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This study assessed the nutritional status of children under five years of age admitted and treated for malaria in hospital settings in the cities of Lubumbashi and Likasi. The purpose of this study was to describe the nutritional profile of these children based on anthropometric measurements. We conducted a cross-sectional descriptive study conducted in the Haut-Katanga province in southeastern Democratic Republic of the Congo. Children under 60 months of age with a positive diagnosis of malaria, biologically confirmed by a positive RDT and/or a positive thick blood smear, were included. The incidence of malaria was 34.3%. The overall prevalence of acute malnutrition (moderate to severe) was 32.9%, predominantly represented by severe acute malnutrition (27.5%). Acute malnutrition was more frequent in its moderate form (67.1%) and was observed across nearly all age groups. Overweight was identified in 13.9% of children, including 8.5% with severe overweight. A consistently significant association was observed. This study focused on the nutritional status of children under 5 years of age admitted and monitored for malaria in hospital settings in the cities of Lubumbashi and Likasi. The objective was to outline the nutritional profile of these children based on anthropometric measurements. This was a descriptive cross-sectional study conducted in the Haut-Katanga province, in the southeast of the Democratic Republic of Congo. Included were children under 60 months of age with a positive diagnosis of malaria, biologically confirmed by a positive rapid diagnostic test (RDT) and/or a positive thick blood smear. The incidence of malaria was 34.3%. The overall prevalence of acute malnutrition (moderate to severe) was 32.9%, mainly represented by severe malnutrition at 27.5%. Acute malnutrition was more prevalent in its moderate form (67.1%), but was present in almost all age categories. Overweight was observed in 13.9% of children, with severe overweight in 8.5% of children. A consistently significant association was observed between moderate to severe underweight (Z-score <-2 SD), moderate to severe stunting (Z-score <-2 SD), moderate to severe acute malnutrition (Z-score <-2 SD), and uncomplicated malaria rather than severe malaria. There is a relatively high frequency of cases of underweight, wasting, and stunting, often higher than that documented in the general population. Impact studies are needed to establish a potential causal link. La présente étude a porté sur l'état nutritionnel des enfants de moins de 5 ans admis et suivis pour paludisme en milieu hospitalier dans les villes de Lubumbashi et Likasi. L'objectif était de dresser le profil nutritionnel de ces enfants, basé sur l'anthropométrie. Il s'agit d'une étude descriptive transversale effectuée dans la province du Haut-Katanga, au sud-est de la République démocratique du Congo. Ont été inclus les enfants de moins de 60 mois, dont le diagnostic positif est celui du paludisme, confirmé biologiquement par un TDR positif et/ou une goutte épaisse positive. L'incidence du paludisme était de 34,3%. La prévalence globale de la malnutrition aiguë (modérée à sévère) est de 32,9%, représentée essentiellement par la malnutrition sévère avec 27,5%. La malnutrition aiguë est plus prévalente dans sa forme modérée (67,1%), mais présente dans quasiment toutes les catégories d'âge. Le surpoids a été rencontré chez 13,9% d'enfants; il était sévère chez 8,5% d'enfants. Une association systématiquement significative a été observée entre l'insuffisance pondérale modérée à sévère (Z-score <-2 ET), le retard de croissance modéré à sévère (Z-score <-2 ET), la malnutrition aiguë modérée à sévère (Z-score <-2 ET) et le paludisme simple plutôt qu'avec le paludisme grave. Il ressort une fréquence relativement élevée des cas d'insuffisance pondérale, d'émaciation et de retard de croissance, souvent plus importante que celle documentée dans la population générale. Des études d'impact sont nécessaires pour établir un éventuel lien de causalité.
The global food and nutrition enterprise is confronted with daunting challenges to all aspects of the food system, from social/economic/political crises to pandemic diseases to climate change, all of which impact our ability to meet the health needs of a growing population. The response has been focused on vulnerable groups and critical periods of human development, starting with the "first 1000 d" (i.e., pregnancy and the first 2 y of life). However, another critical developmental period, the "next 7000 d" (i.e., 2-21 y of age), has received less attention in terms of efforts to inform our understanding of the role of nutrition in the health and development of children and adolescents. Although significant effort has gone into providing nutritional support to school-aged children (particularly via school-based programs), a lack of research (and thus evidence) has constrained our ability to assess the need for and impact of these programs on health and development. The recent impact of the COVID-19 pandemic on our ability to provide services to this vulnerable age group has highlighted not only the need to redouble efforts to address the effects of food and nutrition insecurity on these children but also a daunting lack of evidence to inform the development and evaluation of such programs. When viewed as a complex biological system, we can understand that school-aged children interact with both internal (biological, genetic, and nutritional) and external (social/behavioral/economic/political, home, community, and physical) environments (i.e., an ecology). The "Biomarkers of Nutrition for Development: Knowledge Indicating Dietary Sufficiency (BOND-KIDS)" Project was initiated to apply a transdisciplinary approach to address this ecology and help inform the range of communities involved in providing nutritional support to school-aged children in the United States and globally. This Executive Summary provides an overview of the conceptual approach, goals, objectives, and process of the BOND-KIDS Project.
The vegan/vegetarian athlete's plate (Veg AP) is a modification of the Athlete's Plate designed to guide athletes about how to fuel adequately at various training loads on a vegetarian or vegan diet. The purpose of this study was to validate and determine the usefulness of the Veg AP among athletes of various competition levels. Part 1 involved developing 120 vegetarian or vegan "plates" for athletes of different weights at different training loads. Nutrient content of these plates was measured and compared with sport nutrition and vegetarian nutrition guidelines. Part 2 entailed athletes watching a presentation about how to use the Veg AP and then having the athletes create their meals in a university dining hall in accordance with the Veg AP. The appropriateness of the plate was determined by a group of experts. A subset of these athletes participated in a focus group to further ascertain perceptions of the utility of the Veg AP. The Veg AP meets international sport nutrition guidelines for energy and macronutrient content. Micronutrient content of the Veg AP varies, and proper instruction about how best to build plant-based meals to include adequate iron, zinc, and vitamin B12 while avoiding excessive dietary fiber is warranted, particularly to support easier training loads and lighter weight categories. Athlete perception of the Veg AP was that it was educational and helpful for creating a vegetarian or vegan meal that sufficiently supports variable training loads, even for those experienced with vegetarian nutrition. The Veg AP is a useful tool for teaching about vegetarian sport nutrition and providing practical guidance for athletes of a variety of sports and competition levels.
This study explores the risk of delayed psychomotor development (PMD) in children treated for severe acute malnutrition (SAM) in the Democratic Republic of Congo. The present research is a sub-study of the EfRAMAS clinical trial conducted in health zones in the province of Kasaï Oriental. Children aged 6-59 months with SAM according to WHO criteria and no congenital malformations affecting child development were enrolled in the study. The risk of delayed psychomotor development was assessed among repeated cross-sectional samples of children at admission, discharge and 6 months after recovery, using the Ages and Stages Questionnaires (ASQ3). Mixed-effects linear regression with health center as random intercept was performed to identify potential predictors of the risk of psychomotor delay in children. A total of 413 children were included at admission, 143 at discharge and 581 at 6 months post-discharge. At admission, the risk of delayed psychomotor development was greatest in the domains of fine motor skills (21.3%), gross motor skills (23.7%) and problem solving (21.5%). At discharge, the risk of delay was considerably reduced, with 0% risk of delay in communication, while the three most affected domains hovered around 2%. At 6 months post-discharge, the risk of delay in gross motor skills and problem-solving was still present in over 10% of children. Age, sex, MUAC < 115 mm or WHZ < -3 as admission criteria, breastfeeding, episodes of illness during treatment, measles vaccination, mother's education level, and living in a female-headed household were predictors of the risk of psychomotor development delay. Globally, gross and fine motor skills and problem solving were the domains most affected for children with SAM. Regarding our findings, we recommend investing in the integration of children's psychosocial stimulation within the undernutrition management care pathway by trained health care workers, as well as in caregivers' parental skills. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Network (ISRCTN15258669). Registered 25/01/2022.
Crop biofortification is an important tool to improve micronutrient deficiency, but the evidence of its cost-effectiveness remains limited. This study aims to estimate the cost-effectiveness of biofortified crops to address iron, zinc, and vitamin A deficiency in 13 countries. We used the burden of disease (BoD) measured in disability-adjusted life years (DALYs) compiled by the Institute for Health Metrics and Evaluation (IHME), supplemented by a literature review, to quantify DALYs resulting from micronutrient deficiencies. Data and assumptions from the Food and Agriculture Organization of the United Nations (FAO) were used to estimate micronutrient intake and the potential impact of biofortification on micronutrient intake to calculate the efficacy of biofortification in reducing DALYs under conservative, moderate, and optimistic scenarios. The cost was estimated for 30 years (2024-2053) while the benefits were for 20 years (2034-2053). An incremental cost-effectiveness ratio (ICER), defined as additional cost per DALY averted, was estimated. The total cost of biofortification programs varied across countries, ranging from $4.28 million in Guatemala to $34.04 million in Nigeria over 30 years. The ICERs of biofortification varied by type of crop and country; regardless, all are cost-effective using GDP-based cut-offs, except for biofortified cassava and sweet potatoes in Zimbabwe. For example, for iron biofortification of beans under the conservative scenario, ICER was as low as $58.04 per DALY averted in Kenya and as high as $535.52 per DALY averted in Zimbabwe, demonstrating the range of cost-effectiveness of the intervention among the countries selected for the study. A similar pattern was found for iron biofortification of pearl millet; vitamin A biofortification of cassava, maize, and sweet potatoes; and zinc biofortification of rice, wheat, and maize in most countries. Biofortification of staple crops by selective plant breeding is potentially cost-effective to address iron, zinc, and vitamin A deficiencies.
The 2025-2030 Dietary Guidelines for Americans (DGA) introduced substantial controversy by diverging from long-standing practices and many scientific recommendations of the 2025 Dietary Guidelines Advisory Committee (DGAC). The final guidelines promote dietary protein intakes of 1.2-1.6 grams per kilogram of body weight per day (g/kg/d). These recommendations rely on a rapid systematic review of randomized controlled trials focused on weight-management outcomes and, to a lesser extent, a narrative review on nutrient adequacy. Recognizing protein as a component of a healthy diet is consistent with recent editions and a strength of the 2025-2030 DGA. However, the 2025-2030 DGA emphasize a single dimension of the evidence base and give limited attention to the relationship between protein intake and risk for, or management of, diet-related chronic disease, including cardiovascular disease, type 2 diabetes, chronic kidney disease, cancer, and bone disease. The scientific basis underlying the new protein guidance was, in our assessment, insufficiently comprehensive, while also departing from the DGA process to be food based and not nutrient based in the context of protein. These recommendations also lack sufficient clarity to distinguish between varying dietary macronutrient strategies for managing body weight in individuals with overweight or obesity and the specific protein requirements linked to the physiological roles of individual amino acids. The Scientific Foundation for the 2025-2030 DGA states that the recommendations were developed independent of equity and inclusion, raising practical concerns with how new higher protein targets will be interpreted and applied across diverse populations and federal nutrition programs. In this Perspective, we summarize the new protein recommendations, compare them with past DGA editions, the Scientific Report of the 2025 DGAC, and current population-level protein intake patterns, as well as highlight strengths and areas needing additional clarity or research. Central to our perspective is the view that evidence derived from weight loss studies does not provide a sufficient scope of evidence to support a universal dietary protein recommendation for all Americans across the lifespan.
Suboptimal diet quality contributes to poor health. Numerous factors at all levels of the socioecological model intersect to influence individuals' diet quality. A precision public health nutrition framework can be used to understand how these factors jointly shape diet quality across several subgroups in the population. This is, however, very challenging to operationalize. The purpose of this study was to assess whether machine learning can be leveraged to operationalize a precision public health nutrition approach by more precisely identifying subgroups with the highest proportion of adults with poor diet quality and the most important predictors of diet quality. We conducted a secondary analysis of cross-sectional data from the 2018 and 2019 International Food Policy Study in Canada (n=5,093). A total of 42 candidate predictors within four domains (sociodemographic characteristics and socioeconomic position; food policies and environments; food literacy; health-related practices and indicators) were used. The Healthy Eating Index-2015 (HEI-2015) was used to assess diet quality; tertiles of HEI-2015 scores were defined as the outcome. Conditional inference tree (CIT) and conditional random forest (CRF) analyses were conducted. The CIT partitioned the sample into seven subgroups with different proportions of adults with lower, moderate or higher diet quality using six predictors. The probability of lower diet quality ranged from 16.9% to 49.9% across subgroups. The subgroup with the highest proportion of adults with lower diet quality was characterised by individuals confident in using ≤4 cooking techniques. Based on the CRF model and conditional variable importance, the five most important predictors of diet quality in were: frequency of food label use, confidence in using cooking techniques, perceived general health, household food insecurity status, and health literacy. This study provides evidence that machine learning approaches can be leveraged to operationalize a precision public health nutrition approach.
Donor human milk (DHM) is widely used for preterm infants when mother's own milk (MOM) is unavailable, yet its metabolome is poorly described. This study aimed to profile the metabolome of pooled, pasteurized DHM obtained from a single milk bank over a 1-y period and compare it with human milk (HM) from reference cohorts. Pooled DHM (n = 47) was collected weekly from the Mother's Milk Bank of Florida over 47 consecutive weeks from July 2022 to June 2023. Using 1H nuclear magnetic resonance spectroscopy, we quantified 59 polar metabolites in DHM and compared the metabolomic profile with previously published data on HM from mothers of preterm (n = 29) and term (n = 97) infants collected across the first 3 mo postpartum and analyzed using identical methods. Variability and group differences were assessed with regression, linear mixed-effects models, principal component analysis (PCA), and permutational multivariate analysis of variance (PERMANOVA); P values were false discovery rate (FDR)-adjusted. DHM showed limited variability, as the coefficient of variation for nearly half of the metabolites was 20% to 30%. Compared with both preterm and term colostrum and transitional milk, DHM had lower acetylcarnitine, myo-inositol, 3'-sialyllactose, and 6'-sialyllactose (FDR-adjusted P value < 0.1). PCA separated HM by lactation stage and delivery type, with DHM clustering closest to term HM at 3 mo postpartum and farthest from preterm colostrum. PERMANOVA and dispersion testing indicated that DHM differed significantly from all HM groups (FDR-adjusted P value < 0.1), reflecting compositional differences related to lactation stage and reduced heterogeneity from pooling. Although DHM is the preferred alternative to MOM for preterm infants, it contains lower concentrations of several potentially important metabolites than preterm HM, which may be further diluted by fortification. Future studies should evaluate how these differences and fortification may affect infant growth, development, and long-term outcomes.
The protein requirement of clinically normal but chronically undernourished (stunted) children is unknown. Stressors, like intestinal parasites, in poor environments may increase this requirement. The current protein requirement, which is based on factorial methods in healthy well-nourished children, may be incorrect. To determine the effect of intestinal parasites on the protein requirement of chronically undernourished school-age South Indian children, by the Indicator Amino Acid Oxidation (IAAO) technique. Eighteen undernourished school-age South Indian children (6-11y old) were studied before and after treatment for confirmed presence of intestinal parasites. They were randomized to receive a low or high protein intake from a range of 8 protein levels (0.24-2.38 g·kg-1·d-1), provided as an egg protein-based amino acid mixture in an isocaloric experimental diet providing energy at 1.7 times the measured resting energy expenditure (REE). A constant and generous intake of the indicator amino acid (phenylalanine and its metabolite tyrosine) was ensured across all intake levels. A 2-phase linear regression crossover analysis of the pattern of 13C-phenylalanine oxidation (F13CO2) across the protein intake levels before and after treatment, identified a minimal oxidation breakpoint that represented the mean protein requirement. The mean (95% CI) protein requirement of undernourished school age South Indian children with intestinal parasites was determined to be 1.25 (1.0,1.5) g·kg-1·d-1. After anti-parasite treatment, the requirement was not different at 1.43 (1.1,1.8) g·kg-1·d-1. The presence of intestinal parasites does not increase the protein requirement of undernourished Indian children. However, the current mean (+2 SD) protein requirement of 0.76 (0.95) g·kg-1·d-1 might be inadequate for this group.
Diarrheal disease remains a leading cause of morbidity among children under 5 years of age in sub-Saharan Africa, yet many estimates rely on outdated data. Using the most recent Demographic and Health Survey (DHS) datasets, this study is aimed at providing updated estimates of childhood diarrheal morbidity and at identifying associated factors to inform monitoring and targeted interventions. This study analyzed pooled DHS data collected between 2021 and 2024 from 11 sub-Saharan African countries, focusing on diarrheal morbidity among 124,167 children under 5 years of age. A multilevel modified Poisson regression model was employed to estimate adjusted prevalence ratios (APRs) and corresponding 95% confidence intervals (CIs), accounting for the hierarchical structure of the data, including clustering at household and community levels. Statistical significance was declared at p < 0.05. The prevalence of diarrheal morbidity among children under 5 years of age was 13.8% (95% CI: 13.6%-14.0%), with significant variation across the included sub-Saharan African countries. Lower prevalence was observed among children born to mothers aged 25-34 years (APR = 0.89; 95% CI: 0.85-0.92) and 35-49 years (APR = 0.82; 95% CI: 0.78-0.86), female children (APR = 0.93; 95% CI: 0.91-0.96), children aged 37-59 months (APR = 0.42; 95% CI: 0.40-0.44), children of literate mothers (APR = 0.86; 95% CI: 0.82-0.89), those from wealthier households (APR = 0.84; 95% CI: 0.79-0.88), children covered by health insurance (APR = 0.89; 95% CI: 0.83-0.95), and those who had received measles vaccination (APR = 0.95; 95% CI: 0.90-0.99). Conversely, distance to health facilities as a big problem (APR = 1.09; 95% CI: 1.05-1.13), underweight status (APR = 1.17; 95% CI: 1.10-1.24), and wasting (APR = 1.17; 95% CI: 1.09-1.26) were associated with a higher prevalence of diarrheal morbidity. Positive associations were also observed for media exposure, improved toilet facilities, four or more antenatal care visits, postnatal checkups, vitamin A supplementation, rotavirus vaccination, and deworming treatment. These associations should be interpreted cautiously, as they are unlikely to be causal and may reflect reverse causation, residual confounding, or reporting and detection bias. Childhood diarrhea remains a major public health concern in sub-Saharan Africa, with substantial variation across the included countries. Diarrheal morbidity among children under 5 years of age was associated with a range of biological, socioeconomic, nutritional, and health service-related factors. Lower diarrheal morbidity was associated with older maternal age, female sex, older child age, maternal literacy, higher household wealth, health insurance coverage, and measles vaccination, whereas undernutrition and barriers to healthcare access were associated with higher morbidity. Counterintuitive associations observed for several health service and infrastructure variables likely reflect reverse causation and reporting bias rather than harmful effects. These findings underscore the need for integrated interventions aimed at improving child nutrition, reducing socioeconomic inequalities, and expanding equitable access to quality healthcare services.
The cold, hot, and neutral natures are core concepts in Tibetan dietary therapy and guide traditional food classification and dietary use. However, their identification has largely depended on empirical judgment, and quantitative standards based on modern nutritional features remain limited. This study aimed to develop an interpretable machine learning framework integrating feature selection, multimodel classification, and SHapley Additive exPlanations (SHAP) analysis to identify nutritional drivers of Tibetan dietary nature and support prediction for currently unlabeled food items. A structured database of 786 Tibetan dietary items was constructed by integrating traditional Tibetan medical attributes with modern nutritional data. Key features were selected using least absolute shrinkage and selection operator regression and recursive feature elimination with cross-validation. Nine machine learning algorithms were compared, and SHAP analysis was used to interpret nonlinear feature contributions to the cold, hot, and neutral classifications. Ten core features were identified, including trace elements, vitamins, macronutrients, and sensory attributes, represented by selenium, manganese, niacin, protein, and bitter taste. eXtreme Gradient Boosting achieved the best overall performance, with an area under the receiver operating characteristic curve of 0.843 and a Brier score of 0.145. SHAP analysis showed that selenium and niacin were dominant predictors with nonlinear interactions. Cold foods were characterized by a bitter-taste-related, low-nutrient nutrient-density pattern; hot foods showed a high-energy-driven pattern associated with niacin, protein, and sweet taste; and neutral foods reflected a dynamic balance of multiple driving factors. This study established an interpretable intelligent classification system for the 3 natures of Tibetan dietary therapy and proposed a selenium-niacin-metabolism axis hypothesis. These findings provide quantitative evidence for the Tibetan dietary theory and support standardized dietary classification and individualized dietary guidance.
As the world's population ages, health problems among older rehabilitation patients show complicated features characterized by multimorbidity, functional decline, and interwoven dietary hazards. This study uses a narrative review methodology to systematically examine the theoretical framework, key components, and current practice of the integrated rehabilitation-clinical-nutrition management model among older rehabilitation patients. The integrated management model demonstrates potential benefits in terms of functional recovery, nutritional improvement, prevention and control of complications, and mental health. The paper also critically examines the limitations of current research, evidence heterogeneity, and research gaps. The collaborative integration-based integrated rehabilitation-clinical-nutrition management approach has emerged as a crucial tactic for boosting quality of life, optimizing healthcare resource distribution, and increasing functional outcomes among older patients. Suggestions for improvement are offered from the standpoints of public health service systems, human resource allocation, and policy support. This review aims to provide recommendations for clinical practice, health management, and policy-making, while encouraging more consistent and long-lasting use of integrated care models in geriatric rehabilitation.
Pancreatic cancer is relatively rare but remains one of the most lethal tumors. Identifying modifiable risk factors is a crucial step to reduce disease burden. Evidence suggests a potential role of type 2 diabetes mellitus in its pathogenesis. To examine the association between dietary patterns related to diabetes and pancreatic cancer risk in a European population. A total of 367,395 participants from the European Prospective Investigation into Cancer and Nutrition study were included. After a median follow-up of 14.9 years, 926 incident cases were identified. The Diabetes Risk Reduction Diet (DRRD), the Empirical Dietary Index for Hyperinsulinemia (EDIH) and the Empirical Dietary Index for Insulin Resistance (EDIR) were estimated from food frequency questionnaires at recruitment. Hazard ratios (HRs) and 95% confidence intervals (CI) for the association between dietary patterns and pancreatic cancer were calculated using multivariable Cox proportional hazards regression models, adjusted for relevant confounders. Adherence to DRRD showed no association with risk of pancreatic cancer (HRT3vsT1 = 0.94, 95% CI 0.79-1.12). Higher adherence to EDIH was associated with a borderline 19% increased pancreatic cancer risk (HRT3vsT1 = 1.19, 95% CI 0.99-1.44). No significant associations were observed in relation to EDIR. No heterogeneity was observed among the subgroups. Higher adherence to a hyperinsulinemic dietary pattern may contribute to the risk of developing pancreatic cancer in our population. Further research is warranted to elucidate the potential role of dietary factors in cancer risk prevention.
Sports nutrition experts are commonly employed by professional collision sports teams to provide nutrition support to athletes, including guidance related to concussions and repeated head impacts. At present, there are limited clinical guidelines to base dietary advice regarding concussions, which may result in differing management approaches. This study aimed to explore the practices and perspectives of sports dietitians working in professional-level Australian collision sports (Australian Rules Football, Rugby League, and Rugby Union) regarding nutrition strategies for concussion management. Online semi-structured interviews were conducted with 14 Accredited Sports Dietitians. A qualitative descriptive methodological approach guided data collection and analysis, with structured content analysis used to identify key categories. Quantitative summaries of supplement practices were also reported. Five categories were identified: 1) the dietitian's role in concussion management:dietitians considered themselves integral to multidisciplinary concussion management and were primarily involved after concussion; 2) nutrition strategies for concussion and brain health: which included dietary adjustments to manage symptoms and supplementation with fish oil and creatine monohydrate (93% of participants) to mitigate potential neurological sequelae; 3) confidence in management of concussion: dietitians felt confident in recommending strategies for concussion that were commonly used for other indications (e.g., creatine monohydrate supplementation for performance enhancement) but were less certain when providing tailored/individual recommendations, particularly in complex cases; 4) barriers to and enablers of recommendations: that spanned from individual level (e.g., symptoms affecting dietary intake) to organizational level (e.g., financial resourcing to support supplementation protocols); and 5) differences in care between squads and codes: in female and academy squads compared with their professional-level male counterparts. Sports dietitians in Australian collision sports actively contribute to concussion management, despite limited clinical guidelines. Further clinical research and the development of evidence-informed guidelines are critical to enhance the integration of nutrition into multidisciplinary concussion management and ensure optimal recovery for athletes.
A soft matter physics framework offers a systematic approach to designing texture-modified foods (TMFs) that can improve swallowing safety, nutritional adequacy, and acceptability in older adults with dysphagia, malnutrition, and sarcopenia. This narrative review synthesizes experimental and clinical studies published from 2020 onward that treat TMFs as soft matter systems, including gels, emulsions, and composite biopolymer networks, used in geriatric nutrition and dysphagia care. Evidence on rheology, tribology, microstructure, particle size, protein-polysaccharide and emulsion gels, 3-dimensional (3D) food printing, and thermal and nonthermal processing is integrated to relate material parameters to swallowing safety and nutritional outcomes. Across studies, safer boluses are consistently soft, shear thinning, cohesive, low adhesive, and sufficiently extensible, with quantitative windows of viscosity, yield stress, viscoelastic moduli, extensional viscosity, and friction offering better prediction of swallowability than qualitative texture levels alone. Protein-polysaccharide gels, emulsion-filled matrices, plant-based networks, and 3D-printed structures can be engineered to meet standardized dysphagia diet levels while increasing protein density, hydration, and delivery of bioactive compounds. Processing conditions and particle-size control further tune tenderness, cohesion, digestibility, and nutrient bioaccessibility. A physics-aware soft matter approach thus provides actionable design rules linking formulation and processing to bolus flow, lubrication, and sensory properties, enabling TMFs that are safer, more palatable, and more nutritious for older adults, although phenotype-specific targets and long-term clinical trials remain important gaps for future research on healthy aging. Unlike prior reviews that emphasize either clinical dysphagia management or processing technologies in isolation, this work uniquely integrates rheology, tribology, microstructure, particle size, 3D printing, and thermal/nonthermal processing under a single soft matter physics design framework and translates these soft matter descriptors into quantitative, phenotype-aware engineering windows for safer and more nutritious geriatric TMFs.
Ultraprocessed foods (UPFs) are a major component of modern diets and are associated with many adverse health outcomes. Accurate assessment of UPF consumption is essential for nutritional research. We compared estimates of UPF consumption derived from 24-h dietary recall (24HDR) and food frequency questionnaire (FFQ) data in the National Health and Nutrition Examination Survey (NHANES) 2003-2006 and assessed agreement between these methods in classifying UPF consumption. This study included 10,937 participants in the NHANES 2003-2004 and 2005-2006 cycles with FFQ and 24HDR data. UPFs were classified according to the Nova classification system. Spearman's rank correlation coefficients and weighted κ statistics were used to assess agreement between 24HDR and FFQ in estimating UPF intake. The Wilcoxon signed-rank test was used to compare mean UPF intake percentages reported by the 2 methods. FFQ weights were used to account for sampling. UPFs accounted for 34.7% of energy using the FFQ and 52.2% of energy intake using the 24HDR, with a mean difference of 18.9% of energy (P < 0.001). This difference was observed across age, sex, and race subgroups. There was a weak positive correlation (Spearman's r: 0.20; P < 0.001) and slight agreement (weighted κ: 0.05) in classifying energy intake from UPF using the 2 methods. The difference in estimating UPF intake by 24HDR and FFQ was substantially smaller after reclassifying food items on the FFQ with an ambiguous classification level. Differences in UPF intake estimates are consistently observed between FFQ and 24HDR in the overall United States population and across demographic subgroups. Nova classification decisions for foods with ambiguous processing levels may contribute to differences between methods, highlighting the need for standardized approaches to classifying foods according to processing level. These findings highlight the need to further the development of dietary assessment instruments designed to capture UPF consumption.
Longitudinal studies suggest that diets encouraging a higher intake of fruits and vegetables and a lower intake of red meat are associated with a lower risk of laparoscopically confirmed endometriosis. However, no studies have examined whether plant-focused dietary patterns are associated with endometriosis risk. This study aimed to investigate the association between 3 plant-based diet indices and the risk of laparoscopically confirmed endometriosis in a predominantly omnivorous population. We followed 82,084 premenopausal women participating in the Nurses' Health Study II for 30 y. Diet was assessed using a validated food frequency questionnaire every 4 y. We calculated an overall plant-based diet index (PDI), a healthful plant-based diet index (hPDI), and an unhealthful plant-based diet index (uPDI); higher scores indicated greater intake of plant foods and lower intake of animal foods. Laparoscopically confirmed endometriosis was ascertained from 1993. We used Cox proportional hazards models with age in months to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). During 1,038,888 person-years of follow-up, 3829 cases of laparoscopically confirmed endometriosis were reported. We observed no association between PDIs and endometriosis risk. The HRs of each plant-based diet index with multivariable-adjusted models comparing participants in the highest quintile of adherence to those in the lowest quintile were 1.01 (95% CI: 0.91, 1.13) for PDI, 1.07 (95% CI: 0.96, 1.20) for hPDI, and 1.05 (95% CI: 0.94, 1.16) for uPDI. Estimates were consistent regardless of infertility status. This study suggests that variation in the proportion of plant to animal foods, as captured by plant-based diet indices within predominantly omnivorous populations, is unrelated to the risk of laparoscopically confirmed endometriosis.
Almonds contain dietary fiber, micronutrients, and phytochemicals that have been implicated in the regulation of the gut-brain axis and mental health. The aim of this study was to investigate the effect of whole almonds, compared with an isocaloric snack, on mental health and the gut-brain axis, in adults with symptoms of anxiety and depression. Adults with mild-to-moderate symptoms of anxiety and depression participated in a randomized controlled trial, receiving almonds (56 g/d) or isocaloric control for 12 wk. The primary outcome was symptoms of anxiety and depression (Patient Health Questionnaire Anxiety and Depression Scale) at week 12. Secondary mental health outcomes were measured at weeks 0, 6, and 12. Gut microbiota composition (16S rRNA gene sequencing), short-chain fatty acids (SCFAs; gas chromatography), stool output (frequency and consistency), and gut symptoms (7-d diary) were measured at weeks 0 and 12. Eighty-four participants were recruited (mean age 25 y, 75% female). There was no significant difference in anxiety and depression scores between the almond (mean ± SD, 11.6 ± 5.3) and control group (12.5 ± 5.3; P = 0.945). Functional impairment was borderline significantly improved in the almond group (9.6 ± 7.0) compared with control (12.2 ± 8.7, P = 0.055) in the intention-to-treat analysis and was significant in the per-protocol analysis (almond 9.0 ± 6.4 compared with control 12.5 ± 9.6; P = 0.015). Almonds did not alter the gut microbiota composition or SCFA concentrations. Almonds significantly reduced the frequency of hard stools compared with control (median [interquartile range]: 0.0 [0.1] compared with 0.1 [0.4] stools/d, P = 0.002), with no impact on gut symptoms. Almond consumption for 12 wk has limited impact on anxiety and depression, although it may impact functional impairment in adults with mild-to-moderate anxiety and depression. Further research is needed in populations with severe depression and anxiety. This trial was registered at clinicaltrials.gov as NCT06087471.
Multiple micronutrient deficiencies, including zinc deficiency, remain highly prevalent among pregnant women in many low- and middle-income countries and are associated with a multitude of adverse outcomes. The objectives of this analysis were to assess the impacts of prenatal multiple micronutrient supplements (MMS) compared with iron and folic acid (IFA) supplements on maternal zinc status among pregnant women at 36 weeks of gestation and to assess associations with birth outcomes. We analyzed plasma zinc concentrations at baseline (<20 weeks of gestation) and late pregnancy (36 weeks of gestation) from a subset of pregnant women randomly assigned to receive either daily MMS (containing 30 mg/d zinc) or IFA supplements (n = 125/group) in the iLiNS-DYAD trial in Ghana. Gestational and infant anthropometric outcomes were measured at birth. At baseline, mean ± standard deviation (SD) plasma zinc concentration was 61.9 ± 13.6 μg/dL, and 16.5% of women were zinc deficient. At 36 weeks of gestation, mean ± SD plasma zinc concentration was lower compared with baseline, but did not differ significantly between groups (IFA: 52.2 ± 8.1 μg/dL compared with MMS: 52.9 ± 9.5 μg/dL; P = 0.25). Similarly, there was no difference in the estimated prevalence of zinc deficiency between groups at 36 wk (IFA: 43.0% compared with MMS: 38.4%; P = 0.24). There were a few significant associations between maternal plasma zinc concentrations or zinc deficiency and birth outcomes. Daily MMS supplementation for ≥16 wk during pregnancy did not significantly increase plasma zinc concentrations, and the prevalence of zinc deficiency increased over the course of pregnancy. Other complementary interventions to address both nutritional and underlying nonnutritional causes of zinc deficiency may be necessary to improve zinc status during pregnancy in this and other vulnerable populations. The trial was registered at clinicaltrials.gov as NCT00970866. https://clinicaltrials.gov/study/NCT00970866.
food insecurity in the Democratic Republic of Congo affects over 25 million people, with Kasaï Oriental Province among the most impacted-approximately 74.9% of households face acute food shortages. While food access has been widely studied, evidence on intra-household, gender-based differences in dietary diversity is limited, particularly in highly food-insecure urban settings. This study aimed to investigate the differences in dietary diversity between men and women in Mbuji-Mayi and to identify the household- and individual-level factors associated with these differences. a cross-sectional study was conducted among 360 households selected by multistage random sampling, from Bonzola Health Zone, Mbuji-Mayi City. Data were collected through interviews using an electronic questionnaire. Dietary diversity was assessed using 24-hour dietary recall scores for men and women. Differences in dietary diversity scores were tested using the Mann-Whitney U test. Poisson regression models were used to identify predictors of dietary diversity for men and women, while a generalized linear model was used to assess the determinants of dietary diversity differences within households. women had significantly higher dietary diversity scores than men (p=0.030). Key factors associated with the difference in dietary diversity scores between women and men (DDS-WM) included wealth index (β=-0.159; p=0.001), household size (β=-0.139; p=0.004), number of meals per day (β=-0.127; p=0.008), education level of the household head (β=-0.146; p=0.003), and the reduced Coping Strategies Index (rCSI) (β=0.100; p=0.029). these findings revealed disparities in dietary diversity between men and women in Bonzola, and some associated factors were also identified. They highlight the need for gender-sensitive approaches in nutrition policies and programs to ensure equitable dietary outcomes in food-insecure settings.