Background The decline in pulmonary function among older adults is a widespread issue, lacking specific dietary guidelines for optimising respiratory health.Methods Data from the Guangzhou Biobank Cohort Study (GBCS) and National Health and Nutrition Examination Survey (NHANES) were analysed to assess the association of the Composite Dietary Antioxidant Index (CDAI) with key pulmonary function indicators in individuals aged 50 and older.Results The study included 8640 participants from GBCS and 4029 from NHANES, with a mean age of 62.5 years. After adjusting for confounders, higher CDAI scores were significantly linked to increased forced expiratory volume in 1 s (FEV1) and FEV1 percentage predicted (FEV1pp) in GBCS (β=0.004 L, 95% CI 0.001 to 0.008; β=0.193%, 95% CI 0.045% to 0.342%). Similar trends were observed in NHANES for FEV1pp (adjusted β=0.353%, 95% CI 0.059% to 0.646%). Subgroup analyses showed that women exhibited consistent positive associations between CDAI and both FEV1pp and forced vital capacity (FVC) percentage predicted (FVCpp) in both cohorts. In GBCS, stronger associations were found for participants over 65 years.Conclusions Higher CDAI scores correlate with improved pulmonary function, particularly in women and older adults, underscoring the need for dietary recommendations that emphasise antioxidant-rich foods to enhance respiratory health and support healthy ageing.
Background Food insecurity is a lack of physical and/or economic access to sufficient, safe and nutritious food that meets dietary needs and food preferences. Disease-related malnutrition (DRM) occurs in the context of illness or its treatment and is associated with inadequate nutrient intake and the inflammatory processes of diseases or medical conditions. Food insecurity and DRM both pose significant health risks, are prevalent and have similar underlying foundations, yet minimal research has explored these connections. The objective was to explore the complex relationship between food insecurity and DRM to inform system change, research, intervention and education supporting both topics.Methods We conducted online semistructured interviews and focus groups with clinicians, researchers/academics and staff from health systems and community organisations purposefully recruited from across Canada. A codebook supported inductive thematic analysis. Following the interviews/focus groups, participants were sent a list of research questions which they rated by priority level, actionability, feasibility and health equity considerations.Results Interviews (n=7) and focus groups (2; n=5) were conducted with 12 participants from four provinces. There was an even split between clinicians (n=4), researchers/academics (n=4), management (n=4) or representatives (n=3) from health system or community organisations (n=4). Half (n=6) self-identified as providing more input on DRM, and n=8 on food insecurity. The overarching theme was how structural inequities connected food insecurity and DRM. Participants discussed the need for ethical screening for both, but only if results could connect to services beyond food charity and if screening was unbiased and respectful. The need for system change was reported, alongside opportunities to support practice change through research, intervention and education. A list of research questions was generated.Conclusions This study reveals that food insecurity and DRM are fundamentally linked by structural inequities, necessitating a shift from food charity toward ethical, system-wide intervention. Addressing these interconnected issues requires integrated research and policy changes to support equitable health outcomes.
Introduction Osteoporosis remains a significant global health issue, and prevention of age-related bone loss is of particular interest.Aim To assess whether daily Jarlsberg cheese fermented by Propionibacterium freudenreichii (PF) is associated with changes in bone turnover markers and bone mineral density (BMD) in postmenopausal women and men aged ≥55 years.Methods The study was performed as a randomised semi-cross-over designed multicentre trial using delayed start-up. 57 postmenopausal women and men ≥55 years, both with BMD T-score between −2.5 and 0, who did not use any osteoporosis medication were included. All participants received daily calcium and vitamin D. One group was randomly allocated to Jarlsberg from start till 32 weeks, whereas the second had a 16-week delay before Jarlsberg start-up for 32 weeks. Bone turnover markers and BMD were assessed every 16 weeks.Results In the Jarlsberg group, total osteocalcin (OC) increased from 18.8 to 23.5 ng/mL at week 32 (p<0.01), carboxylated OC from 11.8 to 17.3 ng/mL (p<0.001) and the ratio between procollagen type 1 N-terminal propeptide (P1NP) and crosslinked C-terminal telopeptide of type 1-collagen (CTX) (P1NP/CTX) from 168.8 to 203.9 (p<0.01). Lumbar spine BMD increased from 1.151 to 1.163 g/cm² (p=0.04) and total hip BMD from 0.929 to 0.933 g/cm² (p=0.02). The differences between groups in BTM were significant in favour of Jarlsberg cheese. After Jarlsberg was introduced, OC-level, biomarkers and BMD increased.Conclusion Jarlsberg intake alongside calcium and vitamin D was associated with favourable increases in OC-related markers, P1NP/CTX ratio and BMD in postmenopausal women and older men.
Background Anaemia remains highly prevalent among females, primarily due to iron deficiency, which can be prevented through iron supplementation and by enhancing iron absorption using vitamin C. Guava, rich in vitamin C and other micronutrients, may serve as a natural adjunct to iron therapy. This systematic review and meta-analysis aimed to evaluate the effect of guava juice consumption on haemoglobin levels among females, including adolescent girls and pregnant women.Methods This review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. Randomised controlled trials (RCTs) and quasi-experimental studies published in English since 2000 were included. Literature searches were performed across PubMed, Scopus and Google Scholar. Two independent reviewers screened studies using EndNote X9, and data were extracted into Microsoft Excel. Study quality was assessed using the Cochrane Risk of Bias 2.0 tool for RCTs and ROBINS-I for non-randomised studies. Meta-analysis was conducted using Review Manager 5.4 and R Studio.Results 17 studies were included in the qualitative synthesis, and 12 in the quantitative analysis; 15 were quasi-experimental trials, and 2 were RCTs. Six studies involved adolescent females and 11 involved pregnant women. Most studies (n=9) evaluated guava juice in combination with iron supplementation. The pooled mean difference in haemoglobin was 1.71 g/dL (95% CI 1.37 to 2.05 g/dL, I²=89%), indicating a significant improvement post-intervention. Subgroup analysis showed mean differences of 1.52 g/dL (95% CI 1.09 to 1.95 g/dL, I²=66%) among adolescents and 1.84 g/dL (95% CI 1.37 to 2.32 g/dL, I²=93%) among pregnant women. In five studies comparing guava juice plus iron versus iron alone, the mean difference was 1.29 g/dL (95% CI 0.88 to 1.71 g/dL, I²=83%), favouring guava juice. The results of the sensitivity analysis were consistent with the main findings as well.Conclusion Guava juice consumption significantly improves haemoglobin levels among females and may serve as a cost-effective adjuvant to standard iron therapy. Further well-designed RCTs are warranted to validate these findings and guide public health recommendations.PROSPERO registration number CRD4202453529
Background Plant-based foods, compared with animal-based foods, have a smaller environmental impact.Objective This secondary analysis used a randomised, crossover trial to calculate and compare the environmental impact of two plant-forward diets: low-fat vegan and Mediterranean.Methods 62 overweight adults were randomly assigned to a low-fat vegan or Mediterranean diet for 16-week periods, separated by a 4-week washout. 3-day dietary records were analysed, and greenhouse gas emissions (GHGEs) and cumulative energy demand (CED) were calculated for completers of the study. The calculated GHGEs and CED relationship to changes in body weight were analysed.Results Total calculated GHGEs and CED were reduced on the low-fat vegan diet by 57%, or by −1451.7 g CO2-eq/person-day (95% CI −1776.5 to −1126.9; p<0.0001), and 55%, or by −9306.7 kJ/person-day (95% CI −11022 to −7591.5; p<0.0001), respectively. Total calculated GHGEs in the Mediterranean diet reduced by 20%, or by −451.3 g CO2-eq/person-day (95% CI −859.7 to −42.8; p=0.03), and no change in calculated CED. In both treatment groups combined, changes in body weight correlated with changes in total CED (r=+0.41; p=0.004), even after adjustment for changes in energy intake (r=+0.34; p=0.02). The correlation between changes in body weight and changes in GHGEs did not reach statistical significance (r=+0.26; p=0.07).Conclusion Collectively, a low-fat vegan diet demonstrated statistically significant reductions in GHGEs, CED and weight loss compared with the non-plant-forward and Mediterranean diets, suggesting that a low-fat vegan diet can improve both human and planetary health.Trial registration number NCT03698955
Background:Adequate physical activity (PA) promotes health, but whether it also reduces health-related expenditures has not been thoroughly assessed. We investigated the association between PA levels and individual health expenditures and health insurance deductibles. Methods:Data from the third follow-up (2018-2021) of a prospective cohort study based in Lausanne, Switzerland. PA was measured via accelerometry and categorised as <or ≥150 min/week of moderate+vigorous PA (MVPA). Information on deductibles was self-reported. Health expenditures were obtained from health insurers. Results:Overall, 858 participants (53% females, 65.4±9.7 years) had deductible data. Participants with ≥150 min/week MVPA were more likely to choose higher health insurance deductibles than the less active group: 29.3% against 17.5%; p<0.001. However, this association was no longer significant after multivariable adjustment. Health expenditures were available for 360 participants (50.3 % females, 66.1±9.7 years). Participants with ≥150 min/week of MVPA had lower expenditures: median and (IQR) 1987 (427-5490) against 4118 (1699-8743) CHF, p<0.001. After multivariable adjustment, a nonsignificant (p=0.073) trend remained. Age, female sex and low deductible choice remained significant predictors of higher expenditures. In sex-stratified analyses, a significant inverse association was found between expenditures and MVPA: β (95% CI) -0.0034 (-0.0065 to -0.0003) in females, but not in males. Conclusions:Although less active individuals tend to choose lower deductibles, the association is mainly driven by clinical and sociodemographic factors. In women, each extra 30 min of MVPA per week was correlated to a 10% annual decrease in individual health expenditures, with a same borderline effect in the full sample.
Background Several studies have suggested that high intakes of legumes and soy products are associated with a lower risk of hypertension; however, the results have been inconsistent. We conducted a systematic review and meta-analysis to clarify the association between legumes and soy consumption and the risk of hypertension.Methods PubMed and Embase databases were searched up to 14 June 2025. Random effects models were used to calculate summary relative risks (RRs) and 95% confidence intervals (95% CIs) for the association between legume or soy consumption and hypertension risk. Heterogeneity was evaluated using I2. The likelihood of causality was evaluated using World Cancer Research Fund (WCRF) criteria.Results 12 prospective studies were included in the meta-analysis. The summary RR for high versus low intake of legumes was 0.84 (95% CI 0.77 to 0.93, I2=65%, pheterogeneity=0.003, n=10 studies, 86 098 cases, 309 853 participants) and for soy was 0.81 (95% CI 0.70 to 0.93, I2=82%, pheterogeneity<0.0001, n=7 studies, 93 934 cases, 278 200 participants). In the linear dose–response analyses, the summary RR per 100 g/day was 0.88 (95% CI 0.80 to 0.97, I2=69%, pheterogeneity=0.001, n=10) for legumes and 0.76 (95% CI 0.60 to 0.96, I2=89%, pheterogeneity<0.0001, n=6) for soy. The test for non-linearity was not significant for legumes (pnon-linearity=0.13), suggesting a linear reduction in risk up to ~170 g/day, while for soy there was indication of non-linearity (pnon-linearity=0.01), and most of the reduction in risk was observed up to an intake around 60–80 g/day. Although there was an indication of publication bias with Egger’s test (p=0.04) for legumes, this was explained by two outlying studies. Using WCRF criteria, the likelihood of causality was considered probable for both legumes and soy in relation to hypertension risk.Conclusion In this meta-analysis of 12 prospective cohort studies, legume and soy intakes were associated with lower risk of hypertension. These findings support dietary recommendations to increase the intake of legumes in the general population.
Background We previously showed in a randomised crossover trial that a moderate carbohydrate diet improved mean glucose and time in range (TIR) in adults with type 1 diabetes without adverse effects. This study aimed to examine diet quality and explore baseline predictors of improved glycaemic control and treatment satisfaction.Methods Secondary analysis of a randomised crossover trial including adults with type 1 diabetes and glycated haemoglobin A1c (HbA1c) ≥58 mmol/mol who followed a moderate carbohydrate diet (30% energy from carbohydrates) and a traditional diet (50% energy from carbohydrates) for 4 weeks each, separated by a 4-week washout period. Glucose levels, diet and treatment satisfaction were assessed using masked continuous glucose monitoring (CGM), 4-day food records and the Diabetes Treatment Satisfaction Questionnaire (DTSQs), respectively. Correlation analyses between baseline variables (dietary intake, HbA1c, age, sex, physical activity and insulin delivery route) and changes in CGM metrics such as mean glucose, TIR, time above range, time in tight range and DTSQs score between diets were performed.Results This post hoc analysis included 50 individuals with a mean (SD) baseline HbA1c of 69 (11) mmol/mol, body mass index 29 (5) kg/m2, age 48 (14) years and 25 (50%) were female. Carbohydrate quality was similar across the two diets, whereas fat quality differed, with a higher proportion of unsaturated fat and higher cholesterol intake in the moderate carbohydrate diet. Fibre and saturated fat intakes did not fully meet general recommendations in either diet. Age 40–60 years was significantly associated with greater improvements in TIR (p=0.045). Lower baseline carbohydrate intake (p=0.039) and improved mean glucose during the moderate carbohydrate diet (p=0.034) were associated with higher treatment satisfaction.Conclusions Fibre and saturated fat intakes were similar between diets, but neither fully aligned with recommendations, highlighting the need to ensure adequate fibre intake and appropriate levels of saturated fat when recommending a moderate carbohydrate diet. Middle-aged adults appeared to benefit most from a moderate carbohydrate diet in terms of glucose control.Trial registration number NCT03400618.
Background Nutrition is a modifiable driver of morbidity and mortality in the UK, yet nutrition education remains marginal within medical curricula. Despite guidance from the General Medical Council (GMC) and the Association for Nutrition (AfN), evidence suggests persistent under-provision.Methods We triangulated findings from: (1) a curriculum review and mapping exercise of UK medical schools; (2) a curriculum survey (n=31) of final-year or newly qualified students; and (3) a rapid review (2010–2025) of literature on nutrition education in UK medical programmes. Survey items mapped to AfN competencies and GMC Outcomes for Graduates.Results Across all data sources, nutrition education was inconsistently delivered, theoretical and rarely assessed. Most students (71%) reported receiving ≤10 hours of teaching. Although 84% rated nutrition as important, only 61% felt prepared to address nutrition issues. Confidence was lowest for practical skills (nutrition assessment, referral pathways and brief interventions). The rapid review identified longstanding barriers: low curricular legitimacy, limited assessment, insufficient faculty expertise and weak clinical integration. Enablers included nutrition leads, interprofessional learning and competency-aligned teaching.Conclusions Despite national prevention ambitions, nutrition remains insufficiently integrated into UK medical education. Aligning curricula with AfN/GMC standards, strengthening assessment, embedding leadership and co-designing applied teaching with students represent practical high-impact opportunities to develop prevention.
Introduction While social capital is linked to various health outcomes, its association with metabolic syndrome (MetS) remains underexplored, particularly in low- and middle-income countries (LMICs) facing rising cardiovascular disease burdens. This study examines the association between social capital and MetS in Vietnam, a country undergoing rapid epidemiological and nutritional transitions.Research design and methods Data were collected from 2825 participants in the baseline survey of the Khánh Hòa Cardiovascular Study, a prospective cohort study of local residents aged 40–60 years in the Khánh Hòa province, Vietnam. Poisson regression models with robust variance estimator were used to assess the association between cognitive (low, middle or high) and structural social capital (yes or no) and MetS, as well as its individual components, with results stratified by sex.Results We found that 34.7% of male and 36.8% of female participants had MetS. Among female participants, those with high cognitive social capital had a lower likelihood of MetS compared with those with low cognitive social capital (prevalence ratio (PR)=0.84, 95% CI 0.72 to 0.97), while no significant association was observed among male participants. Regarding structural social capital, no association with MetS was observed in either sex. In analyses of individual MetS components, high cognitive social capital was associated with a lower prevalence of elevated blood pressure among females (PR=0.92, 95% CI 0.86 to 1.00).Conclusions Cognitive social capital was associated with lower prevalence of MetS among women in rural Vietnam. Further longitudinal studies are warranted to clarify causal pathways. Social capital may be important to consider in cardiometabolic health efforts in LMICs undergoing rapid socioeconomic change.
Background Malnutrition is common in patients with cancer. Limited data exist on the association between nutritional status, chemotherapy cycles and therapeutic responses in low-resource settings. This study investigated the association between pretreatment nutritional status, chemotherapy cycles and treatment response in Addis Ababa, Ethiopia, providing insights through count data analysis.Methods A multicentre prospective cohort study was conducted from February 2024 to June 2025, involving 400 patients with solid tumours followed from prior to chemotherapy to 1 month after completing treatment. Nutritional status was assessed using the Patient-Generated Subjective Global Assessment, and treatment response was measured using the Response Evaluation Criteria in Solid Tumours (V.1.1). Multivariable logistic and Poisson regression analyses were used to determine the association between malnutrition, treatment response and number of chemotherapy cycles.Results At baseline, 39% of the patients exhibited severe malnutrition. Of the 400 recruited participants, only 204 (51%) completed six or more chemotherapy cycles, and 19.6% showed progressive disease (PD). In bivariate analysis, severe malnutrition was associated with PD (crude OR = 2.67 (95% CI: 1.12 to 6.1)). In the multivariable logistic regression analysis, low dietary diversity (adjusted OR (AOR) = 3.63 (95% CI: 1.19 to 11.05)) and low performance status (AOR = 4.3 (95% CI 1.35 to 13.67)) were associated with PD. Additionally, based on Poisson regression, patients with severe malnutrition received 17% fewer chemotherapy cycles than well-nourished patients (incidence rate ratio = 0.83 (95% CI: 0.73 to 0.93)).Conclusions Based on a prospective cohort study, malnutrition may not predict chemotherapy response. However, it was associated with a reduced number of chemotherapy cycles. Therefore, early nutritional assessment and intervention are imperative to reduce treatment dropouts. Patients should also be encouraged to consume a diverse diet rich in essential nutrients to improve their treatment responses.
Background Diet is increasingly recognised as a modifiable factor influencing the severity of menopausal symptoms. While global studies have examined this relationship, there is limited evidence on how culturally specific dietary patterns relate to menopausal health among African populations.Methods A cross-sectional study was conducted among 376 postmenopausal women. Data were collected using structured questionnaires. χ2 tests and Cramer’s V were used to evaluate associations between dietary intake and menopausal symptom severity, with post hoc standardised residuals to identify contributing categories.Results Most participants were aged 51–55 (34.8%), with vaginal dryness reported as the most severe symptom (38.6%). Menopause severity was moderate, with most (83%) respondents experiencing mild-to-moderate menopausal symptoms. Indigenous diet was moderately consumed by 51.6%, the Western diet was highly consumed by 44.7% and processed foods were moderately consumed by 91%. There were statistically significant associations between all three dietary patterns and menopausal symptom severity. For Indigenous food, moderate consumption was marginally associated with being asymptomatic (Standard Residual (SR)=+1.9), while high consumption was marginally associated with fewer asymptomatic cases (SR=–1.9) (χ²(2)=8.31, p=0.016, φc=0.149). Western food intake showed a strong inverse association, with asymptomatic women over-represented among low consumers (SR=+5.9) and under-represented among high consumers (SR=–3.1) (χ²(4)=50.09, p<0.001, φc=0.495). Similarly, low processed food consumption was strongly associated with being asymptomatic (SR=+7.6), while moderate consumption was associated with fewer asymptomatic cases (SR=–2.5) (χ²(4)=78.21, p<0.001, φc=0.795).Conclusion The associations between dietary patterns and menopausal symptoms severity reflect potential influences of varied dietary patterns on the menopause symptom experiences. These associations suggest that culturally relevant dietary strategies may contribute to managing menopausal symptoms among Nigerian women, warranting further longitudinal investigation.
Background:Dietary patterns that limit or avoid animal products contribute fewer greenhouse gases and require less energy than diets containing more animal products. However, quantifications of these outcomes on a vegan diet in real-life conditions still need to be explored. Methods:In a randomised controlled trial, a low-fat vegan diet supplemented with soybeans led to a significant reduction in hot flashes in postmenopausal women. In this secondary analysis of that study, we hypothesised that the intervention diet would have a reduced environmental impact, greenhouse gas emissions (GHGEs) and cumulative energy demand (CED). 3-day diet records were analysed at baseline and at the end of the 12-week study, and we linked dietary intakes to environmental footprints. Results:Compared with no change in the omnivorous control group, we found that the vegan group had a decrease in GHGEs (p <0.001) of 35% (-662.7 g CO2-eq/person-day) and a decrease in CED (p =0.002) of 34% (-4956 kJ/person-day). These reductions in environmental impact were primarily due to reduced consumption of meat and dairy products. Conclusion:Adoption of a soybean-supplemented low-fat vegan diet significantly reduced cumulative energy demand and GHGEs, important drivers of climate change. Trial registration number:NCT04587154.
Background A newly developed machine-learning-driven cardiovascular disease (CVD) risk prediction tool, the Personalised CARdiovascular DIsease risk Assessment for Chinese (P-CARDIAC), tailored for the Hong Kong population, has demonstrated superior predictive performance compared with existing risk prediction tool. This study aims to explore the acceptability and expectations of P-CARDIAC among clinicians and the general public, and to assess its feasibility within pharmacist-led services in local primary healthcare systems.Methods A cross-sectional study was conducted to investigate the awareness and expectations of risk prediction tools among clinicians and the general public. A pragmatic pilot study was carried out to implement P-CARDIAC in pharmacist-led services at local primary healthcare centres. Data analysis included descriptive statistics, univariate regression modelling and reliability assessments of validated measurement scales.Results For the cross-sectional study, a total of 113 of the general public and 17 clinicians responded to the questionnaire. The general public demonstrated low awareness but high health-seeking behaviour related to CVD risk prediction tools. Clinicians, especially cardiologists, reported limited experience with such tools due to unavailability and limited user-friendliness. In the pilot study, 15 participants engaged with pharmacist-led services incorporating P-CARDIAC. They expressed positive perceptions of the tool, believing that it could support better medication adherence and disease management. The pharmacist-led services incorporating P-CARDIAC were well-received by participants.Conclusion P-CARDIAC demonstrates promise as a local risk prediction tool to enhance cardiovascular care in Hong Kong. The study underscores the importance of improving awareness and adoption of such CVD risk tools.
Introduction:Undernutrition remains a significant public health challenge in the Democratic Republic of Congo (DRC). This study aims to identify dietary and non-dietary factors associated with undernutrition among children aged 6-23 months using the Composite Index of Anthropometric Failure. Methodology:The secondary analysis was conducted using data from the 2023 National Nutrition Survey, a nationally representative cross-sectional study. The final analytical sample consisted of 5396 children, stratified into two age bands 6-11 months (n=1792) and 12-23 months (n=3604). Bivariate analysis (p<0.2), Multivariable logistic and stepwise regression models (p<0.05) were used to identify factors associated with undernutrition. Results:The overall prevalence of undernutrition was 47.4%, rising significantly from 37.4% in infants aged 6-11 months to 52.6% in children aged 12-23 months. Stepwise logistic regression identified distinct risk profiles: for the 6-11 month group, male sex (adjusted OR (aOR)=1.7; 95% CI 1.3 to 2.1) and larger households with >2 children (aOR=1.3; 95% CI 1.1 to 1.6) increased the undernutrition, while acceptable minimum meal frequency (MMF) was the primary protective factor (aOR=0.12; 95% CI 0.08 to 0.19). Among the 12-23 month, high dietary diversity (aOR=0.5; 95% CI 0.4 to 0.7), acceptable MMF (aOR=0.6; 95% CI 0.5 to 0.8) and maternal education significantly reduced undernutrition. Conversely, rural residency, recent diarrhoea (aOR=1.4; 95% CI 1.2 to 1.7) and poor hand hygiene remained major factors associated with undernutrition. Conclusion:Traditional indices significantly underestimate the true nutritional burden in the DRC. These findings underscore the need for a National Nutrition Programme to implement multisectoral interventions that prioritise maternal literacy and the integration of Water, Sanitation and Hygiene protocols to address the diverse drivers of undernutrition.
Objective Childhood acute respiratory infections (ARI) and diarrhoea are prevalent and have placed significant medical burden on the society. This study was conducted to examine the associations between maternal feeding practices and childhood ARI and diarrhoea in rural China. To allow wider comparison across studies, the most recent WHO feeding indicators were adopted.Design A prospective cohort study (n=629).Setting Five rural regions of China.Participants Multi-stage stratified random cluster sampling was applied to recruit mothers who had given live birth to their child within 6 months. A baseline survey was conducted in participants’ houses or village health centres between January 2014 and August 2016. A follow-up survey was conducted with all participants through telephone interviews from January 2017 to September 2018.Results The prevalence of childhood ARI and diarrhoea during the past 2 weeks at follow-up was 14.2% and 11.4%, respectively. Poor complementary feeding practices were found, with only 33.1% and 22.3% of mothers feeding their children with sufficient diet diversity (MDD) and meeting the WHO requirement of minimal acceptable diet (MAD), respectively. Logistic regression analyses demonstrated that MDD was associated with a lower risk for childhood ARI (adjusted OR=0.39, 95% CI 0.17 to 0.93) and diarrhoea (adjusted OR=0.38, 95% CI 0.15 to 0.93). MAD was protective for childhood diarrhoea (adjusted OR=0.36, 95% CI 0.14 to 0.94).Conclusion Interventions to ensure children’s diet diversity during complementary feeding stage might be useful to prevent and reduce childhood ARI and diarrhoea in rural areas.
Background Unhealthy diets are a leading cause of death, yet nutrition education for medical and healthcare professionals remains inadequate internationally. Beyond ‘top-down’ curriculum and accreditation initiatives, student-led teaching and learning initiatives typically commence to fill curricular gaps. This scoping review aimed to synthesise evidence on student-led nutrition education initiatives for medical and health students.Methods Following JBI methodology for scoping reviews, MEDLINE, Embase, CINAHL, ERIC and Web of Science were searched for studies from any country and year that related to student-led nutrition education initiatives for medical and health students. A grey literature search ensured a comprehensive overview of available literature. Data were synthesised narratively.Results Twenty articles published between 2012 and 2024 were included, and most were from the USA (n=15). Student-led nutrition education initiatives included culinary education (n=11, 55%), placement opportunities (n=10, 50%), lecture series (n=7, 35%) and student interest groups (n=6, 30%). Twelve studies (60%) included more than one type of initiative. Initiatives mostly targeted medical students (n=13, 65%), and four were interdisciplinary (20%). Studies included students from undergraduate or preclinical years through to practising health professionals. Initiatives were delivered by students, physicians, dietitians, and other health professionals, mostly in-person (n=12, 60%) within university (n=12, 60%) or community (n=7, 35%) settings. Thirteen studies evaluated the initiative(s) using questionnaires (n=10, 50%), informal feedback (n=2, 10%) or focus groups (n=1, 5%). Of these, seven studies (54%) reported improved confidence and competence in nutrition among the students involved.Conclusions Student-led nutrition education initiatives are likely to be well received and may improve nutrition competence. These initiatives are a promising approach to address the persistent gap in nutrition education for medical and health students.
Background Despite advances in neonatal care, many preterm infants continue to experience growth faltering, with long-term consequences. We aimed to identify early, modifiable feeding-related risk factors and develop machine learning models to predict growth faltering at discharge.Methods We retrospectively analysed 700 preterm infants (≤34 weeks gestational age (GA), ≤1800 g birth weight (BW)) admitted to a single level IV neonatal intensive care unit between 2014 and 2022, representing a relatively homogeneous population with standardised feeding practices. Over 100 demographic, clinical and nutritional variables, including parenteral and enteral intake during the first 28 days, were evaluated. Growth faltering was defined as a longitudinal decline in weight z-score of ≥1.2 SD from birth to 36 weeks postmenstrual age, rather than an absolute cross-sectional threshold. Supervised machine-learning models were trained using a 70% training and 30% testing split.Results Growth faltering occurred in 17.7% (n=124). Affected infants had lower GA, lower BW and greater oxygen dependence at day of life 28 (all p<0.001). Although both enteral feeding volume and caloric intake were lower among infants with growth faltering, differences in enteral volume emerged earlier and persisted more strongly over time. The final predictive model demonstrated good discrimination (area under the curve=0.85). In adjusted models evaluating individual nutritional exposures, both enteral feeding volume and caloric intake were significantly associated with reduced odds of growth faltering. However, enteral volume demonstrated earlier divergence and a greater consistency across time points.Conclusions Although both volume and caloric intake were significant when modelled independently, enteral feeding volume emerged as the more robust and clinically informative predictor, likely reflecting feeding tolerance and advancement decisions. Combining dynamic nutritional monitoring with artificial intelligence-based prediction tools may enable earlier identification of at-risk infants and guide individualised nutrition strategies.
The oral cavity poses a challenging surgical site due to physiologically high bacterial load and limited disinfection efficacy, attributed to biofilm-promoting surfaces of teeth and saliva. To minimise postoperative wound healing complications, clinicians in German-speaking countries traditionally advise against the consumption of milk and dairy products following dental, oral and maxillofacial (OMF) surgery. Although primarily rooted in historical tradition, the belief that milk impairs wound healing remains prevalent. Therefore, this study aims to evaluate the impact of milk and dairy product consumption on intraoral wound healing following elective surgical removal of impacted third molars.This prospective, controlled, single-blinded clinical trial analysed data from 157 healthy patients who underwent surgical removal of impacted third molars. Participants were randomised to either consume milk and dairy products at least three times per day (experimental group; n=77) or completely avoid dairy (control group; n=80) during a 7-day postoperative period. Wound healing was assessed using the adapted ASEPSA (Additional treatment, Serous exudate, Erythema, Purulent exudate, Separation of deep tissue, Admission to the hospital) wound scoring system. The total follow-up period was 3 months to monitor for late wound healing complications.The majority of patients (90,4%; n=142), regardless of group allocation, achieved an ASEPSA score of 0, indicating undisturbed wound healing. The overall postoperative complication rate was 7.0% (n=11), with a higher incidence observed in the control group (n=8) compared with the dairy group (n=3) (p>0.05). Specifically, the rate of infectious complications was 2.5% (n=4), with no evidence of an increased infection risk associated with dairy consumption.These findings do not support the assumption that milk consumption impairs wound healing. Postoperative intake of milk and dairy products was not associated with an increased rate of wound healing disturbances or infectious complications. Moreover, the dairy-containing diet was perceived as less restrictive and contributed to greater patient comfort. Consequently, the recommendation to avoid milk following oral surgery can no longer be justified.
Objectives:This study aimed to investigate the association between vitamin E intake, its serum levels and all-cause mortality by smoking status. Participants:This study included 30280 adults from National Health and Nutrition Examination Survey (NHANES) 1999-2014. We categorised participants into current smokers, former smokers and non-smokers. Measurements:Vitamin E intake was assessed via a 24-hour dietary recall and categorised into tertiles. Serum vitamin E levels (alpha-tocopherol) were measured using high-performance liquid chromatography. Mortality data were obtained through linkage to the National Death Index. Results:During a median follow-up of 119.7 months, 15.4% of participants experienced all-cause mortality. The former smokers were the oldest and had the highest proportions of men, hypertension, diabetes mellitus and chronic kidney disease. This group had the highest Body Mass Index, serum cholesterol, uric acid and urinary albumin creatinine ratio. The proportion of participants who met the recommended dietary allowance (RDA) of vitamin E was only 2491 (8.3%), and the RDA meeting rate was highest in the order of non-smokers, former smokers and current smokers. Cox regression analysis revealed that higher vitamin E intake was associated with lower mortality risks in former smokers and non-smokers, but not in current smokers. The association between vitamin E intake and mortality in former smokers was observed, particularly those who had quit smoking for more than 20 years. Serum vitamin E levels were associated with mortality only in non-smokers. Conclusions:Vitamin E intake was not associated with a lower mortality risk in current smokers but was associated with lower mortality risk in former smokers and non-smokers. This finding suggests the importance of smoking cessation and the potential benefits of antioxidant vitamin E in former smokers.
