The United States Food and Drug Administration (FDA) recently proposed a new rule on front-of-package (FOP) labeling. Focusing on added sugars, sodium, and saturated fat, the proposed FOP label would identify foods with low [<5% daily value (DV)], medium (6‒19% DV), and high (20% DV) concentrations of each nutrient, calculated per serving size. This study applied the proposed FDA criteria to food categories and subgroups as defined in the USDA Food and Nutrient Database for Dietary Studies (2017‒2018). Nutrient composition data were joined with the FDA Reference Amounts Customarily Consumed. Analyses show the distribution of foods into FDA low, medium, and high criteria for each nutrient. Further analyses addressed food categories that were good (10%‒19% DV) or high/excellent (20% DV) sources of calcium, protein, and dietary fiber. This proposed labeling approach focuses only on nutrients to limit, similar to “warning label” FOP approaches seen in other countries. A balanced labeling approach that also includes nutrients to encourage (e.g., protein, dietary fiber, vitamins, and minerals) may be the preferred option to establish the relative healthfulness of foods.

Potassium-containing low-sodium salt substitutes (LSSS) may lower sodium intake, increase potassium intake, and reduce cardiovascular risk in mixed adult populations, but the review literature is overlapping and methodologically heterogeneous. This umbrella review assessed the efficacy, safety, and evidence quality of potassium-containing LSSS for blood pressure, cardiovascular outcomes, and adverse events. Following a registered PROSPERO protocol (CRD420261294404), we searched PubMed, Embase, Web of Science, Global Health (EBSCO) and the Cochrane Database of Systematic Reviews from inception to 6 March 2026 for systematic reviews, meta-analyses and umbrella reviews of potassium-containing LSSS. Eleven reviews met eligibility criteria. Methodological confidence was high in one review, moderate in three, low in five and critically low in two. Primary-study overlap was very high (corrected covered area 28.5%). Review-level pooled estimates consistently favoured potassium-containing LSSS for systolic blood pressure (mean differences -4.61 to -8.87 mmHg) and diastolic blood pressure (-1.42 to -4.04 mmHg). Later reviews also reported lower all-cause mortality (RR 0.88-0.89), cardiovascular mortality (RR 0.72-0.87), composite cardiovascular events and selected stroke outcomes; however, clinical-outcome estimates were heavily influenced by the Salt Substitute and Stroke Study. Serum potassium changed minimally (-0.02 to 0.18 mmol/l), and pooled estimates for hyperkalaemia and serious adverse events showed no clear excess risk in trial populations that largely excluded participants at higher risk of impaired potassium handling. Potassium-containing LSSS consistently lower blood pressure and may improve cardiovascular outcomes, but further trials are needed outside Eastern Asia, with clearer formulation reporting, prespecified baseline CVD-history strata, and stronger safety data in higher-risk populations.

Severe obesity and associated negative outcomes have increased in prevalence in America. Furthermore, people who identify as African American/Black (Black), Hispanic/Latine (Hispanic), Native Hawaiian/Pacific Islander (HPI), or American Indian/Alaskan Native (AIAN) suffer disproportionate impacts from obesity. Bariatric surgery is one of the most effective treatments for severe obesity. However, many patients with diverse ethnic backgrounds are less likely to receive bariatric surgery compared to their White counterparts, and when they do, they may have less weight loss and higher complication rates. This study seeks to describe the experiences of patients an average of 5 years after bariatric surgery. Semi-structured qualitative interviews were conducted between September 2021 and March 2022 with participants who received bariatric surgery within a large integrated health system. Interviews aimed to understand the perspectives of patients from diverse racial and ethnic backgrounds regarding weight loss and regain. Interviews were audio-recorded and transcribed for thematic analysis. A total of 68 interviews were collected; 29

Background:Pulses, which include beans, peas, lentils, and chickpeas, are a cornerstone of dietary recommendations. However, studies evaluating the association between pulse intake and cardiometabolic diseases (CMD) have yielded mixed findings, and no study has evaluated this association in a nationally representative sample of United States adults. To address this gap, we evaluated the association between usual pulse intake and prevalent CMD among United States adults from 1999 to 2018, and analyses were stratified by CMD subtype and sociodemographic groups. Objectives:The objective was to evaluate the association between usual pulse intake and CMD prevalence in a nationally representative sample of United States adults. Methods:Data from 46,939 adults were acquired from the NHANES, 1999 to 2018. Usual pulse intake was estimated using the National Cancer Institute Method, and CMD outcomes were identified using standardized criteria. Multivariable logistic regression models were used to estimate the association between usual pulse intake and CMD outcomes, adjusting for demographic, behavioral, and dietary risk factors. All analyses were stratified by CMD subtype and sociodemographic group. Results:In fully adjusted models, each 1 oz/d increase in pulse intake was associated with a 19% lower prevalence of cardiometabolic disease overall [odds ratio (OR): 0.81, 95% confidence interval (CI): 0.68, 0.97; P = 0.026]. In sensitivity analyses that excluded BMI as a covariate, each 1 oz/d increase in pulse intake was associated with a 21% lower prevalence of CMD (OR: 0.79, 95% CI: 0.65, 0.95; P = 0.013) and a 20% lower prevalence of diabetes (OR: 0.80, 95% CI: 0.64, 0.99; P = 0.042). No differences were observed between sociodemographic groups for any outcome (P ≥ 0.05 for all comparisons). Conclusions:Greater pulse intake is associated with lower prevalence of CMD and subtypes. Exploratory analyses demonstrate no differences in the association of pulse intake with CMD or its subtypes across sociodemographic groups.

To examine surgical experiences of diverse participants with obesity who underwent bariatric surgery and interacted with nurses and physicians in the prior 2-5 years. Qualitative analysis of a prospective longitudinal cohort study to understand adult experiences of people with obesity before and after bariatric surgery. Semi-structured interview data (n = 68) were analysed to identify patterns in supportive practices and unmet needs of participants with obesity. Two theme categories emerged describing supportive care and care gaps. Supportive themes were Appreciation, Support, Listening, and Understanding, Impact of Classes, and Importance of Information. Care gap themes included Stigma, Bias, and Judgement Lack of Decision Support, More Than Losing Weight, Weight Bias, Lack of Support/Communication, Lack of Follow-Up, Few Mental Health Supports, and Not Being Seen and Heard. Participants with obesity described experiences of bias, stigma, and concerns about knowledge and communication. Our study found stigma, bias, and judgement experienced by patients with obesity are barriers to bariatric care and successful outcomes. Gaps in communication, follow-up, and mental health contributed to feelings the participants expressed of "not being seen and heard." Active listening, transparent communication, and coordinated care were perceived by participants with obesity as essential for trust, respect, and belonging.

Consumption of foods containing live microbes has been associated with multiple health benefits. This study assessed exposure to live microbes in foods, including fermented foods, in the nationally representative INCA 3 dietary survey (2014-2015) in France. Foods in the French nutrient composition database (CIQUAL) were assigned to low, medium or high food groups of live microbe content. Dietary intakes came from the last French national dietary survey (INCA3 2014-2015). Participants were stratified by socio-demographic characteristics and by tertiles of medium/high food consumption. Diet quality measures were mean adequacy ratio (MAR, %), mean excess ratio (MER, %) and a score developed by the Programme National Nutrition Santé (sPNNS-GS2). Foods with Medium/High levels of live microbes were consumed by 97.7% of children and 98.4% of adults. Yogurt and cheese (unpasteurised) were the top sources of high food codes (99%). Vegetables and fruit (in particular, raw and unpeeled) were the top sources of medium food codes (75%). The leading fermented foods consumed in France were yogurt and cheese. Consumption of medium/high foods was 166.8 g/day for children and 215.9 g/day for adults. Medium/High foods accounted for < 4.5% of daily energy but provided > 10% of some key nutrients. Consumption of foods containing medium/high levels of live microbes was associated with higher socio-economic status and with higher quality diets. This was the first analysis of exposure to dietary live microbes in France by population strata.

The stated purpose of nutrient profiling (NP) models is to help implement dietary guidelines by addressing prevailing health issues. In high-income countries, obesity and non-communicable diseases are the main health issues of concern. As a result, NP models typically penalize packaged processed foods that contain calories, total or added sugar, sodium, and saturated fat. This negative nutrition approach may not be optimal for Southeast Asia, where nutrient shortfalls and nutrient deficiencies are still prevalent. A more positive approach featuring nutrients to encourage might be more appropriate. NP models should incorporate protein, fibre, calcium, iron, zinc, vitamin A, B vitamins, vitamin B12, and vitamin E. The specific choice of index nutrients may depend on population health needs. Further, given the diversity of Asian food cultures, it may be time to go beyond packaged foods and apply the NP methodology to mixed dishes and to complete meals. This article illustrates the application of NP models to composite meals.

Background Pulses, which include beans, peas, lentils, and chickpeas, are a cornerstone of dietary recommendations. However, studies evaluating the association between pulse intake and cardiometabolic diseases (CMD) have yielded mixed findings, and no study has evaluated this association in a nationally representative sample of US adults. To address this gap, we evaluated the association between usual pulse intake and prevalent CMD among U.S. adults from 1999-2018, and analyses were stratified by CMD subtype and sociodemographic groups. Objective The objective was to evaluate the association between usual pulse intake and CMD prevalence in a nationally representative sample of US adults. Methods Data from 46,939 adults were acquired from the National Health and Nutrition Examination Survey, 1999–2018. Usual pulse intake was estimated using the National Cancer Institute Method, and CMD outcomes were identified using standardized criteria. Multivariable logistic regression models were used to estimate the association between usual pulse intake and CMD outcomes, adjusting for demographic, behavioral, and dietary risk factors. All analyses were stratified by CMD subtype and sociodemographic group. Results In fully adjusted models, each 1 oz/day increase in pulse intake was associated with a 19% lower prevalence of cardiometabolic disease overall (OR: 0.81, 95% CI: 0.68–0.97; p=0.026). In sensitivity analyses that excluded BMI as a covariate, each 1 oz-/day increase in pulse intake was associated with 21% lower prevalence of CMD (0.79, 0.65-0.95; p=0.013) and 20% lower prevalence of diabetes (0.80, 0.64-0.99; p=0.042). No differences were observed between sociodemographic groups for any outcome (p≥0.05 for all comparisons). Conclusions Greater pulse intake was associated with lower prevalence of CMD and subtypes. Exploratory analyses demonstrated no differences in the association of pulse intake with CMD or its subtypes across sociodemographic groups.

The U.S. Food and Drug Administration (FDA) recently proposed a new rule on front-of-package (FOP) labeling. Focusing on added sugars, sodium and saturated fat, the proposed FOP label would identify foods with low (<5%DV), medium (6-19%DV), and high (20%DV) levels of each nutrient, calculated per serving size. This study applied the proposed FDA criteria to food categories and subgroups as defined in the USDA Food and Nutrient Database for Dietary Studies (FNDDS 2017-18). Nutrient composition data were joined with the FDA Reference Amounts Customarily Consumed (RACC). Analyses show the distribution of foods into FDA low, medium, and high criteria for each nutrient. Further analyses addressed food categories that were good (10 to 19 %DV) or high/excellent (20% DV) sources of calcium, protein, and dietary fiber. This proposed labeling approach focuses only on nutrients to limit, similar to “warning label” FOP approaches seen in other countries. A balanced labeling approach that also includes nutrients to encourage (e.g. protein, dietary fiber, vitamins, and minerals) may be the preferred option to establish the relative healthfulness of foods. Statement of Significance Front-of-package (FOP) labeling is meant to provide an indication of the healthfulness of a packaged food product to the consumer. Healthfulness is often viewed as the absence of added sugars, sodium, or saturated fat. This study is the first to apply the proposed FDA criteria to foods in the What We Eat in America nutrient composition database. The distribution into low, medium, and high FOP classes is provided for each of the three nutrients to limit by food category. Analyses were also conducted for dietary fiber, calcium, and protein. The findings include the following, as expected; meats contain no added sugars whereas beverages are low in saturated fat. The healthfulness of a food is not solely determined by nutrients to limit, a more balanced approach is preferred. With the provision of only nutrients to limit, the consumers could be misled and misinformed about the overall healthfulness of a food.

BACKGROUND:Capturing the healthfulness of mixed dishes per serving can be a challenge. OBJECTIVES:To develop a Nutrient Density Calculator (NDC) for mixed dishes to guide recipe innovation and reformulation. METHODS:Recipe files and nutrient composition data for mixed dishes came from the US Department of Agriculture Food and Nutrient Database for Dietary Studies (FNDDS 2021-2023). Included were mixed dishes with meat, poultry, seafood, grains, vegetables or legumes as their main ingredient, Asian and Mexican dishes, pizza, sandwiches, burgers, and nuts and seeds (n = 1570). Observed servings as consumed came from the National Health and Nutrition Examination Survey data (NHANES 2017-2020/2021 -2023). The NDC version 643 had three components: NR6 based on six nutrients to encourage (protein, fiber, calcium, iron, potassium, vitamin D); MP4 based on ingredients (fruits and vegetables, whole grains, pulses, nuts and seeds); and LIM based on three nutrients to limit (saturated fat, added or total sugar, sodium). An abbreviated version, NDC343, used NR3 (protein, fiber, calcium). Alternative NDC models tested different component weights. Nutrient density was calculated per serving. RESULTS:Both NDC643 and NDC343 gave higher scores to vegetables, pulses, and nuts and lower scores to meat-based dishes. Equal weighting of the three components produced NDC scores that were correlated with Nutri-Score (r = -0.64 for NDC343 and -0.70 for NDC643) and Health Star Rating values (r = -0.74 for NDC343 and -0.75 for NDC643). Correlations with energy density were -0.25 for NDC343 and -0.33 for NDC643. The NDC643 model was sensitive to recipe improvements for a variety of mixed dishes-more so than the Nutri-Score or the Health Star Rating. CONCLUSION:The three-component NDC model, combining both nutrients and ingredients, successfully captured nutrient density of mixed dishes and was sensitive to recipe improvements.

There is a large body of research about physical complications following metabolic and bariatric surgery (MBS); less is known about psychosocial sequelae that may adversely affect people’s lives after MBS such as loneliness and social isolation. This is important because loneliness and social isolation may affect health outcomes following MBS. Patients preparing to have MBS in a large health system were surveyed before (baseline) and at years 1, 3, and 5 following MBS. A total of 1,338 had MBS and were included in follow-up surveys. Survey response rates were 75

Background:The EAT-Lancet planetary health diet was designed as a universal nutritionally adequate diet with minimal environmental impact. We aim to assess and propose revisions to increase its nutrient adequacy in the context of West Africa based on the local food supply. Methods:We created a model EAT-Lancet diet using nutrient composition data from the FAO's Food Composition Tables for Western Africa (WAFCT). Median energy and nutrient profiles of EAT-Lancet diet food groups were calculated using WAFCT foods (n = 596). Protein content was adjusted using the Protein Digestibility Corrected Amino Acid Score (PDCAAS). We multiplied the recommended EAT-Lancet diet intake for each food subgroup by these medians to determine daily nutrient intake. Nutrient adequacy was determined based on alignment with the FAO Codex nutrient reference values for adults. The Nutrient Rich Food (NRF) index, based on priority micronutrients, defined nutrient density. Isocaloric revisions were made to the EAT-Lancet diet to enhance its nutrient adequacy using WAFCT foods. Results:Total energy of the modeled diet was 2,516 kcal/day. Total protein was 87 g/day while PDCAAS corrected protein was 62 g/day. Micronutrient shortfalls were observed for zinc, calcium, and vitamin A but not for iron, folate, and vitamin B12. Increasing intake of nutrient-rich liver, small dried fish, and pulses, while reducing whole grains and tree nuts, achieved micronutrient adequacy. Conclusion:When analyzed using foods available in West Africa, the EAT-Lancet diet may provide adequate protein but not vitamin A, zinc, and calcium. Future iterations of the diet should consider including categories for micronutrient dense foods to ensure adequacy.

The COVID-19 pandemic disrupted global food systems, contributing to rising food prices and altering the affordability of healthy diets. This study examined the relationship between nutrient density of foods, food prices and inflation in Mexico before, during, and after the pandemic. Foods from the ENSANUT dietary survey were assigned to 4 categories using the NOVA classification system and were linked to nutrient composition data and national food price series from 2012 to 2025. The Nutrient Rich Food Index (NRF9.3) was a measure of nutrient density. Affordability was defined as nutrient density relative to price per 100 kcal. Trends in prices and inflation were analyzed using a panel data model with food-level fixed effects. Minimally processed foods had substantially higher nutrient density (NRF9.3: 202.2) than processed (15.7) and ultra-processed foods (UPFs; 5.4), but were also markedly more expensive per 100 kcal. Across the study period, higher nutrient density was consistently associated with higher prices per calorie. During the pandemic, inflation for minimally processed foods increased by 1.64 percentage points (p.p.; p = 0.064) relative to pre-pandemic levels, and by 6.04 p.p. in the post-pandemic period (p < 0.001). Processed foods and culinary ingredients experienced additional inflation of 1.99 p.p. and 1.21 p.p., respectively, during the pandemic, while no significant differences across processing categories were observed post-pandemic. Following the onset of the pandemic, food prices increased across all processing categories. Because minimally processed foods had higher baseline prices, similar inflation rates translated into a widening affordability gap between more and less nutritious foods. These findings suggest that foods aligned with dietary recommendations became relatively less affordable during a period of economic disruption, potentially incentivizing substitution toward lower-cost, energy-dense UPFs. Policies that improve the affordability and price stability of nutrient-dense foods may be critical to support healthy diets under conditions of economic volatility.

Background: Grain foods are important sources of complex carbohydrates, fiber, vitamins, and minerals. Objective: To identify healthy grain foods and to assess their associations with composite diet quality measures and selected health outcomes. Methods: Healthy grain foods were identified using two methods. The first one, Carbohydrate Food Quality Score (CFQS-3) was based on whole grains, fiber, and added sugar. The second, NRF9.3g score for grains, balanced nutrients to encourage (protein, fiber, vitamins B1, B2, B3, and E, folate, iron, and magnesium) against added sugar, sodium, and saturated fat. Nutrient composition data for 1244 grain foods came from the USDA Food and Nutrient Database for Dietary Studies (FNDDS 2017-2023). Dietary intakes came from the National Health and Nutrition Examination Surveys (NHANES 2017-2023). The Healthy Eating Index (HEI 2020) and the diet-level Nutrient Rich Food Index (NRF) were the two measures of diet quality. National food prices came from the USDA 2021 Thrifty Food Plan. Data on body weight, waist circumference, insulin, and cholesterol came from NHANES clinical files. Results: Healthy grain foods were those that scored >2 points on CFQS-3 or were in the top tertile of NRF9.3g scores. The CFQS-3 score favored cooked whole grains and cereals and savory snacks. The NRF9.3g score gave the highest ratings to breads, rolls, and RTE cereals. Consumers of healthy grains identified using both methods had higher HEI 2020 values and higher diet-level NRF scores. Both effects were dose-dependent. Consumption of healthy grains was associated with lower obesity rates and lower fasting insulin levels. Conclusions: Consumption of healthy grain foods was associated with healthier diets and lower obesity prevalence. Dietary guidelines need to acknowledge the contribution of healthy grain foods to diet quality and health.

Almonds are consumed by individuals around the world. Because almonds are rich in protein, unsaturated fatty acids, and fiber, a significant amount of research has been conducted on their role in affecting various cardiometabolic endpoints (body weight, blood pressure, blood cholesterol levels, and glycemic response). The most current meta-analyses on almond consumption and various health-related endpoints suggest that almond consumption does not result in weight gain and results in small reductions in LDL cholesterol and diastolic blood pressure, as well as improved glycemic responses in certain populations (i.e. Asian Indians). A number of research gaps on almond consumption and cardiometabolic health were identified that should be addressed to further understand their role in the various cardiometabolic endpoints, including the mechanisms of action interactions with the microbiome with regular consumption and their role as part of a healthy dietary pattern for both individuals and the general population.

Background: The Dietary Guidelines for Americans (DGA) and the American Academy of Pediatrics recommend limiting 100% juice consumption to 0.5-1.25 cups/day and to no more than one half of total fruit intake. Objective: To explore the dietary benefits of consuming 100% fruit juice and diluted 100% juice across diverse socio-demographic strata in the US. Methods: Consumption patterns for 100% juice and diluted 100% juice were examined by sex, age group, income-to-poverty ratio (IPR), and race/ethnicity. Dietary intakes came from the National Health and Nutrition Examination Survey (NHANES 2017-2020 and 2021-2023). The Healthy Eating Index 2020 (HEI 2020) and diet-level Nutrient Rich Food (NRF9.3) scores were the two measures of diet quality. The amounts of 100% juice consumed were compared to published DGA recommendations. Results: The consumption of 100% juice was greatly below that of water, milk, and sugar-sweetened beverages (SSBs). The consumption of diluted 100% juice was very low. Consumers of 100% juice had higher HEI 2020 scores (53 vs. 48) and diets with less added sugar and more total fruit, more potassium, calcium, and vitamin C. About 88% of the NHANES sample consumed <4 oz/day (1/2 cup) of 100% juice and most derived at least 50% of fruit from whole fruit, though some variation by income and race/ethnicity was observed. About 93% of the sample consumed <1 cup/day (8 oz) of 100% juice. Lower income groups consumed less whole fruit and more 100% juice. Conclusion: The consumption of 100% fruit juice was a marker of healthier dietary choices. The observed social gradient suggests that 100% fruit juice may provide valuable nutrients to populations who may be unable to afford or access whole fruit. Public health recommendations: The consumption of 100% fruit juice by some population subgroups could be increased. Fruit juice was not displacing whole fruit, and current consumption was well below the current DGA recommended values.