搜索结果：Public health nutrition

Adverse childhood experiences (ACEs), toxic stress, relational insecurity, and structural adversity are major public-health concerns for children and adolescents, but ACE evidence should not be treated as an individual diagnostic score or deterministic prognosis. This Hypothesis and Theory article proposes developmental literacy and epistemic dignity as linked upstream constructs for primary child protection. Developmental literacy is defined as developmentally staged and disability-inclusive neurobiopsychosocial knowledge and skills concerning bodies, emotions, stress, attachment, co-regulation, play, nutrition, safety, rights, boundaries, non-violent care, and help-seeking. Epistemic dignity refers to the supported capacity and right of children-including preverbal, disabled, neurodivergent, and communication-diverse children-to have bodily, emotional, relational, play-based, and communicative signals interpreted with seriousness, humility, and appropriate response. Drawing on research on ACEs and positive childhood experiences (PCEs), nurturing care, relational health, health-promoting schools, social and emotional learning, mental-health literacy, sexuality/safety education, child participation, epistemic injustice, disability studies, implementation science, and critiques of ACE and trauma-informed practice, the article develops a universal, proportionate, relationally safe, anti-bias, and non-coercive public-health framework. It argues that early-childhood services, schools, pediatric/public-health touchpoints, caregiver support, and community systems can provide age-appropriate developmental knowledge without turning schools into clinics, teachers into trauma detectors, or children into individual risk scores. The framework does not recommend routine individual ACE-score screening in schools as a default practice; it supports ethically governed, service-linked pathways for recognizing distress and unmet support needs. Coercive reproductive control is treated only as a rejected comparator because it targets reproductive status rather than modifiable developmental environments, support access, and institutional trust. The article concludes with safeguards and testable hypotheses for evaluating developmental literacy, epistemic dignity, relational safety, accessibility, help-seeking, response quality, caregiver support, referral continuity, and unintended harms.

Nutritional biomarkers are linked to body composition changes, but limited evidence has studied how nutritional biomarkers relate to low muscle mass, excess adiposity, and both coexisting conditions across different physical activity levels. This study aims to investigate associations between low muscle mass, obesity, and low muscle mass with obesity and nutritional biomarkers across physical activity levels among U.S. adults across physical activity levels. This cross-sectional study analyzed data from adults aged 20-59 years from the 2015-2018 cycles of the National Health and Nutrition Examination Survey (NHANES) 2015-2018. Low muscle mass was defined by low appendicular lean mass relative to body weight (LALM/W). Obesity was classified using body mass index (BMI1), waist circumference (WC2), and body fat percentage (FM%3), and low muscle mass with obesity was defined using three coexisting phenotypes (LALM/W-O1, LALM/W-O2, LALM/W-O3). Nutritional biomarkers included serum albumin, vitamin D, triglyceride, cholesterol, LDL cholesterol, iron, insulin resistance (HOMA IR), and high-sensitivity C-reactive protein (hs-CRP). Physical activity was categorized as inactive, insufficiently active, or sufficiently active based on MET minutes per week. Multivariable regression models accounted for the complex survey design and relevant covariates. After adjustment, LALM/W was significantly associated with low serum albumin, low vitamin D, high triglyceride, high HOMA-IR, and high CRP. Obesity was significantly associated with low serum albumin, low vitamin D, high triglyceride, high LDL cholesterol, high HOMA-IR, and high CRP. LALM/W-O in all phenotypes were significantly associated with low serum albumin, low vitamin D, high triglyceride, high LDL cholesterol, high HOMA-IR, and high CRP. LALM/W-O phenotypes demonstrated the strongest associations, particularly with high HOMA-IR and hs-CRP. Although the associations varied by physical activity level, sufficiently active group was associated with lower odds of adverse nutritional biomarkers compared with insufficient activity. Nutritional biomarkers are associated with LALM/W and obesity. Sufficient physical activity was associated with fewer adverse outcomes. This suggests that adequate physical activity may be associated with better nutritional status and body composition.

Background: Sarcopenia and frailty are highly prevalent extrapulmonary manifestations of chronic obstructive pulmonary disease (COPD) and are strongly associated with reduced exercise tolerance, exacerbation risk, hospitalizations, and mortality. Beyond inflammation, oxidative stress, and physical inactivity, emerging evidence highlights nutrition as a major modifiable driver of muscle deterioration in COPD. Nutritional deficits impair anabolic signaling, exacerbate proteolysis, worsen mitochondrial dysfunction, and contribute to frailty progression. Methods: This narrative review synthesizes evidence from PubMed, Embase, Scopus, and Web of Science up to 2025, integrating mechanistic, metabolic, nutritional, and biomarker-related pathways underlying muscle dysfunction in COPD. Studies examining inflammation, hypoxemia, oxidative stress, hormonal imbalance, nutrition, and emerging biomarkers were included. Results: COPD-related sarcopenia results from converging inflammatory (TNF-α, IL-6), catabolic (FOXO, UPS), metabolic, and vascular mechanisms, compounded by energy deficiency, protein insufficiency, and micronutrient deficits. Inadequate intake of protein, vitamin D, antioxidants, and omega-3 fatty acids increase anabolic resistance, enhance muscle catabolism, and worsen frailty. Nutritional interventions, particularly high-protein supplementation, leucine-enriched formulas, vitamin D repletion, omega-3 fatty acids, and multimodal nutrition-exercise programs, demonstrate benefits in muscle mass, strength, and physical performance. Biomarkers such as GDF-15, CAF22, and specific microRNAs reflect nutritional status and correlate with muscle health in COPD. Conclusions: Sarcopenia and frailty in COPD arise from a complex interplay of inflammatory, metabolic, nutritional, and lifestyle-related factors. Integrating nutritional assessment and targeted dietary interventions with exercise and pulmonary rehabilitation is essential to counteract anabolic resistance and improve functional outcomes. Advances in biomarker research may support earlier diagnosis and personalized nutrition-based therapeutic strategies.

Background: Early childhood nutrition is strongly associated with neurodevelopmental outcomes, particularly in socially vulnerable settings. Limited evidence is available describing the relationship between nutritional status, food security, and neurodevelopment among preschool children in low-income urban areas of Colombia. This study aimed to evaluate nutritional status, household food insecurity, and neurodevelopmental outcomes in children attending early childhood centers in El Codito, Bogotá, and to explore the association between anthropometric indicators and neurodevelopmental performance. Methods: A cross-sectional study was conducted in children enrolled in community childcare centers. Nutritional status was assessed using anthropometric indicators according to World Health Organization growth standards, including weight for age, height for age, and body mass index for age. Neurodevelopment was evaluated using the Escala Abreviada de Desarrollo (EAD). Household food insecurity was measured through a validated questionnaire. Descriptive statistics were performed, and associations between variables were analyzed using correlation tests and group comparisons according to data distribution. Results: Most participants presented adequate nutritional status; however, a proportion of children showed risk of stunting or excess weight. Neurodevelopmental scores were generally within expected ranges, although variability was observed across developmental domains. Significant associations were identified between certain anthropometric indicators and neurodevelopmental outcomes. Moderate to severe household food insecurity was identified in 21.4% of participating households. Conclusions: Nutritional status and household food insecurity represent important contextual factors for child health in vulnerable urban populations. These findings highlight the importance of integrated nutritional and developmental monitoring strategies within early childhood programs. Further longitudinal studies are required to clarify causal pathways and to guide targeted public health interventions in similar contexts.

Indigenous women experience a disproportionate burden of adverse perinatal health outcomes, yet the extent and nature of health promotion interventions addressing modifiable behavioural and social determinants remain poorly synthesised. This scoping review mapped smoking, nutrition, alcohol, physical exercise, and social and emotional wellbeing (SNAPS(o))-related perinatal health promotion programs delivered through Australian Aboriginal Community Controlled Health Organisations (ACCHOs), supplemented by relevant peer-reviewed evidence identified across Australia, Aotearoa New Zealand, Canada, and the United States. A two-phase design looked at peer-reviewed literature from January 2010 to January 2025 across PubMed, CINAHL, and the Cochrane Library, followed by a structured review of Aboriginal Community Controlled Health Organisation (ACCHO) websites in Australia (n = 145). Data were extracted on program characteristics, SNAPS(o) components, implementation models, and evaluation outcomes. Findings were synthesised using content analysis. Thirty-four programs were identified in total, most delivered through ACCHOs (n = 26) and predominantly implemented in Australia (n = 29). Smoking was the most frequently addressed component (n = 18, 55%), while nutrition and social and emotional wellbeing were each included in 27% of programs (n = 9), physical exercise in 18% (n = 6), and alcohol in 15% (n = 5). Grey-literature programs more commonly reflected multi-component, holistic models compared with peer-reviewed studies and formal evaluations. Only 10 programs had identifiable formal evaluation evidence, including published or publicly reported evaluations, almost all of which were identified through academic sources. Evaluations focused primarily on tobacco-related behavioural outcomes, with limited reporting of sustained maternal or infant health endpoints. The perinatal SNAPS(o) intervention landscape for Indigenous women is characterised by strong community-controlled delivery but limited published evaluation, particularly of integrated models implemented within ACCHOs. The concentration of evidence on smoking cessation highlights a need to expand evaluation across broader domains of maternal wellbeing. Strengthening Indigenous-led evaluation frameworks and outcome measures that reflect holistic models of care is essential to advancing equitable and culturally grounded perinatal health systems.

People with disabilities face a disproportionately higher disease burden alongside reduced healthcare accessibility, resulting in elevated unmet healthcare needs (UHN). Understanding the factors that drive UHN-and whether these factors differ by disability status-is critical for developing targeted public health interventions. A secondary cross-sectional analysis was conducted using linked national survey and administrative data-specifically the Korea National Health and Nutrition Examination Survey (KNHANES) cycles VI to VIII (2013-2021) linked with National Health Insurance Service (NHIS) administrative records-to examine determinants of healthcare access and utilization barriers by disability status. Independent variables were selected based on Andersen's Behavioral Model of Health Services Use for vulnerable populations, encompassing predisposing factors, enabling factors, and need factors (including functional status indicators). Interaction terms between disability status and sex, and between disability status and household income level, were introduced to identify effect modification by disability status. People with registered disabilities had significantly higher UHN compared to those without disabilities. The contributing factors to UHN differed between the two groups, with sex and household income showing statistically significant interaction effects with disability status, indicating that their associations with UHN vary depending on whether an individual has a registered disability. UHN in people with disabilities is shaped by a distinct set of determinants compared to the general population. The overall pattern of contributing factors differed between people with and without disabilities across multiple dimensions. These findings highlight the need for tailored healthcare policies that account for the unique vulnerabilities of people with disabilities, rather than applying uniform strategies across all population groups.

Background: Exogenous nucleotides are bioactive compounds involved in nucleic acid synthesis, cellular metabolism, intestinal function, immune regulation, and related physiological processes. Owing to their potential roles in supporting growth, gut health, immune function, metabolic regulation, and physiological resilience, they have attracted increasing attention as functional dietary supplements and feed additives. However, the global research landscape of exogenous nucleotides has not been systematically characterized. This study aimed to map the development of this field and identify its major contributors, knowledge structures, application domains, and emerging research hotspots. Methods: Global literature on exogenous nucleotides published between 2000 and 2025 was retrieved from the Web of Science Core Collection. After screening and data standardization, 710 records were analyzed using VOSviewer, CiteSpace, and R-based visualization tools. The bibliometric analysis included publication output, country and institutional collaboration, keyword co-occurrence, co-cited references and journals, and citation burst detection. Results: A total of 710 publications were included. Annual publication output showed an overall upward trend, with marked growth after 2017. China and the United States were the leading contributors, while the Chinese Academy of Sciences and Peking University were among the most productive institutions. Keyword and co-citation analyses identified three major research themes: basic molecular mechanisms, physiological and health-related effects, and practical applications. Aquaculture and animal nutrition represented the most prominent application areas, with studies mainly focusing on growth performance, feed utilization, intestinal morphology, immune responses, oxidative stress resistance, and disease resistance. In human nutrition, research was mainly related to infant nutrition, intestinal and immune health, nutritional recovery, metabolic regulation, and healthy aging. Burst detection indicated a shift in research attention from early topics such as human milk and receptors to intestinal morphology and, more recently, nicotinamide mononucleotide and molecular activation. Conclusions: Research on exogenous nucleotides has expanded rapidly and is moving toward more mechanism-oriented and more diverse applications. Current evidence suggests that exogenous nucleotides have potential value as functional dietary supplements and feed additives, particularly in aquaculture, animal nutrition, infant nutrition, gut and immune health, metabolic regulation, and healthy aging. Future studies should further clarify compound-specific mechanisms, effective dose ranges, bioavailability, long-term safety, and population- or species-specific benefits to support their evidence-based application in functional foods, dietary supplements, infant formula, clinical nutrition, and functional feed products.

Household food insecurity (HFI), defined as the lack of reliable access to adequate food because of limited money or resources, may influence children's nutritional status. This study aimed to examine the association between HFI risk, based on a single screening item, and underweight and obesity among kindergarten children in Nevada. Cross-sectional data from the Kindergarten Health Survey (KHS) collected across three school years (2022-2023, 2023-2024, and 2024-2025) were analyzed using a pooled sample of 7267 children. HFI risk was assessed using one item from the Hunger Vital Sign. Weight status was determined using Body Mass Index (BMI) guidelines from the Centers for Disease Control and Prevention (CDC). Descriptive statistics and multinomial logistic regression examined associations between HFI risk and underweight and obesity, adjusting for confounders. Across the pooled sample, 16.3% were at risk for HFI, 16.0% were underweight, and 21.9% had obesity. In pooled analysis, HFI risk was associated with higher odds of obesity (Adjusted Odds Ratio [AOR] 1.29; 95% Confidence Interval [CI]: 1.05-1.59), but not underweight, compared with food-secure children. In year-specific analyses, higher odds of underweight were observed in 2023-2024 (AOR 1.74; 95% CI: 1.14-2.66) and 2024-2025 (AOR 1.58; 95% CI: 1.04-2.38). HFI risk was associated with obesity among kindergarten children in Nevada, while associations with underweight were observed only in certain school years and should be interpreted cautiously. These findings suggest HFI risk as an important early childhood health concern and support the need for nutrition support, family assistance, and longitudinal research.

The growing burden of noncommunicable diseases (NCDs) cannot be addressed through clinical interventions alone. Population-level regulatory interventions-such as fiscal measures, marketing restrictions, and labeling regulations-are central to effective NCD prevention and control. This article addresses the role of regulatory policies in preventing NCDs, with a focus on progress and implementation gaps in the Americas. In the context of NCDs, unhealthy commodity industries, including companies that produce and promote tobacco, alcohol, and ultra-processed food products, play a significant role in shaping patterns of NCD risk. Their activities influence not only the availability, access, and affordability of unhealthy commodities but also misinform the public's perception about what is healthy. These industries shape trends in consumption and harm while actively working to expand markets and influence regulatory environments in ways that may delay or dilute effective public health measures. Although considerable progress has been made in recent years, most Member States have not fully met their international commitments to regulate unhealthy commodities industries, products, practices, and policies. The fabrication of NCD epidemics due to the unhealthy commodities industries moves faster and stronger than the capacity to improve care for NCDs in the absence of effective policies to regulate these corporations' products, practices, and policies. Therefore, an essential component of the improvement of care for NCDs in the Americas is the strengthening of the regulatory capacities of Member States to regulate tobacco, alcohol, and ultra-processed products industries and to safeguard policies from their interference. La carga cada vez mayor de las enfermedades no transmisibles (ENT) no puede abordarse únicamente mediante intervenciones clínicas. Las intervenciones regulatorias a nivel poblacional, como las medidas fiscales, las restricciones al mercadeo y las regulaciones sobre el etiquetado, son fundamentales para la prevención y el control eficaces de las ENT. En este artículo se aborda el papel de las políticas regulatorias en la prevención de las ENT, haciendo hincapié en el progreso y las lagunas en cuanto a su aplicación en la Región de las Américas. En el contexto de las ENT, las industrias de productos no saludables, incluidas las empresas que producen y promueven el tabaco, el alcohol y los alimentos y bebidas ultraprocesados, tienen una participación importante en la configuración de los patrones de riesgo de las ENT. Sus actividades influyen no solo en la disponibilidad, el acceso y la asequibilidad de los productos que no son saludables, sino también en la percepción errónea del público sobre lo que es saludable. Estas industrias dan forma a las tendencias en relación con el consumo y los daños, al tiempo que trabajan activamente para ampliar los mercados e influir en los entornos regulatorios en diversas formas que pueden retrasar o diluir la aplicación de las medidas eficaces de salud pública. Aunque en los últimos años se han logrado progresos considerables, la mayor parte de los Estados Miembros no han cumplido plenamente sus compromisos internacionales de regular las industrias, los productos, las prácticas y las políticas en relación con estos productos no saludables. La producción de epidemias de ENT debidas a las industrias de productos básicos no saludables avanza más rápido y con mayor fuerza que la capacidad de mejorar la atención para las ENT cuando no hay políticas eficaces para regular los productos, las prácticas y las políticas de estas corporaciones. Por lo tanto, un componente esencial de la mejora de la atención a las ENT en la Región de las Américas es el fortalecimiento de las capacidades regulatorias de los Estados Miembros para regular las industrias del tabaco, el alcohol y los alimentos y bebidas ultraprocesados, y evitar que las políticas puedan sufrir su interferencia. Não é possível enfrentar a crescente carga de doenças não transmissíveis (DNTs) apenas com intervenções clínicas. Intervenções regulatórias em nível populacional — como medidas fiscais, restrições na publicidade e regulamentação da rotulagem — são fundamentais para prevenir e controlar eficazmente as DNTs. Este artigo aborda o papel das políticas regulatórias na prevenção das DNTs, com destaque para os avanços e as lacunas de implementação na Região das Américas. No contexto das DNTs, as indústrias de produtos não saudáveis, incluindo as empresas que produzem e promovem o tabaco, as bebidas alcoólicas e os alimentos ultraprocessados, desempenham um papel significativo na forma como evoluem os padrões de risco de DNTs. Suas atividades não só afetam a disponibilidade, a facilidade de acesso e a acessibilidade financeira aos produtos não saudáveis, como também distorcem a percepção do público sobre o que é saudável. Esses setores moldam as tendências de consumo e de danos e, ao mesmo tempo, trabalham ativamente para expandir seus mercados e influenciar os ambientes regulatórios de maneiras que podem atrasar ou diluir medidas efetivas de saúde pública. Embora tenha havido um progresso considerável nos últimos anos, a maioria dos Estados Membros não cumpriu totalmente seus compromissos internacionais de regulamentar indústrias, produtos, práticas e políticas relacionados a produtos prejudiciais à saúde. Na ausência de políticas efetivas para regulamentar os produtos, as práticas e as políticas das indústrias de produtos não saudáveis, a proliferação de epidemias de DNTs devido a esses setores avança mais rápido e com mais força do que a capacidade de melhorar o tratamento das DNTs. Portanto, um componente essencial da melhoria da atenção às DNTs na Região das Américas é o fortalecimento das capacidades regulatórias dos Estados Membros para regulamentar as indústrias do tabaco, de bebidas alcoólicas e de produtos ultraprocessados e proteger as políticas contra a interferência desses setores.

The Mediterranean Diet is one of the most extensively studied dietary patterns in nutritional science and public health [...].

Pregnancy represents a critical eco-biological window during which maternal physiology integrates environmental exposures, lifestyle factors, and interconnected microbial ecosystems to shape fetal development and long-term health. From a One Health perspective, defined here as the interconnection between maternal health, environmental determinants, and microbial ecosystems across generations, the maternal microbiome functions as a dynamic interface linking the external environment to the intrauterine milieu, translating ecological signals into immunological, metabolic, and neuroendocrine pathways that influence placental function and developmental programming. Across gut, vaginal, oral, and mammary niches, maternal microbial communities operate as an integrated network regulating systemic inflammation, metabolic homeostasis, and the production of bioactive metabolites, including short-chain fatty acids, bile acids, and tryptophan derivatives. This review proposes an integrated systems framework in which pregnancy is viewed as a transient ecological system shaped by ten interconnected maternal determinants, encompassing microbial niches, nutrition, lifestyle factors, medical interventions, mode of delivery, and postnatal microbial transmission, that converge on shared microbiome-mediated signaling pathways affecting fetal and neonatal immune, metabolic, and neurodevelopmental trajectories. Broader macro-environmental drivers, including biodiversity loss, urbanization, pollution, and industrialized lifestyles, are considered as upstream modulators of maternal microbial ecology within a One Health context. A systems model is presented to illustrate how environmental inputs are biologically transduced through maternal microbial networks to influence placental function, fetal development, and early-life health trajectories. Framing pregnancy as an integrated eco-biological continuum highlights the maternal microbiome as a central hub of intergenerational health and may support microbiome-informed preventive strategies and public health approaches aimed at reducing the burden of non-communicable diseases (NCDs) of early-life origin.

Background/Objectives: To clarify the cognitive level and selection behavior of the exercising population regarding sports nutrition foods, as well as their relationship with athletic performance, this narrative review examined the literature published from 2001 to 2025. Methods: CNKI, Wanfang Data, PubMed, and ScienceDirect were searched for studies published between 2001 and 2025 using keywords: sports nutrition foods, exercise intensity, public cognition, and food development. Studies addressing ingredient functionality, exercise-related nutritional requirements, public cognition, or product development were included. After screening, 45 full-text articles and four authoritative documents were incorporated into the synthesis. Results: The synthesis reveals a persistent disconnect between the cognition and utilization of sports nutrition foods. Common misconceptions include inappropriate supplementation timing, indiscriminate product selection, and imprecise dosage control, while structural constraints on the industrial side-product homogenization, inadequate standardization, and imprecise product development-remain significant barriers. Conclusions: To bridge this gap, we recommend establishing a three-in-one public education framework that integrates professional education, mass media communication, and regulatory oversight, and we encourage enterprises to transition toward clean labeling, precision nutrition, and green processing. This review provides an evidence-based reference for advancing the development of sports nutrition foods.

Background: Ready-to-use therapeutic foods (RUTFs) have been developed to treat severe acute malnutrition (SAM) in children by promoting rapid weight gain, but the long-term effects have been overlooked. Incorporating prebiotic rice bran into RUTF can enhance balanced weight gain. We hypothesized that children receiving RUTF + rice bran would exhibit increased fat-free mass (FFM) and reduced body fat percentage and abdominal adiposity. Methods: A double-blinded randomized controlled trial (ClinicalTrials.gov:NCT05319717) involving 200 children with different degrees of acute malnutrition compared the effectiveness of RUTF with or without rice bran. Children received treatment for 8 weeks, with another 8 weeks of follow-up. Anthropometry, including skinfolds, was collected every 4 weeks. Results: Compliance was similar in both groups (~21%). Children aged 6 to 23 months receiving RUTF + rice bran gained more FFM than those receiving RUTF alone (p = 0.05 at week 8). Over the 8-week treatment, the fat mass index increased in children receiving RUTF (p = 0.02), but not in those receiving RUTF + rice bran (p = 0.48), although the increase in body fat percentage was similar (p = 0.23). The ratio of abdominal to peripheral skinfolds decreased in both groups during treatment but increased during follow-up, though the difference was not statistically significant. In children aged 24 to 59 months, no significant differences in body composition were observed. The fat-free mass index increased in both groups during treatment but declined afterwards, with significant changes noted in the RUTF + rice bran group. Conclusions: The addition of rice bran to RUTF affected body composition changes during treatment only in younger children, where more lean mass was gained and fat mass gain was limited. Differences in intestinal microbiome maturity might underlie this age difference.

Commercial determinants of health (CDoHs) describe how corporate practices influence population health. This scoping review aimed to characterize the extant evidence base regarding how CDoH in the sugar-sweetened beverage (SSB) industry affects health and health-related outcomes among Latinx populations in the United States of America (USA). The present study was conducted in accordance with the JBI methodology for scoping reviews. Overall, 1236 references were identified and imported for screening. After duplicate removal, screening, and full-text eligibility assessment, 33 studies met all inclusion criteria. SSB marketing and advertising was the most frequently examined CDoH (61%), including advertising exposure, messaging strategies, and warning label interventions. SSB taxation studies projected reductions in consumption and obesity prevalence. Outcomes associated with health focused primarily on perceptions of marketing and purchasing intentions (94%). Additional studies examined the impact on knowledge, attitudes, beliefs, and behaviors (e.g., purchasing and consumption of SSBs) (66%), while a few studies included chronic disease (27%) or healthcare outcomes (6%). Evidence highlights several gaps in CDoH research associated with SSBs, with 94% of the included studies focused on understanding marketing exposure, signaling a need to examine other domains of CDoH, SSB industry practices, and impacts on health disparities. Findings suggest that structural policy interventions such as taxation and stronger regulation of commercial practices are necessary to address higher exposure to marketing and consumption of SSBs among Latinx populations in the USA.

Background/Objectives: The increasing burden of non-communicable diseases, together with accelerating environmental degradation, highlights the urgent need for sustainable dietary patterns that promote both human and planetary health. The Mediterranean diet (MedDiet), traditionally followed in countries bordering the Mediterranean basin, has gained recognition as a model of sustainable nutrition due to its well-documented health benefits and relatively low environmental impact. However, its broader role within sustainable food systems requires comprehensive and interdisciplinary evaluation. The aim of this review is to provide a state-of-the-art synthesis of the evidence on the MedDiet as a sustainable dietary pattern, integrating its health, environmental, economic, and socio-cultural dimensions. Methods: This state-of-the-art narrative review synthesizes evidence from peer-reviewed literature on the MedDiet and sustainability. Relevant studies were identified through major scientific databases, focusing on publications addressing nutritional, environmental, economic, and socio-cultural dimensions. Both observational and interventional studies, as well as modeling and life cycle assessment analyses, were included. Additional sources from international organizations and policy reports were incorporated to contextualize global trends and challenges. Results: High adherence to the MedDiet is consistently associated with a reduced risk of cardiovascular disease, type 2 diabetes, cancer, and all-cause mortality. From an environmental perspective, the MedDiet is associated with lower greenhouse gas emissions, reduced land and water use, and enhanced biodiversity conservation compared with Western dietary patterns. Economically, it may represent a cost-effective dietary model and support local food systems when grounded in traditional practices, although affordability varies across contexts. Socio-culturally, the MedDiet promotes food heritage, culinary skills, and social cohesion. Nevertheless, globalization, urbanization, and the increasing consumption of ultra-processed foods have contributed to declining adherence, posing significant challenges to its sustainability and scalability. Moreover, the sustainability benefits of the MedDiet seem to be context-dependent rather than intrinsic, raising several challenges and limitations for its adoption. Conclusions: The MedDiet should be viewed not as a definitive solution to global food-system challenges but as a valuable reference model that illustrates how dietary practices can contribute simultaneously to human health, environmental sustainability, and cultural continuity. Modern sustainable dietary strategies should build upon the strengths of the MedDiet while recognizing its limitations, embracing contextual adaptation, and addressing the structural determinants that shape food choices.

As global trends continue to embrace environmentally friendly, plant-based diets, food systems that are nutrient-dense, climate-resilient, and economically viable in addressing protein-energy malnutrition, micronutrient deficiencies, and food insecurity have increased. Although cereal-legume combinations are widely recognised to be highly nutritious, most studies have focused primarily on enhancing compositional efficiency and have overlooked their interactions with the food matrix and the processing-mediated transformations they undergo. This review combines recent findings examining cereal-legume food matrices as functional systems, with particular emphasis on nutritional complementarity, bioactive interactions, processing-induced modifications, and sensory acceptability. Studies indicate that cereals and legumes provide complementary amino acid profiles, dietary fibre, essential micronutrients, and phytochemicals within these composite matrices that influence digestibility, bioavailability, antioxidant activity, and glycaemic response. Processing methods, including fermentation, germination, roasting, and extrusion, modulate these interactions by releasing bound phenolics, reducing antinutritional factors, and altering starch-protein-phenolic complexes, thereby affecting health functionality and sensory quality. However, inadequately optimised processing can affect nutrient retention and consumer acceptability. Overall, this review emphasises the relevance of integrating food matrix science and processing optimisation for the production of functional, acceptable, and sustainable cereal-legume foods that promote product innovation, public health improvement, and the utilisation of underutilised crops for sustainable food systems.

Due to the rise in chronic disease in the United States, several policies, guidelines, and programs have focused on promoting healthy eating. This includes those aimed at service members, who may struggle to find nutritious food options on military bases. The Military Nutrition Environment Assessment Tool (mNEAT) assesses the access, availability, and promotion of nutritious foods and beverages on military bases. Military services vary in their policies related to the food environment, including the use of mNEAT, on their installations. The aim of this article is to examine the difference in mNEAT scores for those military services with a comprehensive mNEAT policy compared to those with a partial policy. Installations with mNEAT scores from October 2021 to September 2024 were separated into two groups: full-policy group (Air Force, Space Force, nf = 76) and partial-policy group (Army, Navy, Marine Corps, np = 69). Food venue types assessed include: commissary (nf = 67, np = 44); fast-food (nf = 63, np = 48); vending (nf = 42, np = 18); express stores (nf = 65, np = 50); food truck (nf = 42, np = 24); dining facility/galley (nf = 51, np = 40); Morale, Welfare, and Recreation (MWR) food service venues (nf = 56, np = 38). Installation-level venue types assessed include community (nf = 56, np = 24) and worksite (nf = 49, np = 20). Installations were separated into venue-type variety groups according to how many different venue types they assessed: low (1-4 venue types, n = 47), moderate (5-7 venue types, n = 48), and high (8-9 venue types, n = 50). The full-policy group had higher total installation mNEAT scores on average than the partial-policy group (54.6% vs 50.4%, p = 0.034), but results were no longer significant when venue type assessment variety was added as a covariate (p = 0.074). In addition, the full-policy group had higher scores (p ≤ 0.05) for the following venue types: dining facility/galley, MWR, fast-food, express, and community. In the moderate (p = 0.012) and high (p = 0.022) venue-type variety groups, the full-policy group had significantly higher mNEAT scores, but not for the low venue-type variety group (p = 0.547). Higher mNEAT scores for full-policy installations may indicate a more supportive food environment than those in the partial-policy group, when ≥5 food venue types were assessed. Military services without a comprehensive mNEAT policy can consider modifying or implementing one to support easier access and availability of nutritious options. This public health strategy can support service members' health and performance and can be applied to similar settings, such as universities and worksites.

To evaluate the status of the nutritional management of diet-treated IEM in Brazil from the perspectives of healthcare professionals, patients, and families. Data were collected through two nationwide digital questionnaires administered to healthcare professionals involved in dietary management (n = 37) and to patients and caregivers (n = 278), addressing professional training, workload, access to resources, treatment adherence, and socioeconomic factors. Healthcare professionals from 20 out of the 26 Brazilian states participated, most of them female (81%) and dietitians (81%). Although more than half had over 10 years of experience, 59% considered their training insufficient to work with IEM. Only 19% reported exclusive dedication to the field, and 54% were the sole professional responsible for dietary prescriptions at their center. Weekly workload dedicated to IEM varied widely. Among the patients and families, phenylketonuria (60.4%) and glycogen storage disease (25.9%) were the most frequent conditions. Higher educational level and longer time since diagnosis were associated with a better understanding of dietary management (p < 0.05). Among patients on protein-restricted diets, most reported regular use of protein substitutes, although 92% reported poor palatability and 36% reported supply problems. Access to special low-protein foods was limited, and over half of the families reported some level of food insecurity. Significant systemic, logistical, and socioeconomic barriers to optimal dietary management of IEM persist in Brazil, highlighting the need for strengthened public policies, professional training, and equitable access to dietary resources.

Background: Childhood obesity remains a major public health challenge worldwide, with increasing prevalence across Europe. Schools represent an important setting for promoting healthy lifestyles through physical activity and nutrition-related interventions. This systematic review aimed to evaluate the effectiveness of school-based interventions promoting physical activity and healthy eating behaviours among children and adolescents aged 6-18 years in European countries. Methods: A systematic literature review was conducted using PubMed and Scopus. Studies were eligible if they were conducted in school settings, targeted children and adolescents aged 6-18 years, were implemented in European countries, had a minimum duration of nine months, and assessed anthropometric and/or behavioural outcomes related to obesity prevention. Methodological quality was assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool. Results: Sixteen studies conducted across nine European countries met the inclusion criteria. Intervention duration ranged from nine months to five years, and most studies employed multicomponent approaches combining physical activity promotion, nutrition education, environmental modifications, and parental involvement. Seven studies were rated as strong quality, six as moderate quality, and three as weak quality. Among the fourteen studies assessing BMI or other anthropometric outcomes, eleven (78.6%) reported statistically significant improvements in at least one obesity-related measure, including BMI, BMI z-score, waist circumference, waist-to-height ratio, body fat percentage, or overweight/obesity prevalence. Evidence regarding physical activity and nutrition-related outcomes was more heterogeneous, although several studies reported improvements in dietary behaviours, nutrition knowledge, sedentary behaviour, and physical activity levels. Positive anthropometric effects were more commonly observed in interventions lasting at least one academic year and in multicomponent programmes. Some studies also reported differential effects according to sex and parental educational background. Conclusions: The findings of this review suggest that long-term, multicomponent school-based interventions can contribute to improving obesity-related anthropometric outcomes among children and adolescents in European countries. However, evidence regarding sustained changes in physical activity and dietary behaviours remains less consistent. Future research should focus on identifying the most effective intervention components and strategies for achieving long-term behavioural change across diverse populations and educational contexts.