Malnutrition is a serious condition impacting the health, functionality, and quality of life of older adults living in the community. This article provides the history, context, and suggestions for better addressing it in the United States. It briefly reviews the prevalence of malnutrition associated with undernutrition in the American older adult population and why it is of concern. Malnutrition screening and assessment tools are then described. Next, it turns to how Older Americans Act (OAA) nutrition programs are addressing malnutrition today. Finally, practical steps are outlined to better identify and intervene to eliminate or at least ameliorate malnutrition among older adults. They include strengthened linkages between the OAA social service infrastructure already in place and the broader community healthcare and social services sectors.
Private sector employees are frequently exposed to stressful situations like long working hours, harsh deadlines, and high sedentary time. These influence their diets, making them vulnerable to noncommunicable diseases (NCDs). The current study aimed at assessing the diets of sedentary employees from 2 regions of India: (1) Delhi-National Capital Region (NCR), (2) Bengaluru. This would help in understanding the dietary patterns of employees. Employees (n=390) were enrolled from 17 worksites in this cross-sectional study. Sociodemographic and dietary data (using 2-day 24-hour recall and Food frequency questionnaire (FFQ) were collected. DietCal software was used to estimate the nutrient intakes, which were compared with the estimated average requirements (EAR). Ultraprocessed foods (UPF) intake was assessed using the NOVA-UPF screener. Statistical analysis was conducted using MS-Excel and STATA. Both cities had similar sociodemographics. A total of 4%, 60%, and 40% did not fall within the recommended ranges for percentage calories from proteins, fats and carbohydrates, respectively. The prevalence of inadequacy for micronutrients was also high (calcium: 70%, zinc: 99%, riboflavin: 998%, niacin: 74%, folate: 85.%, ascorbic acid: 54%, vitamin B 12 : 93% and retinol: 59%), with more Bengaluru subjects contributing to this prevalence ( P <0.05). Eighty-nine percent had sodium intakes that exceeded the recommended limit, while only 3% had potassium intakes at or above the recommended intake. This indicated poor diets among subjects. A higher percentage of Delhi subjects consumed UPFs (76%) than Bengaluru (48.%). Subjects had poor nutrient intake, with high fat and salt intake, and processed/fast food consumption. Educating employees about healthy diets and ensuring healthier food environments could reduce the NCD burden.
Extra virgin olive oil (EVOO) is a central component of traditional dietary patterns such as the Mediterranean diet and has been extensively investigated for its potential health benefits. Numerous epidemiological studies, randomized trials, and mechanistic investigations associate EVOO consumption with favorable effects on cardiovascular risk factors, inflammation, endothelial function, and overall mortality. Despite this body of evidence, some influential proponents of no-oil whole-food plant-based diets recommend eliminating all added oils, including EVOO, often citing concerns related to caloric density, nutrient displacement, and vascular impairment. As such views gain increasing visibility, a careful evaluation of the scientific evidence underlying these claims is warranted. This manuscript examines 10 commonly cited arguments against EVOO and evaluates them in the context of published research on dietary fats, olive oil, and cardiometabolic health. The analysis indicates that none of the claims used to discourage EVOO consumption are supported by the broader scientific literature.
The safety of foods and their ingredients is paramount. Several regulatory approaches are used to assess ingredient safety. One of those approaches is the Generally Recognized As Safe (GRAS) process, a voluntary process implemented in 1997. This process requires extensive review by experts recognized for their training and experience across the disciplines required to assess ingredient safety. The data used to assess ingredient safety are publicly available, enabling an expert panel to achieve a consensus on its safety for the intended use and population. This approach was codified in the 2016 final ruling of GRAS. In the decades since GRAS was implemented, the FDA has withdrawn GRAS status for a few ingredients: cyclamate (1969), partially hydrogenated vegetable oil (2015), triclosan and triclocarban (packaging components) (2016), and artificial trans-fatty acids and select flavorings (2018). Each of these was reviewed by the FDA before its use in food-based applications. Despite this rich history of ensuring safe foods and food ingredients, there is a current movement to change the GRAS affirmation process, which many contend creates a regulatory loophole that compromises public health. The history and processes of GRAS are presented, and the future of GRAS assessment is summarized.
Abstract The increasing popularity of vegan and vegetarian diets highlights the need for dietetic professionals to provide evidence-based guidance on optimizing nutrient intake. While plant-based diets are associated with numerous health benefits, including reduced risk of ischemic heart disease, type 2 diabetes, several gastrointestinal disorders, and certain cancers, they may also predispose some individuals, particularly vegans, to nutrient insufficiency. This manuscript provides practical strategies that will help to ensure nutrient adequacy in vegans and vegetarians. Vitamin B 12 (B 12 ) deficiency remains a global concern, with studies showing high prevalence among all types of vegetarians, particularly vegans. Older vegan and vegetarian adults are at even higher risk of deficiency due to age-related gastrointestinal changes that impair B 12 absorption. As a result, B 12 supplementation should be considered for individuals following any type of meatless diet. Iodine insufficiency is also widespread among vegans. Seaweed is a suitable iodine source for vegans. However, seaweed iodine content needs to be reduced by using preparation techniques such as soaking or blanching. Safer strategies include iodized salt and supplements. Long-chain omega-3 fatty acids EPA and DHA are consistently low in vegans and vegetarians. Microalgae-based EPA+DHA supplements can effectively raise omega-3 status and may be recommended for some individuals. Iron remains a challenge due to the low bioavailability of non-heme iron and the inhibitory effects of phytates, with premenopausal women at greatest risk of deficiency. Iron bisglycinate supplementation offers superior absorption and tolerability. Finally, choline intake is suboptimal among vegetarians, especially vegans, and requires emphasis on plant sources, such as soy flour and wheat germ. Dietitians can help vegans and vegetarians to maximize nutrient intake, prevent nutrient deficiencies, and optimize health outcomes.
ABSTRACT: Protein and amino acid supplements are among the most widely used dietary supplements by active-duty military personnel and other physically active young adults, primarily to increase muscle mass, enhance recovery, support physical performance, and meet protein needs during strenuous training and operations. Randomized controlled studies conducted in laboratory settings demonstrate that supplemental protein and amino acids can enhance muscle and whole-body protein-related responses to military-relevant stressors under highly controlled conditions, and military nutrition policies acknowledge their potential benefit when food intake or logistical constraints impede optimal dietary intake. However, evidence from military field studies is mixed, with supplementation often failing to improve protein balance or related physiological and performance outcomes under severe, multifactorial operational stress. These findings suggest that supplementation may be unnecessary in most real-world contexts and that overemphasis on protein could detract from the critical goal of achieving energy balance by consuming enough energy from mixed-macronutrient sources. This brief commentary reviews accessibility and drivers of heavy protein or amino acid supplement use by military personnel, including safety concerns and access to reliable education resources; contrasts laboratory randomized controlled efficacy trials with real‑world effectiveness studies; and offers practical recommendations for supplemental intake during strenuous military operations.
The concept of highly processed or ultra-processed foods (HUPFs) has been elevated in the national dialogue as never before. Of interest is the relationship of HUPF intake to diet-related chronic disease, and how this might be best mitigated. HUPFs are typically identified by various processing and formulation characteristics; however, there is no agreed-upon definition of these foods. The varying approaches have led to controversy around how to support evidence-based policy and dietary guidance. In this environment, nutrition and other health care practitioners are faced with patient and client questions related to if, or how, to incorporate these foods into a healthy dietary pattern. This paper presents a science-based approach to classifying and interpreting information about these foods through 9 Guiding Principles developed by the Institute for the Advancement of Food and Nutrition Sciences (IAFNS). The principles are also translated for specific application by nutrition practitioners to guide responses to patient questions and support evidence-based, individualized nutrition guidance.
To investigate the shift away from Mediterranean Diet model, based on the consumption of minimally processed foods, validated and tailored instruments are needed. In this study, we translated and cross-culturally adapted a validated questionnaire for the assessment of cooking and food skills (CS and FS). The process followed a 6 steps standardized protocol, supervised by a group of language, health, and statistics experts. A pilot test of the pre-final version was conducted among 40 volunteers (20 females, 20 males, aged 46.43±19.21). Six experts in the field of nutrition performed the content validity study of the final version. The Scale-level Content Validity Indexes based on average (S-CVI/Ave) and Universal Agreement (S-CVI/UA) were calculated (cutoff=0.83). A preliminary descriptive analysis on the pilot group answers was provided. Content validity coefficients S-CVI/Ave and S-CVI/UA were 0.98±0.07 and 0.91±0.29, respectively, and the internal consistency reliability was maintained in comparison to the original English version. The qualitative analysis of the pilot group responses showed an average CS of 60.53±26.68 (out of possible 98) and FS of 74.35±3.35 (out of possible 133). Overall, values recorded by males were significantly lower than those of females. Consumption of ready-to-eat ultra-processed foods is increasing, and culinary heritage of Mediterranean countries may be at risk. The translation and cross-cultural adaptation of a validated questionnaire to assess CS and FS, provided us with a tool suitable for the Italian population, essential to design observational and intervention studies.
The systematic review aimed to investigate the pathophysiology, symptoms, and diagnostic methods of these conditions to determine the main approaches to their recognition. The study used a systematic review of peer-reviewed articles for the period 2019 to 2024, with the involvement of earlier works to obtain basic knowledge. The main findings demonstrated that lactose intolerance is a metabolic disorder caused by lactase deficiency, which leads to gastrointestinal symptoms such as bloating and diarrhea. Instead, milk allergy was an immunologically mediated condition triggered by proteins such as casein and whey, which often manifested itself in systemic reactions, including skin rashes and respiratory distress. Differentiation of conditions was achieved using methods such as the hydrogen breath test for lactose intolerance and specific IgE testing for milk allergy. The study also noted that the use of an elimination diet contributed to a more accurate diagnosis of milk allergy. The practical significance of the work was the possibility of avoiding unreasonable dietary restrictions and improving the quality of life of patients, as these conditions required different approaches to diagnosis and treatment. The findings contributed to a deeper understanding of these conditions and highlighted the importance of further research into the role of the microbiota in shaping symptoms and potential therapeutic interventions.
Abstract: About 90% of Americans exceed recommended sodium intakes. The top 15 sodium food contributors have been previously identified, but their dietary contributions to other nutrients and food groups are unknown. The objective was to determine nutrient and food group contributions of the top food sources of sodium to the diets of the US population overall and by age/sex, ethnicity, and income. Data from a single 24-hour dietary recall from the 2017–2018 National Health and Nutrition Examination Survey (NHANES), with corresponding nutrient databases, were used. A population-ratio approach was used to estimate macro- and micronutrient contributions. Food group contributions were calculated as the proportion consumed from the top sodium sources in relation to overall population food group intakes. NHANES weights, strata, and primary sampling units were used to adjust for the complex sample survey design to ensure nationally representative results. Among the top sodium contributors (ie, pizza, breads/rolls/buns, cold cuts/meats, soups, burritos/tacos, savoury snacks, poultry, cheese, pasta, burgers, meat, cookies/brownies/cakes, bacon/frankfurters/sausages, vegetables, and chicken nuggets), pizza provided moderate amounts of iron, folate, and calcium, and cheese was a major source of calcium and vitamin D, but both contributed significantly to energy, saturated fat, and sodium intakes. Cakes, cookies, and brownies were among the top contributors to sodium intakes but provided limited nutritional value. Vegetables were a good source of fiber and potassium. Vegetables, pasta, burritos/tacos, and pizza contributed <10% to 35% of vegetable servings recommended intakes, while the main contributors to grain servings consumed (40% to 50%) were pizza, breads/rolls, and burritos/tacos. Pizza, burritos/tacos, and cheese contributed <10% to 35% of dairy recommended intakes. Cold cuts, meat mixed dishes, burritos/tacos, burgers, poultry, and chicken nuggets were the highest contributors (40% to 50%) to protein servings. Stratified analyses by age, sex, income, and race and Hispanic origin showed similar overall patterns with some key differences. For example, middle-income households derived more added sugars from processed meats and soups (>4% to >6%), while higher-income groups consumed more folate and fiber from breads and vegetables (>3% to >9%). Asian Americans obtained more iron from breads (10.42%), soups (4.69%), and vegetables (5.57%), and older adults consumed more fiber (>11%) from these sources. Younger ages had higher protein intake from chicken nuggets compared with other age groups. Major sources of sodium also contribute key nutrients (such as iron, calcium, potassium, among others), with variation across foods and population groups. While reducing high-sodium food intake is a dietary goal, reformulating products to lower sodium by 10% to 30%, such as combination foods, bread and bakery products, soups, snack foods, and processed vegetables, has been shown to be feasible without compromising acceptability, but should also be implemented in ways to preserve the nutrient contributions of these foods. Along with dietary patterns, strategies should consider sociodemographic patterns and support lower-sodium alternatives to advance public health.
Online grocery shopping interventions using optimal defaults have improved the nutritional quality of grocery purchases, but no studies have explored impacts on dietary intake. This analysis examines the potential of an optimal defaults online grocery shopping intervention to promote healthier intake by assessing (1) the relationship between the nutritional quality of grocery shopping purchases and the nutritional quality of intake, and (2) intervention effects on the nutritional quality of participants' dietary intake. A randomized controlled trial tested the effects of an optimal defaults intervention promoting grocery purchases consistent with a diabetic diet. As part of the 5-week, 3-arm study, participants were randomly assigned to grocery shop either (1) in person as usual (control group), (2) online (online group), or (3) online with a prefilled, default grocery shopping cart (defaults group) during a 3-week intervention. All groups received recipes corresponding to the Dietary Approaches to Stop Hypertension diet. Participants submitted grocery receipts and completed interviews weekly. Fifty-five adults provided a complete food frequency questionnaire post intervention. Linear regression tested the relationship between the nutritional quality of grocery shopping purchases and the nutritional quality of intake. Analysis of variance examined the effect of study group on the nutritional quality of dietary intake. The nutritional quality of household grocery purchases was positively associated with the nutritional quality of participants' intake ( P < .001). The effect of study group on the nutritional quality of intake was not significant ( P = .07), although trend-level results were in the expected direction with the defaults group having the highest nutritional quality of the 3 groups. Optimal defaults interventions' effects on grocery purchases may extend to dietary intake. Future research using more precise and objective measures of dietary intake could elucidate potential effects.
Disorders of gut-brain interaction (DGBI) such as irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO) pose a clinical challenge because of their complex pathophysiology and diagnostic difficulties. This study aimed to analyze modern diagnostic methods and therapeutic strategies, focusing on emerging technologies and personalized approaches. IBS and SIBO are complex gastrointestinal disorders involving gut dysbiosis, motility disturbances, and interactions within the gut-brain axis. In IBS, dietary and psychological factors are key to making dietary interventions, such as a low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet, and psychological therapies are particularly effective. SIBO treatment primarily relies on antibiotic therapy, although frequent relapses have driven the search for alternative approaches, including microbiota modulation. Increasing attention has been given to advanced technologies such as metabolomic analysis, microbiome profiling, and fecal microbiota transplantation, which may enhance treatment efficacy and enable a more personalized therapeutic approach. Advancements in IBS and SIBO diagnostics and treatment have allowed for a more precise therapeutic approach. Further research is required to assess the efficacy of these novel methods. Understanding gut-brain interactions and the role of gut microbiota in the pathogenesis of these disorders is crucial for developing more effective and sustainable therapeutic strategies.
Social media has become a major source of nutrition information among adults; however, its influence on eating attitudes and potential connections to disordered eating remain insufficiently examined. This study explored the relationship between excessive social media engagement, exposure to nutrition-related content, and disordered eating tendencies among 385 adults aged 18 to 65 who were recruited online. Participants completed validated scales, including the Social Media Addiction Scale, REZZY Eating Disorder Scale (the Turkish-validated adaptation of the SCOFF screening tool), and the Social Media Influence on Eating Behavior Scale (SESMEB). Excessive social media exposure positively associated with disordered eating symptoms (β=0.341, P <0.001). The analysis showed that individuals with higher social media addiction scores were more likely to believe that nutrition-related content they see online affects their eating behavior (β=0.623, P <0.001). Individuals frequently exposed to dieting or fast-food–related content demonstrated significantly higher scores compared with those following health-promoting recipe content ( P <0.001). Longer daily usage of social media (>4h) and higher trust in online nutrition content further predicted vulnerability to media-driven dietary attitudes. Higher engagement with nutrition-related content on social media was linked to increased susceptibility to media-driven eating attitudes and elevated disordered eating risk. Strengthening evidence-based nutrition communication and improving users’ digital literacy may help mitigate these effects.
