Food habits vary across ethnic groups and geographical regions. However, validated dietary assessment tools accounting for such diversity remain limited. A semi-quantitative food frequency questionnaire (FFQ) was developed and validated to assess the habitual food intake of adolescents and adults across Malaysia. The 147-item FFQ was constructed using commonly consumed foods from five main ethnicities (Malay, Chinese, Indian, and Sabah and Sarawak indigenous groups) identified from national surveys. A cross-sectional validation study was conducted among purposively sampled healthy individuals aged 10–59 years from 16 administrative regions. Trained community nutritionists administered the FFQ to assess monthly intake, alongside a three-day dietary record and recall (3DRR) covering two weekdays and one weekend. Spearman’s correlation, Bland–Altman plots, and quartile cross-classification evaluated the agreement between the FFQ and 3DRR for energy, macronutrients, and selected micronutrients (Vitamin C, thiamine, calcium, and iron). Respondents (n = 361; 50.3% adults, 49.7% adolescents) were 50.4% female and represented five main ethnicities (range: 15.8–25.2%), with 60.4% from Peninsular Malaysia. Energy intake estimated by the FFQ (median: 2285 kcal) was significantly higher than by the 3DRR (median: 1785 kcal; Wilcoxon p < 0.001). Spearman’s correlation coefficients observed for energy (crude r = 0.31), and selected nutrients (energy-adjusted r range: 0.19–0.38), along with <10% of extreme quartile misclassification indicated acceptable ranking ability and agreement for most nutrients. Bland–Altman plots indicated no proportional bias for energy and macronutrients. In conclusion, the FFQ is a valid tool for assessing dietary intake within the multi-ethnic Malaysian population nationwide.

This study aimed to identify barriers and facilitators to reducing free sugar intakes while participants were in the process of attempting to do this. Sixty-two adults with free sugar intakes >5% total energy intake; participants in a randomised controlled trial examining the effects of three different dietary recommendations versus control for reducing free sugar intakes were interviewed at either 1, 2, 4, 8, or 12 weeks after receiving their recommendation. Data were analysed using thematic analysis and framework analysis based on recommendation received, time for change, and success in reducing free sugar intakes at 12 weeks. Thematic analysis revealed seven interactive themes leading to dietary change: ‘Is it possible?’; ‘Power of knowledge’; ‘Personal balance and empowerment’; ‘Habitual approach’; ‘Realities of life’; ‘Extensive awareness and viewpoint’; and ‘Proof and impact’. Framework analysis revealed greater knowledge, including knowledge related to practical solutions, in intervention groups compared to control; greater intentions and expectations at the start of the process, followed by increasing or decreasing engagement and satisfaction over time, with noticeable physical and subjective proof occurring from 4 weeks; and active engagement, with growing confidence and motivation in those who ended the trial having reduced their free sugar intakes compared to more passive attitudes in those less successful. Our findings demonstrate clear variation in barriers and facilitators to reducing free sugar intakes throughout the process, dependent also on recommendation received and individual orientation. Suggestions for improving free sugar intake reduction can be offered based on these differences.

Accurately assessing dietary intake in children and adolescents is essential for understanding dietary patterns and informing public health strategies. In Latin America, rapid nutrition transitions and increasing childhood obesity highlight the need for culturally appropriate, validated dietary assessment tools (DATs). However, methodological challenges and limited regional data hinder effective dietary surveillance. This scoping review identified and characterised DATs used among children and adolescents (5–18 years) in Latin America, examining tool types, features, validation and regional coverage. Following Joanna Briggs Institute and PRISMA-ScR guidelines, comprehensive searches were conducted in EMBASE, Web of Science, PubMed, and LILACS (April 2024) in English, Spanish, and Portuguese. Eligible studies included original research developing, validating, or applying DATs in Latin American populations. Of 13,946 records screened, 105 reports met the inclusion criteria. Brazil and Mexico contributed the most studies, while six countries (Paraguay, El Salvador, Nicaragua, Panama, Honduras, and Belize) had none. Forty-three DATs were identified, 77% of which were food frequency questionnaires (FFQs). Half targeted adolescents, 39% children, and 11% both groups. Most were interviewer-administered (58%) and applied in person (49%), with only 19% conducted online, reflecting regional digital limitations. Validation was reported for 70% of tools, primarily against 24 HR. The DAT landscape in Latin America remains dominated by FFQs and traditional administration methods, with limited use of digital platforms. Developing age-appropriate, validated and culturally adapted digital DATs is essential to strengthen dietary surveillance and guide effective nutrition policies across the region.

Workplaces offer a key setting for health improvement interventions, given their reach and potential to promote lasting behaviour change. While diet and physical activity (PA) are common targets, sleep remains an underexplored yet influential factor in employee health. This randomised feasibility trial evaluated the practicality and acceptability of a 14-week, remotely delivered sleep-enhanced intervention (SEI) integrating sleep, PA, and diet, compared with a standard intervention (SI) focusing on PA and diet only, with exploratory assessment of behavioural and health-related outcomes. Staff from a UK higher education institution (n = 28) with short sleep duration (<7 h) and elevated cardiometabolic risk were randomised to SEI or SI. Quantitative data included self-reported and objective measures of PA, sleep, diet, and anthropometry over 14 weeks. Feasibility outcomes (recruitment, retention, compliance) and acceptability were assessed through qualitative interviews informed by the Theoretical Framework of Acceptability (TFA). Recruitment targets were achieved with 82% retention and 84% adherence. The SEI group showed indications of improvement in PA, dietary behaviours, anxiety symptoms, and sleep hygiene, while both groups showed reductions in BMI and waist circumference. Qualitative data highlighted the value of personalised guidance, peer support, and accountability, but also noted that the SEI’s complexity sometimes hindered adherence. The WHOLE trial demonstrates the feasibility and acceptability of a remotely delivered, holistic lifestyle intervention for UK employees. A phased or extended approach may enhance sustainability and engagement in future large-scale evaluations.

Acute malnutrition (wasting) remains a global public health problem. Ready-to-use therapeutic foods (RUTF) and supplemental foods (RUSF) for treatment of severe acute malnutrition (SAM) and moderate acute malnutrition (MAM), respectively, come in the form of macro- and micronutrient-dense pastes. These lipid-dense treatments provide the energy and nutrients needed to support growth but have significant rates of relapse. Their role in reversing pathophysiological contributors to malnutrition, such as intestinal barrier dysfunction, intestinal dysbiosis, and systemic inflammation have not been evaluated. Traditional lipid-dense RUTFs and RUSFs are rich in pro-inflammatory omega-6 polyunsaturated fatty acids (PUFAs) but low in anti-inflammatory omega-3 PUFAs, which could fuel malnutrition-related pathological inflammation. We reasoned that reduced dietary omega-6 (n-6) PUFAs and increased dietary long-chain omega-3 (n-3) PUFAs found in fish oil would reduce malnutrition-related pathological inflammation. In an established mouse model of MAM, we observed that altering the dietary n-3/n-6 PUFA ratio through replacing dietary corn oil with fish oil improved the diversity and composition of the caecal microbiota, improved intestinal mucosal barrier and immune defence, reduced translocation of bacteria and bacterial lipopolysaccharides (LPS), and dampened systemic inflammation. Furthermore, dietary fish oil protected against weight loss upon systemic challenge with bacterial LPS. The anti-inflammatory effects of dietary fish oil did not compromise host defence against challenge with the intestinal pathogen, Citrobacter rodentium. Collectively, these results suggest that dietary fish oil blunts inflammation that contributes to the pathogenesis of MAM. Inclusion of fish oil in dietary interventions may be beneficial in prevention or reduction of malnutrition-associated inflammation.

Food insecurity (FI) has increased in recent years due to economic shifts and rising food prices, with 13.6% of UK households experiencing FI, 47% including children in 2024. Following PRISMA guidelines, this systematic review with narrative synthesis explored the impact of UK interventions addressing FI for children, families, and pregnant women. Seven databases and two clinical trial registers were systematically searched for articles published between 2008–November 2023 (rapid search November 2023–February 2026). Peer-reviewed intervention studies were eligible if they were conducted in the UK, had an experimental design, targeted at least one FI pillar (accessibility, utilisation, availability, and stability) and if most participants were children aged 0–11 years, families with at least one child 0–11 years, or pregnant women. 18,225 articles were identified (rapid search identified 5,514); 11 intervention studies were included (rapid search n = 2). Types of interventions included cooking interventions (n = 4), free school meals (n = 3), holiday clubs (n = 2), supermarket vouchers (n = 1), and food bags (n = 1). Food availability was targeted in seven studies, food accessibility and utilisation in five, and food stability in one, one study included FI as an outcome. The interventions demonstrated barriers and facilitators to inform future intervention development. Most studies were considered serious or critical risk of bias. A lack of high-quality interventions addressing FI were identified. The additional studies reflected the evidence from the original studies. Government policies and funding are needed to relieve FI. Research needs to co-develop acceptable interventions and evaluate their effectiveness to reduce FI among families.

We examined whether diet quality is associated with executive function (EF) in middle-aged women with a family history of Alzheimer’s disease (AD) and whether this is moderated by a genetic AD risk factor, APOE-ε4 allele carriage. Data from 102 low-physically active women (AgeMean = 56.9 ± 5.8 years) were analyzed cross-sectionally. Diet quality was quantified via the Healthy Eating Index-2020 (HEI-2020). Overall EF and sub-domains (working memory [WM], exogenous inhibitory control [ICex], endogenous inhibitory control [ICen], and cognitive flexibility) were measured using neurocognitive assessments. APOE-ε4 carriage was determined from saliva. Moderated regression models tested HEI-2020*APOE-ε4 interactions; significant (p < .05) and near-significant (p < .10) interactions were followed by simple slope analyses. Main effects of HEI-2020 predicted overall EF (p = .033) and WM (p = .003). Interaction effects of HEI-2020*APOE-ε4 for EF and WM (p’s = .056–.038) were such that diet quality was positively associated with overall EF (p = .003) and WM (p = .005) in noncarriers only. Main effects of select HEI-2020 sub-scores were observed for overall EF and sub-domains (p’s = .001–.047). Interaction effects of total vegetables*APOE-ε4 on overall EF and ICex, saturated fatty acids*APOE-ε4 on overall EF and WM, and added sugars*APOE-ε4 on ICen (p’s = .007–.074) were such that sub-scores were positively associated with cognition in noncarriers only (p’s < .05). Diet quality and select sub-scores were positively associated with EF in middle-aged women without APOE-ε4 only. Future work should explore if APOE-ε4 carriers require a threshold of diet quality to yield cognitive benefits.

Oral nutritional supplements (ONS) are essential adjuncts in managing malnutrition in hospitalised older people. This study aimed to explore the adherence and palatability of a new porridge supplement (PS) compared to a standard drink-based supplement (DS) in hospitalised older adults. A single-centre multi-method randomised controlled crossover study was conducted on adults aged ≥65 years at risk of malnutrition (Malnutrition Universal Screening Tool score 1–4). Each participant was prescribed PS (16 g protein; 249 kcal) and DS (18 g protein; 306 kcal) twice per day for 4 days in crossover sequence. ONS leftovers were weighed, and adherence calculated (% consumed). Palatability ratings were assessed with a 7-point Likert scale, and interviews were conducted with 9 older adults and 5 staff to explore product acceptability. Twenty-seven older people (mean age 80 years, 17 female) participated. Median daily PS intake (26.31% [IQR 10.23–48.02]) was significantly lower compared to DS (66.8% [IQR 26.29–75.37]), and texture of PS was significantly disliked compared to DS. There were no significant differences in the absolute volume consumed between products, and supplements did not replace normal dietary intake. Changes in physical ability and appetite, the hospital culture (e.g., staff attitudes), and palatability (e.g., thickness and taste) of products influenced ONS acceptability. To improve patient-centred nutritional care, participants requested a wider in-hospital range of food-based supplementation with natural ingredients and enhanced training for staff in nutritional care.

Adequate nutritional knowledge (NK) is an essential aspect of team sport athletes (TSA) meeting their nutritional requirements, yet limited research has examined the NK of TSA using validated tools. This study aimed to assess the NK of male and female TSA using the validated Nutrition for Sport Knowledge Questionnaire (NSKQ) which was administered via the online platform REDCap. A total of 920 athletes (male n = 576 [62.6%], female n = 344 [37.4%]) from a range of sports including, Gaelic football n = 576 (62.6%), hurling & camogie n = 133 (14.5%), rugby n = 107 (11.6%) and soccer n = 104 (11.3%) completed the study. Participants were recruited from elite (county, country, province, professional) n = 343 (37.3%) and non-elite (club, university) n = 577 (62.7%) teams. The mean total score was 50.4 ± 12.78%, considered ‘average’ using accepted cut-offs. Across sports, rugby players’ total score was significantly higher when compared to Gaelic field sport athletes (p =.002). Scores in all NSKQ sub-sections fell within the ‘average’ or ‘poor’ category. NK was classified as ‘poor’ in the micronutrients (42.77 ± 19.89%), sports nutrition (46.93 ± 17.55%) and supplementation (35.42 ± 18.86%) sub-sections, with ‘poor’ scoring in these sub-sections observed across all sports. In this study, NK was sub-optimal in 89.8% (n = 826) of participants and although 74.9% of participants expressed a desire for access to nutritional resources, the majority (64.3%) reported having no such access, as indicated by participant responses from the demographic section of NSKQ. These findings suggest TSA may benefit from tailored nutrition education interventions to enhance NK, potentially improving dietary intake and subsequently health and performance outcomes.

India’s Supplementary Nutrition Programme (SNP), under the Integrated Child Development Services, provides a Morning Snack and a Hot Cooked Meal to children aged 36–72 months through Anganwadis (day-care centres). This study assessed these meals against SNP standards (2012) and age-specific ICMR recommendations, when standards were unavailable, and explored the use of linear programming (LP) to improve nutrient quality of SNP meals. A cross-sectional survey documented the SNP-meals, ingredients, serving portions and other details, using questionnaires administered to Anganwadi workers and programme officials from purposively selected Anganwadis across 27 States and Union Territories. Nutrient composition was estimated using standard food composition tables, and State-specific food lists and retail prices were incorporated into the LP framework to identify foods that could improve nutrient content of SNP meals. Energy standards were met in 56% of States, while 22% fell more than 20% below recommendations. Protein standards were achieved in 74% of States; however, declined to 52% after adjusting for digestibility. Only 22% of States met the ICMR-based fat requirement. Zinc, iron and folate were largely met, whereas calcium and vitamins A, B6 and B12 were below recommendations in more than half the States. Meals were predominantly cereal-based with limited inclusion of nutrient-dense foods. LP identified foods that reduced nutrient gaps, although many improvements exceeded the per-child cost allocation. Overall, meals showed wide variability, with persistent gaps in fat and key micronutrients. LP provides a structured approach to enhance nutrient provision within the programme setting, although meeting all nutrient targets may require adjustments to cost and procurement strategies.

Plant-based diets are favourable for both climate and health. However, not much is known about different barriers to adopting more plant-based diets across sociodemographic groups. This study examined the proportions of the population reporting a shift towards more plant-based diets and identified perceived barriers to these changes across different sociodemographic groups. The study was based on the Healthy Finland Survey 2022–2023, including 5390 participants aged 20–74 years. Participants responded to questions on plant-based diets using pre-defined response options. Results were presented as prevalences and 95% CIs. Women reported that they had changed their diets to more plant-based more often than men did (46% vs. 31%). Urban residents, higher educated participants, and those with higher income were more likely to have adopted more plant-based diets than others. Concerns about nutritional adequacy (women 20%; men 24%) and lacking skills to prepare tasty vegetarian foods (women 30%; men 28%) were common perceived barriers. In men, barriers included a dislike of vegetarian foods (23%) and a lack of interest (28%). In women, 17% cited the preferences of their close ones as a barrier. Barriers also differed between groups. Older participants were more concerned about the nutritional adequacy (29%), while younger participants struggled with cooking skills (35%). One third of men living in rural areas or with basic education reported a lack of interest in the topic. Tailored health promotion and food education strategies are critical to overcoming barriers to adopting plant-based diets in diverse sociodemographic groups.

The objective of this study was to assess the prevalence and predictors of nutrition knowledge, nutrition label use and dietary diversity among a sample of university students in Bangladesh. A cross-sectional study was carried out from November 2023 to April 2024 among undergraduate and postgraduate students. About 428 participants (aged 18–26 years) completed a structured questionnaire containing questions related to their demographic information, nutrition knowledge, nutrition label use, and dietary diversity (consumption of different food categories). Separate logistic regression models identified the main factors associated with nutrition knowledge, nutrition label use and dietary diversity. Approximately 32.5% participants had satisfactory nutrition knowledge and 36.0% were frequent nutrition label users. Female participants were more likely to have satisfactory nutrition knowledge (adjusted odds ratio, AOR = 2.05, 95% CI = 1.29, 3.26) and use nutrition labels more frequently (AOR = 1.97, 95% CI = 1.22, 3.17) than their male counterparts respectively. Around 40% of the participants had a high level of dietary diversity. Students with satisfactory nutrition knowledge (AOR = 3.02, 95% CI = 1.41–6.45) and frequent use of nutrition labels (AOR = 2.73, 95% CI = 1.35–5.55) had a higher dietary diversity compared to their counterparts. Less than half of Bangladeshi students in this study have adequate nutrition knowledge, label use, and dietary diversity. The findings highlight the importance of implementing nutrition awareness programmes and nutrition education interventions for university students, such as basic food and nutrition knowledge and the use of nutrition labels, to enhance their dietary diversity and health status.

A high sodium intake is a major risk factor for raised blood pressure. Consumption of fish fillet is associated with lower blood pressure in humans and other animals, whereas the effects of consuming fish residuals are less explored. To obtain high-quality fishmeal with acceptable sensory properties, the fish residuals may be washed with seawater onboard factory trawlers. This will increase the sodium content in the residuals, and whether this affects blood pressure has not yet been investigated. The primary objective of the present study was to investigate if the increased sodium content in Atlantic cod (Gadus morhua) residuals after washing with saltwater affected the development of high blood pressure in male obese Zucker fa/fa rats which spontaneously develop hypertension. Rats were fed diets containing cod protein powders prepared from unwashed or saltwater-washed backbone or head fractions (n 6/group) as 25% of total protein with the remaining 75% as casein, or casein as the sole protein source (Control group, n 6) for six weeks. Blood pressure was measured on day 0 and 40. The diets containing backbone protein powder, independent of whether this fraction was washed with saltwater or not, attenuated the blood pressure increase compared to the Control group, whereas diets containing washed or unwashed head protein powder did not affect the blood pressure development. To conclude, a diet containing cod backbone protein powder attenuated the blood pressure increase in obese Zucker fa/fa rats, and this effect was not compromised by the higher sodium content in backbones washed with saltwater.

Puppetry-based activities could serve as a low cost and manageable intervention in improving health-related outcomes. This review aims to identify the research to date and gaps in practice of the role and application of puppetry interventions in nutrition education. A scoping review was conducted using the PICOS framework and PRISMA-ScR guidelines, identifying studies across eight databases between January, 1980 and July, 2025.Twenty-five studies were identified, with the majority (n = 19) aimed at pre-school and school-aged children. Fifteen studies used quasi-experimental, pre–post designs. The use of hand and finger puppets was common, as well as videos and puppet theatre. Studies reported consistently positive findings in knowledge gain and psychosocial involvement, but mixed results on behaviour change. Little is known about the rationale for the type of puppet used, the scripts, and what audience was targeted for nutrition intervention messaging. Research could be undertaken to give more insight into matching what type of puppet to use to match the nature, scope, and extent of the educational message. Reports and recommendations in this review showed that participant engagement is a common and important objective. The gaps of knowledge in use of puppetry in nutrition education are many, thus creating opportunities for further evaluations and research, particularly in utilising what seems to be a manageable intervention within health promotion and disease prevention programmes. Puppetry can be a low cost, flexible, and easy to manage adjunct to nutrition education activities, providing culturally appropriate messaging with a range of audiences.