Nutritional Criteria Research Articles

Examining purchasing strategies in public food procurement: Integrating sustainability, nutrition, and health in Spanish school meals and social care centres

Sustainable Public Food Procurement (SPFP) is pivotal in advancing sustainable and healthier food systems. However, practical gaps persist in understanding how policies function at the local implementation. This study addresses these gaps by analysing 22 SPFP contracts for school meals and social care centres in Spain, focusing on implementation while contextualizing findings within the broader policy cycle. This research categorizes SPFP criteria in tenders and evaluate their potential for actionability across sustainability, nutrition, & health dimensions. It also explores how these criteria are combined into purchasing strategies to achieve simultaneous or individual goals. Key findings reveal a strong use of product quality criteria, particularly organic foods, supported by policy and ease of implementation. However, non-ambitious targets, market constraints and procurement officers’ limited knowledge hinder progress. The study highlights significant adoption of nutritional & health criteria, though non-mandatory policies and varying regional targets impede consistent implementation and reveal gaps in promoting healthy and sustainable dietary practices. Environmental criteria are widely used signalling policy priorities within the EU policy framework. In contrast, proximity and social criteria are underutilized due to regulatory constraints and insufficient guidance. Despite these challenges, innovative local procurement strategies are utilized to overcome barriers. At the strategy level, the study reveals diverse approaches to SPFP implementation, highlighting adaptability but underscoring the need for flexible frameworks that accommodate local variations while aligning with broader EU or national goals. This research advocates for a holistic approach to SPFP that addresses both the practical challenges of implementation and the systemic issues present in the earlier stages of policy development.

Impact of Ultra-Processed Foods on Food Sustainability: Exposure Assessment and Health Implications.

Excessive consumption of ultra-processed food (UPF) is a global health concern as-sociated with an increased incidence of non-communicable diseases. UPFs are characterized by their extensive industrial processing and high content of additives, preservatives, chemicals, and artificial ingredients that are used to mask defects or inferior ingredients of end food products, presenting a multifaceted challenge to contemporary society. Exposure assessment showed that almost 50% to 30% of the energy consumption per day comes from UPFs. The more processed a food is, the less likely it is to be healthy and nutritious. UPFs affect human health by increasing the risk of obesity, heart disease, cancer, depression, diabetes, etc., as these foods are typically made up of a large number of preservatives, high content of fats, sodium, and sugars, and low contents of protein, fiber, and potassium. The ingredients required for the production of UPFs are commonly derived from intensive monoculture and livestock of raw foods. This, in turn, exerts imminent effects on agriculture, biodiversity, and the global food system by altering the bioavailability of nutrients within agricultural soil, thereby increasing the dependency on ferti-lizers and insecticides. Recent studies have shown that over-consumption of UPF has an effect on culinary traditions, loss of biodiversity, human well-being, and food system sustainability. Therefore, for better food system sustainability, the consumption of UPFs should be reduced, and we should move toward minimal processing technologies, preferably for seasonal and or-ganic local products. Based on available data, there is an urgent need to implement policies and regulations for the agro-food industry to include nutritional and environmental criteria. This review explains the different dimensions of UPFs in relation to health, nutrition, environment, current challenges, future innovations, and wider sustainability concerns.

Comparison of three objective nutritional screening tools for identifying GLIM-defined malnutrition in patients with gastric cancer.

This study aimed to compare three objective nutritional screening tools for identifying GLIM-defined malnutrition in patients with gastric cancer (GC). Objective nutritional screening tools including geriatric nutritional risk index (GNRI), prognostic nutritional index (PNI), and controlling nutritional status (CONUT) score, were evaluated in patients with GC at our institution. Malnutrition was diagnosed according to the GLIM criteria. The diagnostic value of GNRI, PNI, and COUNT scores in identifying GLIM-defined malnutrition was assessed by conducting Receiver Operating Characteristic (ROC) curves and calculating the area under the curve (AUC). Additionally, sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were determined. The Kappa coefficient (k) was used to assess agreement between three objective nutritional screening tools and GLIM criteria. A total of 316 patients were enrolled in this study, and malnutrition was diagnosed in 151 (47.8%) patients based on the GLIM criteria. The GNRI demonstrated good diagnostic accuracy (AUC = 0.805, 95% CI: 0.758-0.852) for detecting GLIM-defined malnutrition, while the PNI and COUNT score showed poor diagnostic accuracy with AUCs of 0.699 (95% CI: 0.641-0.757) and 0.665 (95% CI: 0.605-0.725) respectively. Among these objective nutritional screening tools, the GNRI-based malnutrition risk assessment demonstrated the highest specificity (80.0%), accuracy (72.8%), PPV (74.8%), NPV (71.4%), and consistency (k = 0.452) with GLIM-defined malnutrition. Compared to PNI and COUNT scores, GNRI demonstrated superior performance as an objective nutritional screening tool for identifying GLIM-defined malnutrition in GC patients.

Impact of low-carbohydrate diet on health status: an umbrella review.

The prevalence of diet-related non-communicable diseases has increased. A low-carbohydrate diet (LCDs) is one of the most popular interventions. Several systematic reviews and meta-analyses of randomised clinical trials (RCTs) and non-RCTs have linked LCDs to the management of obesity, diabetes, cardiovascular disease, epilepsy, and cancer. However, there has been limited appraisal of the strength and quality of this evidence. To systematically appraise existing meta-analyses and systematic reviews of RCTs and non-RCTs on the effects of LCDs on different health conditions. To understand their potential efficacy, we summarised the studies' findings and assessed the strength of the evidence. A search was conducted using the PubMed database from inception to October 2021 for systematic reviews and meta-analyses of RCTs and non-RCTs investigating the association between LCDs and multiple health outcomes in humans. The Academy of Nutrition and Dietetics Quality Criteria was used for the quality assessment. In addition, the evolution of heterogeneity, strength of the included studies, and effect sizes were extracted from each systematic review and meta-analysis. Ten systematic reviews and meta-analyses were included. Of the included reviews, 70% were of positive quality, 30% were neutral, and none were negative. The majority of the studies included strength in each systematic review, and the meta-analyses were of low to medium strength. The existing literature indicates that LCDs may help promote weight reduction in adults who are obese or overweight. This conclusion is supported by the findings of studies included in the analysis, which were of low to moderate strength. Furthermore, compelling data indicates a significant association between low-carbohydrate diets (LCDs) and a reduction in haemoglobin A1c levels among those diagnosed with type 2 diabetes mellitus. In contrast, there was a lack of evidence of this correlation in type 1 diabetes mellitus patients or those with cardiovascular diseases. Additionally, there was limited evidence regarding the effectiveness of LCDs in epilepsy and adult cancer patients. This review thoroughly examines the current body of information on how LCDs affect various health outcomes. Studies have presented evidence to support the idea that incorporating LCDs can positively influence weight management and HbA1c levels. However, there is a lack of information regarding the association between LCDs and individuals with Type 1 diabetes mellitus and cardiovascular diseases. Additionally, there is limited empirical evidence to substantiate the effectiveness of LCDs in the treatment of epilepsy and adult cancer patients. The long-term effects of LCDs on mortality and other chronic diseases that account for different carbohydrate subtypes is unclear. Further longitudinal cohort studies are required to reach definitive conclusions.

A Comparative Analysis of the SARC-F Questionnaire and the Malnutrition-Inflammation Score for Sarcopenia Risk Assessment and Negative Outcome Probability in Chronic Hemodialysis Patients.

Background/Objectives: Protein-energy wasting (PEW) and sarcopenia are common in chronic hemodialysis (HD) patients, leading to numerous complications and increased mortality. This study aimed to compare the reliability of the SARC-F (Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls) and the Malnutrition-Inflammation Score (MIS) in assessing sarcopenia and predicting negative outcomes in HD patients. Methods: This cross-sectional study enrolled 109 HD patients. Nutritional assessments were performed, and blood samples were taken for routine blood laboratory investigations. The MIS was used as a scoring system to represent the severity of PEW, while the SARC-F was applied as an indicator of sarcopenia risk and general functional capacity. A multivariable logistic regression was conducted to analyze the association of several predictors with a negative cross-sectional outcome (death). Results: Patients with SARC-F scores ≥ 4 and MISs ≥ 6 were older, had significantly lower albumin and prealbumin levels, and more severe anemia. They were also more likely to report weight loss and poor appetite. A higher MIS was closely associated with unfavourable nutritional status according to the International Society of Renal Nutrition and Metabolism (ISRNM) criteria for PEW. However, in 71.25% of patients with satisfactory functional capacity (SARC-F scores 0-3), some form of PEW was still observed. After performing logistic regression modelling, only the MIS remained strongly associated with the probability of a negative outcome. Conclusions: The SARC-F alone often did not correspond to an increased sarcopenia risk or clear clinical and biochemical indicators of PEW in HD patients. When assessing nutritional risk in this group, it is recommended to use more detailed tools, such as the MIS, to ensure the accurate identification of those at the highest risk for negative outcomes.

Prevalence and Predictors of Sarcopenia, Protein-Energy Wasting, and Sarcopenic Obesity in Patients with Chronic Kidney Disease

Background Sarcopenia, sarcopenic obesity, and protein-energy wasting (PEW) are common in patients with chronic kidney disease (CKD) and are associated with adverse outcomes. This study is aimed at determining their prevalence and predictors. Materials and Methods This cross-sectional study included 442 adult CKD patients. Sarcopenia was defined using a modified Asian Working Group for Sarcopenia criteria, sarcopenic obesity as the coexistence of sarcopenia and obesity, and PEW according to the International Society of Renal Nutrition and Metabolism criteria. Results Sarcopenia prevalence was 29.9% (132 patients), with 9.5% being severe, 12.7% moderate, and 7.7% mild. Sarcopenic obesity affected 13.3% (59 patients) and PEW was noted in 27.3% (121 patients). Among sarcopenic patients, 59% met PEW criteria. Multivariate analysis identified increasing age, male sex, higher body mass index BMI, lower estimated glomerular filtration rate (eGFR), and cardiovascular disease as independent predictors of sarcopenia. Higher BMI, lower eGFR, and cardiovascular disease predicted sarcopenic obesity. For PEW, significant predictors included age, lower BMI, decreased eGFR, advanced CKD stage, cardiovascular disease, and sarcopenia. Conclusion Sarcopenia, sarcopenic obesity, and PEW are highly prevalent in CKD patients, with substantial overlap. Advanced age, lower kidney function, and cardiovascular disease are significant predictors across all three conditions. These findings highlight the need for comprehensive nutritional assessment and targeted interventions in CKD patients.

Liking and sensory determinants of perceived naturalness and healthiness. A study on pizzas with young adults in a natural eating environment

This study aims to determine the sensory drivers of liking, perceived naturalness, and healthiness of pizzas in an ecological setting. The approach consisted in evaluating beliefs, perceptions, and liking by consumers of a large range of 16 pizzas representative of the French commercial market and selected on environmental and nutritional criteria. Sixty-four pizza consumers were invited to take 16 different meals in real-setting conditions of consumption at a university restaurant with pizza as the main course. Pizzas were also characterized by a trained sensory panel. This study confirms a positive link between liking and healthiness and naturalness, even though individual differences were evident, with some consumers prioritizing naturalness while others favored healthiness. Frozen pizzas are perceived as highly processed but were well liked when evaluated in the dining condition. Overall, preferences were mainly driven by the presence of multiple pieces of vegetables, sauce, and color. Drivers of dislike were mostly related to texture (stickiness and difficulty to cut). Although preference, naturalness, and healthiness mappings are relatively similar, our models show a discrepancy in the way texture drives preferences and perceived healthiness. This suggests that texture may play a critical role in the trade-offs between liking and healthiness, and that there may be a fine line between what is considered a desirable texture and a healthy texture. Individual regressions provided insights into consumer diversity, while combining sensory profiling with consumer-based methods offered a comprehensive understanding of product perception.

Validity test of the Global Leadership Initiative on Malnutrition (GLIM) diagnostic criteria compared with the American Society for Parenteral and Enteral Nutrition (ASPEN) criteria in inpatients at Dr. Cipto Mangunkusumo hospital

Background: Malnutrition experienced by numerous inpatients is linked to various complications. The Global Leadership Initiative on Malnutrition (GLIM), which established the latest malnutrition criteria, recommends a two-step methodology for diagnosing malnutrition in adult inpatients. This study aims to evaluate the validity of the GLIM criteria for the diagnosis of malnutrition in hospitalized patients at Cipto Mangunkusomo Hospital Jakarta by comparing them with the ASPEN criteria. Methods: This cross-sectional study was conducted at Cipto Mangunkusomo Hospital, Jakarta. Secondary data was taken from 100 inpatients from October 2021 to February 2022 selected by consecutive sampling technique. The diagnosis of malnutrition in the patients applied the ASPEN and GLIM criteria. Furthermore, data were analyzed using Cohen's Kappa and chi-square tests. Results: Of 100 inpatients, 63% were diagnosed with malnutrition according to the GLIM diagnostic criteria. Meanwhile, 48% of them were found to be malnourished according to the ASPEN criteria. The GLIM criteria have a specificity of 69.2%, a sensitivity of 97.9%, a PPV of 74.6%, and an NPV of 97.3%. Conclusion: The GLIM diagnostic criteria are valid as an instrument for diagnosing malnutrition but require further research to assess the severity of malnutrition.

Total energy expenditure measured using doubly labeled water in adults with major chronic diseases: a systematic review

BackgroundEnergy requirement assessment is a cornerstone for nutrition practice. The extent to which total energy expenditure (TEE; indicator of energy requirements) has been measured in adults with chronic diseases has not been explored. ObjectivesThis systematic review aimed to characterize evidence on TEE among individuals with chronic diseases and describe TEE across chronic diseases and in comparison to controls without a chronic disease. MethodsA literature search using terms related to doubly labeled water and TEE was conducted in PubMed, MEDLINE, Web of Science, and Embase. Eligible articles included those that measured TEE using doubly labeled water in adults with a major chronic disease. Methodological quality was determined using the Academy of Nutrition and Dietetics quality criteria checklist. Sample size-weighted TEE was calculated in each chronic disease subgroup. ResultsFifty studies were included, of which 15 had a control group. Median sample size was 20 participants, and approximately half of studies were published over 10 y ago. Thirty-five (70%) studies reported resting energy expenditure, and approximately half (k = 26) reported physical activity level. Methodological quality was neutral (k = 25) or positive (k = 23) for most studies. TEE among individual studies ranged from 934 to 3274 kcal/d. Mean weighted TEE was lowest among gastrointestinal (1786 kcal/d) and neurologic (2104 kcal/d) subgroups and highest among cancer (2903 kcal/d), endocrine (2661 kcal/d), and autoimmune (2625 kcal/d) subgroups. Excluding 1 article in cancer survivors resulted in a low TEE in the cancer subgroup (2112 kcal/d). Most studies with a control group reported no differences in TEE between controls and patients; however, only 1 study was powered for between-group comparisons. ConclusionsEnergy requirements vary across chronic diseases, although there is insufficient evidence to suggest that TEE in patients with chronic disease is different than that among controls. Further research is needed to inform energy requirement recommendations that consider chronic disease.This review was registered at PROSPERO as CRD42022336500 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=336500).

Association between pro-vegetarian dietary pattern and the risk of protein-energy wasting and sarcopenia in patients with chronic kidney disease

BackgroundChronic kidney disease (CKD) is characterized by structural abnormalities in nephrons, loss of functional nephrons, and impaired renal excretory function. A pro-vegetarian dietary pattern (PDP) is a gradual and progressive approach to vegetarianism. The current study aimed to assess the association between PDP and the odds of protein-energy wasting (PEW) and sarcopenia in patients with CKD.MethodsThe present cross-sectional study was conducted on kidney disease patients (n = 109) referred to two clinics in Shiraz, Iran. The diagnosis of sarcopenia and PEW was made according to the guidelines of the Asian Working Group for Sarcopenia (AWGS) and the International Society of Renal Nutrition and Metabolism (ISRNM) criteria, respectively. The participants’ dietary intake was evaluated using a 168-item semi-quantitative food frequency questionnaire (FFQ). For PDP index calculation, plant and animal food sources were categorized into 12 subgroups. The association between sarcopenia and PEW with PDP was evaluated using logistic regression.ResultsThe PDP was significantly associated with a lower risk of PEW in the second tertile compared to the first in the crude model (odds ratio (OR) = 0.225; confidence interval (CI): 0.055–0.915; p-value = 0.037). After adjusting for potential confounders, lower significant odds of PEW were observed in the second and last tertiles of PDP compared to the first (T2: OR = 0.194; CI: 0.039–0.962; p-value = 0.045, and T3: OR = 0.168; CI: 0.030–0.950; p-value = 0.044). In contrast, no significant relationship was observed between PDP and the odds of sarcopenia (p-value ˃ 0.05).ConclusionsOverall, the findings indicated that greater adherence to PDP was negatively associated with the odds of PEW. Additionally, the results showed no association between PDP and the odds of sarcopenia. Further studies are needed to support these findings.

Leveraging real-world data to predict cancer cachexia stage, quality of life, and survival in a racially and ethnically diverse multi-institutional cohort of treatment-naïve patients with pancreatic ductal adenocarcinoma.

Cancer-associated cachexia (CC) is a progressive syndrome characterized by unintentional weight loss, muscle atrophy, fatigue, and poor outcomes that affects most patients with pancreatic ductal adenocarcinoma (PDAC). The ability to identify and classify CC stage along its continuum early in the disease process is challenging but critical for management. The main objective of this study was to determine the prevalence of CC stage overall and by sex and race and ethnicity among treatment-naïve PDAC cases using clinical, nutritional, and functional criteria. Secondary objectives included identifying the prevalence and predictors of higher symptom burden, supportive care needs, and quality of life (QoL), and examining their influence on overall survival (OS). A population-based multi-institutional prospective cohort study of patients with PDAC was conducted between 2018 and 2021 by the Florida Pancreas Collaborative. Leveraging patient-reported data and laboratory values, participants were classified at baseline into four stages [non-cachexia (NCa), pre-cachexia (PCa), cachexia (Ca), and refractory cachexia (RCa)]. Multivariate regression, Kaplan Meier analyses, and Cox regression were conducted to evaluate associations. CC stage was estimated for 309 PDAC cases (156 females, 153 males). The overall prevalence of NCa, PCa, Ca, and RCa was 12.9%, 24.6%, 54.1%, and 8.4%, respectively. CC prevalence across all CC stages was highest for males and racial and ethnic minorities. Criteria differentiated NCa cases from other groups, but did not distinguish PCa from Ca. The most frequently reported symptoms included weight loss, fatigue, pain, anxiety, and depression, with pain significantly worsening over time. The greatest supportive care needs included emotional and physical domains. Males, Black people, and those with RCa had the worst OS. Using clinical, nutritional, and functional criteria, nearly one-quarter of the PDAC cases in our diverse, multi-institutional cohort had PCa and 62.5% had Ca or RCa at the time of diagnosis. The PCa estimate is higher than that reported in prior studies. We recommend these criteria be used to aid in CC classification, monitoring, and management of all incident PDAC cases. Findings also highlight the recommendation for continued emotional support, assistance in alleviating pain, and supportive care needs throughout the PDAC treatment journey.

Dietary inflammatory index could increase the risk of sarcopenia in patients with chronic kidney disease

Using a system that incorporates a variety of food items rather than focusing on individual components can aid in assessing the inflammatory effects of a diet on disease outcomes such as chronic kidney disease (CKD). Therefore, we decided to investigate the association between dietary inflammatory index (DII) and the risk of protein–energy wasting (PEW) and sarcopenia in patients with CKD. In this cross-sectional study, 109 patients with CKD were selected from two clinics in Shiraz, Iran. The intake of individuals’ diets was recorded using a validated 168-item food frequency questionnaire. Additionally, Asian Working Group for Sarcopenia (AWGS) guidelines were utilized to evaluate muscles’ strength, mass, and function. Also, four International Society of Renal Nutrition and Metabolism (ISRNM) criteria (body mass index, intake of protein, albumin, and urine creatinine) were used to diagnose PEW. Logistic regression was used to assess the association between DII and sarcopenia as well as PEW. The results showed that the intake of saturated fatty acids, trans fatty acids, niacin, beta-carotene, and vitamin C was significantly different between lower and higher DII groups. In the univariate model, higher odds of sarcopenia was observed by each unit increase in DII (odds ratio (OR) = 1.379, 95% confidence interval (CI): 1.042–1.824) and age (OR = 1.073, 95% CI: 1.017–1.132). Additionally, in the multivariate model, the association between DII and age with odds of sarcopenia remained significant (DII: OR = 1.379, 95% CI: 1.030–1.846 and age: OR = 1.063, 95% CI: 1.007–1.121). The current study suggests the possible role of pro-inflammatory foods in worsening muscle health, specifically sarcopenia, in CKD patients. Future longitudinal studies may reveal the causative nature of these correlations.

Edaphoclimatic variation and harvest seasonality as determining factors of multidimensional quality in avocado cv. hass grown in the tropics

The increase in cultivated areas in tropical zones such as Colombia for avocado cv. Hass and the lack of knowledge on edaphoclimatic relationships with factors associated with quality led to the present research. The aim of this research was to establish the relationship of soil, climatic, spatial factors (plot location), and harvest seasonality (principal and transitory) with the multidimensional quality of avocado cv. Hass planted under tropical conditions. This research was carried out on eight farms located in three producing subregions. Soil, environmental and harvest data were recorded for three years (2015–2017) in each plot. Avocado fruit samples were used to determine the parameters of macronutrient, fatty acids, minerals, and vitamin E. Descriptive, inferential statistics, multivariate analysis, effect size, second-order exponential model, and causal relationships were used to determine variables associated with soil, climate, harvest seasonality, and spatial location, and to determine quality parameters. The results established a relationship between nutritional quality and the origin region. Similarly, it was possible to identify parameters associated with differential quality with a robust statistical methodology to propose origin as a differentiating factor for quality. This study provided useful information for the value chain that selected the best areas for avocado crops according to market expectations and nutritional quality criteria.

Associations between bioelectrical impedance analysis-derived phase angle, protein-energy wasting and all-cause mortality in older patients undergoing haemodialysis.

Protein-energy wasting (PEW) is a common syndrome in patients undergoing haemodialysis (HD) and is associated with poor prognosis. Bioelectrical impedance analysis (BIA)-derived phase angle (PA) is useful for predicting PEW, but sex and age need to be considered. We aimed to reveal sex-specific cut-off values of PA predicting PEW in HD patients aged ≥65. This two-centre retrospective cohort study included patients on HD who underwent BIA. PEW was detected using the International Society of Renal Nutrition and Metabolism (ISRNM) criteria as a reference. The PA was measured using a multifrequency bioimpedance device. Sex-specific cut-off values of PA predicting PEW were detected by receiver-operator characteristic analysis. We investigated the association between PEW determined using sex-specific cut-off values for PA and all-cause mortality. This study included 274 patients undergoing HD, with a median age of 75 (70-80) years, mean PA of 3.8 ± 1.1° and PEW of 43%. Over a median follow-up duration of 1095 (400-1095) days, 111 patients died. Cut-off values of PA predicting PEW were as follows: female, 3.00° (sensitivity, 87.3%; specificity, 77.5%), and male, 3.84° (sensitivity, 77.6%; specificity, 71.4%). The kappa coefficient between sex-specific cut-off values of the PA and ISRNM criteria had a moderate coincidence level of 0.55. PEW detected by PA was independently associated with all-cause mortality (hazard ratio: 2.40; 95% confidence interval: 1.51-3.85; p < .001). Sex-specific cut-off values for PA in older HD patients may be useful as a screening tool for predicting PEW and mortality.

Large-scale production of non-conventional edible plants for biodiverse school meals.

School feeding programs are important for ensuring food security and promoting child health and development, particularly in low-income countries. In view of this importance, it is possible to increase the quality of these meals by diversifying the vegetables offered and incorporating underutilized plants to improve dietary diversity and nutritional quality into school meals. This study was carried out using the action research methodology following the implementation and development of the "Inova na Horta" project in the city of Jundiaí, São Paulo, Brazil. The project was based on the existing and functioning physical and organizational structure of a municipal organic farm. Vegetables were selected from among 210 non-conventional species and varieties, which were further selected for continuous production based on 8 nutritional, culinary and cultivation criteria. Thirty-four vegetables were selected for continuous cultivation and provisions to the school kitchens. Nine tons of vegetables were produced and provided to 90 municipal schools from 2020-2023. Leafy vegetables accounted for most the production, with a total weight of 6441 kg corresponding to 71.6% of the total harvest. Kitchen teams were trained throughout the project duration. The feasibility of the production and culinary use of 34 biodiverse, nutrient-rich and underutilized food vegetables for school meals was demonstrated. The selected vegetables are nutrient-rich and contain higher amounts of minerals and proteins than the control vegetables (conventional vegetables), thus complementing several nutrients in school meals. This methodology can be replicated by municipalities of various sizes as a public policy of food and nutritional security associated with the valorization of local biodiversity.

The effect of using sour cherry (Prunus cerasus L.) puree in tarhana formulations on nutritional value and functional properties of tarhana.

The aim of this study was to investigate the effects of using sour cherry puree in tarhana formulations on the nutritional value and quality criteria of tarhana. In the formulation, 50% and 100% of tomato and pepper purees were replaced by sour cherry puree, and in another formulation, 100% of sour cherry puree was used instead of yogurt. The use of sour cherry puree instead of tomato and pepper puree enriched the tarhana in terms of essential and other amino acids. Tarhana samples were found to be rich in oleic acid (22.02%-39.12%) among monounsaturated fatty acids. The presence of polyunsaturated fatty acids including linoleic (11.09%-33.56%) and linolenic acids (14.04%-28.91%) was determined in the samples. The dominant saturated fatty acid found in the samples was palmitic acid (8.05%-12.89%). There were no significant changes in moisture, a w, ash content, pH, HMF content as well as water and fat absorption capacity values. When sour cherry puree was used instead of yogurt, there was a decrease in protein (10.71%) and fat (0.38%) contents as well as L (43.46) value, while an increase was detected in total phenolic content (2.38 mg GAE/g), antioxidant activity (10.35 μmol TE/100 g) and mineral composition, namely K, Fe, Cu, Mn, and B. Considering sensory analyses, the sample in which tomato and pepper purees were substituted with 50% sour cherry puree received the highest scores in general taste, flavor, and consistency parameters together with the control tarhana (CT0). The 50% substitution of sour cherry puree with tomato and pepper purees enriched the tarhana samples both nutritionally and sensorially.

Nutritional quality and level of processing of food items broadcasted on Italian television in advertisements targeted to children

This study evaluates the nutritional quality and level of processing of food and beverage products advertised on television channels most watched by children, in Italy. Data were collected over 20 non-consecutive days from the five top channels in Italy. A total of 209 food items were analysed using the Nutri-Score and the NOVA classification. Additionally, compliance with nutritional criteria established by the World Health Organisation (WHO) and the EU-PLEDGE was assessed. Results indicate a high proportion of energy-dense and low nutritional quality foods, with 68% falling into less favourable Nutri-Score categories (C, D, and E), and 61% classified as ultra-processed by NOVA classification. When applying WHO and PLEDGE criteria, 71% and 56% of products, respectively, did not meet nutritional standards. This study underscores the low prevalence of nutritionally adequate products in food advertisements targeting children on Italian television, despite differences found based on methodological variations.

Is investing in food small and medium enterprises a viable path to improved nutrition in Sub‐Saharan Africa? A multidisciplinary perspective

AbstractThrough the perspectives of impact investors, and the nutrition community, this paper explores whether impact investment in food‐related small and medium enterprises (SMEs) creates a viable path to improved nutrition in Sub‐Saharan Africa. From the nutrition perspective, investment in food SMEs could help address coexisting multiple forms of malnutrition by shifting nutritional quality of available foods. From the investor perspective, attractiveness of investment in food SMEs depends on financial risks, how costs are passed on to consumers, and probability of impact. Clear nutritional objectives and investment criteria are needed, as well as research to maximize the potential of this innovative approach.

Caregiver self-efficacy providing nutritional support for pediatric patients undergoing hematopoietic stem cell transplant is associated with psychosocial factors.

Caregiver self-efficacy in providing nutritional support to pediatric hematopoietic stem cell transplantation (HSCT) patients has been little studied despite the increased risk of these children potentially being over- or under-nourished after HSCT, and nutritional status could possibly affect treatment outcomes. The current study aimed to describe caregiver dietary self-efficacy and its associated psychosocial factors and barriers to following dietary recommendations. Caregivers completed questionnaires pre-HSCT and 30 days, 100 days, and one year post-HSCT. A subset provided a 24-h recall of food intake. Results showed generally high caregiver confidence and low difficulty supporting their child nutritionally. However, lower confidence was associated with higher caregiver depression, anxiety, and stress 30 days post-HSCT. Further, higher difficulty at various time points was correlated with lower income, higher depression and anxiety, stress, and miscarried helping (i.e., negative caregiver-child interactions surrounding eating), as well as child overweight status and failure to meet protein intake guidelines. Nutritional criteria for protein, fiber, added sugar, and saturated fat were met by 65%, 0%, 75%, and 75%, respectively. Caregiver attitudes and child behavior were the most frequently reported barriers to healthy eating. Results suggest that directing resources to caregivers struggling emotionally, economically, or transactionally could support pediatric patients undergoing HSCT in maintaining optimal nutritional status.

FACTORS RELATED TO INCIDENCE OF MALNUTRITION IN UNDER FIVE CHILDREN

Background: Malnutrition is one of the main nutritional problems in Indonesia and East Java. Malnutrition is the cause of more than 1/3 of 9.2 million deaths in children under the age of 5 in the world. Toddlers are a very vulnerable group related to nutrition in society. If the nutrition of children under five is not fulfilled continuously it will cause stunting. Method: This study uses descriptive analysis to overview of the problem of factors related to the incidence of undernutrition in children under five at Posyandu Randugading, Tajinan District, Malang Regency. The sample consisted of 36 children under five using a total sampling technique. This data was obtained from the nutritional status report of the Tajinan Community Health Center which met the nutritional criteria of less than -3 SD to &lt;-2 SD based on the z-score formula. This research instrument used a questionnaire, data collection was carried out by interviews to obtain data on variables Frequency of giving MP-ASI, Infectious diseases, Exclusive breastfeeding, Mother's weight gain during pregnancy, and Number of siblings. The data collection period was carried out on 18 April 2023–25 April 2023. Result: from 36 children showed that 30.55% giving MP-ASI at most was according to the child’s request, children who have had history of an infectious disease 58.33%, exclusive breastfeeding was 50 %, weight gain during pregnancy less as it shouls was 50%, children who have siblirng is more than 2 was 63.89%. Conclusion: Malnutrition children under five year old in Posyandu Randugading, Tajinan District, Malang Regency have characteristic related to feeding meals was most of them according to the child’s request, majority children have history of an infectious disease, Mother wight gain during pregnancy lower as it should, majority children have more than 2 sibling.