Smaller quasi-experimental studies and short-term controlled trials of medically tailored meals (MTMs) have shown health benefits for several conditions, but MTMs have not been evaluated in large-scale policy initiatives. Multiple US states are now implementing MTMs in Medicaid, the health insurance program for low-income individuals, yet their impact has not been evaluated. We investigated changes in hospitalizations, emergency department (ED) visits and healthcare costs among 1,866 MTM recipients and 1,372 comparators from 2020 to 2023 across 11 health systems in Massachusetts. Both groups met eligibility criteria for diet-related conditions and food insecurity. We used propensity overlap-weighted generalized estimating equations to compare a 6-month baseline period to the program period. MTM receipt (mean, 6.7 months) was associated with 31% fewer hospitalizations (adjusted incidence rate ratio (aIRR) = 0.69 (95% confidence interval (CI): 0.58−0.82)), 20% fewer ED visits (aIRR = 0.80 (95% CI: 0.72−0.89)) and US$3,433 lower total healthcare costs (95% CI: $−1,215 to −$5,651). Healthcare cost reductions offset 98% of the MTM program costs during the enrollment period. Findings were robust across sensitivity analyses, a negative control test and a secondary comparison group. In stratified analyses, MTM receipt was net cost-saving among participants with cardiovascular disease, chronic kidney disease, depression, diabetes or high comorbidity. This large MTM policy evaluation informs consideration of ‘food is medicine’ therapies in clinical care. Between 2020 and 2023, in Massachusetts, receiving medically tailored meals was associated with reductions in hospitalizations and emergency department visits and lower healthcare costs.

Although the broad outlines of a healthy diet are clear, controversy has arisen surrounding certain foods and nutrients. This review updates contemporary nutrition controversies and the extent to which they may promote or protect against cardiovascular disease (CVD). In this review, beef tallow, ultraprocessed foods, full-fat dairy, seed oils, medium chain triglyceride oils, seafood, and alternative sweeteners are considered. Three groupings included: 1) evidence of harm with a recommendation to limit or avoid; 2) lacking in evidence for harm or benefit; and 3) evidence of benefit. The evidence of harm category included beef tallow, due to association with increased low-density lipoprotein cholesterol, ultraprocessed foods associated with worsened cardiometabolic health, and artificial sweeteners owing to correlations with increased CVD. Within the category lacking in evidence were full-fat dairy, medium chain triglyceride, monk fruit, and stevia. Finally, evidence of benefit included seed oils and seafood based on improved CVD outcomes.

INTRODUCTION:Only Congress can amend the statutory definition of eligible food for the Supplemental Nutrition Assistance Program, but states are actively engaged on this topic. The aim of this study was to identify state strategies to address Supplemental Nutrition Assistance Program-eligible food and inform future Supplemental Nutrition Assistance Program policy. METHODS:Using Lexis+, a legal research platform, in 2025 and 2026, state strategies-including legislative actions (bills and laws) and executive orders and U.S. Department of Agriculture state waivers-to restrict Supplemental Nutrition Assistance Program-eligible foods in 2025 were identified. Data were evaluated in 2026. RESULTS:In 2025, 31 states engaged in relevant activities. There were 40 unique policies that sought to exclude: sugar-sweetened beverages and candy (12 bills, 3 laws, 3 executive orders); sugar-sweetened beverages, candy, snacks, and/or prepared desserts (7 bills); sugar-sweetened beverages (3 bills, 1 law, 1 executive order); food based on broad nutrition criteria (4 bills, 1 executive order); ultraprocessed food (1 bill, 1 law, 1 executive order); and specific additives (2 bills). One law included evaluation requirements. In 2025, U.S. Department of Agriculture granted 18 state waivers to exclude sugar-sweetened beverages and candy (n=9); sugar-sweetened beverages (n=6); and sugar-sweetened beverages, candy, snacks, and/or prepared desserts (n=3); all of which contained evaluation requirements. CONCLUSIONS:The majority of state activity focused on sugar-sweetened beverages and candy. Although bills were proposed by states with diverse political party make-ups, activities with the force of law (laws, executive orders, and U.S. Department of Agriculture waivers) were predominantly passed or issued by Republican trifectas (when the governor and both legislative houses are of the same political party), with 2 waivers granted to Democratic trifectas. The waivers' evaluation requirements are essential to understanding the impacts of Supplemental Nutrition Assistance Program food-eligibility exclusions.

Sugar-sweetened beverages (SSBs) have adverse effects on health and the environment, but comprehensive and sustained strategies to curb their intake are lacking. While several countries have implemented policies, a broad suite of effective approaches has been challenging to enact and evaluate due to insufficient administrative or political capacity and strong influence from transnational corporations. Continued research, advocacy and support are needed to successfully implement, monitor, evaluate and revise strategies to reduce SSB intakes worldwide.

BACKGROUND:Food is Medicine (FIM) interventions leverage food-based therapies to address diet-related conditions and disparities. Although nutrition and/or culinary education are recommended, the details and extent of these activities remain unclear. OBJECTIVE:To evaluate the following 5 key educational characteristics within FIM interventions: components, delivery format, setting, frequency, and educators. METHODS:Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a scoping review was conducted of FIM interventions (ie, medically tailored meals, groceries, or produce prescriptions) that included an educational component. Cochrane Central Register of Controlled Trials, CINAHL, Embase, PubMed, and SIREN databases were searched from January 2010 to May 2025. Two investigators independently assessed texts for inclusion and extracted data using standardized methods. Descriptive analysis and narrative synthesis identified patterns and strategies related to educational methods. RESULTS:Of 5703 articles reviewed, 100 met inclusion criteria, mostly from the United States (n = 91) and focused on adults (n = 84). Forty-one percent of the studies provided 1 educational component, 49% provided 2 to 3, and 10% provided 4 or more. Among 10 major educational components, printed materials (43%), cooking classes (35%), and individual counseling (32%) were most common. Most were delivered in-person (55.3%), followed by virtual (23.9%). Educational settings included virtual platforms (24%), clinics or hospitals (22.4%), and community locations (10.4%). Frequency of activities varied from 1 time to available on-demand; weekly (18.6%) and monthly (17.5%) were most common. Educators were most often registered dietitian nutritionists (23.6%), followed by clinicians (11.3%) and community health care workers (7.7%); 42.6% were unspecified. CONCLUSIONS:These novel results provide a comprehensive characterization of educational components of FIM interventions. Findings highlight common patterns, structural gaps, and opportunities to strengthen the design, implementation, evaluation, and reporting of nutritional and culinary education within FIM.

Importance:Nutrition security is increasingly recognized as a critical but underexamined driver of health. Identifying barriers to nutrition security is essential for developing effective interventions. Objective:To examine associations among barriers to healthy eating, their prevalence by sociodemographics, and their associations with health conditions. Design, Setting, and Participants:In this cross-sectional study, a population-based survey was conducted between February and April 2023 among English-speaking US adults aged 18 years or older recruited and surveyed through the Qualtrics panel service, with oversampling among people with annual household incomes less than $50 000. Data were analyzed from March 18 to November 9, 2025. Exposures:Nutrition security status and barriers to nutrition security, assessed through the Nutrition Security Screener. Main Outcomes and Measures:Primary outcomes were health conditions: type 2 diabetes, obesity, heart disease, high blood pressure, high cholesterol, stroke, and cancer. Independent variables were nutrition security barriers. Covariates included age, gender, race, ethnicity, educational attainment, annual household income, and food security status. Multivariable regressions with health condition outcomes were stratified by nutrition security status. Results:Of 3009 survey respondents, 3000 provided information on barriers to nutrition security and were included in analyses (1518 [50.6%] were female; 1983 [66.1%] were between ages 18 and 49 years). A mean (SD) of 7.8 (3.0) barriers were reported among participants with nutrition insecurity compared with 4.4 (3.2) among those who had nutrition security. Most barriers were only modestly intercorrelated (mean [SD] r = 0.45 [0.13]), with the highest correlation (r = 0.86) between insufficient time to shop and to cook. Barriers clustered into 2 factors that explained 61.4% of the variance. Black adults had higher odds of transportation barriers (adjusted odds ratio [AOR], 1.56 [95% CI, 1.17-2.08]) than White adults, whereas Hispanic/Latinx adults had higher odds of nutrition assistance barriers (AOR, 1.65 [95% CI, 1.26-2.17]) than those who were non-Hispanic/Latinx. A higher number of barriers (per unit increase [range, 0-13]) was associated with higher prevalence of diabetes (AOR, 1.10 [95% CI, 1.04-1.16]), heart disease (AOR, 1.16 [95% CI, 1.07-1.24]), and obesity (AOR, 1.09 [95% CI, 1.04-1.14]) among adults with nutrition security and of heart disease (AOR, 1.12 [95% CI, 1.03-1.22]) and stroke (AOR, 1.12 [95% CI, 1.02-1.25]) among those with nutrition insecurity. Conclusions and Relevance:In this study among US adults, barriers to nutrition security were interrelated, varied across demographics, and were associated with disease conditions. These findings provide new insights into how barriers to healthy eating can be assessed, informing more targeted clinical, public health, and policy initiatives.

[This corrects the article DOI: 10.1016/j.obpill.2025.100181.].

This Viewpoint discusses both the shortcomings and strengths of the Make Our Children Healthy Again (MAHA) Strategy and how it could represent a shift toward food and nutrition as foundations of US health.

Background Chronic kidney disease (CKD) is a global health problem which is associated with poor outcomes, and its prevalence is expected to increase. Identifying novel risk factors for CKD may lead to improved outcomes. Circulating saturated fatty acids (SFAs) have been posited as contributors to CKD risk. Objectives We aimed to evaluate associations between circulating SFAs (measured in phospholipids in 7 cohorts, serum or plasma total in 5 cohorts, and cholesterol esters in 1 cohort) and incident CKD in 13 cohorts, and to pool results by meta-analysis across the studies. Methods SFAs were measured in 13 cohorts in the Fatty Acids Outcomes Research Consortium, including 18,193 participants with estimated glomerular filtration rate >60 mL/min/1.73 m2 across 9 countries. Associations between each SFA [palmitic acid (16:0), stearic acid (18:0), arachidic acid (20:0), behenic acid (22:0), and lignoceric acid (24:0)] and incident CKD (defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2 and ≥25% decrease from baseline) were assessed by Cox or Poisson regressions. Results were pooled using inverse variance weighted meta-analysis. Results In total, 2554 participants developed CKD over a weighted median follow-up of 7.6 y. After adjustment, higher concentrations of 18:0 were associated with a lower risk of CKD with minimal heterogeneity (relative risk per interquintile range: 0.87; 95% confidence interval: 0.80, 0.95, P = 0.003, I2 = 14.7%). These associations remained consistent in secondary and sensitivity analyses. We did not observe significant associations of other SFAs with CKD. Conclusions In a meta-analysis of 18,193 participants across 9 countries, we observed no indication that SFA increased CKD risk, whereas higher 18:0 concentrations were associated with a lower risk of CKD. Future research is needed to assess mechanisms by which SFA 18:0 may exert kidney-protective effects, and how circulating SFA 18:0 concentrations may be altered.

Policy Points The United States is an outlier in its permissive regulatory landscape for direct-to-consumer (DTC) advertising of prescription drugs. The First Amendment is a barrier to banning DTC prescription drug promotion, but it is not a barrier to addressing false, deceptive, or unfair advertising, which may include forms of influencer and social media promotion. The learned intermediary doctrine shields drug manufacturers from liability in most states, even when they engage in pervasive DTC advertising that leads to consumer misunderstanding. State courts and legislatures should reconsider this doctrine to ensure that consumers are adequately protected. The US Food and Drug Administration needs increased resources and additional authority over the promotion of compounded drugs. CONTEXT:The United States is an outlier worldwide in its permissive regulatory landscape for direct-to-consumer (DTC) prescription drug promotion. Recent proposals to restrict DTC prescription drug advertising raise questions about potential challenges under the First Amendment of the U.S. Constitution which protects commercial speech. Prescription drugs are unique in that they require a healthcare provider (HCP) to prescribe the product; the HCP serves as a "learned intermediary" between the pharmaceutical company and the consumer of the product. Under the learned intermediary doctrine, pharmaceutical companies satisfy their duty to warn consumers about drug risks by warning HCPs, and are thereby shielded from tort liability even if consumers rely on their advertisements and are harmed. METHODS:Using government websites and Lexis+, we researched statutes, regulations and case law related to the First Amendment's protection of commercial speech, the statutory and regulatory framework for DTC prescription and compounded drug promotion, and the learned intermediary doctrine. FINDINGS:The Food and Drug Administration (FDA) oversees DTC prescription drug promotion but lacks comparable authority over compounded drug promotion. Certain forms of DTC advertising may be particularly misleading and warrant increased FDA oversight. Although commercial speech is broadly protected under the First Amendment, false, deceptive and misleading commercial speech can be regulated or restricted. FDA issued guidance to industry for traditional media promotion, but lacks guidance on social media, online telehealth, and influencer-generated content. The learned intermediary doctrine was created by state courts before the advent of DTC advertising and now provides perverse incentives to companies to aggressively market their drugs without consequence. CONCLUSIONS:Congress should provide FDA with equal authority over compounded drug promotion as it has for prescription drug promotion. FDA should issue regulations or guidance on modern forms of DTC advertising. The learned intermediary is based on outdated concepts and should be reconsidered by state legislatures and courts.

Background: Poor nutrition is a major contributor to disease and mortality, and intersects with food insecurity, broader social determinants of health (SDOH), and mental health. However, few studies have examined how these factors jointly shape mortality risk or mediate each other. Objective: To evaluate independent and mediating relationships among diet quality, food insecurity, SDOH, and mental health in relation to mortality among U.S. adults. Methods: Ten cycles of the National Health and Nutrition Examination Survey (1999–2018) were linked to the National Death Index. Diet quality was assessed using the Alternative Healthy Eating Index–2010 (AHEI-2010). Food insecurity was defined from the U.S. Household Food Security Survey Module. SDOH were summarized in a composite score (range: 0-8), including income, education, employment, insurance, SNAP participation, marital status, and homeownership. Mental health was represented using depressive symptoms and sleep indicators, each evaluated separately as sensitivity analyses. Demographic-adjusted Cox models evaluated the independent associations of diet quality, food insecurity, SDOH, and mental health with all-cause mortality, and their mediating effects. Additional analyses examined the extent to which prevalent cardiometabolic conditions mediated the diet–mortality association. Results: In multivariable models, each higher SDOH unit was associated with 14% higher mortality. Food insecurity mediated 20% of this association; diet quality, 12%; and depressive symptoms, 5%. Adjusting for SDOH, food insecurity was associated with 77% higher mortality, mediated by diet quality (1%) and depressive symptoms (7%). Evaluating all factors jointly, each higher SDOH unit was associated with 19% higher mortality; each 10 units of AHEI-2010, 9% lower; food insecurity, 79% higher; depressive symptoms, 36% higher; and sleep trouble, 34% higher. Conclusions: Diet-related metrics mediate a relatively small proportion of mortality risk related to SDOH but are themselves independently associated with mortality. Diet quality and depressive symptoms are not major downstream mediators of the food insecurity-mortality relationship but rather reflect independent risks. These new findings suggest a need to address each of these important risks to poor health, without assuming that policies to address one will address the others.

The aim of this study was to determine the trend in different diet quality scores and dietary CO2 emissions in the Eastern Mediterranean region (EMR) and globally. We used data from the global dietary database to assess diet quality using Dietary Approaches to Stop Hypertension (DASH), modified Planetary Health Diet index (PHDI), and Mediterranean diet (MED). CO2-equivalents (CO2 eq) emissions were calculated using carbon footprint methodology and compared by Wilcoxon test. The average of dietary CO2 eq emissions increased from 2228 in 1990 to 2370 g CO2 eq/kg in 2018 in the EMR and from 1929 to 2309 g CO2 eq/kg in the world. DASH score declined over time in EMR, but remained almost identical in the world. PHDI was slightly higher in the world than EMR and increased somewhat in EMR and in the world. The MED trend showed small variations in the EMR, and remained higher in EMR compared with the world. Although DASH and MED diet scores in the EMR were slightly higher than the world, dietary CO2 eq emissions were greater in the EMR than the world, which underscore the need for region-specific changes in food intake to achieve a nutritionally adequate and sustainable diet.

Introduction Healthful plant-based foods can improve youth nutrition and contribute to global targets such as Sustainable Development Goal (SDG) 2 on ending malnutrition, SDG3 improving health and SDG12 promoting sustainable diets, yet global intakes remain unquantified.Methods We analysed the Global Dietary Database, aggregating 1248 dietary surveys from 185 countries in a Bayesian hierarchical model adjusted for survey heterogeneity, temporal trends and data uncertainty. We assessed energy-adjusted consumption of fruits, non-starchy vegetables, starchy vegetables (excluding potatoes), beans/legumes and nuts/seeds among youth by age (0–19) globally in 2018; evaluated heterogeneity regionally, nationally and by sex, education and urbanicity; and assessed trends from 1990.Results Globally, plant-based food intake was low, from 1.19 servings/day (95% uncertainty interval (UI) 1.16 to 1.35) in <1-year-olds to 3.55 servings/day (3.35 to 3.79) in 15–19-year-olds. South Asia had the lowest intakes across all ages; East/Southeast Asia had the highest intakes for several ages, driven by non-starchy vegetables. Intake increased with age in all regions except high-income countries, where <1-year-olds consumed the most (3.77 servings/day (95% UI 3.30 to 4.35)), mainly from fruit (2.43 (2.14 to 2.77)). Across most regions, females consumed more fruit and non-starchy vegetables; urban youth consumed more fruit and nuts/seeds and those from higher educated households had higher intakes of all plant-based foods except beans/legumes. Among the 25 most populous countries, lowest intakes of total plant-based foods were in Spain (1.35 (1.10 to 1.75)), Pakistan (1.43 (1.21 to 1.76)), and the UK (1.71 (1.50 to 2.01)); and highest in Vietnam (4.28 (3.29 to 5.78)), Congo (4.38 (3.49 to 5.95)) and Mexico (5.18 (4.75 to 5.65)). Compared to 1990, youth globally in 2018 consumed more non-starchy vegetables and nuts/seeds, less starchy vegetables, and higher total plant-based foods.Conclusion Youth globally consume inadequate healthful plant-based foods, varying substantially by age, region and sociodemographic factors. These findings highlight gaps towards SDGs, underscoring the needs for targeted surveillance, policy interventions, and equity-focused strategies to improve youth dietary quality.

Objectives. To examine associations of ultraprocessed foods (UPFs, defined by Nova) with cardiometabolic risk factors, prevalent conditions, and mortality, before and after comprehensively adjusting for nutritional quality. Methods. We analyzed data from 47 999 adults in the National Health and Nutrition Examination Survey (NHANES) 1999-2018. Survey-weighted, multivariable adjusted linear or logistic regression evaluated cross-sectional associations with risk factors and disease prevalence, and Cox models evaluated prospective associations with all-cause mortality. Models were compared before and after adjustment for each individual's Food Compass Score (i.FCS) to test independence from nutritional quality. Results. Every 10% of energy supplied from UPFs was associated with higher body mass index, HbA1c, diastolic blood pressure, total-to-high-density lipoprotein cholesterol (HDL-C); lower HDL-C and low-density lipoprotein cholesterol (LDL-C); greater prevalence of metabolic syndrome (odds ratio [OR] = 1.07; 95% confidence interval [CI] = 1.05, 1.09), diabetes (OR = 1.03; 95% CI = 1.00, 1.07), and cancer (OR = 1.05; 95% CI = 1.02, 1.08); and higher risk of all-cause mortality (hazard ratio = 1.04; 95% CI = 1.02, 1.07). When we adjusted for i.FCS, associations were only partly attenuated, remaining significant. By comparison, adjustment for saturated fat, added sugar, or sodium had little effect. Findings were consistent in population subgroups, except for stronger associations among lower-income adults. Conclusions. UPF consumption is associated with adverse risk factors, disease conditions, and all-cause mortality, only partly explained by nutritional quality. (Am J Public Health. 2026;116(7):1015-1024. https://doi.org/10.2105/AJPH.2026.308499).

Background Food and nutrition insecurity are linked to poor health outcomes and disparities, yet how health care systems implement screening and referrals remains poorly understood. Methods We searched for studies evaluating screening and referral processes for food and nutrition insecurity for patients of all ages in US health care settings. Searches were performed through May 2025 in MEDLINE (via PubMed), Cochrane (via Ovid), Cumulative Index of Nursing and Allied Health (EBSCO), and Social Interventions Research and Evaluation Network Evidence and Resource Library. Studies were included if they reported both a screening process and referral mechanism. Findings were synthesized narratively. Results Of 11 406 records identified, 136 studies met the inclusion criteria; all screened for food insecurity, and none screened for nutrition insecurity. Most studies screened general populations across age, sex, race, and ethnicity, with few restricting by socioeconomic status or clinical conditions. Screening primarily used tools embedded within broader social determinants of health screenings (46%) and integrated into electronic health records (48%), typically in outpatient settings (49%). Screening methods varied, most commonly self‐administered by patients (21%) or by clinic staff (20%) and were unspecified in one fifth of studies (21%). A total of 129 studies described 39 unique referral strategies across 4 categories: community‐based resources (46%), health care–embedded services (35%), federal nutrition programs (12%), and Food Is Medicine interventions (7%), with 46% spanning multiple categories. While about half of studies (46%) reported referral rates, only about one third (37%) reported referral completion. Conclusions These findings highlight current practices and evidence gaps, informing priorities to strengthen screening and referral systems that advance food security, nutrition, health, and health equity.

This Viewpoint discusses the US Food and Drug Administration’s authority over food safety, including prior regulations surrounding ingredients, preemption, and federal vs state laws.