Obtaining estimates of food intake via the 24-h dietary recall is laborious and expensive. Simpler methods for estimating dietary quality are needed in clinical settings and for evaluating nutrition education interventions. The objective of this study was to validate a simple, pictorial tool for assessing diet quality using vegetable variety as the indicator. The My Veggies tool, containing 28 pictures of vegetables and items about food preparation, eating at home, and eating fast food, was administered to 258 healthy adults aged 18-65 y. To assess convergent validity, 3 dietary recalls were used to calculate the Healthy Eating Index (HEI) 2015 and dietary energy density (DED), both of which serve as measures of diet quality. To determine criterion validity, height, weight, and body composition (as measured by dual-energy X-ray absorptiometry) were assessed. Using cluster analysis, responses to My Veggies generated 3 vegetable variety groups: high variety (HV; n = 84), medium variety (MV; n = 107), and low variety (LV; n = 67). Values for HEI, DED, body mass index (BMI) (in kg/m2), and body composition were compared across the variety groups to determine whether differences existed. Demographic characteristics did not differ between the variety groups. The LV group had lower total HEI score (median = 54.4; IQR = 15.6) than HV (62.1; 17.3) and MV (68.0; 18.6) groups (P < 0.0001 for both). The LV variety group had a higher DED score (median = 2.6; IQR = 0.4) than the HV (2.2; 0.6) and MV (2.3; 0.5) groups (P < 0.0001 for both). Both HV and MV groups reported cooking from scratch more often than LV group (P < 0.0001), and HV and MV reported eating out and fast food less frequently than LV (analysis of variance, P < 0.0001; post hoc mean comparisons of HV and MV compared with LV, P < 0.0001). The LV group had higher BMI (P < 0.003) and body fat percentage (P < 0.005) than MV and HV groups. This study provides evidence of the convergent and criterion validity of a simple, pictorial assessment tool for evaluating diet quality based on vegetable variety. Overall, adults with lower vegetable variety scores had lower diet quality and higher body mass index and fat mass. My Veggies can be used by health professionals as an evaluation tool for community nutrition education interventions or as a screener for counseling in a clinical setting.This trial was registered at clinicaltrials.gov as NCT02367287.

Healthy default beverage (HDB) policies, which require restaurants to offer healthier drinks with children's meals, may reduce child sugar-sweetened beverage consumption. Although they are gaining popularity across the United States, restaurant awareness and compliance remains low, warranting deeper investigation into policy guidance and implementer knowledge. To examine implementing agencies' awareness of HDB policies, the prevalence of implementation and enforcement practices and their alignment with policy documents, and challenges to implementation and enforcement. We used a mixed-methods approach combining an analysis of HDB policy documents and an online survey of implementers across jurisdictions with state or local policies. A codebook was developed to assess implementation and enforcement provisions in policy documents. Descriptive statistics were used to summarize survey-reported practices, and we examined alignment between these practices and the corresponding policy language. Nineteen policy documents (4 state, 15 local) and 64 survey responses from unique jurisdictions were analyzed. Among jurisdictions, 46 (72%) were knowledgeable about their policy. Most state jurisdictions (86%) and all local jurisdictions reported using a communication strategy regardless of inclusion in policy documents. Restaurant compliance was typically assessed through in-person restaurant visits (state: 78%; local: 42%). Equity-related implementation considerations included additional time for policy implementation (state: 43%; local: 60%) and technical support (state: 72%; local: 60%). Most state (67%) and local (73%) jurisdictions reported issuing warnings and fines for enforcement. Equity considerations for enforcement were reported for some state jurisdictions (27%) and included additional time to become compliant (75%) and issuing warnings without escalating to fines (25%). Implementation misalignment between practices and documents often reflected jurisdictions exceeding policy documents, whereas enforcement misalignment between practices and documents often involved inconsistent or incorrect use of the enforcement strategy in the policy document and misalignment of reported funding allocation. Although jurisdictions frequently expanded beyond written implementation requirements, enforcement knowledge and practices inconsistent with policy documents highlight potential gaps in resources, training, and infrastructure. Efforts to bolster implementer capacity and promote equitable approaches may increase the ability of localities to implement and enforce HDB policies.

Breast cancer (BC) is responsible for a high proportion of cancer-related morbidity and mortality. A varied diet may play a role in the onset of BC. We aimed to investigate the association between dietary diversity and BC risk. This population-based case-control study was conducted between May 2021 and October 2023, comprising 600 incident BC cases and 600 general population controls. We employed a valid and reliable 168-item food frequency questionnaire, with data collected one year prior to the date of diagnosis for cases and within the past year for controls. A dietary diversity score (DDS), focusing on consuming a variety of 5 food groups, with attainable scores between 0 and 10, was created as an indicator of total nutritional quality. Potential confounders were also assessed, including educational year, menopause, age at menarche, family socioeconomic status during adolescence, multivitamin intake, and benign breast diseases. We employed logistic regression models to estimate crude and adjusted odds ratios (ORs), controlled for potential confounders, to estimate the effect of DDS on BC risk. DDS was associated with BC odds when analyzed as both a continuous and a categorical variable. The OR for DDS as a continuous variable was 0.90 [95% confidence interval (CI): 0.82, 0.99]. For participants with a DDS between 2.5 and 6, the OR was 0.58 (95% CI: 0.36, 0.95), and for those with a DDS >6, the OR was 0.41 (95% CI: 0.23, 0.73). A clear dose-response association was also observed [test for trend: OR= 0.66 (0.49, 0.86)]. We identified DDS, a measure of a balanced diet, as a novel protective factor for BC. Given the global increase in BC morbidity and mortality, this finding underscores the need for public health interventions and educational programs targeting diverse and balanced dietary patterns.

Medicinal plants contain bioactive compounds with potential benefits for metabolic regulation, including glucose homeostasis. Vachellia farnesiana (VF) pods are rich in polyphenols, including quercetin, catechins, methyl gallate, prutin, and hydroxycinnamic acids; however, their clinical effects in humans remain underexplored. This study aimed to evaluate the feasibility, safety, and acute metabolic effects of a polyphenol-rich extract from VF pods in healthy adults, with emphasis on glycemic regulation and incretin hormone responses. A single-blind, randomized, controlled pilot trial was conducted in 60 healthy volunteers (BMI 18.5-24.9 kg/m2). Participants received a single oral dose of VF extract (1.2 mg/kg) or placebo (water) before a 75-g oral glucose tolerance test (OGTT). Blood glucose, insulin, glucagon-like peptide-1 (GLP-1), and glucose-dependent insulinotropic polypeptide (GIP) concentrations were measured at multiple time points. Safety was assessed through clinical symptoms, hepatic and renal biomarkers, and urinary levels of kidney injury molecule-1. VF extract was well tolerated, with no adverse clinical events or biochemical changes in liver and kidney function. Glycemic reduction during OGTT (P = 0.117), as well as GLP-1 (P = 0.288) and GIP (P = 0.085) concentrations, did not reach statistical significance. Insulin concentrations remained unchanged, suggesting that incretin enhancement is independent of insulin stimulation. A single oral dose of VF polyphenol extract was safe for healthy individuals. In a predefined subsample (n = 10/group), incretin responses (GLP-1 and GIP) remained unchanged, suggesting that acute metabolic effects of VF are not mediated through incretin pathways. Although the extract produced only a modest effect on postprandial glycemia, this trial provides the first translational clinical evidence linking the ethnopharmacological use of VF with rigorously controlled human experimentation. These findings support its therapeutic promise in metabolic health, while underscoring the need for longer interventions, larger cohorts, and studies in individuals with impaired glucose regulation.This trial was registered at clinicaltrial.gov as NCT05802472 (https://register.clinicaltrials.gov/prs/beta/studies/S000D2E700000124/protocol/protocolSummary).