Insulin-like growth factor 1 (IGF-1) is an important growth factor in childhood. We aimed to investigate the impact of food supplements for the treatment of moderate acute malnutrition (MAM) on serum IGF-1 (sIGF-1). Secondary analysis of a randomised 2 × 2 × 3 factorial nutrition trial was performed. Children aged 6–23 months with MAM received 2093 kJ/d as lipid-based nutrient supplement (LNS) or corn soy blend (CSB), containing either dehulled soya or soya isolate and different quantities of dried skimmed milk (0 %, 20 % or 50 % of total protein) for 12 weeks. The trial was double-blind with regard to soya and milk but not to matrix (LNS v. CSB). sIGF-1 was measured at inclusion and after 12 weeks of supplementation. Of 1609 children enrolled, 1455 (90 %) had sIGF-1 measured at both time points. During supplementation, sIGF-1 increased 6·7 (95 % CI 6·1, 7·3) ng/ml compared with an expected age-dependent decrease of 0·3 (95 % CI 0·2, 0·4) ng/ml. Children who received LNS v. CSB had a lower increase in sIGF-1 (–8 %, 95 % CI − 12, −3). The effect of LNS was partly attenuated when sIGF-1 was corrected for inflammation. Children who received soya isolate compared with dehulled soya had a higher increase in sIGF-1 (6 %, 95 % CI 1, 12). Milk content did not affect sIGF-1. Overall, sIGF-1 increased during supplementation. The lower increase with LNS v. CSB was only partly explained by increased inflammation with LNS and needs further investigation. Isolate v. dehulled soya led to a higher increase which may be due to antinutrients in dehulled soya.

This study aims to assess the therapeutic effects of probiotic oral therapy in paediatric patients with anorexia nervosa (AN) and to investigate its impact on intestinal flora composition, brain–gut peptide levels and overall clinical outcomes. A retrospective study was conducted involving 100 children diagnosed with AN at Xingtang County People’s Hospital between January 2023 and June 2024. Patients were divided into two groups: a control group (n 50) receiving zinc gluconate oral solution alone and an observation group (n 50) receiving zinc gluconate plus probiotics. Outcome measures included intestinal flora analysis, brain–gut peptide levels (somatostatin (SS) and nitric oxide (NO)), clinical efficacy, serum trace element levels (Ca, Zn and Fe) and prognosis, including recurrence rates 6 months post-treatment. Baseline characteristics were similar between the two groups (P > 0·05). After treatment, the observation group showed significantly higher levels of Bifidobacterium and Lactobacillus and lower levels of Enterobacter compared with the control group (P < 0·05). Additionally, the observation group had lower levels of SS and NO (P < 0·05), indicating improved brain–gut communication. Clinical efficacy was significantly higher in the observation group (P < 0·05), with improved serum trace element levels (P < 0·05 for Ca, Zn and Fe). Furthermore, the recurrence rate 6 months post-treatment was significantly lower in the observation group compared with the control group (P < 0·05). Probiotic supplementation in children with AN effectively modulates intestinal flora, improves brain–gut peptide levels and enhances clinical outcomes.

This study aimed to investigate the association between family characteristics and adherence to the EAT-Lancet dietary recommendations in 7-year-old children. This is a prospective birth cohort study with 2125 children from Generation XXI (Porto, Portugal), who provided 3-day food diaries at age 7, used to assess habitual food consumption. At the age of 4, maternal diet was assessed using a Food Frequency Questionnaire, and a diet quality score was calculated (higher scores indicating a better maternal diet), and parental–child feeding practices were assessed with the Child Feeding Questionnaire. Adherence to the EAT-Lancet dietary recommendations was evaluated using the World Index for Sustainability and Health (WISH) at the age of 7 years, previously adapted to paediatric age. Hierarchical linear regression models (consecutive addition of blocks of variables based on a theoretical framework) were employed to evaluate the associations between family characteristics and adherence to the WISH at age 7 (β regression coefficients and the respective 95 % confidence intervals (95 % CI)). Higher maternal age and education at child’s birth were associated with increased adherence to the WISH at age 7 (β = 0·018, 95 % CI 0·005, 0·031; β = 0·038, 95 % CI 0·024, 0·053, respectively). A better maternal diet quality and using more restrictive practices on child’s diet, at 4 years old, were both associated with higher scoring in the WISH at 7 years old (β = 0·033, 95 % CI 0·018, 0·049; β = 0·067, 95 % CI 0·009, 0·125, respectively). Early maternal sociodemographic and diet quality play a significant role in influencing the adherence to a healthy and environmentally sustainable dietary pattern at school-age.

In the last decades, it has been well known that low-grade inflammation plays a potential role in the pathogenesis of different cancers. The aim of this systematic review and meta-analysis of observational studies was to evaluate the association between inflammatory potential of diet measured through the Dietary Inflammatory Index (DII), Energy-adjusted DII (E-DII), Empirical Dietary Inflammatory Pattern (EDIP), the Inflammatory Score of Diet (ISD), and risk of colorectal cancer (CRC) and site-specific colon cancer. A systematic electronic search of PubMed/Medline, Scopus, the Web of Sciences and reference lists up to 21 November 2023 was performed. Data were pooled by the generic inverse variance method using random effect model. To assess the heterogeneity of included studies, the I2 index was used. A total of twenty-eight original studies, comprising 2 287 836 participants, were selected to include in this meta-analysis. Pooled results showed a significant association between higher adherence to pro-inflammatory diet and increased risk of CRC (effect size (ES): 1·39; 95 % CI 1·29, 1·51; I2 = 82·9 %), colon (ES: 1·40; 95 % CI 1·26, 1·55; I² = 73·3 %, P< 0·01), proximal colon (ES: 1·28; 95 % CI 1·17, 1·40; I² = 29·1 %), distal (ES: 1·50; 95 % CI 1·30, 1·74; I² = 63·5 %) and rectal (ES: 1·46; 95 % CI 1·23, 1·74; I² = 80 %). Stratified analysis by type of dietary indices noted that greater adherence to the DII, E-DII and EDIP were related to significant increase in the risk of overall CRC and site-specific colon cancers. Our results highlighted the proposed role of inflammatory potential of diet as important risk factor for CRC. Adherence to an anti-inflammatory dietary pattern should be recommended to reduce incidence of CRC, globally.

The study aim was to determine the prevalence of food addiction (FA) in individuals with type 2 diabetes and to assess the association between FA and type 2 diabetes. MEDLINE, EMBASE, Web of Sciences, Latin American and Caribbean Literature in Health Sciences, ScienceDirect, Scopus and PsycINFO were searched until November 2024. This study was registered with PROSPERO (CRD42023465903). Cross-sectional studies, case–control, cohorts and clinical trials that were carried out with individuals with type 2 diabetes, regardless of age and sex, were included. The complete data extracted included the prevalence, OR and/or risk ratio of FA, the number of individuals evaluated, age, sex, weight, presence of co-morbidities, age of participants and FA symptoms. A pooled prevalence of FA of 30 % (95 % CI (18, 44) with estimated predictive interval (0; 85); I2 = 99·51; 12 studies; 15 947 participants) was identified. For the associations between FA and type 2 diabetes, we found a grouped crude OR value of 2·35 (95 % CI (1·71, 2·98)). The pooled OR adjusted for age and sex was 2·60 (95 % CI (1·77, 3·42)). Finally, the OR adjusted for age, sex and BMI was 2·01 (95 % CI (1·39, 2·64)). The results of the meta-analyses showed a high prevalence of FA in individuals with type 2 diabetes and that the associations between these two conditions remained even after adjustment for age, sex and BMI, although with a high heterogeneity among individual estimates.

A hospital-based cross-sectional study involving children aged 2–15 years attending the obesity clinic of a tertiary care hospital from January 2016 to March 2018 was carried out to study carotid intima media thickness (cIMT) and its association with cardiometabolic risk factors in children with overweight and obesity. Secondary objective was to compare children with elevated (EcIMT) and normal cIMT (NcIMT). Out of 223 patients enrolled for the study, 102 (45·7 %) had EcIMT. Mean cIMT of the study participants was 0·41 (sd 0·13) mm. Median alanine transaminase levels (27 v. 24, P= 0·006) and proportion of patients with fatty liver (63·7 % v. 48·8 %, P= 0·025) and ≥ 3 risk factors (80·4 % v. 66·1 %, P= 0·003) were higher in the EcIMT group compared with NcIMT group. Proportion of patients with hypercholesterolemia (36·4 % v. 16 %, P= 0·024), elevated LDL-cholesterol (38·6 % v. 16 %, P= 0·013), low HDL-cholesterol (40·9 % v. 20 %, P= 0·027) and dyslipidemia (84·1 % v. 58 %, P= 0·006) was higher in the pubertal EcIMT group and those with fatty liver (63·8 % v. 45·1 %, P= 0·034) was higher in the prepubertal EcIMT group compared with pubertal and prepubertal NcIMT groups, respectively. No significant correlations were observed between cIMT and various cardiometabolic parameters. Our finding of EcIMT in nearly half of the study participants including young children is very concerning as these children are at increased risk of atherosclerotic CVD in adulthood. Interventions starting at a young age are important when trajectories are likely to be more malleable and adverse cardiometabolic phenotypes and subclinical atherosclerosis are reversible.

Understanding protein fermentation in the hindgut of pigs is essential due to its implications for health, and ileal digesta is commonly used to study this process in vitro. This study aimed to assess the feasibility of utilising in vitro digested residues as a replacement for ileal digesta in evaluating the protein fermentation potential. In vitro residues from cottonseed meal, maize germ meal, peanut meal, rapeseed cake, rapeseed meal, soyabean meal and sunflower meal were analysed using a modified gas production (GP) technique and curve fitting model to determine their fermentation dynamics and compare with the use of ileal digesta. Significant variations were observed in GP parameters between in vitro digested residues, indicating differences in nitrogen utilisation by fecal microbiota. Soyabean meal and sunflower meal exhibited the highest maximum GP rates (Rmax), with values of 29·5 ± 0·6 and 28·0 ± 1·2 ml/h, respectively, while maize germ meal showed slowest protein utilisation (17·3 ± 0·2 ml/h). A positive relationship was found between the Rmax of in vitro residues and ileal digesta (R2 = 0·85, P < 0·01). However, GP potential (GPs) showed a tendency for a negative relationship (R2 = 0·39, P < 0·1), likely due to narrow observed GPs values and the presence of varied endogenous proteins in ileal digesta. Our results demonstrate the potential of using in vitro digested residues as a substitute for ileal digesta in assessing the fermentation potential of protein ingredients, particularly regarding the rate of protein fermentation.

Although research on the relationship between lean body mass and blood pressure (BP) has been inconsistent, most studies reported that measures of lean body mass are associated with a higher risk of hypertension. We explored relationships between body composition (fat and skeletal muscle mass) and BP in 1162 young adult African women. Dual-energy X-ray absorptiometry-derived measures of whole-body, central and arm fat mass were associated with higher systolic and diastolic BP, while leg fat percentage was associated with lower systolic and diastolic BP. However, only the associations with diastolic BP remained after adjusting for appendicular skeletal muscle mass (ASM). ASM was associated with higher systolic and diastolic BP, before and after adjusting for whole-body fat percentage and visceral adipose tissue. While there was no overlap in targeted proteomics of BP and body composition, REN was lower in the elevated BP than the normal BP group and was inversely associated with diastolic BP (false rate discovery adjusted P< 0·050). Several proteins were positively associated with both visceral adipose tissue and ASM (LEP, FABP4, IL6 and GGH) and negatively associated with both visceral adipose tissue and ASM (ACAN, CELA3A, PLA2G1B and NCAM1). NOTCH3, ART3, COL1A1, DKK3, ENG, NPTXR, AMY2B and CNTN1 were associated with lower visceral adipose tissue only, and IGFBP1 was associated with lower ASM only. While the associations between body fat and BP were not independent of skeletal muscle mass, the associations between muscle mass and BP were independent of overall and central adiposity in young adult African women. Future interventions targeting muscle mass should also monitor BP in this population.

Adherence to healthy diet principles and to cardiopreventive medication, both key behaviours in CVD prevention, is known to differ between women and men. Whether these adherence behaviours are differentially related among women and men has never been thoroughly assessed. The objective was to assess gender differences in the association between adherence to healthy diet principles and to cardiopreventive medication in adults free of CVD. This cross-sectional study included 268 women and 204 men from the CARTaGENE cohort (Québec, Canada) who were using antihypertensive and/or cholesterol-lowering medication. Adherence to healthy diet principles was assessed using the Alternate Healthy Eating Index (AHEI, %), calculated from a validated FFQ assessing diet in the 12-month preceding its completion. Medication adherence was assessed using the daily pharmacotherapy possession rate (DPPR, %), calculated from prescription claim data over the same 12-month period. In multivariable-adjusted analyses, an inverse association between AHEI and DPPR was observed among men (βAHEI for 10 % increment in DPPR = –0·65 %; 95 % CI −1·28 %, −0·03 %; P = 0·04), while it tended to be positive among women (β = 0·44 %; 95 % CI −0·11 %, 1·00 %; P = 0·12; Pgender×DPPR = 0·01). The negative association between AHEI and DPPR was stronger among men who never smoked or used cholesterol-lowering medication only. Among women, the positive association was stronger and statistically significant among those with obesity or using ≥ 3 medications simultaneously. Association between adherence to healthy diet principles and to cardiopreventive medication differs between women and men, with men potentially facing greater challenges in achieving optimal complementarity between these two behaviours.

Increased ultra-processed food (UPF) is associated with adverse health outcomes. However, with limitations in UPF evidence, and partial overlap between UK front-of-package labelling (FOPL) and degree of food processing, the value of food processing within dietary guidance is unclear. This study compared food and drink from the UK National Diet and Nutrition Survey (NDNS) database based on micronutrient content, Nova classification and FOPL. The aim was to examine the micronutrient contributions of UK food and drink to UK government dietary micronutrient recommendations for adult females and males, aged 19–64 years, based on the degree of food processing and FOPL. NDNS items were coded into minimally processed food (MPF), processed culinary ingredients, processed food (PF) and UPF, and FOPL traffic lights. MPF, PF and UPF provided similar average contributions per 100 g to micronutrient recommendations. Per 100 kcal, MPF provided the greatest average contribution (14·4 % (interquartile range (IQR): 8·2–28·1)), followed by PF (7·7 % (IQR: 4·6–10·9) and then UPF (5·8 % (IQR: 3·1–9·7)). After adjusting for healthy/unhealthy items (presence of 1+ red FOPL), MPF had higher odds of an above-average micronutrient contribution per 100 kcal than UPF (OR: 5·9 (95 % CI 4·9–7·2)) and PF (OR: 3·2 (95 % CI 2·4–4·2)). MPF were more likely to provide greater contributions to micronutrient recommendations than PF or UPF per 100 kcal. These findings suggest that UPF or PF diets are less likely to meet micronutrient recommendations than an energy-matched MPF diet. The results are important for understanding how consumers perceive the healthiness of products based on FOPL.

This interventional single-centre prospective open-label study aims to evaluate the effects of a vegan diet, compared with a vegetarian and omnivorous diet, on metabolic parameters, insulin sensitivity, and liver and kidney steatosis in healthy adults. The study included fifty-three omnivorous participants aged 18–40 years, BMI 18–30 kg/m2, without any chronic disease, chronic medication use, active smoking or significant alcohol consumption. All participants were omnivorous at baseline and selected to continue an omnivorous diet or transition to a vegetarian or vegan diet, with follow-up over 6 months. Anthropometric measurements, biochemical parameters and liver and kidney steatosis were assessed at baseline and after six months using MRI-proton density fat fraction. Primary outcomes included changes in liver and kidney steatosis, while secondary outcomes were alterations in anthropometric and biochemical markers. Among fifty-three participants, eighteen followed an omnivorous diet, twenty-one adopted a vegetarian diet and fourteen transitioned to a vegan diet. Dietary interventions did not result in statistically significant changes in BMI, fat mass, fat percentage or muscle mass over 6 months. However, statistically significant improvements in systolic and diastolic blood pressure, favouring the vegan diet, were observed. We aimed to control for potentially confounding variables to ensure the reliability of these findings. We have demonstrated a better decline in steatosis at the lower kidney pole, the total hilus and the Liver 6 index in vegans. We demonstrated that a plant-based diet is associated with improvements in several metabolic parameters and may reduce liver and kidney steatosis.

Low vegetable consumption among school-age children and adolescents puts them at risk of micronutrient malnutrition and non-communicable diseases. There is a dearth of synthesised literature on vegetable intake and interventions to promote increased consumption among this age group in West Africa. This study pooled evidence on vegetable consumption and interventions to promote vegetable consumption among school-age children and adolescents (6–19 years) in West Africa. Quantitative and qualitative studies from 2002 to 2023 were electronically searched in PubMed, African Journals Online (AJOL) and Google Scholar databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses system was adhered to in reporting this review (PROSPERO ID: CRD42023444444). The Joanna Briggs Institute critical evaluation tool was used to appraise the quality of studies. Forty (40) studies met the search criteria out of n 5080 non-duplicated records. Meta-analysis was not possible due to high heterogeneity. Low vegetable consumption expressed in frequency or amounts was recorded among school-age children and adolescents in the reviewed studies. Intervention studies were mostly among adolescents; the most common type of intervention was the use of nutrition education. Insufficient evidence and high heterogeneity of studies reflect the need for more high-quality interventions using globally identified standards but applied contextually. School-age children appear to be an under-served population in West Africa with regard to nutrition interventions to promote vegetable consumption. There is a need for multi-component intervention studies that encourage vegetable consumption as a food group. Gardening, parental involvement, gamification and goal setting are promising components that could improve the availability, accessibility and consumption of vegetables.

Oxidative stress is present in chronic obstructive pulmonary disease (COPD); however, the effect of increased dietary antioxidants on reducing COPD risk remains unclear. The aim of this study was to investigate the association of the composite dietary antioxidant index (CDAI) with COPD in adults. This study conducted a cross-sectional investigation using data from the National Health and Nutrition Examination Survey (NHANES) spanning from 2015 to March 2020 to explore the association between CDAI and COPD in adults. This study included 9295 participants. Three logistic regression models (crude model, partially adjusted model and fully adjusted model) and restricted cubic spline (RCS) curves were utilised to assess the association between CDAI levels and COPD risk. Subsequently, a two-sample Mendelian randomisation (MR) was employed to analyse the causal impact of antioxidant levels within CDAI on the occurrence of COPD. CDAI levels were inversely associated with COPD after adjusting for confounders (OR = 0·97, 95 % CI 0·95, 1·00), and the association was linear (P < 0·001), and the results of the RCS showed that CDAI was linearly correlated with COPD occurrence (P < 0·001). MR analysis revealed a causal relationship between vitamin C and COPD occurrence (OR = 0·99, 95 % CI 0·98, 1·00, P < 0·05). Our study indicates that dietary sources of antioxidants may reduce the risk of COPD occurrence, and the results of the MR analysis further show that vitamin C is causally associated with a reduced risk of COPD occurrence. However, further exploration is needed to understand how antioxidants prevent COPD.

Colorectal cancer (CRC), the third most common cancer globally, causes over 900 000 deaths annually. Although vitamin D is observed to have potential anti-carcinogenic properties, research findings on its preventable effect against CRC remain inconclusive. Notably, different subsites within the colon and rectum may be associated with distinct risk factors. While some studies have explored this relationship with circulating 25-hydroxyvitamin D (25(OH)D), the results remain contradictory. Our study employed a nested case–control design, involving 775 CRC cases matched with 775 cancer-free controls based on age, region of living and the time of blood sampling. The study was conducted within the Norwegian Women and Cancer post-genome cohort, which comprises approximately 50 000 women. We measured pre-diagnostic circulating plasma 25(OH)D status 5–13 years before diagnosis. Adjustment variables were based on self-administered questionnaires and included BMI, physical activity level, smoking, intake of processed meat, calcium, alcohol and fibre. An increase of 5 nmol/l in 25(OH)D reduced the risk of proximal colon cancer by 6 % (OR = 0·94, 95 % CI 0·89, 0·99). Furthermore, a sensitivity analysis revealed a 62 % increased risk among the women with 25(OH)D levels below 50 nmol/l compared with sufficient levels, ≥ 50 to < 75 nmol/l (OR = 1·62, 95 % CI 1·01, 2·61). No association was found with CRC, colon or distal colon cancer. We observed a subsite-specific association between 25(OH)D and CRC, highlighting the need for further investigation to elucidate the potential underlying mechanisms and clinical implications.

Low iron (Fe) stores at birth may adversely influence child cognitive and motor development. The aims of this study were to assess cord blood Fe levels and explore maternal and neonatal factors associated with Fe status. Cord blood specimens (n 46) were obtained from the BC Children’s Hospital BioBank in Vancouver, Canada. The primary outcome was cord plasma ferritin, measured using sandwich-ELISA. Predictors of interest included maternal age, gestational age, gravidity, infant sex, birth weight and delivery method. Median (interquartile range (IQR)) maternal age and gestational age at delivery was 33·5 (29·3–35·8) years and 36·5 (30·0–39·0) weeks, respectively, and 44 % of infants were female. Median (IQR) cord ferritin was 100·4 (75·7–128·9) µg/l, and 26 % had low Fe status (ferritin <76 µg/l). Among preterm deliveries, a 1-week increase in gestational age was associated with a 6·22 (95 % CI (1·10, 9·52)) µg/l increase in median cord ferritin. However, among term deliveries, a negative trend was observed (–2·38 µg/l per week of gestation (95 % CI (–34·8, 0·78))), indicating a potential non-linear relationship between gestational age and cord ferritin. Female term infants had higher cord ferritin compared with males (β (95 % CI): 30·3 (18·4, 57·9) µg/l), suggesting sex-specific differences in Fe transfer, acquisition and utilisation. Cord ferritin was higher with vaginal deliveries compared with caesarean sections (β (95 % CI): 39·1 (29·0, 51·5) µg/l). Low Fe status may be a concern among infants in Canada; however, further research is needed to inform appropriate thresholds to define optimal Fe status in cord blood.

Indigenous peoples are often not routinely included in iodine programmes because of language barriers and remote access and may thus be at higher risk of iodine deficiency disorders, which could adversely impact their quality of life. We conducted this cross-sectional study in the remote Pwo Karen community of Thailand to determine the urinary iodine concentration of school-aged children and women of reproductive age and investigate the iodine content in household salt. We measured urinary iodine concentration in spot urine samples from healthy school-aged children and women of reproductive age, administered a questionnaire, estimated daily iodine intake and collected household salt samples to determine salt iodine concentration. The median urinary iodine concentration (range) of school-aged children (n 170) was 192 (136–263) µg/l, which was significantly higher than women of reproductive age (n 306) (147 (89–233) µg/l) (P < 0·001). The estimated daily iodine intake in school-aged children and women of reproductive age were 135 and 195 μg/d, respectively. The median (range) iodine concentration in rock and granulated salts consumed in the households were 2·32 (0·52–3·19) and 26·64 (20·86–31·01) ppm, respectively. Surprisingly, the use of iodised salt and the frequency of seafood consumption were NS predictors of urinary iodine concentration in these two groups. Our data suggest that school children and women of the Pwo Karen community have sufficient iodine intake, indicating the Thai salt iodisation programme is effectively reaching even this isolated Indigenous community. Sentinel surveys of remote vulnerable populations can be a useful tool in national iodine programmes to ensure that programme coverage is truly universal.

In this study, nine isonitrogenous experimental diets containing graded levels of carbohydrates (40 g/kg, 80 g/kg and 120 g/kg) and crude lipids (80 g/kg, 120 g/kg and 160 g/kg) were formulated in a two-factor (3 × 3) orthogonal design. A total of 945 mandarin fish with similar body weights were randomly assigned to twenty-seven tanks, and the experiment diets were fed to triplicate tanks twice daily for 10 weeks. Results showed that different dietary treatments did not significantly affect the survival rate and growth performance of mandarin fish. However, high dietary lipid and carbohydrate levels significantly decreased the protein content of the whole body and muscle of cultured fish. The lipid content of the whole body, liver and muscle all significantly increased with increasing levels of dietary lipid, while only liver lipid level was significantly affected by dietary carbohydrate level. Hepatic glycogen content increased significantly with increasing dietary carbohydrate levels. As to liver antioxidant capacity, malondialdehyde content increased significantly with increasing dietary lipid or carbohydrate content, and catalase activity showed an opposite trend. Superoxide dismutase activity increased significantly with increasing levels of dietary lipid but decreased first and then increased with increasing dietary carbohydrate levels. Additionally, the increase in both dietary lipid and carbohydrate levels resulted in a significant reduction in muscle hardness. Muscle chewiness, gumminess and shear force were only affected by dietary lipid levels and decreased significantly with increasing dietary lipid levels. In conclusion, considering all the results, the appropriate dietary lipids and carbohydrate levels for mandarin fish were 120 g/kg and 80 g/kg, respectively.

Ultra-processed foods (UPF), defined using the Nova classification system, are associated with increased chronic disease risk. More recently, evidence suggests the UPF subgroup of whole-grain breads and cereals is in fact linked with reduced chronic disease risk. This study aimed to explore associations of cardiometabolic risk measures with Nova UPF intake v. when foods with ≥ 25 or ≥ 50 % whole grains are excluded from the definition. We considered dietary data from the Australian National Nutrition and Physical Activity Survey 2011–2012. Impacts on associations of UPF intake (quintiles) and cardiometabolic risk measures were analysed using regression models. The median proportion of UPF intake from high whole-grain foods was zero for all quintiles. Participants in the highest Nova UPF intake quintile had significantly higher weight (78·1 kg (0·6)), BMI (27·2 kg/m2 (0·2)), waist circumference (92·7 cm (0·5)) and weight-to-height ratio (0·55 (0·003)) compared with the lowest quintile (P< 0·05). Associations were the same when foods with ≥ 25 and ≥ 50 % whole grains were excluded. Adjusted R-squared values remained similar across all approaches for all outcomes. In Australia, high whole-grain foods considered UPF may not significantly contribute to deleterious cardiometabolic risk associations. Until conclusive evidence on Nova UPF is available, prioritisation should be given to the nutrient density of high whole-grain foods and their potential contribution to improving whole-grain intakes and healthful dietary patterns in Australia.

The COVID-19 pandemic has presented multifaceted challenges globally, impacting adolescent health. Among these, food security and nutrition are intertwined closely with mental health outcomes. In Indonesia, with its diverse socio-economic landscape, these interconnections may have been exacerbated by the pandemic. This study investigated the relationship between food security, nutrition and adolescent mental health in Indonesia during COVID-19. Longitudinal data were collected from 511 adolescent boys and girls in 2021–2022 in Gunungkidul district, Yogyakarta. Food security was measured using the Household Food Insecurity Access Scale (HFIAS), and the validated Kessler-10 Psychological Distress Scale (K10) was used to measure adolescent depression. Multivariate linear regression and linear mixed-effects regression were employed to explore associations between these variables, while adjusting for sex, age, pubertal status and household income. Overall, food insecurity score was positively associated with depressive symptoms (β: 0·72, 95 % CI 0·52, 0·92), while BMI z-score was inversely associated (β: −0·31, 95 % CI 0·68, −0·03). We found an increase in strength of association between food insecurity and depressive symptoms over time (moderately food-insecure: β: 1·36 (95 % CI −0·10, 2·83) to 4·63 (95 % CI 2·17, 7·09); severely food-insecure: β: 1·89 (95 % CI 0·36, 3·41) to 3·30 (95 % CI 1·50, 5·10). Enhancing food access, improving nutritional status and providing mental health support are crucial components of adolescent health.