Gender differences in perceived food healthiness and food avoidance in a Swedish population-based survey: a cross sectional study

Knowledge, attitudes and practices relating to nutritional support and immune-related adverse events among patients undergoing immunotherapy for liver cancer: cross-sectional study

OBJECTIVES

To examine the knowledge, attitude and practice (KAP) regarding immune-related adverse events (irAEs) and nutritional support among patients with liver cancer (LC).

DESIGN

Cross-sectional study.

SETTING

Recruitment was carried out at Haikou People's Hospital, Haikou, China, from December 2022 to April 2023.

PARTICIPANTS

Patients undergoing immunotherapy for LC.

PRIMARY AND SECONDARY OUTCOME MEASURES

Mean knowledge, attitudes, practices, and lifestyle scores were assessed using an investigator-designed questionnaire completed by patients during immunotherapy.

RESULTS

The study included 402 participants. The mean knowledge, attitudes, practices and lifestyle scores were 6.60±3.51 (/10, 66.00%), 41.26±5.06 (/50, 82.52%), 30.74±4.20 (/40, 76.85%) and 42.37±6.04 (/55, 77.04%), respectively. Attitude scores were associated with practice scores (β=0.381, p<0.001) and lifestyle (β=1.928, p<0.001). Urban residence was associated with higher attitude scores (β=1.242, p=0.013). Living with someone was associated with a higher attitude score (β=1.619, p=0.044). More than one immunotherapy line was associated with a higher lifestyle score (β=1.928, p<0.001). Finally, the female gender was associated with a lifestyle score (β=1.431, p=0.023).

CONCLUSION

Patients with LC and undergoing immunotherapy had moderate KAP towards irAEs and nutritional support. They also displayed moderate lifestyle scores. Urban residents, people not living alone, females and those having received two or more immunotherapy treatments were positively associated with attitude, while attitude was positively associated with practice and lifestyle.

Food neophobia and its relationship with dietary quality and diversity in Turkish young adults: a cross-sectional study

Food neophobia, the fear of trying new foods, may reduce dietary variety, posing risks for nutritional deficiencies. This study examined the links between food neophobia, dietary quality, and diversity among Turkish young adults. A cross-sectional study with 949 participants (470 males, 479 females) aged 18-35 years used the Food Neophobia Scale (FNS) and a 24-h dietary recall to assess food intake. Dietary diversity score (DDS), food variety score (FVS), mean adequacy ratio (MAR), and healthy eating index (HEI-2015) were calculated. The mean neophobia score was 37.07 ± 12.17, with 13.4% high, 67.9% average, and 18.8% low neophobia. The average neophobia group had higher diet quality scores (MAR, DDS, FVS) than the low and high neophobia groups (p < 0.01). Positive relationships with food neophobia were found for niacin, calcium, zinc, plant protein, and cholesterol (p < 0.05). These findings suggest that food neophobia may affect dietary quality variably, with certain micronutrients positively linked to it.

Exploring the dietary changes and support required for healthy eating with female students at UK universities: Findings from focus group discussions

Students' diets often change when leaving home and starting university due to increased responsibility for their diet and finances. However, there is limited qualitative research with students at UK universities about how their diets change during the transition to, and whilst at university and the reasons for these changes. The aim of this study was to qualitatively explore three topics: 1) specific dietary changes reported by students at UK universities, 2) reasons for these dietary changes and 3) how students can be supported to eat more healthily. Fifteen students (100% female, 54% white) across different academic years (60% undergraduate and 40% postgraduate) from the Universities of Reading and Hertfordshire were recruited. Four online focus groups were conducted, ranging from groups of 2 to 6 participants, using a semi-structured topic guide. Discussions were recorded and professionally transcribed. Transcripts were coded and themes derived for each research topic using qualitative analysis software. After joining university, dietary changes commonly reported by the students included either increased or decreased fruit and vegetable intake, increased snacking behaviour, and increased alcohol and convenience food consumption. Common reasons for changes included limited budget, time management struggles, a lack of cooking skills, and peer influence. Students suggested that reduced cost of healthy foods on campus and cooking classes to learn new skills could help them to adopt a healthier diet. These suggestions could be used to guide future healthy eating interventions for university students.

Food neophobia among university students in Saudi Arabia: a cross-sectional survey of prevalence and predictor analysis

Introduction

Due to the absence of scientific information on food neophobia (i.e., fear or reluctance to try new or unfamiliar foods) among young adults in Saudi Arabia, the aim of this study was to assess the prevalence and predictors of food neophobia in Saudi university students.

Methods

This cross-sectional study included 480 students from two public universities of Saudi Arabia. The data was collected via an internet-based structured questionnaire. Participants' sociodemographic, health and behavioral information were included as explanatory variables (15 variables). Participants' food neophobia was assessed using a10-item validated food neophobia scale. A logistic regression model was fitted to find out the predictors of food neophobia.

Results

Approximately half of the participants (49.6%) exhibited food neophobia. Participants who engaged in regular physical exercise had a lower risk of developing food neophobia than their counterparts (AOR: 0.43, 95%CI: 0.20-0.92). Participants with food allergies (AOR: 4.36, 95%CI: 2.73-6.94) and disordered eating attitudes (AOR: 2.52, 95%CI: 1.27-5.02) and who took dietary supplements (AOR: 6.76, 95%CI: 3.54-12.90) were more likely to be food neophobic. Moreover, participants' preferences for fish and sea food (rs = -0.150), milk and dairy products (rs = -0.309,), chocolate and candies (rs = -0.329) and snacks, chips, and nuts (rs = -0.166) were significantly correlated with food neophobia.

Conclusion

A higher level of food neophobia was observed among surveyed university students in Saudi Arabia. Several factors, such as regular physical exercise, food allergies, dietary supplement consumption, and disordered eating attitudes, were found to be associated with food neophobia. To provide empirical evidence on food neophobia, additional research with large and representative samples could be performed in other regions of Saudi Arabia.

Exploring the Potential for Graphic Warning Labels to Reduce Intentions to Consume Energy Drinks

ISSUE ADDRESSED

Effective interventions to reduce energy drink (ED) consumption are needed. This study explored the effect of warning labels on intentions to reduce ED consumption, perceived label effectiveness and protection motivation theory (PMT) constructs.

METHODS

Australian ED consumers aged 18 to 39 years (N = 343) participated in an experimental online survey, randomly assigned to view one of three ED warning label conditions (weight gain, cardiac effects, no label-control). Intentions to reduce ED consumption, perceived effectiveness of labels and selected PMT constructs were assessed.

RESULTS

Participants reported moderate-high awareness of the health effects of consumption (62.68%) and advisory statements on EDs (69.39%), including daily consumption limits (48.40%). EDs were consumed frequently, with 56.26% regular (at least weekly) consumers and most commonly for functional benefits (e.g., alertness). ED warning labels did not have a statistically significant effect on intentions to reduce consumption. The cardiac label performed better than the weight gain label in 'grabbed attention' (72.97% vs. 55.66%, p = 0.008), with non-significant trends (p > 0.05, absolute differences ≥ 10%) suggesting it was stronger on some other perceived effectiveness measures. Supplementary analyses indicated females in the cardiac condition reported greater intentions to reduce ED consumption than females in the control condition (p = 0.042).

CONCLUSIONS

Graphic warning labels and labels warning of cardiac effects are worthy of further exploration as a potential intervention to reduce ED consumption. SO WHAT?: Future research should explore the motivations underlying ED consumption and further explore messages that will resonate with consumers.

Planet-friendly plates: the effect of a plant-based diet on sustainable eating behavior in a sample of Turkish adults

BACKGROUND

In addition to the health effects of plant-based diets, their impact on the environment is becoming increasingly important. This study was conducted to assess the impact of adherence to a plant-based diet on sustainable eating behaviors.

MATERIALS AND METHODS

This cross-sectional study was conducted on 2122 Turkish adults, 73% female and 27% male. The plant-based diet index (PDI), healthy plant-based diet index (hPDI) and unhealthy plant-based diet index (uPDI) were obtained from a validated semi-quantitative food frequency questionnaire (FFQ). After the index scores were calculated, the sample was divided into tertiles for each index. The sustainable eating behaviors of the participants were determined with the 'Behaviors Scale towards Sustainable Nutrition'.

RESULTS

The PDI and hPDI levels of female participants were found to be higher than those of male participants. Factors such as age, exercise and educational status were also found to affect adherence to a plant-based diet. In regression models, PDI (Model 1; β: 0.413, Model 2; β: 0.369, Model 3; β: 0.367) and hPDI (Model 1; β: 0.462, Model 2; β: 0.366, Model 3; β: 0. 351) scores had a positive effect on sustainable eating behavior scores, whereas uPDI (Model 1; β: -0.496, Model 2; β: -0.471, Model 3; β: -0.459) scores had a negative effect (P < 0.001).

CONCLUSION

Our findings suggest that individuals with higher adherence to overall plant-based and healthy plant-based diets exhibit more sustainable eating behaviors. Promoting healthy plant-based diets presents a promising approach to advancing sustainable nutrition, and mitigating environmental challenges. © 2024 Society of Chemical Industry.

Awareness and Practice of Global Cancer Prevention Dietary Guidelines among Koreans

Due to rapid westernization, Korean dietary habits have emerged as significant risk factors for chronic disease and cancer. Despite this transition, Korea's cancer prevention guidelines have remained consistent since their establishment about 18 years ago. This study aimed to investigate the degree of awareness and practice to global dietary guidelines among Korean adults and identify demographic and lifestyle factors associated with low practice. A cross-sectional survey conducted in 2023 included 4,000 adults and assessed their awareness and practice of four global recommendations: "Eat a diet rich in whole grains," "Limit consumption of processed meat," "Limit consumption of sugar-sweetened beverages," and "Limit consumption of fast and other processed foods." While more than half of the participants recognized the guidelines' importance for cancer prevention, implementation rates remained below 40%. Furthermore, over 80% of the respondents expressed a compelling requirement for updated and tailored dietary guidelines. Younger individuals, those who were physically inactive, individuals who had not received prior nutrition education, and participants with obesity were more likely to exhibit low practice, particularly to guidelines limiting processed foods and sugary beverages intake. These findings highlight the need to revise Korea's cancer prevention recommendations by incorporating global dietary practices and addressing the westernized eating patterns prevalent within the population. Efforts should focus on promoting these updated guidelines through targeted education and public health interventions that improve practice, especially in high-risk groups, and effectively mitigate the burden of diet-related cancers in Korea.

Socioeconomic Status and Diabetes Prevalence in the Japanese: Insights From the JPHC-NEXT Study

OBJECTIVE

To assess the association between socioeconomic status (SES) and diabetes prevalence among a Japanese population with a wide age range, stratified by gender.

PATIENTS AND METHODS

Socioeconomic, behavioral, and diabetes-related data (diagnosis or medication use based on self-report) were collected from 112,492 participants aged 40 to 74 years using self-administered questionnaires in a population-based study across seven regions in Japan from January 1, 2011, through December 31, 2016. Logistic regression analyses, stratified by gender, were performed to estimate the association between each SES (income, education, and occupation) and diabetes prevalence after adjusting for demographic status, family history of diabetes, health-related behaviors, and body mass index. We also examined the heterogeneity of age (before or after retirement age - 60 years) with this association.

RESULTS

In women but not in men, lower household income and education were significantly associated with diabetes prevalence (lowest income quartiles vs highest income quartiles: 1.26 [Q1-Q3: 1.10-1.45]; junior high school vs college or higher: 1.20 [Q1-Q3: 1.13-1.28]). Unemployment was significantly associated with diabetes prevalence both in women and men (unemployed vs professionals or office workers: 1.18 [Q1-Q3: 1.10-1.27] in women, and 1.11 [Q1-Q3: 1.05-1.18] in men). The association of education and occupation with diabetes prevalence tended to be stronger at younger ages, although the heterogeneity by age was not significant.

CONCLUSION

Lower SES was associated with higher diabetes prevalence, especially in women, and the associations were stronger at younger ages in Japan. As in other countries, the strength of associations between SES and diabetes prevalence varied by gender in Japan.

A socio-ecological lens to segmenting adult's eating behaviour

Background: The increasing levels of overweight and obesity are negatively impacting the health and wellbeing of individuals and communities. Whilst individual factors are important, the prevalence of overweight and obesity is partly caused by several social and environmental factors that can potentially be modified. A limited number of studies apply a broader theoretical lens to expand the focus beyond individual factors targeted for change. Furthermore, many interventions take a one-size-fits-all approach, which overlooks the differences between subgroups of the population, such as gender, which has a significant impact on eating habits. Aim: This study aims to identify avenues to increase healthy eating by accommodating a wider theory-based socio-ecological viewpoint for change. Additionally, the theory-based socio-ecological lens was applied to identify if segments can be revealed, enabling tailored strategies to be developed to better meet the needs of segments. Methods: A male-dominated sample of n = 3044 Australians was sourced through CINT an online consumer panel provider. Participation was anonymous and voluntary, and consent to participate was indicated by the completion of the survey. Results: Three segments were identified with Socio-Economic Index For Individuals, being the most influential variable differentiating the segments. The most socio-economically advantaged segment (M = 3.7, SD = 0.7) had the highest diet quality score (79.7) while the least advantaged (M = 0.3, SD = 1.4) scored the lowest (67.1). Conclusion: This study confirms the suitability and usefulness of theory-driven segmentation in the development of eating behaviour programs for Australian adults. More effective interventions are required given overweight and obesity levels among this population are increasing.

The big five personality traits and eating habits among female students at Zayed University

Background

Adhering to healthy dietary habits is crucial for disease prevention and improving overall quality of life. Understanding how personality traits influence eating behaviors is essential for developing effective interventions aimed at promoting healthier eating habits. Personality traits are consistent behavioral patterns that individuals typically exhibit, and the Five-Factor Model (also known as the Big Five) is widely recognized as an effective framework for predicting personality traits.

Methods

This study analyzed the relationship between personality traits and eating behaviors among 425 female students using a cross-sectional design. Sociodemographic data and personality traits were assessed using an online questionnaire, while eating behaviors were evaluated with the validated Three-Factor Eating Questionnaire (TFEQ). Key aspects of eating behavior studied included cognitive restraint, disinhibition, and emotional eating. The findings provide insights into how personality characteristics may influence eating habits, offering potential implications for interventions targeting healthier eating behaviors.

Results

The majority of participants scored highest on the personality trait of openness to experience. The study found that certain personality traits, particularly neuroticism and agreeableness, were linked to dietary habits. Specifically, personality traits were associated with emotional eating (p < 0.003), but not with cognitive restraint (p = 0.25) or disinhibition (p = 0.308). Participants with higher levels of agreeableness demonstrated significantly higher cognitive restraint (p = 0.041).

Conclusion

Personality traits can influence eating habits, particularly emotional eating. However, further research is needed to identify individuals at risk for diet-related diseases and to determine the most effective intervention strategies. This study is the first of its kind conducted in the United Arab Emirates, contributing valuable insights into the relationship between personality traits and eating behaviors.

Nutrition Assessment and Counseling in Integrative Cancer Care: Effects on Patient Self-Reported Symptoms

BACKGROUND

Nutrition guidance can affect treatment and survival outcomes for patients with cancer. The effect of a single nutrition consult on patient-reported outcomes is not well known. This study describes characteristics of patients referred for a single outpatient nutrition consult in an integrative oncology center at a cancer hospital, examining effects on self-reported symptoms.

METHODS

We completed a retrospective chart review of 1517 adult oncology patients who completed a single nutrition consult. Demographics, clinical characteristics, and reasons for referral were extracted. Modified Edmonton Symptom Assessment System (mESAS) and Patient-Reported Outcomes Measurement Information System (PROMIS10) scores were collected. Standard descriptive statistics and the Wilcoxon signed-rank test were used.

RESULTS

Most patients were white, women, overweight/obese with breast cancer and non-advanced disease, mean age 55.3 years. Primary reasons for referral were "lifestyle change," "overweight weight-related," and "nutrition knowledge deficit." PROMIS10 results were average. Other than sleep and hot flashes, mESAS symptom scores at baseline were in the mild range. All change scores after nutrition consult were statistically but not clinically significant.

CONCLUSION

Patients presenting for nutrition counseling had a mild symptom burden at baseline and experienced statistically, not clinically, significant improvement in self-reported symptoms following a single visit. Additional research is needed to explore strategies to enhance the intervention and understand the effects of multiple follow-up sessions.

Food sources of energy and nutrients among US college students: The Health Starts Here cohort study

Objective: Identifying the food sources contributing most to total energy percentage, macronutrients, vitamin and mineral consumption among college freshmen, and whether sex played a role. Participants: First-year undergraduate students (N = 269). Methods: Diet was assessed using a DHQ-III and estimated with food source composition tables. Nutrient intakes were expressed as a percentage of total dietary intakes for each food category. Mann-Whitney U tests were used to determine the differences between the two sexes for each food category. Results: A significant proportion of energy and nutrients is contributed by certain food categories, such as grain products, meat, poultry, fish; however, other less desirable sources of energy and nutrient are also identified, including sugary and sports drinks. Among female students, a greater portion of nutritional intakes came from healthier choices. Conclusions: A majority of total energy intake comes from food categories that are energy-dense but also provide essential nutrients.

Assessment of Nutritional Intake in Patients With Kidney Failure Treated by Haemodialysis on Dialysis and Non-dialysis Days

INTRODUCTION/AIMS/OBJECTIVE

Inadequate nutritional intake in haemodialysis (HD) patients increases the risk of muscle wasting, nutrient deficiencies, leading to an increased risk of additional morbidity and mortality. We aimed to assess nutritional intake on the dialysis day and nondialysis day (NDD) of patients established on HD.

METHODS

We employed a 2-day dietary record, one on the day of dialysis and one on the NDD, and then determined nutritional intake using the Nutritics software. Muscle strength was assessed by hand grip strength, and the body composition was determined using multifrequency bioelectrical impedance recorded postdialysis.

RESULTS

We recruited 51 established HD patients dialysing between May 2022 and July 2022, of mean age 60 ± 15 years, 52.9% male, and 51% diabetic. Only 25% achieved the calorie and protein intake recommended by Kidney Disease Outcomes Quality Initiative. Most patients had inadequate consumption of fiber (96%), calcium (86%), iron (80%), zinc (82%), selenium (92%), folate (82%), vitamin A (88%), and (100%) vitamin D. On the other hand, the great majority followed the restriction guidelines for potassium (96%), phosphorus (86%), and sodium (84%), respectively. However, consumption was greater for potassium (P = .007), phosphorus (P = .015), and zinc (P = .032) on NDDs versus dialysis days, but there was no difference in protein or calorie intake between days.

CONCLUSION

Our results suggest that many of our HD patients do not achieve the recommended nutritional targets. Patient compliance with restricting sodium, potassium, and phosphate limits protein and calorie intake. HD patients are at increased risk of sarcopenia, so failure to achieve dietary protein intake will further increase this risk.

Analysis of Nutrition Knowledge After One Year of Intervention in a National Extracurricular Athletics Program: A Cross-Sectional Study with Pair-Matched Controls of Polish Adolescents

Background: Nutrition knowledge may be translated into adequate dietary intake and proper eating habits, so adolescent education programs focusing on improving eating habits and nutrition knowledge are needed. The aim of the cross-sectional study with pair-matched controls was to assess the Consumer Nutrition Knowledge Scale (CoNKS) results and its determinants after one year of intervention in a national extracurricular athletics program within a pair-matched sample of Polish adolescents. Methods: The #goathletics Study evaluated a Polish national extracurricular athletics program, 'Athletics for all', being a voluntary and free-of-charge physical activity program organized by the Polish Athletics Association. The study allowed comparing the intervention group of adolescents aged 10-14 years, participating in the program for at least 9 months (a school year) and a pair-matched group not participating in it, while the matching was based on city, gender, and age (each group: n = 506 adolescents, n = 281 females and n = 225 males). The nutrition knowledge was assessed using a Consumer Nutrition Knowledge Scale (CoNKS), and during the analysis, the following factors were taken into account: body weight, height, Body Mass Index (BMI), waist circumference, and waist-to-height ratio (WHtR). Results: The 'Athletics for all' program participation influenced not only the total CoNKS score (p < 0.0001) but also the scores in all studied areas-within procedural nutrition knowledge (p = 0.0002), declarative nutrition knowledge on nutrients (p = 0.0001), and declarative nutrition knowledge on calories (p < 0.0001), and program participants revealed a stronger understanding of all the studied areas compared to non-participating individuals. Gender, BMI, and central obesity tendency were not associated with the total CoNKS score (p > 0.05), or any of the studied areas (p > 0.05). The statistically significant differences in the number of correct answers were observed for four items within procedural nutrition knowledge, for four items within declarative nutrition knowledge on nutrients, and for four items within declarative nutrition knowledge on calories (p < 0.05), while for all of them, 'Athletics for all' program participants revealed a stronger understanding. Conclusions: One year of intervention in a national extracurricular athletics program significantly influenced the nutrition knowledge of the studied group of adolescents aged 10-14 years. While compared with the pair-matched control group of Polish adolescents, they were characterized by a stronger understanding of all areas of nutrition knowledge.

Food Behavior and Lifestyle Among Students: The Influence of the University Environment

INTRODUCTION

A key element for a healthy lifestyle in the formative years of a young adult is a balanced, healthy, individualized diet.

AIM

The aim of this study was to analyze the eating behavior and lifestyles of students at a university in Romania, as well as the extent to which the study program interferes with these factors.

METHODS

A retrospective study was performed, with the data being collected through an online questionnaire via the Google Forms platform; data collection for the current study was carried out in November 2024 during a student session.

RESULTS

Out of the total of 501 questionnaires collected, 416 were completed by women and 85 by men. It can be observed that 57.65% of men (49 participants) eat three meals a day compared to 53.13% of women (221 participants). The university program influenced the students' meal schedules for 59.88% (n = 300) of participants, while 30.94% (n = 155) declared that they never have an ordered meal schedule. For 39.92% of students, the exam period has an influence on the meal schedule, including an increase the intake of sweet foods (59.88%), and some declared that they forget to eat (33.93%).

CONCLUSIONS

The food and lifestyle behaviors in the studied group show health risk elements, especially an increase in tobacco consumption, a lack of regular meal schedules, and the consumption of an excess of unhealthy snacks. It was found that intensive study schedules may intensify this behavior.

Exploring the potential utility of a single-item perceived diet quality measure

BACKGROUND/OBJECTIVES

Perceived diet quality (PDQ) has been suggested as an easy-to-use dietary assessment tool. However, its practicality and efficiency are still questionable. This study aimed to gauge the utility of PDQ as an alternative dietary assessment tool among Korean adults by examining PDQ and its associated factors.

SUBJECTS/METHODS

An online survey was conducted on 514 Korean adults aged 19 to 64 years in October 2022. PDQ was assessed using a 5-point Likert scale, and participants were categorized into healthy, fair, or unhealthy PDQ groups. The participants were asked about the perceived importance of nutrients and food groups for health and the extent to which they considered these factors in their usual diets using a 5-point Likert scale. A multivariate linear regression model was used to identify the factors associated with PDQ.

RESULTS

About 26.7% of participants rated their diets as healthy, while 63.2% rated them as fair and 10.1% rated them as unhealthy. Participants with a healthy PDQ rated perceived importance and consideration of nutrients and food groups higher than the fair or unhealthy PDQ groups. A healthier PDQ was associated with the male gender, an older age, being normal or underweight, having better subjective health, lower use of alcohol, being physically active, having a high interest in healthy diets, and a higher perception of the importance of nutrients and food groups for health.

CONCLUSION

The PDQ could serve as a simple and rapid screening tool for identifying individuals at risk of poor diets.

Development of Body Weight Management Among the Hungarian Population

BACKGROUND/OBJECTIVES

Nowadays, body weight management has gained significant consumer attention due to the health megatrend. It plays a key role in preventing diseases, maintaining health, and creating a balanced diet, as well as in mental and physical health. Overweight and obesity are serious problems that can result in various non-communicable diseases; thus, managing the body weight of those who are overweight or obese without pathological changes would help reduce the prevalence of these diseases. By reducing body weight, not only individual health expenses but also public health costs could be reduced. To do so, it is necessary to assess at what levels consumers perceive their own health status, as well as the extent to which they pay attention to body weight management. Our research aimed to contribute to the foundation of public intervention programs by exploring some characteristics of body weight management among Hungarian consumers.

METHODS

We used a large-sample questionnaire survey involving a total of 550 people. Various statistical methods were used to analyze the data, including descriptive statistics, association tests, and hypothesis tests.

RESULTS

According to our results, those who want to lose weight are more engaged in managing their body weight than those who are satisfied with their weight or who want to gain weight, often aiming to reach an ideal weight through diet and exercise, and are willing to invest more in healthier lifestyles, both in terms of their diet and physical activity. In this regard, we did not find significant differences between the genders.

CONCLUSIONS

Based on our findings, we can conclude that dietitians and doctors should play a more active role in guiding lifestyle changes since the majority of our respondents do not consider them credible sources of information on healthy eating, and they do not consult them on this topic. On the other hand, however, a much larger proportion seek information from them regarding regular physical activity, and after personal trainers, they are considered the second most authentic source of information.

How hand-made affects consumers' perceived nutritional quality of organic food

This study analyzed the impact of handmade in depth on consumers' perceived nutritional quality of organic food through three experiments. Experiment 1 found that handmade significantly enhanced consumers' positive perceptions of nutritional quality of organic food. Experiment 2 revealed the mediating role of handicraft cultural identity between handmade and perceived nutritional quality. Experiment 3 further explored the moderating role of perceived authenticity on the impact of handmade. We found that these factors above significantly enhanced the positive effect of handmade on perceived nutritional quality. The findings suggest that handmade directly affected consumers' perceived nutritional quality of organic food, which could be further strengthened through the mediating effect of handcraft cultural identity and the moderating effect of perceived authenticity. These findings provide important guidance for organic food manufacturers and marketers on marketing strategy-making that can help better meet consumer demand for high-quality organic food.

Sex-specific dietary habits and their association with weight change in healthy adults

BACKGROUND

Dietary intake plays a pivotal role in the prevalence and management of obesity. While women and men exhibit differences in dietary habits and food-related behaviors, sex-based weight loss recommendations are lacking. This study aims to examine the impact of specific foods and food categories on weight reduction in men and women over a two-year period.

METHODS

A total of 8,548 participants from the 10K cohort, from 2019 to 2023, were included in the analysis (53.1% women, mean age 51.7 years). Anthropometric measurements and laboratory results were collected at baseline and at the two-year follow-up visit. Dietary assessment was based on daily food intake digitally logged through an application for at least 3 consecutive days at both timepoints. We compared intake of macronutrients, micronutrients, food groups and daily energy consumption between sex and body mass index (BMI) categories at baseline and weight change categories at follow-up. Using linear regression, we assessed the associations between food categories or specific foods and BMI at baseline as well as weight change percentage at follow-up.

RESULTS

Dietary habits varied by BMI and sex. Women and men living with obesity (BMI > 30 kg/m2) reported a greater intake of animal-based protein and lower intake of plant-based proteins and fats at baseline, as compared to participants with normal weight. In linear regression models predicting two-year weight change, including age, income, and baseline weight, the explained variance was 5.6% for men and 5.8% for women. Adding food categories and specific foods increased the explained variance to 20.6% for men and 17.5% for women. Weight reduction in men was linked to daily consumption of an egg (1.2% decrease) and beef (1.5% decrease), while in women, the most pronounced reductions were associated with an apple (1.2% decrease) and cashew nuts (3.4% decrease). Notably, total energy intake changes significantly impacted weight outcomes only in women.

CONCLUSIONS

Sex-specific dietary habits significantly influence weight change over time. In men, weight loss was primarily associated with the addition of animal-based protein, while in women, it was linked to caloric deficit and plant-based fat, suggesting that sex-based nutritional interventions may demonstrate greater efficacy.

TRIAL REGISTRATION

NCT05817734 (retrospectively registered January 31, 2023).

Navigating Food Fraud: A Survey of Nigerian Consumer Knowledge and Attitudes

Food fraud presents a growing threat globally, impacting consumer health; food safety; and brand credibility. The key motivation for food fraud is usually an economic or financial advantage. Economically motivated food fraud (EMA) is the illegal deception, deliberate and intentional substitution or addition of a substance in a food product, which may pose a possible health risk to unsuspecting consumers. This study aims to assess the awareness and attitudes of Nigerian consumers towards food authenticity and the regulatory measures in place to combat food adulteration. The study comprised 2160 respondents who were asked about their knowledge of high-profile food fraud incidents, frequently adulterated products, and their opinions of the effects of food fraud and preventative measures. The findings of this study revealed that more than a third of respondents were unfamiliar with the term "food fraud". However, they were aware of local high-profile cases, such as "plastic rice" and counterfeit dairy products. Most participants relied on point-of-sale information for assessing food authenticity, with street vendors being viewed as potential sources of food adulteration. The study also found that more than half of the respondents were concerned about food fraud regardless of whether it involved local or imported products. A wide variety of food items were identified as prone to adulteration or fraudulent activity. These included alcoholic drinks, dairy products, honey, rice, and tomato paste, amongst others. These findings highlight the need for improved consumer awareness, regulatory effectiveness, and remediation efforts to combat food fraud in Nigeria.

Perceived healthiness of foods, food avoidance and diet-related anxiety in individuals with self-reported irritable bowel syndrome: a cross-sectional study

BACKGROUND

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder in which the intake of food is known to exacerbate symptoms. Experiencing food related symptoms can lead to avoidance of food, and cause anxiety related to food intake. We aimed to explore perceptions of the healthiness of food, food avoidance, and food-related worry and anxiety among individuals with and without IBS.

METHODS

This study was based on a survey conducted in January-February 2017. In total, 2000 participants aged 20-65 were invited by postal letter randomly obtained through the Swedish state personal address register. The questionnaire included aspects of socioeconomic position, different disorders including IBS and food intolerances, food avoidance, and food-related worry or anxiety.

RESULTS

In total, 538 participants were included in this study, of whom 8.4% (n = 45) reported having IBS. There were few differences regarding the perceived healthiness of foods between individuals with and without IBS. Participants with IBS avoided gluten (OR 3.45, p = 0.002), lactose (OR 5.0, p < 0.001) and alcohol (OR 2.0, p = 0.042) more frequently than individuals without IBS, and avoidance was driven by abdominal pain. Participants with IBS also reported feeling more worried and having anxiety about diet than those without IBS (p = 0.032 and p = 0.002, respectively).

CONCLUSION

This study indicates that individuals with IBS perceive most foods as equally healthy as individuals without IBS. Having IBS increases the odds of avoiding gluten, lactose, and alcohol. Worry and anxiety related to diet were more common among individuals with IBS, and these aspects need to be considered both in clinical practice and in future research.

Fluctuations in Mediterranean Diet Adherence Pre- and Post-Pandemic: A Study of Portuguese Cohorts 2019-2024

BACKGROUND/OBJECTIVES

The Mediterranean Diet (MD) is a lifestyle offering numerous health benefits. Nevertheless, the adherence to the MD is moderate even in Mediterranean countries. While sociodemographic factors influence MD adherence, additional impacts occurred due to the COVID-19 pandemic. This cross-sectional longitudinal study with three cohorts of Portuguese adults analyzes MD adherence before, during, and after the COVID-19 pandemic, and explores the effect of sociodemographic variables.

METHODS

Sociodemographic factors, lifestyle habits, and MD adherence were assessed in the years 2019, 2021, and 2024 with an online self-filled questionnaire. MD adherence was measured with the Mediterranean Diet Adherence Screener (MEDAS).

RESULTS

MEDAS score increased significantly (p < 0.05) from 2019 to 2021 (6.2 ± 0.7 to 7.7 ± 0.1), followed by a significant (p < 0.05) decrease in 2024 (7.2 ± 0.1) relative to 2019, which was more pronounced in participants with higher income. Accordingly, a trend in healthier food choices was observed followed by a decline in 2024. Of note is the significant increase in red meat consumption (p < 0.05) in 2024 relative to 2021. Respondents who consumed more red meat were mostly men, employed, or in a stable relationship. Most respondents practiced sport "Never or occasionally" in 2019 and 2021 (59.4 and 55.2%, respectively); in 2024, this category was significantly (p < 0.05) reduced (40.9%); men or higher-income participants were more likely to meet the recommended activity levels.

CONCLUSIONS

This study reveals that the improvements in MD lifestyle during the pandemic were not sustained in 2024, as healthier habits formed during confinement were not fully integrated into long-term behavior. These findings strengthen the need for targeted public health interventions to promote the MD.

Factors associated with diet quality of adolescents in Saudi Arabia

Introduction

Research exploring factors that may influence the diet quality of adolescents in the Middle East are very limited. We aimed to investigate factors associated with diet quality and the weight status of adolescents in Saudi Arabia.

Methods

A cross-sectional study that included 638 healthy adolescents aged between 11 and 18 years who were randomly recruited from 16 private and public middle- and high-schools located in two Saudi cities (Jeddah and Madinah). All participants were given an envelope for parents to collect socioeconomic data. Diet quality and anthropometric data of adolescents were evaluated at school.

Results

Median diet quality score was higher among males compared to female adolescents (10.00 (8.00-11.00) vs. 9.00 (8.00-10.0), respectively, p = 0.018). Median diet quality score was significantly higher among adolescents residing in Jeddah compared to adolescents residing in Madinah (10.00 (9.00-11.0) vs. 9.00 (8.00-10.0), respectively, p = 0.002). Stepwise linear regression analysis indicated that city of residence (B = -0.53, SE = 0.16 [95% CI: -0.83 to -0.22]), and child's sex (B = -0.34, SE = 0.15 [95% CI: -0.64 to -0.05]) were associated with diet quality scores of adolescents in Saudi Arabia.

Discussion

Future longitudinal research should be directed to further investigate other possible factors influencing the diet quality of adolescents and individuals from other age groups in Saudi Arabia.

Gender differences in body composition, dietary patterns, and physical activity: insights from a cross-sectional study

Introduction

This study investigates the interplay between body composition, dietary patterns, and physical activity across genders, focusing on gender-specific differences in food preferences and eating behaviors. Understanding these interactions is crucial for developing targeted nutritional and lifestyle interventions.

Methods

A cross-sectional study was conducted with 1,333 participants (58.7% female, 41.3% male), aged 18-65 years. Participants were categorized into tertiles based on their fat mass to fat-free mass (FM-to-FFM) ratio. Data on dietary choices, eating behaviors, and physical activity were collected and analyzed to identify gender-specific trends.

Results

Significant gender-specific differences were observed in food preferences and eating behaviors. Males experienced greater hunger in the late afternoon, while females felt more hunger in the morning. Males showed a preference for processed and red meats, whereas females preferred cooked vegetables. Eating behaviors such as meal skipping, uncontrolled eating, nocturnal eating, and taste preferences (sweet or salty) varied distinctly between FM-to-FFM tertiles and genders. Higher FM-to-FFM ratios correlated with lower physical activity levels, particularly in strength training and general sports engagement.

Discussion

These findings highlight the complex interactions between body composition, dietary habits, and lifestyle factors, emphasizing gender-specific differences. The results suggest that body composition and BMI significantly impact health-related behaviors, necessitating tailored interventions to address these differences and promote healthier lifestyles.

Can a health warning label diminish the persuasive effects of health-oriented nutrition advertising on ready-to-drink alcohol product packaging? A randomized experiment

BACKGROUND AND AIMS

A health warning label (HWL) cautioning about the link between alcohol and cancer may be able to communicate alcohol risks to consumers and potentially counter health-oriented nutrition advertising on ready-to-drink alcoholic beverages. This study aimed to examine the independent and combined effects of nutrient content claims (e.g. 0 g sugar) and a HWL on perceived product characteristics and intentions to consume, and whether these effects differed by gender and age.

DESIGN

A between-subjects randomized experiment. Participants were randomized to view one of six experimental label conditions: nutrient content claims plus nutrition declaration (NCC + ND), ND only, NCC + ND + HWL, ND + HWL, HWL only and no NCC, ND or HWL, all on a ready-to-drink (RTD) vodka-based soda container.

SETTING AND PARTICIPANTS

Alcohol consumers (n = 5063; 52% women) in Canada aged 18-64 recruited through a national online panel.

MEASUREMENTS

Participants completed ratings of perceived product characteristics, perceived product health risks, and intentions to try, buy, binge and drink the product.

FINDINGS

Compared with the reference condition NCC + ND (current policy scenario in Canada), the other five experimental label conditions were associated with lower ratings for perceiving the product as healthy. All experimental conditions with a HWL were associated with lower product appeal, higher risk perceptions and reduced intentions to try, buy and binge. The experimental condition with a HWL only was associated with intentions to consume fewer cans in the next 7 days (β = -0.72, 95% confidence interval [CI] = -1.37,-0.08) versus the reference. Few interactions were observed, suggesting that label effects on outcomes were similar by gender and age.

CONCLUSIONS

Health warning labels on alcohol packaging appear to be associated with lower product appeal, higher perceived health risks and reduced consumption intentions, even in the presence of nutrient content claims.

Exploring the spatial mental associations of distinct food types

Previous research explored the spatial representations of healthy low-calorie and unhealthy high-calorie food items, revealing an association of healthy low-calorie food with left and top sides, and unhealthy/high-calorie food with right and top sides. This association, namely side bias, was limited to these specific categories leaving the representations of healthy high-calorie and unhealthy low-calorie food categories yet to be explored. Present study was designed to examine the spatial representation of four food categories (unhealthy low-calorie, unhealthy high-calorie, healthy low-calorie, healthy high-calorie) using a computerized food placement task. In Experiment 1, participants placed four food items from different categories into eight locations. In Experiment 2, identical task was used with the addition of centrally presented anchor food item to investigate the mental representation of food items in relation to each other. The frequency of placing food items in specific spatial locations were measured. The results of Experiment 1 provided partial support for side bias. However, the use of anchor items in Experiment 2 provided compelling evidence for vertical side bias, demonstrating consistent pattern of placing healthy foods on the upper sides and unhealthy foods on the lower sides. In both experiments, real-life food choices were examined to investigate whether the high-calorie bias would be observed in actual food choice behavior. The results from both experiments indicated strong preference to select high-calorie foods, supporting high-calorie bias. Overall, this study extends the evidence on the spatial representations of distinct food categories.

Association between Diet Quality and Eating Behavior in Type 2 Diabetes Adults: A Cross-Sectional Study

Type 2 diabetes mellitus (T2DM) has become a global epidemic. To effectively control T2DM, individuals must adhere to a high-quality diet that encompasses not only healthy dietary patterns but also promotes positive eating behaviors. We conducted a cross-sectional study on 314 patients with T2DM, and we evaluated the diet quality and also examined the associations between eating behavior, diet quality, and anthropometric and clinical factors in T2DM patients. We used the Diet Quality Index-International and Dutch Eating Behavior Questionnaire to assess dietary characteristics. We found that women had a significantly higher diet quality than men (61.40 vs. 58.68, p = 0.002) but were also more prone to emotional eating (2.00 vs. 1.53, p < 0.001) and restrained eating (2.39 vs. 2.05, p = 0.002). Restrained eating correlated with duration of diabetes (r = -0.169, p = 0.003), body mass index (r = 0.182, p = 0.001), and external eating with glycated hemoglobin (r = 0.114, p = 0.044). Patients with emotional eating had a higher vitamin C adequacy score (β = 0.117, p = 0.045). External eating was positively associated with grain adequacy (β = 0.208, p < 0.001) and negatively associated with empty-calorie food moderation score (β = -0.125, p = 0.032). For restrained eating, we found associations with vitamin C adequacy (β = -0.138, p = 0.017) and fruit adequacy (β = 0.125, p = 0.033). In conclusion, the results of this study provide valuable insight into dietary behavior and emphasize the importance of promoting healthy eating habits for T2DM patients.

Influence of Food Environments on Dietary Habits: Insights from a Quasi-Experimental Research

Nutrition is a vital factor that exerts a profound and direct impact on health. Food environments significantly influence individuals' dietary behaviors, health outcomes, and overall food security. Individuals in food deserts and food swamps do not have access to healthier food options. And in both cases, the emphasis is primarily on the physical configuration of the environment as it relates to food availability. This quasi-experimental study aims to investigate the impact of two different food environments (defined to include a social component) on food choices. A total of 246 participants were surveyed by telephone, half of whom were primed with Scenario A (a food environment deficient in healthy options and cues that support and reinforce healthier choices) and half were primed with Scenario B (an environment with an abundance of healthy food options and cues that support and reinforce healthy eating). Ordered logit regression was used for analysis. The results show significant differences in likely food consumption between the groups. Individuals in Scenario B were found to be 4.48 times more likely to consume fruits and vegetables. In addition, it was determined that being a woman increases the probability of consuming more fruits and vegetables by 0.92 times (1/0.52-1), and adherence to a healthy diet increases by 3.64 times. Age and race were not significant predictors. This study highlights the crucial role of environmental factors in shaping dietary habits and underscores the importance of the social components of the food environment in promoting the adoption of healthier dietary habits. Based on these findings, policymakers should prioritize developing strategies that go beyond providing physical access and consider social aspects of the environment in promoting healthy eating habits to improve public health and bolster the food security of communities.

Knowledge of cardiovascular diseases and associated risk factors in the general adult population of Jeddah, Saudi Arabia: A cross-sectional study examining gender disparities

To assess knowledge about cardiovascular diseases (CVD) among the general population, we emphasized gender-related disparities and other lifestyle and health-related factors. This cross-sectional study was conducted among 395 individuals from the general population of Jeddah, Saudi Arabia. An online questionnaire was administered to assess knowledge of CVD types, symptoms, and risk factors. The majority of participants identified coronary heart disease (73.7%) as having CVD, with no sex effect. Males had higher knowledge regarding cerebrovascular disease (44% vs 31.5%) and congenital heart diseases (60% vs 51.9%) as being part of CVD, while they had lower knowledge of peripheral arterial disease (44% vs 50.7%) than females, respectively (P < .05). Males exhibited better knowledge of heart attack and stroke symptoms than females. Knowledge was optimal for major CVD risk factors, such as smoking (90.6%) and high low-density lipoprotein cholesterol levels (85.1%); however, gaps were observed in recognizing diabetes (56.2%) and stress (69.4%) as factors for CVD. The mean overall knowledge score was 16.33 ± 5.72 25, with no difference between sexes (P = .239). Predictors of good CVD knowledge included university-level education, daily healthy food consumption, and perceived life as highly stressful; nonetheless, sex showed no significant effect. While the general population displayed a suboptimal understanding of CVD, notable sex disparities were observed, highlighting the need for tailored public health interventions. Emphasizing cognitive and behavioral aspects can foster better prevention and management strategies, given the evident gender disparities.

Association of a Low-Carbohydrate High-Fat Diet With Plasma Lipid Levels and Cardiovascular Risk

Background

Low-carbohydrate high-fat (LCHF) diets have attracted interest for a variety of conditions. In some individuals, these diets trigger hypercholesterolemia. There are limited data on their effects on cardiovascular disease risk.

Objectives

The purpose of this study was to investigate the association between LCHF dietary patterns, lipid levels, and incident major adverse cardiovascular events (MACE).

Methods

In a cohort from the UK Biobank, participants with ≥1 24-hour dietary questionnaire were identified. A LCHF diet was defined as <100 g/day and/or <25% total daily energy from carbohydrates/day and >45% total daily energy from fat, with participants on a standard diet (SD) not meeting these criteria. Each LCHF case was age- and sex-matched 1:4 to SD individuals.

Results

Of the 2034 LCHF and 8136 SD identified participants, 305 LCHF and 1220 SD individuals completed an enrollment assessment concurrently with lipid collection. In this cohort, low-density lipoprotein-cholesterol (LDL-C) and apolipoprotein B levels were significantly increased in the LCHF vs SD group (P < 0.001). 11.1% of LCHF and 6.2% of SD individuals demonstrated severe hypercholesterolemia (LDL-C >5 mmol/L, P < 0.001). After 11.8 years, 9.8% of LCHF vs 4.3% of SD participants experienced a MACE (P < 0.001). This difference remained significant after adjustment for cardiovascular risk factors (HR: 2.18, 95% CI: 1.39-3.43, P < 0.001). Individuals with an elevated LDL-C polygenic risk score had the highest concentrations of LDL-C on a LCHF diet. Similar significant changes in lipid levels and MACE associations were confirmed in the entire cohort and in ≥2 dietary surveys.

Conclusions

Consumption of a LCHF diet was associated with increased LDL-C and apolipoprotein B levels, and an increased risk of incident MACE.

Oxidative balance score: a potential tool for reducing the risk of colorectal cancer and its subsites incidences

Background

The Oxidative Balance Score (OBS) is commonly used to assess oxidative stress and provides a comprehensive evaluation of dietary and lifestyle-related exposures. However, there is limited research on the association between OBS and colorectal cancer (CRC), its subsites, and complications. The objective of this study was to assess the relationship between OBS and the risk of CRC, its subsites, and common complications in a large prospective cohort study.

Methods

We included data from 175,808 participants in the UK Biobank data sample repository from 2006 to 2010. We evaluated OBS using a scoring system based on 22 dietary and lifestyle factors. Multiple adjustments, including multivariate Cox proportional hazard regression, gender stratification, subgroup analysis, and sensitivity analysis, were performed to fully explore the relationship between OBS and CRC, its subsites, and complications. The mediation analysis was conducted to investigate whether serum albumin, uric acid, and neutrophil levels mediate the relationship between OBS and CRC.

Results

After adjusting for potential confounding factors, a significant negative correlation was found between OBS and the risk of CRC and its subsites (proximal colon cancer, distal colon cancer, and rectal cancer). This correlation was particularly pronounced in male CRC patients. Serum albumin, uric acid, and neutrophil count, which are biomarkers, were found to have a significant mediating effect between OBS and CRC.

Conclusion

Our study suggests that higher exposure to antioxidants assessed through OBS (diet and lifestyle rich in antioxidants) may decrease the occurrence of CRC and its subsites.

Digital health literacy and associated factors among internet users from China: a cross-sectional study

BACKGROUND

As the internet develops and 5G technology becomes increasingly prominent, the internet has become a major source of health-related information. Increasingly, people use the internet to find health-related information, and digital health literacy is now a set of essential capabilities to improve their health in the digital era. However, little is known about the factors that influencing digital health literacy. This study aimed to assess digital health literacy scores and identify its influencing factors among internet users in China. Additionally, this study explored the participant's actual skills using an additional set of performance-based items from the Digital Health Literacy Instrument (DHLI).

METHODS

An online cross-sectional study was conducted in August 2022. Participants aged ≥18 years were recruited to complete the survey. Data were collected using the Chinese revised version of the DHLI, the self-reported internet use questionnaire, and the sociodemographic questionnaire. We conducted multivariate linear regression analyses to explore the relationships among the sociodemographic variables, behavior of internet use, and the digital health literacy scores.

RESULTS

In total, 702 participants completed the survey. The mean DHLI score was 2.69 ± 0.61. Multivariate linear regression analyses showed that the age groups 35-49 (β = - 0.08, P = 0.033), 50-64 (β = - 0.161, P < 0.001), and ≥ 65 (β = - 0.138, P < 0.001) were negatively associated with DHL scores. However, education level, including bachelor's or associate degree (β = 0.255, P = 0.002) and master's degree and above (β = 0.256, P < 0.001), frequency of health-related Internet usage (β = 0.192, P < 0.001), the number of digital devices used (β = 0.129, P = 0.001), and OHISB (β = 0.103, P = 0.006) showed a positive relationship with DHL scores.

CONCLUSIONS

The study findings demonstrate that age, educational levels, number of technological devices used, and greater use of the web for health information were independently associated with DHL scores. Healthcare providers should consider providing training programs tailored to specific sociodemographic factors to improve the ability that find and use accurate information online to meet digital health services, which contributes to enhance their self-management and reduce health disparities.

How an agreement with restriction of unhealthy food marketing and sodium taxation influenced high fat, salt or sugar (HFSS) food consumption

BACKGROUND

Food taxation and food marketing policy are very cost-effectiveness to improve healthy diets among children. The objective of this study was to investigate the socio-demographic characteristics of Thais and attitude towards on policy unhealthy food marketing restriction and sodium taxation which influence high fat, sodium, and sugar (FHSS) food eating.

METHODS

The data were obtained from the 2021 Health Behavior of Population Survey, four-stage sampling method of the Thai people, aged 15 years and above, using a offline survey application-assisted face-to-face interview. Logistic Regression were used to analyze the explanatory variables on agreement and HFSS food intake.

RESULTS

Almost half (48.4%) of samples disagreed with sodium taxation, and 42.7% of the samples disagreed with food marketing restriction. Most (99.6%) of Thai respondents consumed HFSS food, including sugar sweetened beverages (SSB). Gender, age, education, income, BMI, and health status were associated with agreement with food marketing restriction policy and sodium taxation policy. There is no association between agreement with policy on sodium taxation and food marketing and HFSS food consumption.

CONCLUSION

Nearly half of Thais indicated that they disagreed with policy on food marketing restriction and sodium taxation. Therefore, understanding and awareness of the two policies among Thais should be further investigated in order to develop better policy communication for increased public understanding and engagement.

How Do Brazilian Consumers Understand Food Groups in the Food-based Dietary Guidelines?

In the Food-based Dietary Guidelines (FBDGs), food classification is based on food groups and nutrient sources. Much research has already investigated multiple aspects of consumer understanding of the information described in these documents. However, no study has evaluated consumer understanding of all food items contained in the groups described in the FBDGs. This study aimed to assess Brazilian consumers' understanding of food classification according to food groups in the concepts of the FBDGs. Therefore, an instrument, Consumer Understanding of Food Groups (UFG), was constructed and validated to assess consumer understanding of food groups. The instrument comprised 44 items approved by experts (agreement > 80%). A total of 894 Brazilians from all regions participated in this study. The results suggest that 48.9% of the participants believe it is easier to classify food according to food groups. The classification of food groups is based on the origin of the food (animal and vegetable). Although consumers easily recognize foods according to their origin, we still identify asymmetries regarding including food items from the animal kingdom and species from the plant kingdom. This exploratory study highlights important information that can contribute to improving the FBDGs. It is essential to consider consumers' understanding and guide them regarding choices from a technical point of view.

Penn Healthy Diet survey: pilot validation and scoring

Though diet quality is widely recognised as linked to risk of chronic disease, health systems have been challenged to find a user-friendly, efficient way to obtain information about diet. The Penn Healthy Diet (PHD) survey was designed to fill this void. The purposes of this pilot project were to assess the patient experience with the PHD, to validate the accuracy of the PHD against related items in a diet recall and to explore scoring algorithms with relationship to the Healthy Eating Index (HEI)-2015 computed from the recall data. A convenience sample of participants in the Penn Health BioBank was surveyed with the PHD, the Automated Self-Administered 24-hour recall (ASA24) and experience questions. Kappa scores and Spearman correlations were used to compare related questions in the PHD to the ASA24. Numerical scoring, regression tree and weighted regressions were computed for scoring. Participants assessed the PHD as easy to use and were willing to repeat the survey at least annually. The three scoring algorithms were strongly associated with HEI-2015 scores using National Health and Nutrition Examination Survey 2017-2018 data from which the PHD was developed and moderately associated with the pilot replication data. The PHD is acceptable to participants and at least moderately correlated with the HEI-2015. Further validation in a larger sample will enable the selection of the strongest scoring approach.

Twelve Month Efficacy of Computer-Tailored Communication in Boosting Fruit and Vegetable Consumption Among Adults Aged Forty and over: A Three-Level Meta-Analysis and Systematic Review of Randomized Controlled Trials

Computer-tailored health communication (CTC) can enhance fruit and vegetable (F&V) intake and, consequently, health by providing personalized feedback. However, few studies have examined the long-term effects of such interventions in middle-aged and older adults. This research aimed to assess the 12-mo efficacy of CTC in promoting F&V consumption and potentially identify who among middle-aged and older adults changed their diet after the intervention. The protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO) on 2021-12-09, code CRD42022330491. The research was performed without external funding. We searched 6 databases (MEDLINE via PubMed, EMBASE, Scopus, Web of Science Core Collection, Cochrane Library, and PsycINFO) for randomized controlled trials (RCTs) comparing CTC interventions for increasing F&V intake with usual care/no intervention control in adults aged ≥40, measured 12 mo after the pretest. The search covered the period from 1 January 1990 to 1 January 2022. We selected 16 RCTs with 25,496 baseline participants for the review systematic literature reviews (SLR) and 11 RCTs with 19 measurements for the meta-analysis (MA). We assessed risk of bias with the JBI Critical Appraisal Checklist. The SLR revealed that at 1-y postCTC intervention, most of the treatment groups increased F&V intake more than the control groups. The overall bias in the data set was not high. The MA model on 11 RCTs revealed a significant effect size for F&V consumption in intervention groups compared with control, standardized mean difference of 0.21 (confidence interval [CI]: 0.12, 0.30), P = 0.0004. The evidence suggests that CTC is a suitable strategy for public interventions aiming to increase F&V intake in adults aged ≥40. The design of CTC for public interventions should consider the process of change and stages of change addressing awareness, attitudes, self-efficacy, and social influence as promising concepts for influencing behavior change.

Identifying barriers and facilitators to adopting healthier dietary choices in clinical care: a cross-sectional observational study

Background and aims

Adopting healthier diets can drastically improve societal health. Our environment plays a crucial role in daily dietary choices and hospitals in particular can stimulate patients to adopt healthier eating habits. Unfortunately, no robust clinically applicable cuing tools exist to help guide in-hospital dietary interventions. The purpose of this study was to identify patient-related barriers and facilitators to adopting healthier dietary choices.

Methods and results

This cross-sectional observational study was conducted on the cardiology ward of a university medical center between June 2020 and January 2021. Of the 594 patients asked and the 312 completed surveys on healthy eating intentions, 285 responses were considered for analysis. Notably, the majority of respondents were male (68.8%), with an average hospital stay of 3.3 days. The results indicate that cardiac patients attribute significantly greater influence on their dietary behavior to doctors compared to other caregivers, including dieticians (X2 = 37.09, df = 9, p < 0.001). Also, younger patients (below 70 years of age) were more inclined to plan changing dietary behavior than older patients. Most mentioned facilitators for adopting a healthier diet were more information/counseling, help in preparing food, support from family and friends, and more emphasis from a doctor.

Conclusion

The study highlights the importance of involving doctors in formulating dietary policies and patient-directed interventions within hospital settings. It also sheds light on the barriers and facilitators for promoting healthier dietary behaviors among patients during their hospitalization.

The Psychological Impact of the Widespread Availability of Palatable Foods Predicts Uncontrolled and Emotional Eating in Adults

This study aimed to investigate the role of the psychological impact of environments rich in palatable foods on three aspects of eating behavior: cognitive restraint (CR), uncontrolled eating (UE), and emotional eating (EE). The hypotheses were as follows: (a) The psychological impact (i.e., motivation to eat) of an environment rich in palatable foods will positively predict CR, UE, and EE; (b) dieting will predict CR, UE, and EE; and (c) CR, UE, and EE will positively predict body mass index (BMI). This study had a cross-sectional design in which data were collected online from 413 subjects. The psychological impact of food-rich environments (food available, food present, and food tasted) was assessed using the Power of Food Scale (PFS), and CR, UE, and EE were assessed using the Three-Factor Eating Questionnaire (TFEQ-R18). Both instruments were tested for confirmatory factor analysis. The relationship between constructs was measured using partial least-square structural equation modeling (PLS-SEM). "Food available" positively predicted all TFEQ-R18 factors (p < 0.01). "Food present" positively predicted UE (p < 0.001) and EE (p = 0.01). People currently on a diet showed higher levels of CR (p < 0.001) and EE (p = 0.02). UE and EE positively predicted BMI. Thus, CR, UE, and EE were positively predicted by the motivation to consume palatable foods in varying proximity, suggesting that the presence of food and, more importantly, its general availability may be important determinants of eating behavior, particularly UE and EE. Health strategies should consider the influence of the food environment to prevent and better manage impairments in eating behavior. Sex differences suggest that special attention should be paid to women. Furthermore, dieting was associated with higher levels of EE, which in turn was associated with higher BMI. Weight loss interventions should consider this vulnerability.

Sex differences in frailty among older adults

By definition, aging is a natural, gradual and continuous process. On the other hand, frailty reflects the increase in vulnerability to stressors and shortens the time without disease (health span) while longevity refers to the length of life (lifespan). The average life expectancy has significantly increased during the last few decades. A longer lifespan has been accompanied by an increase in frailty and decreased independence in older adults, with major differences existing between men and women. For example, women tend to live longer than men but also experience higher rates of frailty and disability. Sex differences prevent optimization of lifestyle interventions and therapies to effectively prevent frailty. Sex differences in frailty and aging are rooted in a complex interplay between uncontrollable (genetic, epigenetic, physiological), and controllable factors (psychosocial and lifestyle factors). Thus, understanding the underlying causes of sex differences in frailty and aging is essential for developing personalized interventions to promote healthy aging and improve quality of life in older men and women. In this review, we have discussed the key contributors and knowledge gaps related to sex differences in aging and frailty.

Bolstering the willingness to uptake covid-19 vaccination through multidisciplinary health communication intervention: a cue for reaching herd immunity in Nigeria

Background

The prevailing unwillingness to accept COVID-19 vaccination among the eligible population has been a serious setback in Nigeria's bid to reach herd immunity against the pandemic.

Objective

We assessed the impact of a multidisciplinary health communication intervention (MHCI) on willingness to accept COVID-19 vaccination among eligible unvaccinated community dwellers (EUCD) in Nsukka Urban, Enugu State, Nigeria.

Methods

Through a quasi-experiment that adopted a pre-test, post-test, non-control group design, we studied a total of 85 eligible unvaccinated adults. A researcher-designed "Willingness to Accept COVID-19 Vaccination Questionnaire" was the instrument used for data collection. The data gathered was analysed by means of Statistical Package for Social Sciences (SPSS) version 23.0. Specifically, descriptive and inferential statistics were used to test the formulated research questions and the hypothesis at 0.05 level of significance.

Results

We found that the mean scores of willingness to accept COVID-19 vaccination increased significantly after the treatment. There was no significant interaction effect of gender, level of education, and age on the mean of willingness to accept COVID-19 vaccination scores of EUCD after MHCI.

Conclusion

The study established that MHCI is impactful in bolstering the willingness to accept COVID-19 vaccination. The Nigerian government should adopt and implement this intervention in schools, communities, and other institutions in order to attain herd immunity in Nigeria.

Associations between physical activity, physical fitness, and body composition in adults living in Germany: A cross-sectional study

BACKGROUND & AIMS

Body composition (BC) changes with age and is associated with morbidity and mortality. A physically active lifestyle influences BC and represents an important predictor of successful aging. To emphasize this, the World Health Organization established activity recommendations for all age groups. We describe BC during adulthood using a cross-sectional sample from a German community and investigate the associations between physical activity (PA), physical fitness (PF), and BC.

METHODS

Data from 329 men and women aged 35 to 86 years were analyzed. PA was measured by questionnaire and classified into sport activity and habitual activity. PF was measured through physical performance tests and BC by bioelectrical impedance analysis. Fat mass index (FMI) and fat-free mass index (FFMI) were calculated to represent height-adjusted BC. Associations between PA, PF, and BC were analyzed using linear regression models.

RESULTS

For both sexes, strength was positively associated with FFMI (♂: ß = 0.313; ♀: ß = 0.213) and phase angle (♂: ß = 0.357; ♀: ß = 0.409). For FMI, a significant negative association with strength was found only in women (ß = -0.189). Cardiorespiratory fitness showed a negative association with FMI (ß = -0.312) and FFMI (ß = -0.201) for men, while in women a positive association was found for FFMI (ß = 0.186). For coordination, a significant association with FMI was observed only in women (ß = -0.190). Regarding PA only one significant relationship between sport activity and FMI among women (ß = -0.170) was found.

CONCLUSIONS

In our sample, PF was closer related to BC than PA. Strength and cardiorespiratory fitness were the strongest predictors for BC. This supports the World Health Organization's activity recommendations to include both resistance and endurance training in the weekly sports program to maintain a healthy BC.

Gender differences in the association between food costs and obesity in Korean adults: an analysis of a population-based cohort

BACKGROUND/OBJECTIVES

Prior studies, mostly conducted in Western countries, have suggested that the low cost of energy-dense foods is associated with an increased risk of obesity. This study aimed to investigate the association between food costs and obesity risk among Koreans who may have different food cost and dietary patterns than those of Western populations.

SUBJECTS/METHODS

We used baseline data from a cohort of 45,193 men and 83,172 women aged 40-79 years (in 2006-2013). Dietary intake information was collected using a validated food frequency questionnaire. Prudent and Western dietary patterns extracted via principal component analysis. Food cost was calculated based on Korean government data and market prices. Logistic regression analyses were performed to investigate the association of daily total, prudent, and Western food cost per calorie with obesity.

RESULTS

Men in the highest total food cost quintile had 15% higher odds of obesity, after adjusting for demographic characteristics and lifestyle factors (adjusted odds ratio, 1.15; 95% confidence interval, 1.08-1.22; P-trend < 0.001); however, this association was not clear in women (P-trend = 0.765). While both men and women showed positive associations between prudent food cost and obesity (P-trends < 0.001), the association between Western food cost and obesity was only significant in men (P-trend < 0.001).

CONCLUSIONS

In countries in which consumption of Western foods is associated with higher food costs, higher food costs are associated with an increased risk of obesity; however, this association differs between men and women.

Survey of dietary beliefs and habits of inflammatory bowel disease patients

BACKGROUND & AIMS

It is presumed that diet plays a role in the prevention and pathogenesis of inflammatory bowel disease (IBD). Patients with Crohn's disease (CD) and ulcerative colitis (UC) often report a link between their disease and diet. However, studies evaluating patient perceptions on diet in IBD are lacking. This study aimed to assess patient beliefs on the role of diet in IBD and the adequacy of dietary advice they received.

METHODS

A self-administered questionnaire was offered to consecutive patients attending two IBD centers in Switzerland. Data were collected regarding patient dietary beliefs and behaviors and whether they received medical advice on their diet.

RESULTS

Of 210 questionnaires distributed, 171 were completed. Participants were mainly female (53%), young (median age 38 years) with either CD (66%) or UC (34%). Most patients believed that diet plays a role in their disease (74%), whereas only 15% believed that diet could be the trigger of their disease. Since their IBD diagnosis, more than half of patients (56%) modified their diet, and 39% did not receive dietary advice from their physicians or a dietician. Most patients (91-95%) ingested gluten, lactose, red and white meat. 20% of patients practiced intermittent fasting and only a minority had previously tried a low-FODMAP (9%) diet or probiotics supplementation (16%).

CONCLUSION

The majority of IBD patients believe that diet plays a role in their disease but have never received dietary advice from their doctor or a dietician. This highlights a need for more information for IBD patients on dietary advice from the medical profession.

Age-Related Dietary Habits and Blood Biochemical Parameters in Patients with and without Steatosis-MICOL Cohort

BACKGROUND

Steatosis is now the most common liver disease in the world, present in approximately 25% of the global population. The aim of this study was to study the association between food intake and liver disease and evaluate the differences in blood parameters in age classes and steatosic condition.

METHODS

The present study included 1483 participants assessed in the fourth recall of the MICOL study. Patients were subdivided by age (65 years) and administered a validated food frequency questionnaire (FFQ) with 28 food groups.

RESULTS

The prevalence of steatosis was 55.92% in the adult group and 55.88% in the elderly group. Overall, the results indicated many statistically significant blood parameters and dietary habits. Analysis of food choices with a machine learning algorithm revealed that in the adult group, olive oil, grains, processed meat, and sweets were associated with steatosis, while the elderly group preferred red meat, dairy, seafood, and fruiting vegetables. Furthermore, the latter ate less as compared with the adult group.

CONCLUSIONS

Many differences were found between the two age groups, both in blood parameters and food intake. The random forest also revealed different foods predicted steatosis in the two groups. Future analysis will be useful to understand the molecular basis of these differences and how different food intake causes steatosis in people of different ages.

A qualitative study of young peoples' thoughts and attitudes to follow a more plant-based diet

Plant-based diets (PBDs) refer to dietary habits that reduce the consumption of animal-based products and increase the consumption of nutritionally rich plant foods. PBD's have been shown to provide significant health benefits, such as reducing obesity and improving psychological wellbeing, and are environmentally friendly. However, few studies have investigated factors that influence young people's thoughts and attitudes toward following a PBD in western societies, particularly in the United Kingdom. Understanding these factors may benefit public health interventions that encourage the consumption of more fruit and vegetables. The aim of this study was to explore the factors that affect young people's intentions toward following a PBD. Twenty-one young people (18-24 years) participated in this qualitative study. Participants were asked about their views of PBDs in a semi-structured interview. Thematic analysis was utilized to explore views and the barriers and facilitators to following a PBD. The Theory of Planned Behavior (TPB) was used as a framework to organise the findings. Within attitudes, the sub-themes identified were an awareness of a healthy diet, environmental concerns, health concerns and distrust, perceptions of PBDs and associated stereotypes, perceived restriction and lack of enjoyment, and need for education. Within subjective norms, the sub-themes identified were cultural and familial norms, peer influence, and exposure through social media. Within perceived behavioral control (PBC), the sub-themes identified were a lack of independence and parental control, lack of knowledge and perceived difficulty, lack of inclusiveness and accessibility, and inconvenience. Overall, the findings suggest that increased provision of education and knowledge about PBDs to young people, and widening access to PBDs, could encourage and help improve their understanding and intention to follow this dietary style. Tailored health promotion strategies, which also consider additional barriers and facilitators found within this study, could motivate young people to consume a more PBD.

Patients ' perspectives on bone replacement materials in a German university hospital setting

BACKGROUND

The challenges in developing new bone replacement materials and procedures reside not solely in technological innovation and advancement, but also in a broader patient therapy acceptance. Therefore, there is a need to assess patients' perspectives on the materials and approaches in use as well as the ones being developed to better steer future progress in the field.

METHODS

A self-initiating cross-sectional questionnaire aimed at people seeking treatment at the university hospital environment of Charité Berlin was formulated. The survey contained 15 close-ended questions directed toward the participant's epidemiological profile, willingness, acceptance, and agreement to receive different bone replacement materials, as well as, worries about the post-surgical consequences that can arise post bone replacement surgery. Descriptive and categorical analysis was performed to compare the observed number of subjects, their profile and each related response (Pearson's chi-square test or Fischer's test, p < 0.05).

RESULTS

A total of 198 people engaged with the questionnaire, most of them Millennials. Overall patients trusted scientifically developed biomaterials designed for bone replacement, as demonstrated by their willingness to participate in a clinical trial, their acceptance of alloplastic materials, and the none/few worries about the presence of permanent implants. The data revealed the preferences of patients towards autologous sources of cells and blood to be used with a biomaterial. The data have also shown that both generation and education influenced willingness to participate in a clinical trial and acceptance of alloplastic materials, as well as, worries about the presence of permanent implants and agreement to receive a material with pooled blood and cells.

CONCLUSION

Patients were open to the implantation of biomaterials for bone replacement, with a preference toward autologous sources of blood and/or tissue. Moreover, patients are concerned about strategies based on permanent implants, which indicates a need for resorbable materials. The knowledge gained in this study supports the development of new bone biomaterials.

The credibility of dietary advice formulated by ChatGPT: Robo-diets for people with food allergies

The introduction of ChatGPT has sparked enormous public interest in large language (deep-learning) models, which have been sophisticated enough to perform well on a variety of tasks. One way people are using these models is to construct diets. The prompts often include food restrictions that are an obligatory part of everyday life for millions of people worldwide. The aim of this study was to investigate the safety and accuracy of 56 diets, constructed for hypothetical individuals who are allergic to food allergens. Four levels, corresponding to the "baseline" ability of ChatGPT without prompting for specifics, as well as its ability to prepare appropriate diets when an individual has an adverse food reaction to two allergens or solicits a low-calorie diet, were defined. Findings from our study demonstrated that ChatGPT, although generally accurate, has the potential to produce harmful diets. More common errors involve inaccuracies in portions or calories of food, meals, or diets. We discuss here how the accuracy of large language models could be increased and the trade-offs involved. We propose that prompting for elimination diets can serve as one way to assess differences between such models.

Adherence to the World Cancer Research Fund/American Institute for Cancer Research and Korean Cancer Prevention Guidelines and cancer risk: a prospective cohort study from the Health Examinees-Gem study

OBJECTIVES

The purpose of this study was to explore the association between adherence to 2 cancer prevention recommendations and cancer risk.

METHODS

In total, 104,386 individuals aged 40-69 years old who were recruited between 2004 and 2013 in the Health Examinees-Gem study were included. Adherence scores were constructed based on 8 items from the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations, including body weight, physical activity, diet, alcohol consumption and breastfeeding, and on 6 items from the Korean cancer prevention guidelines (smoking status, eating vegetables and fruits, salty foods, alcohol intake, physical activity, and body weight). A Cox proportional hazards model was used to estimate the associations between adherence scores and the risk of total and 5 major cancers.

RESULTS

The multivariable hazard ratio (HR) for total cancer with the high adherence score versus the lowest score (4.25-7.00 vs. 0.00-3.25) for the WCRF/AICR guidelines was 0.91 (95% confidence interval [CI], 0.82 to 1.00) in men. A reduced breast cancer risk was observed among women with the highest score. Men within the highest category of the Korean cancer prevention guideline score (3.25-6.00) had an HR of 0.80 (95% CI, 0.73 to 0.88) for developing total cancer compared to men within the lowest score (0.00-2.50). The higher adherence group among men showed lower risks of developing stomach, colorectal, and lung cancers.

CONCLUSIONS

Adhering to guidelines for cancer prevention can help to reduce the risk of developing cancer in Korean men. The association might differ by cancer type and gender.

Specific health beliefs mediate sex differences in food choice

Objective

Although sex differences in dietary habits are well documented, the etiology of those differences is still a focus of research. The present study examines the role of specific health beliefs regarding healthy amounts of food for food choice and its relation to sex, more specifically, the assumption that sex differences in food choices are mediated by differentiating health beliefs.

Method

212 German participants (44.3% female) aged 18-70 answered an online self-report questionnaire on their dietary habits and health beliefs, based on the recommendations of the German Nutrition Society.

Results

Most of the anticipated sex differences in food choice and some differences in health beliefs were found. The mediation hypothesis was partly supported, as the relationship between sex and fruit, vegetable, and fish consumption was mediated by the respective health beliefs. However, no mediation effects were found for meat, egg, cereal, and milk product consumption.

Conclusion

The support for the mediation hypothesis aligns with previous findings and indicates that health beliefs might be an important pathway to fostering healthier food choices, especially for men. Nonetheless, sex differences in food choice were only partially mediated by sex differences in specific health beliefs, indicating that future studies might benefit from parallel mediation analyses to reveal the impact of other relevant factors influencing sex differences in food choice.

Is obesity associated with taste alterations? a systematic review

Background

Obesity is a growing chronic public health problem. The causes of obesity are varied, but food consumption decisions play an important role, especially decisions about what foods to eat and how much to consume. Food consumption decisions are driven, in part, by individual taste perceptions, a fact that can influence eating behavior and, therefore, body mass.

Methodology

The searches were conducted in the electronic databases PubMed, Web of Science, Scopus, Lilacs, and the grey literature (Google Scholar and Open Grey). The acronym PECO will be used, covering studies with adult humans (P) who have obesity (E) compared to adult humans without obesity (C), having as an outcome the presence of taste alterations (O). After searching, duplicates were removed. The articles were first evaluated by title and abstract, following the inclusion and exclusion criteria; then, the papers were read in full. After the studies were selected, two reviewers extracted the data and assessed the individual risk of bias and control statements for possible confounders and bias consideration. The narrative GRADE system performed the methodological quality assessment using the New Castle Ottawa qualifier and analysis of certainty of evidence.

Results

A total of 3782 records were identified from the database search, of these 19 were considered eligible. Forty percent of the eligible studies show that there was an association between obesity and different taste alterations for different flavors comparing with normal weights adults. In the methodological quality analysis of the nineteen studies, which assesses the risk of bias in the results, fifteen showed good methodological reliability, three showed fair methodological reliability, and one showed low methodological reliability.

Conclusion

Despite methodological limitations, the results of the studies suggest the existence of a association between obesity and taste alterations, but further investigations with more sensitive methodologies are necessary to confirm this hypothesis.

Systematic review registration

https://osf.io/9vg4h/, identifier 9vg4h.