The NutriLight system presents a novel dietary approach designed to enhance health communication, promote sustainable eating habits, and address limitations in existing dietary patterns. Using a traffic light scoring system, it simplifies dietary recommendations, making them more accessible and adaptable across diverse populations. Unlike rigid diets, NutriLight categorises foods into green, yellow, and red groups, encouraging balance rather than restriction. This flexibility allows for cultural adaptations, ensuring relevance in different dietary contexts while supporting planetary health. Additionally, NutriLight mitigates the risk of nutrient deficiencies by emphasising whole, minimally processed foods and reducing overconsumption of unhealthy options. While promising, its effectiveness depends on proper implementation, localised adaptation, and long-term evaluation to confirm its health benefits. By bridging the gap between nutritional science and practical application, NutriLight has the potential to serve as an effective tool in public health nutrition, fostering healthier and more sustainable dietary choices worldwide.

Food insecurity (FIS) is a critical public health issue, particularly among older adults. This study investigates the association between FIS with diet quality and anthropometric indices in the US older adults. A cross-sectional analysis was conducted using NHANES data from 2017 to 2020, involving 2592 participants aged ≥ 60 years. FIS was assessed using the USDA Household Food Security Survey Module. Diet quality was assessed using the Healthy Eating Index (HEI)-2020 and adherence to Mediterranean diet (MedDiet) score. Anthropometric measures were calculated following standardised protocols. Multivariable logistic regression models, adjusted for demographic, socio-economic and behavioural factors examined the association between FIS and the higher quartile and tertile of anthropometric and diet quality indices, respectively. Of the participants, 27·4 % experienced FIS. FIS participants were younger and had lower education and income levels compared with FS individuals (P < 0·05). In the adjusted model, FIS was associated with lower adherence to both the Mediterranean Diet (OR: 0·48, 95 % CI: 0·31, 0·67) and HEI-2020 (OR: 0·61, 95 % CI: 0·37, 0·84), indicating poorer diet quality in older adults. In adjusted analyses, FIS was significantly associated with higher A Body Shape Index quartiles (Q3: OR: 1·44, 95 % CI: 1·06, 1·95; Q4: OR: 1·46, 95 % CI: 1·07, 2·01), the waist-to-hip ratio (Q4: OR: 1·44, 95 % CI: 1·01, 2·06) and the Conicity index (Q4: OR: 1·36, 95 % CI: 1·02, 1·81). FIS in older adults is associated with unfavourable diet quality and body composition patterns, particularly central obesity measures. Addressing FIS may mitigate health risks related to obesity and its complications.

Environmental impacts of food systems have stimulated research to examine how to create healthy diets that will be more sustainable while meeting nutrient requirements. Increasing compliance with existing food-based dietary guidelines in most jurisdictions could be a first step to improve health and reduce environmental impact. MyPlanetDiet was an all-Ireland 12-week randomised controlled trial designed to inform sustainable healthy dietary guidelines. Healthy adults (n 355) aged 18–64 years with moderate-to-high greenhouse gas emitting (GHGE) diets were recruited from three study sites on the island of Ireland. The aim of this research is to assess the relationship between dietary intakes, diet-related environmental impacts and metabolic health using baseline data collected during the MyPlanetDiet study. Dietary assessments collected using Foodbook24 were used to calculate diet-related GHGE, adherence to healthy eating guidelines (HEG) and healthy eating index (HEI) score. Anthropometrics and metabolic health markers (e.g. lipids, glucose and insulin) were included. Overall HEG adherence was low, with 43 % meeting zero or one HEG food group recommendations. Adherence to 4 + HEG food group targets was associated with 31 % lower diet-related GHGE compared with those with lowest adherence. Higher HEG adherence was associated with lower BMI and waist circumference and higher HEI scores. While our findings suggest HEG adherence is associated with positive health and environmental impacts, substantial behaviour change will be needed to meet existing HEG. Further research is needed to assess response and acceptability to HEG. However, adherence to HEG may be an important first step to reducing the environmental impact of food consumption.

Diet indices are quantitative assessments of the quality of population intake. Understanding diet quality is crucial to support health and well-being; however, knowledge of diet quality across racial groups is limited. To examine diet quality of acial groups ‘White’, ‘Black’, ‘Asian’, and ‘Other’ in the United Kingdom (U.K.) and United States (U.S.), U.K. and U.S. national survey data were used to calculate Alternative Healthy Eating Index (AHEI-2010), Diet Quality Index-International (DQI-I), and EAT-Lancet scores. ANCOVA tests compared median total quality scores across racial groups adjusting for covariates. Kruskal–Wallis tests examined differences in individual component scores. Spearman correlations identified association of diet quality scores across indices. Highest diet quality scores were reported for U.K. and U.S. Asian groups. Most noticeable differences were apparent between U.S. Asian and White/Black groups (62% Asians within highest tertile of AHEI-2010 score vs. 29% Whites; P < 0.001). All racial groups demonstrated poor diet quality in terms of sustainability; EAT-Lancet scores were <40% of maximum total score for U.S. White, Black, and Other groups. AHEI-2010 diet quality scores were moderately associated with EAT-Lancet scores, evident across all groups (r = 0.53–0.65; P < 0.001). There is a need for all groups to increase intake of wholegrains, especially Black groups (mean Wholegrain score for U.S. Black group within DQI-I was 0.60 (maximum score of 5)) as demonstrated within AHEI-2010, DQI-I, and EAT-Lancet component scores. Additionally, increased intake of vegetables and legumes and decreased intake of processed and red meat would improve the adequacy, healthiness, and sustainability of U.K. and U.S. racial diets.

No study has validated questionnaires for assessing easily calculable diet quality scores in Japan. The Brief-type self-administered Diet History Questionnaire (BDHQ) is widely used to assess dietary intake in Japan, while the Meal-based Diet History Questionnaire (MDHQ) assesses dietary intake for each meal (breakfast, lunch, dinner and snacks) and overall dietary intake. This study examined the relative validity of the BDHQ and MDHQ for assessing three diet quality scores in Japanese adults. A total of 111 women and 111 men aged 30–76 years completed the web MDHQ and BDHQ, followed by 4-non-consective-day weighed dietary records. The diet quality scores examined included the Diet Quality Score for Japanese (DQSJ), Dietary Approaches to Stop Hypertension (DASH) score and Alternate Mediterranean Diet (AMED) score. The means of the three scores for overall diet from the BDHQ were not significantly different from those from the dietary records in both sexes, whereas those from the MDHQ were higher than those from the dietary records, except for the DASH and AMED in women. Pearson’s correlation coefficients between both questionnaires and dietary records were 0·57–0·63 for DQSJ, 0·49–0·57 for DASH and 0·31–0·49 for AMED across both sexes and both questionnaires. For each meal, Pearson’s correlation coefficients between the MDHQ and dietary records ranged from 0·01 (DASH for snacks in women) to 0·55 (DQSJ for breakfast in men), with a median of 0·35. This study showed that the ability of the BDHQ and MDHQ to rank individuals was good for DQSJ and DASH and acceptable for AMED.

Beyond obesity, visceral adipose tissue (VAT) has emerged as an important predictor of chronic disease, but the role of diet quality patterns (DQP) in VAT development is not well defined. Therefore, we conducted a systematic review of how various DQP are associated with VAT via literature searches in PubMed and EMBASE. We included observational investigations in disease-free adults/adolescents that related DQP to VAT assessed by imaging methods. The studies were evaluated separately for a priori and a posteriori DQP and according to design differences. Study quality was assessed using the Risk of Bias in Non-randomised Studies of Interventions tool. Of the 1807 screened articles, thirty-five studies met the inclusion criteria. The majority of a priori indices, for example, the Healthy Eating Index, showed significant inverse associations with VAT, while only a small proportion of a posteriori patterns were related to VAT. Results did not differ substantially by the method of exposure and outcome assessment or between studies with (n 20) or without (n 15) body-size adjustment, but significant findings were more common in younger v. older individuals, USA v. other populations and investigations with moderate v. serious risk of bias. The heterogeneity of the existing literature limited the ability to quantify the magnitude of the associations across studies. These findings suggest that a high-quality diet, as assessed by a priori DQP, is generally inversely associated with VAT, but results for a posteriori DQP are less consistent. As associations persisted after adjusting for body size, diet quality may beneficially influence VAT beyond its association with obesity.

The purpose of this study was to examine the potential for sustained almond consumption to reduce HbA1c concentrations among individuals with elevated values. A 16-week randomised, parallel-arm, controlled trial was conducted. Eighty-one adults with elevated HbA1c concentrations (> 5·7 %) were randomly assigned to incorporate 2 oz of raw almonds (A: n 39) or energy-matched snacks (C: n 42) into their daily diets. Body weight, body composition, plasma lipids, HbA1c, plasma vitamin E, glycaemia (by meal tolerance test and continuous glucose monitoring), dietary intake and hedonic responses to test foods were measured at stipulated time points. Participants consuming almonds ingested 253 kcal/d more than participants in the control group (P = 0·02), but this did not result in a significant difference in body weight. No statistically significant differences were observed in HbA1c concentrations, blood chemistries, body composition or glycaemia over time or between groups. However, Healthy Eating Index scores improved within the almond group as compared with the control group (P < 0·001). Additionally, the hedonic rating of almonds within the almond group did not decline as markedly as the control group’s reduced liking of the pretzel snack. Alpha-tocopherol increased significantly, and gamma tocopherol tended to decrease in the almond group, indicating compliance with the dietary intervention. Overall, daily ingestion of 2 oz of raw almonds in a self-selected diet for 16 weeks did not alter short-term or longer-term glycaemia or HbA1c concentrations in adults with elevated HbA1c concentrations, but they were well-tolerated hedonically and improved diet quality without promoting weight gain.

Sleep apnoea is a known risk factor for cardiometabolic diseases (CMD), but it is unknown whether sleep apnoea or its symptoms contribute to increased CMD through an association with diet quality. This study assessed the association between sleep apnoea symptoms on future diet quality in the Bogalusa Heart Study (BHS). This prospective study included 445 participants who completed a sleep apnoea questionnaire in 2007–2010 and a FFQ in 2013–2016 (mean follow-up: 5·8 years; age 43·5 years; 34 % male; 71 % White/29 % Black persons). Diet quality was measured with the Alternate Healthy Eating Index (AHEI) 2010, the Healthy Eating Index (HEI) 2015 and the alternate Mediterranean diet score. Adjusted mean differences in dietary patterns by sleep apnoea risk, excessive snoring and daytime sleepiness were estimated with multivariable linear regression. Models included multi-level socio-economic factors, lifestyle and health characteristics including BMI, physical activity and depressive symptoms. Those with high sleep apnoea risk, compared with low, had lower diet quality 5·8 years later (percentage difference in AHEI (95 % CI −2·1 % (–3·5 %, −0·7 %)). Daytime sleepiness was associated with lower diet quality. After adjusting for dietary pattern scores from 2001 to 2002, having high sleep apnoea risk and excessive sleepiness were associated with 1·5 % (P < 0·05) and 3·1 % (P < 0·001) lower future AHEI scores, respectively. These findings suggest that individuals with sleep apnea or excessive sleepiness should be monitored for diet quality and targeted for dietary interventions to improve CMD risk.

The objective was to examine associations between social jetlag and diet quality among young adults in the US using nationally representative data from the 2017–2018 NHANES survey, and evaluate effect modification by gender and race/ethnicity. Social jetlag was considered ≥2-hour difference in sleep midpoint (median of bedtime and wake time) between weekends and weekdays. Diet quality was assessed with the Healthy Eating Index (HEI)-2015 and its 13 dietary components. Ordinal logistic models were run with diet scores binned into tertiles as the outcome. Models accounted for potential confounders and survey weights. Effect modification by gender and race/ethnicity was examined. The study sample included 1,356 adults aged 20–39 years. 31% of young adults had social jetlag. Overall, there were no associations between social jetlag and diet quality. However, interaction analysis revealed several associations were race-specific (P, interaction<0.05). Among Black adults, social jetlag was associated with lower overall diet quality (OR = 0.4, 95% CI 0.2, 0.8; i.e. less likely to be in higher diet quality tertiles) and more unfavourable scores on Total Vegetables (OR = 0.6, 95% CI 0.3, 1.0) and Added Sugar (i.e. OR = 0.6, 95% CI 0.4, 0.9). For Hispanic adults, social jetlag was associated with worse scores for Sodium (OR = 0.6, 95% CI 0.4, 0.9) However, White adults with social jetlag had better scores of Greens and Beans (OR = 1.9, 95% CI 1.1, 3.2). Within a nationally representative sample of US young adults, social jetlag was related to certain indicators of lower diet quality among Black and Hispanic Americans.

The rate of adult severe obesity has been continually rising in the USA. While improving diet quality has been shown to reduce the risk of obesity, few studies have explored the differences in diet quality among adults with overweight and obesity by different weight statuses along with socio-demographic factors and physical activity using data from a nationally representative survey in the USA. The main goal of the study is to assess the diet quality of adults with overweight and obesity by examining differences in the Healthy Eating Index-2015 (HEI-2015) scores, using data from the 2015–2018 National Health and Nutrition Survey. Among 6746 adults with overweight and obesity (aged ≥ 20 years), severe obesity was prevalent (27 %), particularly among females, non-Hispanic Blacks and those with lower education and income. Compared to adults with overweight, adults with severe obesity had lower HEI-2015 total scores as well as component scores for total fruits, whole fruits, greens and beans, refined grains, sodium and saturated fats. Among adults with overweight and obesity, non-Hispanic Blacks had lower diet quality than non-Hispanic Asians; females had better diet quality than males; older adults had better diet quality than younger adults; adults with a college degree and above had better diet quality than those with less than a high school degree. Socio-demographic differences in diet quality and weight status should be considered in future obesity interventions to reduce adult severe obesity in the USA.

An increasing number of studies have evaluated the association between ultra-processed foods (UPF) consumption and metabolic disorders. However, the association between UPF intake and non-alcoholic fatty liver disease (NAFLD) remains unclear. In this study, we analysed data from 6545 participants who were recruited in National Health and Nutrition Examination Surveys 2011–2018. UPF were defined in light of the NOVA food classification system and divided into quartiles based on its proportion of total weight intake. Complex logistic regression models were used to assess the association between UPF and NAFLD. Mediation analyses were conducted to reveal underlying mediators. We found that NAFLD patients consumed more UPF than controls (925·92 ± 18·08 v. 812·70 ± 14·32 g/d, P < 0·001). Dietary intake of UPF (% weight) was negatively related to the Healthy Eating Index-2015 score (Spearman r = −0·32, P < 0·001). In the multivariable model, the highest quartile compared with the lowest, the OR (95 % CI) were 1·83 (1·33, 2·53) for NAFLD (OR per 10 % increment: 1·15; 95 % CI: 1·09, 1·22; P for trend < 0·001) and 1·52 (1·12, 2·07) for insulin resistance (OR per 10 % increment: 1·11; 95 % CI: 1·05, 1·18; P for trend = 0·002). Mediation analyses revealed that poor diet quality, high saturated fat and refined grain intake partly mediated the association between UPF and NAFLD. In conclusion, high UPF intake was associated with an increased risk of NAFLD in US adults. Further prospective studies are needed to verify these findings.

Numerous observational studies have investigated associations between diet indices and health outcomes. Our aim was to systematically synthesise data that was previously summarised separately for each diet index in one umbrella review of all diet indices with sufficient evidence gained in systematic reviews and to assess the quality and strength of evidence for selected health outcomes. The MEDLINE, EMBASE and Scopus databases were systematically searched following the PRISMA guidelines through October 2021 for systematic reviews of observational studies investigating associations between adherence to diet indices and selected health outcomes (all-cause mortality, CVD incidence or mortality, type 2 diabetes mellitus incidence or mortality). Methodological quality and quality of evidence were assessed using the AMSTAR 2 and NutriGrade tools. The inclusion criteria were met by seven systematic reviews, entirely based on prospective cohort studies and reviewing five different diet indices – alternate healthy eating index (AHEI), dietary approaches to stop hypertension (DASH), dietary inflammatory index (DII), healthy eating index (HEI) and Mediterranean diet (MedDiet). All seven included systematic reviews showed that greater adherence to these diet indices reduces the risks of all-cause mortality, CVD incidence and mortality and type 2 diabetes mellitus incidence. Moderate meta-evidence was presented for AHEI and DASH for all outcomes, also for DII for all-cause mortality, CVD mortality and incidence, MedDiet for all-cause mortality and for HEI for CVD incidence and mortality. Our umbrella review provides further evidence for AHEI, DASH, DII and HEI diet indices to be used as predictors of selected health outcomes.

Evidence on the association between children’s food insecurity (FI) and dietary patterns (DPs) is scarce. This study assessed the association between children’s FI and a priori and a posteriori-defined DPs in a Portuguese population-based sample of children. A cross-sectional study including 2800 children from the 10-year-old follow-up of the Generation XXI birth cohort was performed. Data on food security status, assessed by the Self-administered Food Security Survey Module for children (SAFSSMC), dietary intake and socio-demographics were collected. A previously developed Healthy Eating Index (HEI) was adapted for this study. Using the HEI score and its food groups, linear and logistic regression models were performed. Using latent class analysis, five a posteriori-defined DPs were identified. The DPs names considered an overall picture of the DP. Food security status as a categorical (food security/FI) and continuous variable (SAFSSMC raw score: higher scores representing higher FI) was used. Multinomial logistic regression models were used to assess the association between food security status and DPs. Children’s FI (9·4 %) was inversely associated with the HEI score (β=–0·695;95%CI:–1·154,–0·235), representing worse diet quality. A higher SAFSSMC raw score was associated with low fruit and vegetables (OR=1·089;95%CI:1·023,1·159) and seafood and eggs consumption (OR=1·073;95%CI:1·009,1·142) and high consumption of meat and meat products (OR=1·091;95%CI:1·026,1·160), salty snacks (OR=1·067;95%CI:1·003,1·136) and soft drinks (OR=1·097;95%CI:1·031,1·168). The SAFSSMC raw score was positively associated with ‘Low consumption’ (OR=1·119;95%CI:1·016,1·232), ‘Energy-dense foods’ (OR=1·155;95%CI:1·028,1·298) and ‘Snacking’ (OR=1·119;95%CI:1·006,1·245) DPs. FI was associated with worse dietary choices. Intervention strategies targeting food insecure children should be developed to promote healthy dietary habits.

For an optimal performance, soccer players and referees need to consume a high-quality diet. The Healthy Eating Index (HEI) is a tool that can estimate diet quality and has been shown to be associated with body composition. The aims of the present study were first to determine the HEI-2015 score of the diets consumed by athletes and second its association with different body composition parameters of athletes. We conducted a cross-sectional study on 198 soccer players and referees. Dietary intakes were recorded using a validated food frequency questionnaire (FFQ), and HEI scores were calculated. Body composition parameters were measured using the bioelectrical impedance analysis. The mean score for the HEI-2015 was 65⋅04. A multiple linear regression model showed significant associations of the HEI-2015 score with percent body fat (PBF), percent muscle mass (PMM), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) in male soccer players aged <18 years, body mass index (BMI) in male soccer players aged ≥18 years and BMI and waist-to-height ratio (WHtR) in male soccer referees after adjustment for covariates (P < 0⋅05). The mean overall score for the HEI-2015 shows that Iranian soccer players and referees have an acceptable quality of diet. We also found significant associations between the HEI-2015 score and different body composition parameters in male soccer players and referees but we did not find any significant association in female athletes (P > 0⋅05).

Some evidence suggests that breast-feeding may modify food preferences in the later years of life. The present study aimed to provide a systematic review of observational studies investigating the association between exposure to breast milk and its duration with data-driven or hypothesis-driven (or diet quality scores) dietary patterns over 1 year of age. The databases of PubMed, Scopus and Web of Science were searched for observational studies published from January 2010 until July 2021, which led to the identification of twenty-two eligible articles. There was considerable heterogeneity between studies in terms of assessment of exposure and outcome. Of the eleven studies that assessed data-driven dietary patterns, ten reported a significant association for at least one identified dietary pattern. Overall, being breast-fed and a longer duration of any/exclusive breast-feeding were associated with higher scores on healthy dietary patterns characterised mainly by high loadings of fruits, vegetables and whole grains. In comparison, a negative association was found for unhealthy dietary patterns rich in foods with high content of added sugar, salt and saturated fats. In terms of diet quality scores, nine out of eleven studies reported a significant positive association between the duration of any breast-feeding and adherence to recommended healthy diets or dietary guidelines. In conclusion, the evidence from this review was generally in support of the hypothesis indicating breast-feeding is associated with healthy dietary patterns at later ages. However, due to the methodological limitations in the available studies, further research is warranted to elucidate solid evidence on this topic.

Poor dietary quality is a major contributor to malnutrition and disease burden in Vietnam, necessitating the development of a tool for improving dietary quality. Food-based dietary guidelines (FBDGs) have been proposed to do this by providing specific, culturally appropriate and actionable recommendations. We developed the Vietnamese Healthy Eating Index (VHEI) to assess the adherence to the 2016–2020 Vietnamese FBDGs and the dietary quality of the general Vietnamese population. This VHEI consists of eight component scores, ‘grains’, ‘protein foods’, ‘vegetables’, ‘fruits’, ‘dairy’, ‘fats and oils’, ‘sugar and sweets’ and ‘salt and sauces’, representing the recommendations in the FBDGs. Each component score ranges from 0 to 10, resulting in a total VHEI score between 0 (lowest adherence) and 80 (highest adherence). The VHEI was calculated using dietary intake data from the Vietnamese General Nutrition Survey 2009–2010 (n = 8225 households). Associations of the VHEI with socio-demographic characteristics, energy and nutrient intakes and food group consumptions were examined. The results showed that the mean and standard deviation score of the VHEI was 43⋅3 ± 8⋅1. The component ‘sugar and sweets’ scored the highest (9⋅8 ± 1⋅1), whereas the component ‘dairy’ scored the lowest (0⋅6 ± 1⋅6). The intake of micronutrients was positively associated with the total VHEI, both before and after adjustment for energy intake. In conclusion, the VHEI is a valuable measure of dietary quality for the Vietnamese population regarding their adherence to the FBDGs.

The purpose of this study was to assess impact of different volumes of exercise as well as cumulative moderate to vigorous physical activity (MVPA) on energy intake (EI) and diet quality, as assessed by the Healthy Eating Index-2010(HEI-2010), across a 12-month weight maintenance intervention. Participants were asked to attend group behavioural sessions, eat a diet designed for weight maintenance and exercise either 150, 225 or 300 min/week. Dietary intake was assessed by 3-d food records, and MVPA was assessed by accelerometry. Two hundred and twenty-four participants (42·5 years of age, 82 % female) provided valid dietary data for at least one time point. There was no evidence of group differences in EI, total HEI-2010 score or any of the HEI-2010 component scores (all P > 0·05). After adjusting for age, sex, time, group and group-by-time interactions, there was an effect of cumulative MVPA on EI (1·08, P = 0·04), total HEI-2010 scores (–0·02, P = 0·003), Na (–0·006, P = 0·002) and empty energy scores (–0·007, P = 0·004. There was evidence of a small relationship between cumulative daily EI and weight (β: 0·00187, 95 % CI 0·001, P = 0·003). However, there was no evidence for a relationship between HEI total score (β: −0·006, 95 % CI 0·07, 0·06) or component scores (all P > 0·05) and change in weight across time. The results of this study suggest that increased cumulative MVPA is associated with clinically insignificant increases in EI and decreases in HEI.