Military veterans (ex-serving members of the Armed Services) experience unique physical and mental health challenges, with diet playing a critical role in chronic disease management and well-being. This review aimed to evaluate veterans’ dietary intake against nutrient reference values (NRV) relevant to age and sex. A systematic search of CINAHL, MedLine, Scopus, PubMed and AMED (January 2024, updated March 2025) identified 1268 records; thirty-three studies (n 654 323) met inclusion criteria. Eligible designs included cross-sectional, cohort, quasi-experimental and randomised controlled trials. Data were extracted using the Joanna Briggs critical appraisal checklist, indicating low risk of bias. Across studies, veterans’ intake of fibre, folate, vitamin D, Ca, potassium, fruits, vegetables, wholegrains and legumes was consistently inadequate, with overall diet quality rated poor to average. BMI ranged widely, and veterans reported high rates of mood disorders and low quality-of-life scores. These findings highlight key nutrients and dietary patterns that might be considered and targeted in dietary and lifestyle interventions for promoting the physical and mental health of veterans.

To identify associations between Hb concentration in different trimesters, Hb changes and Hb trajectories during pregnancy with risk of preterm birth (PTB) and low birth weight (LBW). A retrospective cohort study included 18 980 participants from Haidian District Maternal and Child Health Care Hospital from 2018–2021. Hb concentrations were measured at first (0–12 weeks), second (13–27 weeks) and third trimesters (≥ 28 weeks). Hb was categorised into four groups (< 110, 110–119, 120–129, ≥ 130 g/l), and Hb changes between trimesters were calculated. The latent class growth mixed model was employed to estimate Hb trajectories. Association assessment and dose–response relationship used logistic regression and restricted cubic spline. Compared with Hb 110–119 g/l, women with Hb ≥ 130 g/l significantly increased odds of PTB (OR: 1·74, 95 % CI 1·29, 2·31) and LBW (OR: 2·31, 95 % CI 1·65, 3·20) during the second trimester. In the third trimester, women with Hb 120–129 g/l showed 26 % (OR: 1·26, 95 % CI 1·04, 1·51) increased odds of PTB and 72 % (OR: 1·72, 95 % CI 1·36, 2·17) increased odds of LBW, while the OR of Hb ≥ 130 g/l for PTB and LBW were 1·45 (95 % CI 1·12, 1·86) and 2·60 (95 % CI 1·96, 3·43). Hb changes exhibited a linear increase in odds of PTB and LBW. Women with a decline-sharp-rise trajectory had a 1·48-fold odds of PTB (OR: 1·48, 95 % CI 1·26, 1·75), compared with a decline-gradual-rise trajectory. These findings underscore the importance of monitoring Hb during pregnancy.

Using National Health and Nutrition Examination Survey data (2011–2020), we assessed the association between the nutritional risk index (NRI) and stroke risk among 22 839 adults (mean age, 49·61 (sd 17·07) years), including 910 individuals (3·98 %) with stroke. Weighted multivariable logistic regression and restricted cubic spline (RCS) analysis were used to characterise the association, with subgroup analyses to examine consistency across populations and mediation analyses to investigate the roles of lipid and inflammatory biomarkers. Higher continuous NRI was inversely associated with stroke, with each 1-unit increase associated with 4 % lower odds (OR = 0·96, 95 % CI: 0·95, 0·97), and participants in the highest NRI quartile (Q4) had a significantly lower stroke risk than those in the lowest NRI quartile (Q1) (OR 0·60, 95 % CI 0·42, 0·85). RCS analysis indicated a linear relationship (P for nonlinearity > 0·05), and the protective effect of higher NRI remained robust across nearly all subgroups examined. Mediation analyses revealed that total cholesterol, systemic immune-inflammation index, product of platelet and neutrophil count, neutrophil:lymphocyte ratio and lymphocyte:monocyte ratio each partially mediated the NRI–stroke association, with mediation effects ranging from 1·71 % to 13·65 %. These findings suggest that favourable nutritional status, reflected by higher NRI, is linked to lower stroke risk, with lipid metabolism and inflammation playing mediating roles in this association. Further longitudinal and mechanistic studies are warranted.

This study aimed to evaluate adherence to the Mediterranean diet, a recognised healthy eating pattern, and the tendency towards orthorexia nervosa in professional athletes, and to examine their relationship with physical activity levels. The study was conducted with athletes (n 134) at the Turkish Olympic Preparation Center (TOHM). Data were collected using a questionnaire covering sociodemographic information, dietary habits, anthropometric measurements, the Mediterranean Diet Quality Index (KIDMED), the International Physical Activity Questionnaire-Short Form (IPAQ-SF) and the Orthorexia-11 (ORTO-11) scale assessing orthorexic tendencies. Of the participants, 17·2 % had poor dietary quality, 60·4 % moderate and 22·4 % good dietary quality. According to the ORTO-11 (cut-off ≤ 25 points), 30·6 % of athletes exhibited orthorexic tendencies. Athletes adhering to a diet had significantly higher orthorexia tendencies compared with non-dieters (P < 0·05). A significant association was found between athletic experience and orthorexic tendencies, particularly among those with 4–8 years and ≥8 years of experience (P < 0·05). Moreover, athletes consuming three main meals had significantly higher KIDMED and ORTO-11 scores than those consuming two meals (P < 0·05). No statistically significant correlation was found between the KIDMED score, ORTO-11 score and physical activity level (P > 0·05). Professional athletes showed moderate adherence to the Mediterranean diet, while certain groups displayed higher orthorexia tendencies. Diet quality and orthorexic tendencies differed significantly with eating habits such as athletic experience and meal patterns, whereas physical activity level had no effect. These findings highlight the importance of multidisciplinary nutrition strategies focusing on both performance and sustainable healthy eating behaviours.

The objective is to describe energy, macro- and micronutrient intake according to Nova food groups and to estimate its association with ultra-processed foods (UPF) energy participation in the diets of children, stratified by age (6–23 m/24–59 m). A single 24-h recall from 12 553 children in the Brazilian National Survey on Child Nutrition was used to estimate the relative energy contribution of Nova groups: unprocessed or minimally processed foods and culinary ingredients (G1 + G2); processed foods (G3) and UPF (G4). Age-stratified linear regression and 95 % CI assessed differences in nutrient intake (per 1000 kcal) across UPF energy quintiles. The G1 + G2 group accounted for most of the energy consumed (6–23 m: 74·5 %; 24–59 m: 65·1 %) compared with G3 or G4. For both age groups, in the lowest quintile of UFP participation, ≤ 2 % of energy came from UPF, while in the highest quintile, this proportion was > 55 % and the G1 + G2 group provided most nutrients. In 6–23 m, higher UPF quintiles were associated with lower fat (β: –3·1 (–3·6, –2·5)), potassium (β: –49·7 (–67·9, –31·4)) and vitamin A RAE (β: –113·7 (–136·7, –90·6)) intake, but higher Ca ((β: 75·5 (57·6, 93·4)), Fe (β: 2·9 (2·5, 3·3)), vitamin A RE (β: 104·3 (72·3, 136·3)) and folate (β: 15·7 (12·0, 19·5)) intake. In 24–59 m, nutrient intake generally decreased with increasing UPF quintiles. For 6–23 m/24–59 m, UPF consumption was positively associated with energy (β: 73·6 (44·6, 102·7); 92·8 (66·7, 118·8), respectively) and carbohydrate (β: 7·3 (5·8, 8·7); 2·3 (1·2, 3·3), respectively), while contributing little to overall micronutrient intake.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease worldwide. Flavonoids may offer protective benefits, but the role of overall diet quality in modulating this remains unclear. In this cross-sectional study, we analysed 2815 participants from the Framingham Heart Study. Hepatic steatosis was defined by liver:phantom ratio < 0·33 using multidetector computed tomography. Dietary intake was assessed using a validated FFQ, and intake of six flavonoid subclasses and total flavonoid was estimated using the USDA database. Logistic regression models evaluated associations between flavonoid intake quartiles and hepatic steatosis, adjusting for demographic and lifestyle covariates, followed by additional models adjusting for a priori dietary quality indexes: the Alternative Healthy Eating Index, the Mediterranean-style diet score and the Dietary Approaches to Stop Hypertension score. Higher intake of flavonols, flavan-3-ols, anthocyanidins, flavonoid polymers and total flavonoids is associated with lower odds of hepatic steatosis (Ptrend < 0·05), with up to 40 % reduced odds at the highest quartiles before adjustment for diet quality. After adjustments, associations attenuated and lost statistical significance. The attenuation does not rule out a potential protective role of flavonoids; it may indicate that higher flavonoid intake is an important element of a broader healthy diet. Alternatively, the associations could be confounded by other components of diet which may independently reduce steatosis risk. Nonetheless, these findings underscore the importance of promoting flavonoid-rich diets in the context of overall healthy diet and support further investigation in prospective and interventional studies targeting MASLD prevention.

The relationship between mild ketosis and metabolic syndrome (MetS) remains unclear. We aimed to investigate the association between serum ketone levels and MetS and to examine how genetic and lifestyle factors influence this relationship. We conducted a cross-sectional observational study using data from the UK Biobank, comprising 269 178 participants. Participants were categorised into low and high serum ketone groups based on β-hydroxybutyrate levels (cut-off: 0·12 mM). Dietary patterns were assessed using validated questionnaires, and a polygenic risk score (PRS) was generated to examine genetic influences on ketone metabolism. Individuals with higher ketone levels showed significantly lower MetS prevalence, with reduced BMI, waist circumference, TAG and glucose levels, alongside higher HDL-cholesterol. These individuals also exhibited distinct dietary patterns, characterised by lower carbohydrate (CHO) and higher fat intake, as well as increased physical activity. The PRS was inversely associated with MetS risk, particularly for abdominal obesity, TAG and HDL-cholesterol components. Notably, PRS modified the relationship between plant-based diet and ketone levels, with stronger positive associations observed in individuals with higher PRS. However, a high CHO diet showed weaker associations with PRS. In conclusion, genetic predisposition influenced ketone metabolism and its protective association with MetS risk. The interaction between genetic predisposition and lifestyle factors has crucial clinical implications for developing personalised dietary and lifestyle interventions. This research provides evidence for individualised approaches to optimise metabolic health through targeted ketone metabolism modulation, which could inform precision medicine strategies for MetS prevention and management.

This study aimed to investigate the association between the timing and quality of the last meal and sleep quality among Iranian adults. In this cross-sectional study, healthy Iranian adults were included. Dietary intake and meal timing were assessed using three non-consecutive 24-h dietary recalls to calculate the interval between the last meal and bedtime. Dinner quality was evaluated using the NRF9·3 index, and sleep quality was measured using the Pittsburgh Sleep Quality Index. Multivariable logistic and ordinal regressions assessed associations of meal timing and dinner quality with sleep outcomes, adjusting for confounders. The study included 450 adults (mean age: 38·1 (sd 9·7) years), of whom 55·8 % had good sleep quality. The mean interval between the last meal and sleep was 2·38 (sd 1·08) h. A longer interval between the last meal and bedtime was associated with higher odds of poor global sleep quality (OR = 2·03, 95 % CI: 1·24, 3·32; P = 0·005). Longer intervals were significantly associated with better subjective sleep quality, shorter sleep latency, longer sleep duration and higher habitual sleep efficiency. Dinner quality demonstrated a mixed pattern of association with sleep quality, showing higher odds of poor sleep in the second tertile (OR = 1·66, 95 % CI: 1·01, 2·73), whereas this association was not observed in the highest tertile (OR = 1·24, 95 % CI: 0·75, 2·04). In conclusion, longer dinner-to-bedtime intervals may improve specific sleep quality aspects, though results remain inconsistent. Further research is essential to clarify these associations and determine optimal meal timing.

While chrono-nutrition behaviours are inter-related, few studies examined patterns of chrono-nutrition behaviours using a comprehensive set of these behaviours. This study aimed to identify chrono-nutrition behaviour patterns and examine their associations with sociodemographic characteristics, diet quality and obesity. This cross-sectional study included 1047 Japanese adults aged 20–69 years. Using 11-d diaries of eating, chrono-nutrition behaviours (such as frequency and timing of eating) were evaluated for workdays and non-workdays separately. Principal component analysis identified four patterns: ‘early, large breakfast on workdays’, ‘skipping breakfast on non-workdays’, ‘frequent snacking with small dinner’ and ‘early last eating with large lunch’. Female sex was associated with the ‘frequent snacking with small dinner’ and ‘early last eating with large lunch’ patterns; male sex was associated with the ‘skipping breakfast on non-workdays’ pattern. Age was positively associated with the ‘skipping breakfast on non-workdays’ and ‘early last eating with large lunch’ patterns. Having a full-time paid job was associated positively with the two patterns characterised mainly by breakfast but inversely with the remaining two patterns. After adjustment for potential confounders, none of the four patterns were significantly associated with diet quality (Healthy Eating Index-2020 score), general obesity (BMI ≥ 25 kg/m2) or abdominal obesity (waist circumference ≥ 90 cm for males; ≥ 80 cm for females). In conclusion, this study suggests that different chrono-nutrition behaviour patterns were differentially associated with sociodemographic characteristics, but not with diet quality or obesity. Further research is needed to clarify if the patterning approach is useful to comprehensively interrogate chrono-nutrition behaviours.

A limited intake of free and added sugars is recommended due to potential associations with adverse health effects and nutrient inadequacy. However, the impact of free and added sugars intakes on dietary intake is unknown in Swedish adolescents. This study investigated associations of free and added sugars intakes with nutrient and food consumption. Data were derived from the Riksmaten Adolescents 2016–2017 cross-sectional survey, including a nationally representative sample of 3099 adolescents, aged around 12, 15 and 18 years, which provided two 24-h recalls. Median nutrient and food group intakes were compared across sugars intake quintiles, with adjustments for sex, school year and energy misreporting. Inverse associations were observed for almost all micronutrients, dietary fibre, essential fats and food groups commonly included in a healthy diet (e.g. vegetables, fruit, dairy products, meat, fish). However, positive associations between free sugars and vitamin C intake were observed, with fruit juice influencing intake trends. Total energy intake was not positively associated with free or added sugars intakes. Higher intakes of free and added sugars (> 12·9 and > 11·3 % of total energy intake) significantly reduced the likelihood of meeting nutrient reference values. However, for critical nutrients within the adolescent diet (vitamin D, Se, dietary fibre and polyunsaturated fats), lower odds of meeting reference values were observed even at lower intakes of free and added sugars. To conclude, with increasing sugars intake, Swedish adolescents appear to displace nutrient-dense foods with sugars-rich foods, emphasising differences in dietary patterns between those with lower v. higher free and added sugars intake.

Fe deficiency (ID) is a common nutritional disorder, especially among children and women of reproductive age. Detecting ID before it progresses to Fe deficiency anaemia (IDA) is critical for prevention. This study assessed mean corpuscular Hb (MCH) and red cell distribution width (RDW) as complete blood count (CBC) based markers for early non-anaemic Fe deficiency (NAID). We retrospectively analysed records of children aged 2 months to 6 years who underwent regular general health checks at Fujian Provincial Maternal and Child Health Hospital between July 2022 and July 2024. ID was defined by serum ferritin < 15 µg/l. Children with thalassemia, inflammatory conditions (C-reactive protein > 5 mg/l) or incomplete data were excluded. Logistic regression was used to evaluate associations between CBC indices and ID. Model discrimination was assessed by the area under the receiver operating characteristic curve and externally validated using National Health and Nutrition Examination Survey (August 2021–August 2023, Cycle 12) data. A total of 2018 children were included (training: n 1413, testing: n 605; external validation: n 232). MCH (OR = 0·63; 95 % CI, 0·52, 0·76; P < 0·001) and RDW (OR = 1·44; 95 % CI, 1·16, 1·79; P = 0·001) were independent predictors of ID. The model showed consistent performance, with AUC of 0·77 (training), 0·81 (testing) and 0·87 (validation). MCH and RDW are practical markers for early NAID detection in Chinese and US children, offering a valuable tool for any setting with an automated haematology analyser, particularly when access to advanced Fe studies is restricted.

Intra-household energy and nutrient inequity occur when food is distributed differentially, leaving some members without adequate nutrition. If unaddressed, this can reduce the effectiveness of food based nutrition interventions. This study assessed energy and micronutrient intake inequities among urban Ethiopian households before and after wheat flour and edible oil fortification. Using 24-h dietary recall data from the 2013 Ethiopian Household Food Consumption Survey, we analysed 375 households with adult men and women. The Ethiopian mandatory fortification standard for wheat flour and edible oil was considered in the simulation. Usual intake estimates and fortification modelling were performed using the Simulating Intake of Micronutrients for Policy Learning and Engagement macro 1-day method. Inequity ratios were calculated by comparing energy and nutrient intakes with dietary requirements for each group. Prefortification, the median nutrient consumption was generally higher among men, except for vitamin A. Fortification of wheat flour with Zn and vitamin B1, along with vitamin A-fortified vegetable oil, led to a 26–74 percentage point reduction in nutrient inadequacy among all participants. Men could benefit more from Zn and vitamin A fortification, whereas women could benefit more from vitamin B1 fortification. Inequity estimates before and after fortification ranged from 1 to 1·5, favouring men. Although intra-household food allocation was not directly assessed, observed differences in nutrient intake between men and women suggest gender-related disparities that should be considered in nutrition interventions.

Discrepancies in iodised salt coverage rate (ISCR) between household salt and that used in catering establishments may significantly compromise the accuracy of dietary iodine intake assessments. To evaluate this impact, we analysed data from the 2023 Shanghai Diet and Health Survey, a cross-sectional study involving 2920 adults. Dietary intake was assessed using three 24-h dietary recalls and an FFQ, while condiment intake was collected using the weighed inventory method. Additionally, salt samples from 960 canteens and restaurants were tested to determine the ISCR in dining establishments. Results showed that the ISCR was 85·9 % in dining establishments, markedly higher than the 53·3 % observed in households. Among employed participants in Shanghai, 51·7 %, 56·1 % and 18·7 % reported consuming breakfast, lunch and dinner outside the home at least once during the 3-d study period, respectively. The estimated daily iodine intake was 101 μg/d when dining-out salt was assumed to have the same ISCR as household salt, but it increased to 118 μg/d after accounting for the ISCR discrepancy. In conclusion, the rising prevalence of eating out has reshaped residents’ dietary habits, rendering traditional household-centric survey methods inadequate for iodine intake estimation in Shanghai. Incorporating ISCR differences between household and dining settings is essential for more accurate dietary iodine assessments.

Food literacy is important for understanding the factors that determine food choices, eating behaviours and diet quality. However, few studies have examined the relationship between food literacy, diet quality and food consumption. The present study aimed to examine this relationship in an adult population. This cross-sectional study included 639 adults (50·2 % female; age range: 19–65 years) at Ondokuz Mayıs University in Samsun, Türkiye. Participants completed the Short Food Literacy Questionnaire (SFLQ). Anthropometric measurements and 24-h food recall were recorded. Diet quality was assessed using the Healthy Eating Index (HEI)-2015. Total scores for vegetables and seafood and plant proteins (HEI-2015 components) were higher in the adequate–excellent food literacy group (2·9 (sd 2·25) v. 2·5 (sd 1·85), P = 0·041 and 12·8 (sd 12·51) v. 11·0 (sd 10·58), P = 0·040). Conversely, the refined grain scores were higher in the inadequate–limited food literacy group (3·6 (sd 5·77) v. 4·5 (sd 5·67), P = 0·041). In the regression model, the SFLQ score was positively associated with HEI-2015 scores (β = 0·364, P = 0·026) and total vegetable consumption (β = 0·029, P = 0·015). For each 1-point increase in the SFLQ score, the HEI-2015 score increased by 0·364 points on average (β = 0·364, P = 0·026). Furthermore, SFLQ scores were negatively associated with refined grain scores (β = −0·107, P = 0·001) and added sugar scores (β = −0·021, P = 0·042). Food literacy is an important factor associated with diet quality. Enhancing nutrition knowledge, skills and attitudes in adults may contribute to healthier eating behaviours.

The Healthy Eating Index (HEI) is widely used to assess diet quality, but certain contexts (e.g. pregnancy) may benefit from tailored versions. We evaluated whether the HEI’s current approach of assigning approximately equal weights to all components to compute the total score is appropriate when studying diet quality around conception. Data were from a US prospective cohort of individuals who had not delivered a previous pregnancy past 20 weeks’ gestation (2010–2013, n 7882). Usual dietary intake around conception was estimated from FFQ. Select adverse pregnancy outcomes (gestational diabetes, pre-eclampsia, preterm delivery and small-for-gestational age birth) were abstracted from the medical record. We regressed each outcome on the thirteen HEI-2015 component scores using SuperLearner, an ensemble machine learning method that combines predictions from multiple algorithms and avoids relying on parametric assumptions that characterise standard regression. We assessed the relative importance of each component using two permutation-based metrics: change in negative log likelihood (global influence) and absolute difference in the predicted probabilities (individual-level influence). Six of the thirteen components (Greens and Beans, Saturated Fats, Total Protein Foods, Seafood and Plant Proteins, Fatty Acids and Added Sugars) were important according to at least one metric for at least two of the four outcomes. In contrast, the Refined Grains component was not appreciably important for any outcome. These findings suggest that equal weighting of the HEI components may not be appropriate when evaluating diet quality for studies of pregnancy.

Existing studies suggest that foods rich in phytoestrogens could reduce mortality and protect against the shortening of telomere length (TL). However, the specific phytoestrogens responsible for this effect remain unidentified. We conducted a cross-sectional study using data from the 1999–2002 US National Health and Nutrition Examination Survey. Four metabolites of soya isoflavones (daidzein, equol, genistein, O-demethylangolensin) and two metabolites of lignans (enterodiol and enterolactone) were detected. Leukocyte TL was measured. After ln-transformed, the association of phytoestrogen metabolites and leukocyte TL was assessed using multivariable linear regression. Percentage change was calculated as (eβ–1) × 100 %. Of the 2607 participants, 48·52 % were male. A 1-sd increase in urinary equol was associated with a 1·50 % (95 % CI 0·51, 2·50) increase in TL, and TL was 4·26 % (95 % CI 1·07, 7·56) longer in the highest quintile of equol compared with the lowest. Similarly, a 1-sd increase in the equol:daidzein ratio was linked to a 1·87 % (95 % CI 0·91, 2·84) rise in TL, and TL was 4·83 % (95 % CI 1·71, 8·05) longer in the highest quintile of the equol:daidzein ratio compared with the lowest. No significant association of urinary daidzein, genistein, O-demethylangolensin, enterodiol and enterolactone with TL was observed. Our findings suggested that higher levels of urinary equol and its ratio with daidzein were associated with longer leukocyte TL, highlighting the need for further research into their relationship with ageing.