搜索结果：Journal of the Academy of Nutrition and Dietetics

Despite the well-known health benefits of fruit and vegetable (FV) intake, dietary quality among Americans remains low. Barriers to healthy food intake, such as cost, may contribute to suboptimal FV intake. The aim of this study was to assess the effects of multi-level supermarket price discounts of 30%, 15%, or 0% (control) on fruits, vegetables, and noncaloric beverages (NCB) on FV and NCB intake and health outcomes. In this randomized controlled trial (RCT), Multi-level Supermarket Discounts of Fruits and Vegetables' Impact on Intake and Health, participants underwent an 8-week baseline without price discounts, a 32-week intervention, and a 16-week follow-up period. At week 8, participants were randomized to receive a 30%, 15%, or 0% price discount on FV and NCB. Adult supermarket shoppers (n = 312) were recruited in New York City, starting in September 2018 through August 2021. Participants had body mass indexes (BMIs) of 25 to 50, were aged 18 and 70 years, and were primary household shoppers. Of those recruited, 167 were randomized. The final intention-to-treat analysis was based on 33 participants in the 30% discount group, 38 participants in the 15% discount group, and 36 participants in the 0% discount group. At week 8, participants were equally randomized into 1 of 3 price discount intervention groups: 30%, 15%, or 0% (control) discount on qualifying FV and NCB. The primary outcomes were FV and NCB intake (g/day) and body weight (kg). FV and NCB intake were assessed through unannounced 24-hour dietary recalls conducted on 2 weekdays and 1 weekend day, covering the previous day's consumption. Dietary outcomes were collected a month before weeks 8, 24, 40, and 56, and body weight was obtained at weeks 0, 8, 24, 40, and 56. Linear mixed models were used to detect significant group-by-time interactions with planned contrasts to examine the differential change (shown as mean &#xb1; standard error [SE]) in primary outcomes between groups over time for the intention-to-treat and complete case samples. A sensitivity analysis was then performed on the intention-to-treat sample by adding key covariates to the model: sex, age at enrollment, season at enrollment, primary supermarket, income level, and COVID-19 pandemic presence. Planned contrasts (shown as mean &#xb1; SE) showed that the 15% discount group had greater fruit intake from baseline to the end of the follow-up (+137.4 g/day &#xb1; 38.7; P < .001) vs the 0% discount group. Contrasts also revealed the 30% discount group had increased vegetable intake during the mid-intervention period (+88.6 g/day &#xb1; 40.1; P = .028) vs the 0% discount group. Additionally, contrasts showed that diet soda intake increased in the 30% discount group (vs the 0% discount group) from baseline to mid-intervention (+67.5 g/day &#xb1; 20.3; P = .001), to the end of intervention (+42.5 g/day &#xb1; 21.2; P = .046), and follow-up (+56.7 g/day &#xb1; 22.4; P = .012). Finally, contrasts showed that the 30% discount group lost more weight from baseline to mid-intervention vs the 0% discount group (-2.4 kg &#xb1; 0.918; P = .010). The results showed that the 15% discount on fruits led to increased intake during the follow-up period. The 30% discount on vegetables and diet soda led to greater intake during the first half of the intervention, and sustained increases in diet soda intake throughout the intervention and follow-up periods. Participants in the 30% discount group also exhibited decreased body weight during the first half of the intervention compared with controls. These findings support the use of supermarket-based economic incentives as an effective strategy to promote healthier food intake.

Nutrition influences cancer outcomes, yet access to Registered Dietitian Nutritionists (RDNs) remains inconsistent. Patient-centered data can reveal gaps in care, unmet needs, and disparities, providing real-world insight into oncology nutrition services. The objective of this study was to characterize cancer survivors' experiences with professional nutrition care since diagnosis, including sources, met and unmet needs, timing, and priority areas, and to examine variation by sociodemographic and clinical characteristics. The cross-sectional study analyzed online surveys from the Cancer Experience Registry, an online patient-reported outcomes registry of cancer survivors in the United States and Canada, collected between November 2022 and November 2024; analyses of this study were restricted to U.S. Participants included 1,427 cancer survivors, predominantly women (76.5%), older adults (45.5% aged &#x2265;65 years), and non-Hispanic White (85.5%), with smaller proportions identifying as non-Hispanic Black (5.6%), Hispanic (3.2%), and non-Hispanic other race (4.3%) (1.5% missing). The most common cancers were breast (32.6%), blood (29.6%), and gastrointestinal (10.5%). Primary outcomes included receipt of nutrition care since cancer diagnosis (any nutrition care and care from an RDN and patient-reported nutrition care need, categorized as met (wanted and received support), unmet (wanted but did not receive support), no perceived need (did not want support), or unsure. Descriptive statistics summarized receipt of nutrition services, expressed need, timing, and priority areas. Bivariate and multivariable regression analyses examined differences in nutrition care need and RDN engagement across patient characteristics. Since diagnosis, 53.6% reported receiving nutrition care, with 39.3% from an RDN. Need was met in 41.0%, unmet in 13.4%, no perceived need in 33.2%, and unsure in 12.5%. Among participants desiring nutrition care, demand peaked during treatment and post-treatment. Unmet need was more common after treatment and linked to increasing energy level (p=.002), emotional health (p<.001), intentional weight loss (p<.001), and cancer worry (p<.001). Endorsement of symptom management (p=.008) and intentional weight gain (p=.001) as reasons for nutrition support was higher among participants who saw a provider (RDN or non-RDN) compared with those who did not. Participants with unmet need were more often younger, women, food-insecure, lacking caregiving support, and had higher symptom burden, while no perceived need was associated with rural residence, lower education, lacking caregiving support, and private practice care (all p values <.05). Unmet nutrition care needs were observed among cancer survivors and varied by sociodemographic and clinical characteristics. Future research should evaluate the impact of systematic malnutrition screening and referral pathways on access to RDN services and examine how nutrition care needs and engagement evolve from diagnosis through survivorship. Additional work is needed to understand and address disparities across population subgroups and care settings.

Updates to the meal pattern requirements for the Child and Adult Care Food Program (CACFP) took effect in 2017. The updates were designed to align CACFP meals and snacks with the 2015-2020 Dietary Guidelines for Americans and represented the first major revision of the CACFP meal patterns since the program's inception in 1968. The aim of the study was to examine changes in the nutritional quality of CACFP meals and snacks served to children aged 3 to 5 years in early child care programs before and after the updated meal patterns were implemented. The US Department of Agriculture's Study of Nutrition and Activity in Child Care Settings (SNACS-I) collected data in program year 2016-2017, and SNACS-II collected data in program year 2022-2023 from nationally representative samples of CACFP programs and the children they served. Both studies used a menu survey to collect detailed descriptions and recipes for all foods and beverages served in CACFP meals and snacks during a 1-week period, and on-site measurements of reference portions to estimate portion sizes for the foods and beverages served. The analysis included data from 664 early child care programs in SNACS-I and 759 early child care programs in SNACS-II. Mean Healthy Eating Index 2015 (HEI-2015) scores were calculated for all CACFP meals and snacks served combined, in addition to separate HEI-2015 scores for breakfast, lunch, morning snack, and afternoon snack. Differences in the mean HEI-2015 scores between the 2 time periods were estimated, and 2-tailed Welch's t tests were conducted to test for statistical significance. After the meal pattern updates, mean total HEI-2015 scores significantly improved for CACFP breakfasts by 6.1 points (P < .001), lunches by 5.4 points (P < .001), afternoon snacks by 4.7 points (P < .05), and all meals and snacks combined by 5.1 points (P < .001). Results of this analysis showed that CACFP meals and snacks served in early child care programs were more consistent with the 2015-2020 Dietary Guidelines for Americans after updated CACFP meal pattern requirements were implemented in 2017. This work underscores the importance of updating meal pattern requirements for nutrition assistance programs such as the CACFP to ensure meals provided to children are aligned with the Dietary Guidelines for Americans.

Postpartum weight retention (PPWR) is common and associated with poor health outcomes. Traditional weight management approaches have limited success postpartum. Due to infant-related sleep disruptions, late-night eating may be more common postpartum and contribute to PPWR. Chrononutrition interventions, which align energy intake with circadian rhythms in metabolism, demonstrate promise for weight loss in nonpostpartum populations and offer a novel approach to preventing PPWR. However, no studies have explored whether chrononutrition approaches may be acceptable postpartum, which is needed to inform which approaches may warrant subsequent testing. To characterize perceived determinants of eating timing and understand the feasibility of following various chrononutrition approaches among postpartum mothers. A qualitative descriptive study using semistructured interviews to query participants about the following chrononutrition approaches, which they also ranked from most to least preferred: bedtime stopping rule (no energy intake within a certain number of hours of bedtime); king's breakfast, pauper's dinner (distributing kilocalories so intake is highest at breakfast and lowest at dinner), and time-restricted eating (shortening the daily eating window to &#x2264;10 hours). Mothers (N = 10) within 6 months postdelivery recruited from the University of Alabama at Birmingham Hospital and interviewed between August and December 2023. Interviews were coded through an iterative process using an exhaustive approach. Themes influencing eating habits included infant schedule and availability of childcare/home assistance. Barriers to chrononutrition approaches included the importance of the evening family meal and enjoying relaxing and eating after children went to bed. Participants most preferred the bedtime stopping rule and were willing to stop eating a median of 2 hours before bedtime. This study provides novel insights into mothers' perceptions of implementing various chrononutrition approaches, highlighting the importance of external barriers (eg, partner work schedule). Findings can inform the development of novel chrononutrition interventions to manage PPWR.

The "gold standard" for successful blinding in controlled food-based dietary interventional trials includes a sham diet. This study aimed to develop and evaluate a sham diet intended for use as a comparator in ulcerative colitis dietary trials. A sham diet to the experimental 4 Strategies to SUlfide REduction (4-SURE) diet was systematically constructed using a 6-step process. Health care professionals na&#xef;ve to the sham and 4-SURE diet were surveyed to evaluate the impression of the sham diet as an intervention. Healthy adult volunteers then received dietary education and implemented the sham diet for 7 days to evaluate blinding. Twenty-two health professionals were recruited from the hospital and research institute in Adelaide, South Australia, from September to October 2020 to complete the survey. Twenty health professionals met the eligibility criteria and completed the survey. Twenty-five healthy adults were recruited via advertisements on notice boards and email distribution lists at the hospital and a university in Adelaide, South Australia, from March through June 2021 to complete the 7-day diet trial. Twelve healthy adults met eligibility requirements, agreed to participate, and completed the 7-day trial. The combined primary outcome was the believability that the sham diet could be an intervention diet and the success of blinding by asking whether the diet was designed to be an intervention or placebo for ulcerative colitis trials. Secondary outcomes included acceptability and tolerability (visual analog scales), adherence, nutrient intake, and dietary education. Descriptive data are presented as mean (95% confidence interval [CI]) or median (interquartile ranges [IQR]) for continuous variables. T-tests were used to compare the meal plans and trial time points. Of 20 health care professionals surveyed, 19 (95%) agreed both diets impressed a similar complexity, and 15 of 20 (75%) agreed both set meal plans gave the impression of therapeutic dietary prescriptions. Eight (40%) correctly identified the 4-SURE diet. Twelve adults, 10 women and 2 men, completed the sham diet trial. Blinding was successful. All believed the diet could be the intervention diet. The diet was highly tolerable (mean, 83 mm; 95% CI, 75, 92 mm). The nutrient composition of volunteers' diets remained uniformly unchanged between baseline and 7 days. This sham diet is credible as a therapeutic dietary prescription. It was highly tolerable, did not alter nutrients of therapeutic interest to the 4-SURE diet, and was suitable to deploy in food-based trials for ulcerative colitis as a control to diets with a similar dietary scaffold.

Taste preferences and eating habits develop in the first two years of life and often persist over time, influencing the risk of obesity, cardiovascular disease, and other chronic conditions. Although diet quality is known to decline from early childhood to adolescence, less is known about how dietary patterns evolve during toddlerhood. The aim of this study was to assess toddler diet quality using the Healthy Eating Index-Toddlers-2020 (HEI-Toddlers-2020) and characterize longitudinal shifts in dietary components and patterns between 12 and 24 months of age. This was a secondary analysis of children in a prospective cohort. Dietary recalls were collected at 12 and 24 months. HEI-Toddlers-2020 scores quantified diet quality, and dietary patterns were derived using principal component analysis (PCA). Of the 254 children enrolled in the Growth and Adiposity in Newborns Study (GAINS) cohort in Kansas City, KS, 88 were excluded due to incomplete and/or invalid dietary data, yielding a final analytic sample of 166 children. Data were collected from November 2017-August 2022. Diet quality was assessed using the HEI-Toddlers-2020 total and component scores. Emerging dietary patterns and shifts over time were identified. Paired t-tests and Wilcoxon signed-rank tests assessed changes in HEI scores with effect sizes expressed as the correlation coefficient r. Radar plots visually depicted diet quality changes. PCA with varimax rotation identified dietary patterns, and paired t-tests evaluated changes in pattern adherence over time. Mean HEI-Toddlers-2020 scores decreased from 59.8 at 12 months to 57.1 at 24 months (p=0.03; d=0.17), but the difference was not significant after FDR adjustment. Total HEI scores were below recommended levels at both time points. Component-level changes included decreased intake of total vegetables (p<0.001, r=0.33), and increased intake of refined grains (p=0.01, r=0.21) and added sugars (p<0.001, r=0.62). PCA at 12 months identified four dietary patterns: (PC1) high unsaturated fat, low dairy/saturated fat; (PC2) vegetable and plant protein; (PC3) fruit-rich, low added sugars; and (PC4) low whole grain, high refined grain and sodium. From 12 to 24 months, mean adherence scores decreased for PC1 (mean difference: -0.66, p<0.001), PC2 (mean difference: -0.40, p=0.02), and PC3 (mean difference: -0.61, p<0.001), and increased for PC4 (mean difference: 0.38, p=0.002). Toddler diet quality was below recommendations at both 12 and 24 months. Modest changes over time reflected a consistent directional shift in dietary components and patterns, including reduced vegetable intake and increased consumption of refined grains and added sugars, suggesting early emergence of less healthful dietary patterns rather than a large decline in overall diet quality. Findings underscore the importance of early dietary interventions to support healthy eating trajectories.

Approximately 75% of the US population uses dietary supplements to boost their nutrient intake beyond what they obtain from foods and drinks. Therefore, it is crucial to clearly communicate how dietary supplements contribute to overall nutrient intake, enabling consumers to make informed health decisions. The objective of this study was to test user comprehension of 4 aspects of nutrient intake displayed in the ASA24 Respondent Nutrition Report (Total, Target, Limit, and Warning) among adults with diverse numeracy levels. Two-phase qualitative study using semi-structured interviews with dietary supplement users (Phase I conducted March 1-April 31, 2021; Phase II conducted June 1-July 31, 2021). A total of 50 dietary supplement users &#x2265;19 years of age were recruited via a nationwide opt-in research panel for phases I (30 participants) and II (20 participants). Participant interviews were conducted virtually. A deductive-to-inductive coding method was used for creation of the codebook; 20% of transcripts were double-coded with inter-rater reliability >90%. Summative content analysis assessed comprehension of reviewed concepts. In Phase I, participants found the graphic format easier to understand than a table. Additionally, most participants believed the graphic would be easier for the general public to understand. Using participant feedback from Phase I, the graphic was revised, which led to a better understanding of key features of the graphic for participants in Phase II, especially for nutrients that fell below the target. These updates improved understandability among both higher and lower numeracy participants. Content for Total Nutrient Intake from Foods, Drinks, and Supplements for the ASA24's Respondent Nutrition Report was developed, underwent usability testing, and demonstrated sufficient user comprehension. Future research can evaluate the effectiveness of the final graphic for behavior change with different populations or conduct future testing of the Respondent Nutrition Report (RNR), with a focus on individuals with lower numeracy scores.

Indexes are a standardized tool for assessing dietary exposures from foods/beverages (F&B) and have recently been extended to include dietary supplements (DS). The Total Nutrient Index (TNI) (F&B + DS) and the Food Nutrient Index (FNI) (F&B only) were developed to assess micronutrient intakes relative to Dietary Reference Intakes for micronutrients and were previously examined for relative validity among US adults. This study examined the micronutrient quality (ie, TNI and FNI) of the diet across all age groups and compared TNI and FNI total and component scores with Healthy Eating Index 2020 scores among the US population. This analysis also sought to demonstrate the flexibility of the TNI and FNI frameworks across the life course. A nationally representative, cross-sectional analysis of the 2015-2020 National Health and Nutrition Examination Survey demographic, dietary, and dietary supplement data (ie, 24-hour dietary recall and DS inventory) was conducted among the US population. This study included US adults and children (aged 1 year and older; n = 19 903) who participated in the 2015-2020 National Health and Nutrition Examination Survey. The main outcome measures were TNI and FNI total and component scores (range = 0 to 100) overall and by age group, with higher scores indicating greater adherence to the Dietary Reference Intakes. TNI and FNI scores were calculated via the simple algorithm method, for 11 age group-dependent micronutrients (calcium, choline, magnesium, phosphorus, potassium, and vitamins A, B12, C, D, E, and K), and compared with Healthy Eating Index 2020 scores. Americans scored 72 out of 100 on TNI, but scores varied by age and were higher for the TNI than FNI (&#x223c;3 to 11 points.). Younger children (aged 1 to 3 years, TNI = 87; aged 4 to 8 years, TNI = 82) and older adults (aged 71 years and older, TNI = 77) exhibited higher TNI scores than other ages, due to higher calcium, magnesium, and vitamins A, C, and B12 intake. Healthy Eating Index 2020 total scores were low (52) overall and followed similar scoring trajectories by age group as the TNI and FNI. Evaluating total dietary exposures is important, considering the differential intake patterns from F&B, vs those with DS. Given low Dietary Reference Intakes adherence for some nutrients across the life span, these findings warrant improved diet quality and micronutrient density for many, to optimize nutrition and reduce diet-related chronic disease risk among Americans.

Low energy diets (LEDs) (800-1200 kcal/day) can lead to 10-15 kg weight loss and diabetes remission. LEDs are now being explored for managing obesity in chronic kidney disease (CKD). Understanding patient experiences and perspectives of LED programs is essential for planning large-scale trials and to inform translation into clinical practice. To describe participants' experiences and perspectives of being involved in a randomized controlled trial (RCT) for weight loss involving an LED intervention or usual care (UC). A qualitative description approach was followed using semi-structured interviews to collect data. /setting Telephone interviews were conducted with 25 adults living with stages G1-3b CKD and a body mass index >30 kg/m2 from the SLOW-CKD feasibility RCT, in which participants had been randomized 1:1 to either an LED group or UC. Interviews explored participants' experiences and perspectives of following an LED with weight loss support, or receiving UC, and participating in a weight loss RCT. Interviews were audio recorded, transcribed verbatim and analyzed using reflexive thematic analysis. Five themes were generated which highlighted: the longstanding battle with weight management and health experienced by people living with CKD and obesity; the value of a trusted study team and patient centered trial design; the role of support, persistence and personalized routines in developing new habits on an LED; the need to navigate individual challenges, motivations and preferences; and the benefits of the LED beyond weight loss. After initial challenges, LED participants adapted and were pleased with their commitment and success, noting improvements in kidney function, eating habits, diet quality and physical capacity. Several UC participants expressed disappointment and a sense of missed opportunity. The study highlights the challenges faced by adults living with CKD and obesity. Provision of individualized support from trusted healthcare professionals can enhance participant experiences of LED interventions for adults with CKD and obesity. Findings support LED use in clinical practice and further research on its effectiveness in slowing CKD progression. Future weight loss trials should balance scientific rigor with strategies like 2:1 randomization, wait-list controls, or post-trial weight loss options to reduce randomization disappointment.

Throughout the COVID-19 pandemic, Supplemental Nutrition Assistance Program (SNAP) participants experienced changes in benefits alongside the evolving social and economic environment. Understanding how these factors may have influenced food purchasing decisions can clarify SNAP's role in shaping diet quality. To document SNAP participants' perspectives on how benefit changes during the pandemic influenced their food purchasing behaviors in the context of concurrent socioeconomic factors. This study used a qualitative semistructured interview design. SNAP participants (n = 47) who identified as regular shoppers of a large northeastern supermarket chain (in Maine, Massachusetts, New Hampshire, New York, and Vermont) and had previously completed a survey about pandemic food purchasing participated in virtual interviews between April and December 2024. Themes related to the direct role of SNAP benefit amounts in food purchasing and the modifying role of other evolving social and economic factors were identified and interpreted. Interviews were audiorecorded, transcribed, and coded using MaxQDA. Thematic content analysis was applied to identify themes. Six themes emerged related to participants' perceptions of SNAP benefit changes during the pandemic: SNAP benefit increases improved food security and expanded food choices; the SNAP benefit decrease worsened food security and limited food choices; pandemic onset decreased fresh food purchases while increasing stockpiling of shelf-stable foods; mid-pandemic, individuals returned to routines, including fresh food purchases and eating out; postpandemic economic pressures constrained food choices; and other individual factors persistently influenced food purchasing. Participants perceived that SNAP increases expanded food security and choice, but external factors constrained their food choices. Policymakers seeking to improve diet quality should consider increasing SNAP benefits and improving access to affordable healthy options.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is a potentially curative treatment for peritoneal metastasis in colorectal cancer. The procedure is extensive, and colorectal cancer survivors experience prolonged nutrition-impact symptoms and significant weight loss. The aim of this study was to explore colorectal cancer survivors' and caregivers' experiences with managing nutrition after the CRS-HIPEC procedure. A qualitative descriptive design was used to gain insight into colorectal cancer survivors' and caregivers' experiences with nutrition. Participants included 20 colorectal cancer survivors who underwent CRS-HIPEC in the past 3-12 months and 10 colorectal cancer caregivers at a single cancer center. Semi-structured interviews were conducted in 2024 and 2025 by videoconference. Interviews were recorded, transcribed verbatim, and analyzed using rapid qualitative analysis. Four key themes were observed: (1) Nutrition-impact symptoms, such as diarrhea, early satiety, and pain, were more severe and lasted longer after the CRS-HIPEC procedure than anticipated; (2) After the procedure, survivors had difficulty purchasing, preparing, and eating food, which led to anxiety and frustration; (3) Caregivers struggled to implement nutrition guidance from the care team and expressed a desire for more tailored resources, such as recipes and meal plans tailored based on the surgical procedure (eg, presence of colostomy); and (4) The timing and continuity of registered dietitian nutritionist support affected readiness for self-managing nutrition after the procedure. Early and proactive registered dietitian nutritionist support may help colorectal cancer survivors and caregivers cope with nutrition challenges after CRS-HIPEC. Future interventions are needed to test early and proactive delivery of nutrition counseling and tailored nutrition education based on the surgical procedure (eg, colostomy).

Community-based foodservice outlets (e.g., caf&#xe9;s in sporting centres or healthcare settings) have the potential to support population health, but currently these outlets predominantly encourage less healthy food purchases. No tools exist to rapidly assess the healthiness of the in-store food environments in foodservice outlets from the '4Ps of marketing' perspective (product, placement, price, and promotion) while providing real-time feedback to support the planning and implementation of healthy changes. This study aimed to adapt the 'Store Scout App', originally developed for grocery stores, to assess the healthiness of in-store food environments in Australian foodservice outlets, and to evaluate the validity and reliability of the new tool. A two-stage approach was used to develop 'Caf&#xe9; Scout': (1) tool development (convening a working group, identifying tool requirements, and developing an initial prototype; February 2022 -February 2023); and (2) tool refinement and validity evaluation (pilot testing - "Round 1", tool updates, training development, and extended testing - "Round 2"; February 2023 - December 2023). /setting: Tool testers included health promotion or local government officers (n=12), food outlet managers (n=3), researchers (n=3), and university nutrition placement students (n=5), all based in Victoria, Australia. The tool was tested across 27 foodservice outlets in community-based sporting centres in regional and metropolitan areas of Victoria. Interrater reliability, validity (construct, concurrent criterion and face validity), and usability were assessed. Gwet's Agreement Coefficient were used to assess interrater reliability, Pearson correlation to assess construct and concurrent validity, and descriptive analysis to assess face validity and usability based on user feedback. 'Caf&#xe9; Scout' with up to 278 Yes/No questions was developed to assess food outlet marketing practices across eight food and drink product categories. Evaluation showed good interrater reliability (mean Gwet's Agreement Coefficient 0.70 [95% CI: 0.64-0.76]), strong alignment between tool scores and product healthiness (e.g., total score versus healthiest product availability, r=0.70, p<0.001), and moderate alignment between tool scores and the healthiness of customer drink purchases (e.g., mean drink score versus healthiest drink purchases, r=0.60, p=0.01). User feedback (n=13 surveys) highlighted the tool's value in supporting healthy changes. Caf&#xe9; Scout can rapidly assess the in-store food environments and provide real-time feedback, facilitating the continuous monitoring and planning of healthy changes in foodservice outlets to support healthier food choices and population health.

Dietary intake, including both quantity and quality, plays a critical role in supporting nutrition outcomes and the long-term health and wellbeing of cancer survivors. While primary care dietitians are well-placed to support these outcomes, many report a desire to upskill or expand their scope of practice due to limited access to evidence-based resources that support cancer-related nutrition care. To explore stakeholder perspectives of the usefulness, relevance, and potential application of two prototype resources (Toolkit and Checklist) co-designed to support dietitians in providing care to cancer survivors within primary care settings. This qualitative study used the think-aloud method. Individual interviews were conducted while participants reviewed the Toolkit and Checklist prototypes. This work formed the final phase of a broader co-design project. Eligible participants were clinicians involved in cancer care, and adults with lived experience of cancer as survivors or carers. Twenty stakeholders from across Australia participated in online interviews conducted in August-September 2025. Participants included primary care dietitians (n=14), carers (n=7), cancer survivors (n=3), other health practitioners (n=2). Six participants represented more than one group. Performed: Verbatim interview transcripts were analysed inductively using thematic analysis, supported by the Framework Method. Themes and subthemes were iteratively developed and refined through team discussion. Themes included: (1) building confidence in cancer nutrition care through accessible, evidence-based knowledge; (2) enhancing consultation structure and efficiency through timesaving and trustworthy guidance; and (3) sustaining and expanding future use of the co-designed resources through ongoing updates, digital integration, and broader educational or clinical applications. The co-designed Toolkit and Checklist were perceived as relevant, credible, and feasible supports for equipping primary care dietitians to deliver optimum cancer nutrition care. Future research should evaluate real-world implementation of the resources through a trusted website, workflow integration, and impacts on practitioner confidence and patient outcomes.

Changes in macronutrient intakes, their determinants, and associations with body weight outcomes in early childhood remain unclear. To describe longitudinal changes (ie, trajectories) of macronutrient intakes, identify associated factors, and determine concurrent associations with trajectories of body mass index (BMI) z score in early childhood. Secondary analysis of longitudinal data from the Melbourne Infant Feeding, Activity and Nutrition Trial Program, conducted from 2008 to 2013. Australian children (N = 432) with 2 or more days of dietary intake data and BMI z score measurements were included. Macronutrient intake (% energy intake) and BMI z scores were measured at ages 9 months, 18 months, 3.5 years, and 5 years. Multitrajectory modeling identified groups of children following similar trajectories of protein, fat, and carbohydrate intakes. Multivariable logistic regression examined factors associated with macronutrient intake multitrajectories and associations with BMI z score trajectories. Children followed 3 macronutrient, multitrajectory groups. Two groups exhibited consistently high carbohydrate or protein intakes and were referred to as "consistent high carbohydrate" and "consistent high protein," respectively. The third group showed variable macronutrient intake trajectories and was named "variable macronutrient." BMI z scores trajectories were categorized as low-BMIz, mid-BMIz, and high-BMIz. Higher maternal age was associated with a lower relative risk of children following a consistent high carbohydrate trajectory compared with a variable macronutrient trajectory (relative risk ratio [RRR] = 0.93; 95% CI, 0.87 to 0.99). Children of mothers born outside Australia had a lower relative risk of following a consistent high protein trajectory compared with a consistent high carbohydrate trajectory (RRR = 0.49; 95% CI, 0.27 to 0.92). Children who were breastfed for <6 months had a higher relative risk of following the consistent high protein trajectory compared with the consistent high carbohydrate group (RRR = 1.72; 95% CI, 1.03 to 2.86). No significant association was observed between trajectories of macronutrient intake and BMI z score trajectories. Distinct macronutrient intake and BMI z score trajectories were observed in early childhood, and maternal age, country of birth, and breastfeeding duration were identified as determinants. No longitudinal associations were observed between macronutrient intakes and BMI z score trajectories.

Although human milk is the gold standard for infant feeding, by 4 months of age >50% of US infants are fed infant formula, either alone or to supplement human milk. Little is known about infants fed both human milk and infant formula (i.e., mix-fed). To evaluate variations in sociodemographic and economic characteristics of infants <12 months of age by primary milk feeding type and to characterize the types of formulas fed to mix-fed infants. Cross-sectional analysis of pooled data from nine National Health and Nutrition Examination surveys (2007-2023). This study used nationally representative data to identify primary milk feeding type of infants <12 months of age (n=2,112) in the United States. Infant and household sociodemographic and economic characteristics by type of milk(s) fed (mix-fed, human milk only, infant formula only). Survey-adjusted weights and 95% confidence intervals (CIs) were applied to summarize differences in main outcome measures by primary milk feeding type. Group differences were assessed using Chi-square tests. 19.4% (CI: 17.3, 21.5) of infants were mix-fed, 24.9% (CI: 22.6, 27.3) were fed human milk only, 55.7% (CI: 53.1, 58.2) were fed infant formula only. The percentage of mix-fed infants was greatest among Mexican American (29.3%, CI: 23.4 35.2) and Other Hispanic (19.9%, CI: 13.5, 26.4) infants, and lowest among Non-Hispanic Black infants (13.5%, CI: 8.6, 18.3). Households with food insecurity (reliance on emergency food assistance, worried food would run out, household food did not last, reliance on low-cost food for child) had higher percentages of infants fed infant formula only, followed by mix-fed infants, compared to those households that were food secure. Among mix-fed infants, 91.1% (CI: 86.5, 95.6) were fed term infant formula with nonhydrolyzed protein. Mexican American infants represented the largest percentage of mix-feeding. Feeding human milk only was most prevalent in food secure households, while food insecure households had the highest percentage of exclusive formula feeding, and secondarily, mix-feeding. Among mix-fed infants, non-hydrolyzed protein term formula was most commonly used, followed by partially hydrolyzed protein formula.

Malnutrition is common in adults with hematologic malignancies and can negatively influence treatment outcomes. This systematic review evaluated the association between nutrition support interventions compared with alternative or usual care, and primary outcomes (nutritional status, anthropometric measures, length of stay, readmissions, and quality of life) and secondary outcomes (survival, mucositis, graft-vs-host disease, delayed engraftment, inflammation, cost, and calorie or protein intake), in adults with hematologic malignancies. MEDLINE, CINAHL, Cochrane CENTRAL, Food Science Source, and SPORTDiscus databases were searched for controlled trials and observational studies published in English in peer-reviewed journals from January 2000 to July 2024. Risk of bias (RoB) was assessed using the Cochrane RoB 2 tool for randomized controlled trials (RCTs), RoB in Non-randomized Studies of Interventions for non-RCTs, and RoB in Nonrandomized Studies of Exposures for observational studies. Meta-analyses used a maximum likelihood random-effects model, and heterogeneity was quantified using I2. Certainty of evidence for primary outcomes was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation method. Twenty-one articles (11 RCTs, 9 cohorts, 1 non-RCT) representing 2122 participants were included. RoB was low (2 studies), some concerns/moderate (11 studies), and high (8 studies). Meta-analysis indicated a decrease in length of stay for enteral nutrition over parenteral nutrition, and no effect on length of stay for glutamine-enriched nutrition support; however, evidence was of very low certainty. Individualized nutrition support interventions, including the calculation of estimated needs, demonstrated benefit in decreasing weight loss. Overall, the association between nutrition support interventions and nutritional status, weight, readmissions, quality of life, and secondary outcomes was uncertain (very low certainty). No single nutrition support intervention emerged as superior for all outcomes of interest, although current best practices were supported. Certainty of evidence was very low for primary outcomes, and heterogeneity limited conclusions for secondary outcomes. Further high-quality research is needed.

High-protein, energy-restricted diets support weight loss and maintenance; however, whether consuming a moderate amount of protein in a balanced distribution throughout the day reduces the reinforcing value (RV) and energy intake of energy-dense snack foods is not known. This study aimed to assess the effect of 2 patterns of protein distribution during weight loss on (1) the relative reinforcing value (RRV) of energy-dense snack foods compared with the RV of a nonfood alternative; (2) energy intake when presented with snack foods; and (3) potential moderators of adherence to a weight-loss diet, including food-related motivations, attitudes, and behaviors. This was a 16-week randomized parallel study testing 2 patterns of daily protein intake: even distribution across 3 meals (EVEN) vs a skewed distribution with most protein consumed at dinner (SKEWED). Healthy community-based women aged 20 to 44 y with a body mass index (BMI) of 28 to 45 were recruited from the greater Grand Forks, ND, area between October 2017 and April 2023; study activities were suspended from March 2020 through May 2022 during the COVID-19 pandemic. Participants completed an 8-week weight loss phase (20% energy restriction, all foods provided), followed by an 8-week self-choice phase with instructions to maintain their assigned protein distribution pattern and energy intake. RRV was assessed at baseline, week 8, and week 16 using an operant responding computer task 2 hours after eating a lunch consistent with the assigned protein distribution (EVEN 35 g; SKEWED 20 g). Data from 44 participants who completed the study were analyzed using a linear mixed model analysis of variance. The RRV of energy-dense snack foods was lower (P = .0476) in the EVEN group (0.44 &#xb1; 0.04) than in the SKEWED group (0.55 &#xb1; 0.04). In this study, an RRV score >0.5 signified a greater reinforcing value for energy-dense snack foods than for the preferred sedentary activity. Although the amount of snacks earned did not differ between groups (P = .2338), the EVEN group consumed less than the SKEWED group (44.3 &#xb1; 5.2 g vs 62.0 &#xb1; 5.1 g; P = .0197). Lower RRV and consumption of energy-dense snack foods in the EVEN group are consistent with differences in food-related motivation and satiety associated with protein distribution across meals. These findings may help refine dietary strategies aimed at supporting weight loss efforts among women.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) increased the cash value benefit (CVB) for fruits and vegetables in 2021. While WIC participants reported increased purchasing, consumption, and variety of fruits and vegetables after the CVB increase, it is unknown whether this resulted in higher fruit and vegetable intake relative to nonparticipants. The objective of this study was to estimate differences in fruit and vegetable behaviors and total diet quality by WIC participation status in a convenience sample of children 1-4 years old who participated in the Understanding Pandemic WIC-Waivers: Access, Redemption, Disparities (UPWARD) study. This was a cross-sectional study. From January 2024 to February 2025, caregivers of 280 Massachusetts children after the CVB increase proxy-reported their child's intake via a frequency-based dietary screener and 24-hour recalls. Primary outcomes were fruit and vegetable frequency of consumption (times per week) and average daily intake (cup-equivalents). Secondary outcomes were diet quality scores using the Healthy Eating Index-2020 (HEI-2020) (range: 0-100 points). Inverse probability weighted regression models evaluated the association between WIC participation status and dietary outcomes. WIC-participating children 1-4 years old consumed fruits 4.0 more times per week (SE: 1.2, p<0.01) and consumed 0.6 cups more fruits per day [0.6 (SE: 0.4), p<0.001] than nonparticipating children. WIC children also consumed vegetables 2.5 more times per week [2.5 (SE: 0.9), p<0.01], though there was no difference in vegetable intake [-0.02 c-eq (SE: 0.3), p>0.05]. There were no differences in toddler or child diet quality by WIC participation status, though power was limited in these age-stratified models. After the CVB increase, WIC-participating children consumed fruits and vegetables more often, and consumed higher quantities of fruits, than nonparticipants.

Plant-based diets have been associated with lower risks of chronic diseases; however, not all plant-based diets confer equal health benefits. Data-driven methods provide an opportunity to empirically identify distinct plant-based dietary subtypes and examine their associations with health outcomes. To categorize subtypes of plant-based dietary patterns using a data-driven approach and evaluate their associations with cardiovascular disease (CVD), type 2 diabetes (T2D), and cancer incidence among postmenopausal women in the Women's Health Initiative (WHI). Prospective cohort study using principal component analysis (PCA) and k-means clustering to empirically derive dietary subtypes. A total of 823 postmenopausal women from the WHI Observational Study who were healthy at baseline and reported low meat or poultry consumption during screening (1993 - 1998) were included and followed prospectively for incident chronic disease outcomes during WHI follow-up and extension periods (2023). A stratified comparison group of 823 higher-meat consumers also drawn from WHI Observational Study, was constructed using stratified random sampling on dietary pattern position, and key demographic variables. Incident cases of CVD, T2D, and any type of cancer (except nonmelanoma skin cancer), verified through adjudicated clinical outcomes. Cox proportional hazards models estimated associations with CVD, T2D, and cancer outcomes, adjusting for sociodemographic, lifestyle, and clinical factors. Three dietary clusters were identified: (1) Lower Meat; Fruit and Vegetable, (2) Lower Meat; Dairy and Solid Fat, (3) Lower Meat; Fish and Meat (classified as lower-meat based on screening but reporting relatively higher fish and moderate meat intake on the FFQ). No statistically significant associations were observed between any lower-meat dietary pattern and overall cancer incidence. Compared to higher-meat consumers, the Fish and Meat cluster was associated with a significant 67% lower risk of T2D (HR = 0.33, 95% CI: 0.14-0.81, p = 0.02). The Dairy and Solid Fat and Fruit and Vegetable clusters did not reach statistical significance for T2D risk (HR = 0.77, 95% CI: 0.34-1.75 and HR = 1.10, 95% CI: 0.46-2.61, respectively). For CVD, the Dairy and Solid Fat cluster was associated with a statistically significant higher risk (HR = 2.63, 95% CI: 1.05-6.56, p = 0.04), while results for the Fruit and Vegetable cluster did not reach statistical significance (HR = 0.47, 95% CI: 0.13-1.73, p = 0.26). This combined PCA-clustering approach revealed meaningful heterogeneity within lower-meat dietary patterns, offering a novel framework for characterizing plant-based diets and improving precision in future diet-disease investigations.