Dietary Behavior: An Interdisciplinary Conceptual Analysis and Taxonomy

The association between appetite and eating behaviors among Chinese female university students

Background

Young females are at a higher risk of developing unhealthy eating behaviors. This study investigated the relationship between appetitive traits and eating behaviors among female university students.

Methods

The study participants were 520 female university students from a public university in Eastern China. Appetitive traits were assessed using the Chinese version of the Adult Eating Behavior Questionnaire (C-AEBQ). Data on eating behaviors, including food intake frequency, meal regularity, and dieting behavior, were collected using self-administered questionnaires. The body mass index (BMI) was calculated using self-reported data. Pearson's and Spearman's correlations were used to correlate appetitive traits with BMI and eating behaviors. Latent profile analysis (LPA) was used to identify different appetitive patterns, and logistic regression was used to analyze the relationship between different appetitive patterns and eating behaviors.

Results

Two food-approach traits (food enjoyment and emotional over-eating) were positively correlated with BMI, while two food-avoidance traits (slowness in eating and satiety responsiveness) showed negative correlations. Food responsiveness was linked to a higher intake of delivered food, spicy food, and sugar-sweetened beverages, whereas satiety responsiveness was correlated with more frequent meal skipping. The LPA identified four appetitive patterns: food approachers, food approachers with emotional under-eating, food avoiders, and food avoiders with emotional over-eating. Food avoiders had significantly lower BMI than the other groups. Compared to food approachers, food avoiders skipped breakfast more frequently, and food avoiders with emotional over-eating skipped both breakfast and lunch more often. After adjusting for BMI, appetitive patterns showed no significant relationship with dieting behavior.

Conclusion

Among female university students, appetitive patterns correlated with eating behaviors, and students with food-avoidance patterns had a higher risk of meal irregularity. These findings emphasize the importance of implementing trait- and pattern-specific approaches to promote healthy eating behaviors among female university students.

Examining the effectiveness of food literacy interventions in improving food literacy behavior and healthy eating among adults belonging to different socioeconomic groups- a systematic scoping review

BACKGROUND

In high-income countries, significant diet-related health inequalities exist between people of different socioeconomic backgrounds. Individuals who face socioeconomic challenges are less likely to meet dietary guidelines, leading to increased incidence and prevalence of morbidity and mortality associated with dietary risk factors. To promote healthy eating, strategies may focus on individual-level factors (e.g., knowledge, skills, and behavior) along with broader societal factors (e.g., social determinants of health). The concept of food literacy is considered an individual-level factor and has been framed as a skill set that individuals must possess to effectively navigate the complexities of the modern food system. Food literacy interventions can be a complementary but effective tool for encouraging healthy eating behavior among diverse populations, including those facing socioeconomic disadvantage. However, there is limited evidence to guide the design of food literacy intervention for vulnerable population groups. In the process of developing an ideal portfolio of solutions and strategies to promote food literacy and healthy eating for people experiencing socioeconomic disadvantage, this systematic scoping review aims to comprehensively examine the effects of food literacy interventions on promoting food literacy behavior and healthy eating in adults (18 years and above) from various socioeconomic groups (SEGs) in high-income countries.

METHODS

The review includes both qualitative and quantitative papers obtained from academic databases, including MEDLINE (via EBSCOhost), Embase, Web of Science, and Google Scholar. In addition to the electronic search, manual forward and backward citation searching will be conducted to identify additional relevant papers. Food literacy interventions will be evaluated across four domains: planning and management, selection, preparation, and consumption. Papers included in the review will be analyzed for process, impact, and outcome evaluation. The main outcome of a food literacy intervention is the modification in eating behavior, while the mechanism for this action will be through impact measure of food literacy behaviors. Implementation factors will be extracted for process evaluation. This review will also include a range of dietary behavior measures, such as diet quality index and dietary intake indicator. The screening process for all citations, full-text articles, and abstract data will be carried out by two reviewers independently. In case of any potential conflicts, they will be resolved through discussion. The quality of quantitative studies will be reviewed using the JBI critical appraisal checklist for analytical cross-sectional studies. The "Consolidated Criteria for Reporting Qualitative Studies (COREQ)" will be used to report on the quality of qualitative papers.

SYSTEMATIC REVIEW REGISTRATION

https://doi.org/10.17605/OSF.IO/TPNKU.

Social Determinants Influencing Nutrition Behaviors and Cardiometabolic Health in Indigenous Populations: A Scoping Review of the Literature

Nutrition behavior is influenced by a large number of factors, including social and cultural factors. This scoping review aims to summarize how social determinants of health (SDoH) influence nutrition behaviors in Indigenous populations affected by or at risk of cardiometabolic diseases. Following the PRISMA-ScR guidelines, we conducted a systematic search in six databases-PubMed, Web of Science, CINAHL, PsycINFO, Cochrane Library, and World Health Organization Global Index Medicus-limiting results to studies published in English up to 27 October 2023. A descriptive synthesis was conducted. We identified 1490 articles, and after screening, 31 of them met our inclusion criteria. We found that nutritional behavior is impacted by various SDoH domains, including economic stability, neighborhood and built environment, education, health and healthcare, and social and community context. The shift from traditional diets to Westernized diets and from subsistence-based food gathering to reliance on store-bought and processed foods reflects changes in SDoH, affecting both nutrition behaviors and health outcomes. Although not all included studies examined every SDoH domain in our review, future research should consider all domains to gain a comprehensive understanding of how they impact nutritional behavior. This approach will better inform interventions and policies, ultimately promoting health equity in Indigenous communities.

Associations of sugar-related food parenting practices and parental feeding styles with prospective dietary behavior of children and adolescents: a systematic review of the literature from 2017 to 2023

Introduction

High consumption of sugar-rich foods and beverages has been associated with increased overweight and obesity in children and adolescents. Dietary behavior is influenced by learned mechanisms that originate in childhood and is associated with food parenting practices (FPP) and parental feeding styles (PFS). This systematic review aimed to narratively synthesize FPP and PFS concerning sugar-rich foods and beverages and their associations with the prospective dietary behavior of children and adolescents to derive evidence-based recommendations for health professionals and parents to promote healthy behaviors.

Methods

A systematic literature search was conducted using PubMed and Web of Science databases covering the publication years 2017-2023. The results were narratively synthesized, and exposure-outcome matrices were used for visual representation. The review included 15 peer-reviewed studies from different geographical regions that investigated FPP or PFS regarding the handling of sugar-rich foods and beverages in children's diets and reported the associations with the prospective dietary behavior of children and adolescents.

Results

The findings indicate that highly controlling parental practices were associated with the development of unhealthy eating behaviors and preferences for sugar-rich foods and beverages over time. Conversely, parental practices that emphasized structure and balance in dietary choices yielded more positive long-term outcomes, associated with reduced preferences for sugar-rich foods and drinks.

Discussion

The results underscore the significance of fostering a healthy home environment and active parental role modeling in promoting healthier dietary behaviors among children and adolescents.

Development and evaluation of a food literacy questionnaire for schoolchildren in France

Food literacy is gaining importance in nutrition education programs for children. To date, food literacy assessment tools have been developed in many countries, however, none exist in France. The objectives of this study were to develop a questionnaire and to evaluate its measurement properties among French schoolchildren aged 8-11 years. The questionnaire was developed in three phases: i) item selection (literature review and adaptation or creation of items) and content validity (submission to an expert panel), ii) questionnaire development including a pre-test in a small sample of children (n = 41) and item reduction and dimensionality based on the responses of children who completed the questionnaire in 31 schools between December 2022 and March 2023, and iii) questionnaire evaluation in terms of reliability, validity and acceptability. In total, 1187 responses were included in the analysis. The mean age of the children was 9.6 ± 0.7 years (girls: 51.2%, boys: 48.8%). The development process resulted in a 25-item questionnaire with good acceptability and satisfactory estimated reliability (McDonald omega coefficient = 0.73). Factor evaluation revealed a three-dimensional structure encompassing food and nutrition knowledge, participation in food preparation activities and food habits. To our knowledge, this study was the first to assess food literacy for schoolchildren in France. Our questionnaire can contribute to assess the factors that make food literacy vary, especially regarding socioeconomic variables to target priority populations for nutrition education actions and to describe changes in food literacy scores from a longitudinal perspective.

Adherence to Dietary Behavior Recommendations Moderates the Effect Between Time Since Metabolic and Bariatric Surgery and Percentage Total Weight Loss

PURPOSE

Metabolic and bariatric surgery (MBS) is the gold standard in treating severe obesity. Previous research implies that different psychological and behavior-related factors might be critical for MBS' sustained success. Yet adherence to dietary behavior recommendations and its impact on weight development is rarely examined. This study investigated the relationship between adherence to dietary behavior recommendations and the percentage of total weight loss (%TWL) after MBS.

MATERIALS AND METHODS

This study is a cohort study (acquisition in Germany). N = 485 patients after MBS, being in grade III of obesity (body mass index (BMI) ≥ 40 kg/m2) pre-MBS, were included. Participants answered a standardized assessment on the relevant constructs, including adherence to dietary behavior recommendations, depression symptoms, weight, diet, and MBS characteristics.

RESULTS

BMI pre-MBS, type of MBS, age, regularity of physical activity, and depression symptoms were identified as significant covariates of %TWL and adherence. Within 6 months after MBS, adherence seems to peak, F(5,352) = 12.35, p < .001. Adherence and time since MBS predict %TWL. A higher adherence (moderator) is related to a higher %TWL, R2 = 52.65%, F(13,344) = 31.54, p < .001.

CONCLUSION

After MBS, adherence to dietary behavior recommendations seems crucial for maximizing its success. Implications for the optimization of MBS' success in aftercare management arise. In particular, behavior modification interventions should be routinely implemented.

An Evaluation of &iexcl;Haz Espacio Para Papi!, a Culturally Tailored Nutrition and Physical Activity Pilot Program for Mexican-Heritage Fathers

Fathers are potential leaders of healthy behavior changes in their families. Culturally tailored programs are needed to support behavior changes within families, including Latino families; however, there have been few father-focused nutrition programs for Latino families. This study evaluated the immediate effects of ¡Haz Espacio Para Papi! (Make Room for Daddy!; HEPP), a six-week, father-focused, family-centered program focused on nutrition and physical activity near the Texas-Mexico border. A modified stepped-wedge study design included a treatment group for the HEPP pilot and a wait-listed control group. Pre/post-tests included instant skin carotenoid scores, the self-reported dietary intake of fruits and vegetables (FV), and healthy dietary behavior scores (HDBSs). A 2 × 2 mixed analysis of variance evaluated changes in outcomes across time and between groups for 42 fathers with pre/post-test measures. There were no statistically significant changes in fathers' VM scores and FV intake across time or between groups. Fathers' HDBSs increased across time (p ≤ 0.01, 95% CI [0.23, 1.38]). Age, educational attainment, and the number of children living in the household did not have a significant effect on the program outcomes (p > 0.05). The HEPP program may guide the design of future father-focused nutrition interventions aimed at dietary behavior changes.

E-health Dietary Interventions for Participants of SNAP and WIC: A Systematic Review

The migration of federal assistance services to online platforms during the COVID-19 pandemic sparked interest in digital nutrition education for individuals participating in the Supplemental Nutrition Assistance Program (SNAP) and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) programs. With federal government investing in the modernization of the nutrition education components of both programs, there is a need to identify science-backed electronic health (e-health) dietary interventions to improve health outcomes in this population. Therefore, the objective of this systematic literature review was to summarize the effectiveness, acceptability, and feasibility of e-health dietary interventions among individuals participating in WIC or SNAP. Keyword searches were performed in Google Scholar, PubMed, and Science Direct. The search included peer-reviewed literature from 2014 to 2023 and a few articles offering context about interventions used long-term by the nutrition assistance programs. PRISMA guidelines were followed to conduct this systematic literature review, which resulted in 36 articles eligible for extraction. The studies evaluated e-health (52.8%), short message service/text messaging (27.8%), and smartphone application interventions (19.4%) delivered to WIC or SNAP participants. The interventions identified aimed to modify food choice, eating behavior, and dietary intake among SNAP participants, SNAP-eligible adults, and WIC participants. Most interventions were developed using content delivery and health behavior theoretical frameworks (77.8%) and evidence-based nutritional recommendations (59.3%). Review findings show a high level of acceptability and feasibility for e-health and mobile health dietary interventions among WIC and SNAP participants but varying levels of effectiveness. Level of engagement, dosage, retention, and adherence were strong predictors of positive dietary behavior change regardless of the mode of intervention delivery. Future studies need to prioritize health equity by recruiting samples representative of food nutrition assistance participants and addressing digital health literacy as a potential barrier to intervention effectiveness, as none of the present studies measured literacy among participants.

Response of the consumers to the menu calorie-labeling on online food ordering applications in Saudi Arabia

BACKGROUND

The use of online food ordering applications is widespread; however, to date, there have been no studies on the effect of the menu calorie labeling in online food ordering applications on the consumers' dietary habits and food choices in Saudi Arabia. Therefore, this study aimed to evaluate the response of the consumers to the menu energy-labeling on online food ordering applications in Saudi Arabia by exploring: (a) the consumers' preference and frequency of ordering from online food applications; (b) the consumers' self-reported knowledge, awareness, and interest towards menu calorie information on online food ordering applications; (c) the impact of menu calorie information on online food ordering applications on consumers' food choices.

METHODS

This is a cross-sectional study conducted between October and November of 2022. A total of 419 participants were recruited using an online questionnaire.

RESULTS

The findings showed that most participants (59%) preferred to order using online food ordering applications. Saving time and effort are the main reasons for using online food ordering applications (61%). Nearly half of the participants (45%) were interested in viewing calorie information on online food ordering applications menus and (47%) did notice calorie information displayed on the menu when ordering from an online food ordering application. Calorie information in online food ordering applications menus is primarily utilized to monitor intake for weight maintenance (19%). The ability to calculate energy requirements and interest in viewing calorie information on online food ordering applications menus were linked to younger age and a higher level of education (p < 0.05).

CONCLUSIONS

Overall, consumers showed limited awareness and interest towards the menu calorie information displayed in the online food ordering applications. These findings highlight the importance of developing public health programs to increase public awareness about calorie labeling on menus to aid in the success and effectiveness of the calorie labeling in online food ordering applications as a tool to promote balanced energy intake. Further research is needed to understand the most effective way to deliver calorie information to consumers on an online food ordering application.

Relationships Between Three Eating Behaviors and Nine Motives for Food Choices Among Brazilian Adults: A Structural Equation Model

We examined the relationships between three eating behaviors and nine motives underlying food choices made by Brazilian adults. Using participant responses to the short version of the Three-Factor Eating Questionnaire and the Food Choice Questionnaire, we investigated eating behaviors (cognitive restriction, uncontrolled eating, and emotional eating) and motives for food choices (health, mood, convenience, sensory appeal, natural content, price, weight control, familiarity, and ethical concern). We used a structural equation model to test relationship pathways (β), with eating behaviors as independent variables and motives for food choices as dependent variables. Participants were 1297 individuals (69.5% female) with a mean age of 25.0 years (SD = 5.8). We confirmed the validity and reliability of the questionnaires in this sample. Restrictive eating behavior was significantly related to motives of health (β = .415), mood (β = .127), natural content (β = .364), weight control (β = .681), and ethical concern (β = .161). Emotional eating behavior was related to motives of mood (β = .277), health (β = -.137), and natural content (β = -.136). Uncontrolled eating behavior was related to motives of convenience (β = .226), sensory appeal (β = .121), price (β = .153), and familiarity (β = .090). We believe these findings can now help design future research and clinical interventions for managing people's risky eating behaviors and promoting beneficial food choices.

Dietary Behaviour and Sociocultural Determinants of Dietary Diversity among Rural Women of Reproductive Age: A Case of Amhara Region, Ethiopia

Women of reproductive age have specific nutritional requirements due to pregnancy and lactation. Little is known about the sociocultural determinants of dietary diversity among women of reproductive age. This study assesses trends of dietary behaviour and associated determinants of dietary diversity of women of reproductive age. A community-based cross-sectional study was conducted in the Amhara region of Ethiopia in 2019. Using multistage systematic random sampling, the dietary diversity of n = 421 women of reproductive age was assessed by a qualitative 24 h dietary recall. Descriptive analysis revealed characteristics of dietary behaviour and a chi-square test enabled the identification of associated determinants of women's dietary diversity. Only about a quarter (26.8%) of the women consumed five or more food groups per day and met the minimum dietary diversity score (MDD-W). Drawing on the socioecological framework, at an intrapersonal/individual level, women's education, age, perception of nutritious diet, and frequency of consumption of animal-sourced foods, vegetables, and fruit were significantly associated with MDD-W. At an interpersonal/household level, the husbands' education, women's decision-making regarding food purchase/consumption, the family's actual eating occasion, and women's engagement in domestic and farming tasks were significantly associated with MDD-W. At a community level, access to clean water and especially cultural beliefs were significant determinants of MDD-W. Amharic proverbs and sayings prioritise men and pose severe restrictions on women regarding food allocation. The majority (76.7%) of women of reproductive age practise frequent religious fasting, relating to the institutional/national level. This undermines efforts to support healthy dietary behaviour of women of reproductive age. Indepth studies on religious and cultural practices are needed, to assess not only their negative effects on the dietary diversity of women of reproductive age but also on women's lives.

Caregiver perceptions of snacks for young children: A thematic synthesis of qualitative research

Snacks are inconsistently defined in nutrition research and dietary guidelines for young children, challenging efforts to improve diet quality. Although some guidelines suggest that snacks include at least two food groups and fit into an overall health promoting dietary pattern, snacks high in added sugars and sodium are highly marketed and frequently consumed. Understanding how caregivers perceive "snacks" for young children may aid in development of effective nutrition communications and behaviourally-informed dietary interventions for obesity prevention. We aimed to synthesize caregivers' perceptions of snacks for young children across qualitative studies. Four databases were searched for peer-reviewed qualitative articles including caregiver perceptions of "snacks" for children ≤5 years. We conducted thematic synthesis of study findings, concluding with the development of analytical themes. Data synthesis of fifteen articles from ten studies, conducted in the U.S., Europe, and Australia, revealed six analytical themes that captured food type, hedonic value, purpose, location, portion size, and time. Caregivers perceived snacks as both "healthy" and "unhealthy" foods. Less healthy snacks were described as highly liked foods, which required restriction and were consumed outside the home. Caregivers used snacks to manage behavior and curb hunger. Snack portions were described as "small", although caregivers reported various methods to estimate child portion size. Caregivers' perceptions of snacks revealed opportunities for targeted nutrition messaging, especially supporting responsive feeding and nutrient-dense food choices. In high-income countries, expert recommendations should consider caregivers' perceptions of snacks, more clearly defining nutrient-dense snacks that are enjoyable, achieve dietary requirements, reduce hunger, and promote healthy weight.

The myth and reality of familial resemblance in dietary intake: a systematic review and meta-analysis on the resemblance of dietary intake among parent and offspring

Background

There is a strong societal belief that parents are role models for their child's dietary behaviours in early life that may persist throughout the life course. Evidence has shown inconclusive dietary resemblance in parent-child (PC) pairs. This systematic review and meta-analysis aimed to examine dietary resemblance between parent and children.

Methods

We systematically searched for studies on PC dietary resemblance, via six electronic databases (PubMed, Ovid MEDLINE, Embase, APA PsycNet, CINAHL, and Web of Science) and other grey sources of literature between 1980 and 2020. We performed quality effect meta-analysis model on transformed correlation coefficients (z) to examine the resemblance in dietary intakes including nutrient intakes, food group intakes and whole diet. Finally, the Fisher's transformed coefficient (z) was used for meta-regression analysis to identify potential moderators. Heterogeneity and inconsistency were examined using the Q and I² statistic. The study is registered on PROSPERO, CRD42019150741.

Findings

A total of 61 studies met the inclusion criteria for systematic review, 45 were included in the meta-analysis. Pooled analyses showed weak to moderate PC dietary intake associations for energy: (r: 0.19; 95% CI: 0.16, 0.22), fat (% energy): (r: 0.23; 95% CI: 0.16, 0.29), protein (% energy): (r: 0.24; 95% CI: 0.20, 0.27), carbohydrate (% energy): (r: 0.24; 95% CI: 0.19, 0.29), fruits and vegetable (g/d): (r: 0.28; 95% CI: 0.25, 0.32), confectionary food (g/d): (r: 0.20; 95% CI: 0.17, 0.23), and whole diet (r: 0.35; 95% CI: 0.28, 0.42). Dietary intakes associations by study characteristics, including population, study year, dietary assessment method, person reporting dietary intake, quality of the study, and study design were highly variable, but associations were similar between PC pairs.

Interpretation

The resemblance among parent-child pairs was weak to moderate for most aspects of dietary intakes. These findings challenge the social myth that parental dietary intake behaviour shapes their child's dietary intake.

Funding

None.

Effects of a Nudging Cue Targeting Food Choice in a University Cafeteria: A Field Study

Many students approaching adulthood often choose high-calorie food products. Concurrently, health interventions applied during this life phase can potentially lead to a healthier lifestyle. Nudge health interventions in experimental cafeteria settings have been found to improve eating behavior effectively, yet research in real-world settings is lacking. Accepting nudges as health interventions impacts nudge effectiveness. The present study applies a pretest-posttest design for a period of three consecutive weeks (no nudge, nudge, no nudge), testing the effectiveness of the so-called Giacometti cue on the number of calories purchased in a real-world cafeteria. Students were exposed to the nudge during the intervention week when entering the cafeteria and when choosing their meals. After purchasing a meal, their choice was recorded, and they completed a questionnaire. The Giacometti cue immediately reduced the number of calories purchased (comparing weeks one and two). After nudge removal, an effect was identified, increasing the number of calories purchased (comparing weeks two and three). Contrary to expectations, higher nudge acceptance resulted in more calories purchased. Neither awareness of the nudge's presence when buying food nor the interaction between acceptance and awareness played a role. We explore potential explanations for the Giacometti cue's effects.

Participant recruitment, baseline characteristics and at-home-measurements of cardiometabolic risk markers: insights from the Supreme Nudge parallel cluster-randomised controlled supermarket trial

BACKGROUND

Recruiting participants for lifestyle programmes is known to be challenging. Insights into recruitment strategies, enrolment rates and costs are valuable but rarely reported. We provide insight into the costs and results of used recruitment strategies, baseline characteristics and feasibility of at-home cardiometabolic measurements as part of the Supreme Nudge trial investigating healthy lifestyle behaviours. This trial was conducted during the COVID-19 pandemic, requiring a largely remote data collection approach. Potential sociodemographic differences were explored between participants recruited through various strategies and for at-home measurement completion rates.

METHODS

Participants were recruited from socially disadvantaged areas around participating study supermarkets (n = 12 supermarkets) across the Netherlands, aged 30-80 years, and regular shoppers of the participating supermarkets. Recruitment strategies, costs and yields were logged, together with completion rates of at-home measurements of cardiometabolic markers. Descriptive statistics are reported on recruitment yield per used method and baseline characteristics. We used linear and logistic multilevel models to assess the potential sociodemographic differences.

RESULTS

Of 783 recruited, 602 were eligible to participate, and 421 completed informed consent. Most included participants were recruited via letters/flyers at home (75%), but this strategy was very costly per included participant (89 Euros). Of paid strategies, supermarket flyers were the cheapest (12 Euros) and the least time-invasive (< 1 h). Participants who completed baseline measurements (n = 391) were on average 57.6 (SD 11.0) years, 72% were female and 41% had high educational attainment, and they often completed the at-home measurements successfully (lipid profile 88%, HbA1c 94%, waist circumference 99%). Multilevel models suggested that males tended to be recruited more often via word-of-mouth (ORfemales 0.51 (95%CI 0.22; 1.21)). Those who failed the first attempt at completing the at-home blood measurement were older (β 3.89 years (95% CI 1.28; 6.49), whilst the non-completers of the HbA1c (β - 8.92 years (95% CI - 13.62; - 4.28)) and LDL (β - 3.19 years (95% CI - 6.53; 0.09)) were younger.

CONCLUSIONS

Supermarket flyers were the most cost-effective paid strategy, whereas mailings to home addresses recruited the most participants but were very costly. At-home cardiometabolic measurements were feasible and may be useful in geographically widespread groups or when face to face contact is not possible.

TRIAL REGISTRATION

Dutch Trial Register ID NL7064, 30 May 2018, https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7302.

Can Ordering Groceries Online Support Diet Quality in Adults Who Live in Low Food Access and Low-Income Environments?

During the COVID-19 pandemic, U.S. food assistance programs allowed the use of program benefits to order groceries online. We examined relationships between the food environment, food assistance, online grocery ordering, and diet quality among adults from one low-income, low food access community in Northeastern Connecticut during the pandemic. Via online survey, adults (n = 276) reported their perceived home and store food environments, food assistance participation, whether they ordered groceries online, and consumption frequency and liking of foods/beverages to calculate diet quality indices. Those who ordered groceries online (44.6%) were more likely to participate in food assistance programs and report greater diet quality. Perceived healthiness of store and home food environments was variable, with the ease of obtaining and selecting unhealthy foods in the neighborhood significantly greater than healthy foods. Healthier perceived home food environments were associated with significantly higher diet qualities, especially among individuals who participated in multiple food assistance programs. Ordering groceries online interacted with multiple measures of the food environment to influence diet quality. Generally, the poorest diet quality was observed among individuals who perceived their store and home food environments as least healthy and who did not order groceries online. Thus, ordering groceries online may support higher diet quality among adults who can use their food assistance for purchasing groceries online and who live in low-income, low-access food environments.

Integrated consumers' sustainable and healthy dietary behavior patterns: Associations between demographics, psychological factors, and meal preparation habits among Japanese adults

The consumers' Sustainable and Healthy Dietary Behaviors (SHDBs) links sustainable behaviors related to eating (e.g., choosing, cooking, eating, and disposing of foods) with the level of "dietary behavior." It was hypothesized that SHDBs will vary depending on consumers' meal preparation habits, such as food selection, cooking frequency, and skill. This study examined (1) some of the behavioral patterns of SHDBs and (2) independent predictors of each pattern. In total, 508 Japanese adults who completed cross-sectional self-administered questionnaire surveys in December 2021 were included in the study. Principal component analysis (PCA) was used to identify the behavioral patterns of the 30-item SHDBs developed previously by the authors. Additionally, independent predictors of each component score were analyzed using multiple linear regression models, which included demographics, psychological factors concerning SHDBs (pros and cons for the decisional balance of SHDBs and number of environmental issues of interest), and meal preparation habits. Participants' median age was 41 (18-59) years (women: n = 259, 51.0%). Five SHDB patterns with several independent predictors were identified: amalgamation of all SHDBs, healthy food choices but unsustainable cooking, sustainable disposal, avoiding plastic products, and sustainable behaviors regarding expiry date. The multiple linear regression analysis demonstrated the independent predictors of the amalgamation of all SHDBs, such as being a man (β = -0.105), greater pros (β = 0.134), higher cooking frequency (β = 0.443) and skill (β = 0.244). Greater pros and/or smaller cons were associated with four of the five SHDB patterns, including an amalgamation of all SHDBs, healthy food choice and unsustainable cooking, avoiding disposal, and avoiding plastic products. Sustainable and healthy diet education must be implemented to ensure the adoption of all SHDBs.

Measuring Adherence to Sustainable Healthy Diets: A Scoping Review of Dietary Metrics

Comprehensive metrics that provide a measure of dietary patterns at global and national levels are needed to inform and assess the effectiveness of policy actions that promote sustainable healthy diets. In 2019, the Food and Agriculture Organization of the United Nations and the World Health Organization reported 16 guiding principles of sustainable healthy diets, but it is still unknown how these principles are considered in dietary metrics. This scoping review aimed to explore how principles of sustainable healthy diets are considered in dietary metrics used worldwide. Forty-eight food-based, investigator-defined dietary pattern metrics assessing diet quality in free-living, healthy populations at the individual or household level were assessed against the 16 guiding principles of sustainable healthy diets, which was used as a theoretical framework. A strong adherence of the metrics to health-related guiding principles was found. Metrics had a weak adherence to principles related to environmental and sociocultural aspects of diets, except for the principle related to diets being culturally appropriate. No existing dietary metric captures all principles of sustainable healthy diets. Notably, the significance food processing, environmental, and sociocultural aspects of diets are generally understated. This likely reflects the lack of focus on these aspects in current dietary guidelines, which highlights the importance of including these emerging topics in future dietary recommendations. The absence of quantitative metrics that comprehensively measure sustainable healthy diets limits the body of evidence that would otherwise inform national and international guideline developments. Our findings can help grow the quantity and quality of the body of evidence available to inform policy activities to realize 2030 Sustainable Development Goals of multiple United Nations. Adv Nutr 2022;x:xx.

A Proposed Conceptual Sport Nutrition Approach for Athlete Development and Assessment: The Athlete Nutrition Development Approach

Appropriate dietary intake can improve athletes' health and sport performance and is a direct result of eating behaviours. Therefore, assessing and shaping athletes' eating behaviours and dietary intake is critical to the provision of sport nutrition services. As such, nutrition practitioners must also consider the determinants of eating behaviours. However, dietary intake, eating behaviours, and its determinants are inconsistently defined in the literature, requiring nutrition practitioners to navigate a complicated landscape of concepts and terminology. This is further complicated by limitations in practically measuring and influencing eating behaviours and dietary intake. The proposed Athlete Nutrition Development Approach was developed to aid practitioners in servicing decisions through the athlete development process, through a three-tiered approach to sport nutrition service delivery. Tier 1 addresses the determinants of eating behaviours, Tier 2 directly addresses eating behaviours and dietary intake, and Tier 3 addresses the consequences of dietary intake in relation to health and sport performance. Each tier includes tools for assessment and development.

The role of reinforcement learning and value-based decision-making frameworks in understanding food choice and eating behaviors

The obesogenic food environment includes easy access to highly-palatable, energy-dense, "ultra-processed" foods that are heavily marketed to consumers; therefore, it is critical to understand the neurocognitive processes the underlie overeating in response to environmental food-cues (e.g., food images, food branding/advertisements). Eating habits are learned through reinforcement, which is the process through which environmental food cues become valued and influence behavior. This process is supported by multiple behavioral control systems (e.g., Pavlovian, Habitual, Goal-Directed). Therefore, using neurocognitive frameworks for reinforcement learning and value-based decision-making can improve our understanding of food-choice and eating behaviors. Specifically, the role of reinforcement learning in eating behaviors was considered using the frameworks of (1) Sign-versus Goal-Tracking Phenotypes; (2) Model-Free versus Model-Based; and (3) the Utility or Value-Based Model. The sign-and goal-tracking phenotypes may contribute a mechanistic insight on the role of food-cue incentive salience in two prevailing models of overconsumption-the Extended Behavioral Susceptibility Theory and the Reactivity to Embedded Food Cues in Advertising Model. Similarly, the model-free versus model-based framework may contribute insight to the Extended Behavioral Susceptibility Theory and the Healthy Food Promotion Model. Finally, the value-based model provides a framework for understanding how all three learning systems are integrated to influence food choice. Together, these frameworks can provide mechanistic insight to existing models of food choice and overconsumption and may contribute to the development of future prevention and treatment efforts.

Individual-level drivers of dietary behaviour in adolescents and women through the reproductive life course in urban Ghana: A Photovoice study

Evidence on the individual-level drivers of dietary behaviours in deprived urban contexts in Africa is limited. Understanding how to best inform the development and delivery of interventions to promote healthy dietary behaviours is needed. As noncommunicable diseases account for over 40% of deaths in Ghana, the country has reached an advanced stage of nutrition transition. The aim of this study was to identify individual-level factors (biological, demographic, cognitive, practices) influencing dietary behaviours among adolescent girls and women at different stages of the reproductive life course in urban Ghana with the goal of building evidence to improve targeted interventions. Qualitative Photovoice interviews (n = 64) were conducted in two urban neighbourhoods in Accra and Ho with adolescent girls (13-14 years) and women of reproductive age (15-49 years). Data analysis was both theory- and data-driven to allow for emerging themes. Thirty-seven factors, across four domains within the individual-level, were identified as having an influence on dietary behaviours: biological (n = 5), demographic (n = 8), cognitions (n = 13) and practices (n = 11). Several factors emerged as facilitators or barriers to healthy eating, with income/wealth (demographic); nutrition knowledge/preferences/risk perception (cognitions); and cooking skills/eating at home/time constraints (practices) emerging most frequently. Pregnancy/lactating status (biological) influenced dietary behaviours mainly through medical advice, awareness and willingness to eat foods to support foetal/infant growth and development. Many of these factors were intertwined with the wider food environment, especially concerns about the cost of food and food safety, suggesting that interventions need to account for individual-level as well as wider environmental drivers of dietary behaviours.

Development and Validation of Dietary Behavior Inventory-Surgery (DBI-S) in the Scope of International Post-Bariatric Surgery Guidelines and Recommendations

(1) Dietary behavior is highly relevant for patients after bariatric surgery. No instrument exists assessing adherence to medical guidelines concerning the dietary behavior of patients after bariatric surgery. The aim of this study was to develop and validate such an instrument. (2) Data from patients after bariatric surgery (n = 543) were collected from March to May 2022. The development of the DBI-S was theory-based and interdisciplinary. Items’ and content validity of the DBI-S were examined. (3) The final version of the DBI-S consists of 13 items. Convergent validation was confirmed by significant correlations between DBI-S score and attitude towards healthy food (r = 0.26, p = <0.001) and impulsivity (r = −0.26, p = <0.001). Criterion validity was confirmed by significant correlations between DBI-S score and pre-/post-surgery BMI difference (r = −0.14, p = 0.002), pre-/post-surgery weight difference (r = 0.13, p = 0.003), and quality of life (r = 0.19, p = <0.001). Cluster analysis confirmed the ability to distinguish between two dietary behavior clusters (rather healthy and rather unhealthy). (4) The DBI-S is an economic and valid instrument to assess the adherence of post-bariatric surgery patients to the relevant dietary behavior recommendations and guidelines and can distinguish between rather unhealthy and healthy dietary behavior.

Exploring the Linkages of Digital Food Communication and Analog Food Behavior: A Scoping Review

The linkages of digital food communication on social media platforms and analog food behavior of social media users are widely discussed in media and research, but less differentiated. Due to the interdisciplinary nature of the research field, the scientific studies are characterized by great heterogeneity in approaching the role of communication and modelling of food behavior, and thus also the conclusions on how digital food communication might be linked to analog food behavior. There is still much uncertainty regarding the relationship and underlying assumptions between digital communication and analog action. The rationale of this scoping review is to systematically summarize the findings of this heterogeneous body of knowledge. The importance and originality of this review are that it focuses explicitly on studies that provide insights into the nexus of digital food communication and analog food behavior, be it in the theoretical foundation, the results, or their interpretation. It draws on a socio-ecological model of food behavior that depicts food behavior variables in different domains and uses a differentiated categorization of food behavior (food choice, dietary intake, and eating behavior) to synthesize the results. Using the Web of Science and PubMed databases, 267 abstracts were identified and screened, of which 20 articles met the inclusion criteria and were selected for full-text analysis. The review offers some important insights on how different variables of the socio-ecological model of food behavior are related to digital food communication and different areas of analog food behavior. This review provides a more discerning understanding of which aspects of analog food behavior may be linked to social media food communication and in which ways. Implications are derived to reflect the role of communication in previous models of food behavior by adding a more nuanced and cross-cutting understanding of food communication.

Development of mealtime difficulty scale for older adults with dementia in long-term care facilities

BACKGROUND

In older patients with dementia, functional dependence on individuals affects their eating behavior, leading to difficulties with meals. In addition to individual factors, several social, cultural, and environmental factors influence mealtime difficulties in older individuals with dementia. Therefore, a measure is required to evaluate the difficulty of eating, considering the different interacting phenomena.

METHODS

Mealtime Difficulties Scale for older adults with Dementia (MDSD) was developed through a literature review. A pilot test was undertaken to confirm the meaning of the items and the relevance of mealtime difficulties for older patients with dementia. A panel of six experts examined the content validity of the MDSD. Convenience sampling was used to recruit direct care workers from long-term care facilities, of which 150 were recruited for exploratory factor analysis (EFA) and 208 for confirmatory factor analysis (CFA).

RESULTS

The final version of the MDSD included 19 items, with a Cronbach's α of 0.91. The EFA identified three factors ("functional," "caregiving," and "behavioral") that account for 54.6% of the total variance. The CFA confirmed the validity of the instrument.

CONCLUSIONS

Evidence to substantiate the validity and reliability of MDSD was found. While this tool has limitations in that it does not ensure convergent validity, it can be considered significant as it can assess the mealtime difficulty among older patients with dementia from different perspectives.

Exploring the Barriers and Motivators to Dietary Adherence among Caregivers of Children with Disorders of Amino Acid Metabolism (AAMDs): A Qualitative Study

Dietary intervention is generally accepted as the mainstay of treatment for patients with disorders of amino acid metabolism (AAMDs). However, dietary adherence to a low-protein diet is always reported as a common challenge among these patients. This study explored the perception of barriers and motivators to dietary adherence among caregivers of AAMD patients in Malaysia. Twenty caregivers of children with AAMDs receiving ongoing treatment at the genetic clinic participated in an online focus group discussion from November to December 2021. Findings showed a total of five interrelated main themes identified from focus group discussion (FGD) exploring parents’ experiences related to the management of their child’s daily diet. The barriers to dietary adherence were burden of dietary treatment, diet and dietary behavior, parenting challenges, limited knowledge related to dietary treatment, and challenges in healthcare system delivery. Key factors facilitating good dietary adherence include good knowledge of dietary treatment, parental coping strategies, social coping, and dietary behavior. In conclusion, despite the existence of several barriers to the implementation of dietary treatment, caregivers managed to use a wide range of coping strategies to overcome some, if not all, of the challenges. The important next step is to develop, in conjunction with multidisciplinary healthcare professionals, feasible implementation strategies that could address these barriers and at the same time improve the quality of life of caregivers.

How Does the University Food Environment Impact Student Dietary Behaviors? A Systematic Review

The food environment has been implicated in creating an obesogenic generation; and while previous research has focused on population-wide initiatives, the university population resides in a research gap. To explore detailed components of the university food environment and what shaped dietary behaviors, we retrieved literature from the following databases: ScienceDirect, Scopus, PubMed, Medline, and EMBASE. Eleven studies were identified for qualitative content analysis and study quality assessment identified most of the studies as of good quality (n 8) and some as of fair quality (n 3). The certainty of evidence remained at a low level for all (n 11) studies due to the cross-sectional, observational nature of studies. Three major themes emerged: (1) food environment, (2) student perceptions (SPs), and (3) dietary outcome (DO). In a university food environment, the taste of food was paramount for the food choices of students, followed by the availability of food and the price of food. When university students perceive and choose foods and beverages, they sometimes regard unhealthy foods and beverages as healthy options. The diet quality of university students is more susceptible to living arrangements and socioeconomic status, but higher salt, fat, and added sugar consumption generally resulted in poorer quality of diet on campus. Future research could use novel methods to explore a wider range and deeper level of students' dietary behavior determinants in university food environments.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier: CRD42021283562.

Validation of the English Version of the General Dietary Behavior Inventory (GDBI-E)

In medical science and practice, dietary behavior is mostly assessed by item-extensive questionnaires (e.g., food-frequency-questionnaires) or by questionnaires focusing on psychological aspects of dietary behavior neglecting dietary quality or quantity. In consequence, these questionnaires do not capture the full bandwidth of dietary behavior or are less effective in the assessment of dietary behavior because of the large item pools. Therefore, the aim of this validation study was to translate the existing General Dietary Behavior Inventory (GDBI), which was constructed as a behavior-related, as well as effective, instrument, and verifying its construct and criterion validity. This inventory is based on the general nutrition recommendations of the World Health Organization (WHO). Our English-speaking convenience sample consisted of 263 participants. The study results confirmed convergent, as well as criterion validity of the English version of the GDBI (GDBI-E). Discriminant validity of the GDBI-E could mainly be verified. Different dietary behavior clusters were identified in a cluster analysis. The found clusters represented a rather healthy and a rather unhealthy dietary behavior in the sample according to the recommendations of the WHO. The results underpinned the validity of the GDBI-E. The GDBI-E is applicable in research and clinical practice to assess dietary behavior in the English-speaking population.

The role of material and psychosocial resources in explaining socioeconomic inequalities in diet: A structural equation modelling approach

We examined whether material and psychosocial resources may explain socioeconomic differences in diet quality. Cross-sectional survey data from 1461 Dutch adults (42.5 (SD 13.7) years on average and 64% female) on socio-demographics, diet quality, psychosocial factors and perceptions of and objective healthiness of the food environment were used in a structural equation model to examine mediating pathways. Indicators for socioeconomic position (SEP) were income, educational, and occupational level and the 2015 Dutch Healthy Diet (DHD15) index assessed diet quality. Material resources included food expenditure, perceptions of healthy food accessibility and healthfulness of the food retail environment. Psychosocial resources were cooking skills, resilience to unhealthy food environments, insensitivity to food cues and healthy eating habits. Higher SEP was associated with better diet quality; Beducation 8.5 (95%CI 6.7; 10.3), Bincome 5.8 (95%CI 3.7; 7.8) and Boccupation 7.5 (95%CI 5.5; 9.4). Material resources did not mediate the association between SEP and diet quality and neither did the psychosocial resources insensitivity to food cues and eating habits. Cooking skills mediated between 13.3% and 19.0% and resilience to unhealthy food environments mediated between 5.9% and 8.6% of the relation between SEP and the DHD15-index. Individual-level factors such as cooking skills can only explain a small proportion of the SEP differences in diet quality. On top of other psychosocial and material resources not included in this study, it is likely that structural factors outside the individual, such as financial, work and living circumstances also play an important role.

Polish Adaptation of the Dutch Eating Behaviour Questionnaire (DEBQ): The Role of Eating Style in Explaining Food Intake-A Cross-Sectional Study

Knowledge of associations between emotional, external, and restrained eating with food choices is still limited due to the inconsistent results of the previous research. The aim of the study was to adopt the Dutch Eating Behavior Questionnaire (DEBQ) and then to examine the relationship between emotional, external, and restrained eating styles and dietary patterns distinguished on the basis of intake of fruit and vegetables (fresh and processed separately), fruit and/or vegetable unsweetened juices, sweets and salty snacks, and the adequacy of fruit and vegetable intake. The cross-sectional study was conducted in 2020, in a sample of 1000 Polish adults. The questionnaire consisted of the Dutch Eating Behavior Questionnaire, questions on selected food groups intake, and metrics. DEBQ structure was tested using both exploratory and confirmatory factor analysis (EFA, CFA) and structural equation modelling (SEM), while multi-group analysis was used to test measurement invariance. Logistic regression was applied to investigate the association between eating styles and dietary patterns, identified with the use of K-means cluster analysis. EFA, CFA and SEM revealed a three-factor, 29-item tool with satisfactory psychometric parameters. Restrained eating (ResEat) and external eating (ExtEat) were found to decrease chances of low intake of both favorable (fruit, vegetables, and unsweetened juices) and unfavorable (sweets and salty snacks) foods and increased the chances of their moderate intake. ResEat increased the probability of the high intake of favorable and moderate or high intake of unfavorable foods. ResEat and ExtEat were predisposed to adequate intake of fruit and vegetables while emotional eating had the opposite effect. Gender, education, and BMI were also found to determine food intake. Our results provide evidence that both eating styles and sociodemographic characteristics should be taken into account while explaining food intake as they may favor healthy and unhealthy eating in different ways.

Evidence Use in the Development of the Australian Dietary Guidelines: A Qualitative Study

Dietary guidelines are important nutrition policy reference standards that should be informed by the best available evidence. The types of evidence that are reviewed and the evidence review methods that are used have implications for evidence translation. The aim of this study was to explore perceived advantages, disadvantages, and practicalities associated with the synthesis and translation of evidence from nutrient-based, food-based, and dietary patterns research in dietary guideline development. A qualitative descriptive study was conducted. Twenty-two semi-structured interviews were conducted with people involved in the development of the 2013 Australian Dietary Guidelines (ADGs). Transcripts were analysed thematically. To inform future ADGs, there was support for reviewing evidence on a range of dietary exposures (including dietary patterns, foods and food groups, nutrients and food components, and eating occasions) and health outcomes, as well as evidence on environmental sustainability and equity. At the evidence synthesis stage, practicalities associated with planning the evidence review and conducting original systematic reviews were discussed. At the evidence translation stage, practicalities associated with integrating the evidence and consulting stakeholders were described. To ensure that the best available evidence is translated into future ADGs, evidence review methods should be selected based on the exposures and outcomes of interest.

Feasibility, acceptability, and effects of behavior change interventions for improving multiple dietary behaviors among cancer survivors: a systematic review

OBJECTIVE

This study aimed to systematically identify and synthesize evidence on the feasibility, acceptability, and effects of behavior change interventions for improving multiple dietary behaviors among cancer survivors.

METHODS

A total of 14 electronic databases and three trial registries were searched. Experimental studies that examined the feasibility, acceptability, and effects of behavior change interventions for improving multiple dietary behaviors among cancer survivors and published in English or Chinese peer-reviewed journals or protocols were considered eligible. The methodological quality of the included studies was evaluated using the revised Cochrane risk-of-bias assessment tool. Data were extracted and synthesized narratively.

RESULTS

Six studies, with a sample size ranging from 50 to 3088, were included. The studies had a high overall risk of bias. Six studies reported feasibility data, and the average eligibility, recruitment, and retention rates at post-intervention were 60.7%, 66.7%, and 90.7%, respectively. Only one study measured the acceptability and reported that 66.6% of participants were satisfied with the intervention. Five out of the six studies that measured fruit and vegetable consumption reported statistically significant positive intervention effects. Two studies reported inconsistent intervention effects on wholegrain consumption. Only one study measured the consumption of processed meat, sugar, and alcohol, which had statistically nonsignificant intervention effect.

CONCLUSIONS

Behavior change interventions for improving multiple dietary behaviors might be feasible and effective to increase fruit and/or vegetable consumption among cancer survivors. Further research is needed to examine the acceptability and effects of the intervention for modifying other dietary behavior.

Can Assessing Physical Activity Liking Identify Opportunities to Promote Physical Activity Engagement and Healthy Dietary Behaviors?

Improving our understanding of what physical activities are enjoyed and the factors that are associated with physical activity liking can promote participation in regular physical activity. We aimed to study physical activity (PA) liking in college women by modelling interactions between body size perception and dietary behaviors on PA liking, and by examining discrepancies between PA liking versus engagement on body size perception and dietary behaviors. Women (n = 251; 74% white) utilized an online survey to report their level of liking for PA types (scored into a PA liking index) and frequency of PA participation. They also reported their perceived body size, level of dietary restraint, and frequency of consuming foods (scored into a diet quality index). In multivariate analyses, a greater perceived body size was directly associated with lower PA liking and indirectly through greater dietary restraint but lower diet quality. Healthiest dietary behaviors were reported by women who both liked and engaged in PA. Women who reported high PA liking but low PA participation reported a higher dietary restraint and lower diet quality. These findings support the empowerment of women across all body sizes to identify physical activities that they enjoy. Health promotion efforts should encourage women to couple physical activity liking and engagement with a healthy level of dietary restraint and consumption of a healthy diet.

Longitudinal patterns of lifestyle behaviours in adolescence: a latent transition analysis

The interdependence among eating behaviour (EB), physical activity (PA) and sedentary time (ST) suggests simultaneously identifying homogeneous profiles and describing their changes. This study aimed to (1) identify cross-sectional lifestyle behaviour profiles and their 2-year changes among French school-age adolescents and (2) identify factors associated with these profiles and changes. Longitudinal data from adolescents who participated in the PRomotion de l'ALIMentation et de l'Activité Physique trial were used. PA and ST were assessed with the International Physical Activity Questionnaire and EB with a FFQ. Profiles at baseline and their changes were identified by latent transition analysis. Multinomial logistic regression models were used to identify factors associated with profiles and their changes. Among 2390 adolescents included (14-18 years), five baseline profiles that differed mainly in EB were identified: 'healthy diet and high PA (7·9 %)', 'big eater and moderate to high PA (23·8 %)', 'healthy diet and low PA (31·2 %)', 'restrictive diet and moderate PA (20·6 %)' and 'sugar products, nibbling and moderate PA (16·5 %)'. Young adolescents, those who were overweight or obese and socially advantaged, were more in the 'healthy diet and low PA' than others. Boys, older and socially less advantaged adolescents exhibited more 'unfavourable' than 'mixed' changes, while adolescents with overweight or obesity had less 'unfavourable' than 'mixed' changes. In conclusion, adolescents were twice the number in the least than the most favourable profile. Findings highlighted the importance of EB among adolescents and suggest taking adolescents' sociodemographic and weight characteristics into account in interventions aimed at acting on adolescents' behaviours.

Effectiveness of Nutritional Advice for Community-Dwelling Obese Older Adults With Frailty: A Systematic Review and Meta-Analysis

Objectives: This systematic review was aimed to examine the effectiveness of nutritional advise interventions compared with usual care, or exercise, or exercise combined with nutritional advice as a means of improving the body weight, body composition, physical function, and psychosocial well-being of frail, obese older adults. Methods: CINAHL, Cochrane Library, Embase, MEDLINE, PsycINFO, and Scopus databases were searched to identify relevant studies. The quality of the included studies was assessed using Cochrane's risk of bias tool 2. Meta-analysis was performed with respect to body weight and fat mass. Other outcomes were synthesized narratively. Results: Eight articles (from two studies) with a total of 137 participants were included in the review. The results revealed that nutritional advice was more effective than exercise in reducing body weight and fat mass. The nutritional advice was also beneficial in enhancing physical function and psychosocial well-being. However, it was less effective than exercise or combined interventions in increasing muscle strength and preventing lean mass loss. Conclusions: Nutritional advice is an essential intervention for reducing body weight and fat mass, for enhancing physical function, and for improving the psychosocial well-being of obese older adults experiencing frailty. The limited number of studies included in this review suggests that there is a need for more well-designed interventional studies in order to confirm these findings.

A Simple Liking Survey Captures Behaviors Associated with Weight Loss in a Worksite Program among Women at Risk of Type 2 Diabetes

In a secondary analysis, we assessed the ability of dietary and physical activity surveys to explain variability in weight loss within a worksite-adapted Diabetes Prevention Program. The program involved 58 overweight/obese female employees (average age = 46 ± 11 years SD; average body mass index = 34.7 ± 7.0 kg/m² SD) of four long-term care facilities who survey-reported liking and frequency of dietary and physical activity behaviors. Data were analyzed using a latent variable approach, analysis of covariance, and nested regression analysis to predict percent weight change from baseline to intervention end at week 16 (average loss = 3.0%; range—6% gain to 17% loss), and follow-up at week 28 (average loss = 2.0%; range—8% gain to 16% loss). Using baseline responses, restrained eaters (reporting liking but low intakes of high fat/sweets) achieved greater weight loss at 28 weeks than those reporting high liking/high intake (average loss = 3.5 ± 0.9% versus 1.0 ± 0.8% S.E., respectively). Examining the dietary surveys separately, only improvements in liking for a healthy diet were associated significantly with weight loss (predicting 44% of total variance, p < 0.001). By contrasting liking versus intake changes, women reporting concurrent healthier diet liking and healthier intake lost the most weight (average loss = 5.4 ± 1.1% S.E.); those reporting eating healthier but not healthier diet liking (possible misreporting) gained weight (average gain = 0.3 ± 1.4% S.E.). Change in liking and frequency of physical activity were highly correlated but neither predicted weight loss independently. These pilot data support surveying dietary likes/dislikes as a useful measure to capture dietary behaviors associated with weight loss in worksite-based programs. Comparing dietary likes and intake may identify behaviors consistent (appropriate dietary restraint) or inconsistent (misreporting) with weight loss success.

Contribution of food groups to energy, grams and nutrients-to-limit: the Latin American Study of Nutrition and Health/Estudio Latino Americano de Nutrición y Salud (ELANS)

OBJECTIVE

To quantify the energy, nutrients-to-limit and total gram amount consumed and identify their top food sources consumed by Latin Americans.

DESIGN

Data from the Latin American Study of Nutrition and Health (ELANS).

SETTING

ELANS is a cross-sectional study representative of eight Latin American countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru and Venezuela.

PARTICIPANTS

Two 24-h dietary recalls on non-consecutive days were used to estimate usual dietary intake of 9218 participants with ages between 15-65 years. 'What We Eat in America' food classification system developed by United States Department of Agriculture was adapted and used to classify all food items consumed by the ELANS population. Food sources of energy, added sugars, SFA, Na and total gram amount consumed were identified and ranked based on percentage of contribution to intake of total amount.

RESULTS

Three-highest ranked food categories of total energy consumed were: rice (10·3%), yeast breads (6·9%), and turnovers and other grain-based items (6·8 %). Highest ranked food sources of total gram amount consumed were fruit drinks (9·6%), other 100% juice (9·3%) and rice (8·3%). Three highest ranked sources for added sugars were other 100% juice (24·1 %), fruit drinks (16·5%), and sugar and honey (12·4%). SFA ranked foods were turnovers and other grain-based (12·6 %), cheese (11·9%), and pizza (10·3%). Three top sources of Na were rice (13·9%), soups (9·1 %) and rice mixed dishes (7·3 %).

CONCLUSION

Identification of top sources of energy and nutrients-to-limit among Latin Americans is critical for designing strategies to help them meet nutrient recommendations within energy needs.

Identifying and measuring the behavioural, dietary, and physical activity components of weight management consultations delivered by general practice nurses in routine care

Background

Many people with obesity receive weight loss consultations by general practice nurses (GPNs) in routine primary care. This exploratory study aimed to characterise the components of these consultations, including behaviour change techniques (BCTs), and dietary and physical activity recommendations.

Methods

We analysed audio recordings of weight management consultations conducted by 8 GPNs as part of the ‘usual care’ group in a randomised controlled trial (ISRCTN75092026). Consultations were coded against three taxonomies to classify BCTs, dietary recommendations, and physical activity recommendations. Associations between coded content and weight loss were assessed. Differences in the content of consultations where weight loss was < 5% or ≥ 5% from baseline weight at 6 months were explored.

Results

One hundred and fifty audio recordings were available from 53 out of 140 (38%) participants in the usual care group. Participants had on average 3 (SD = 1) recorded consultations over 3 months, lasting 14 (SD = 7) minutes each. Weight change at 3, 6, and 12 months was -3.6% (SD = 4.3), -5.5% (SD = 6.0) and -4.2% (SD = 6.5) for participants with audio recordings. GPNs used 3.9 (SD = 1.6) of 93 BCTs, 3.3 (SD = 2.7) of 30 dietary recommendations and 1.4 (SD = 1.2) of 10 physical activity recommendations per consultation. The most commonly employed BCTs were feedback on outcome of behaviour (80.0%), problem solving (38.0%), and social reward (34.3%). The most common dietary recommendations were about portion size (31.3%), nutrients (28.0%), and balanced diet (19.7%). The main physical activity recommendation was about walking (30.3%). There was no association between weight loss and the number of dietary recommendations, physical activity recommendations, or BCTs used per consultation, or per participant. Social reward was the only technique used significantly more in consultations of participants that lost ≥ 5% of their baseline weight at 6 months.

Conclusions

The study provides a new method that could be used to describe the content of weight management consultations. Specific dietary or physical activity recommendations and BCTs were used infrequently and inconsistently in this group of GPNs. Although replication is required in larger samples, this may point to a weakness in current practice.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-021-01403-1.

Pediatric Adapted Liking Survey (PALS) with Tailored Nutrition Education Messages: Application to a Middle School Setting

We tested the feasibility of a school-based, liking-based behavioral screener (Pediatric Adapted Liking Survey (PALS)) and message program to motivate healthy diet and activity behaviors. Students, recruited from middle- (n = 195) or low-income (n = 310) schools, online-reported: likes/dislikes of foods/beverages and physical/sedentary activities, scored into healthy behavior indexes (HBI); perceived food insecurity; and sleep indicators. Students received tailored motivating or reinforcing messages (aligned with behavior change theories) and indicated their willingness to improve target behaviors as well as program feasibility (acceptability; usefulness). Although HBIs averaged lower in the lower versus middle-income school, frequencies of food insecurity were similar (39-44% of students). Students in both schools reported sleep concerns (middle-income school-43% reported insufficient hours of sleep/night; low-income school-55% reported excessive daytime sleepiness). Students across both schools confirmed the PALS acceptability (>85% agreement to answering questions quickly and completion without help) and usefulness (≥73% agreed PALS got them thinking about their behaviors) as well as the tailored message acceptability (≥73% reported the messages as helpful; learning new information; wanting to receive more messages) and usefulness (73% reported "liking" to try one behavioral improvement). Neither message type nor response varied significantly by food insecurity or sleep measures. Thus, this program feasibly delivered students acceptable and useful messages to motivate healthier behaviors and identified areas for school-wide health promotion.

Perceptions About Health, Nutrition Knowledge, and MyPlate Food Categorization Among US Adolescents: A Qualitative Study

OBJECTIVE

To understand how adolescents define related nutrition terms and use food groups to classify commonly consumed foods into the MyPlate food groups.

DESIGN

Qualitative study with telephone interviews.

SETTING

Houston metropolitan area in Texas.

PARTICIPANTS

A convenience sample of 21 adolescents from a volunteer database of the research center.

MAIN OUTCOMES MEASURES

Sociodemographic questions were asked before semiquantitative structured interviews. The interview focused on understanding how adolescents defined health, other nutrition terms, and food groups, and how to use the MyPlate icon in categorizing commonly consumed foods into groups.

ANALYSIS

Hybrid thematic approach with inductive and deductive analyses.

RESULTS

Adolescents defined being healthy in terms of wellness-type behaviors (eg, diet, physical activity, and sleep). They perceived clear differences between terms such as healthy vs unhealthy food but struggled to define others (eg, energy-dense foods and processed foods). Mixed dishes, hard candies, chocolate chip cookies, and potato chips were the most difficult foods for the adolescents to classify into the MyPlate food groups, whereas apple, lettuce, and milk were easily classified.

CONCLUSIONS AND IMPLICATIONS

Food guidance systems, public health policies, and behavioral nutrition programs targeting adolescents might use health and nutrition terms and prescriptive food categories more clearly understood by adolescents.

Obesity Prevention within the Early Childhood Education and Care Setting: A Systematic Review of Dietary Behavior and Physical Activity Policies and Guidelines in High Income Countries

As a strategy for early childhood obesity prevention, a variety of dietary behavior and physical activity policies and guidelines published by leading health agencies and early childhood education and care (ECEC) licensing and accreditation bodies exist. Given the potential diversity in recommendations from these policies, this narrative review sought to synthesize, appraise and describe the various policies and guidelines made by organizational and professional bodies to highlight consistent recommendations and identify opportunities to strengthen such policies. An electronic bibliographic search of seven online databases and grey literature sources was undertaken. Records were included if they were policies or guidelines with specific recommendations addressing dietary behavior and/or physical activity practice implementation within the ECEC setting; included children aged >12 months and <6 years and were developed for high income countries. Recommended dietary behavior and physical activity policies and practices were synthesized into broad themes using the Analysis Grid for Environments Linked to Obesity framework, and the quality of included guidelines appraised. Our search identified 38 eligible publications mostly from the US and Australia. Identified guidelines were largely consistent in their recommendation and frequently addressed the physical and sociocultural environment and were well-aligned with research evidence. Broader consideration of policy and economic environments may be needed to increase the impact of such policies and guidelines within the ECEC setting.

Eating Behavior in Aging and Dementia: The Need for a Comprehensive Assessment

Eating behavior can change during aging due to physiological, psychological, and social changes. Modifications can occur at different levels: (1) in food choice, (2) in eating habits, and (3) in dietary intake. A good dietary behavior, like the Mediterranean dietary pattern, can be a protective factor for some aging related pathologies, such as dementia, while a worse eating behavior can lead to pathological conditions such as malnutrition. Changes in eating behavior can also be linked to the onset of dementia: for some types of dementia, such as frontotemporal dementia, dietary changes are one of the key clinical diagnostic feature, for others, like Alzheimer's disease, weight loss is a clinical reported feature. For these reasons, it is important to be able to assess eating behavior in a proper way, considering that there are normal age-related changes. An adequate assessment of dietary behavior can help to plan preventive intervention strategies for heathy aging or can help to identify abnormal behaviors that underline aging related-diseases. In this review, we have analyzed normal age-related and dementia-related changes and the tools that can be used to assess eating behavior. Thus, we make recommendations to screening and monitoring eating behavior in aging and dementia, and to adopt these tools in clinical practice.

Differences in Dietary Patterns Identified by the Gaussian Graphical Model in Korean Adults With and Without a Self-Reported Cancer Diagnosis

BACKGROUND

The synergistic effect of food groups on health outcomes is better captured by examining dietary patterns (DPs) than single food groups. Regarding this issue, a Gaussian graphical model (GGM) can identify pairwise correlations between food groups and adjust for the remaining items. However, the application of GGMs in the nutritional field has not been widely investigated, especially in Korean adults.

OBJECTIVE

The aim of this study was to identify the major DPs of Korean adults by using a GGM and to examine the associations between the DP scores and prevalence of self-reported cancer.

DESIGN

This cross-sectional study used baseline data from the 2007-2019 Cancer Screenee Cohort of the National Cancer Center, Korea.

PARTICIPANTS/SETTING

In total, 10,777 Korean adults who completed a questionnaire regarding their general medical history, including clinical test results, and a validated food frequency questionnaire were included.

MAIN OUTCOME MEASURES

The main outcome measure was the prevalence of self-reported cancer at baseline.

STATISTICAL ANALYSIS

DP networks were identified using a GGM. The GGM-identified networks were scored and categorized into tertiles, and their association with the prevalence of self-reported cancer was investigated using a multivariable logistic regression model.

RESULTS

The GGM identified the following 4 DP networks: principal, oil-sweet, meat, and fruit. After adjusting for covariates, the odds of moderate and high consumption of foods in the oil-sweet DP for participants who self-reported cancer were 25% and 34% lower than those for participants who did not report a cancer diagnosis (odds ratio [OR] = 0.75, 95% confidence interval [CI] = 0.62-0.90 and OR = 0.66, 95% CI = 0.53-0.81, respectively). Additionally, the odds of meat DP consumption in the self-reported cancer group was 29% lower than in participants who did not report a cancer diagnosis (OR = 0.71 and 95% CI = 0.57-0.88). In contrast, an increase in the odds of fruit DP consumption was observed for self-reported cancer participants (OR = 1.34 and 95% CI = 1.09-1.65). Similar results were observed among the female but not the male subjects.

CONCLUSIONS

GGM is a novel method that can distinguish the direct pairwise correlation of food groups and control for the indirect effect of other foods. Future large-scale longitudinal population-based studies are needed to build on these findings in general populations.

A latent class analysis of dietary behaviours associated with metabolic syndrome: a retrospective observational cross-sectional study

BACKGROUND

Obesity defined solely by the Body Mass Index (BMI) may not reflect the true heterogeneity of the obese population. This study aimed to classify the dietary behaviours of overweight and obese individuals and to explore the relationship between patterns of dietary behaviour and cardiometabolic risk factors.

METHODS

A total of 259 patients who visited an outpatient weight management clinic at a tertiary hospital and underwent a dietary behaviour assessment between January 2014 and February 2019 were enrolled in the study. Dietary behaviours were assessed in three domains with nine categories, including choice of food (frequently eating out and consumption of instant/fast/takeaway food), eating behaviour (irregular meals; frequent snacking, including eating at night; emotional eating; and overeating/binge eating), and nutrient intake (high-fat/high-calorie foods, salty food, and poorly balanced diet). Latent class analysis (LCA) was used to classify the subjects according to these categories. Associations between latent class and metabolic syndrome were assessed by logistic regression.

RESULTS

The subjects were classified into three LCA-driven classes, including a referent class of healthy but unbalanced eaters (n = 118), a class of emotional eaters (n = 53), and a class of irregular unhealthy eaters (n = 88). Compared with the referent class, emotional eaters had a significantly higher BMI (beta = 3.40, P < 0.001) accompanied by metabolic syndrome (odds ratio 2.88, 95% confidence interval 1.16-7.13).

CONCLUSIONS

Our three LCA-driven obesity phenotypes could be useful for assessment and management of obesity and metabolic syndrome. The association between emotional eaters and higher BMI and metabolic syndrome was stronger than that with other eaters. Thus, emotional regulation strategies might have benefit for emotional eater's diet.

Dietary patterns, foods and nutrients: a descriptive analysis of the systematic reviews conducted to inform the Australian Dietary Guidelines

Dietary guidelines should be underpinned by the best available evidence on relationships between diet and health, including evidence from nutrient-based, food-based and dietary patterns research. The primary aim of the present study was to analyse the systematic reviews conducted to inform the 2013 Australian Dietary Guidelines according to dietary exposure. The secondary aim was to analyse the reviews by health outcome, and design of included studies. To identify the systematic reviews, the dietary guidelines report was used as a starting point and relevant references were retrieved. The evidence report contained the data used in this analysis. Descriptive statistics were used to analyse reviews according to exposure, outcome, and design of included studies. A total of 143 systematic reviews were included in this analysis. Foods were the most common exposure (86·7 % of reviews), followed by nutrients (10·5 %) and dietary patterns (2·8 %). Chronic disease morbidity and/or mortality was the most common outcome (80·4 %), followed by chronic disease risk factors (19·6 %). Most reviews included evidence from cohort or nested case-control studies (92·3 %), many included evidence from case-control studies (61·5 %) and some included evidence from randomised controlled trials (28·7 %). These results reflect the research questions that were asked, the systematic review methods that were used, and the evidence that was available. In developing future iterations of the Australian Dietary Guidelines, there is an opportunity to review the latest evidence from dietary patterns research.

Diet quality scores in relation to fatness and nutritional knowledge in women with polycystic ovary syndrome: case-control study

OBJECTIVE

The purpose of the study was to analyse the dietary habits identified by diet quality scores (DQS) in the scope of body fatness (BF) and nutritional knowledge (NK) of polycystic ovary syndrome (PCOS) women.

DESIGN

Case-control study. The DQS were accessed by Dietary Habits, and Nutrition Beliefs Questionnaire (KomPAN, The Committee of Human Nutrition, Polish Academy of Science) included food frequency consumption of thirty-three food items and was formulated by six diet indexes: Pro-Healthy-Diet-Index (pHDI-10), Non-Healthy-Diet-Index (nHDI-14), High-Glycemic-Diet-Index-7 (hGIDI-7), Low-Glycemic-Diet-Index-4 (lGIDI-4), High-Sugar-Diet-Index-4 (hSDI-4) and High-Saturated-Fats-Diet-Index-8 (hSFDI-8). The BF was analysed by air displacement plethysmography (BodPod, Life Measurement Inc.). NK was assessed by using the twenty-five 'true or false' statements included in the KomPAN questionnaire.

SETTING

Poland, Clinical Hospital, Department of Endocrinology, Metabolism, and Internal Diseases.

PARTICIPANTS

The study group included 122 PCOS women and 116 age- and socio-economic status-matched healthy controls (CON) aged 17-44 years.

RESULTS

Higher BF and lower NK in PCOS women v. controls were observed. PCOS women had a lower pHDI-10 and LGIDI-4 than CON. There was no relation between NK and DQS in PCOS women. The higher NK in the CON group was associated with increased intensity of pHDI-10 and lower frequency of hSFDI-8 levels.

CONCLUSIONS

Pro-healthy DQS and NK of PCOS women in this study were lower than CON. Professional dietary education might improve dietary behaviours and understanding of the necessity of dietary habits modification in this group. A multidisciplinary approach is needed in the treatment of PCOS women.

Evaluating Nutrient-Based Indices against Food- and Diet-Based Indices to Assess the Health Potential of Foods: How Does the Australian Health Star Rating System Perform after Five Years?

Nutrient-based indices are commonly used to assess the health potential of individual foods for nutrition policy actions. This study aimed to evaluate the nutrient profile-informed Australian Health Star Rating (HSR), against NOVA and an index informed by the Australian Dietary Guidelines (ADGs), to determine the extent of alignment. All products displaying an HSR label in the Australian marketplace between June 2014 and June 2019 were extracted from the Mintel Global New Product Database, and classified into one of four NOVA categories, and either as an ADG five food group (FFG) food or discretionary food. Of 4451 products analysed, 76.5% were ultra-processed (UP) and 43% were discretionary. The median HSR of non-UP foods (4) was significantly higher than UP foods (3.5) (p < 0.01), and the median HSR of FFG foods (4) was significantly higher than discretionary foods (2.5) (p < 0.01). However, 73% of UP foods, and 52.8% of discretionary foods displayed an HSR ≥ 2.5. Results indicate the currently implemented HSR system is inadvertently providing a ‘health halo’ for almost ¾ of UP foods and ½ of discretionary foods displaying an HSR. Future research should investigate whether the HSR scheme can be reformed to avoid misalignment with food-and diet-based indices.