Background Malnutrition is prevalent in patients with esophago-gastric cancer and is associated with poorer outcomes. Malnutrition screening tools are used to screen for risk of malnutrition and to determine whether full nutritional assessment is required. The optimal malnutrition screening tool to use in esophago-gastric cancer is unknown. Objective To assess the validity of the Malnutrition Universal Screening Tool (MUST) in esophago-gastric cancer by measurement of its sensitivity, specificity, positive and negative predictive values for detecting risk of malnutrition. Design A validation study comparing MUST with full malnutrition assessment using Patient-Generated Subjective Global Assessment (PG-SGA) as the reference standard. Participants /setting. 80 patients with newly diagnosed esophago-gastric cancer awaiting radical treatment at an oncology specialist hospital (Royal Marsden NHS Foundation Trust, London, United Kingdom) were recruited between December 2011 and June 2013. Main outcome measures Validity (accuracy) of MUST compared with PG-SGA as a reference method. Association of individual MUST features (BMI, percent weight loss) with PG-SGA score. Statistical analyses Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MUST compared with PG-SGA. Spearman’s rank correlation (ρ) between BMI and percentage weight loss with PG-SGA score. Results MUST was found to have agreement with PG-SGA in 53/80 (66.3%) patients, misclassifying 19 (23.8%) patients as being at low risk of malnutrition when they were not and 8 (10%) at risk when they were not. MUST demonstrated a sensitivity of 61.2% (95% CI: 46.2-74.8%) and a specificity of 74.2% (95% CI: 55.4-88.1%). PPV for MUST was 78.9% (95% CI: 66.5-87.6%) and NPV was 54.8% (95% CI: 44.6-64.6%). Lower BMI was weakly associated with higher PG-SGA score (correlation -0.259, p=0.021) while greater percentage weight loss was moderately associated with higher PG-SGA score (correlation +0.653, p< 0.001). Conclusions MUST did not meet a priori criteria (sensitivity and specificity ≥70%) for validation against PG-SGA. MUST is unlikely to be an appropriate malnutrition screening tool in patients with newly diagnosed esophago-gastric cancer.
Background Foods and beverages high in saturated fats, sodium, and added sugars (HFSS) are often ultra-processed and linked to poor health outcomes, but few studies have investigated their intake. Objective To describe the trends in the intake of HFSS foods and beverages between 2007 and 2018 in a nationally representative sample of U.S. adults, by sociodemographic characteristics and What We Eat in America food groups. Design This is a secondary, cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2018. Participants/setting The final sample included 27,984 adults 19 years of age or older from NHANES with at least one complete dietary recall. Main outcome measures The primary outcomes are the percentage of total energy intake from foods classified as HFSS according to the Pan American Health Organization (PAHO) Nutrient Profile Model. Statistical analyses performed To estimate the percentage of energy intake from foods and beverages HFSS, linear regression models with interaction terms between cycles and covariates were used. Results The overall intake of foods and beverages HFSS did not change, representing over 60% of the total energy intake between 2007-2010 and 2015-2018. The intake of foods and beverages high in sodium increased by 2.0 percentage points (95% CI: 0.5, 3.5) and 3.5 percentage points (95% CI: 1.1, 5.8), respectively. The intake of foods and beverages high in saturated fats increased by 6.1 percentage points (95% CI: 4.5, 7.6) and 6.1 percentage points (95% CI: 3.9, 8.2), respectively. The intake of foods and beverages high in added sugars did not change. Conclusion In the U.S., intake of HFSS foods and beverages is high. Future research should focus on whether public health interventions and policies might reduce the intake of foods high in nutrients of concern.
BACKGROUND:Patients undergoing hematopoietic cell transplantation (HCT) face nutrition-impacting symptoms that compromise oral intake and increase malnutrition risk. The independent relationship between nutrition intake adequacy and clinical outcomes in this population remains incompletely characterized. OBJECTIVE:To determine whether adequate intake (≥75% of estimated needs) during HCT admission is independently associated with hospital length of stay (LOS), 30-day readmission, and acute graft-versus-host disease (GVHD). DESIGN:Twelve-month retrospective cohort study using electronic medical records between June 15, 2022 - June 15, 2023. Nutrition intake was averaged across admission from registered dietitian assessments and categorized as adequate (≥75%) or inadequate (<75%). PARTICIPANTS:/Setting: 283 adults (85 autologous, 198 allogeneic) aged ≥18 years admitted to Stanford Health Care for HCT with a length of stay ≥7 days. MAIN OUTCOME MEASURES:Hospital LOS, 30-day readmission, and acute GVHD within 100 days. STATISTICAL ANALYSES PERFORMED:Multivariable linear regression for LOS and logistic regression for readmission and GVHD, each adjusted for age, gender, race/ethnicity, and BMI. RESULTS:In autologous HCT patients, adequate intake was independently associated with shorter LOS (β = -1.91 days, 95% CI -3.33 to -0.48; P = 0.009), and malnutrition at discharge with longer LOS (β = 1.43 days, 95% CI 0.02 to 2.91; P = 0.04). Sensitivity analyses for autologous HCT patients with adequate intake, excluding patients who received enteral or parenteral nutrition support, did not alter these findings (β = -1.51 days, 95% CI -2.99 to -0.03; P = 0.048). In allogeneic patients, no significant associations were found between intake and LOS after adjustment. Intake was not associated with 30-day readmission or acute GVHD in either group. CONCLUSIONS:Among autologous HCT patients, adequate intake was associated with shorter LOS and discharge malnutrition with longer LOS. Optimizing nutritional status may help improve outcomes and reduce hospitalization in this population.
BACKGROUND:The consumption of ultra-processed foods (UPF) has been associated with diseases in which inflammation plays a key role. The Dietary Inflammatory Index (DII) was developed as a tool to estimate the inflammatory potential of the diet; however, the association between UPF consumption and higher DII scores remains insufficiently explored. OBJECTIVE:To investigate the association between UPF consumption and the DII. DESIGN:This was a cross-sectional study. PARTICIPANTS:/Setting: Data from 36,669 adults enrolled in the NutriNet-Brasil cohort between 2020 and 2025 were analyzed. MAIN OUTCOME MEASURES:The outcome was the DII, calculated as proposed in previous studies, based on dietary components such as macronutrients, vitamins, minerals, and bioactive compounds STATISTICAL ANALYSES: UPF contribution to energy intake was estimated using the mean of 2-3 24-hour recalls (Nova24h). Associations between UPF consumption (percentage of energy, in quintiles and as a continuous variable) and the DII were analyzed using multiple linear regression models. RESULTS:The mean DII was 1.31 (95% CI: 1.28-1.33) and mean UPF contribution was 22.7%, ranging from an average of 7.50% (Q1) to 41.14% (Q5). In adjusted models, the DII increased linearly across quintiles of UPF intake (p for linear trend < 0.001). The estimated DII score in the highest quintile (Q5: 2.57) was eleven times higher than in the lowest quintile (Q1: 0.22), demonstrating a strong positive association between UPF consumption and the pro-inflammatory potential of the diet. As a continuous variable, each 10% increase in UPF energy was associated with a 0.70-point higher DII (p <0.001). CONCLUSIONS:Higher UPF consumption was associated with a more pro-inflammatory dietary pattern. These findings highlight the potential role of UPF consumption in shaping the inflammatory potential of the diet and support further research on its implications for diet-related health outcomes.
Background Store checkouts are key retail locations that promote impulse purchases of unhealthy foods and beverages. Perris, California, became the second U.S. jurisdiction—following Berkeley, California—to adopt a healthy checkout policy to improve the nutritional quality of items displayed at checkout. Objectives To assess the healthfulness of food and beverage facings at retail store checkouts in Perris and three neighboring Southern California cities, prior to the implementation of the policy. Design Cross-sectional observational study using in-store audits on all checkout product facings at sampled checkouts. Setting Product-level data at checkouts were collected in June 2023 from 19 stores in Perris and 69 matched stores in Moreno Valley, Rialto, and Riverside, California. Stores included chain supermarkets, chain drugstores, chain convenience stores, chain dollar stores, chain mass merchandisers, and independent grocery stores. A total of 42,294 product facings were included in the analysis. Main Outcome Measures The main outcome was the proportion of food and beverage facings at checkout in Southern California that met the nutritional standards of Perris’ healthy checkout ordinance (HCO). For comparison, the analysis also examined this proportion using Berkeley’s HCO standards. Statistical Analyses Performed Descriptive analyses and log-binomial regression with robust standard errors clustered by store and checkout location were used to estimate the proportion of healthy food and beverage facings and compare differences by location, store type, and checkout staffing. Results Only 33% of food and beverage checkout facings were considered healthy under Perris’ standards, and only 22% under Berkeley’s. The most common food and beverage categories at checkouts were candy (35%), gum (14%), salty snacks (13%), sugar-sweetened beverages (12%), and mints (6%). Water accounted for 2%, and fruits and vegetables for less than 1%. The percentage of checkout foods and beverages meeting Perris’ standards was lowest at checkout endcaps and independent grocery stores. Conclusions Most checkout foods and beverages were unhealthy before the implementation of a healthy checkout policy. To improve checkouts, healthy checkout policies should include the entire checkout (e.g., including endcaps where most SSBs are located) and cogent nutritional standards such as those in Berkeley’s HCO.
Background Inflammation contributes to cancer recurrence through signaling pathways responsible for cell growth and metastasis, impacting circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA). A high fat diet may contribute to inflammation directly or indirectly through changes in visceral adipose tissue (VAT), a body composition compartment associated with inflammation. Objective This analysis examined the association between percent energy from fat and circulating markers of inflammation, CTCs, and ctDNA. Design This study was an exploratory secondary analysis of cross-sectional data from the Exercise and Colorectal Cancer Treatment (EXACT) trial conducted from August 2019 to May 2023 at Pennington Biomedical Research Center. Estimated percent energy from fat was collected at baseline using the National Cancer Institute (NCI) Fat Screener. VAT was assessed using dual energy x-ray absorptiometry. Participants /Setting: Participants included 57 stage I-III colorectal cancer survivors. Main Outcome Measures Outcomes included eleven inflammatory biomarkers, CTCs, and ctDNA. Statistical Analyses Performed Associations between percent energy from fat and inflammatory and tumor biomarkers was quantified using the Spearman correlation coefficient (r). Spearman partial correlations adjusted for age, sex, race, cancer stage, and moderate-to-vigorous physical activity (MVPA). Fully adjusted models additionally adjusted for VAT. Results In unadjusted analyses, percent energy from fat was associated with soluble interleukin (IL)-6 receptor (sIL-6r) (r = 0.32, 95% Confidence Interval (CI): 0.06-0.53), soluble tumor necrosis factor (TNF) receptor 1 (sTNFr1) (r = 0.32, 95% CI: 0.06-0.53), soluble TNF receptor 2 (sTNFr2) (r = 0.34, 95% CI: 0.09-0.55), and soluble IL-2 receptor alpha (sIL-2rα) (r = 0.29, 95% CI: 0.03-0.51). sTNFr2 remained associated with percent energy from fat in adjusted (r = 0.32, 95% CI: 0.06-0.55) and fully adjusted (r = 0.28, 95% CI: 0.02-0.51) models. Conclusions This exploratory analysis provides insight into the mechanisms by which diet may impact cancer recurrence to support encouraging a healthy dietary pattern.
BACKGROUND:The low fermentable, oligosaccharide, disaccharide, monosaccharide and polyol diet presents significant practical and behavioral challenges for managing irritable bowel syndrome. OBJECTIVE:To explore people's expectations and experiences across a dietitian-led low fermentable, oligosaccharide, disaccharide, monosaccharide and polyol diet. DESIGN:Using a qualitative descriptive methodology, semi-structured interviews were conducted with 17 adults (mean age 39.1 ± 15.1 years) with irritable bowel syndrome (Rome IV criteria) who participated in dietitian-led intervention. Participants completed one interview, conducted remotely via video or phone call in Australia (mean duration 46 minutes) exploring expectations, experiences and symptoms across all phases. Participants' socio-demographic data were collected. PARTICIPANTS/SETTING:Participants were purposively recruited between 2020 and 2022 from a community-based low fermentable oligosaccharide, disaccharide, monosaccharide and polyol diet parent trial exploring psychological predictors of symptom response to dietary management. Eligible participants consented to future research contact from the parent trial, had English proficiency and provided informed consent. ANALYSIS:Two researchers conducted an inductive thematic analysis, constructing key themes on expectations and experiences of the low fermentable oligosaccharide, disaccharide, monosaccharide and polyol diet, identifying barriers and enablers to completion. RESULTS:Four themes were constructed: (1) Past experiences with irritable bowel syndrome and health interventions and services underpinned expectations; (2) Diverse expectations and experiences across each FODMAP phase; (3) The low fermentable oligosaccharide, disaccharide, monosaccharide and polyol diet required significant planning, effort and motivation, leading to cognitive and emotional burden; (4) Integrating dietary and health learning into daily life post-trial. CONCLUSIONS:The low fermentable, oligosaccharide, disaccharide, monosaccharide and polyol diet is complex, with personal expectations, symptom response, and psychological factors influencing adherence and perceived success. These findings underscore the importance of a person-centred approach that considers an individual's contextual factors to support completion.
BACKGROUND:Lack of knowledge about sugary drinks may contribute to the high prevalence of consumption. OBJECTIVES:This study aimed to assess knowledge of 1) sugar content, and 2) health effects of sugary drinks and associations with intake. DESIGN:Annual cross-sectional data from the International Food Policy Study were analyzed. Using pooled data from 2018 to 2021, Study 1 assessed knowledge of sugar content of sugary drinks within ±4 grams (1 teaspoon) of the actual value for 1 of 7 beverage types. Using data from 2019 and 2020 only, Study 2 assessed knowledge of health effects (obesity, diabetes, and tooth decay) with true/false measures. Sugary drink frequency of intake was assessed using a Beverage Frequency Questionnaire. PARTICIPANTS/SETTINGS:A total of 61,002 and 37,965 adults (aged 18 and over) from Australia, Canada, Mexico, the United Kingdom, and the United States were included in Studies 1 and 2, respectively. MAIN OUTCOME MEASURES:The main outcome measures were self-reported knowledge and intake of sugary drinks. STATISTICAL ANALYSIS PERFORMED:Negative binomial regressions examined the association between knowledge and sugary drink frequency of intake. Logistic regression models examined differences in knowledge of health effects between countries. RESULTS:Few participants correctly estimated the sugar content of beverages, except for water. Underestimation was most frequent for chocolate milk (34.9%) and 100% juice (29.7%), and overestimation most frequent for energy and diet soft drinks (51.3% and 50.5%, respectively). Most participants agreed sugary drink consumption can cause obesity (93.3%), diabetes (92.3%), and tooth decay (94.5%), with highest overall agreement in Mexico and Australia. In relatively few countries, knowledge of the sugar content of sports drinks, 100% juices, and diet soft drinks, as well as knowledge of health effects of sugary drinks, were associated with intake. No associations were found for chocolate milk, iced tea, and energy drinks. CONCLUSION:Findings indicate high awareness of the health effects of sugary drinks, but lower knowledge of their sugar content. The inconsistent findings between knowledge and intake indicate that measures only targeting knowledge may have limited impact.
BACKGROUND:Polycystic ovary syndrome (PCOS)/polyendocrine metabolic ovarian syndrome (PMOS), is the most common female endocrine disorder, presenting with reproductive, metabolic, psychological, and social complications. Current lifestyle modifications focus on weight loss, despite PCOS/PMOS affecting individuals across body sizes and the high prevalence of disordered eating. Thus, alternative treatment approaches, such as intuitive eating, should be explored. OBJECTIVE:The primary objective was to describe intuitive eating behaviors in individuals with PCOS/PMOS. The secondary objective was to examine the associations between intuitive eating and biopsychosocial factors related to the disease, including body appreciation, health-related quality of life (HRQOL), psychological symptoms, social support, and diet quality. DESIGN:This study was a cross-sectional online survey. PARTICIPANTS/SETTING:Individuals living in the United States with a self-reported PCOS/PMOS diagnosis (n=342), between ages 18-40 years, were recruited online using social media between March 2023 and January 2024. MAIN OUTCOME MEASURES:Main outcomes included intuitive eating, body appreciation, HRQOL, psychological symptoms, social support, and diet quality. STATISTICAL ANALYSES PERFORMED:Multiple linear regression analyses explored relationships between intuitive eating and biopsychosocial measures, with age, length of time since diagnosis, and BMI as covariates. RESULTS:Individuals with PCOS/PMOS (79.2% white, 83.9% non-Hispanic, mean [SD], 30.8 [4.8] years) had moderate intuitive eating scores (mean [SD], 3.0 [0.6]; 75th percentile: 3.4, possible range 1-5). Intuitive eating scores were positively associated with body appreciation (ß= 0.496, p<0.001), HRQOL (ß= 0.250, p<0.001), diet quality (ß= 0.210, p<0.001), and tangible social support (ß= 0.190, p<0.001) Additionally, intuitive eating scores were negatively associated with psychological symptoms (ß= -0.257, p<0.001), and psychological symptoms subscales, depression (ß= -0.230, p<0.001), anxiety (ß= -0.172, p<0.05), and stress (ß= -0.282, p<0.001). CONCLUSIONS:Greater self-report of intuitive eating practices was associated with more favorable biopsychosocial measures, highlighting intuitive eating as an area for future research in PCOS/PMOS populations.
BACKGROUND:Digital health technologies are transforming healthcare. There is limited research describing how these technologies have been applied by nutrition and dietetic professionals across the nutrition care process. A summary of the literature is needed to guide future research. OBJECTIVE:To examine how digital health technologies have been applied in acute care nutrition and dietetics practice, identify strengths and gaps in the literature, and offer recommendations for future research. METHODS:A scoping review was conducted according to JBI guidance and was reported against the PRISMA-ScR checklist. Six databases (MEDLINE, Embase, Web of Science, Scopus, PsycInfo, IEEE Xplore) were systematically searched from January 1, 2014 to 16 April, 2025. Articles that described the use of any digital health technology by nutrition and dietetic professionals to deliver, monitor, or evaluate practice across the nutrition care process in acute hospital settings were eligible. Data were extracted, narratively synthesized, and mapped to the nutrition care process, National Institute of Health & Care Classification of Digital Health Technologies, and Quadruple Aim of Healthcare. RESULTS:A total of 101 articles across 24 countries (85% high-income) were included, representing 333,517 patients, 2,846 nutrition professionals, 21 diseases, and 78 primary outcomes. Telehealth was the most common technology applied in practice (31%), followed by electronic medical records and mHealth (19% each), clinical decision support (15%), machine learning and computerized provider order entry (5% each), data visualizations (3%), and digital food service systems (2%). Malnutrition was the primary therapeutic target (39%). Most study designs were observational (67%) compared to interventional (33%). Process outcomes (quality, efficiency, or safety) were more common than health, cost, or experience outcomes. Patterns of reported findings may suggest mostly favorable or mixed primary outcomes where technologies were the main exposure. Technologies were mostly applied at the intervention (n=55) or assessment (n=35) stages of the nutrition care process. Nutrition and dietetic professionals had diverse digital roles, such as interpreting risk scores in assessment, delivering telehealth care as interventions, and navigating and extracting electronic medical record data in monitoring and evaluation. CONCLUSIONS:In 24 countries, a range of digital health technologies were applied across the entire nutrition care process in acute care nutrition and dietetics practice. Telehealth, electronic medical records, mHealth, and clinical decision support were most frequently used by nutrition and dietetic professionals to deliver nutrition interventions and undertake nutrition assessment.
BACKGROUND:Dietary intake, including both quantity and quality, plays a critical role in supporting nutrition outcomes and the long-term health and wellbeing of cancer survivors. While primary care dietitians are well-placed to support these outcomes, many report a desire to upskill or expand their scope of practice due to limited access to evidence-based resources that support cancer-related nutrition care. OBJECTIVE:To explore stakeholder perspectives of the usefulness, relevance, and potential application of two prototype resources (Toolkit and Checklist) co-designed to support dietitians in providing care to cancer survivors within primary care settings. DESIGN:This qualitative study used the think-aloud method. Individual interviews were conducted while participants reviewed the Toolkit and Checklist prototypes. This work formed the final phase of a broader co-design project. PARTICIPANTS/SETTING:Eligible participants were clinicians involved in cancer care, and adults with lived experience of cancer as survivors or carers. Twenty stakeholders from across Australia participated in online interviews conducted in August-September 2025. Participants included primary care dietitians (n=14), carers (n=7), cancer survivors (n=3), other health practitioners (n=2). Six participants represented more than one group. ANALYSIS:Performed: Verbatim interview transcripts were analysed inductively using thematic analysis, supported by the Framework Method. Themes and subthemes were iteratively developed and refined through team discussion. RESULTS:Themes included: (1) building confidence in cancer nutrition care through accessible, evidence-based knowledge; (2) enhancing consultation structure and efficiency through timesaving and trustworthy guidance; and (3) sustaining and expanding future use of the co-designed resources through ongoing updates, digital integration, and broader educational or clinical applications. CONCLUSION:The co-designed Toolkit and Checklist were perceived as relevant, credible, and feasible supports for equipping primary care dietitians to deliver optimum cancer nutrition care. Future research should evaluate real-world implementation of the resources through a trusted website, workflow integration, and impacts on practitioner confidence and patient outcomes.
BACKGROUND:Although human milk is the gold standard for infant feeding, by 4 months of age >50% of US infants are fed infant formula, either alone or to supplement human milk. Little is known about infants fed both human milk and infant formula (i.e., mix-fed). OBJECTIVES:To evaluate variations in sociodemographic and economic characteristics of infants <12 months of age by primary milk feeding type and to characterize the types of formulas fed to mix-fed infants. DESIGN:Cross-sectional analysis of pooled data from nine National Health and Nutrition Examination surveys (2007-2023). PARTICIPANTS/SETTING:This study used nationally representative data to identify primary milk feeding type of infants <12 months of age (n=2,112) in the United States. MAIN OUTCOME MEASURES:Infant and household sociodemographic and economic characteristics by type of milk(s) fed (mix-fed, human milk only, infant formula only). STATISTICAL ANALYSES:Survey-adjusted weights and 95% confidence intervals (CIs) were applied to summarize differences in main outcome measures by primary milk feeding type. Group differences were assessed using Chi-square tests. RESULTS:19.4% (CI: 17.3, 21.5) of infants were mix-fed, 24.9% (CI: 22.6, 27.3) were fed human milk only, 55.7% (CI: 53.1, 58.2) were fed infant formula only. The percentage of mix-fed infants was greatest among Mexican American (29.3%, CI: 23.4 35.2) and Other Hispanic (19.9%, CI: 13.5, 26.4) infants, and lowest among Non-Hispanic Black infants (13.5%, CI: 8.6, 18.3). Households with food insecurity (reliance on emergency food assistance, worried food would run out, household food did not last, reliance on low-cost food for child) had higher percentages of infants fed infant formula only, followed by mix-fed infants, compared to those households that were food secure. Among mix-fed infants, 91.1% (CI: 86.5, 95.6) were fed term infant formula with nonhydrolyzed protein. CONCLUSIONS:Mexican American infants represented the largest percentage of mix-feeding. Feeding human milk only was most prevalent in food secure households, while food insecure households had the highest percentage of exclusive formula feeding, and secondarily, mix-feeding. Among mix-fed infants, non-hydrolyzed protein term formula was most commonly used, followed by partially hydrolyzed protein formula.
BACKGROUND:Registered dietitian nutritionists (RDN) should be essential contributors to weight management and diabetes care for people using glucagon-like peptide-1 receptor agonist-based therapy (GLP-1 RA-based therapy), as they provide education, prevent and manage side effects, and address nutritional deficiencies. Little is known about the practice behaviors of RDNs , providing care to people using these medications. OBJECTIVE:To determine demographic, professional characteristics, and practice behaviors of RDNs who provide medical nutrition therapy (MNT) to people using GLP-1 RA-based therapy diagnosed with either obesity or diabetes. DESIGN:An online, cross-sectional survey was distributed from May 28, 2025, through June 25, 2025, consisting of 55 questions covering topics such as screening for eating disorders and malnutrition, nutrition assessment, diagnosis, intervention, monitoring, and evaluation within the nutrition care process. RESPONDENTS:The sample included 212 RDNs who were members of the Weight Management Dietetic Practice Group and/or the Diabetes Dietetic Practice Group of the Academy of Nutrition and Dietetics and had experience working with people receiving GLP-1 RA-based therapy. STATISTICAL ANALYSIS PERFORMED:Survey data were analyzed via descriptive statistics. RESULTS:Respondents were female (95.3%), with 20.4 (SD + 11.9) years of experience, 64.1% held a master's degree, and 61.5% worked in an outpatient or ambulatory clinic. Regarding assessment practices, 26.4% screen for eating disorders, 42.9% perform a nutrition-focused physical exam, and 31.1% routinely assess body composition. The RDN respondents most commonly recommend monitoring for Vitamin D (78.2%) and iron (75%) deficiencies. Over 80% of respondents "strongly agree" (62.0%) or "somewhat agree" (22.4%) that there is a need to create specific GLP-1 RA-based therapy MNT practice guidelines. CONCLUSIONS:This survey not only identifies key patterns of consistency and variation in practice among RDNs but also reinforces the integral role that RDNs play in supporting and managing people on GLP-1 RA-based therapy. A majority of RDNs indicated a need to develop dietetic-specific MNT guidelines for GLP-1 RA-based therapy.
BACKGROUND:Pediatric dietary assessment is challenging, particularly for young children who cannot accurately report their own intake. Many existing measures are burdensome for proxy-reporters, and briefer dietary screeners focus on specific dietary components but not total diet quality. OBJECTIVE:The objective of this study was to develop and evaluate the reliability and validity of an adapted brief parent-reported diet quality screener - rapid Prime Diet Quality Score for Kids (rPDQS-Kids) - in relation to food groups and overall diet quality estimated from repeated Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24) diet recalls for young children. DESIGN:This was a cross-sectional study that evaluated the psychometric properties of the 16-item rPDQS-Kids. PARTICIPANTS/SETTING:Participants of this study included parents of 1-4 year-old children participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (n=175) in the state of Massachusetts from January 2024 to February 2025. MAIN OUTCOME MEASURES:Information about consumption frequencies was reported by parents using the rPDQS-Kids screener. Mean intake and overall diet quality were also assessed using two 24-hour recalls. STATISTICAL ANALYSES PERFORMED:Test-retest reliability and internal consistency of the rPDQS-Kids were evaluated. Criterion validity was assessed by comparing rPDQS-Kids diet quality score with the Healthy Eating Index (HEI) score (HEI-2020 for 2-4y; HEI-Toddlers-2020 for 1 to <2 y). RESULTS:The rPDQS-Kids showed moderate test-retest reliability [Intraclass Correlation Coefficient for total score: 0.69 (95% CI: 0.62, 0.75)]. Consistent with a priori hypotheses, internal consistency reliability was low, with ordinal alpha=0.27 and ordinal alpha=0.34 for the healthy and unhealthy sub-scores, respectively. Further, significant correlation was observed between the rPDQS-Kids traffic light diet quality score and HEI-2020 total score among children 2-4 (n=127) years old (r=0.32) (P<0.001). Among children 1 to <2y (n=48), rPDQS-Kids was not significantly correlated with the HEI-Toddlers-2020 (P>0.05). CONCLUSIONS:The parent-reported rPDQS-Kids shows potential as a low-burden tool for measuring young children's dietary quality.
BACKGROUND:Choosing products with fewer ingredients is commonly recommended to promote healthier food choices. However, the association between ingredient count and nutritional quality is poorly documented. OBJECTIVE:To investigate the association between ingredient count and overall nutritional quality of products within five processed food categories in Québec, Canada. DESIGN:In this cross-sectional study, all products from the studied food categories were purchased from food retailers. SETTING:A total of 1930 products were analyzed across five food categories (2021-2024) in Québec City: sliced breads (n=340), pasta sauces (n=347), sliced processed meats (n=487), granola bars (n = 369), and yogurts and dairy desserts (n=387). MAIN OUTCOME MEASURE:Ingredient counts were double-coded, both manually and in R. Nutritional quality was assessed using two nutrient profiling systems: the Nutri-Score (NS) and the Canadian front-of-pack nutrition symbol (C-FOP). STATISTICAL ANALYSES PERFORMED:Analyses were performed in R. Linear regressions were used to assess the association between ingredient count and NS, while logistic regressions were used for the C-FOP. RESULTS:Using the NS, higher ingredient counts were associated with a poorer nutritional quality (higher NS) in pasta sauces (β=0.37, p <0.001), granola bars (β=0.18, p <0.001), and yogurts and dairy desserts (β= 0.08, p=0.006), with variation by subcategories for sliced breads, pasta sauces, and sliced processed meats (p<0.05). Using the C-FOP, higher ingredient counts were associated with a better nutritional quality (lower probability of displaying the C-FOP) in sliced breads (β=-0.09, p <0.001), and yogurts and dairy desserts (β=-0.07, p=0.003), but with poorer nutritional quality in pasta sauces (β=0.14, p <0.001), with variation by subcategories for granola bars, yogurts and dairy desserts with the C-FOP (p<0.05). CONCLUSION:The association between ingredient count and nutritional quality in processed food is heterogeneous and varies between and within food categories. Hence, for foods available in Québec, it would be preferable not to recommend relying solely on ingredient count to assess the nutritional quality of foods.
BACKGROUND:Prospective evidence on the association between ultra-processed food (UPF) consumption and type-2 diabetes, and the potential mediator role of body mass index (BMI), is lacking in Australia. OBJECTIVE:To investigate the association between UPF consumption and incident type-2 diabetes in Australian adults, and to further examine the mediating role of BMI in this association. DESIGN:Prospective study using the Melbourne Collaborative Cohort Study (MCCS) data. PARTICIPANTS:/Setting: Participants were recruited from the Melbourne metropolitan area between 1990-1994 (baseline), with follow-ups conducted in 1995-2002 and 2003-2007. A total of 25,214 participants aged 40-69 years, without diabetes at baseline, and who provided baseline dietary and follow-up diabetes data were included. MAIN OUTCOME MEASURES:Incidence of type-2 diabetes was assessed at follow-up 1 (self-report) and follow-up 2 (self-report, elevated plasma glucose (≥ 126 mg/dL fasting or ≥ 200 mg/dL non-fasting), or medication use). STATISTICAL ANALYSES PERFORMED:Adjusted Poisson regression models estimated Incidence Rate Ratios (IRRs) and 95% confidence intervals (CIs) for the risk of type-2 diabetes per 10% increase and by quartiles of UPF consumption (% total grams/day), using age as the time metric. Regression-based mediation analyses were employed to assess the mediation role of BMI. RESULTS:During follow-up (mean: 11.6 ± 1.7 years), 1,734 cases of type-2 diabetes occurred. The direct association between each 10% increase in UPF consumption and type-2 diabetes was statistically significant (IRR: 1.16; 95%CI: 1.11, 1.21), yet spline analyses indicated evidence of non-linearity. Participants in the highest quartile of UPF consumption had a 40% higher risk of type-2 diabetes (IRRhighxlow category = 1.40, 95%CI: 1.22, 1.60; p<0.001). BMI significantly mediated 18% of the association. CONCLUSIONS:In this large cohort of Australian adults, higher UPF consumption was associated with an increased risk of type-2 diabetes, with BMI as an important mediator.
BACKGROUND:Postpartum weight retention (PPWR) is common and associated with poor health outcomes. Traditional weight management approaches have limited success postpartum. Due to infant-related sleep disruptions, late-night eating may be more common postpartum and contribute to PPWR. Chrononutrition interventions, which align energy intake with circadian rhythms in metabolism, demonstrate promise for weight loss in nonpostpartum populations and offer a novel approach to preventing PPWR. However, no studies have explored whether chrononutrition approaches may be acceptable postpartum, which is needed to inform which approaches may warrant subsequent testing. OBJECTIVE:To characterize perceived determinants of eating timing and understand the feasibility of following various chrononutrition approaches among postpartum mothers. DESIGN:A qualitative descriptive study using semistructured interviews to query participants about the following chrononutrition approaches, which they also ranked from most to least preferred: bedtime stopping rule (no energy intake within a certain number of hours of bedtime); king's breakfast, pauper's dinner (distributing kilocalories so intake is highest at breakfast and lowest at dinner), and time-restricted eating (shortening the daily eating window to ≤10 hours). PARTICIPANTS/SETTING:Mothers (N = 10) within 6 months postdelivery recruited from the University of Alabama at Birmingham Hospital and interviewed between August and December 2023. ANALYSIS:Interviews were coded through an iterative process using an exhaustive approach. RESULTS:Themes influencing eating habits included infant schedule and availability of childcare/home assistance. Barriers to chrononutrition approaches included the importance of the evening family meal and enjoying relaxing and eating after children went to bed. Participants most preferred the bedtime stopping rule and were willing to stop eating a median of 2 hours before bedtime. CONCLUSIONS:This study provides novel insights into mothers' perceptions of implementing various chrononutrition approaches, highlighting the importance of external barriers (eg, partner work schedule). Findings can inform the development of novel chrononutrition interventions to manage PPWR.
BACKGROUND:Carbohydrate (CHO) restriction has regained attention as a dietary approach for weight management and cardiometabolic health, though evidence supporting its effectiveness remains controversial, particularly regarding degree of restriction. OBJECTIVE:Examine effects of CHO-restricted versus higher CHO dietary approaches on weight- and cardiometabolic-related outcomes in adults with overweight or obesity without other established disease. METHODS:Searches of MEDLINE, CINAHL, and Cochrane databases identified relevant randomized controlled trials (RCTs) published from 2010-2025. Primary outcomes were anthropometric outcomes (body weight, BMI, waist circumference, fat and lean body mass) and glycemic outcomes (fasting blood glucose, HbA1c). Meta-analyses were conducted using random-effects models for an outcome of interest. Heterogeneity was assessed using I2, evidence certainty using the GRADE methodology, and publication bias was assessed using Begg and Egger's statistic and by generating funnel plots. RESULTS:Twenty-three RCTs, represented in 28 articles, were included. Degree of CHO restriction varied across studies, with self-reported intake often less restrictive than prescribed levels. CHO restriction resulted in modest but significant reductions in body weight (Mean difference (MD): -1.32kg, 95% CI: -2.03, -0.61), waist circumference (MD: -0.89 cm, 95% CI: -1.44, -0.34), and fat mass (standardized mean difference (SMD): -0.29, 95% CI: -0.48, -0.10) compared to higher CHO diets. CHO restriction reduced fasting blood glucose (MD: -0.08mmol/L, 95% CI: -0.17, 0.00), HbA1c (MD: -0.16%, 95% CI: -0.28, -0.04), triglycerides (MD: -0.17mmol/L, 95% CI: -0.26, -0.08), and systolic blood pressure (MD: -4.86mmHg, 95% CI: -6.60, -3.11). CONCLUSIONS:CHO restriction (<45% total daily energy intake) likely provides modest benefits for weight management and certain cardiometabolic risk factors in adults with overweight or obesity.
BACKGROUND:Low energy diets (LEDs) (800-1200 kcal/day) can lead to 10-15 kg weight loss and diabetes remission. LEDs are now being explored for managing obesity in chronic kidney disease (CKD). Understanding patient experiences and perspectives of LED programs is essential for planning large-scale trials and to inform translation into clinical practice. OBJECTIVE:To describe participants' experiences and perspectives of being involved in a randomized controlled trial (RCT) for weight loss involving an LED intervention or usual care (UC). DESIGN:A qualitative description approach was followed using semi-structured interviews to collect data. PARTICIPANTS:/setting Telephone interviews were conducted with 25 adults living with stages G1-3b CKD and a body mass index >30 kg/m2 from the SLOW-CKD feasibility RCT, in which participants had been randomized 1:1 to either an LED group or UC. Interviews explored participants' experiences and perspectives of following an LED with weight loss support, or receiving UC, and participating in a weight loss RCT. DATA ANALYSIS:Interviews were audio recorded, transcribed verbatim and analyzed using reflexive thematic analysis. RESULTS:Five themes were generated which highlighted: the longstanding battle with weight management and health experienced by people living with CKD and obesity; the value of a trusted study team and patient centered trial design; the role of support, persistence and personalized routines in developing new habits on an LED; the need to navigate individual challenges, motivations and preferences; and the benefits of the LED beyond weight loss. After initial challenges, LED participants adapted and were pleased with their commitment and success, noting improvements in kidney function, eating habits, diet quality and physical capacity. Several UC participants expressed disappointment and a sense of missed opportunity. CONCLUSIONS:The study highlights the challenges faced by adults living with CKD and obesity. Provision of individualized support from trusted healthcare professionals can enhance participant experiences of LED interventions for adults with CKD and obesity. Findings support LED use in clinical practice and further research on its effectiveness in slowing CKD progression. Future weight loss trials should balance scientific rigor with strategies like 2:1 randomization, wait-list controls, or post-trial weight loss options to reduce randomization disappointment.
