Healthy Diet Research Articles

Healthy and unhealthy plant-based diets and the risk of cardiovascular diseases: The Rotterdam study and updated meta-analysis

BackgroundConsumption of more plant-based foods is gaining popularity, but the role of healthy versus unhealthy plant-based diets in cardiovascular disease (CVD) risk remains inconclusive. ObjectivesWe investigated associations of plant-based diet indices (PDIs) with incident CVDs in a prospective cohort study and conducted an updated meta-analysis. MethodsWe included 3507 men and 5345 women of the population-based Rotterdam Study. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for CVD, coronary heart disease (CHD) and stroke with per SD increment of an overall PDI, healthy PDI (hPDI) and unhealthy PDI (uPDI), among men and women separately. We combined our findings with previously published effect estimates in an updated meta-analysis. ResultsWe documented 2015 CVD cases (1231 CHD and 952 stroke) during 107,290 person-years follow-up. Among men, the PDI and hPDI were associated with a 7 % (HR 0.93, 95 % CI 0.87–0.99) and 8 % (HR 0.92, 95 % CI 0.86–0.98) lower CVD risk. Among women, there was evidence suggesting a U-shaped association of the PDI with stroke (pnon-linearity < 0.01). In meta-analyses including up to 43,067 incident CVD cases among 359,740 participants from nine studies, the PDI and hPDI, were associated with a lower CVD risk, while uPDI with a higher CVD risk (pooled HRs [95 % CI], per SD, PDI: 0.94 [0.91–0.97], I2 = 50.4 %; hPDI: 0.94 [0.91–0.98], I2 = 74.7 %; uPDI: 1.03 [1.01–1.06], I2 = 49.0 %). ConclusionsOur findings support recommendations to consume relatively more healthy plant-based foods for CVD prevention. Potential differences by sex and non-linear associations warrant further investigation.

Diet and Survival in Black Women With Epithelial Ovarian Cancer

Ovarian cancer survival among Black women is the lowest across all racial and ethnic groups. Poor dietary quality also disproportionately affects Black populations, but its association with ovarian cancer survival in this population remains largely unknown. To examine associations between dietary patterns and survival among Black women diagnosed with epithelial ovarian cancer (EOC). This prospective cohort study was conducted among self-identified Black women aged 20 to 79 years newly diagnosed with histologically confirmed EOC in the African American Cancer Epidemiology Study (AACES) between December 2010 and December 2015, with follow-up until October 2022. AACES is a population-based study of ovarian cancer risk and survival among Black women in 11 US regions. Data were analyzed from March 2023 to June 2024. Dietary patterns were assessed by the Healthy Eating Index-2020 (HEI-2020) and Alternative Healthy Eating Index-2010 (AHEI-2010), with scores calculated based on dietary intake in the year prior to diagnosis and collected via the validated Block 2005 Food Frequency Questionnaire. Higher scores indicate better dietary quality. Hazard ratios (HRs) and 95% CIs were estimated from multivariable Cox models for the association between adherence to dietary recommendations and overall mortality among all participants and those with high-grade serous ovarian cancer (HGSOC). Among 483 Black women with EOC (mean [SD] age, 58.1 [10.5] years), 310 deaths were recorded during a median (IQR) follow-up of 4.3 (2.0-8.2) years. No association of dietary patterns with mortality was found among women with EOC overall. However, among 325 women with HGSOC, better adherence to HEI-2020 was associated with decreased mortality in later quartiles compared with the first quartile (HR, 0.63; 95% CI, 0.44-0.92 for quartile 2; HR, 0.67; 95% CI, 0.46-0.97 for quartile 3; HR, 0.63; 95% CI, 0.44-0.91 for quartile 4 ). Similar results were observed with AHEI-2010 among women with HGSOC for the second (HR, 0.62; 95% CI, 0.43-0.89) and fourth (HR, 0.67; 95% CI, 0.45-0.98) quartiles compared with quartile 1. In this study, women with moderate and high prediagnosis dietary quality had significantly lower mortality rates from HGSOC compared with women with the lowest prediagnosis dietary quality. These findings suggest that even moderate adherence to dietary guidelines prior to diagnosis may be associated with improved survival among Black women with HGSOC, the most lethal form of ovarian cancer.

Healthy Eating and Active Lifestyles for Diabetes (HEAL-D) Online: a mixed methods evaluation exploring the feasibility of implementing a virtual culturally tailored diabetes self-management programme for African and Caribbean communities

ObjectivesTo assess the feasibility and acceptability of delivering Healthy Eating and Active Lifestyles for Diabetes (HEAL-D) Online.InterventionHEAL-D Online—a 7-week culturally tailored type 2 diabetes educational programme delivered using online platform.SettingProgramme...

The Role of Nutrition in Maintaining the Health and Physical Condition of Sports Volunteers.

Nutrition plays a key role in maintaining health and physical condition, particularly for active individuals, including athletes. It can therefore be assumed that individuals performing physically demanding tasks during the organization of sporting events, such as volunteers, should also pay attention to their nutrition. While the importance of diet for athletes has been widely studied, the impact of nutrition on sports volunteers remains under-researched. Volunteers often have to cope with varying degrees of physical and mental exertion, which may affect their nutritional needs. A qualitative study was conducted using in-depth individual interviews (IDIs) with 17 sports volunteers who had experience in organizing various sporting events. Participants were purposefully selected based on specific inclusion criteria, which included active involvement in sports volunteering (with a minimum of two years of experience in volunteer activities) as well as volunteering experience at sports events of various scales. The interviews aimed to understand the eating habits, dietary awareness, and impact of nutrition on health and physical fitness. The data were transcribed and subjected to thematic analysis, focusing on coding responses and identifying recurring themes. Most participants did not place much importance on their diet, making random food choices due to a busy lifestyle and lack of time. Only a few volunteers consciously adjusted their diet when they had knowledge of the physically demanding tasks they were expected to perform during their volunteer work. The majority of volunteers relied on less reliable sources of nutritional information, such as blogs or social media, rather than credible sources of knowledge. This study revealed that many individuals involved in sports volunteering are unaware of the impact of diet on their fitness and health. There is a need for nutritional education for this group to improve their awareness of the importance of a balanced diet in the context of increased physical activity. It is also advisable to provide better nutritional conditions during sporting events and to promote the use of professional sources of information about healthy eating.

Dietary intake of polyamines in a Spanish adult population: Age-dependent and correlation with the healthy dietary index and dietary inflammatory index scores

ObjectivesA healthy and balanced diet is crucial to maintaining optimal health. Understanding the benefits of different food components is essential. Polyamine spermidine is linked to age-related disease protection, but daily intakes and whether these vary with age are unknown. This study aimed to determine polyamine intake in a Mediterranean diet population and its association with participants' age, Healthy Eating Index (HEI) and Dietary Inflammatory Index (DII) scores. Research Methods & ProceduresA database was elaborated with references concerning polyamine content in foods to determine the daily intake of frequent foods consumed by 203 participants (84 males and 119 females), aged 18–90 years, using a nutritional survey (VioScreen), that includes HEI and DII scores. ResultsThe participants' characteristics are as reported in the 2020 corresponding Spanish Nutritional Survey. Two-thirds accomplished moderate to high adherence to the Mediterranean diet. The mean HEI score was 74.45 (out of 100), and the DII was −1.94 (anti-inflammatory). The median intake of polyamines was 45.59 mg/day/person (mean: 46.89 mg/day/person, 410.57 µmol/day/person), without gender differences. After normalising the intake per kcal, the Kruskal-Wallis test showed significant differences among age groups for total polyamines ingested, putrescine, and spermidine. The intake of putrescine and spermidine was significantly higher in the 60–69 age group compared to the 24–59 and 18–23 age groups, respectively. HEI scores positively correlated with polyamine intake, while DII was negative. ConclusionsPolyamine intake was higher than reported in other populations, did not decrease based on age, and was associated with healthy eating and anti-inflammatory foods.

Effect of Digital Health Coaching on Healthy Eating in Individuals with Cardiometabolic Conditions

Effect of Digital Health Coaching on Healthy Eating in Individuals with Cardiometabolic Conditions

Co-creation and implementation of a healthy lunch at Dutch primary schools in disadvantaged neighbourhoods: design of a cluster randomised cross-over effectiveness study

IntroductionThe majority of children fails to have a healthy diet. Providing a healthy lunch at school is a way to target all children, regardless of ethnic and socioeconomic background. This...

Maternal exercise during pregnancy is associated with reduced risk of asthma in the child: A prospective birth cohort study.

The means of primary prevention of asthma are limited. Maternal physical activity during pregnancy promotes fetal lung development and the newborn's lung function; thus, it could lower asthma risk and aid in asthma prevention. The objective of this study is to determine whether maternal physical activity during pregnancy is associated with asthma development in the child. The study population included 963 mother-infant pairs from the prospective Kuopio Birth Cohort study. Data on maternal physical activity during pregnancy, confounding factors, and children's asthma at 5 to 7 years of age were obtained from the Kuopio University Hospital birth registry and questionnaires. Maternal physical activity during pregnancy, when practiced three or more times per week, was associated with a reduced risk of asthma in the child, with an adjusted odds ratio of 0.54 (95% confidence interval 0.33-0.89; p= 0.02). The association was stable across a comprehensive set of adjustments, including length of gestation, mode of delivery, and maternal health indicators (e.g., asthma, smoking, pre-pregnancy body mass index and weight gain during pregnancy, infections, medication, healthy diet, stress), as well as various family environment variables. Maternal physical activity during pregnancy may be associated with marked protection of asthma in childhood and should be studied further as an applicable measure for asthma prevention. The study has been financially supported by grants from the Academy of Finland (no. 349427), the Emil Aaltonen Foundation, the Finnish Cultural Foundation, the Yrjö Jahnsson Foundation, the Juho Vainio Foundation (no. 202200461), the Kuopio Area Respiratory Foundation, and the Ida Montini Foundation.

Implementing mobile text messaging on glycemic control in patients with diabetes mellitus.

Uncontrolled blood glucose may lead to serious complications in patients with type two diabetes mellitus (T2DM). Patients may not have the support, motivation, or encouragement to adhere to the lifestyle changes necessary to control their T2DM. More than 75% of the primary care clinic's patients are diagnosed with T2DM, with most patients at the practice site having an average hemoglobin A1c (HbA1c) level of 8.5%. The primary care clinic did not use text messaging to disseminate diabetes self-management education and support (DSMES) as outlined in Standard 4 of the American Diabetic Association's (ADA) clinical practice guideline. This evidence-based quality improvement project was conducted in a rural outpatient primary care clinic to determine whether implementing the ADA's 2022 National Standards for DSMES using text messaging would affect HbA1C levels among adult patients with T2DM. Patients were sent weekly text messages over a 12-week period. Text messages contained information promoting self-care, tips about healthy diet, exercise reminders, instructions about proper blood glucose monitoring, and reminders about medication adherence. A total of 160 patients were included. A paired-sample t -test showed a reduction in HbA1c levels after the intervention from baseline (M = 7.53, SD = 1.72) to postimplementation (M = 6.91, SD = 0.89), t (159) = 11.88, p = .001. Based on the results, implementing the ADA's National Standards for DSMES Standard 4 may affect HbA1c levels in this population.

Nitrogen excretion and utilisation of dairy cows grazing temperate semi-natural grasslands

Diets reliant on grazed, temperate herbage are prone to greater nitrogen (N) losses via urine than balanced stall-fed diets which poses a greater risk for N emissions. Measures for improving the N utilisation in grazing-based dairy cattle systems are predominantly investigated on homogenous clover-ryegrass pastures with high herbage yields and nutritional quality. In contrast, grazing-based systems reliant on less external inputs (e.g., synthetic fertilisers or concentrates) using semi-natural grassland as main feed source, such as in large parts of Central Europe, received less attention. The N utilisation and excretion of grazing cows in low-input dairy farms was, thus, investigated on nine commercial organic dairy farms in South Germany across one to four periods per farm. The dataset captured a diverse set of dairy production systems comprising 323 individual animal observations. A mean (± one standard deviation) milk production, DM intake (DMI), and pasture DMI of 23.9 kg (± 5.35), 21.0 kg (± 3.21), and 11.3 kg/d (± 4.83), respectively, was determined using titanium dioxide and faecal crude protein concentration as markers of faecal excretion and diet digestibility, respectively. Milk N use efficiency (MNE; i.e., milk N secretion as share of N intake) averaged 24.7 g/100 g N intake (± 5.91), which is greater than observations in temperate, high-input grazing systems but lower than in cows receiving balanced diets in the barn. The MNE and another seven indicators of N utilisation and excretion displayed a wide range of values. The grazing management factors explaining this variation were, thus, identified via backward elimination. The supplementation strategy had the greatest potential for manipulating N utilisation and excretion of dairy cows. Increasing shares of fresh forages (i.e., meadow grass or clover-grass leys) as well as of hay in supplement DMI increased N utilisation (e.g., MNE) and decreased urinary N excretion (e.g., urinary N to creatinine ratio), while increasing shares of concentrates in supplement DMI are related to lower N losses via urine. At the same time, increases in total supplement DMI reduced N utilisation and increased urinary N excretion. Hence, full-time grazing combined with supplementation of fresh forage and hay in the barn is a viable option for low-input, grazing-based dairy operations with moderate levels of N losses.

Assessing the Role of Nutrition Knowledge in Shaping Dietary Practices Among Secondary Level School Students: Implications for Healthcare Management

Introduction: This study investigates the nutrition knowledge and dietary practices among secondary-level school students, a demographic prone to unhealthy habits such as junk food consumption, meal skipping for weight loss, and non-compliance with balanced diets. These behaviors increase the risk of non-communicable diseases like obesity and diabetes in adolescents. This study has aims to examine the nutrition knowledge and dietary practices of secondary-level school students, a demographic that is increasingly susceptible to unhealthy eating habits. Specifically, it focuses on behaviors such as junk food consumption, meal skipping for weight loss, and the neglect of balanced diets. These specific practices contribute to a heightened risk of non-communicable diseases, including obesity and diabetes, among adolescents. Methodology: The quantitative research approach was employed an exploratory design, analyzing data from 121 students in Kathmandu valley using a close-ended questionnaire during 7th April to 28th May 2024. The systematic sampling technique was used, and respondents were selected by using a lottery system. As a result, Grade 11 was picked up randomly. Descriptive analyses were made to describe the practices of the students. Result (s): Study indicates that out of 121 respondents, about near to half (48.8%) were male and little more than half (51.2%) were female. Similarly, there were no significant relationship exists between nutrition knowledge and dietary practices among the students. Likewise,, independent variables such as age, gender, and religion do not significantly influence either nutrition knowledge or dietary practices. Despite the students' understanding of nutrition, this knowledge does not translate into healthier eating behaviors. Conclusion and recommendation: The study reveals that there are notable gaps in their knowledge, particularly regarding the energy content of fat-free foods, the role of dietary fiber, and the impact of empty-calorie foods and meal-skipping on health. Likewise, findings highlight the disconnect between what students know about nutrition and how they apply it in their daily lives, suggesting the need for more effective interventions to encourage healthier dietary practices. Moreover, targeted nutritional education programs at school could address these gaps in knowledge and encourage healthier dietary practices.

Healthful plant-based diets are negatively associated with the rate of biological aging: A national study based on US adults

Plant-based diets are recognized for their health benefits. However, evidence on the association between plant-based diet quality and aging in the US population is limited. This study aimed to investigate the association between different plant-based diet indices, phenotypic age acceleration (PhenoAgeAccel), and biological age acceleration (BioAgeAccel). We hypothesized that healthful plant-based diets would negatively affect PhenoAgeAccel and BioAgeAccel in US adults. The cross-sectional analysis included 22,363 participants, and information was obtained from the National Health and Nutrition Examination Survey database. The quality of plant-based diet was assessed using three indices: overall plant-based diet index (PDI), healthful PDI (hPDI), and unhealthful PDI (uPDI). Phenotypic age (PA) and biological age (BA) was calculated based on a linear combination of chronological age and 12 multi-system clinical chemistry biomarkers in accordance with the previously established method. PhenoAgeAccel and BioAgeAccel are the residuals of the PA and BA. Weighted linear regression analyses were performed to evaluate the relationships between PDI, hPDI and uPDI, and PhenoAgeAccel and BioAgeAccel. After adjusting for all covariates, we observed that a 10-unit higher PDI score was associated with 0.80 years lower PhenoAgeAccel (β: −0.80, 95% confidence interval [CI]: -0.94,-0.67), and 1.91 years lower BioAgeAccel (β: −1.91, 95% CI: -2.42,-1.40). A 10-unit higher hPDI score was associated with 0.83 years lower PhenoAgeAccel (β: −0.83, 95% CI: -0.96,-0.70), and 1.76 years lower BioAgeAccel (β: −1.76, 95% CI: -2.18,-1.34). Conversely, a 10-unit higher uPDI score was associated with 0.77 years higher PhenoAgeAccel (β: 0.77, 95% CI: 0.66,0.89) and 1.21 years higher BioAgeAccel (β: 1.21, 95% CI: 0.80,1.62). These findings suggest that US adults may be able to slow the aging process by increasing adherence to a healthy plant-based diet.

Residential food environment and dietary antioxidant consumption among pregnant women: Modifying effects of socioeconomic factors and ethnic identity

BackgroundResidential food environment influences dietary patterns, however the impact of individuals' perceived social identity on the antioxidant intake, an indicator of healthy dietary patterns, remains underexplored. ObjectiveWe conducted a cross-sectional analysis using data collected in a longitudinal cohort. In the study, we aim to investigate the interactions between the food environment and two indicators of social identity, specifically a subjective ladder measure of socioeconomic status (SES) and the Multigroup Ethnic Identity Measure (MEIM) score, in relation to dietary antioxidant intake (DAI) among n = 512 Boston and NYC-resident pregnant women. MethodsThe modified Retail Food Environment Index (mRFEI) was calculated using the Centers for Disease Control and Prevention's equation, with higher scores indicating a healthier food environment. DAI was estimated by summing standardized data from six micronutrients (magnesium, selenium, zinc, and vitamins A, C, and E) obtained through the Block98 Food Frequency Questionnaires administered during pregnancy, with higher scores indicating increased intake. The mRFEI and DAI were dichotomized based on a median split. Multivariable-adjusted logistic regressions were used to analyze associations, both with and without considering women's subjective SES or MEIM levels as effect modifiers. ResultsWomen were racially/ethnically mixed (19.2 % White, 42.7 % Black, and 33.1 % Hispanic) with 32.2 % reporting more than high school education. In the main effect models, no significant association was observed between mRFEI and DAI. Women with higher MEIM scores exhibited higher DAI [Odds ratio (OR) =1.85, 95 % Confidence interval (CI) = 1.26–2.73]. Exploratory interaction models showed that subjective SES significantly modified the association (p-value for interaction = 0.03), women perceiving themselves to have a lower SES compared to their community (n = 45) exhibited a significantly positive association between mRFEI and DAI. ConclusionThese findings suggest that women perceiving their SES to be lower than their neighborhoods may benefit from better access to healthy food.

Development of a Concise Healthy Diet Score for Cardiovascular Disease among Japanese; The Japan Collaborative Cohort Study.

Several diet quality indicators have been developed primarily for cardiovascular disease (CVD) prevention in Western countries. However, those previous indicators are complicated and less feasible in clinical and health-promoting settings. Therefore, we aimed to develop a concise dietary risk score for CVD prevention in Japanese. Using the self-administered food frequency questionnaire with 35 food items, we developed a concise healthy diet score (cHDS) ranging from 0 to 5 points. We examined the association of cHDS with risks of all-cause and cause-specific mortality among 23,115 men and 35,557 women who were free of CVD and cancer. During 19.2 years of median follow-up, 6,291 men and 5,365 women died. In men, the multivariable hazard ratios (95% confidence intervals) for the highest cHDS (5 points) compared to the lowest (0-1 points) were 0.74 (0.60-0.91, P-trend=0.008) for CVD and 0.86 (0.77-0.95, P-trend=0.05) for all causes. No significant associations were found for stroke, coronary heart disease, and other causes in men. The corresponding hazard ratio in women was 0.65 (0.52-0.81, P-trend＜0.001) for CVD, 0.63 (0.45-0.88, P-trend＜0.001) for stroke, 0.48 (0.30-0.78, P-trend=0.008) for coronary heart disease, 0.67 (0.54-0.84, P-trend＜0.001) for other causes, and 0.75 (0.66-0.85, P-trend＜0.001) for all causes. We developed a concise diet quality score named cHDS in the Japanese population and found the inverse association of cHDS with mortality from CVD and all causes for both men and women.

Developing and testing personalised nutrition feedback for more sustainable healthy diets: the MyPlanetDiet randomised controlled trial protocol.

Agriculture and food production contribute to climate change. There is mounting pressure to transition to diets with less environmental impact while maintaining nutritional adequacy. MyPlanetDiet aimed to reduce diet-related greenhouse gas emissions (GHGE) in a safe, nutritionally adequate, and acceptable manner. This paper describes the trial protocol, development, and testing of personalised nutrition feedback in the MyPlanetDiet randomised controlled trial (RCT). MyPlanetDiet was a 12-week RCT that provided standardised personalised nutrition feedback to participants based on new sustainable healthy eating guidelines (intervention) or existing healthy eating guidelines (control) using decision trees and corresponding feedback messages. To test the personalised nutrition feedback, we modelled a sample of 20 of the MyPlanetDiet participants baseline diets. Diets were modelled to adhere to control and intervention decision trees and feedback messages. Modelled nutrient intakes and environmental metrics were compared using repeated measure one-way analysis of covariance. Intervention diets had significantly lower (p < 0.001) diet-related GHGE per 2500 kilocalories (kcal) (4.7kg CO2-eq) relative to control (6.6kg CO2-eq) and baseline (7.1kg CO2-eq). Modelled control and intervention diets had higher mean daily intakes of macronutrients (carbohydrates, fibre, and protein) and micronutrients (calcium, iron, zinc, and iodine). Modelled control and intervention diets had lower percent energy from fat and saturated fat relative to baseline. Adherence to the MyPlanetDiet personalised nutrition feedback would be expected to lead to better nutrient intakes and reduced diet-related GHGE. The MyPlanetDiet RCT will test the effectiveness and safety of personalised feedback for a more sustainable diet. Clinical trials registration number: NCT05253547, 23 February 2022.

Consumption of food markers of a healthy diet according to racial groups of women in Brazil.

This article aims to analyze the consumption of healthy food consumption markers, according to racial groups of Brazilian women interviewed in the 2019 National Health Survey (NHS). This work was a cross-sectional study with data from 45,148 white and black women, aged ≥ 20 years. The variables used were the consumption of fruits, vegetables and legumes, beans, and fish. The association between color/race and the dietary intake indicators was tested using crude Poisson regression and adjusted to estimate prevalence ratios and 95% confidence intervals (95%CI). The prevalence of the consumption of fruits and vegetables was statistically higher among white women, while fish and beans was higher among black women. After adjusting for socioeconomic and demographic variables, it was found that black women remained only less likely to consume fruit (PR = 0.91; 95% CI: 0.88-0.95) and only more likely to consume beans (PR = 1.07; 95% CI: 1.04-1.10) than whites. There were racial inequalities for the consumption of healthy foods among Brazilian women, indicating that color/race defined a dietary pattern for black women that put them in vulnerable conditions in terms of fruit consumption.

Cross-context equivalence and agreement of healthy diet metrics for national and global monitoring: a multicountry analysis of cross-sectional quantitative 24-hour dietary intake studies

Cross-context equivalence and agreement of healthy diet metrics for national and global monitoring: a multicountry analysis of cross-sectional quantitative 24-hour dietary intake studies

Defining a healthy diet globally: The good, the bad, and the ugly

Defining a healthy diet globally: The good, the bad, and the ugly

Using Less Processed Food to Mimic a Standard American Diet Does Not Improve Nutrient Value and May Result in a Shorter Shelf Life at a Higher Financial Cost

BackgroundThe “clean eating” trend suggests that consuming fewer processed foods is important for healthy diets. Yet, a diet of mostly ultra-processed foods (UPFs) can meet recommendations from the Dietary Guidelines for Americans. Whether a diet comprised mostly of simple ingredient foods can provide a low-quality diet remains unexplored. ObjectivesThe objective of this study was to compare the diet quality, shelf stability, and cost of 2 similar nutrient-poor menus, one containing primarily UPFs and the other containing less-processed foods (LPW), as defined by the Nova classification system. MethodsA “Western” menu using LPW was developed to match the meals and recipes of a menu that contained more-processed foods (MPW). Processing level was determined using the Nova classification system. Final menus were assessed for nutrient quality and Healthy Eating Index (HEI) score. Shelf stability of foods/ingredients on both menus was determined from food storage guidance manuals. The condition of each food item when purchased (room temperature, frozen, refrigerated) was used to estimate the number of days until expiration. Food costs were determined from prices at grocery chains in Fall 2023. ResultsThe LPW had similar nutrient density and diet quality scores to the MPW (HEI scores of 44 and 43, respectively). The LPW included 20% energy (kcal) from UPFs, whereas the MPW included 67% energy from UPFs. Relative percentages of shelf-stable, frozen, and refrigerated foods were similar. Using the Kaplan-Meier survival analysis method, median time to expiration of the LPW menu items was 35 d compared with 120 d for the MPW items. The “per person” cost reflecting only the amount of the food used in the menu was $15.91/d for the LPW and $9.85/d for the MPW. ConclusionsLess-processed menus can have comparable diet quality with more-processed menus although being more costly and less shelf stable.

Nutritional literacy of patients who underwent surgery for esophageal cancer based on Nutbeam's health literacy model: a qualitative study.

The level of nutritional literacy reflects the self-management ability of individuals for a healthy diet and serves as a foundation for effective nutritional interventions. This qualitative study aimed to gain a comprehensive insight into the nutritional literacy levels of patients with esophageal cancer who underwent surgery, obtaining information from both patients and medical staff through interviews. Based on Nutbeam's health literacy model, 27 participants were selected from December 2023 to February 2024. We used semi-structured interviews and directed content analysis. Sixteen patients who underwent surgery for esophageal cancer and 11 medical staff from the Department of Esophageal Cancer completed the interviews. There were five themes, including attitude and cognition, functional nutrition literacy, interactive nutrition literacy, critical nutrition literacy, and ways to improve patients' nutritional literacy. This study investigated the nutritional literacy levels of patients after esophageal cancer surgery from the perspectives of both patients and medical staff, offering comprehensive insights into the assessment of patients' nutritional literacy and the corresponding strategies for improvement. It emphasizes the hierarchical nature of nutritional literacy among patients after surgery and systematically outlines the different levels of nutritional literacy in this population. The results indicated that the level of nutrient literacy was low and exhibited marked differences. This finding suggests that future studies should be individualized, continuous, and comprehensive, following the Nutbeam's health literacy model, to improve patients' nutritional literacy levels.