Dietetics

Being overweight or obese is a public health problem. This work evaluated a food and nutrition education (FNE) intervention to reduce overweight status among schoolchildren in four schools in the West Panama Province. This was a quasi-experimental before-and-after study that implemented a 34-week FNE intervention through workshops with didactic material to 403 children between 8 and 13 years old. A knowledge and attitude survey was used as an evaluation tool before and after the FNE intervention. The prevalence of excess weight (40%) did not reduce after the intervention. The zBMI at the beginning was 0.57 (1.29) for girls and 0.70 (1.36) for boys, and at the final evaluation was 0.57 (1.28) for girls and 0.67 (1.33) for boys. No significant differences were observed between the point of evaluation and sex. No differences were reported in the median level of attitude, although higher levels of knowledge were reported in students of both sexes. The FNE in schoolchildren can be effective in acquiring knowledge and maintaining a positive attitude towards food, but more research is needed to address nutritional status. Although the intervention had no impact on nutritional status, the FNE facilitated the adoption of skills and competencies in schoolchildren. The success of the implementation of the study highlighted the feasibility of replicating the FNE interventions on a larger scale to contribute positively to the multi-level and sectoral public policy Study Without Hunger in Panama. Full article

Recent evidence suggests a link between Inflammatory Bowel Disease (IBD) and eating disorders, an emerging complex bidirectional association. Indeed, the overlap of symptoms and signs can lead to delayed diagnosis and misdiagnosis of both conditions, but also the fear of food-induced symptoms, commonly observed in patients with IBD, determines dietary restrictions which in predisposed individuals may induce an overt eating disorder. ARFID (Avoidant Restrictive Food Intake Disorder) and anorexia nervosa are the eating disorders more frequently reported, while disordered eating and orthorexia nervosa are emerging conditions. Disease worsening due to refusal of therapies in patients with anorexia is also a matter of concern and an increased awareness of the possible association of these conditions by gastroenterologists and dietitians is strongly warranted in order for patients to receive the appropriate counseling. Full article

Sleep quality (duration, efficiency, and latency) is directly associated with human health. An interventional study reported that the time of dinner influenced sleep latency, suggesting that it may also be associated with other sleep quality indices under free-living conditions. Therefore, we cross-sectionally examined the association between the time from dinner to bedtime (TDB) and sleep quality indices under free-living conditions in the young Japanese population. Based on the TDB, 264 participants were separated into three quantiles (T1, ≤3.79 h; T2, 3.80–4.94 h; T3, ≥4.95 h from dinner to bedtime). The T1 (mean ± standard error; 26.4 ± 2.2 min, p = 0.081) and T2 groups (30.8 ± 2.2 min, p = 0.001) showed longer sleep latency compared to the T3 group (19.6 ± 2.2 min), after adjusting for confounding factors. Sleep efficiency in the T1 group (77.5 ± 1.6%) tended to be greater than in the T3 group (72.1 ± 1.6%, p = 0.061), whereas sleep efficiency in the T2 group was not significantly different (77.0 ± 1.6%) from that in the T1 group. Therefore, shortened TDB was associated with prolonged sleep latency in free-living conditions. Meal timing, especially dinner, should be considered along with other sleep hygiene measures to improve human health. Full article

Cancer survivors consider nutrition to be highly important and are motivated to seek information about lifestyle changes, including nutrition, to improve their long-term health. Despite this, suboptimal dietary intake is still reported. Understanding cancer-specific barriers and facilitators to healthy eating among this population could help develop targeted interventions for this group. This study explored the barriers and facilitators to following a healthy diet among cancer survivors using the Theoretical Domains Framework (TDF) and COM-B model. Semi-structured focus groups with 20 cancer survivors were conducted between February and August 2021, which were transcribed verbatim. Seven key TDF domains accounted for 87% of all coded responses. These were (a) environmental context and resources; (b) knowledge; (c) behavioural regulation; (d) social/professional role and identity; (e) belief about consequences; (f) social influences; and (g) skills. Key barriers were lack of knowledge, non-specific or irrelevant information, environmental aspects, and family. Facilitators were awareness of the importance of nutrition, the health benefits of a plant-based diet, confidence in cooking skills, organisation, balance, family, time, and viewing themselves as someone who eats healthily and access to fresh produce. Enablement was the most prominently linked intervention function. This work can inform future interventions in this area and ensure they are end-user-centred. Full article

Background: Climate change is a serious threat to human wellbeing and development. Global reduction of meat intake is key to addressing climate change and other modern sustainability challenges. Plant-based and mycoprotein-based meat substitutes are predicted to play a key role in the reduction of meat intake; however, their impact on human health is unclear. The main objective of this meta-analysis was to assess the short-term effects of meat substitutes on important cardiometabolic biomarkers (total cholesterol, TC; LDL-cholesterol, LDL-C; HDL-cholesterol, HDL-C; triglycerides, TG; systolic blood pressure, SBP; diastolic blood pressure, DBP; fasting blood glucose, FBG; weight) in controlled clinical trials. Methods: Embase and MEDLINE were searched to identify controlled clinical trials with meat substitute interventions and cardiometabolic biomarker outcomes. Standardised mean differences in TC, LDL-C, HDL-C, TG, FBG, SBP, DBP, and weight and 95% confidence intervals were pooled using a random effects model. Risk of bias, heterogeneity, sensitivity, and publication bias were assessed. Of the 934 records identified, 12 studies met the inclusion criteria. In the pooled analyses, the consumption of meat substitutes was associated with significantly lower TC (−0.50 mmol/L [95% CIs −0.70, −0.29]), LDL-C (−0.39 mmol/L [−0.57, −0.21]), and TG (−0.15 mmol/L [−0.29, −0.01]), non-significantly lower FBG (−0.08 [−0.23, 0.08]), SBP (−0.32 [−1.79, 1.41]), and weight (−0.12 [−1.52, 1.27]), and non-significantly higher HDL-C (0.01 [−0.02, 0.05]) and DBP (0.49 [−0.30, 1.28]). There was evidence of publication bias, and some heterogeneity was detected. The certainty of evidence was moderate for the TC and HDL-C results, low for the LDL-C, TG, SBP, DBP, and weight results, and very low for the FBG results. Conclusions: Replacement of some or all meat with plant-based or mycoprotein-based substitutes may lower TC, LDL-C, and TG. Full article

Anxiety disorder is characterized by excessive fear or avoidance of perceived threats that can be persistent and debilitating. Diet is a modifiable risk factor that may contribute to the pathogenesis or treatment of anxiety, depending on diet quality. Although the biological mechanisms by which food, specific nutrients, and nutraceuticals impact mental health are not completely understood, implicated pathways include inflammation, oxidative stress, brain plasticity effects, mitochondrial dysfunction, and neurotransmitter metabolism. Essential dietary trace minerals such as zinc, copper, iron, and selenium are critical components for numerous biological proteins and may have a role in these proposed mechanisms related to brain health and anxiety. This narrative review examines the influence of essential trace elements zinc, copper, iron, and selenium on anxiety symptoms based on the latest peer-reviewed scientific evidence. Current research indicates that deficiencies in zinc, iron, and selenium are associated with anxiety, while copper overload may impact anxiety to a greater degree than copper deficiency. Further investigation is needed to understand the specific neurobiological mechanisms involved. Overall, the collective findings demonstrate the importance of optimizing trace mineral homeostasis for the mitigation of anxiety disorders and preservation of mental health. Full article

Supervised practice is a prerequisite to becoming a registered dietitian. Research suggests that environmental and social factors may affect dietary choices. This focus group research aimed to gather opinions from dietetic interns to understand what factors related to supervised practice, if any, affected their dietary habits. Qualitative data were collected via seven recorded virtual focus groups in which trained moderators facilitated a discussion using a series of controlled questions. Participants, dietetic interns (n = 42) who were currently completing or had completed their supervised practice within the previous six months, attended one of seven virtual focus groups. Each focus group had five to eight participants. Transcripts were separately coded by two trained researchers using a grounded theory approach to identify themes and subthemes. Researchers discussed any disagreements in coding and established a consensus. Elements related to the dietetic internship were observed to influence participants’ dietary choices. Main themes included time, finances, food access and availability, physical and mental effects, non-supervised practice factors, and social factors. Dietetic programs and preceptors should explore ways to raise interns’ awareness and minimize the potential negative impacts of these factors on interns’ dietary habits to improve their overall internship experience. Full article

The aim of this survey was to identify, (1) use of Dietitians Australia best practice guidelines, (2) contemporary practices/knowledge, and (3) professional development needs of Australian dietitians in relation to management of clients with overweight or obesity. A cross-sectional online survey consisting of 67 multiple choice and Likert scale questions on the three survey aims was administered. Data were collected between 2020–2021 and reported descriptively as frequency (%). Of 178 survey attempts, 80 respondents completed all questions (45%). Most respondents spent >50% of their time working with individuals with overweight/obesity, usually in private practice (47%). Two thirds of respondents had accessed best practice guidelines, but only 12% had completely read best practice guidelines. General healthy eating was the most frequent dietary approach used (77%). Seventy-five percent (n = 56) of dietitians reported that dietary interventions were selected based on client preference. Almost half of dietitians rated their knowledge and level of skill in management of obesity as good. Approximately 60% (n = 41) dietitians reported their skill gap was related to providing behavioural therapy/counselling. Results of the current survey indicate that use of best practice guidelines is low. However, dietitians surveyed reported that they had a good understanding of obesity management and choose a client centred approach to management, which is in line with current recommendations. Professional development activities, particularly regarding behavioural counselling are of particular interest to dietitians working with individuals with obesity. Full article

Technological advances, such as the GloboDiet software, have enabled the development of instruments to standardize dietary data collection through the 24-h dietary recall (24HR). Thus, the aim of this study was to evaluate the feasibility of using the Brazilian version of the GloboDiet software. The 24HR method guided by the GloboDiet software was applied by face-to-face (n = 2093) interviews and a second measurement by telephone (n = 1084) interviews with participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The adherence rate was calculated using data from control worksheets filled out by interviewers, whereas the Chi-square test was used to assess differences between sociodemographic groups and the participants’ final adherence status. For the interview’s duration, the data were presented as the median and the interquartile range—IQR (Q1–Q3 (25–75%)). Non-parametric tests were used to assess differences among individuals in terms of the total duration and stages of the interview. Adherence rates were 82.8% face-to-face and 68.4% telephone interviews. The total duration of the face-to-face and telephone interviews was 30.7 (IQR, 23.3–40.7) and 35.3 (IQR, 25.3–49.7) minutes (p < 0.001). These results evidence that the GloboDiet software is viable for the routine of an epidemiological study. Full article

Background: Diabulimia is associated with “resistance to treatment”, impaired glycemic control, and increased risk of diabetic complications. The aim of this study was to explore the possible lifestyle and diet factors associated with diabulimia using the “Diabetes Eating Problem Survey-Revised” (DEPS-R), a questionnaire assessing the risk of diabulimia in patients with T1DM. Methods: 100 outpatients with a diagnosis of T1DM for over a year, from two hospitals in Athens, Greece were asked to complete a questionnaire about their medical history and lifestyle behaviors along with the Eating Attitudes Test (EAT-26), the Beck Depression Scale (BDI-II) and the DEPS-R. Results: Multivariate linear regression analysis showed statistically significant associations between DEPS-R score and HbA1c% levels (b = 4.447, 95% CI 3.220–5.675), sex (male) (b = −4.413, 95% CI −8.778–−0.047, weight perception higher than normal (b = 9.896, 95% CI 5.266–14.526), time spent walking minutes per week (b= −0.019, 95% CI −0.031–−0.006), having received diabetes nutritional education (b = −5.128, 95%CI −10.141–−0.115), eating breakfast (b = −6.441, 95% CI −11.047–−1.835) and having a first relative diagnosed with an eating disorder (b = 6.164, 95%CI 0.030–12.298). The presence of these factors could help highlight the profile of potential individuals at risk of diabulimia and enhance preventive interventions. Full article

Purpose: A diet rich in fruits and vegetables is vital for prolonged health and wellness. Yet, the consumption of fruits and vegetables remains low in some regions. Methodology: This exploratory quantitative study utilized a web-based survey instrument to probe the likelihood of consumption by Canadian consumers. Canadians who have lived in the country for 12 months or more and were 18 years of age or older were surveyed. Care was given to get a representative sample from all Canadian regions. Findings: Barriers to produce consumption include cost (39.5%), lack of knowledge and preparation skills (38.5%), and confusion surrounding health benefits (6.3%). There is further confusion surrounding the nutrition of frozen vs. fresh vegetables. Finally, respondents were concerned about pesticide residue on imported produce (63.4%). Originality: Although evidence that fruits and vegetables can mitigate disease and that promotion of fruit and vegetable consumption has been a key policy area for the Canadian government, consumers still fail to integrate sufficient fruits and vegetables into their diets. To our knowledge, this is the only study probing consumers on their fresh produce intake in the Canadian context. Public awareness and education about the regular consumption of fruits and vegetables and their nutritional value and health-promoting benefits can increase consumption in many Canadian regions and demographics. Full article

In India, indigenous communities are nutritionally vulnerable, with indigenous women suffering the greater burden. Studies and surveys have reported poor nutritional outcomes among indigenous women in India, yet systematic documentation of community-specific nutrition data is lacking. We conducted a narrative review of 42 studies to summarise the nutritional profile of indigenous women of India, with details on their food and nutrient intakes, dietary diversity, traditional food consumption and anthropometric status. Percentage deficits were observed in intake of pulses, green leafy vegetables, fruits, vegetables, flesh foods and dairy products when compared with recommended dietary intakes for moderately active Indian women. Indices of diet quality in indigenous women were documented in limited studies, which revealed poor dietary diversity as well as low consumption of diverse traditional foods. A high risk of nutritional inadequacy was reported in all communities, especially for iron, calcium, and vitamin A. Prevalence of chronic energy deficiency was high in most communities, with dual burden of malnutrition in indigenous women of north-eastern region. Findings from this review can thus help guide future research and provide valuable insights for policymakers and program implementers on potential interventions for addressing specific nutritional issues among indigenous women of India. Full article

The present study aimed to clarify the differences in nutritional intake in relation to the consumption of local food products and dietary patterns between two rural Kenyan regions, Kitui and Vihiga, where different ethnic groups live in different agro-ecological zones. A participant observation study with weighted dietary records was conducted in August 2019. Enumerators stayed in each targeted household for approximately one week and measured the ingredients and dishes. We compared the dietary intake of farm women in charge of meal preparation (n = 21) between the two regions and examined the contribution of each dish to the intake and the degree of home production for each food item. The results showed no difference in energy intake, but vitamin B₂, B₁₂, and C intakes were significantly higher in Vihiga, influenced by their consuming small fish and a variety of homegrown leafy vegetables. The people in Kitui consumed large quantities of homegrown pigeon peas, largely contributing to their nutritional intake. Dietary patterns were similar; common staple foods and tea with sugar accounted for about 40% of energy and protein intakes and fruit consumption was low. There was no difference in foods purchased frequently. These results suggested that promoting locally available fruits and vegetables would contribute to a sustainable supply of adequate micronutrients. Further studies are required to develop strategies to promote healthy dietary habits and improve health status. Full article

Due to its anti-inflammatory and antioxidant capacity and, by inference, its involvement in the myelin stealth attainment, oral nutrient supplementation (ONS) with saffron has recently been investigated as a complementary treatment in multiple sclerosis (MS). The purpose of the present study was to systematically review the literature for randomized controlled trials (RCTs) comparing saffron supplementation to placebo, or other interventions, in patients with an MS diagnosis. PubMed, CENTRAL, and clinicaltrials.gov were searched for relevant completed or ongoing RCTs. The Cochrane’s RoB tool 2.0 was used, and a qualitative synthesis without meta-analysis (SWiM) was performed. In total, five parallel, double-, or triple-blind RCTs were identified, fulfilling the study’s criteria, and were included in the SWiM. Intervention duration ranged from four weeks to a year. The summary RoB revealed some concerns, or even high risk for overall bias. The included RCTs failed to report particularities of their interventions (exact composition, active compound, safety assays, etc.) and adverse events. The SWiM revealed that according to the results of single trials, inflammation markers (TNF-a and IL-17) were reduced, and MS-specific biomarkers (MMP-9 and TIMP-1) and cognition were improved after saffron ONS, although definite conclusions regarding saffron efficacy with regard to these outcomes cannot be drawn. Two RCTs reported improvement in the redox status of patients receiving saffron, whereas, with regard to depression, the findings were conflicting. Overall, ONS with saffron compounds may prove beneficial in improving antioxidant defense and oxidative stress in patients with MS; however, the evidence appears scattered, heterogenous, and inadequate in terms of making any suggestions regarding the direction of effect of other outcomes. Trials of better design and MS-specific outcomes are required. Full article

Female athletes who endure physical strain on the same bone area are prone to stress fractures. Preventing these improves their quality of life. Blood vitamin B2 (V.B2) and E (V.E) levels influence blood homocysteine (Hcy) levels, which, when elevated, increase the risk of stress fractures. We aimed to determine the effects of V.B2 and V.E supplementation on plasma Hcy concentrations in these athletes carrying the C677T polymorphism in methylenetetrahydrofolate reductase (MTHFR). This study is a before–after study in 16 female athletes. It was divided into three intervention periods of V.B2 (28 mg/day), V.E (60 mg/day), and V.B2 + V.E intake, and each period was 14 days. Blood samples were collected before and after each period, and plasma Hcy concentration and each blood vitamin concentration were measured. Plasma Hcy concentration significantly decreased in all periods, but the maximum lowering effect was obtained when V.B2 and V.E were used in combination. The administration of V.B2 might have lowered the plasma Hcy level by maximizing the catalytic activity of MTHFR; V.E might have suppressed cell oxidation, increasing the efficiency of folate in lowering the plasma Hcy level. We propose the combined intake of V.B2 and V.E as effective nutrients to reduce plasma Hcy concentrations in female athletes with MTHFR polymorphisms. Full article

(1) Background: The quality of dietetic care is crucial to improve patient outcomes. The aim of this study was to measure the current practices regarding the provision of nutrition care in type 2 diabetes mellitus (T2DM) among dietitians in Malaysia. (2) Methods: A 49-item online survey was distributed via Malaysian Dietitians’ Association and Ministry of Health Malaysia social media platforms. Self-reported dietetic practices in the management of T2DM were evaluated against practice guidelines. (3) Results: A total of 173 dietitians completed the survey, with a response rate of 62%. Three-quarters of dietitians in the public sector consulted patients within two to three weeks or more than four weeks versus less than two weeks (86.3%) among private dietitians (p-value < 0.001). More than 95% of private dietitians spent 31–60 min or more than 60 min on new cases versus 71% among public dietitians (p-value < 0.001). Group counseling was only practiced among public dietitians (36.0%). Different practice settings led to the current findings. A limited use of behavioral counseling theories and strategies was observed among dietitians from both sectors. Limited adherence to nutrition-related recommendations (62.8%) and lack of readiness for diet/lifestyle changes (45.5%) were the key challenges faced by dietitians when managing T2DM. (4) Conclusions: The survey indicates that there is a need for the development of comprehensive training to increase the utilization of behavioral counselling. Practice setting is an element to consider when designing training. Full article

Colorectal cancer (CRC) is an abnormal growth that occurs in the rectum or rectal portion. In 2020, an anticipated 104,610 new cases of colon illness and 43,340 new cases of rectal abnormal growth were expected in the United States. Red and processed meat, body bloatedness, belly fatness, and binge drinking expands the occurrence of colorectal disease. Dietary fibres contribute to faecal bulking, but they are break down by gut bacteria and produce metabolites such as short-chain fatty acids (SCFAs). SCFAs are chemical compounds that are mostly made up of acetate, propionate, and butyrate. Acetate and butyrate help to control mucus production and discharge, and thus, protect the gut mucosa. Reduced mucus secretion/increased bacterial catabolism, and fermentation of amino acids resulted in an increase of potentially detrimental metabolites such as branched-chain fatty acids, ammonia, amines, and N-nitroso complex components. Vital roles of fibres include reduction in the time that carcinogens encounter the intestinal lumen and promotion of healthy gut microbiota as well as modification of the host metabolism. The present review focuses on a brief introduction to various dietary fibres and specialised metabolites that can possess beneficial effect on CRC, as well as presenting our current, detailed understanding of various dietary fibres along with their potential effects on gut microbiota and its association with the colon cancer. A comprehensive discussion is also included, advocating the dietary fibre-enriched diet. Full article

Male fertility is declining and affects approximately one in seven couples. Reasons for this are multi-factorial and the subject of on-going research, though environmental contaminants (such xenoestrogens) are believed to be contributory factors. Semen parameters can be improved through a healthy diet and nutritional supplementation has also been shown to improve semen parameters, clinical pregnancy and live birth rates significantly. Despite this, in medical care dietary modification beyond alcohol reduction is rarely recommended. The aim of this review was to consider the psychosocial impacts of infertility in males whilst assessing other nutritional and lifestyle interventions that can be used in personalized nutrition care. More tailored nutrition care needs to consider this and the taboo surrounding the male infertility experience. A systematic approach was used. Three electronic databases (CINAHL, Medline and Academic Search Complete) were searched using predetermined Boolean search terms and identified 125 papers for review. Hand searches were undertaken to ensure recent evidence was included. Duplicates were removed and predefined inclusion and exclusion criteria were applied. Narrative synthesis was used for review and to develop preconceptual guidelines. Review data indicates dietary modification or supplementation with antioxidants such as vitamin C, vitamin E, coenzyme Q10, selenium, carnitine and zinc have been shown to improve markers of male fertility and reduce markers of seminal oxidative damage. Also, a Mediterranean style diet is also associated with higher quality sperm counts. Weight loss is beneficial in terms of normalizing endocrine profiles but at present it is not possible to determine if this is the effect of weight loss alone, or the combined effect of weight loss alongside other dietary improvement. Further research is therefore needed to understand the role of the many potential confounding factors. Despite this, infertility is emotionally challenging for men and nutrition, and personalised nutrition and lifestyle therapies have potential to support men trying to conceive. Pre-conceptual nutrition and lifestyle guidelines for men have been developed from this review and the use should be considered as the basis for more tailored nutrition care in practice. Full article