Dietetics

The environmental impact of unhealthy diets and the obese population is becoming clearer. However, little is known about the impact of ‘healthy’ diets related to ‘fitness’ lifestyles, such as diets directed to gain muscle mass and lose body fat, or the diets of the physically active population. This paper aims to evaluate the Dietary Water Footprint (DWF) of a representative sample of the Guadalajara Metropolitan Area, Mexico, identifying differences according to body composition (levels of fat and muscle) and physical activity (type and intensity), with a focus on contrasting active, healthy lifestyles (i.e., fitness) with sedentary and obesogenic patterns and examining protein consumption. A validated and adapted Food Frequency Questionnaire (FFQ) was applied to 400 adults (18–74 years) from the Guadalajara Metropolitan Area. The participants were grouped according to their body fat and muscle mass levels and physical activity type and intensity. DWF, food and nutrient intake, and adequacy were calculated. The DWF of the sample with a low body fat, a high muscle mass, moderate to intense exercise, and anaerobic exercise (i.e., ‘fitness’ lifestyle) was up to 800 L per person per day (L/p/d) higher than the sedentary/obese populations. Risks of a high DWF were found as protein intake increases (OR = 6; p < 0.0001). Although unhealthy diets linked to obesity are a major environmental problem, ‘fitness’ lifestyles can have serious environmental implications. Full article

Diets will likely play a crucial role in the Anthropocene to support the population’s health and safeguard environmental sustainability for future generations. Based on a cross-sectional–observational–descriptive design for evaluating an entire menu proposal, data on the type and composition of the menus offered by a university catering service during an academic year were collected. Each day during the meal service, 10 plates of the same option offered were weighed, and 10 photographs were taken. With these data, the nutritional value and carbon footprint were evaluated for all possible combinations of first and second courses, while including the average values of other components of the menu (garnishes, bread, desserts, and beverages). The annual menu proposal resulted in 6478 combinations of first and second courses plus the other components. The average caloric intake was 1194 kcal/menu with high consumption of proteins and lipids, and the average carbon footprint was 1.86 kg carbon dioxide equivalent (CO₂eq)/menu, with the second course being the major contributor. Creating menus that consider these two essential parameters is the task of specialists. Achieving food consumption that balances nutrition and environmental sustainability is another issue of education and communication. Full article

Background: Inorganic nitrate is abundant in leafy green vegetables and has been shown to exert positive cardiovascular effects through nitric oxide-related pathways. The enteral microbiome is an emerging key player in cardiovascular diseases and depends on dietary habits. Whether dietary inorganic nitrate impacts on the microbiome and atherosclerosis-associated microbiome-dependent metabolites like short chain fatty acids (SCFA) and trimethylamine N-oxide (TMAO) is unknown. Methods: In a double-blind randomized controlled trial, 30 healthy volunteers were included who either received dietary nitrate (0.12 mmol/kg bodyweight) or placebo (equimolar amounts of sodium chloride) for 30 days. The microbiome metabolites TMAO and SCFA were analyzed. The enteral microbiome was analyzed by 16S-rRNA sequencing at baseline and follow-up. Results: Systolic blood pressure decreased after nitrate supplementation (baseline 124.73 mmHg vs. follow up 120 mmHg, p < 0.05) with no change in controls. Dietary nitrate supplementation increased TMAO levels (nitrate baseline 349.28 μ/L vs. nitrate follow-up 481.15 μ/L, p < 0.05), while SCFA levels remained unchanged. The relative abundance of Akkermansia and taxa of Clostridiales were higher in individuals with high compared to normal TMAO levels after nitrate supplementation, while Shannon diversity, richness and evenness did not differ between both groups. Conclusions: Our results indicate that dietary nitrate supplementation is associated with alterations to the enteral microbiome with an impact on proatherogenic metabolites. Further work is warranted to investigate the causal relationship between dietary nutrients, the microbiome and downstream metabolites. Full article

The dietary supplement industry is expanding, but it still remains far less regulated than the pharmaceutical industry, resulting in inconsistent quality control. Limited research has been performed in the U.S., particularly regarding the quantification of omega-3 fatty acids like eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). The aim of this study was to quantify the omega-3 fatty acid content in fish oil capsules and liquids purchased from major stores and a grocery chain and compare the results to their label claims. A total of 6 out of 15 were found to have EPA levels ±20% and 10 out of 15 were ±20% outside of the label claim for DHA. One product did not have a label claim for EPA and DHA, but did have a claim for total omega-3 content. These discrepancies indicate that consumers may unwittingly be consuming higher or lower quantities of omega-3 fatty acids than expected, potentially affecting their health outcomes. Full article

Vitamin D is a conditionally essential fat-soluble vitamin found in foods such as fish; fish oil; egg yolks; animal fats; some mushroom varieties; and fortified foods such as cheese, margarine, milk, infant formula, and some ready-to-eat cereals. Calcium (Ca) is found in milk, cheese, canned fish, ready-to-eat cereals, milk substitutes, dark green leafy vegetables, and sports drinks. There are more than fifty metabolites of vitamin D. Vitamin D participates in immune regulation, apoptosis induction, insulin secretion, inflammation, cell differentiation, calcium balance and regulation, bone mineralization, and phosphorus homeostasis. Ca is an essential macro-mineral involved in bone and teeth matrices, strength, and hardness; muscle and cardiovascular movement; neurological messaging; and in the release of hormones. Peer-reviewed journal articles were accessed from the search engine PubMed. The authors reviewed the references in the peer-reviewed journal articles, websites, and review articles if the authors proposed a new theory or mechanism. Vitamin D and Ca have important relationships; therefore, many factors may impede or interfere with the body’s ability to absorb or utilize vitamin D and or Ca and may result in low or excessive levels of each. Additionally, genetic/medically related absorption issues and low intake may also result in deficiencies. This review discusses the introduction of each, their functions, absorption, somatic transportation, the relationship between vitamin D and Ca, and recommendations and supplementation strategies if available. Full article

Background: Malnutrition is a major issue in hospitals, impacting over 25% of patients. It can arise from a range of factors, such as chronic underfeeding, diseases, aging, and inappropriate nutritional care. Unnecessary fasting and the use of incorrect dietary prescriptions can also contribute to malnutrition, regardless of a patient’s underlying health conditions. Methods: A search strategy was applied to identify pertinent articles on the prescription and management of therapeutic diets in hospital settings from the last 10 years (2014–2024) using the PubMed database. The following English terms and their combinations were used: hospital diet, non-evidence-based dietary restriction, hospital food service, and therapeutic diets. Only national or international guidelines published in English were considered. Results: The narrative review was developed through the analysis of two guidelines on the prescription and management of therapeutic diets in hospital settings. The main non-evidence-based therapeutic diets that should have limited prescriptions are low-calorie, low-carbohydrate, low-protein, and low-sodium diets because they inevitably lead to a reduction in caloric and/or protein content, limit menu choices, and make recipes less palatable. The preventive total elimination of lactose without diagnostic confirmation should be avoided in the prescription of hospital therapeutic diets for lactose intolerance without symptoms and confirmation of diagnosis. Fasting after surgery should be avoided. The two guidelines differ in part in terminology and the bromatological composition of the diet. Conclusions: The heterogeneity of terminologies and bromatological composition leads to further confusion in determining the correct procedure for managing and prescribing therapeutic diets. Deepening and increasing research in the field of management and prescription of therapeutic diets is necessary to overcome the problem of hospital malnutrition, as the food provided through hospital food service is a very effective medicine for providing calories, macronutrients, and micronutrients. Full article

In the European context shaped by migration, it is necessary to adapt dietitians to cultural diversity for effective professional practice. The objectives of the research are to analyze the cultural and ethnic diversity in Romania, highlighting the possible influence of acculturation on the dietary behaviors of different ethnic groups, and to formulate ways to apply the stages of cultural competence. The research methodology included the collection and use of data from the population census and other statistical sources to analyze the ethnic, linguistic, and religious composition in different regions of Romania, and the use of a cultural competence model that could be applied in the Romanian medical context for the formulation of health recommendations tailored to eating habits and influenced by acculturation and sociocultural factors. The study reveals the cultural diversity of the Romanian population, with more than 1.7 million inhabitants having a native language other than Romanian and with a wide ethnic and religious variety. We adapted a cultural competence model including methods to assess dietary acculturation, understand food preferences, and respect ethnic, religious, and generational diversity, ensuring its applicability in various multicultural contexts. This study emphasizes the importance of cultural competence in dietetic practice in a diverse health care setting and tailoring nutrition services according to cultural diversity to improve health and patient satisfaction. Full article

Medical Nutrition Therapy (MNT) services have shifted from only in-person to digital consultations. This may present a challenge to older patients if they are not digitally literate. This scoping review aimed to identify and analyse tools for assessing digital health literacy to guide dietetic practice in screening patients for digital care needs and training. Publications that used or tested a digital health literacy tool with participants aged 45 years and older in clinical, community, or population settings were deemed eligible. Five scientific databases, reference lists of identified studies, and publications from key authors were searched for peer-reviewed articles published in English between 2014 and March 2024. Relevant data on participant characteristics, tool design, and validation were charted. The generalisability of studies and applicability of tools were assessed using 4-point scales. Searches yielded 1823 articles, of which 66 articles were included in the final analysis. Eight tools were identified, and the electronic Health Literacy Scale (eHEALS) was the most frequently used. After evaluating the validity and feasibility of these tools, the adapted eHEALS emerged as the most applicable for digitally delivered MNT. Future studies should explore effective educational programmes for less digitally literate populations to better connect them to online MNT healthcare services. Full article

The increasing availability of direct-to-consumer personalized nutrition products has raised questions about their scope of personalization and added value compared to general dietary guidelines. This study evaluated eleven personalized nutrition products across six distinct methodologies, including DNA analysis, blood marker analysis, microbiome testing, blood glucose monitoring, questionnaire-based personalization, and consultation with a dietitian, comparatively evaluating their consistency and added value compared to general dietary guidelines. A 24-year-old obese male with no pre-existing illnesses was chosen as the case participant to represent a typical individual seeking personalized nutrition advice for weight loss. Significant variability and inconsistency were observed across and within the different methodologies, particularly in recommendations for energy intake and macronutrient distribution. Most advice was generic and aligned closely with existing dietary guidelines, with a notable lack of behavioral change strategies. This study underscores the challenges in personalized nutrition, highlighting the problem that current practices often fall short of delivering truly tailored recommendations. There is a critical need for clearer definitions, evidence-based guidelines, and more comprehensive approaches to fully realize the potential of personalized nutrition in improving individual health. Full article

Mobile applications, websites and social media networks are now widely used communication tools. With the emergence of communication-related technologies in our lives and, consequently, the rise of social media networks and mobile applications, nutrition-related applications have become popular. Smartphones and other artificial intelligence technologies have become very useful tools for delivering nutrition-related interventions because they are very accessible and cost-effective. Digital interventions are also able to serve a larger number of communities than traditional interventions. Nutrition is not a field that has remained on the sidelines of these technological advances, and numerous mobile applications and technological tools have emerged that are intended to provide dietary advice or guidelines on the process of recovering from a disease. However, many of these applications have limitations and barriers that are important to consider. The aim of this review was to analyze the most current and widely used mobile applications related to nutrition, as well as their complementary tools (activity bracelets and smart scales, among others), highlighting their importance in improving lifestyle habits. In addition, their advantages and disadvantages are discussed and future directions are proposed. Full article

Dietary supplements are products taken orally, and they contain an ingredient intended to augment the diet. Many studies demonstrate clear alterations in microbe abundances and the production of microbiota-derived metabolites, such as short-chain fatty acids, following dietary changes. This review comprehensively explores the possible interactions among gut microbiota, lemon extracts, glycerin, and their mixture products. Lemon extracts/components are associated with a vast array of health benefits, including anti-inflammation, antioxidant, anti-atherosclerotic, and anti-diabetic effects. They are also associated with increased memory and decreased depression. Glycerin can reduce serum free fatty acids and mimic caloric restriction; its metabolites can function as a broad-spectrum antimicrobial. Additionally, glycerin has a dehydrating effect on the central nervous system and can reduce focal cerebral edema and improve performance by expanding plasma volume. However, it may also have side effects, such as hyperglycemia. Therefore, combined consumption of lemon extracts and glycerin may, in part, mitigate each other’s side effects while exerting their benefits. There is growing evidence that both lemon components and glycerin are metabolized by the gut microbiota and may modulate the intestinal microbiome composition. Therefore, gut microbiome alterations are also explored as an important mechanism in the gut–brain axis regulating various effects of these dietary supplements and their application in various noncommunicable neurological disorders. Full article

Saturated fats are widely seen as undesirable components of a healthy diet, as a result of their illusory association with elevated serum cholesterol. The regulation of serum cholesterol is now better understood and a lack of polyunsaturated fatty acids, rather than an abundance of saturated fatty acids, is responsible. Palmitic acid was shown to incite inflammation at unnaturally high concentrations in tissue culture, but later was found to play an auxiliary role as a precursor to ceramide biosynthesis and possibly in the palmitoylation of membrane receptors involved in the initiation of inflammation. Studies of arthritic inflammation in lab animals showed that dietary saturated fats are anti-inflammatory, whereas polyunsaturated oils are pro-inflammatory. Inflammation plays a role in numerous metabolic diseases, including insulin resistance, fatty liver disease and metabolic syndrome, among others. Fat, as triglycerides in adipose tissue, is an efficient way for living organisms to store energy and reduce the toxicity of other macronutrients. Macronutrients, such as excess carbohydrates and polyunsaturated fatty acids, are converted to saturated and monounsaturated fatty acids for storage as triglycerides in adipose tissue. Fatty acids are released from adipose tissue during fasting and as a result of some metabolic disorders, where elevated levels of nonesterified fatty acids in blood can lead to hepatic lipid accumulation, inflammation and insulin resistance. Although most serum nonesterified fatty acids may be saturated fatty acids, they are not necessarily derived from the diet. This paper will attempt to clarify the role of saturated fatty acids, and palmitic acid in particular, with regard to certain adverse health conditions. Full article

Lactation support from health professionals is a crucial social determinant of health. Registered dietitians (RDs) and registered nurses (RNs) can play an important role in supporting breastfeeding, yet most have minimal formal lactation education and training. This study seeks to explore the correlates of professional breastfeeding perceived role, perceived influence, and confidence in providing lactation support among RDs and RNs. Using a cross-sectional design, a convenience sample of 111 credentialed providers completed an online survey assessing their breastfeeding-related training, experiences, knowledge, attitudes, and practices. We also examined perceptions of social support, intentions for future breastfeeding, professional roles, and confidence in lactation support. We tested for relationships between variables using chi-square, Fisher’s exact, and Mann–Whitney U tests and identified which correlates were associated with the dependent variables using bivariate logistic regression. Respondents who were breastfed as infants were 3.4 times more likely to agree that it is their responsibility to highlight health problems associated with infant formula when giving breastfeeding advice (p = 0.009). Those agreeing that people around them support breastfeeding were 8.0 times more likely to believe they can influence a woman’s breastfeeding decision and duration (p = 0.05). Respondents working in maternal/child/family health were 14.3 times more likely to feel confident in their ability to provide lactation counseling, guidance, and recommendations (p = 0.03). Educational institutions and employers should provide all RDs and RNs with opportunities for personal reflection and lactation training while strengthening breastfeeding social norms. Full article

Those with a cancer diagnosis report experiencing a wide range of nutrition impact symptoms, the prevalence of which varies by study, group, and cancer type. We aimed to identify groups of cancer survivors with specific patterns of nutrition impact symptoms. Two hundred and twenty-nine individuals attending oncology day ward and outpatient clinics completed a series of questionnaires and physical measurements. A latent class analysis was performed to identify subgroups based on 13 nutrition impact symptoms taken from the Patient Generated Subjective Global Assessment short form. The identified classes were subsequently compared using analysis of variance and chi-square tests, by sociodemographic, clinical and nutritional variables, and by the Global Health Status (GHS) and five functioning scales determined using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Three latent subtypes were identified: (1) Fatigue (n = 58, 28%); (2) Low Symptom Burden (n = 146, 64%), and (3) High Symptom Burden (n = 25, 11%). Those in the High Symptom Burden group were more likely to be female, were currently receiving some form of treatment, were diagnosed ≥two years, and had consumed less food than usual in the last month compared to those in the Low Symptom Burden group. Those in the Fatigue group were less likely to have reported their food intake to be unchanged and more likely to be diagnosed ≥two years than those in the Low Symptom Burden group. The EORTC-QLQ-C30 functioning and GHS scores were all significantly different between the three nutrition impact symptoms classes (p < 0.001). This is the first study to examine heterogeneity of nutrition impact symptoms in Irish cancer survivors. The findings of this work will inform and allow for more individualised nutrition care. By tailoring interventions to these specific groups, we can enhance the precision of care, improve prognostic accuracy, and significantly elevate the quality of life of survivors. This work underscores the critical importance of symptom management in the continuum of cancer care, ensuring that every survivor receives comprehensive support tailored to their unique journey. Full article

Accurate estimation of food intake is necessary to clarify the relationship between dietary intake and particular health conditions; however, self-reported assessments often result in estimation errors. In addition, increasing evidence indicates an association between a higher intake of fruits and vegetables and a lower risk of some diseases, and many countries are encouraging their consumption. Biomarkers of vegetable and fruit intake are important tools for objectively estimating dietary intake in nutritional epidemiological studies. To determine the association between vegetable and fruit intake and blood biomarkers, we systematically reviewed relevant literature on Asians. Databases, PubMed, and CiNii Articles were searched for English and Japanese articles. Of the 91 articles retrieved, 4 were selected for review, including 2 cross-sectional studies, 1 longitudinal study, and 1 randomized trial. Our literature review showed that vegetable consumption is positively associated with plasma concentrations of γ-tocopherol, β-cryptoxanthin, α-carotene, β-carotene, lutein, threonate, galactarate, creatine, and ascorbic acid. In comparison, fruit consumption is positively associated with blood concentrations of α-tocopherol, β-cryptoxanthin, α-carotene, β-carotene, lycopene, retinyl palmitate, ascorbic acid, proline betaine, threonate, and galactarate. Therefore, blood β-carotene, β-cryptoxanthin, and ascorbic acid concentrations may be useful biomarkers for predicting vegetable and fruit intake in Asian population. Full article

Background: Campus food pantries can address food insecurity among college students, but little is known about how to create a model at a Hispanic-Serving Institution (HSI). This study evaluated a food pantry, which was part of a learning community for dietetics and nutrition students at an HSI. Methods: The Bobcat Bounty food pantry was created and evaluated using a mixed-methods approach, including food inventories before and after each pantry, observations of operations (written by volunteers at each pantry, n = 27), new client intake (n = 947) and client satisfaction surveys (n = 267)), and stakeholder interviews (n = 16 after the first year of implementation). Descriptive statistics and t-tests were used for quantitative analyses, and qualitative analyses included interview transcript coding and peer debriefing. Results: Here, 2 faculty members and a team of 19 students/dietetic interns operated the weekly campus food pantry, which served 3567 students and distributed 33,000 pounds of food. Client satisfaction surveys provided evidence for addressing food insecurity for college students. Volunteers and stakeholders generated insights for operational evolution and sustainability of the food pantry. Conclusions: Results highlighted key factors for initial efficacy and strategies for long-term success. Findings may be incorporated by dietetic education and training programs to provide research-focused and culturally relevant experiential learning. Full article

This study aimed to develop the ‘Healthy Eating Index for Older People’ (the index), based on New Zealand dietary guidelines, and measures the validity and reproducibility of a food frequency questionnaire (FFQ) to derive the index scores in older adults. In Auckland, New Zealand, participants (community-dwelling adults aged 65–74 years, [n = 273, 36% male]) completed a 109-item FFQ administered one month apart (FFQ1, FFQ2), with a four-day food record (4-DFR) collected in between. Adherence to the guidelines was scored using the index, comprising a total score (maximum = 100) and two sub-scores: adequacy (maximum = 60) and moderation (maximum = 40). A comparison of FFQ1 and FFQ2 determined reproducibility, and FFQ1 and 4-DFR determined validity. Higher index scores (from FFQ1) were associated with higher intakes of protein, fibre, vitamins and minerals and lower intakes of alcohol and saturated fats (nutrients from 4-DFR) after adjusting for age and sex (all p < 0.001). Total index and sub-indices correlation coefficients ranged from 0.42 to 0.77 (all p < 0.001); weighted kappa values ranged from 0.35 to 0.67; and mean differences were all <10% of FFQ1 for reproducibility and validity. The Bland–Altman analysis showed no bias for the total index score for reproducibility and validity. However, with validation, the sub-index scores became less reliable as food intake increased (p < 0.05). The index applied to the FFQ demonstrated good construct validity and reproducibility. Relative and absolute validity were acceptable, though caution is required when using the absolute sub-index scores. The index is suitable for measuring total diet quality in older New Zealand adults. Full article

Sustainability is an important aspect of all areas of life, including nutrition and dietetic practice. The Sustainability Development Goals are 17 goals set by the United Nations as a guideline on how the global population can be more sustainable moving into the future. Opportunities are available for nutrition and dietetic professionals to be involved in making changes and supporting the SDGs. Yet, there are limited studies exploring Irish dietitians’ perceptions and experiences of sustainability. An online survey consisting of 16 questions exploring familiarity with, as well as personal and professional perceptions of, sustainability was circulated to Irish dietitians by the Irish Nutrition and Dietetic Institute and promoted online through social media platforms (Twitter and Facebook). The survey was open for four weeks (18 October–16 November 2021) and was housed in Qualtrics and analysed using SPSS. A total of 102 Irish dietitians completed the survey (n = 100, 98% female). Most (96.1%) reported that sustainability is very important or important and 81.4% felt that it was very important or important in dietetic practice. Overall, participants were more familiar with environmental sustainability, e.g., widespread availability (79.4%), climate change (89.2%) and some concepts under economic, social, and general sustainability. They were most unfamiliar with agricultural sustainability concepts, e.g., use of food and agricultural policies (36.2% were familiar). This study illustrates the importance that Irish dietitians place on sustainability, aspects they feel confident in and areas for future education and support. Full article

(1) Background: Patient education materials are frequently used by dietitians to support counselling and reinforce key concepts. No studies have examined the quality of dietetic patient education materials for diabetes and common gastrointestinal conditions. (2) Methods: Materials relating to the dietary management of diabetes and gastrointestinal conditions (IBD, IBS, lactose intolerance, coeliac disease and low-FODMAP diets) were evaluated by three dietitian raters. Readability was assessed, and materials with a reading grade level ≤ 7 were considered readable. The PEMAT was used to assess understandability and actionability. Clarity was determined using the CDCCCI. (3) Results: Overall readability scores were satisfactory with a median grade level of 6 (IQR: 5–8). Readability scores did not differ between material types (p = 0.09). The health literacy demand of materials was suboptimal, with a mean understandability score of 65.9 ± 15.1% and an actionability score 49.6% ± 20.8%. Both scores fell below the benchmark of ≥70%. These did not differ between material types (p = 0.06 and p = 0.15, respectively). Clarity scores were below the benchmark of ≥90% (mean score 64.2 ± 14.8%). Only 6.6% of materials achieved a score of ≥90. (4) Conclusions: Improvements to the health literacy demand and clarity of dietetic patient education materials are required. Areas for future improvement have been identified. Full article