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The rapid growth of e-commerce has highlighted the need for enhanced customised services and operational efficiency. The presented research presents a novel hybrid framework that combines Collaborative Filtering (CF), Matrix Factorisation (MF), and Reinforcement Learning (RL) to enhance the consumer experience and streamline backend operations. By leveraging historical data, this approach provides a dynamic and adaptive system that does not rely on real-time data. While CF and MF are effective at creating personalised recommendations, RL introduces adaptive pricing strategies that take into account market demand and competitor actions, outperforming static models. In addition, Natural Language Processing (NLP) is used to analyse customer feedback, providing sentiment insights that improve customer service. AI-powered automation also optimises supply chain management by improving inventory forecasting, lowering costs, and increasing efficiency. Experimental results on the Retailrocket, Instacart, and Amazon Reviews datasets demonstrate that the hybrid model outperforms traditional approaches. On Retailrocket, the model outperformed baseline models by converting 19.1% and retaining 28.5% of customers. Profitability increased by 6.3%, while the model reduced RMSE to 1.05 and MAE to 0.27 on Retailrocket. These findings show the framework’s ability to improve both personalised recommendations and business operations, making it a scalable solution for e-commerce platforms.

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Nutrition plays a pivotal role in cancer prevention, management, and treatment. To address cancer disparities, reduce risk, and improve outcomes for patients, it is critical to implement Food is Medicine interventions across the care continuum, supported by robust, evidence‐based research, strong community clinical partnerships, and effective policy design that successfully integrates nutrition into oncology practice.

Although the broad outlines of a healthy diet are clear, controversy has arisen surrounding certain foods and nutrients. This review updates contemporary nutrition controversies and the extent to which they may promote or protect against cardiovascular disease (CVD). In this review, beef tallow, ultraprocessed foods, full-fat dairy, seed oils, medium chain triglyceride oils, seafood, and alternative sweeteners are considered. Three groupings included: 1) evidence of harm with a recommendation to limit or avoid; 2) lacking in evidence for harm or benefit; and 3) evidence of benefit. The evidence of harm category included beef tallow, due to association with increased low-density lipoprotein cholesterol, ultraprocessed foods associated with worsened cardiometabolic health, and artificial sweeteners owing to correlations with increased CVD. Within the category lacking in evidence were full-fat dairy, medium chain triglyceride, monk fruit, and stevia. Finally, evidence of benefit included seed oils and seafood based on improved CVD outcomes.

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Smaller quasi-experimental studies and short-term controlled trials of medically tailored meals (MTMs) have shown health benefits for several conditions, but MTMs have not been evaluated in large-scale policy initiatives. Multiple US states are now implementing MTMs in Medicaid, the health insurance program for low-income individuals, yet their impact has not been evaluated. We investigated changes in hospitalizations, emergency department (ED) visits and healthcare costs among 1,866 MTM recipients and 1,372 comparators from 2020 to 2023 across 11 health systems in Massachusetts. Both groups met eligibility criteria for diet-related conditions and food insecurity. We used propensity overlap-weighted generalized estimating equations to compare a 6-month baseline period to the program period. MTM receipt (mean, 6.7 months) was associated with 31% fewer hospitalizations (adjusted incidence rate ratio (aIRR) = 0.69 (95% confidence interval (CI): 0.58-0.82)), 20% fewer ED visits (aIRR = 0.80 (95% CI: 0.72-0.89)) and US$3,433 lower total healthcare costs (95% CI: $-1,215 to -$5,651). Healthcare cost reductions offset 98% of the MTM program costs during the enrollment period. Findings were robust across sensitivity analyses, a negative control test and a secondary comparison group. In stratified analyses, MTM receipt was net cost-saving among participants with cardiovascular disease, chronic kidney disease, depression, diabetes or high comorbidity. This large MTM policy evaluation informs consideration of 'food is medicine' therapies in clinical care.

[This corrects the article DOI: 10.1016/j.obpill.2026.100268.][This corrects the article DOI: 10.1016/j.obpill.2025.100181.].

Nutrition security is increasingly recognized as a critical but underexamined driver of health. Identifying barriers to nutrition security is essential for developing effective interventions. To examine associations among barriers to healthy eating, their prevalence by sociodemographics, and their associations with health conditions. In this cross-sectional study, a population-based survey was conducted between February and April 2023 among English-speaking US adults aged 18 years or older recruited and surveyed through the Qualtrics panel service, with oversampling among people with annual household incomes less than $50 000. Data were analyzed from March 18 to November 9, 2025. Nutrition security status and barriers to nutrition security, assessed through the Nutrition Security Screener. Primary outcomes were health conditions: type 2 diabetes, obesity, heart disease, high blood pressure, high cholesterol, stroke, and cancer. Independent variables were nutrition security barriers. Covariates included age, gender, race, ethnicity, educational attainment, annual household income, and food security status. Multivariable regressions with health condition outcomes were stratified by nutrition security status. Of 3009 survey respondents, 3000 provided information on barriers to nutrition security and were included in analyses (1518 [50.6%] were female; 1983 [66.1%] were between ages 18 and 49 years). A mean (SD) of 7.8 (3.0) barriers were reported among participants with nutrition insecurity compared with 4.4 (3.2) among those who had nutrition security. Most barriers were only modestly intercorrelated (mean [SD] r = 0.45 [0.13]), with the highest correlation (r = 0.86) between insufficient time to shop and to cook. Barriers clustered into 2 factors that explained 61.4% of the variance. Black adults had higher odds of transportation barriers (adjusted odds ratio [AOR], 1.56 [95% CI, 1.17-2.08]) than White adults, whereas Hispanic/Latinx adults had higher odds of nutrition assistance barriers (AOR, 1.65 [95% CI, 1.26-2.17]) than those who were non-Hispanic/Latinx. A higher number of barriers (per unit increase [range, 0-13]) was associated with higher prevalence of diabetes (AOR, 1.10 [95% CI, 1.04-1.16]), heart disease (AOR, 1.16 [95% CI, 1.07-1.24]), and obesity (AOR, 1.09 [95% CI, 1.04-1.14]) among adults with nutrition security and of heart disease (AOR, 1.12 [95% CI, 1.03-1.22]) and stroke (AOR, 1.12 [95% CI, 1.02-1.25]) among those with nutrition insecurity. In this study among US adults, barriers to nutrition security were interrelated, varied across demographics, and were associated with disease conditions. These findings provide new insights into how barriers to healthy eating can be assessed, informing more targeted clinical, public health, and policy initiatives.

In this narrative review complemented by a novel meta-analysis, we critically analyzed current scientific evidence from RCTs and cohort studies regarding the impact of non-nutritive sweeteners (NNS) on cardiometabolic health, and assessed the interplay with the gut microbiome as a potential mechanistic pathway. We focused on the question of direct physiological effects of NNS, rather than the additional effects of energy displacement by NNS, to inform future research and the development of dietary and clinical guidelines. Cohort studies assessing NNS from all dietary sources suggest that total NNS and each commonly used NNS are associated with higher risk of type 2 diabetes, and that total intake and specific agents are associated with certain cardiovascular disease outcomes. These findings are consistent with prior evidence from cohorts focusing on NNS in beverages. Such observational evidence may be confounded by reverse causation: people at higher cardiometabolic risk choosing to use NNS. However, our new meta-analysis of RCTs with non-caloric comparators and a recent RCT on glycemia outcomes with human-to-mice microbiota transplant suggest that NNS have harmful effects on glucose-insulin homeostasis including fasting insulin, HbA1c, and glucose area under the curve during oral glucose tolerance test (OGTT), potentially mediated by effects on the composition and functional potential of the gut microbiome. The summed evidence supports potential long-term risk of cardiometabolic diseases associated with NNS intake and short-term harmful effects of NNS on glycemia. Future clinical trials of physiologic effects and molecular mechanisms will strengthen interpretations and causal inference. Given potential for harm, caution is warranted for the use of NNS.

Taxes on sugar-sweetened beverages can improve public health. We aimed to characterise the extent and types of sugar-sweetened beverage taxes implemented worldwide and the national characteristics predicting implementation, such as sugar-sweetened beverage intake amounts, disease rates, or economic development. This longitudinal analysis aggregated serial global datasets (including the Global Dietary Database, Non-Communicable Diseases Risk Factor Collaboration, Global Burden of Disease study, and World Bank data) from 1990 to 2024 in 183 countries to assess sugar-sweetened beverage tax characteristics and national predictors of policy adoption. Sugar-sweetened beverage taxes for public health purposes were identified and characterised, including amounts, fiscal instruments, structures, and covered beverages. Sugar-sweetened beverage consumption, obesity and diabetes prevalence, gross domestic product (GDP), and sociodemographic index (SDI) were assessed as predictors of tax implementation using Cox proportional hazards models with time-varying covariates. From 1990 to 2024, 64 countries implemented sugar-sweetened beverage taxes, accelerating over time and covering 3·5 billion people globally. South Asia led in adoption (50% of countries; median tax rate 7·5%), followed by southeast and east Asia (47·8%; 5·0%), the Middle East and North Africa (30·0%; 17·0%), and Latin America and the Caribbean (31·3%; 7·0%). Taxes were ad valorem (ie, based on price; 45%), volume-based (44%), sugar-content-based (5%), or mixed (6%), and 13% of countries earmarked revenue for public health. Multivariable-adjusted predictors of tax implementation included diabetes prevalence (hazard ratio [HR]=1·22 [95% CI 1·05-1·43]), obesity prevalence (1·14 [1·00-1·29]), GDP per capita (HR per $10 000: 1·19 [1·06-1·34]), and SDI (0·70 [0·57-0·86]), but not sugar-sweetened beverage intake (0·77 [0·42-1·39]). Global adoption of sugar-sweetened beverage taxes has rapidly accelerated since 1990; however, there is important heterogeneity by region and tax structure, and the taxes are shaped by a country's economic capacity, social development, and health conditions. This work was supported by the National Institutes of Health (R01HL115189).

This economic evaluation examines the 10-year US pricing and affordability for glucagon-like peptide-1 receptor agonists (GLP-1RAs) for obesity treatment in Medicare.

Food and nutrition insecurity are linked to poor health outcomes and disparities, yet how health care systems implement screening and referrals remains poorly understood. We searched for studies evaluating screening and referral processes for food and nutrition insecurity for patients of all ages in US health care settings. Searches were performed through May 2025 in MEDLINE (via PubMed), Cochrane (via Ovid), Cumulative Index of Nursing and Allied Health (EBSCO), and Social Interventions Research and Evaluation Network Evidence and Resource Library. Studies were included if they reported both a screening process and referral mechanism. Findings were synthesized narratively. Of 11 406 records identified, 136 studies met the inclusion criteria; all screened for food insecurity, and none screened for nutrition insecurity. Most studies screened general populations across age, sex, race, and ethnicity, with few restricting by socioeconomic status or clinical conditions. Screening primarily used tools embedded within broader social determinants of health screenings (46%) and integrated into electronic health records (48%), typically in outpatient settings (49%). Screening methods varied, most commonly self-administered by patients (21%) or by clinic staff (20%) and were unspecified in one fifth of studies (21%). A total of 129 studies described 39 unique referral strategies across 4 categories: community-based resources (46%), health care-embedded services (35%), federal nutrition programs (12%), and Food Is Medicine interventions (7%), with 46% spanning multiple categories. While about half of studies (46%) reported referral rates, only about one third (37%) reported referral completion. These findings highlight current practices and evidence gaps, informing priorities to strengthen screening and referral systems that advance food security, nutrition, health, and health equity.

The COVID-19 pandemic exacerbated issues of poverty and food insecurity in New York City, and many residents experienced difficulty accessing available resources to help them get food on the table. Social media presents an opportunity to observe and understand the barriers people face in accessing affordable, nutritious, and culturally appropriate foods. This study aims to explore the food access discourse during the COVID-19 pandemic on Twitter (subsequently rebranded as X) in New York City by analyzing publicly available tweets posted from March 1, 2020, to March 31, 2021. Tweets posted by individuals in New York City during the first 13 months of the COVID-19 pandemic were collected using the observation platform Talkwalker. We categorized a list of multiple keywords into related groups (search strings). Data were cleaned to keep only tweets relevant to food insecurity and food access in New York City and remove duplicate tweets. The software Botometer was used to remove accounts considered to be bots. Topic modeling was used to group these tweets into relevant themes, which were analyzed. The top viral tweets (ie, tweets that received the highest number of retweets in New York City) from this period were further analyzed. We identified 6 major themes (with subthemes) that emerged from the analysis (in order of popularity): community efforts, public assistance programs, grocery shopping and food workers, school foods, millions go hungry, and food justice. Interesting terms that emerged from the data were also identified. Overall, quantities of tweets increased in correlation with current events, such as the closure of New York City public schools; the expansion of the Supplemental Nutrition Assistance Program and unemployment benefits; the proliferation of mutual aid groups in the spring of 2020; and the May Day Instacart, Amazon, and Target strike in 2020. Findings revealed that in the earliest months of the COVID-19 pandemic, Twitter users in New York City quickly responded to the wave of need by sharing information and resources about food access in their communities. Some users turned to Twitter to either solicit or offer help finding food. Furthermore, the platform lent itself to many conversations about the policies enacted on a federal, state, and city level to help feed New Yorkers in need. Future research on this topic should include an analysis of social media posting on platforms such as Facebook, as well as languages other than English. Results from this type of research can provide information to community leaders and elected officials to better address future crises.

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Trimethylamine-N-oxide (TMAO) is a gut microbiome-derived metabolite of choline, L-carnitine and lecithin, abundant in animal source foods. In experimental models, higher blood TMAO levels enhance atherosclerotic cardiovascular disease (ASCVD). However in humans, most prior studies have evaluated high risk or secondary prevention populations, and no studies have investigated relationships in a diverse, multi-ethnic population. We evaluated 6,767 US adults free of ASCVD at baseline in the community-based Multi-Ethnic Study of Atherosclerosis (MESA), including 38% identifying as White; 28%, as Black; 22%, as Hispanic; and 12%, as Chinese adults. Plasma TMAO was measured serially at baseline and 5-years, and its time-varying association with incident ASCVD determined using Cox proportional hazards. Multivariate analyses adjusted for time-varying demographics, lifestyle factors, medical history, lipid measures, antibiotic use and dietary habits. During median 11.3 years follow-up, 852 ASCVD events occurred. After multivariate adjustment, TMAO associated with higher risk of ASCVD in a dose-dependent fashion, with hazard ratios across quintiles of 1.02, 1.17, 1.23, and 1.33 (95% CI 1.02, 1.74), respectively, compared to the lowest quintile (P-trend = 0.01). Risk appeared possibly larger among Hispanic and Chinese adults; and among individuals with lower baseline renal function; although these interactions did not achieve statistical significance. Plasma concentrations of TMAO associated with higher risk of incident ASCVD in this multi-ethnic US cohort, supporting a need to test dietary and pharmacologic interventions targeting the diet-microbiome axis for potential cardiovascular risk prevention in diverse populations.

The US Food and Drug Administration (FDA) has finalized a new front-of-package binary healthy label for packaged foods. Effects of this governmental label compared with a more holistic food rating score on consumer purchases are unknown. To evaluate the effects of the continuous Food Compass Score (FCS) and FDA healthy label in a real-choice randomized trial. This randomized clinical trial used real-choice experiments among adults recruited on-site at 6 locations of 3 supermarket chains in diverse neighborhoods across Massachusetts from July to November 2023. Participants were randomized into 2 treatments: FCS (1-100) and FDA healthy (binary) labels. Real-choice experiments tested purchasing decisions comparing different snack foods with and without both label treatments, with these decisions leading to an actual final purchase. Each treatment group had 12 choice scenarios (6 labeled and 6 unlabeled) in which they could choose either 1 of 3 products or no product. Purchase choices (healthy product [defined as FCS&#x2265;70], unhealthy product, or no purchase) in multiple choice scenarios, recorded in-person by investigators, and willingness to pay for different features. This study included 275 adults, with a median (IQR) age of 55 (38-66) years, and 175 (63.6%) were female. Compared with no label, both labels increased the purchase of healthier products (FCS: 11.2 [95% CI, 8.2 to 14.2] per 100 choices; P&#x2009;<&#x2009;.001; FDA healthy: 6.4 [95% CI, 3.4 to 9.4] per 100 choices; P&#x2009;<&#x2009;.001). Both labels also reduced the purchase of unhealthy products (FCS: -7.2 [95% CI, -9.9 to -4.6] per 100 choices; P&#x2009;<&#x2009;.001; FDA healthy: -6.3 [95% CI, -9.0 to -3.6] per 100 choices; P&#x2009;<&#x2009;.001). The FCS, but not FDA, label also reduced the occurrence of no purchases by 4.0 (95% CI, 1.8 to 6.1) per 100 choices (P&#x2009;<&#x2009;.001). Compared with the FDA healthy label, the FCS label increased healthy purchases by 1.75-fold (93 of 828 purchases [11.2%] vs 53 of 822 purchases [6.4%]). In this randomized clinical trial, both labels increased healthy and decreased unhealthy product purchases, with larger effects as well as decreases in no-purchase decisions with the FCS label. These results can inform labeling decisions by policymakers, retailers, and manufacturers.

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The consumption of sugar-sweetened beverages (SSBs) is associated with type 2 diabetes (T2D) and cardiovascular diseases (CVD). However, an updated and comprehensive assessment of the global burden attributable to SSBs remains scarce. Here we estimated SSB-attributable T2D and CVD burdens across 184 countries in 1990 and 2020 globally, regionally and nationally, incorporating data from the Global Dietary Database, jointly stratified by age, sex, educational attainment and urbanicity. In 2020, 2.2 million (95% uncertainty interval 2.0-2.3) new T2D cases and 1.2 million (95% uncertainty interval 1.1-1.3) new CVD cases were attributable to SSBs worldwide, representing 9.8% and 3.1%, respectively, of all incident cases. Globally, proportional SSB-attributable burdens were higher among men versus women, younger versus older adults, higher- versus lower-educated adults, and adults in urban versus rural areas. By world region, the highest SSB-attributable percentage burdens were in Latin America and the Caribbean (T2D: 24.4%; CVD: 11.3%) and sub-Saharan Africa (T2D: 21.5%; CVD: 10.5%). From 1990 to 2020, the largest proportional increases in SSB-attributable incident T2D and CVD cases were in sub-Saharan Africa (+8.8% and +4.4%, respectively). Our study highlights the countries and subpopulations most affected by cardiometabolic disease associated with SSB consumption, assisting in shaping effective policies and interventions to reduce these burdens globally.

Glucagon-like peptide 1 receptor agonists and combination medications (GLP-1s) are shifting the treatment landscape for obesity. However, real-world challenges and limited clinician and public knowledge on nutritional and lifestyle interventions can limit GLP-1 efficacy, equitable results, and cost-effectiveness. We aimed to identify pragmatic priorities for nutrition and other lifestyle interventions relevant to GLP-1 treatment of obesity for the practicing clinician. An expert group comprising multiple clinical and research disciplines appraised the scientific literature, informed by expert knowledge and clinical experience, to identify and summarize relevant topics, priorities, and emerging directions. GLP-1s reduce body weight by 5-18&#xa0;% in trials, with modestly lower effects in real-world analyses, with multiple demonstrated clinical benefits. Challenges include side effects, especially gastrointestinal; nutritional deficiencies due to calorie reduction; muscle and bone loss; low long-term adherence with subsequent weight regain; and high costs with resulting low cost-effectiveness. Numerous practice guidelines recommend multicomponent, evidence-based nutritional and behavioral therapy for adults with obesity, but use of such therapies with GLP-1s is not widespread. Priorities to address this include: (a) patient-centered initiation of GLP-1s, including goals for weight reduction and health; (b) baseline screening, including usual dietary habits, emotional triggers, disordered eating, and relevant medical conditions; (c) comprehensive exam including muscle strength, function, and body composition assessment; (d) social determinants of health screening; (e) and lifestyle assessment including aerobic activity, strength training, sleep, mental stress, substance use, and social connections. During GLP-1 use, nutritional and medical management of gastrointestinal side effects is critical, as is navigating altered dietary preferences and intakes, preventing nutrient deficiencies, preserving muscle and bone mass through resistance training and appropriate diet; and complementary lifestyle interventions. Supportive strategies include group-based visits, registered dietitian nutritionist counseling, telehealth and digital platforms, and Food is Medicine interventions. Drug access, food and nutrition insecurity, and nutrition and culinary knowledge influence equitable obesity management with GLP-1s. Emerging areas for more study include dietary modulation of endogenous GLP-1, strategies to improve compliance, nutritional priorities for weight maintenance post-cessation, combination or staged intensive lifestyle management, and diagnostic criteria for clinical obesity. Evidence-based nutritional and lifestyle strategies play a pivotal role to address key challenges around GLP-1 treatment of obesity, making clinicians more effective in advancing their patients' health.