Relationship between nutrition knowledge and dietary intake

Effect of nutrition education integrating the health belief model and theory of planned behavior during pregnancy on gestational weight gain and birth weight in Southeast Ethiopia using complex analyses

BACKGROUND

The incidence of inadequate or excessive gestational weight gain (GWG) is an indicator of reproductive health problems. However, scientific evidence for the effect of nutrition education during pregnancy on GWG and neonatal birth weight (BW) in urban settings in Ethiopia is sparse. This study aimed to assess the effect of nutrition education during pregnancy on GWG and neonatal birth weight (BW) in urban settings in Southeast Ethiopia.

METHODS

A community-based two-arm parallel cluster randomized controlled trial was conducted among 447 randomly selected pregnant women attending antenatal care (224 intervention and 223 control) from February to December 2021. Study participants were selected by multistage cluster sampling followed by systematic sampling. Women receiving the intervention received six nutrition education sessions, while women in the control group received standard care. GWG was the difference between the last recorded weight before delivery and the weight recorded during the first trimester. BW was measured within the first hour of delivery. The generalized structural equations model (GSEM) and structural equations model (SEM) were used to examine the direct, indirect, and total effects of nutrition education on GWG and BW via the dietary diversity score (DDS), food security (FS), and knowledge.

RESULTS

The GSEM revealed that receiving intervention during pregnancy had a total effect on GWG [(AOR = 2.056, 95% CI: 1.705, 2.695)]. Having dietary diversity had direct and total effects on GWG [(AOR = 1.105, 95% CI: 1.022, 1.196)]. Having food security had a total effect on GWG [(AOR = 1.928, 95% CI: 1.817, 2.052)]. Having fruit and vegetable knowledge had a total effect on GWG [(AOR = 1.971, 95% CI: 1.856, 2.105)]. The SEM revealed that receiving intervention during pregnancy had a direct effect on BW (unstandardized β = 0.144, 95% CI: 0.034, 0.252). Similarly, it revealed that receiving intervention during pregnancy had a direct effect on DDS (β = 0.580, 95% CI: 0.024, 1.038). Likewise, it indicated that receiving intervention during pregnancy had a total effect on increasing BW (β = 0.137, 95% CI: 0.029, 0.243). Nevertheless, there was no statistically observed indirect effect of nutrition education during pregnancy on GWG and BW via mediators.

CONCLUSION

The SEM revealed that receiving nutrition education interventions during pregnancy had a total effect on GWG and direct and total effects on BW. The generalized structural equation modelling (GSEM) and structural equation modelling (SEM) findings show that integrating theory-based nutrition education during pregnancy will improve gestational weight gain (GWG) and birth weight (BW) in Ethiopia.

TRIAL REGISTRATION

The trial was registered on Pan African Clinical Trials Registry (PACTR202201731802989, retrospectively registered on 24/01/ 2022).

The effects of a nutritional intervention on the sports nutrition knowledge and nutritional status of track and field athletes: protocol for a randomized controlled trial

BACKGROUND

Sports nutrition plays a crucial role in providing the fuel to meet the energy demands of athletes' training programmes, enhancing adaptations associated with training, and ensuring rapid recovery between workouts. However, evidence suggests that the dietary habits of many athletes are unsatisfactory when compared to sport-specific nutrition recommendations. This discrepancy is mainly due to a lack of up-to-date, evidence-based nutritional knowledge. Hence, this parallel-group, randomized controlled clinical trial aims to evaluate the effectiveness of a 16-week evidence-based, culturally appropriate, personalized sports nutrition intervention on the sports nutrition knowledge and nutritional status of track and field athletes in Sri Lanka, in comparison to a control group that does not receive this intervention.

METHODS

Elite and highly trained track and field athletes, competing at the national level and/or representing Sri Lanka in international competitions, will be randomly allocated to either the intervention group (IG) (n = 15) or the control group (CG) (n = 15). Participants in the IG will receive an evidence-based, culturally acceptable, personalized sports nutrition intervention from the principal investigator through one-to-one consultations at three-time points (zeroth, fourth, and eighth weeks), while participants in the CG will be followed up throughout the period without receiving the intervention. The primary outcome measure is the number of participants who achieve at least a 10% increase in mean sports nutrition knowledge (SNK) score at the end of the 16th week, compared to the CG. Secondary outcomes include nutrition status and sports performance-related measures at the beginning and end of the intervention.

DISCUSSION

While the primary objective is to enhance SNK, it is anticipated that improvements in nutritional status and overall health may significantly impact sports performance and career longevity of the athletes.

TRIAL REGISTRATION

Sri Lanka Clinical Trials Registry, SLCTR/2024/013. Registered on 10th April 2024. Universal Trial Number (UTN), U1111-1304-8890.

Nutrition Knowledge Varies by Food Group and Nutrient Among Adults

The United States Dietary Guidelines for Americans (DGA) have provided recommendations for healthy eating patterns to meet nutrient needs and reduce chronic disease risk for decades. However, few Americans fully meet these guidelines, especially regarding five shortfall nutrients, and the vegetable, fruit, pulse, whole grain, and dairy food groups. Nutrition knowledge is a modifiable factor associated with improved dietary behavior, yet it is unclear whether individuals with nutrition-related chronic diseases possess greater knowledge. The study objectives were to (1) describe knowledge of 10 nutrient sources across six food groups, and (2) determine predictive factors for nutrient source and food group knowledge. A national sample of 930 adults from an online panel answered demographic, nutrition-disease knowledge, desired benefits from foods, chronic disease status questions, and identified the presence or absence of 10 nutrients in six food groups. Respondents were 77% White, 51% women, and 70% married, with a mean age of 45 years. Nutrition-disease knowledge was higher for those who were older, women, and highly educated. Having a nutrition-related disease, e.g., heart disease, was not predictive of nutrient-disease knowledge. Whole grains had the highest average nutrient knowledge score (6.26 ± 2.5; range 0-10), while vegetables had the lowest (4.89 ± 2.3). Fat food sources were the best known (3.98 ± 1.5; range 0-6), and folate was the least recognized (2.16 ± 1.4). General linear models of survey variables for the six food groups explained 10.2% to 19.4% of nutrient knowledge variation and described 4.7% to 27.1% of differences in food-source scores for the 10 nutrients. Nutrient-disease knowledge had the most significant influence on nutrient source scores. Gaps in understanding nutrient sources suggest the public needs more applied education.

An Explanation Interface for Healthy Food Recommendations in a Real-Life Workplace Deployment: User-Centered Design Study

Background

Despite widespread awareness of healthy eating principles, many individuals struggle to translate this knowledge into consistent, sustainable dietary change. Food recommender systems, increasingly used in various settings, offer the potential for personalized guidance and behavior change support. However, traditional approaches may prioritize user preferences or popularity metrics without sufficiently considering long-term nutritional goals. This can inadvertently reinforce unhealthy eating patterns. Emerging research suggests that incorporating explanations into recommender systems can increase transparency, promote informed decision-making, and potentially influence food choices. Yet, the effectiveness of explanations in promoting healthy choices within complex, real-world food environments remain largely unexplored.

Objective

This study aims to investigate the design, implementation, and preliminary evaluation of a food recommender system that integrates explanations in a real-world food catering application. We seek to understand how such a system can promote healthy choices while addressing the inherent tensions between user control, meal variety, and the need for nutritionally sound recommendations. Specifically, our objectives are to (1) identify and prioritize key design considerations for food recommenders that balance personalization, nutritional guidance, and user experience; and (2) conduct a proof-of-principle study in a real-life setting to assess the system's effect on user understanding, trust, and potentially on dietary choices.

Methods

An iterative, user-centered design process guided the development and refinement of the system across 4 phases: (Phase 0) an exploratory qualitative study (N=26) to understand stakeholder needs and initial system impressions, (Phases 1 and 2) rapid prototyping in real-life deployments (N=45 and N=16, respectively) to iteratively improve usability and features, and (Phase 3) a proof-of-principle study with employees (N=136) to evaluate a set of design goals. We collected a mix of data, including usage logs, pre- and post-study questionnaires, in-app feedback, and a pre- and post-Food Frequency Questionnaire to establish nutritional profiles.

Results

Although we experienced a high drop-out (77% after 7 weeks), motivated and remaining participants valued personalization features, particularly the ability to configure allergies and lifestyle preferences. Explanations increased understanding of recommendations and created a sense of control, even when preferences and healthy options did not fully align. However, a mismatch persisted between individual preferences and nutritionally optimal recommendations. This highlights the design challenge of balancing user control, meal variety, and the promotion of healthy eating.

Conclusions

Integrating explanations into personalized food recommender systems might be promising for supporting healthier food choices and creating a more informed understanding of dietary patterns. Our findings could highlight the importance of balancing user control with both the practical limitations of food service settings and the need for nutritionally sound recommendations. While fully resolving the tension between immediate preferences and long-term health goals is an ongoing challenge, explanations can play a crucial role in promoting more conscious decision-making.

Effect of nutrition education on hemoglobin level of pregnant women in Southeast Ethiopia: a cluster randomized controlled trial

BACKGROUND

Maternal hemoglobin (Hgb) is considered an essential, modifiable risk factor for adverse pregnancy outcomes (APOs). Evidence for the effect of nutrition education on the Hgb levels of pregnant women in low-income countries, including Ethiopia, is inconclusive. This study aimed to assess the effect of nutrition education on the Hgb levels of pregnant women in urban settings in the Bale Zone, Southeast Ethiopia.

METHODS

A community-based two-arm parallel cluster randomized controlled trial was carried out among 447 randomly selected pregnant women attending antenatal care (224 intervention and 223 control groups) at health facilities from February to December 2021. A multistage cluster sampling technique followed by systematic sampling was used to select the pregnant women. Pregnant women who took part in the intervention arm received six nutrition education sessions, whereas pregnant women in the control group received routine standard care. We used a pretested, interviewer-administered, structured questionnaire to collect the data. The Hgb level of pregnant women was measured by collecting a finger-prick blood sample using a HemoCue Hb 301. A generalized estimating equation (GEE) model was used to isolate the net effect of the intervention on Hgb, accounting for the clustering. Beta coefficients (β) along with a 95% confidence interval (CI) were used for interpretations.

RESULTS

The mean difference in Hgb levels between the intervention and control groups was 0.12 ± 0.04 (P value < 0.002). The multivariable GEE linear model revealed that nutrition education significantly improved the Hgb levels of pregnant women [β = 0.36, 95% CI: (0.30, 0.43)]. An increase in the consumption of a cup of coffee or tea decreased Hgb levels by 0.14 g/dL [β = -0.14, 95% CI: (-0.23, -0.06)].

CONCLUSION

The findings showed that a comprehensive nutrition education intervention using the health belief model (HBM) and theory of planned behaviour (TPB) designed to improve dietary diversity substantially improved hemoglobin (Hgb) levels among pregnant women. While we found no single dietary factor to be significant, in this group of pregnant women in Ethiopia, an increase in the daily consumption of a cup of coffee or tea decreased Hgb levels. As a consequence, pregnant women should be advised to limit their coffee or tea consumption. The study was registered on Clinicaltrials.gov retrospectively with the registration number PACTR202201731802989 on 24/01/2022.

Does Health Literacy Mediate Sociodemographic and Economic Inequalities in Fruit and Vegetable Intake? An Analysis of Slovenian National HLS19 Survey Data

Health literacy plays an important role in promoting healthier behaviors. However, less is known about its impact on dietary habits, such as fruit and vegetable (FV) intake. This study examines the mediating role of health literacy in the relationship between FV intake and demographic and socioeconomic factors among Slovenian adults. We used Slovenian national data from the 19-country Health Literacy Survey 2019-2021 (HLS19) (n = 3360). Results indicate that health literacy plays a complex role in mediating the relationship between demographic and socioeconomic factors and FV intake. Women and financially stable individuals have higher levels of health literacy, which positively predicts higher FV intake. While older individuals demonstrated greater FV intake, they reported lower health literacy, suggesting other mechanisms may drive their dietary behavior. Additionally, while higher education was associated with improved health literacy, its direct relationship with FV intake was negative, though health literacy partially mitigated this effect. These results underscore the importance of health literacy as a mediating factor in improving dietary behaviors and highlight the need for targeted interventions and policies to enhance nutritional education, particularly for marginalized groups.

Effect of the PakCat program on nutrition status, dietary pattern and nutrition knowledge and skills of Pakistani women living in Catalonia evaluated by a mixed-method randomized control trial (RCT)

BACKGROUND

Pakistani women are among the most affected groups by obesity and heart failure in Catalonia. Due to cultural and linguistic barriers, their participation in standard health promotion programs is limited. To address this issue, we implemented a culturally and linguistically appropriate food education program called the PakCat Program.

METHODS

The study employed a community-based participatory research (CBPR) design, utilizing a two-arm, cluster-assignment, non-blinded mixed-method randomized control trial (RCT) implemented in Badalona and Santa Coloma de Gramenet, two neighboring municipalities with a substantial Pakistani population. Participants were randomly assigned to the control group (n = 67) and the intervention group (n = 70). The intervention group received ten weekly culturally and linguistically appropriate food education sessions over ten weeks, while the control group attended three general sessions. The main outcome measures included nutritional status, nutrition knowledge and skills, dietary patterns, and satisfaction with the intervention, which were assessed pre-and post-intervention combining quantitative methods based on a survey and qualitative approaches consisting of conducting focus group discussions (FGDs).

RESULTS

The quantitative analysis conducted through a two-factor analysis of variance (ANOVA) for repeated measures indicated a significant improvement in the study variables across the entire sample (p < 0.001 within group), with the intervention group experiencing greater improvements in nutrition knowledge and skills and dietary pattern (p <0.001 for interaction and between groups). These findings were corroborated by thematically analyzed qualitative data confirming a more pronounced improvement in the study outcomes of the intervention group. Furthermore, both groups reported a high level of satisfaction with the intervention.

CONCLUSIONS

The PakCat Program effectively improved the nutrition knowledge, skills, and dietary patterns of immigrant women of Pakistani origin residing in Catalonia. However, future research involving a larger sample size and combining the behavioral and clinical parameters is needed to enhance the generalizability of the results.

Adverse childhood experiences and diet quality in the national sample of Poles: The mediating role of emotion regulation

Adverse childhood experiences (ACEs) increase the risk of adverse psychological and physical outcomes and chronic disease in adulthood. The mechanism of this relationship is still unclear. ACEs might exert their negative influence on adult health via both dietary and psychological axes. Our study aimed to examine the relationship between ACEs and diet quality in the national sample of Poles. We also aimed to determine whether difficulty in regulating emotions act as a mediator of this relationship. The national Polish sample of adults (n = 3557) took part in this study. ACEs were assessed via the Adverse Childhood Experiences Questionnaire. Data on food consumption frequency over the past year, body weight and height were collected using the self-administered version of the Dietary Habits and Nutrition Beliefs Questionnaire (KomPAN®). Two diet quality scores were evaluated: Pro-Healthy-Diet-Index-10 (pHDI) and Non-Healthy-Diet-Index-14 (nHDI). Emotion regulation (ER) was evaluated via the Difficulties in Emotion Regulation Scale (DERS). Path analysis was used to examine the associations between the variables, firstly formulated by theoretical assumptions expressed by directed acyclic graphs (DAGs). A higher number of ACEs was related to higher difficulties in ER in adults (p < 0.001), which in turn was related to lower pHDI (p < 0.001) and higher nHDI (p = 0.027). Our findings strengthen the rationale for ACEs screening as a potential risk factor for diet-related chronic disease in adulthood. They provide a framework for public health prevention strategies via interventions targeting diet quality and emotional regulation in the setting of multidisciplinary practice.

Barriers and facilitators to healthy eating among college students

Young adulthood is an influential life stage for developing lifelong eating patterns, yet limited research characterizes dietary intake among young adults. This cross-sectional study assessed dietary intake and characteristics associated with nutrition knowledge and healthy food consumption among college students. We hypothesized that healthy food intake would be lower than United States (U.S.) dietary guidelines and that perceived healthy eating barriers would be negatively associated with diet quality. Participants were undergraduate college students enrolled in an introductory human nutrition course (N = 762), with surveys administered during the first week of class. Survey instruments included the Dietary Screener Questionnaire developed by the National Cancer Institute and the Jones Nutrition Knowledge questionnaire. Perceived encouragement, cost, taste, and ease of eating healthier foods were assessed with questions from the National Health Interview Survey. College student daily mean intakes of fiber (15.46 ± 3.06 grams), whole grains (0.63 ± 0.29 ounce equivalents), combined fruits and vegetables (2.38 ± 0.73 cup equivalents), and dairy (1.49 ± 0.53 cup equivalents) were lower than U.S. recommended dietary guidelines, while mean intakes of added sugars (14.65 ± 4.01 teaspoon equivalents) were greater than recommendations. As hypothesized, dietary intakes of young adult college students were sub-optimal, not meeting the U.S. dietary guidelines for fiber, whole grains, fruits, vegetables, dairy, and added sugars. Additionally, perceived ease of eating healthier foods, cost, and nutrition knowledge were significantly associated with increased consumption of healthier foods. Results highlight the need to reduce barriers to improve healthy eating among young adults.

Nutrition literacy profile among adolescents in Kuwait: a cross-sectional study

Background

Adolescent nutrition literacy and knowledge are associated with nutrient intake and obesity. With the rising prevalence of obesity in Kuwait, limited studies have assessed nutrition literacy among Kuwaiti adolescents. Therefore, this study aims to assess nutrition literacy among Kuwaiti adolescents and examine factors associated with nutrition literacy, such as body mass index (BMI) and dietary intake.

Methods

A school-based cross-sectional study was conducted in public schools across Kuwait, enrolling a convenience sample of 375 adolescents (mean age = 15.6 years, 53.1% female participants). A self-administered questionnaire was used to collect relevant data. The Nutrition Literacy Assessment Instrument (NLit) score was used to assess nutrition knowledge and skills in making food choices.

Results

The median NLit score among adolescents was 29 (IQR = 6). A large percentage (72.5%) of Kuwaiti adolescents demonstrated adequate overall nutrition literacy and scored adequately in the majority of NLit subscales. However, the majority of adolescents (73.3%) demonstrated inadequate nutrition literacy in understanding food labels. Predictors of NLit included BMI, place of residence, and smoking status. Moreover, the NLit score was negatively associated with the intake of sugar-sweetened beverages.

Conclusion

This study's findings may inform future research aimed at designing effective nutrition literacy interventions to enhance food choices among adolescents in Kuwait. The results of this study may also provide insights for policymakers and public health professionals to tailor food and nutrition programs to address the decline in food literacy skills and combat obesity.

Evidence-based food serving size labelling: Survey and laboratory analyses of consumer cooking spray usage

Nutrition label serving sizes are determined primarily based on typical consumption when such data are available. However, such data are not available for certain foods such as spray cooking oil (cooking spray). Our study assessed cooking spray use by the United States (US) adults compared to the 0.25-s serving size used on US-sold cooking spray labels. Adults (n = 1041, aged 33 ± 16.7 years) completed a 13-question survey on cooking spray use and perceptions. In the survey, participants reported using cooking spray for 1.9 ± 0.9 s per use, and 42.3%-43.1% of participants reported being more likely to purchase products if they were labelled calorie- or fat-free. Next, 30 adults (aged 29.7 ± 11.0 years) completed a laboratory-based study which assessed cooking spray durations for seven cookware items. Spray times ranged from 1.0 ± 0.5 (smallest pan) to 2.5 ± 1.3 s (largest baking sheet), with 100% of sprays (210/210) exceeding the 0.25-s US serving size. Our results suggest that cooking spray serving size should be increased to 1 s to better reflect actual consumption, and this would have the added benefit of aligning better with cooking spray serving sizes in other developed countries (0.5-1.0 s). A 1-s serving size would also preclude cooking spray advertised as calorie- or fat-free, allowing consumers to make more informed choices on the dietary implications of using cooking spray.

Nutritional knowledge, attitudes and behaviours in rugby league; influences of age, body composition and ancestry

INTRODUCTION

Rugby league is a physically demanding sport that necessitates considerable nutritional intake, focusing on quality and type, in order to optimize training and competition demands. However, rugby league athletes are reported to have inadequate nutrition intake to match these demands. Some factors that may determine an athlete's nutrition intake have been reported in other sports, including (but not limited to, knowledge, time, cooking skills, food costs, income, belief in the importance of nutrition, body composition goals, and family/cultural support). However, these potential factors are relatively unexplored in rugby league, where a range of personal (age, body composition) or social (ancestry) influences could affect nutritional intake. Further exploration of these factors is warranted to understand the knowledge, attitudes and behavior underlying rugby league athletes' nutritional intake that can provide practitioners with a more detailed understanding of how to approach nutrition behaviors and attitudes in rugby league athletes.

OBJECTIVES

The primary aim was to describe the nutrition behaviors and knowledge of rugby league athletes. A secondary aim was to compare nutrition knowledge and behavior based on age, body composition and self-identified ancestry.

METHODS

Fifty professional rugby league athletes anonymously completed a seventy-six-question online survey. The survey consisted of three sections : 1) sports nutrition knowledge, 2) attitudes toward nutrition on performance , and 3) nutrition behaviors. All participants completed the online survey without assistance using their own personal device, with data entered via REDCap during pre-season. Nutrition knowledge was compared based on age (years), body composition (body fat percentage (%)) and ancestral groups (Pasifika, Aboriginal and/or Torres Strait Islander (ATSI) and Anglo- European).Pearson correlation was used for the relationship between nutrition knowledge, age and body composition. An Analysis of Covariance (ANCOVA) was used to determine nutrition knowledge differences between ancestral groups with age and body composition as covariates. Attitudes and behaviors were compared based on age groups (<20, 20-24 and >25 y), ancestry and body composition. Attitudes and behaviors were analyzed by Pearson correlation for body composition, one-way ANOVA for age groups and ANCOVA for ancestry with covariates age and body composition.

RESULTS

Overall athletes' nutrition knowledge score was reported as 40 ± 12% (overall rating "poor"). Nutritional behaviors were significant for body composition, as those with lower body fat percentage had higher intakes of vegetables and dairy products (p = 0.046, p = 0.009), and ate more in the afternoon (lunch p = 0.048, afternoon snack p = 0.036). For ancestry, after adjustment for both age and body composition, Pasifika athletes were more inclined to miss breakfast and lunch compared to their Anglo-European (p = 0.037, p = 0.012) and ATSI (p = 0.022, p = 0.006) counterparts and ate more fruit than Anglo-Europeans (p = 0.006, p = 0.016). After adjustment for body composition, ATSI athletes also viewed the impact of nutrition on mental health and well-being significantly lower than Pasifika (p = 0.044).

CONCLUSION

These findings suggest differences exist within rugby league athletes based on ancestral backgrounds and body composition for nutrition attitudes, behaviors and knowledge. Such outcomes could be used when designing nutrition education interventions, with consideration given to these factors to optimize long-term positive behavior change.

Barriers and enablers toward healthy eating and weight gain among pregnant women in Vietnam: A qualitative study with analysis informed by the theoretical domains framework and COM-B model

Undernutrition and insufficient gestational weight gain can negatively affect maternal and infant health short- and long-term. In Vietnam, 50% of pregnant women lack essential nutrients, and 75% do not gain enough weight. Current interventions have limited success due to a gap in understanding their determinants. This study aimed to identify barriers and facilitators to healthy eating and weight gain among pregnant Vietnamese women. This qualitative study collected data from 20 pregnant Vietnamese women via virtual focus groups. Discussions were audio-recorded and translated into English for thematic analysis. The study utilized the Capability, Opportunity, Motivation to Behaviour (COM-B) model and Theoretical Domains Framework (TDF) to map the identified themes. Fifteen themes mapped onto nine of the 14 theoretical TDF domains, providing a comprehensive understanding of barriers and enablers to healthy eating and gestational weight gain within the COM-B model.

CAPABILITY

Women had limited knowledge about food sources and the implications of insufficient weight gain and micronutrient deficiencies, though they exhibited high self-care and digital literacy.

OPPORTUNITY

They lacked reliable online sources, had limited healthcare provider communication, spousal support, and faced cultural food beliefs and taboos.

MOTIVATION

The women understood the need for healthier lifestyles during pregnancy, but often lacked confidence in managing gestational weight and misunderstood the role of prenatal supplements. Our research identified key factors to inform future interventions to promote healthy eating and recommended weight gain during pregnancy among Vietnamese women. To be effective, interventions should focus on increasing nutritional knowledge, enhancing communiation with healthcare professionals, and improving husband supports. Addressing food taboos with culturally sensitive approaches is crucial. The potential of digits' al health interventions is enhanced by factors such as self-care and digital literacy among pregnant Vietnamese women.

Streamlining COM-B model: Insights from the Healthy Eating Context

The global rise in diet-related diseases highlights the urgent need for effective behavioural interventions. While theoretical frameworks like the Capability, Opportunity, Motivation-Behaviour (COM-B) model are valuable for understanding and influencing healthy eating behaviours, their practical application is often hindered by complexity and extensive measurement demands. This study addresses these challenges by testing a simplified version of the COM-B model, focusing on a select set of items representing seven core constructs. We conducted a cross-sectional survey with 347 Australian young adults to validate this streamlined model, making it more accessible for researchers and practitioners. Our findings underscore the importance of automatic motivation, the physical environment, and physical capability as critical factors in promoting healthy eating behaviours. By simplifying the COM-B model, this research contributes to developing more practical and effective strategies for healthier eating, addressing a critical public health issue.

Perspectives on Healthy Eating of Adult Populations in High-Income Countries: A Qualitative Evidence Synthesis

BACKGROUND

Understanding how individuals currently perceive healthy eating is essential for developing food policies and dietary recommendations that improve the health and well-being of populations. The purpose of this qualitative evidence synthesis was to systematically outline the views and understandings of healthy eating, focusing on how foods are classified as healthy and unhealthy and what meanings are attached to food and eating by the general adult population in high-income countries.

METHODS

A systematic search of four electronic databases was conducted and yielded 24 relevant primary qualitative studies of generally healthy, community-dwelling adults.

RESULTS

Thematic synthesis of the included studies identified three analytic themes: constructions of healthy and unhealthy eating, considerations on dietary recommendations, and meanings attached to food and eating. Study participants generally understood what constitutes a healthy and unhealthy diet which was in line with dietary recommendations, but those of lower socioeconomic status exhibited gaps in nutrition knowledge. Participants expressed diverse opinions on dietary recommendations, including skepticism and a lack of trust. Food and eating were associated with various meanings, including pleasure, stress relief, and feelings of guilt. Moral, health, and sociocultural considerations also played a role in dietary behaviors.

CONCLUSIONS

The findings suggest that improving population diet requires considering how dietary recommendations are phrased and communicated to ensure that healthy eating is associated with pleasure and immediate well-being. This review provides valuable insights for developing consumer-oriented, practicable, and acceptable food policies and dietary recommendations that effectively improve population health and well-being.

Does early-life famine exposure lead to healthy later-life dietary behavior: Evidence from the great Chinese famine

This paper investigates the long-run effect of early-life exposure to famine on survivors' dietary behavior. By exploiting exogenous variations in local severity of the Great Chinese Famine and variations of different cohorts, we conduct a difference-in-differences analysis. Based on detailed three-day food intake records from the China Health and Nutrition Survey, we find that famine exposure led the famine cohort who was conceived or born during the famine to adopt healthier dietary behaviors, as evidenced by a higher healthy eating score and a healthier dietary composition. Additionally, the pre-famine cohort exposed to the famine at ages 9-12 in late childhood exhibited a healthier food composition, characterized by a higher share of aquatic products. However, no statistically significant effects were observed for the pre-famine cohorts that experienced the famine in early and middle childhood. The results remain robust across various sensitivity checks. We propose that early-life famine exposure influences dietary behavior through mechanisms such as awareness of healthy eating, diet knowledge and risk aversion.

Nutrition Knowledge and Dietary Adequacy in Powerlifters

ABSTRACT

Leonhardt, TPM, Chilibeck, PD, Ko, J, and Zello, GA. Nutrition knowledge and dietary adequacy in powerlifters. J Strength Cond Res 38(11): 1924-1932, 2024-Athletes competing in weight categories (e.g., powerlifters) often restrict food intake approaching competition, which may be detrimental to health and performance. Our purpose was to assess the effect of nutrition knowledge, sex, and time (off-season versus precompetition, when athletes often cut weight) on dietary adequacy in powerlifters. Twenty-three powerlifters (10 females; 30.7 ± 11.2 years) completed questionnaires to assess nutrition knowledge and dietary adequacy. Athletes with higher nutrition knowledge consumed more fruits and nuts and less vitamin B2, B3 across all time points ( p < 0.05) and a greater number (73%) were above the recommended dietary allowance for vitamin D compared with athletes with lower nutrition knowledge (50%) ( p < 0.05). Male powerlifters with higher nutrition knowledge consumed less alcohol and vitamin A than male powerlifters with lower nutrition knowledge ( p < 0.05). Female powerlifters with higher nutrition knowledge consumed less sugar and beverage calories than female powerlifters with lower nutrition knowledge ( p < 0.05). Intake of alcohol and carbohydrate decreased, and meat calories increased from off-season to precompetition ( p < 0.05). Male powerlifters increased B-vitamins, whereas female powerlifters decreased B-vitamin and sugar consumption approaching competition ( p < 0.05). Male powerlifters increased water consumption versus female powerlifters approaching competition (sex × time, p < 0.05). There was no effect of nutrition knowledge on dietary changes approaching competition. Nutrition knowledge, sex, and competitive season affect dietary intake of powerlifters. A higher nutrition knowledge predicts a higher intake of some foods and nutrients important for health and performance. Female powerlifters should pay close attention to the intake of B-vitamins and water before competitions when many are trying to cut weight.

Nutritional Discrepancies Among Inpatients and Outpatients Diagnosed with Hypertension

Objectives: Arterial hypertension (AH) is one of the most common disorders affecting the human population. The diet of patients with AH can influence the course of the disease and prognosis. The aim of this study was to investigate the differences in nutrition in hospitalised and non-hospitalised hypertensive patients, compared to control groups of non-hypertensive patients from the same medical centres. Methods: Patients from nine centres-six hospitals and three ambulatory care centres-were surveyed. The Questionnaire for the Assessment of Dietary Habits, Lifestyle, and Nutrition Knowledge (KomPAN) was administered by interviewers. Results: Complete results were obtained from 172 hospitalised and 63 non-hospitalised patients. A significantly higher mean body mass index was found for the hypertensive patients (p < 0.001), and a higher unhealthy diet index score was also shown for the hypertensive patients (p = 0.003). Over and above this, a lower mean health-promoting diet index score was found in the hospitalised group (who were on a hospital diet) for the hypertensive patients (p = 0.018). Summary: The study highlights a strong positive correlation between body mass index (BMI) and arterial hypertension (AH), with patients exhibiting higher BMI levels compared to a control group. A BMI of over 25 significantly increases the likelihood of developing AH, and obesity is associated with a higher risk in both men and women. Conclusions: The study indicates that a hospital diet may not be suitable for people with AH. Further research should be conducted to obtain reliable results. Clinical implications: The study showed which factors should be considered when composing a diet for people with hypertension, the relevance of which was demonstrated in the discussion. The study shows that the problem that clinicians have been struggling with for years is still present and inadequately remedied.

The association between dietary knowledge based on the Chinese Dietary Guidelines and adherence to healthy dietary habits: a large-scale cross-sectional study

Introduction

Previous systematic review has shown that individuals with more comprehensive dietary knowledge tend to engage in healthier eating patterns among American or European population. However, research on the association between dietary knowledge based on the Chinese Dietary Guidelines and healthy dietary behaviors, particularly among adolescents and college students in China, is lacking. This study aimed to examine the association between dietary knowledge based on the Chinese Dietary Guidelines and adherence to healthy dietary behaviors among adolescents and college students in China.

Methods

A cross-sectional study was conducted in China in August and October 2023. The study involved 527 adolescents and 11,856 college students. A convenience and cluster sampling methodology was employed to select one or two grades from 33 different university majors. The dietary behaviors of college students were evaluated by assessing their consumption of nine food groups: water, eggs, milk and milk products, vegetables, fruit, red meat, soy and soy products, seafood, and sugar-sweetened beverages. The dietary behaviors of adolescents were evaluated by assessing their consumption of five food groups: fast food, salty snack foods, fruits, vegetables, and soft drinks and sugared fruit beverages. The participants' dietary knowledge was assessed using the Chinese Dietary Guidelines. The relationship between dietary knowledge and behaviors was examined using a multivariate logistic regression analysis.

Results

The questionnaire response rate was 100.0%. Multivariate logistic regression analysis revealed a significant positive association between dietary knowledge and the likelihood of exhibiting diverse dietary behaviors among college students. After adjusting for gender, age, family income, place of residence, and parents' education levels, the results demonstrated a positive association between dietary knowledge and adherence to 4-8 eating habits among college students. In contrast, similar association was not observed among adolescent.

Conclusion

This study revealed a significant association between dietary knowledge based on the Guidelines and adherence to healthy dietary behaviors among college students in China. That is to say, the higher the level of dietary knowledge based on the Guidelines among college students, the healthier the dietary behaviors they tend to adopt in their daily lives. These findings indicate the necessity of developing educational interventions based on the Guidelines to enhance dietary knowledge among individuals with limited dietary knowledge. Such interventions could facilitate the acquisition of essential health-related knowledge and strengthen motivation to engage in healthy dietary behaviors. Future studies should employ longitudinal prospective designs or randomized controlled trials in order to establish a causal association between dietary knowledge based on the Guidelines and healthy dietary behaviors.

Validation of a sports nutrition knowledge questionnaire for Sri Lankan track and field athletes

BACKGROUND

While several validated sports nutrition knowledge questionnaires exist, none are specifically designed to assess the sports nutrition knowledge (SNK) of Sri Lankan track and field athletes. This study aims to validate the Sri Lankan Sports Nutrition Knowledge Questionnaire (SLn-SNKQ), tailored for this athlete group, to provide more accurate and meaningful insights for research and practice. This will enable health professionals and coaches to confidently assess athletes' nutrition knowledge, which directly influences their food choices.

METHODS

The validity of the questionnaire was established through a multi-step approach. Content validity was achieved via ratings from nutrition experts, all of whom had specialized training in human nutrition and experience of working with athletes. Face validity was evaluated through in-depth telephone interviews with elite or highly trained athletes, using a retrospective think-out-loud protocol to gather feedback on the clarity and relevance of the questions. Construct validity involved nutrition-trained doctors (NTG), non-nutrition-trained professionals (NNTG), and elite-level athletes' groups (AG). Internal consistency was assessed using Cronbach's alpha, and test-retest reliability was evaluated.

RESULTS

The final tool comprised 123 individual statements or prompts (items) that were organized into 32 broader questions, spanning 12 sub-sections. Content validity was confirmed by fully integrating 49 out of 70 comments and partially integrating four comments received from nutrition experts for each sub-section. Face validity was established by fully integrating 33 out of 40 comments received from 16 elite and highly trained athletes. Construct validity was confirmed, indicating significant differences in the total scores achieved as a percentage of the SLn-SNKQ among the NTG (462.5, 92.5%), NNTG (223.5, 44.7%), and AG (235, 47.0%; p < 0.001). Reproducibility was established by strong test-retest reliability between individuals' scores on two test attempts, three weeks apart (spearman's correlation; ρ = 0.99, p < 0.05). Internal reliability for each sub-section met psychometric reliability requirements (Cronbach's α > 0.7).

CONCLUSIONS

The SLn-SNKQ has been validated and demonstrates robust psychometric properties, offering a reliable tool for assessing SNK among Sri Lankan track and field athletes.

Community-based nutrition education and counselling provided during pregnancy: effects on knowledge and attitude towards iron-folic acid supplementation

Maternal malnutrition is pervasive throughout the world, notably in sub-Saharan Africa, including Ethiopia. This study examined the effect of community-based iron-folic acid supplementation (IFAS) nutrition education on IFAS knowledge and attitude among pregnant women in urban settings in South Ethiopia. A community-based quasi-experimental study was conducted among 198 randomly selected pregnant women attending antenatal care (ANC) (99 intervention and 99 control). We used a multistage sampling technique followed by systematic sampling to select the pregnant women. Pregnant women who participated in the intervention arm received six nutrition education sessions and counselling using a health belief model (HBM), while the control group received only routine ANC services. Baseline and endline data were collected during the ANC and compared. The data was analysed using statistical package for social sciences. Analyses of the effect of the intervention were done using difference-in-difference and generalised estimation equation to allow correlation of repeated observations over time. The results indicated a significant effect of intervention on maternal knowledge towards IFAS; with intervention, group levels increased by 35 percentage points (P < 0.001). The odds of being knowledgeable at the endpoint in the intervention group were 2.6 times higher than baseline (OR = 2.67, 95% CI 1.88-3.80). There was a significant (P = 0.001) change in proportion with a favourable attitude towards IFAS between the two time points. The community-based nutrition education intervention approach has significantly improved maternal knowledge and a favourable attitude towards IFAS among pregnant women. The HBM is effective in improving knowledge and attitude among pregnant women.

Dietary Habits, Awareness, and Knowledge among Polish Healthcare Providers and Healthcare Students

Background/Objectives: Nutrition plays a significant role in preventive medicine, as up to 80% of chronic diseases could be avoided by adhering to healthy dietary principles. The aim of our study was to identify dietary habits, awareness, and nutrition knowledge in a random sample of Polish healthcare students and professionals. Methods: Initially, a total screened sample consisted of 1287 respondents, yet the actual response/participation rate was 634/1287. A validated questionnaire for the Polish population, the Dietary Habits and Nutrition Beliefs Questionnaire (KomPAN), was used for the assessment. Results: The majority of respondents were females (84.2% of medical students and 87.2% of healthcare professionals), current non-smokers (79.6% of medical students and 85.2% of healthcare professionals), and had a normal waist circumference (76.3% of medical students and 63.1% of healthcare professionals). Both clinical dieticians and students studying clinical dietetics received significantly different scores of dietary indexes (pro-healthy pHDI-10 and non-healthy nHDI-14) vs. respective groups of respondents. Both healthcare students and professionals who self-reported better nutritional knowledge indeed yielded significantly better results in the dietary indexes as well as nutritional knowledge scores. The nutrition knowledge score was positively correlated with pHDI-10 and negatively correlated with nHDI-14, BMI, age, and waist circumference. Conclusions: Our results illustrate lifestyle trends among Polish healthcare students and professionals, and such results should encourage the development of evidence-based dietary policies targeting healthcare providers. High-quality continuing nutrition education should be obligatorily provided to all healthcare providers to enhance their dietary awareness as well as ensure high quality of care and outcomes achieved by the Polish healthcare system.

The Effect of Individual Attitude toward Healthy Nutrition on Adherence to a High-UFA and High-Protein Diet: Results of a Randomized Controlled Trial

Despite beneficial cardiovascular effects, substantial long-term modulation of food pattern could only be achieved in a limited number of participants. The impact of attitude towards healthy nutrition (ATHN) on successful modulation of dietary behavior is unclear, especially in the elderly. We aimed to analyze whether the personal ATHN influences 12-month adherence to two different dietary intervention regimes within a 36-month randomized controlled trial.

METHODS

502 subjects were randomized to an intervention group (IG; dietary pattern focused on high intake of unsaturated fatty acids (UFA), plant protein and fiber) or control group (CG; dietary recommendation in accordance with the German Society of Nutrition) within a 36-month dietary intervention trial. Sum scores for effectiveness, appreciation and practice of healthy nutrition were assessed using ATHN questionnaire during the trial (n = 344). Linear regression models were used to investigate associations between ATHN and dietary patterns at baseline and at month 12.

RESULTS

Retirement, higher education level, age and lower body mass index (BMI) were associated with higher ATHN sum scores. ATHN was similar in CG and IG. Higher baseline intake of polyunsaturated fatty acids (PUFA) and fiber as well as lower intake in saturated fatty acids (SFA) were associated with higher scores in practice in both groups. The intervention resulted in a stronger increase of UFA, protein and fiber in the IG after 12 months, while intake of SFA declined (p < 0.01). Higher scores in appreciation were significantly associated with higher intake of fiber and lower intake of SFA in the CG at month 12, whereas no associations between ATHN and macronutrient intake were observed in the IG after 12 months.

CONCLUSIONS

While ATHN appeared to play a role in general dietary behavior, ATHN did not affect the success of the specific dietary intervention in the IG at month 12. Thus, the dietary intervention achieved a substantial modification of dietary pattern in the IG and was effective to override the impact of the individual ATHN on dietary behavior.

Evaluation of daily eating patterns on overall diet quality using decision tree analyses

BACKGROUND

Preliminary evidence suggests that meal timing is associated with higher quality diets. Less is known about whether types of food consumed during specific eating episodes (i.e., day-level eating patterns) predict diet quality.

OBJECTIVES

We investigated the association between day-level eating patterns and diet quality.

METHODS

Decision tree models were built using 24-h dietary recall data from the National Health and Nutrition Examination Survey 2015 and 2017 cycles in a cross-sectional study. Sixteen food groups and 12 eating episodes (e.g., breakfast, lunch) were included as input parameters. Diet quality was scored using the Healthy Eating Index-2020 and categorized as higher or lower quality diets based on the median score. Mean decrease in impurity (MDI) ± standard deviation determined the relative contribution that day-level eating patterns had on diet quality; higher values represented greater contributions.

RESULTS

We analyzed 12,597 dietary recalls from 9347 United States adults who were aged 18 y and older with ≥1 complete recall. Meals (breakfast, lunch, dinner) and respective snacking episodes had the greatest variety of dietary groups that contributed to the Healthy Eating Index-2020 score. Any whole-grain intake at breakfast predicted a higher quality diet (MDI = 0.08 ± 0.00), followed by lower solid fat intake (<8.94 g; MDI = 0.07 ± 0.00) and any plant protein intake at dinner (MDI = 0.05 ± 0.00).

CONCLUSIONS

Day-level eating patterns were associated with diet quality, emphasizing the relevance of both food type and timing in relation to a high-quality diet. Future interventions should investigate the potential impact of targeting food type and timing to improve diet quality.

Behavioural determinants of healthy and environmentally friendly diets in French university students

Although encouraging the shift toward sustainable diets in young adults is a major challenge to preserve population and planet health, the precursors of sustainable diets in this population remain unknown. This study aimed to identify the behavioural determinants of healthier and more environmentally friendly diets among university students. A sample of 582 French university students reported their food consumption using an online 125-item food frequency questionnaire. The nutritional quality (adherence to French recommendations, sPNNS-GS2) and the greenhouse gas emissions (GHGE) of students' diets were calculated for an isocaloric diet. Behavioural determinants were measured based on a literature review and classified into the Capability, Opportunity, Motivation Behaviour (COM-B) framework. Linear models, adjusted for socioeconomic characteristics, were run to identify the most prominent behavioural predictors of nutritional quality and GHGE of students' diets. Higher cooking skills (β = 0.38, p = 0.01) and health motives (β = 0.91, p < 0.001) were associated with higher nutritional quality. Greater environmental knowledge was linked to lower GHGE (β = -0.07, p = 0.002), while health and weight control motives were associated with higher GHGE (β = 0.26, p = 0.02 and β = 0.39, p < 0.001). Enhancing cooking skills and environmental knowledge could enable healthy and environmentally friendly diets, but health-based motives can act as a lever and as a barrier.

Effect of nutrition education on the nutritional status of pregnant women in Robe and Goba Towns, Southeast Ethiopia, using a cluster randomized controlled trial

Maternal malnutrition is pervasive throughout the world, notably in sub-Saharan Africa (SSA), including Ethiopia. This study aimed to assess the effect of nutrition education on the nutritional status of pregnant women in urban settings in Southeast Ethiopia. A community-based two-arm parallel cluster randomized controlled trial was conducted among 447 randomly selected pregnant women attending antenatal care (224 intervention and 223 control). We used a multistage cluster sampling technique followed by systematic sampling to select the pregnant women. Pregnant women who participated in the intervention arm received six nutrition education sessions. Women in the control group received standard care. A nonstretchable mid-upper arm circumference (MUAC) tape was used to measure the MUAC. A linear mixed effects model (LMM) was used to evaluate the effect of the intervention on MUAC, accounting for the clustering. The net mean ± standard error of MUAC between the intervention and control groups was 0.59 ± 0.05 (P < 0.0001). The multivariable LMM indicated that having received nutrition education interventions (β = 0.85, 95% CI 0.60, 1.12, P < 0.0001) improved the MUAC measurement of pregnant women. Thus, nutrition education during pregnancy will combat undernutrition among pregnant women.Trial Registration: Clinicaltrials.gov (PACTR202201731802989), retrospectively registered on 24/01/2022.

Nutrition literacy level of medical personnel in tertiary hospitals: evidence from a cross-sectional study

BACKGROUND

Nutrition literacy (NL), stemming from health literacy, profoundly influences dietary habits and chronic diseases. Despite their pivotal societal role, scant research exists on NL levels among medical personnel. This study examined NL levels among tertiary hospital medical staff in Bengbu and identified influencing factors.

METHODS

Using cluster sampling, all Bengbu tertiary hospitals were selected, with 4-5 departments randomly chosen. A structured questionnaire assessed demographic characteristics, while the NL short-form scale (NL-SF12) evaluated NL. SPSS 26.0 and AMOS conducted statistical analysis, including confirmatory factor analysis and Cronbach's α for reliability. Chi-square tests and logistic regression analyzed group differences and influencing factors.

RESULTS

The NL-SF12 demonstrated robust reliability and validity. Of participants, 34.22% were male and 65.78% female; 41.03% were doctors and 42.16% nurses. Overall, 45.68% exhibited high NL. Females showed higher total NL (OR = 1.47, 95% CI: 1.08-1.98), cognition (OR = 1.66, 95% CI: 1.22-2.24), skills (OR = 1.48, 95% CI: 1.09-2.00), and interactive NL (OR = 2.21, 95% CI: 1.53-3.19) than males. Those with a master's or higher had higher total NL (OR = 2.20, 95% CI: 1.33-3.65) and cognition (OR = 3.23, 95% CI: 1.94-5.37) than those with an associate degree or less. Pharmacists, inspectors, and technicians had higher total NL (OR = 1.55, 95% CI: 1.06-2.26) and functional NL (OR = 1.49, 95% CI: 1.02-2.17). Gender, education level, and career were the influencing factors of nutrition literacy among medical personnel.

CONCLUSIONS

Female medical staff and those with a master's degree or higher showed higher nutrition literacy (NL), particularly in cognition and skills. Pharmacists, inspectors, and other technicians exhibited higher levels of total NL and functional NL. Gender, education level, and career were identified as significant influencing factors of nutrition literacy among medical personnel. Understanding and considering these factors are crucial for developing targeted strategies to enhance nutrition literacy among healthcare professionals. Future efforts to improve nutrition literacy through training and interventions should be tailored to the characteristics of different groups to effectively enhance the capabilities and proficiency of healthcare professionals in nutrition knowledge and practice.

Investigating the Knowledge of Prebiotics, Probiotics, and Synbiotics That May Help to Improve the Gut-Organ Axis Function in Middle-Aged and Older Adults

BACKGROUND AND AIMS

The use of gut biotics, including probiotics, prebiotics, and synbiotics, has shown substantial potential in the management of various health conditions possibly through the gut-organ axis. The role of gut biotics in modulating the gut-brain axis is becoming evident with more research focusing on this intervention. Improvement of gut-organ axis function is possible by using food-related products called gut biotics. However, there is limited comprehension of the knowledge and use of these intestinal or gut biotics. Our aim was to recognize knowledge gaps and assess the improvement of understanding following an education intervention.

METHODS

A single-arm study encompassing a convenient sample of 161 inpatient and outpatient subjects aged 50 years and older was conducted at the University of Alberta Hospital from June to August 2023. Knowledge about gut biotics was evaluated using a structured questionnaire consisting of 16 questions and involving six thematic areas. To ensure validity, the questionnaire was pre-tested on 10 physicians and residents who were not part of the study. The questionnaire was administered to study subjects prior to receiving an information sheet about gut biotics. Two weeks after receiving the information sheet, all participants were contacted by phone, and the same questionnaire was administered again. Of the 161 patients, 122 completed the pre-intervention and post-intervention questionnaires and were considered in the analysis.

RESULTS

The mean age of the participants was 72 years (SD: 10.8), 57% comprised women, and 39% had less than a high school education. The proportion of polypharmacy and multimorbidity was 87% and 97%, respectively. Following the intervention, there was a noticeable enhancement in knowledge across all the themes, with statistical significance (p<0.001) observed in 14 out of 16 questions as determined by the homogeneity statistical test.

CONCLUSIONS

Knowledge gaps in gut biotics were prevalent among study participants, and the educational intervention effectively contributed to the enhancement of knowledge. The results of this study provide valuable information for the development of targeted health education strategies focusing on gut biotics, which may play a role in improving gut-organ axis function.

S'attaquer aux défis de l'adhésion aux principes de la saine alimentation

The purpose of this article is to describe the impact of the research program entitled "Adherence to healthy eating recommendations: identification of measures, determinants and interventions". Beyond the main results described in this article, this program had a major impact on the training of graduate students. It was also a unique opportunity to develop and validate measurement tools relevant to nutrition research, and to make them available to the scientific community. Lastly, this program was a catalyst for establishing new collaborations and setting up larger-scale studies.

Health Belief Model Predicts Likelihood of Eating Nutrient-Rich Foods among U.S. Adults

Despite decades of messaging, most Americans still consume excess fats and sugars, but inadequate fiber, potassium, and calcium. Nutrient-rich foods (NRFs) have a high density of favorable nutrients related to calories. Choosing NRFs could lower risk of nutrition-related chronic diseases and aid in their control. We hypothesized that having greater knowledge of NRFs, the presence of a nutrition-related chronic disease or risk factor, and positive Health Belief Model (HBM) views would be predictive of the likelihood of eating NRFs. Through a national online survey panel, 976 adults aged 18-80 completed demographic, health, NRF knowledge, attitudes, and HBM construct questions. Participants were 77% White, 52% women, and 55% had a nutrition-related disease or risk factor. Multivariable HBM scales were generated by theory, principal components, and reliability analysis. NRF knowledge was significantly higher for women, Whites, households without children, and persons without a nutrition-related disease (all p ≤ 0.015). 'Likelihood of eating NRFs' was significantly higher for persons with a nutrition-related disease, Whites, married participants, main food shoppers, and households with children (all p ≤ 0.022). Regressing demographic and HBM constructs on the 'likelihood of eating NRFs' resulted in R2 of 0.435. Nutrition-related disease and HBM constructs of self-efficacy, perceived benefits, and cues to action were predictive of the likelihood of eating NRFs, but higher NRF knowledge was negatively associated.

Fresh Moringa Stenopetala leaves consumption and its determinants among pregnant women in southern Ethiopia

Background

A woman's health and nutritional status has significant impact on her pregnancy situation. However, many pregnant women are undernourished. Moringa stenopetala is a plant consumed worldwide in various forms, and its consumption showed a reduction in the incidence of malnutrition. Although Moringa stenopetala is rich in essential macro- and micronutrients, there is little evidence on the proportion and determinants of fresh Moringa stenopetala leaf intake among pregnant women. The objective of this study was to fill this gap in the littérature and provide a baseline evidence for further research or intervention by investigation the proportion and determinants of fresh Moringa stenopetala leaf intake among pregnant women in the Gamo zone, south Ethiopian region.

Methods

A community-based cross-sectional study was conducted among 623 randomly selected pregnant women using a pre-tested and structured questionnaire via a face-to-face interview. The consumption pattern was assessed based on a self-reported dietary history over the last 30 days before data collection. Multivariable logistic regression model was fitted using STATA version 14. An adjusted odds ratio with a 95% confidence interval was reported to show an association between the dependent and independent variables with level of statistical significance at a p-value of <0.05.

Results

The proportion of fresh Moringa stenopetala leaves intake among pregnant women was 49.60% (95% CI: 45.67, 53.52%). The déterminants of fresh moringa leaf intake were being below 24 years old (AOR: 2.92; 95% CI: 1.51, 5.63), rural résidence (AOR: 1.97; 95% CI: 1.10, 3.50), antenatal care attendance (AOR: 2.08; 95% CI: 1.03, 4.21), history of contraceptive use (AOR: 1.88; 95% CI: 1.03, 3.55), and having a good knowledge about the importance of moringa Stenopetala (AOR: 9.76; 95% CI: 5.30, 17.95).

Conclusion

The study showed that almost half of the pregnant women consumed fresh Moringa stenopetala leaves. Women's age, place of residence, prenatal care, history of contraceptive use, and knowledge of the benefits of Moringa Stenopetala were positively associated with the consumption of fresh Moringa Stenopetala leaves. Therefore, health authorities and stakeholders involved in maternal and child health need to target older women, and urban residents and promote the benefits of consumption by strengthening uptake of maternal health services and raising awareness about Moringa Stenopetela. Future studies involving large scale and longitudinal designs evidence are required to further validate the findings so that this nutritious diet can be promoted widely among pregnant women in the study area and Ethiopia at large.

Development and validation of a photograph-based instrument to assess nutrition literacy: The NUTLY project

Most instruments measuring nutrition literacy evaluate theoretical knowledge, not necessarily reflecting skills relevant to food choices. We aimed to develop and validate a photograph-based instrument to assess nutrition literacy (NUTLY) among adults in Portugal. NUTLY assesses the ability to distinguish foods with different nutritional profiles; from each of several combinations of three photographs (two foods with similar contents and one with higher content) participants are asked to identify the food with the highest energy/sodium content. The NUTLY version with 79 combinations, obtained after experts/lay people evaluations, was applied to a sample representing different age, gender and education groups (n = 329). Dimensionality was evaluated through latent trait models. Combinations with negative or with positive small factor loadings were excluded after critical assessment. Internal consistency was measured using Cronbach's alpha and construct validity by comparing NUTLY scores with those obtained in the Medical Term Recognition Test and the Newest Vital Sign (NVS), and across education and training in nutrition/health groups. The cut-off to distinguish adequate/inadequate nutrition literacy was defined through ROC analysis using the Youden index criterion, after performing a Latent class analysis which identified a two-class model to have the best goodness of fit. Test-retest reliability was assessed after one month (n = 158). The final NUTLY scale was unidimensional and included 48 combinations (energy: 33; sodium: 15; α = 0.74). Mean scores (±standard deviation) were highest among nutritionists (39.9 ± 4.4), followed by health professionals (38.5 ± 4.1) and declined with decreasing education (p < 0.001). Those with adequate nutrition literacy according to NVS showed higher NUTLY scores (37.9 ± 4.3 vs. 33.9 ± 6.9, p < 0.001). Adequate nutrition literacy was defined as a NUTLY score≥35 (sensitivity: 89.3%; specificity: 93.7%). Test-retest reliability was high (ICC = 0.77). NUTLY is a valid and reliable nutrition literacy measurement tool.

Global food expenditure patterns diverge between low-income and high-income countries

Globalization, income growth and changing cultural trends are believed to prompt consumers in low-income countries to adopt the more affluent diet of high-income countries. This study investigates the convergence of food expenditure patterns worldwide, focusing on total food expenditure, raw food categories and ultra-processed foods and beverages across more than 90 countries over the past decades. Contrary to prior belief, we find that food expenditure patterns of lower-income countries do not universally align with those of higher-income nations. This trend is evident across most raw food categories and ultra-processed foods and beverages, as the income level of a country continues to play a crucial role in determining its food expenditure patterns. Importantly, expenditure patterns offer estimates rather than a precise idea of dietary intake, reflecting consumer choices shaped by economic constraints rather than exact dietary consumption.

Food Resource Management and Healthy Eating Focus Associates with Diet Quality and Health Behaviors in Low-Income Adults

Nutrition education and food resource management (FRM) can assist food-insecure individuals in acquiring healthy and affordable food. We aimed to assess the relationships between FRM skills and healthy eating focus with diet quality and health-related behaviors in low-income adults during the COVID-19 pandemic. This cross-sectional study was conducted using an online survey of 276 low-income adults living in a low-food-access community in Northeast Connecticut. Through analysis of covariance, adults who usually or always had a meal plan, considered reading nutrition labels important, made a grocery list, were concerned about their food healthiness, and rated their diet quality as very good/excellent reported higher diet quality (frequency-based and liking-based scores) (p < 0.05 for all). Individuals who considered reading food labels very important and reported having a good diet reported less frequent pandemic-related unhealthy behaviors (consumption of candy and snack chips, soda or sugary drinks, weight gain, smoking) (p < 0.001). Furthermore, higher-frequency-based diet quality was associated with lower risk of overweight or obesity (OR: 0.37; 95% CI: 0.18, 0.76; p-trend < 0.01). Thus, FRM skills and healthy eating focus were associated with higher diet quality and healthier self-reported changes in diet, weight, and smoking behaviors during the pandemic.

Fathers Nutrition Knowledge and Child Feeding Practices Associated with Childhood Overweight and Obesity: A Scoping Review of Literature From 2000 to 2023

Objective. Childhood overweight/obesity is a serious global public health issue, demanding parental involvement to reverse trends. Despite fathers' crucial parenting roles, research on fathers and childhood overweight/obesity is limited. This scoping review examines the literature on fathers' nutrition knowledge and feeding practices with childhood overweight/obesity. Methods. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and Arksey and O'Malley (2005) framework, multiple databases were searched. Eligible father-child related studies focused on fathers' nutrition knowledge, feeding practices, and childhood overweight/obesity. Results. Of 26 eligible articles, 52% originated from the United States, and 44% focused on father-child dyads. Most studies were cross-sectional (64%) and survey-based (68%). Further, 11.5% assessed fathers' nutrition knowledge, and child feeding practices (53.4%). Conclusion. Literature on fathers' nutrition knowledge and feeding practices concerning childhood overweight/obesity is limited. Scaling-up fathers' inclusion in childhood nutrition research is encouraged for the design of holistic interventions.

Mindful Eating, Nutrition Knowledge, and Weight Status among Medical Students: Implications for Health and Counseling Practices

Academic stress and transitioning to young adulthood can lead medical students to develop inadequate eating habits, affecting both their physical and mental well-being and potentially compromising their ability to offer effective preventive counseling to future patients. The primary objective of this study is to analyze the levels of mindful eating and nutrition knowledge in Romanian medical students and their associations with various sociodemographic variables. Additionally, we explore the relationship between mindful eating and nutrition knowledge while accounting for sociodemographic factors and examine the impact of these factors on excess weight. Significant predictors of excess weight include high weight gain in the past year (OR = 15.8), the mindful eating questionnaire (MEQ) score (OR = 0.131), male gender (OR = 2.5), and being in the clinical years of medical school (OR = 2.2). While nutrition knowledge levels do not directly impact weight status, they share a 4% common variance with mindfulness in multivariate analysis. Notably, high weight gain is independent of the levels of mindful eating, but univariate testing links it to disinhibition and emotional response, components of mindfulness. Mindful eating stands out as independently associated with both nutrition knowledge and excess weight among medical students. Thus, interventions to address obesity should consider incorporating mindfulness training to enhance food intake awareness and improve weight management outcomes in Romanian medical students.

Vitamin A-related nutrition knowledge gaps and predictors among caregivers of preschool children in Eastern Uganda: a cross-sectional study

BACKGROUND

Vitamin A (VA) remains a core micronutrient as VA Deficiency (VAD) in children has persisted as a public health problem in parts of Africa with adverse effects. Caregivers of children are essential in the control of VAD; however, there is a paucity of data on their knowledge of VA, dietary sources, and VAD. This study sought to assess the level of VA-related nutrition knowledge (VANK) and its predictors among caregivers of preschool children in Eastern Uganda.

METHODS

A cross-sectional analytical design was used. Both socio-demographic and knowledge and attitude (KA) data were collected using a structured questionnaire partly adapted from the FAO model Knowledge, Attitude and Practice (KAP) questionnaire. A sample size of 256 was used. Caregivers of 24-59 months-old children were selected from Bukwo District in Eastern Uganda using purposive and random sampling methods. Knowledge scores (%) based on responses to ten questions were determined and eventually classified as low (≤ 40%) and moderate or high (˃40%). Descriptive and inferential statistics were computed using SPSS (version 24). Logistic regression was used to identify predictors with p < 0.05 considered significant.

RESULTS

The study had 247 caregivers with a mean age of 30.9 ± 7.7 years. The majority were female (90%), married, subsistence crop farmers and had primary-level education or lower. The mean VANK score was 18.9 ± 24.7%. Overall, most of the caregivers had low VANK as only about 20% had moderate or high. The proportions that knew the different aspects of VANK were correspondingly small. About half of the caregivers (46.6%) knew VA itself and only 27% knew any of its sources. Those who knew VAD, its causes, signs/symptoms and prevention measures were 31, 22, 13 and 24% respectively. The caregivers' VANK was significantly associated with their overall VA-related attitude, age and level of education. However, education and age were the significant predictors.

CONCLUSION

Caregivers had very low VANK. They barely knew VA and its food sources or VAD. The main predictors of VANK were caregiver age and level of education. The study recommends education of caregivers about VA for effective VAD control which contributes to achievement of the Sustainable Development Goal (SDG) 2.

Food (in)security in relation to nutrition (in)security in a national cross-sectional sample of Supplemental Nutrition Assistance Program participants: considerations of an emerging construct

BACKGROUND

Food insecurity, lack of access to sufficient food for an active, healthy life, is a persistent problem in the United States. Recently, nutrition security has emerged as a new concept. However, limited research exists examining how nutrition security relates to the established concept of food security.

OBJECTIVES

This study assessed a recent metric of nutrition security and explored how well it describes the underlying construct among a sample of Supplemental Nutrition Assistance Program (SNAP) participants. We examined the correlation between food and nutrition security and demographic predictors of joint food and nutrition security status.

METHODS

We conducted a national, web-based survey (Qualtrics; 30 September-19 October, 2022) in English and Spanish of adults aged ≥18 y (n = 1454) who reported receiving SNAP benefits in the past 12 mo. We measured food security using the US Department of Agriculture 6-item Food Security Survey and assessed nutrition security using the Gretchen Swanson Center for Nutrition Household Nutrition Security measure. We used multinominal logistic regression to examine demographic predictors of food and nutrition security.

RESULTS

The majority (80.4%) of SNAP participants experienced food insecurity, and 59.1% reported experiencing nutrition insecurity. Food and nutrition security were moderately correlated (0.41); 55.6% of SNAP participants were both food and nutrition insecure, 3.5% were food secure but nutrition insecure, 24.8% were food insecure but nutrition secure, and 16.1% were both food and nutrition secure. Of SNAP participants, 24.8% reported experiencing food insecurity but not nutrition insecurity. Hispanic ethnicity and Southern residence were associated with joint food and nutrition insecurity.

CONCLUSIONS

These findings raise questions about how nutrition security is conceptualized and measured and its added value beyond existing food security measurement scales. Further research is needed to understand differences in food and nutrition security experiences and risk factors and determine a validated definition and measure of nutrition security for future policy solutions.

Developing a Personalized Meal Recommendation System for Chinese Older Adults: Observational Cohort Study

BACKGROUND

China's older population is facing serious health challenges, including malnutrition and multiple chronic conditions. There is a critical need for tailored food recommendation systems. Knowledge graph-based food recommendations offer considerable promise in delivering personalized nutritional support. However, the integration of disease-based nutritional principles and preference-related requirements needs to be optimized in current recommendation processes.

OBJECTIVE

This study aims to develop a knowledge graph-based personalized meal recommendation system for community-dwelling older adults and to conduct preliminary effectiveness testing.

METHODS

We developed ElCombo, a personalized meal recommendation system driven by user profiles and food knowledge graphs. User profiles were established from a survey of 96 community-dwelling older adults. Food knowledge graphs were supported by data from websites of Chinese cuisine recipes and eating history, consisting of 5 entity classes: dishes, ingredients, category of ingredients, nutrients, and diseases, along with their attributes and interrelations. A personalized meal recommendation algorithm was then developed to synthesize this information to generate packaged meals as outputs, considering disease-related nutritional constraints and personal dietary preferences. Furthermore, a validation study using a real-world data set collected from 96 community-dwelling older adults was conducted to assess ElCombo's effectiveness in modifying their dietary habits over a 1-month intervention, using simulated data for impact analysis.

RESULTS

Our recommendation system, ElCombo, was evaluated by comparing the dietary diversity and diet quality of its recommended meals with those of the autonomous choices of 96 eligible community-dwelling older adults. Participants were grouped based on whether they had a recorded eating history, with 34 (35%) having and 62 (65%) lacking such data. Simulation experiments based on retrospective data over a 30-day evaluation revealed that ElCombo's meal recommendations consistently had significantly higher diet quality and dietary diversity compared to the older adults' own selections (P<.001). In addition, case studies of 2 older adults, 1 with and 1 without prior eating records, showcased ElCombo's ability to fulfill complex nutritional requirements associated with multiple morbidities, personalized to each individual's health profile and dietary requirements.

CONCLUSIONS

ElCombo has shown enhanced potential for improving dietary quality and diversity among community-dwelling older adults in simulation tests. The evaluation metrics suggest that the food choices supported by the personalized meal recommendation system surpass autonomous selections. Future research will focus on validating and refining ElCombo's performance in real-world settings, emphasizing the robust management of complex health data. The system's scalability and adaptability pinpoint its potential for making a meaningful impact on the nutritional health of older adults.

Food Choices, Sustainability and Australian Native Foods: Perceptions among University Students

(1) Background: Urgent changes in our food choices are needed for more sustainable, resilient and equitable food systems. Australian native plant-based foods have both environmental and health benefits. Including these foods in our diet may reduce both the risk of chronic diseases and the impact of climate change. This study explored the perceptions and attitudes towards food choices, sustainability and Australian native plant-based food among university students. (2) Methods: A cross-sectional online survey was completed by 212 university students in Australia from October to December 2022. Questions included information about sociodemographic characteristics, food choices, Australian native foods and the impact on sustainability. Logistic regression was used for analyses. (3) Results: Most participants recognised the impact of food choices on sustainability. There was a significant association between recognition of the impact of food choices on sustainability and the environmental and nutritional benefits of Australian native foods (OR = 2.89, 95% CI 1.29, 6.46, p = 0.010). Students who were familiar with or had tried Australian native plant-based foods were significantly more likely to recognise their environmental and nutritional benefits (p < 0.001). (4) Conclusions: Students who recognise the impact of food choices on sustainability and the benefits of Australian native foods are more likely to include native foods in their diet. More studies are needed to investigate the specific native foods consumed and the barriers and facilitators to the intake of these foods.

Investigating the interrelationships among food habits, sports nutrition knowledge, and perceived barriers to healthy eating: a study of adolescent swimmers

This cross-sectional study aims to explore the relationships between food habits, perceived barriers to healthy eating, and sports nutrition knowledge among adolescent swimmers. The study focuses on understanding how these factors interact and influence dietary choices in young athletes. A cohort of 52 adolescent swimmers aged 12-18 from Al Hussein Youth Club in Al-Hussein Sport City participated in the study. Data were collected through surveys assessing food habits, perceived barriers to healthy eating, and sports nutrition knowledge. Pearson Correlation analysis was employed to examine associations between variables, and stepwise regression analysis was used to identify predictors of food habits. The analysis revealed a significant positive association between food habits and sports nutrition knowledge (r = 0.393, p = 0.004). Knowledge emerged as a significant positive predictor of food habits (β = 0.393, p = 0.004), highlighting the influential role of sports nutrition knowledge in shaping the dietary choices of adolescent swimmers. However, the introduction of Barriers lacked significance, and individual predictors did not reach statistical significance. These findings underscore the importance of targeted interventions aimed at enhancing nutritional education among adolescent swimmers. Understanding the interplay between knowledge, barriers, and food habits provides valuable insights into the complex dynamics that influence the dietary choices of young athletes. Addressing these factors through tailored educational programs can promote healthier eating habits and optimize performance among adolescent swimmers. This study highlights the critical role of sports nutrition knowledge in shaping the dietary behaviors of adolescent swimmers. By addressing knowledge gaps and overcoming perceived barriers, targeted interventions can help improve food habits and enhance the overall health and performance of young athletes.

"We know what we should be eating, but we don't always do that." How and why people eat the way they do: a qualitative study with rural australians

BACKGROUND

There is evidence that most people are aware of the importance of healthy eating and have a broad understanding regarding types of food that enhance or detract from health. However, greater health literacy does not always result in healthier eating. Andreasen's Social Marketing Model and Community-Based Social Marketing both posit that, in order to change health behaviours, it is crucial to understand reasons for current behaviours and perceived barriers and benefits to improved behaviours. Limited research has been conducted, however, that explores these issues with general populations. This study aimed to help address this gap in the evidence using a qualitative methodology.

METHODS

Three group discussions were conducted with a total of 23 participants: (1) young women aged 18-24 with no children; (2) women aged 35-45 with primary school aged children; and (3) men aged 35-50 living with a partner and with pre- or primary school aged children. The discussions took place in a regional centre of Victoria, Australia. Transcriptions were thematically analysed using an inductive descriptive approach and with reference to a recent integrated framework of food choice that identified five key interrelated determinants: food- internal factors; food- external factors; personal-state factors; cognitive factors; and sociocultural factors.

RESULTS

We found that food choice was complex, with all five determinants evident from the discussions. However, the "Social environment" sub-category of "Food-external factors", which included family, work, and social structures, and expectations (or perceived expectations) of family members, colleagues, friends, and others, was particularly prominent. Knowledge that one should practice healthy eating, which falls under the "Cognitive factor" category, while seen as an aspiration by most participants, was often viewed as unrealistic, trumped by the need and/or desire for convenience, a combination of Food-external factor: Social environment and Personal-state factor: Psychological components.

CONCLUSIONS

We found that decisions regarding what, when, and how much to eat are seen as heavily influenced by factors outside the control of the individual. It appears, therefore, that a key to improving people's eating behaviours is to make it easy to eat more healthfully, or at least not much harder than eating poorly.

Nutrition knowledge, attitudes, and perceptions of Greek menopausal women

OBJECTIVE

Nutritional guidelines for postmenopausal women differ. This study aimed to assess postmenopausal women's knowledge, beliefs, and practices regarding nutrition during menopause and their dietary habits.

METHODS

This cross-sectional study was conducted in a menopause clinic, and data from 105 women were analyzed. A nutrition knowledge, attitudes, and perceptions (KAP) questionnaire was designed, structured, and piloted before implementation, based on the Hellenic dietary guidelines. International Physical Activity Questionnaire-Greek version, MedDietScore, and Menopause-specific Quality of Life questionnaires were administered.

RESULTS

The mean ± SD age of the women was 56.9 ± 4.6 years. The mean ± SD KAP score was 12.2 ± 3.5. Those who lived in rural areas had lower KAP scores than those who lived in urban areas ( P = 0.004). Of all the women, 74.5% knew the Mediterranean diet pyramid, whereas 9.8% knew the Hellenic dietary guidelines. Women who had read the guidelines showed better knowledge of Mediterranean diet food groups (Pearson, 0.309; P = 0.039). Knowledge of dairy services was correlated with consumption of dairy products ( P = 0.002). Furthermore, 76.4% were willing to participate in nutrition education programs. The International Physical Activity Questionnaire score was positively correlated with years of smoking ( P = 0.002). Physical activity correlated with adherence to the Mediterranean diet ( P = 0.044).

CONCLUSIONS

The majority of postmenopausal Greek women in this study were unaware of the Hellenic dietary guidelines. In general, women's knowledge of nutrition during menopause was moderate. Greek postmenopausal women are willing to participate in nutrition education programs, which should raise awareness of healthy lifestyles through nutrition, exercise, and smoking cessation.

Diet quality of NCAA Division I athletes assessed by the Healthy Eating Index

Optimizing diet quality is an important concept for college athletes. Purpose: To evaluate dietary quality of National Collegiate Athletic Association (NCAA) Division I athletes. Methods: Total 94 college athletes (n= 21 male, 73 female) from 19 different varsity teams at a single university completed a 24-hour dietary recall using the Automated Self-Administered 24-hour (ASA24) Dietary Assessment Tool. Diet quality was assessed using the Healthy Eating Index (HEI) with higher scores indicating better diet quality (range 0-100). Results: The average HEI score for the total sample was 59.2 ± 16.6 and only nine athletes achieved an HEI score ≥ 80. There were no significant differences in HEI scores between sexes, class, majors, sport played, or those who did or did not report taking previous nutrition coursework. Conclusions: The dietary quality was poor based on US dietary guidelines for the general population, which could have negative effects on health and performance.

Assessing nutrition literacy and nutrition counseling proficiency following an interdisciplinary culinary medicine elective

CONTEXT

Culinary medicine (CM) is a growing field of education that aims to bridge the gap between the clinical need for nutritional counseling and the lack of education on the topic. Healthcare professionals can aid in nutrition-related noncommunicable disease (NCD) prevention by improving a patient's dietary behavior. However, the presence of nutrition education in healthcare curricula is lacking. Early evidence indicates that CM could address this gap.

OBJECTIVES

The objectives of this study are to determine if the provision of an interdisciplinary CM elective will improve student knowledge and confidence with counseling on nutrition and culinary principles, and to improve personal dietary habits of students.

METHODS

This was a one-group pretest-posttest quasi-experimental design. First- and second-year osteopathic medical students (OMS) and nurse practitioner students were recruited to participate in a CM elective via email. Participants were excluded if they were not in good academic standing at their respective institutions. Twelve individuals (n=8 medical; n=4 nursing) were enrolled in the course. Participants completed pre- and postcourse surveys to determine changes in nutrition literacy (Nutrition Literacy Assessment Instrument [NLit42]), nutrition counseling proficiency (Nutrition Survey for Family Practitioners), and dietary quality (Automated Self-Administered 24-h dietary assessment tool; ASA24®). A two-sided, paired t test was conducted to determine changes in outcome variables.

RESULTS

All 12 participants completed the precourse assessments, and 8 participants completed the postcourse assessments. Culinary activity attendance was 94.5 %. Participants exhibited a statistically significant increase in their overall nutrition literacy scores after completing the CM elective (p=0.006). Literacy subcategories indicated that the improvement came from the participant's ability to understand household measurements (p=0.005) better. Increases in self-reported proficiency were observed for participants' confidence to counsel on nutrition and prevention/wellness (p=0.02) and macronutrients in health and food safety (p=0.01). No statistically significant changes in the personal dietary pattern or quality were observed.

CONCLUSIONS

The interdisciplinary CM elective improved nutrition literacy and some aspects of counseling proficiency. Although small shifts in dietary variables were observed, the elective did not statistically improve participants' dietary pattern. However, some changes that were observed may lead to clinically relevant outcomes if maintained long-term. These findings are encouraging. Implementing CM as an educational tool could improve healthcare practitioners' ability to understand and counsel patients on nutrition to prevent the nutrition-related NCDs.

Food-Based Dietary Guidelines for Infants in Latin America and the Caribbean: A Systematic Review

Food-based dietary guidelines (FBDGs) are tools for promoting healthy eating habits. For the population of children under two years old in Latin America and the Caribbean (LAC), there is a lack of reviews analyzing the quality of these guidelines. The objective of this systematic review is to evaluate publicly available FBDGs for the population under two years old in LAC until mid-2023. Guidelines aimed at caregivers of children were included, sourced from government websites in LAC countries and the Food and Agriculture Organization (FAO) portal. Documents targeted at healthcare professionals were excluded. For qualitative analysis, the Agree II guidelines assessment tool and the FAO guide principles for developing healthy and sustainable diets were used. The results showed that more recently released and revised FBDGs with a greater number of pages obtained better scores in both assessments. Additionally, out of the 32 LAC countries, only 13 had these FBDGs available on websites for public access. As a limitation, this study faced challenges in standardizing the searches on government websites. The authors emphasize the need to develop FBDGs for the population under two years old that align with current health and sustainability needs and promote health education.

Effectiveness of personalized meal recommendation in improving dietary behaviors of Chinese community-dwelling elders: study protocol for a cluster randomized controlled trial

BACKGROUND

Inappropriate eating behaviors, particularly a lack of food diversity and poor diet quality, have a significant impact on the prognosis of certain chronic conditions and exacerbate these conditions in the community-dwelling elderly population. Current dietary interventions for the elderly have not adequately considered the nutritional needs associated with multiple chronic conditions and personal dietary preferences of elderly individuals. A personalized recommendation system has been recognized as a promising approach to address this gap. However, its effectiveness as a component of an elderly-targeted dietary intervention in real-world settings remains unknown. Additionally, it is unclear whether this intervention approach will be user-friendly for the elderly. Therefore, this study aims to examine the effectiveness of a personalized meal recommendation system designed to improve dietary behavior in community-dwelling elders. The implementation process in terms of System usability and satisfaction will also be assessed.

METHODS

The trial has been designed as a 6-month, non-blinded, parallel two-arm trial. One hundred fifty community-dwelling elders who meet the eligibility criteria will be enrolled. Subjects will be allocated to either the intervention group, receiving personalized meal recommendations and access to corresponding food provided as one component of the intervention, as well as health education on elder nutrition topics, or the control group, which will receive nutritional health education lectures. Outcomes will be measured at three time points: baseline at 0 months, 3 months, and 6 months. The primary outcomes will include dietary diversity (DDS) and diet quality (CDGI-E) of enrolled community-dwelling elders, representing their dietary behavior improvement, along with dietary behavior adherence to recommended meals. Secondary outcomes will measure the perceived acceptability and usability of the personalized meal recommendation system for the intervention group. Exploratory outcomes will include changes in the nutritional status and anthropometric measurements of the community-dwelling elders.

DISCUSSION

This study aims to examine the effectiveness, acceptability, and usability of a personalized meal recommendation system as a data-driven dietary intervention to benefit community-dwelling elders. The successful implementation will inform the future development and integration of digital health strategies in daily nutrition support for the elderly.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2300074912. Registered on August 20, 2023, https://www.chictr.org.cn/showproj.html?proj=127583.

Improvements in nutrition knowledge among adults with physical disabilities: A program evaluation of the mindfulness, exercise, and nutrition to optimize resilience (MENTOR) program 2020-2021

BACKGROUND

The Centers for Disease Control and Prevention (CDC) funds a quality improvement (QI) health promotion telewellness program for adults with physical disabilities.

OBJECTIVE

The nutrition component of the parent program, Mindfulness, Exercise, and Nutrition to Optimize Resilience (MENTOR) program, from 2020 to 2021, was evaluated to assess changes in nutrition knowledge of people with physical disabilities.

METHODS

This was a quasi-experimental program evaluation by pre-post survey of participating adults with physical disabilities. Participants attended weekly nutrition classes for eight weeks with optional one-on-one counseling with a Registered Dietitian. Participants completed pre-post General Nutrition Knowledge Questionnaire Revised (GNKQ-R) that were analyzed using paired t-tests. Participants were grouped into quartiles by pre-program GNKQ-R scores for additional comparisons. Program attendance and post-program feedback were also evaluated.

RESULTS

A total of 286 participants completed the MENTOR program, and 31% (n = 89) completed pre-post questionnaires for data analysis. Mean pre-program GNKQ-R scores were 58.4 ± 15.1 and post scores were 64.4 ± 11.3, which demonstrated a statistically significant improvement in nutrition knowledge (p < .001). Ancillary analysis revealed that participants with the lowest quartile of pre-program nutrition knowledge had the greatest improvements in their post-GNKQ-R scores (Mean change 16.4 ± 13.9). Questionnaire data revealed participants' subjective knowledge changes and their feedback on the nutrition component of the program.

CONCLUSIONS

The eight-week MENTOR program effectively improved nutrition knowledge among people with physical disabilities. This demonstrates the impact the program can have on individual knowledge levels. Additionally, these results support the implementation of the program to the broader population of people with disabilities.

Investigating the mediating role of food involvement in the relationship between eating restrictions, nutritional knowledge, and dietary patterns in adults

People's Dietary Patterns (DPs) are influenced by culture and ethnicity, and their identification requires a holistic assessment of diet. DP reflects dietary behaviors, and its analysis may provide further details about the dietary etiology of chronic diseases. By examining people's DP and related factors, more practical solutions can be proposed to prevent overweight, obesity, and related diseases. This study aimed to describe DP, Eating Restrictions (ER), Food Involvement (FI), Nutrition Knowledge (NK), and anthropometric indices in Iranian adults and determine the mediating role of FI in the relationship between ER, NK, and DP. A descriptive cross-sectional study was conducted using the structural equation modeling approach. The study was conducted on 2421 adults in Mazandaran Province, northern Iran. The Eating Restrictions Questionnaire (ERQ), the Food Involvement Inventory (FII), the komPAN questionnaire, and a demographic characteristics and anthropometric indices questionnaire were used to collect data. We also measured the seven major food groups, the Diet Quality Scores (DQS), and the six dietary indices, including the pro-Healthy-Diet-Index (pHDI-15), non-Healthy Diet-Index (nHDI-16), high-Glycemic-Diet-Index-7 (hGIDI-7), low-Glycaemic-Diet-Index-4 (lGIDI-4), high-Sugar-Diet-Index-4 (hSDI-4), and high-sugar product (hSFDI-6) and compared their values by gender and four BMI groups. The prevalence of ER and FI was 6.25% and 49.1%, respectively. NK was insufficient for 43.1% of the participants. Most participants (71.2%) had low DQS scores on pHDI-15 and moderate scores (52.9%) on nHDI-16. DQS scores were low in 64.8% of participants in the lGIDI-4 food group, while 71.7%, 92.6%, and 77.2% possessed moderate scores in the hGIDI-7, hSFDI-6, and hSDI-4 food groups, respectively. The mean pHDI-15 and lGIDI-4 indices were higher in women than in men. The amount of unhealthy food indices (nHDI-16, hGIDI-7, hSDI-4, and hSFDI-6) was higher in lean, overweight, and obese people than in people with a normal BMI. The structural model assumed between ER and DP and the mediating role of FI fit well with Iranian adults. Moreover, FI had a mediating role in the relationship between NK and pHDI_15 (Indirect Effects = 0.05, P<0.05) and nHDI_16 (Indirect Effects = -0.07, P<0.01). Most participants are small portions of the healthy food groups and the low glycemic foods, and FI plays a mediating role in the relationship between NK and ER with DP. Therefore, it is necessary to pay attention to the role of FI as a mediating variable in interventions based on reducing ER, increasing NK, and shifting DP from unhealthy to healthy.

The Relationship of Hedonic Hunger, Macronutrient Balance, Nutrition Knowledge, and Body Image and Weight Control with Dietary Intake in Student Athletes and Exercisers

Dietary intake is known to impact athletic performance. The factors that influence dietary intake have been investigated widely, but their collective effect has not been examined. The primary aim of this cross-sectional study was to assess the relationship between dietary intake and nutrition knowledge, body image, weight control, macronutrient balance, and hedonic hunger. Forty-two student athletes or active individuals were recruited through contact with sporting organisations and course coordinators, advertising via twitter, and flyers posted within university buildings. Nutrition knowledge, body image, weight control, macronutrient balance, and hedonic hunger were measured using the Abridged Nutrition for Sport Knowledge Questionnaire, Body Image Disturbance Questionnaire and Contour Drawing Rating Scale, a Weight Fluctuation Measure, Australian Eating Score, and Power of Food Scale, respectively. Hierarchical regression analysis, correlation testing, and mean difference testing were applied. Carbohydrate intake, body image disturbance scores, weight fluctuation, and hedonic hunger for food tasted had a significant relationship (R2 = 64.6%, Adj R2 = 0.608%, p < 0.001) with dietary energy intake. Student athletes' dietary intakes are influenced by multiple potentially modifiable factors. Future studies should use larger sample sizes, with interventions focusing on individual modifiable factors to determine how dietary intake can be most significantly impacted.