Depressive symptoms are common among adults with diabetes and are associated with adverse clinical outcomes, including mortality. Evidence from general populations suggests that physical activity (PA) and diet quality (DQ) may have a joint relationship with mental health and survival; however, evidence focusing specifically on adults with diabetes remains comparatively sparse. We analyzed data from 3451U.S. adults with diabetes in the NHANES 2007-2018 dataset. Depressive symptoms were assessed at the baseline examination using the Patient Health Questionnaire-9 (PHQ-9 score≥10), and all-cause mortality was ascertained through linkage to the National Center for Health Statistics linked mortality files up to December 31, 2019. PA (MET-min/week) and DQ (Healthy Eating Index-2015 [HEI-2015]) were examined using survey-weighted logistic regression for prevalent depressive symptoms and survey-weighted Cox proportional hazards models for subsequent mortality, with restricted cubic splines to assess dose-response relationships. Multiplicative and additive interactions between PA and DQ were evaluated. Additionally, complementary machine learning analyses were conducted to evaluate predictive performance and feature contributions. Higher PA and better DQ were generally associated with lower odds of depressive symptoms and lower hazards of all-cause mortality. A combined favorable PA and DQ profile was also associated with more favorable outcomes. PA showed a nonlinear inverse association with depressive symptoms, with lower predicted probabilities around 2000-3000 MET-min/week, whereas HEI-2015 did not demonstrate a nonlinear association. These findings highlight the potential importance of integrated lifestyle behaviors in relation to mental health and survival among adults with diabetes.

Objectives. To examine how ultraprocessed food (UPF) consumption and diet quality jointly relate to cardiometabolic health. Methods. This serial cross-sectional study used data from 15 760 US adults (aged ≥ 20 years) in the 2009-2018 National Health and Nutrition Examination Surveys. Participants completed two 24-hour recalls and did not have a chronic disease. Diet quality was categorized using Healthy Eating Index-2020 (HEI) scores as high (70 to 100), moderate (60 to < 70), low (50 to < 60), and very low (0 to < 50). UPF consumption, determined by Nova classification, was categorized as high (≥ 40% energy intake) and low (< 40% energy intake). Joint HEI-UPF categories combined these variables. We examined unadjusted and adjusted associations between joint HEI-UPF category and anthropometric and cardiometabolic biomarkers. Results. Among US adults, only 0.3% had high HEI-low UPF consumption, while 45.3% had very low HEI-high UPF consumption. Those with very low HEI-high UPF intake had the least favorable metabolic profiles, including the highest mean body mass index (29.6, defined as weight in kilograms divided by the square of height in meters) and fasting glucose (106.2 milligrams per deciliter). Conclusions. Diet quality was more consistently associated with cardiometabolic health than UPF intake. Public Health Implications. Overall diet quality is a strong predictor of cardiometabolic health, even with varying UPF consumption. (Am J Public Health. 2026;116(7):993-1003. https://doi.org/10.2105/AJPH.2026.308494).

This study aims to examine the complex interrelationships among dietary quality, health literacy, loneliness, physical activity, mental health, and BMI (Body Mass Index) among young Chinese individuals, with particular attention to the mediating role of mental health in the pathways linking health behaviors and BMI. A cross-sectional survey was conducted with a diverse sample of Chinese university students (N = 1568) using validated instruments to measure dietary quality, health literacy, loneliness, physical activity, mental health, and BMI. Structural equation modeling (SEM) was employed to test both direct and indirect relationships among the variables. Findings revealed that higher levels of dietary quality, health literacy, and physical activity were significantly associated with better mental health, while loneliness showed a strong negative effect. Mental health was, in turn, negatively associated with BMI. Furthermore, mental health significantly mediated the effects of dietary quality, health literacy, and physical activity on BMI. These results underscore the central role of psychological well-being in converting health knowledge and behaviors into tangible physical outcomes. The study highlights the need for integrated health promotion strategies that address not only physical behaviors and informational competencies but also the emotional and social dimensions of health. Strengthening mental health support and health literacy among youth may enhance the effectiveness of dietary and physical activity interventions, contributing to the broader goals of the Healthy China 2030 initiative.

Dietary behaviors established during early adulthood are important for long-term health and may influence the risk of non-communicable diseases later in life. University students living away from home are a vulnerable group, as the transition to independent living is often accompanied by economic constraints, changes in meal organization, and suboptimal dietary habits. This study examined diet quality among Italian university students living away from home using an integrated approach. A cross-sectional online survey was conducted among 1973 university students. Dietary behaviors were assessed using three indices: Quality and Completeness of Diet (QCA), Organization and Regularity of Meals (ORA), and Practical and Economic Difficulties (DPE). Associations with monthly food and housing budgets were examined using descriptive analyses, multivariable linear regression, and exploratory cluster analysis. A gradient was observed between monthly food budget and dietary quality, with higher QCA scores in higher food budget categories. In contrast, housing-related expenditures were not associated with QCA but were linked to poorer meal organization and greater perceived difficulties. In multivariable analysis, both ORA and DPE were independently associated with dietary quality. Cluster analysis identified three distinct profiles characterized by different combinations of diet quality, meal organization, and economic and organizational constraints. Diet quality among university students living away from home reflects the combined and partially independent effects of economic resources, meal organization, and organizational constraints. These findings highlight early-life determinants of dietary behaviors with potential implications for future health and support integrated preventive strategies for young adults.

ObjectiveFew studies have simultaneously addressed self-management of cardiovascular disease and mental health in Black women at cardiovascular risk. This 24-week pilot prospective crossover randomized-controlled trial tested TEAM-Red, a 5-session, biweekly, nurse and peer-educator remotely delivered group self-management intervention for young Black women, compared to an enhanced waitlist control (eWL) group.MethodsThe TEAM-Red intervention, adapted from an evidence-based program and culturally tailored based on stakeholder input, enrolled 50 depressed Black women ages 18-49 with at least one risk factor for hypertension. Participants were randomized to TEAM-Red (n = 25) or eWL (n = 24) and assessed at screening, baseline, 12 weeks, and 24 weeks. Those in eWL crossed over to receive TEAM-Red at 12 weeks and all participants were followed to 24 weeks. The primary goal was acceptability and feasibility. The primary outcome was change in depression severity from baseline to 12 weeks assessed by the 9-item Patient Health Questionnaire (PHQ-9). Secondary outcomes were perceived stress, mental health quality of life, diet quality, energy expended, social support, hypertension knowledge, and alcohol use.ResultsAmong women depressed at baseline (N = 31), TEAM-Red participants had 17.1 times higher odds of depression remission at week 12 (OR = 17.14, 95% CI: 1.78, 164.97; P = .014). At 12 weeks, TEAM-Red participants also showed significantly lower PHQ-9 scores (P = .042), improved diet quality (P = .025), higher mental health quality of life (P = .032), and reduced perceived stress (P = .038) compared to those in the eWL. Treatment satisfaction and engagement in the intervention group was high (89% found it useful), with 22% attrition.ConclusionsThe TEAM-Red intervention demonstrated significant clinical benefits with a 17-fold higher odds of depression remission and meaningful improvements in mental health quality of life, diet quality, and perceived stress compared to controls. Despite limitations including small sample size and short follow-up period, this culturally tailored intervention showed promise for reducing cardiovascular risk and improving mental health outcomes in young Black women at risk for hypertension. These results need replication in a larger sample as part of a fully powered trial.

Objectives. To examine associations between (1) food insecurity and participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Supplemental Nutrition Assistance Program (SNAP), and (2) ultraprocessed food (UPF) consumption and Healthy Eating Index-2020 (HEI) score among US pregnant women. Methods. We analyzed data from pregnant women (n = 1286) across 9 waves of National Health and Nutrition Examination Surveys, from 2001 to 2018. We assessed UPF consumption, as percentage of energy from Nova Group 4 classification, and HEI. Multivariable regressions estimated associations of food insecurity and WIC or SNAP participation with UPF consumption and HEI. Results. Food insecurity affected 20% of women and was associated with lower HEI (B = -3.8; SE = 1.4; P = .01) but not UPF consumption. UPF consumption did not differ by WIC or SNAP participation status (P > .05). WIC participants had higher HEI while SNAP participants had lower HEI (P = .01). Conclusions. Food insecurity was linked to lower prenatal HEI but not UPF consumption. WIC may improve otherwise low prenatal HEI; unchanged UPF consumption, irrespective of nutrition assistance beneficiary status, warrants public health and nutrition education strategies to reduce UPF consumption and scale access to affordable, less-processed, nutritious foods. (Am J Public Health. 2026;116(7):971-980. https://doi.org/10.2105/AJPH.2026.308507).

Effects of diet, dietary inflammatory index, modified antiinflammatory dietary intervention via diet management platform on short-term prognosis in patients with ulcerative colitis: A prospective study.

Adolescents' food choice patterns at school: A data driven approach.

Study protocol for weSIPsmarter: A cluster randomized-controlled trial to evaluate the efficacy of a digital health intervention aimed at reducing sugary drinks among rural Head Start preschoolers and their parents.

This study explored meal preferences in young adults and moderation by dietary behaviours and cardiometabolic health. Between April and November 2022, Australian young adults (18-30 years) were invited to complete an online discrete choice experiment (DCE) to understand meal preferences and to provide an 8-item cardiometabolic profile analysis. Participants were presented with 12 choice sets reflecting a typical weekday meal and were asked to choose between four meal options, each with five meal attributes (preparation time, cost, taste, familiarity, nutrition content). Conditional logit models were used to determine meal preferences and associations with diet quality, hunger, appetite disinhibition and cardiometabolic health. A total of 229 adults (49% female, mean age 23.9 [SD 3.9] years) completed the DCE and provided cardiometabolic data. Higher nutrition content was the most important influence on meal choice (β=2.26, 95% CI: 1.97, 2.56), followed by better taste (β=2.05; 95% CI: 1.80, 2.29), higher quality (β=0.96; 95% CI: 0.79, 1.13), lower cost (β=-0.85; 95% CI: 1.07, -0.64), and lower preparation time (β=-0.75; 95% CI: 0.91, -0.59). Higher nutrition content was more important with higher diet quality and less important with increasing appetite disinhibition, VLDL-cholesterol, insulin, hsCRP and triglycerides levels; higher meal quality was more important with higher diet quality and less important with increasing appetite disinhibition; better taste was less important with increasing total and LDL cholesterol; lower cost was more important with increasing VLDL-cholesterol, insulin and triglycerides; and lower preparation time was more important with increasing VLDL-cholesterol and triglycerides. Meal preferences in young adulthood vary according to dietary behaviours and cardiometabolic profile. Targeted interventions and policies that address the underlying reasons for unhealthy behaviours in young adults and differ by cardiometabolic risk groups are needed.

Attention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in adolescents, with maternal pregnancy behaviors and adolescent dietary quality considered risk factors for its onset and progression. This study aimed to analyze associations of maternal pregnancy behaviors and the Healthy Eating Index (HEI)-2020 with adolescent ADHD. Data from 3859 adolescents were extracted from NHANES 2013-2018. Dietary quality was assessed using two-day dietary recall data and quantified as HEI-2020 scores. Multivariate logistic regression assessed associations of HEI-2020 and maternal pregnancy behaviors with ADHD likelihood. Restricted cubic spline regression models were utilized to describe nonlinear relationships, and subgroup analyses were conducted. HEI-2020 index was linked to a lower adolescent ADHD reporting rate (OR=0.977, 95% CI: 0.954-1.000, p=0.048). Subgroup analysis showed that higher HEI-2020 was significantly linked to lower ADHD reporting rates when maternal age of a mother at pregnancy was <25 or ≥35 years or when the child's birth weight was not overweight (OR<1, p<0.05), with no nonlinear relationship detected. Joint association analysis revealed that higher HEI-2020 score was significantly associated with lower ADHD reporting rates in women with maternal age at pregnancy<25 (OR=0.515, 95% CI: 0.310-0.851, p=0.012). Across all HEI-2020 levels, adolescents born to non-smoking mothers had significantly lower ADHD rates than those born to smoking mothers (OR<1, p<0.05). A higher HEI-2020 diet was associated with lower ADHD reporting rates, whereas maternal smoking during pregnancy correlated with higher rates. Improving adolescent diet and promoting healthy pregnancy behaviors are recommended for better prevention.

Previous research has revealed associations between diet and health-related quality of life (HRQoL), between diet and kynurenine pathway (KP) metabolites (kynurenines), and between kynurenines and HRQoL in colorectal cancer (CRC) survivors. We examined if kynurenines mediate longitudinal associations between diet and HRQoL in CRC survivors up to 12-months posttreatment. Repeated measurements were performed in 209 stage I-III CRC survivors. Diet was assessed by seven-day dietary records. Plasma kynurenines were analyzed using LC-MS/MS. HRQoL outcomes were assessed through the validated EORTC QLQ-C30. We used confounder-adjusted multilevel parallel-multiple mediator models with all kynurenines simultaneously and single mediator models with established KP ratios to estimate total (c:diet-HRQoL), direct (c':diet-HRQoL), metabolite-specific indirect (ab: diet-metabolite-HRQoL), and total indirect (ab:diet-metabolites-HRQoL) effects. Higher carbohydrate intake was associated with worse role functioning, while higher fiber, alcohol, and zinc intake, and better adherence to the Dutch Healthy Diet (DHD) recommendations were associated with better physical and role functioning (c-path). Associations of fiber and DHD with HRQoL remained statistically significant after controlling for all KP metabolites (c'-path). All kynurenines simultaneously only mediated associations of higher carbohydrate intake with worse role functioning, and of higher alcohol intake with better physical functioning (ab). The kynurenic acid-to-quinolinic acid (KA/QA) ratio and hydroxykynurenine ratio (HKr) significantly mediated associations of carbohydrate, protein, fat, alcohol, magnesium, and zinc intake, and adherence to DHD recommendations, with physical and role functioning (ab). In conclusion, while all kynurenines simultaneously did not mediate diet-HRQoL associations, the KA/QA ratio and HKr did mediate several associations within the first year after CRC treatment.

Objectives. To examine associations of ultraprocessed foods (UPFs, defined by Nova) with cardiometabolic risk factors, prevalent conditions, and mortality, before and after comprehensively adjusting for nutritional quality. Methods. We analyzed data from 47 999 adults in the National Health and Nutrition Examination Survey (NHANES)1999-2018. Survey-weighted, multivariable adjusted linear or logistic regression evaluated cross-sectional associations with risk factors and disease prevalence, and Cox models evaluated prospective associations with all-cause mortality. Models were compared before and after adjustment for each individual's Food Compass Score (i.FCS) to test independence from nutritional quality. Results. Every 10% of energy supplied from UPFs was associated with higher body mass index, HbA1c, diastolic blood pressure, total-to-high-density lipoprotein cholesterol (HDL-C); lower HDL-C and low-density lipoprotein cholesterol (LDL-C); greater prevalence of metabolic syndrome (odds ratio [OR] = 1.07; 95% confidence interval [CI] = 1.05, 1.09), diabetes (OR = 1.03; 95% CI = 1.00, 1.07), and cancer (OR = 1.05; 95% CI = 1.02, 1.08); and higher risk of all-cause mortality (hazard ratio = 1.04; 95% CI = 1.02, 1.07). When we adjusted for i.FCS, associations were only partly attenuated, remaining significant. By comparison, adjustment for saturated fat, added sugar, or sodium had little effect. Findings were consistent in population subgroups, except for stronger associations among lower-income adults. Conclusions. UPF consumption is associated with adverse risk factors, disease conditions, and all-cause mortality, only partly explained by nutritional quality. (Am J Public Health. 2026;116(7):1015-1024. https://doi.org/10.2105/AJPH.2026.308499).

BackgroundThe Dietary Index for Gut Microbiota (DI-GM) is a novel index reflecting diet quality relative to gut microbiota health.ObjectiveThe study aims to investigate the relationship between DI-GM and cognitive function in older adults.MethodsData were obtained from 2629 participants aged ≥60 years in the National Health and Nutrition Examination Surveys (NHANES) (2011-2014). Cognitive function was assessed using the Consortium to Establish a Registry for Alzheimer's Disease (CERAD), the Animal Fluency Test (AFT), the Digit Symbol Substitution Test (DSST), and a global z score. Multivariable linear regression, restricted cubic splines (RCS), and subgroup analysis were performed. Predictive utility of DI-GM was assessed via the receiver operating characteristic (ROC) analysis against a baseline model. Mediation analysis examined relationships among DI-GM, the Dietary Inflammatory Index (DII), and cognitive outcomes.ResultsHigher DI-GM was associated with higher AFT, DSST, and the global z scores (p < 0.001). After full adjustment, participants with DI-GM (≥ 6) showed higher AFT score (β = 1.11, 95% CI 0.46∼1.75), DSST score (β = 4.95, 95% CI 3.05∼6.86) and z score (β = 0.19, 95% CI 0.10∼0.28), compared to those with DI-GM (0-3). No significant direct association was observed with CERAD (β = 0.45, 95% CI -0.29∼1.18, p = 0.233). RCS indicated linear relationships between DI-GM and cognitive function scores. DI-GM had excellent predictive performances based on the ROC. No significant interactions were detected by subgroup analysis. Furthermore, DII partly mediated the relationship between DI-GM and cognitive function.ConclusionsThe DI-GM showed a linear positive correlation with cognitive function in older adults.

Sleep represents a fundamental pillar of human health. Despite growing evidence highlighting its association with diet, limited data exist on how overall diet diversity relates to sleep health among medical students in low- and middle-income countries. This study aims to assess the association between diet diversity and sleep quality among medical students. A cross-sectional study was conducted at Rawalpindi Medical University among undergraduate medical students from first to final year. A sample size of 246 participants was selected using non-probability purposive sampling. Data were collected using the Diet Quality Questionnaire (DQQ), from which the Dietary Diversity Score (DDS) was derived, along with the Pittsburgh Sleep Quality Index (PSQI) and Healthy Eating Index (HEI). Data were analyzed using IBM SPSS Statistics version 26. Poor sleep quality was defined as a PSQI global score > 5. A total of 246 undergraduate medical students participated in the study, of which 61% were female. More than 70% of participants reported poor sleep quality. Sleep quality showed no significant differences across gender (p = 0.9), year of study, or resident status. Higher body mass index was significantly associated with poorer sleep (p = 0.04). Higher diet diversity was associated with better sleep quality, with each one-point increase in diet diversity score associated with an 11.8% reduction in the odds of poor sleep (B = -0.126, OR = 0.88, 95% CI 0.78-1.00, p = 0.042). Students with good sleep had higher median diet diversity scores compared with those with poor sleep (Mann-Whitney U = 5312.5, Z = -1.984, p = 0.047). Sleep medication use was significantly higher among females (p < 0.001). A high prevalence of poor sleep quality (> 70%) was observed among both male and female medical students. Most notably, greater diet diversity was associated with better sleep quality. Improving diet diversity and managing BMI could be strategic targets for enhancing sleep quality among medical students.

Nudging Toward Sustainable and Healthy Diets: A Randomized Trial of Young Adults.

Development and Validation of a Dietary Adherence Index for Mexican Women Based on the Mexican Dietary Guidelines 2023.

Inflammation and metabolic dysregulation are increasingly considered as key contributors to depression. However, the role of inflammatory-metabolic status in the association between diet quality and depression remains unclear. This study aimed to investigate whether inflammatory-metabolic status, as reflected by the monocyte-to-high-density lipoprotein cholesterol ratio (MHR), modifies the association between dietary patterns and depression, with a focus on potential sex-specific differences. Adults participating in the US National Health and Nutrition Examination Survey (NHANES) 2005-2018 were included. Diet quality was evaluated using four dietary indices: the Healthy Eating Index-2020 (HEI-2020), Dietary Inflammatory Index (DII), Alternative Mediterranean Diet (aMED), and Dietary Approaches to Stop Hypertension (DASH). Depressive symptoms were evaluated using the nine-item Patient Health Questionnaire (PHQ-9). Weighted multivariable logistic regression and restricted cubic spline (RCS) models were used to examine independent and joint associations between dietary patterns, MHR, and depression. Interaction effects between dietary patterns and MHR were assessed on both multiplicative and additive scales. Stratified analyses were conducted to examine the robustness of the results across subgroups. A total of 26,289 participants were included. A positive association between MHR and depression was found in women (OR = 1.61, 95% CI: 1.14-2.28), but not in men. Healthier dietary patterns, reflected by higher HEI-2020 and aMED scores, and lower DII scores, were associated with significantly lower odds of depression in both sexes. RCS analyses indicated a dose-response relationship between dietary pattern scores (HEI-2020, aMED, and DII) and depression. Joint analyses showed that women with both low MHR and high diet quality had the lowest odds of depression. The adjusted ORs were 0.54 (95% CI: 0.42-0.68) for HEI-2020, 0.33 (95% CI: 0.24-0.47) for DII, and 0.55 (95% CI: 0.42-0.71) for aMED. Notably, among women with low MHR, healthier dietary patterns were strongly associated with lower depression odds (HEI-2020: OR = 0.59, 95% CI: 0.44-0.79; DII: OR = 0.38, 95% CI: 0.26-0.55; aMED: OR = 0.62, 95% CI: 0.46-0.84), whereas these associations were weaker among those with high MHR (HEI-2020: OR = 0.75, 95% CI: 0.60-0.95; DII: OR = 0.79, 95% CI: 0.56-1.12; aMED: OR = 0.81, 95% CI: 0.62-1.06). A significant interaction between the DII and MHR on depression was observed in females (multiplicative interaction OR = 0.44, 95% CI: 0.25-0.75). Conversely, among men, the associations between dietary patterns and depression appeared largely independent of MHR status. The associations between dietary patterns and depression differed across MHR levels in a sex-specific manner. A significant interaction between DII and MHR suggests that inflammatory-metabolic status may be involved in the diet - depression association.

This cross-sectional study aimed to investigate the associations between various weight-loss practices and unhealthy dietary patterns among Chinese adolescents. We analyzed 17,483 students aged 6-19 years from The Zhejiang Childhood Behavior and Health Cohort, a school-based, multistage stratified cluster sample. Six weight-loss behaviors (laxatives, vomiting, non-prescribed diet pills, dieting/low-calorie foods, ≥ 24h fasting, increased exercise) were assessed with yes/no items. Dietary quality was quantified with the 8-item Unhealthy Dietary Score (UDS-8; range 0-80, and categorized into low, moderate and high unhealthy dietary groups. Multivariable logistic regression estimated adjusted odds ratios (OR, 95% CI) for the association between each weight-loss method and dietary category. In the fully adjusted model, fasting ≥ 24h conferred the highest risk of high unhealthy diet scores overall (OR = 4.65, 95% CI: 2.90-7.44), followed by vomiting (OR = 4.75, 95% CI: 2.25-10.00), diet pills (OR = 4.03, 95% CI: 1.90-8.56), and laxatives (OR = 2.65, 95% CI: 1.60-4.39), while increased exercise remained protective (OR = 0.83, 95% CI: 0.74-0.92). BMI-stratified analyses revealed that underweight adolescents showed the strongest associations for fasting (OR = 8.21) and vomiting (OR = 5.43); among those with overweight or obesity, fasting remained significant (OR = 3.32) and exercise showed the strongest protective effect (OR = 0.54); among normal-weight adolescents, dieting (OR = 1.59) and fasting (OR = 2.47) were significantly associated with high unhealthy diet, whereas exercise showed no significant association (OR = 1.03, 95% CI: 0.78-1.35). Notably, the associations between extreme weight-loss behaviors (e.g., vomiting, fasting ≥ 24h) and unhealthy diet scores were more pronounced among underweight and obese adolescents, revealing important BMI-stratified heterogeneity. Extreme weight-control behaviors are strongly coupled with poor-quality diets among adolescents, with BMI-stratified heterogeneity, whereas increased exercise predicts healthier eating. School-based programs should prioritize the identification of extreme weight-loss behaviors and promote physical activity and balanced diets to prevent disordered eating.

Black people in the United States have the highest death rates for cancer and a lower overall 5-year cancer survival rate than White people. Although current literature demonstrates the importance of diet in cancer survivors' overall health, there is a limited understanding of the relationship between nutrition insecurity and cancer-related outcomes. This review summarizes evidence and knowledge gaps related to nutrition insecurity, food insecurity, neighborhood food environments, and cancer-related outcomes among Black cancer survivors in the United States. A total of 41 articles were reviewed. None of the included studies assessed for nutrition insecurity using a validated measuring tool. The impact of poor diet quality, food insecurity, and the neighborhood environment on cancer-related outcomes is evident, yet these issues continue to be studied in isolation. Establishing nutrition insecurity as a foundational concept will allow for more studies to better address the multi-level issues impacting Black cancer survivors' overall health.