Nutrition and Health

Background: Human milk provided by healthy, well-nourished mothers represents the best food available for infants. Human milk is species-specific and recommended as the sole source of nutrition for the first 6 months of life and is an important food source until the infants reach 2 years of life. Unlike infant formula, which has a standardized composition, human milk composition varies among and within women. Aim: While many studies of human milk composition have been conducted, none have been done among the Orang Asli people in Malaysia. Hence, this study protocol is designed to determine the human milk composition of the Orang Asli in Peninsular Malaysia and how the transition of culture, nutrition, and different lifestyle experiences will affect the nutrient content of their milk. Methods: Quantitative (interviewer-administered questionnaire) and qualitative (focus group discussion) approaches will be employed in this study and in addition, laboratory works will also be carried out to analyze the nutrient composition of the milk samples collected from various Orang Asli subethnic groups in Peninsular Malaysia. Conclusion: Standardized, multipopulation studies of human milk composition are sorely needed to create a rigorous, comprehensive reference inclusive of nutrients and other factors. The establishment of any dietary parameters positively affecting the nutrient content of human milk may help design healthcare strategies in Malaysia to improve the quality of human milk and therefore the infants’ health status.

Background: Pancreatic cancer has an increasing incidence and prevalence trend. Its prognosis is negatively affected by poor/altered nutritional status. Therefore, nutritional interventions play a critical/pivotal role at any stage. Despite being included in the prehabilitation items of Enhanced Recovery After Surgery (ERAS) protocols for pancreatic surgery, nutritional recommendations concerning early post-discharge period are lacking. Aim: To assess the acceptability and feasibility of a personalized and standardized food plan for patients following pancreatic surgery. A secondary aim is to determine if adherence to a personalized food plan is linked to improved postoperative outcomes. Methods: A prospective monocentric cohort study will be performed, including 180 patients undergoing pancreatic surgery. Body composition, nutritional, muscular, and hydro-electrolyte status will be assessed with bio-impedance analysis (BIA). Patients will receive a personalized nutritional plan after discharge for the following 45 days. Summary: Detailed nutritional indications have been formulated with broad consensus for the pre-operative (prehabilitation) and postoperative period. No previous study has specifically formulated or validated a nutritional intervention focused on the early post-discharge period. The results of this study might contribute to paving the way for future research and to broaden nutritional recommendations within the ERAS protocol.

Background: Ultra-processed food (UPF) consumption is excessive across the United States (US). Understanding perceptions of food based on processing is critical to elucidate reasons for UPF intake and inform tool development for measuring related cognition. Aim: Design and evaluate perceptions of UPF and non-UPF food among general US adults. Hypothesis: Significant differences exist in perceived healthfulness across similar UPF and non-UPF foods. Methods: Photographs of foods were taken to represent eight pairs of similar UPFs and non-UPFs and presented in a Qualtrics survey with questions to gauge healthfulness from 0 to 10 (0 = completely unhealthy, 10 = completely healthy). Paired-samples sign tests were used to detect differences in ratings within pairs. Results: Participants (n = 100) rated stimuli within all pairs significantly differently (P < 0.001), indicating different perceptions of UPF and non-UPF. Conclusion: Adults perceive similar UPF and non-UPF as having different levels of healthfulness. Reasons for these differences warrant investigation.

Background: Preliminary studies suggest that creatine and guanidinoacetic acid (GAA) may function as moderate vasodilators, enhancing tissue oxygen saturation. However, the potential effects of this combination on brain oxygenation in humans remain unknown. Aim: The primary objective of this randomized controlled pilot trial was to assess cerebral blood oxygenation indices following a 7-day administration of a mixture containing creatine and GAA in healthy adults. Methods: Nineteen apparently healthy young adults (mean age 21.2 ± 0.4 years; 9 females) were randomly assigned to receive either a mixture (consisting of 2 g of creatine and 2 g of GAA) or a placebo in a crossover design. Oxygen saturation (SpO₂) and hemoglobin index (tHb) in the prefrontal cortex were assessed at rest (REST), during meditation that focused on mindful breathing (MED), during a three-component cognitive task (TASK), and during a post-task recovery (REC) before and after 7 days of supplementation. Results: Two-way ANOVA with repeated measures revealed statistically significant differences (treatment vs. time interaction) between interventions for SpO₂ during the REST (F = 5.733, P = 0.028), MED (F = 5.897, P = 0.026), and REC phases (F = 6.715, P = 0.018), indicating that the creatine-GAA mixture was more effective than placebo in enhancing oxygen saturation in the prefrontal brain both before, during, and after a cognitive task. Conclusion: These promising findings are of considerable interest for nutritional neuroscience but require validation through well-designed longitudinal trials with larger sample sizes. The study is registered at ClinicalTrials.gov (NCT06371651).

Background: Preclinical studies have suggested that dietary creatine may affect sleep quality yet no studies have explored the potential association between creatine consumption and sleep patterns or disorders in the general population. Aim: This cross-sectional study aims to examine the association between creatine consumption and sleep habits and disorders among individuals aged 16 years and older, using data from the 2007–2008 National Health and Nutrition Examination Survey (NHANES). Methods: The analysis included 5988 individuals (50.5% females) with a mean age of 47.4 ± 19.5 years. Daily creatine intake was assessed through individual in-person 24-h food recall interviews, categorizing respondents into two groups: those with suboptimal creatine intake (<1.00 g per day) and those meeting recommended intake (dietary creatine ≥ 1.00 g per day). Sleep was evaluated during household interviews using questions on sleep habits and disorders from the NHANES Sleep Disorders component. Results: The average daily creatine intake among participants was 0.88 ± 0.85 g (95% CI, 0.86 to 0.90), while the mean nightly sleep duration was 6.8 ± 1.5 h (95% CI, 6.8 to 6.9). Additionally, 1331 respondents (22.2%) reported consulting a doctor or health professional for sleep-related issues. Participants with suboptimal creatine intake had a significantly higher prevalence of trouble sleeping compared to those consuming recommended amounts (23.7% vs 19.3%; P < 0.01), with an odds ratio of 1.30 (95% CI: 1.13 to 1.48) for experiencing sleep disturbances. However, the prevalence of more severe sleep disorders did not differ significantly between the two creatine sub-populations (P > 0.05). Conclusion: Our findings suggest that participants meeting recommended creatine intake levels had a reduced risk of experiencing mild sleeping difficulties. These findings may serve as a basis for future interventional studies aimed at validating and confirming the potential benefits of dietary creatine in the field of sleep medicine.

Background: Vitamin A deficiency (VAD) impacts over 50% of children aged 6–59 months in sub-Saharan Africa, causing severe health issues. Despite the importance of vitamin A supplementation (VAS) programs, barriers limit their effectiveness, making it essential to understand these factors for better outcomes. Aim: This systematic review aimed to identify the barriers and facilitators to VAS programs in Africa, using the Consolidated Framework for Implementation Research (CFIR) to conceptualize the findings. Methods: A comprehensive search was conducted across OVID Embase, OVID Medline, Web of Science Core Collection, Scopus, CINAHL and CAB Direct. Studies were excluded if they did not report VAS administration via capsules or droplets in large-scale programs or omitted discussions on implementation barriers and facilitators. Results: The search yielded 4377 citations, with 10 studies meeting eligibility criteria, published from 2002 to 2021 across 12 countries. The most frequently represented were Ethiopia and Zimbabwe. A total of nine barriers and seven facilitators to VAS programs were identified. The most frequently cited barriers were capsule stock-outs, limited resources and lack of incentive for staff, while the most frequently cited facilitators were Child Health Days and involvement of community-based health workers. The key CFIR constructs associated with these findings were Tailoring Strategies, Incentive Systems and Available Resources. Conclusion: The barriers and facilitators identified in this review offer valuable insights for improving VAS coverage and implementation in Africa. Tailoring implementation strategies based on these findings can enhance the effectiveness and coverage of VAS programs.

Aim: The systematic review summarizes the current evidence on the efficacy and safety of iron replacement in patients with pulmonary hypertension (PH). Methods: A systematic literature search was conducted in electronic databases like PubMed, Scopus, Web of Science, and Embase up to April 2024. Eligible studies investigating iron replacement therapy in pulmonary hypertension patients were included in the review. Quality assessment of included studies was performed using standardized risk of bias tools. Results: Five studies met the study-eligible criteria and were included for review. Out of all final selected five studies, one was a randomized control trial (RCT), two were non-RCT, and two were observational studies. We observed an improvement in the six-minute walk distance (6MWD) test, iron indices, peak oxygen intake, and anaerobic threshold after the iron replacement. In all included studies, the iron replacement was tolerated well with no serious adverse events. Conclusion: Regardless of the variation in the study design, positive effects were observed on multiple outcome measures like the 6MWD test, cardiopulmonary exercise test parameter, and iron indices upon iron replacement in PH patients with iron deficiency. Further controlled trials are needed to enable better treatment group comparisons. Exploring long-term impacts on comorbidities, mortality, and disease progression would provide valuable insights for managing pulmonary hypertension.

Meat consumption has been a common food selection for humans for millennia. Meat is rich in amino acids, delivers vast amounts of nutrients and assists in short term health and hypertrophy. However, meat consumption can induce the activation of mTOR and IGF-1, accelerated aging, vascular constriction, atherosclerosis, heart disease, increased risk of diabetes, systemic inflammatory effects, cancers (including colorectal and prostate cancers), advanced glycation end products, impaired immune function / increased susceptibility to infection via downstream advanced glycation end product accumulation, polycyclic aromatic hydrocarbon ingestion, increased homocysteine levels among many other pathophysiologies. Research papers showing health benefits of meat consumption versus other papers showing the detriment of meat have led to confusion as many cohorts such as bodybuilding, health and wellness groups, carnivore diet practitioners, online social media longevity groups and more are interested in data that exists across the peer reviewed literature, however, few papers offer a super wide view where meat consumption benefits and pitfalls are taken into account.

Background: One of the side effects of doing sports activities is the increase of free radicals and oxidative stress. Aim: The present study aimed to investigate the effect of 8 weeks of increasing endurance training with L-arginine supplementation on oxidative indices in the cardiac organ of male Wistar rats. Methods: 32 male Wistar rats were divided into four groups control, L-arginine, endurance training, and L-arginine plus endurance training. Animals in the endurance training groups completed increasing endurance training on a motorized treadmill (60-min/session, 5 times/week) for 8 weeks. Animals in the L-arginine groups consumed an L-arginine solution daily (4 mg/kg/body weight). In the supplement group, L-arginine was given to the mice as a solution in water and as a gavage. Forty- eight hours after the last endurance training session, a heart tissue sample was taken and placed in an RNAlater liquid. Spectrophotometry and an ELISA kit were used to calculate the concentrations of glutathione peroxidase (GPX), malondialdehyde (MDA), and superoxide dismutase (SOD). Results: The present study showed that endurance training and L-arginine consumption did not affect SOD activity. L-arginine intake increased GPX. Endurance training caused a significant increase in MDA compared to the supplemented group (p = 0.01). Also, the consumption of L-arginine significantly increased the total antioxidant capacity TAC in the supplement group compared to the control group (p = 0.001). Conclusion: It seems that taking an L-arginine supplement can increase antioxidant enzymes.

Purpose: No dietary interventional studies have reported the impact of olive oil on cardiovascular risk markers in groups of different ethnic origins. We report a pilot randomised controlled trial of an intervention supplementing extra virgin olive oil (EVOO) on markers of cardiovascular risk among East Asian Chinese, and European Caucasian individuals. Methods: A cross-over, randomised controlled dietary intervention for 2 weeks was undertaken. Thirty-two adults, healthy, individuals of Chinese and European origin took part in this study. 24-h ambulatory systolic and diastolic blood pressure (SBP, DBP), and blood lipids, were assessed. Results: Positive benefits of EVOO consumption were observed in all participants. Lower 24-h ambulatory SBP (−4.3 mmHg; p = 0.020), and day-time SBP (5.528 mmHg; p = 0.008), night-time DBP (−3.784 mmHg; p = 0.008) and night-time MAP (−3.747 mmHg; p = 0.007) were seen in all participants independently of covariates. In addition, total cholesterol (7.9 mg/dL; p = 0.017) and LDL-cholesterol (6.5 mg/dL; p = 0.028) were increased with butter but not with olive oil. No significant difference in other cardiovascular risk factors were observed. However, differences were observed between Caucasians and East Asian individuals in the absence of significant differences in lifestyle. Conclusion: This pilot study suggests that consumption of EVOO should be advocated as a healthier dietary fat and recommended to replace butter as a dietary strategy to improve cardiovascular health in both Caucasians and East Asian individuals.

Background: In recent years, there has been an increase in the variety and consumption of commercial infant and toddler food products. Aim: The aim of this study is to evaluate the nutritional profiles of commercial infant and toddler food products sold in Turkey. Methods: A cross-sectional survey of the nutritional composition of products available at in-store and online supermarkets in Turkey was derived from the nutritional information panel on the product label or information provided on manufacturer websites in March 2023. The targeted age group, package type, serving size, ingredients list, and nutrition information (energy [kcal], protein [g], total fat [g], carbohydrate [g], dietary fiber [g], total sugar [g], and sodium [mg] per 100 g) were recorded. Results: Of the 189 products identified, more than 90% (n = 47) of the first foods were fruit-based, while 2% (n = 4) contained only vegetables. Almost half of the products (n = 89, 49%) contained added sugar or sweeteners, 41 (22%) had added sugar, and 1 in 3 products (n = 68, 36%) had sugar from fruit-based sources. One in 10 products (n = 18, 9.5%) contained added salt while 40% of the products (n = 76) were above the WHO Europe sodium standards. Almost half of the products (n = 6, 46%) targeting the 12 months older age group were pureed foods using squeeze pouch packaging. Conclusions: The majority of commercial infant and toddler food products did not adhere to nutrition guidelines. There is a need for stronger composition standards for commercial infant and toddler food products by reducing sugar and sodium content, reducing the use of fruits and sweet vegetables, and increasing the variety of products containing different types of vegetables.

Background: Selenium is an essential micronutrient for human growth and development. Breast milk is usually the primary source of this nutrient for infants which is fundamental for their healthy brain development; its deficiency can lead to severe neurocognitive outcomes. The concentration of selenium in breast milk is dependent on the maternal diet. Aim: This study assessed associations between maternal diet and levels of selenium concentrations in breastmilk and serum of 124 lactating mothers. Methods: Breast milk and serum samples were collected from lactating mothers whose breast-fed infant was at least one month old. A validated food frequency questionnaire was used to collect information on dietary intake. Descriptive statistics were used to summarize the data while paired t-test was used to determine any statistically significant differences between sample means. Spearman's rank correlation analysis was used to determine associations between breast milk and serum selenium concentrations and study variables. Results: Average time postpartum was 2.9 months while mean concentrations of selenium in breast milk and serum were 6.57 ± 2.69 and 68.48 ± 26.86 µg/L, respectively. Levels of selenium in breast milk and serum were deficient for more than half of the lactating mothers. No statistically significant associations were found between breast milk selenium concentration and time postpartum as well as maternal diet except for eggs (r = 0.23, p = 0.01). Conclusion: The evidence of deficient concentrations of breast milk selenium indicates a poor correlation with maternal diet and suggests the need for postpartum screening of breastfeeding mothers.

Background: This study seeks to further our understanding of the factors associated with adolescent athletes and disordered eating, by expanding current research into a less-explored eating disorder known as orthorexia. Aim: The aim of the study is to explore the impact of parents’ relationships and emotional regulation on the orthorexia nervosa (ON) tendencies of adolescent athletes. Methods: The participants were 303 adolescents, ranging from 15 to 17 years old, of which 139 participated in competitive sport, and 164 did not. Three self-report questionnaires were administered to assess orthorexia (ORTO-15), relationship with parents (Inventory of Parent and Peer Attachment) and emotion regulation (Emotion Regulation Questionnaire). Results: The results highlight that those who practice sports report higher levels of orthorexia, inadequate relationships with parents, as well as greater emotional regulation difficulties. Furthermore, inadequate parents’ relationship predicts orthorexia while expressive emotional regulation mediates this relationship. Conclusion: These findings highlight how ON tendencies in athletes are linked to poor management of emotions combined with inadequate relationships with parents in terms of communication and affection. Implications for practice and support for athletes are discussed.

Background: The pink color enhances the perceived sweetness, increasing the individuals’ expectation of the presence of sugar/carbohydrate in a beverage. Hence, it is plausible to speculate that providing a pink solution during exercise could induce an ergogenic benefit through a potential placebo effect. Aim: We examined whether ingesting a pink non-caloric, artificially sweetened solution can improve endurance strength exercise performance and psychological responses. Methods: Eighteen strength-trained individuals (34 ± 7 y; 1.74 ± 0.06 m; 79.86 ± 10.91 kg) completed three experimental trials in a randomized, single-blind, crossover counterbalanced fashion. In each trial, participants performed a 5-set strength endurance test at 70% of the one-repetition maximum in the bench press exercise, interspersed by 2 min. Before each set, participants ingested either a pink (PINK) or a transparent (TRANSP) non-caloric, artificially sweetened solution. A session without ingestion (CON) was also completed. Total number of repetitions and psychological responses such as motivation, emotional arousal, affect, and ratings of perceived exertion were obtained throughout the exercise protocol. Results: Total repetitions improved in PINK (60 ± 12 reps) compared to TRANSP (p = 0.03; 56 ± 10 reps; ES = 0.22; ±3.8%) and CON (p = 0.01; 56 ± 9 reps; ES = 0.33; ±6.6%), but no difference occurred between TRANSP and CON (p = 0.84; ES = 0.12; ±2.4%). Comparable responses were observed in motivation, emotional arousal, affect, and ratings of perceived exertion in PINK, TRANSP, and CON trials (all, p > 0.05), despite the greater total physical work performed in PINK trial. Conclusion: Ingesting a pink non-caloric, artificially sweetened solution improved strength endurance performance with comparable psychological responses. These results have implications for future nutritional studies and performance assessments in real-world sports scenarios.

Background: I¹³¹ therapy is regarded as an “internal surgery” (i.e., a non-invasive approach involving no incision or bleeding) that supports “external surgery” (i.e., using a scalpel) in completely eradicating the root cause of thyroid cancer. Limiting iodine intake is of paramount importance in I¹³¹ therapy. I¹³¹ therapy protocols recommend that patients follow a low-iodine diet, ideally with a maximum iodine intake of 50 μg/day for two weeks before the I¹³¹ therapy. Methods: A pre–post compassion uncontrolled clinic intervention study was conducted on a group of over 70 post-thyroidectomy thyroid cancer patients with indications for I¹³¹ therapy at the Vietnam National Cancer Hospital from December 2020 to December 2022. Aim: It aimed to assess the effects of a low-iodine diet on post-thyroidectomy thyroid cancer patients with indications for I¹³¹ therapy. Results: The study found that following the intervention, the percentage of participants at risk of mild to moderate malnutrition, as assessed by the PG-SGA tool, decreased to 4.3% from 40.0% before the intervention, with a statistically significant difference of p < 0.001. There was a considerable improvement in the low calcemia level among the study participants, with 35.7% of patients experiencing hypocalcemia prior to the intervention, which reduced to 17.1% after the intervention. This difference was statistically significant (p = 0.01). The study also revealed a urinary iodine level improvement among the study participants. Before the intervention, patients’ average urinary iodine level was 14.9 ± 11.3 µg/dl. Following the intervention, it reduced to 12.7 ± 3.9 µg/dl, although this difference was not statistically significant (p = 0.29). Patients’ quality of life after adhering to the low-iodine diet tended to decline; however, the change in scores before and after the intervention did not show a significant difference. Conclusion: Despite its negative impact on patients’ quality of life, active nutrition counseling and intervention during the low-iodine diet contributed to the substantial improvement in the hypocalcemia level and the reduced urinary iodine level among patients, which in turn could enhance the efficacy of the subsequent I¹³¹ therapy.

Objective: To determine parents’ perceptions of cooking skills, food skills, and nutritional status of children ages 3 to 5 years. Methods: Parents of preschoolers aged 3 to 5 years completed two questionnaires, a Nutri-STEP questionnaire, assessing nutritional status, and a cooking exposure questionnaire. This parent recall questionnaire assessed cooking skills and food skills children possessed. Results: Willingness to try a new vegetable, parental confidence of child's cooking skills, total food skills possessed, and the covariates of gender, age, and ethnicity significantly predicted child dietary quality grouping p = 0.04. Conclusions and Implications: Trying new vegetables was a significant predictor of dietary behavior, with children more likely to try new vegetables demonstrating better dietary behavior (odds ratio= .43, p = 0.03). Trends showed that children with more cooking skills had better diets. Empirical data are needed through experimental designs to examine the integration of cooking skills in the home on child dietary behaviors and long-term cooking development.

Background: Rapid weight loss (RWL) practices are common amongst strength-sport athletes to ‘make weight’ for a chosen weight class. Aim: This study compared the RWL practices of International Powerlifting Federation (IPF) powerlifters from Great Britain. Methods: Participants (n = 69, male = 36, female = 33) were recruited from IPF lifting populations (mandatory <2-hour competition weigh-in). Participants were categorised based on highest level of competition (regional, national and international) and also sex (male and female). The previously validated ‘Rapid Weight Loss Questionnaire’ established RWL practices, however also included an open-ended question regarding thoughts, feeling and mood during RWL. Results: Nearly all participants (97%) had purposely acutely reduced body mass to compete, with an average typical pre-competition loss of 4.2%. Regional competitors reported a higher ‘typical’ body mass loss compared to international competitors (5.5% vs 3.3%, p = 0.004). Females reported a greater ‘highest’ body mass loss than males (6.7% vs 5.3%, p = 0.028). Fluid restriction (86.5%), water loading (67.2%) and increased exercise (49.2%) were the RWL methods most commonly used ‘always’ or ‘sometimes’. Content analysis revealed a predominance of negative perceptions during RWL with the emergence of codes; fatigue, sensations, anxiety, low mood and irritation, accounting for ∼70% of responses. Conclusion: Prevalence of RWL is high amongst competitive powerlifters, with many competitors attributing negative perceptions during the weight-cutting process. The magnitude of reported acute RWL within regional lifters was beyond where performance decrements are commonly seen (>5%), this should be cautioned against given the IPF's mandatory <2-hour competition weigh-in.

Background: The coexistence of stunting and wasting in a child increases the risk of mortality and requires more intensive treatment and care. However, there is limited research on the burden of concurrent stunting and wasting among children and the socioeconomic factors that are correlated with having both conditions. Aim: To understand the prevalence and sociodemographic correlates of stunting, wasting, and concurrent stunting and wasting among a sample of children ages 6–144 months experiencing poverty in the Philippines. Methods: Cross-sectional data were drawn from nutrition screening and sociodemographic surveys conducted by International Care Ministries in 2018-2019. Descriptive statistics were calculated to determine the prevalence of stunting, wasting, and concurrent stunting and wasting. Multilevel logistic regression modelling was conducted to understand the sociodemographic factors that were associated with stunting and wasting. Results: Among the 3005 children in this sample, the prevalence of stunting, wasting, and concurrent stunting and wasting was 49.9%, 9.3%, and 4.6%, respectively. Children experiencing concurrent stunting and wasting lived in households in lower wealth index quintiles, had a household head with fewer years of education, and were more likely to experience food insecurity compared to children who were not stunted or wasted. The education of the household head, the number of household members, and the wealth of the household were correlated with stunting across age groups, while food insecurity was correlated with wasting among younger children. Conclusion: The presence of concurrent stunting and wasting among children provides the impetus to integrate both conditions into nutrition monitoring, prevention, and treatment interventions.

Background: Adequate calcium intake at an early age is crucial to achieving peak bone mass. Nevertheless, low calcium intake is common in Malaysian children. Aim: This study examined the calcium food sources and factors associated with low calcium intake among 243 children aged 9–11 years in Kuala Lumpur. Methods: Diet histories and bone density were measured. Results: The mean calcium intake was 370 ± 187 mg/day. The main contributors to calcium intake were beverages (19.2%), cereal (18.6%), milk and dairy (13.0%), meat and poultry (12.9%), and fish and seafood (10.1%). Within each food group, calcium-contributing foods tend to be from low bioavailability sources such as rice, cocoa-based and malted drinks, and chicken rather than milk. Children who practised regular meals, ate breakfast and snacks and consumed milk more than one serving daily have a higher calcium intake. Conclusion: In conclusion, public health strategies to improve the status of low calcium intake and poor choices of calcium-rich foods are needed to optimise bone health in this population.

Background: Superfood products are important components of the human diet, which may contain toxic heavy metals that have no beneficial function in the human body (e.g., cadmium, arsenic, mercury). Therefore, due to the high demand for these foods, maintaining their safety is a significant public health concern, resulting in an increasing number of studies in the field of health risk assessment due to population exposure to heavy metals. Aim: The aim of the study was to determine the concentration of selected heavy metals in individual superfood products. Methods: The research material consisted of 48 samples of selected superfood products such as flaxseed, chia seed, black cumin, goji berries, buckwheat, millet, almonds, quinoa and green tea. The collected samples were subjected to the mineralization process. In addition, an exposure assessment was performed by calculating the hazard quotient (HQ). Statistical analysis was performed using Statistica software for cadmium and arsenic. Results: The highest level of cadmium was observed in a sample of flaxseed (ground)—0.35 mg/kg. Again, the highest concentration of arsenic was found in green tea bags (21.94 mg/kg). The exposure assessment showed that the risk of adverse health effects is likely to occur with the consumption of flaxseed, almonds, quinoa and green tea at both the assumed average and maximum arsenic concentrations (HQ > 1). Conclusions: There are many foods on the market that contain heavy metals. The accumulation of various heavy metals in agricultural soils and edible crops should be regularly assessed to minimize public health problems.

Background: Anemia is a severe nutritional issue affecting people worldwide, including in Indonesia. One of the government's initiatives to alleviate anemia afflicting adolescent Indonesian girls is iron and folic acid supplementation (IFAS). However, this program has shown to be ineffective, which may be due to poor compliance of IFAS. Aim: This study aimed to identify the association of social support (sources of information and reminders) with compliance of IFA supplement intake among adolescent girls in Sidoarjo, Indonesia. Methods: This research was an observational analytic study with the cross-sectional method in three schools in Sidoarjo, Indonesia. A total of 202 high school adolescent girls were randomly selected. Bivariate statistics with the Spearman rank test determined associations and the strength of associations at a significant threshold of p < 0.05. Results: IFA compliance was low (11.4%). However, there was a significant association between the number of sources of information (r = 0.175, p = 0.013) and the number of reminders (r = 0.158; p = 0.025) with compliance of high school adolescent girls to consume IFA supplements regularly in Sidoarjo, Indonesia. Meanwhile, age did not significantly affect compliance of regular IFA supplement consumption. Conclusions: The compliance level was positively related to the number of sources of information and the number of reminders for taking IFA supplements among high school adolescent girls. Involvement from social environments such as teachers, parents, and health workers as a source of information and reminders can help improve high school adolescent girls’ compliance.

Background: Poor diet quality in children and adolescents may contribute to decreased immunity and lead to an increased risk of opportunistic diseases. Aim: To investigate diet quality and its relationship to nutritional status in human immunodeficiency virus (HIV)-infected pediatric patients (HIV-PIHIV). Methods: We conducted a cross-sectional study with 87 patients aged between 6 and 19 years carried out in two University Hospitals. Diet quality was analyzed by an adapted Healthy Eating Index (HEI) and nutritional status. The association between HEI with body mass index-for-age (BMI-for-age) and height-for-age was performed using a linear regression model. Clinical, maternal, anthropometric, and dietary data were collected through a semi-structured questionnaire, based on nutrition service protocols. Results: Diet quality was intermediate (median IAS = 54.8 interquartile range: 47.5 to 65.9 points), due to low consumption of fruits, vegetables, and dairy products and high empty calories and sodium by the PPIHIV. The multivariate regression model indicated that HEI was not significant for explaining BMI-for-age [β = −0.01; 95% CI = (−0.03; 0.01); p 0.40] nor height-for-age [β = 0.01; 95% CI = (−0.02; 0.03); p 0.51]. However, it was observed that adolescents showed 1 Z-score [95% CI = (−1.6; −0.44); p 0.001] a reduction in BMI-for-age compared with children, and those black patients showed an increase in BMI-for-age Z-score of 0.57 [95% CI = (0.7; 1.1); p 0.03] compared with non-blacks. Conclusion: The diet quality of the HIV-infected children and adolescents was below desired. No association was found between diet quality and inadequate nutritional status of HIV-PIHIV.

Aim: To explore the perspectives and experiences of healthcare practitioners in providing nutrition care to people with cancer in New Zealand. Methods: Semi-structured interviews were conducted with 16 New Zealand healthcare professionals (HCPs) practicing in specialist secondary and tertiary cancer care (both public and private) who had previously completed an online survey about nutrition in cancer care. Interviews were recorded and transcribed verbatim, and thematic analysis was undertaken. Results: Participants identified nutrition as important in cancer care, from diagnosis to survivorship, in order to maximise recovery and ongoing health. While participants reported that the best person to provide high-quality individualised nutrition care is a dietitian, other HCPs also have a role in nutrition care. Limited nutrition care is currently available, especially for those in rural areas, which impacts health and equity in cancer care. Participants identified a need for increased dietitian capacity in the workforce as well as a need for nutrition resources that were accessible and appropriate. Conclusion: The perspective of participants was that more must be done to provide nutrition care as part of cancer care in New Zealand to improve health and wellbeing among people with cancer.

Background: Vitamin D deficiency has reached pandemic levels affecting over one billion people worldwide. However, limited data is available on the prevalence and determinants of vitamin D status of Canadian Indigenous children and no study has been reported in Inuit children from Nunavik. Aim: Therefore, using data collected between 2006 and 2010, we aimed to investigate the prevalence and main determinants of insufficient serum 25-hydroxyvitamin D (s25(OH)D) concentrations in Inuit children attending childcare centres in Nunavik. Methods: This study included 245 Inuit children aged 11 to 54 months. s25(OH)D concentrations were measured by radioimmunoassay. Dietary intakes were assessed using 24-hour recalls. Usual dietary intakes were estimated using the National Cancer Institute method. We used a multiple imputation technique to replace missing values when performing regression analysis. Results: Our findings revealed that 64.5% of children had a s25(OH)D concentration < 75 nmol/L, while 78.1% did not meet the estimated average requirement (EAR) for vitamin D. Vitamin D intake and fluid milk consumption were positively associated with s25(OH)D concentrations, while negative associations were observed with children’ energy intake, non-alcoholic beverage consumption, body weight, breastfeeding duration and, biological/adoptive/foster parents’ educational level. Conclusion: Vitamin D inadequacy was highly prevalent and closely aligned with levels observed over the years in non-Indigenous children. Breastfed children who do not receive vitamin D supplementation, overweight and obese children, and children with inadequate milk consumption were at high risk of vitamin D insufficiency. Eating vitamin D rich foods such as fluid milk and seafood along with vitamin D supplementation when needed are recommended.

Background: The Mediterranean diet (MD) has many beneficial effects on health. However, compliance with MD is decreasing among university students. Aim: This study aims to investigate compliance with the MD and the association of MD with sleep quality, depression, anxiety, stress, and body mass index (BMI) among university students. Methods: This cross-sectional study included 750 students of Ondokuz Mayıs University, a state university in Samsun, Türkiye. Sociodemographic data and self-reported anthropometric data (weight and height) were recorded using a survey. The Mediterranean diet quality index for children and adolescents (KIDMED), the Pittsburgh sleep quality index (PSQI), and the depression anxiety stress scale-42 (DASS-42) were self-administered. Results: Most students (59.2%) had poor KIDMED adherence. Compared to poor adherers, those with good adherence to the KIDMED had significantly lower depression scores (in males and females). Higher adherence to the KIDMED was correlated with lower depression and stress levels (in males and females) and lower PSQI scores (lower sleep disturbances) in females. The KIDMED scores of overweight females were greater than those of underweight females. Conclusion: University students show poor adherence to the MD. Low adherence to the MD may have a negative impact on depression, stress, and sleep quality. This study suggests that interventions to promote MD may help improve university students’ sleep disturbances and mental health.

Background: Social media networks such as Facebook, Twitter, WhatsApp, and YouTube are among the most commonly used social networks among people. If used properly, they can contribute to enhancing individual knowledge and scientific values. Aim: The study aimed to investigate the use of social media networks for healthy nutritional practices among deaf and hearing students. Methods: The sample of the study consisted of 103 students (50 deaf and 53 hearing). The researchers used a descriptive approach and adopted a questionnaire for data collection. Results: The findings of the study showed that the use of social media networks for healthy nutritional practices among deaf and hearing students was at a moderate level. However, there were statistically significant gender differences in the average responses of deaf and hearing students in the use of social media networks for healthy nutritional practices. For the status of students (deaf and hearing students), there were statistically significant differences in the average responses to the use of social media networks for healthy nutritional practices. Conclusion: Social media networks play an important role in raising awareness and promoting healthy nutrition practices for both deaf and hearing students.

Background: The energy balance between inputs and outputs is essential to avoid a reduction in performance, recovery difficulties, hormonal problems, an increased risk of fatigue, injuries and illnesses. Aim: The purpose of the study is to evaluate whether the energy intake assumed by non-professional sportsmen of the new fitness disciplines on the basis of the guidelines present in the literature, meets the needs required by their sporting activity. Methods: The sample consist of 20 non-competitive adult sportsmen (n.10 females; n.10 males) that were voluntarily enrolled in a gym, belonging to the various fitness disciplines: bodybuilders (n  =  2); calisthenics (n  =  3); crossfitters (n  =  15). The subjects underwent an anamnestic-nutritional interview and used a photographic atlas to estimate the energy intake in the training day (in terms of macronutrients, micronutrients and H₂O). Results: The results of the study reported: a lower energy intake, the breakdown of macronutrients was suitable for the nutritional indications reported by bibliographic sources, with the exception for protein intake that was higher than the other macronutrients; a lower intake of fibers, mono/polyunsaturated fatty acids; an higher intake of simple sugars, proteins and H₂O, and by a normal parameters of carbohydrates, fats and saturated fatty acids. Conclusions: Generally the study has shown that the sample energy intake is extremely low in the training day. Therefore, it is useful to educate sportsmen, coaches and families in order to avoid deficiencies/excess of calories and nutrients which may not be functional for the sporting activity performed.

Background: Blended tube feeding (BTF) is the administration of pureed whole foods via gastric feeding tubes. There is some evidence to suggest that BTF may have clinical and psychosocial benefits when compared to commercial formula, but further investigation of how BTF is understood and recommended by health professionals is needed. This study aims to investigate awareness and knowledge of BTF among multi-disciplinary paediatric staff in Ireland. Methods: A cross-sectional observational study was conducted among paediatric staff in Children's Health Ireland (CHI). The 16-item anonymous online survey gathered information on awareness of BTF, willingness to recommend BTF, confidence in BTF knowledge, and self-assessed competence in managing BTF. Results: Of the 207 responses, doctors (n68), nurses (n66), and dietitians (n32) provided 80.3% of responses. Two-thirds (n136, 66%) of the total group were aware of BTF. Of these, 68.1% had cared for a child on BTF and 70% (n = 63/90) were willing to recommend BTF. Three in five (n = 39/63, 61.9%) stated they were somewhat confident in their BTF knowledge and one in five (n = 12/56, 21.4%) were not yet competent in managing children on BTF. The most common reasons for recommending BTF were parental desire (n17, 39.5%) and commercial formula intolerance (n15, 34.9%). The most common barrier to recommending BTF was family logistics (n18, 41.9%). The most valuable sources of information on BTF for two-thirds (68.3%) of participants were other healthcare professionals (HCPs) and patients/caregivers. Conclusion: Healthcare settings should provide evidence-based training to HCPs on BTF to optimise the treatment and safety of children under their care.

Background: Food frequency questionnaire (FFQ) is the most frequently used dietary assessment method in estimating dietary intakes in epidemiological studies. Aim: This study aimed to assess the relative validity of a semiquantitative FFQ in evaluating dietary intake among pregnant women in the United Arab Emirates. Methods: Within the Mutaba'ah study, a subsample of 111 pregnant women completed a semiquantitative FFQ and a single 24-hour dietary recall (24-HDR) regarded as the reference method. Absolute and energy-adjusted nutrient and food intakes between the FFQ and 24-HDR were compared using the Wilcoxon signed ranks test, correlations, Bland–Altman analysis, cross-classification, and weighted kappa analysis. Results: There were no significant differences in reported absolute intakes between the FFQ and 24-HDR for carbohydrates, whole grains, white meat, beta-carotene, vitamin K, sodium, and selenium. Spearman's correlation coefficients between the FFQ and 24-HDR ranged from 0.09 (trans fatty acids) to 0.5 (potassium) for absolute intakes. Correlation decreased after energy adjustment. Bland–Altman analysis showed that the FFQ overestimated intakes compared with 24-HDR and that the limits of agreement were wide. The average percentage of pregnant women classified into the same or adjacent quartile of intake by both methods was 73%. Weighted kappa values ranged from −0.02 (white meat) to 0.33 (magnesium). Conclusion: Our findings showed that the semi-quantitative FFQ is a useful tool in ranking pregnant women from the Emirati population according to their dietary intake. However, the validity of some estimated intakes was poor; hence, certain intakes should be interpreted with caution.

Background: Childhood obesity is one of the most serious public health epidemics of the 21st century. Observational studies report that increases in portion size (PS) have occurred in parallel with levels of obesity. Increased PSs of high-energy-dense foods can promote overeating, and without compensatory behaviours, can contribute to childhood obesity. Caregivers make decisions about PSs for children in the home and nursery environment, thus are gatekeepers to child food intake. Understanding caregiver PS decisions can aid in the best practice of PS provision to young children. The aim of this study was to explore parent and nursery staff influences on child PS selection and their suggestions for useful tools/strategies in PS decisions. Methods: A qualitative design was employed using focus group discussions (FGDs) with parents and nursery staff of children aged 3–5 years. FGDs were employed given their ability to generate rich data, as well as permit the exploration of collective perceptions, attitudes, behaviours and experiences. Data were analysed using an inductive, semantic approach to reflexive thematic analysis. Results: Four FGDs were conducted: two with parents (n = 13), two with nursery staff (n = 17). Four overarching themes were derived: (i) awareness of PS guidelines; (ii) control over PS; (iii) social influences on children's eating behaviours; (iv) child-specific, social and external factors influencing parent and nursery staff PS decisions. Additionally, participants discussed tools/strategies they believe would be useful in PS decisions. Conclusion: Data from the themes suggest that caregiver control, social, child-specific and external factors are more influential than PS guidelines in both parent and nursery staff PS decisions for young children aged 3–5 years. These findings can inform future childhood obesity prevention initiatives focussed on improving parent and nursery staff provision/use of age-appropriate PSs.

Background: Vitamin D supplementation practices (dose and frequency) are relatively unknown in the Scottish population, with no recent up-to-date data available. Reassessing current knowledge, practices, and awareness of vitamin D supplementation following a national health campaign in 2020 by Food Standards Scotland on vitamin D is warranted. Aim: This article aims to present the knowledge and awareness of vitamin D, and current vitamin D supplementation practices in adults living in Scotland. Methods: A cross-sectional study was performed between June and July 2022 using an online survey adapted from previous work on assessing knowledge of vitamin D in adults. Participants aged 18+, living in Scotland for ≥6 months were eligible to participate. Scores for knowledge were calculated as a percentage. Univariate associations between demographic and supplement use were established by χ²-test and logistic regression performed to predict factors associated with daily vitamin D intake. Results: Four hundred and three participants (72.7% female), mean age 36.4 (±14.2 years), completed the study. Awareness of vitamin D was very high (99.5%) but the mean overall knowledge score was poor (31.4 ± 15.3%), with those with a university degree more likely to have knowledge scores at/above the mean compared with those with lower levels of education, χ²(1, N = 393) 10.7, p = 0.001, odds ratio (OR) = 2.1 (95% confidence interval (CI) 1.7–2.7). Finally, 64.3% took vitamin D supplements, of which 37.5% took them daily during winter months, with only 7.4% taking the recommended daily dose. Conclusion: The current study highlights the need to improve both knowledge of vitamin D and practices of vitamin D supplementation during the autumn and winter months in Scotland.

Background: Manipulation of macronutrient intake and exercise can alter overall energy consumption and potentially body composition. Aim: The purpose of this study was to manipulate the macronutrient content of breakfast before exercise to investigate the impact on exercise energy expenditure and postexercise energy intake (EI). Methods: Twelve active men were recruited, 11 finished the study protocol (age: 28 ± 9 years; VO₂max: 56 ± 5 ml·kg⁻¹·min⁻¹). In a randomized crossover design, each participant completed 4 trials, 3 consisting of a specific breakfast (protein, PRO; carbohydrate, CHO; noncaloric; NON-CAL) followed in 1 h by a 45 minutes moderate intensity treadmill exercise protocol. The fourth trial consisted of breakfast and no exercise (CON). An ad-libitum lunch and food for the rest of the day were provided and assessed for EI. Measures included resting metabolic rate pre- and postbreakfast along with oxygen uptake (VO₂) during and after exercise, along with hunger scales, and blood measures of glucose, insulin and plasma-PYY prebreakfast, pre-exercise, postexercise, and 60 minutes postexercise. Results: Fat oxidation was highest during exercise in the NON-CAL (0.57 g·min⁻¹) trial with similar levels of fat oxidation between PRO (0.50 g·min⁻¹) and CHO trials (0.48 g·min⁻¹). Hunger was not affected by PRO intake or exercise, nor was appetite hormones and glucose. EI at lunch and dinner was not significantly different between trials. Conclusion: Pre-exercise PRO intake did not modify fat oxidation during exercise, did not lead to a larger VO₂ versus CHO, nor did it attenuate EI postexercise.

Purpose: This study aims to investigate the role of ChatGPT in promoting health behavioral changes among cancer patients. Methods: A quasi-experiment design with qualitative approach was adopted in this study, as the ChatGPT technology is novel, and many people are unaware of it. The participants included outpatients at a public hospital. An experiment was carried out, where the participants used ChatGPT for seeking cancer related information for two weeks, which is then followed by focus group (FG) discussions. A total of 72 outpatients participated in ten focus groups. Results: Three main themes with 14 sub-themes were identified reflecting the role of ChatGPT in promoting health behavior changes. Its prominent role was observed in developing health literacy, promoting self-management of conditions through emotional, informational, motivational support. Three challenges including privacy, lack of personalization, and reliability issues were identified. Conclusion: Although ChatGPT has a huge potential in promoting health behavior changes among cancer patients, its ability is minimized by several factors such as regulatory, reliability, and privacy issues. There is a need for further evidence to generalize the results across the regions.

Background: Religiosity is known to have a socio-cultural influence on food choice. However, to date, research exploring the influence of Islam on food selection has almost exclusively focused on fasting during Ramadan and has not explored the influences of Islam on everyday food choices among Muslim people. Aim: This qualitative study explored the influence of Islamic religiosity on everyday food choices among Muslim people. Methods: Thirty-two adult participants residing in the United Kingdom (n = 16 faith leaders and n = 16 lay Muslim people) were recruited from three Sunni mosques, and data was collected using semi-structured interviews. The data was analysed using reflexive thematic analysis and a constant comparison method was applied to draw out similarities and differences between faith leaders and lay Muslim people. Results: The results revealed that Islamic religiosity had an influence over food choice with two main overarching themes 1) Demonstrating religious obedience through food choices and, 2) Spheres of influence on food choice; and five sub-themes 1a) Trusting in familiar food providers, 1b) Verification of halal authenticity, 1c) Seeking purity within food, 2a) The Prophet Muhammed (Peace Be Upon Him) as a role model for food choice and, 2b) Islamic jurisprudence. Conclusion: These findings provide important insights into the influence of Islam on food choice and could be used support the design of faith-informed dietary interventions among Muslim people. Further research is required to examine the role of faith-informed dietary intervention in the Muslim community.

Background: Mindful eating is a promising strategy to address problematic eating behaviors; however, little is known about its applicability during pregnancy. No studies have examined the combined effects of mindful and practical eating skills on eating behaviors. Aim: We examined associations between mindful and practical eating skills and eating behaviors (nutritional intake and emotional eating) among pregnant women who received psychoeducation on healthy eating and pregnancies. Methods: Participants were racially-diverse pregnant women (14–42 years) from four clinical sites in Detroit, Michigan, and Nashville, Tennessee (N = 741). We conducted multiple linear regression to examine associations between mindful (hunger cues, satiety cues, mindful check-ins) and practical (food diary/journal, MyPlate method) eating skills and nutritional intake. We calculated residualized change scores to represent changes in the quality of nutritional intake from second to third trimester. We performed multiple logistic regression to examine associations between mindful and practical eating skills and emotional eating. Results: Women improved over time in eating behaviors (better nutrition, less emotional eating). Regular use of MyPlate was associated with better nutritional intake (unstandardized coefficient [B] = −0.61), but food diaries were not. We found a significant interaction in predicting emotional eating: For those regularly paying attention to hunger cues, some use of MyPlate (Adjusted Odds Ratio [AOR] = 0.39) and especially regular use of MyPlate (AOR = 0.13) reduced the likelihood of emotional eating during pregnancy. Conclusion: Enhancing both mindful and practical eating skills, such as paying attention to hunger cues, and using the MyPlate method, may facilitate pregnant women's ability to improve their eating behaviors.

Aim: To assess the effect of cashew nut flour on the hematological parameters of children living with HIV-AIDS. Method: A 32-week randomized, blind clinical trial conducted at a specialized outpatient clinic. Children aged 2–12 years were allocated to intervention groups (IGs) (n = 11) receiving 12 g/day of cashew nut flour and control groups (CGs) (n = 9) receiving 12 g/day of carboxymethyl cellulose. Parameters of erythrocytes, leukocytes, platelets, and lipid profiles were evaluated. Results: In the IG, the elevation and reduction of leukocyte and lipid profile biomarkers, respectively, were not statistically significant (p > 0.05). A clinically and statistically significant increase in mean corpuscular hemoglobin concentration was observed in the CG (p = 0.018), with a large effect size (Cohen's d = 0.9). There were no statistically significant changes in platelet counts among participants (p = 0.18). The effect size for white blood cell count, low-density lipoprotein cholesterol, very low-density lipoprotein, and triglycerides was moderate in the IG compared to the CG. Conclusion: Cashew nut flour supplementation may increase levels of leukocytes and lipid profile parameters in children living with HIV. Brazilian Clinical Trials Registry (REBEC): U1111.1276.6591.

Background: Maternal phenylketonuria (mPKU) is a pathologic condition occurring in the fetus of a mother with PKU that is caused by prolonged elevated intrauterine blood phenylalanine (Phe) levels, which can lead to congenital abnormalities and mental retardation of newborns. Management of PKU during pregnancy can be challenging as protein substitutes may exacerbate nausea, vomiting, and gastrointestinal symptoms. Aim: To report the successful management of four PKU pregnant women. Methods: The patients were administered with prolonged-release amino acid supplementation and were recommended to follow a strict diet. Blood Phe concentration, adherence to diet, and occurrence of adverse events were monitored. Results: All patients achieved safe levels of blood Phe concentration (120–360 µmol/L) since preconception and during pregnancy (mean Phe concentration values of 143.34 ± 137.59, 226.48 ± 194.57, 186.68 ± 133.67, and 187.47 ± 42.59 µmol/L). During the first trimester of pregnancy, all patients manifested gastrointestinal symptoms such as nausea, gastrointestinal reflux, and abdominal bloating, which were managed by either changing protein substitute or extending the time window between different meals and amino acid mixtures administration. The four women continued their pregnancies without experiencing further complications and delivered neonates with normal growth parameters and no malformations. Conclusion: Findings of this case series suggest that the intake of a prolonged-release amino acid mixture in granules is well tolerated by pregnant PKU patients, eventually leading to good metabolic control and fetal growth within normal ranges.

Introduction: One of the dimensions of food security has to do with economic access to food. Aim: Propose a methodology that allows evaluating economic access to food in Argentina for the elderly population. Methods: Dietary guides for the Argentine population are used. Meanwhile, the food consumption patterns observed in the elderly population in Argentina are considered from a household expenditure survey, from which implicit food prices can also be obtained. Results: Six dietary plans corresponding to different regions of the country are designed and evaluated and it is found that they would be affordable only in two of the six regions analyzed. Conclusion: in the Metropolitan, Pampas, Cuyo, and Northeast regions the cost of the ideal basket is higher than food spending, fundamentally in the Northeast region where food spending should increase by 25%.