI 1·08, 1·33), C16:0 (OR = 1·24, 95 % CI 1·12, 1·38) and C18:0 (OR = 1·25, 95 % CI 1·12, 1·39). RCS models revealed largely linear dose–response relationships. Both WQS and QGC indicated a positive joint association of SFA with MASLD, with C16:0 identified as a major contributor. Among SFA significantly associated with MASLD, IR accounted for 30·0–47·4 % of the associations, while serum albumin accounted for 5·9–8·0 %. Higher intakes of short- and long-chain SFA, both individually and collectively, are associated with higher odds of MASLD. IR and serum albumin may partially explain these associations. These findings support the development of precision dietary strategies targeting specific SFA for MASLD prevention.