There is growing evidence that optimising dietary quality and engaging in physical activity (PA) can reduce dementia and cognitive decline risk and improve psychosocial health and quality of life (QoL). Multimodal interventions focusing on diet and PA are recognised as significant strategies to tackle these behavioural risk factors, however, the cost-effectiveness of such interventions is seldom reported. A limited cost consequence based on a 12-month cluster randomized Mediterranean Diet (MedDiet) and walking controlled trial (MedWalk) was undertaken. In addition, QoL data were analysed. Program costs ($AUD2024) covered staff to deliver the MedWalk program and foods to support dietary behaviour change. The primary outcome measure of this study was change in QoL utility score, measured using the Assessment of Quality of Life (AQoL-8D). Change scores were compared for the groups using general linear models while controlling for demographic factors associated with baseline group differences and attrition. Change in QoL (decreased, maintained, or improved) was determined using a crosstabulation test. MedWalk program costs were estimated at $2,695 AUD per participant and control group cost at $165 per person – a differential cost of $2,530. Mean change in utility scores from baseline to 12-months were not statistically significant between groups. Nevertheless, the MedWalk group was significantly less likely to experience a reduction in their QoL (20.3% MedWalk vs 42.6% control group) (p=.020). A MedDiet and walking intervention may have a role in preventing decline in QoL of older Australians, however, longer term follow up would be beneficial to see if this is maintained.

Nutrition plays a key role in shaping children’s eating behaviors, which can be influenced by environment and social interactions, making careful management essential at home and school. This cross-sectional study aimed to evaluate the perceptions of caregivers in these settings regarding the consumption and eating behaviors of children aged 3-6 years. Food preferences and frequency questionnaires were administered to teachers, children, and their caregivers, supplemented by free drawing and coloring activities. The results revealed discrepancies between parents and teachers, with parents recognizing the importance of fruits and vegetables for health and reporting that children have access to these foods at home. Although parents recognized the importance of vegetable consumption, teachers did not share this perception, as they observed limited access to these foods among children and even reported difficulties in introducing them into the school environment. The most consumed foods during main meals were rice, beans, vegetables, and meats, while fruits and dairy products were predominant in breakfast and snacks. Children frequently mentioned fruits like watermelon, strawberry, and apple in free drawing and coloring activities. These findings highlight significant differences in perceptions between parents and teachers regarding children’s access to healthy foods, underscoring the need for improved communication to promote healthier eating habits.

Sepsis affects 50 million people globally, contributing to 20% of all deaths and significantly increasing healthcare costs due to intensive care needs. Although the role of omega-3 fatty acids in reducing sepsis mortality remains debated, recent studies suggest their potential in modulating immune responses and improving outcomes. This umbrella review aims to clarify the benefits of omega-3 supplementation on mortality rate, length of ICU stays, and days on mechanical ventilation in patients with sepsis.

Following Cochrane and GRADE methodologies, a systematic search was conducted across multiple databases up to February 2025. After independent screening, data extraction, and critical appraisal, meta-analyses were reassessed using the DerSimonian and Laird model. Evidence was graded using the GRADE approach, categorizing outcomes based on strength and quality.

A comprehensive search identified 934 records, of which 34 RCTs from 21 systematic reviews and meta-analyses focused on omega-3 supplementation in sepsis patients. Omega-3 significantly reduced mortality (RR: 0.79, 95% CI: 0.69 to 0.90), length of ICU stays (MD: -3.6 days, 95% CI: -4.39 to -2.81), and ventilation days (MD: -2.86 days, 95% CI: -4.46 to -1.26). Parenteral nutrition showed slightly better outcomes than enteral nutrition, and EPA and DHA provided superior results compared to mixed oils.

These findings suggest omega-3 supplementation could improve mortality, ICU stays, and ventilator dependency in patients with sepsis. However, the certainty of the evidence ranges from low to very low, emphasizing the need for further high-quality RCTs to validate these benefits. Also, clinicians should prescribe omega-3 supplements cautiously in this regard.

Obesity is characterised by chronic low-grade inflammation, which is a key factor in the development of obesity-related co-morbidities. Intake of n-3 long-chain PUFAs are associated with anti-inflammatory effects. Recent studies suggest that also n-11 long-chain MUFAs may reduce the concentrations of inflammatory markers, possibly by increasing the biosynthesis of EPA. The primary aim was to investigate if diets added herring oil containing cetoleic acid (CA, C22:1n-11) or a CA concentrate affected the fatty acid composition in tissues from obese rats with chronic inflammation. Secondary aims included investigating the effects on inflammatory markers. Thirty male obese Zucker fa/fa rats were fed diets containing herring oil (HERO) or a CA concentrate (CECO), containing 0.70 or 1.40 wt% CA, respectively, with a comparable content of EPA (0.17 and 0.20 wt%, respectively), or a control diet with soyabean oil for 5 weeks. Data were analysed using one-way ANOVA. CA from HERO and CECO diets were recovered in liver, adipose tissue, muscle and blood cells. The EPA concentration was similar between HERO and CECO groups in tissues, whereas the hepatic concentrations of fatty acid desaturases were lower or similar to Controls. The concentrations of TNFα, matrix metalloproteinase-3, IL6, monocyte chemotactic protein 1 and integrin alpha M in adipose tissue, and the hepatic concentration of CD68 were lower after CECO intake but were not affected by the HERO diet. To conclude, rats fed the CECO diet had lower concentrations of inflammatory and macrophage infiltration markers, but this effect was probably not mediated through increased EPA biosynthesis.

The objective of this study was to evaluate the impact of incorporating group-based nutritional education into usual care on adherence to nutritional counseling among outpatients with T2DM. This parallel-group, randomized controlled superiority trial was conducted with outpatients diagnosed with T2DM and poor glycemic control. The control group received individual usual care, while the intervention group received usual care plus group-based nutritional education, which included three sessions: “Let’s Go Shopping,” “Healthy Plate,” and “Hunger and Satiety.” Baseline and four-month follow-up assessments were conducted, and outcome measures included adherence to nutritional counseling, glycemic control, weight, and physical activity. A total of 213 participants were included: 61.9% were women, aged 60 years (IQR=53–65), 67.6% with low socioeconomic status, 67.3% had obesity, and the HbA1c was 9.3% (IQR=8.3–10.2%). The intervention did not result in superior glycemic control; however, short-term reductions in HbA1c were observed across all participants [-0.3% (IQR=-0.7–0.3%)]. The intervention group demonstrated an increase in physical activity levels between visits [262 METs (IQR=99–257); P=0.038], but no significant difference between the groups. Participants in the intervention group adhered to 67% of combinations, compared to 50% in the control group (P = 0.012), and adherence to the Diabetes Plate Method was significantly higher in this group (75.9% vs. 62.2%; P = 0.05). In conclusion, no significant between-group differences in glycemic control were found, although both groups improved HbA1c short-term. Group-based nutritional education increased dietary adherence, particularly to the Diabetes Plate Method, and physical activity. Long-term effects on metabolic outcomes warrant further study.

Dietary phytosterols exert hypocholesterolemic effects by inhibiting cholesterol absorption in the small intestine. However, oxidised phytosterols exert harmful effects. In this study, we compared the effects of dietary stigmasterol or oxidised stigmasterol on cholesterol absorption and metabolism in mice. ICR male mice were fed one of the following diets: a standard AIN diet; the standard diet plus 0.25% cholesterol; the standard diet plus 0.25% cholesterol and 0.25% stigmasterol; or the standard diet plus 0.25% cholesterol and 0.25% oxidised stigmasterol. Stigmasterol, but not oxidised stigmasterol, decreased plasma total cholesterol (TC) levels. Unlike stigmasterol, dietary oxidised stigmasterol increased the cholesterol levels in micellar solutions. Thus, oxidised stigmasterol could not exert hypocholesterolemic effects as it could not displace cholesterol in micellar solutions. In contrast, dietary oxidised stigmasterol downregulates the mRNA expression of genes involved in cholesterol synthesis and upregulates the mRNA expression of genes involved in cholesterol catabolism in mice fed cholesterol. In addition, dietary stigmasterol and oxidised stigmasterol increased the levels of faecal-neutral steroids by downregulating the mRNA expression of Niemann-Pick C1-like 1 protein (NPC1L1) in the small intestine. Dietary stigmasterol may directly regulate the mRNA expression of NPC1L1, whereas dietary oxidised stigmasterol may reduce the mRNA expression of sterol regulatory element-binding protein 2 (SREBP2) and act as a Liver X receptor α (LXRα) agonist, reducing the mRNA expression of NPC1L1. Therefore, oxidised stigmasterol may affect cholesterol absorption and metabolism through a mechanism different from that of stigmasterol.

Inadequate eating habits in adolescence are an important risk factor for obesity and other chronic non-communicable diseases in adulthood. The school environment can have a relevant impact on adolescent behaviour, since many habits acquired in this phase affect the individual throughout life, with visible effects on health. In this study, we aimed to evaluate the association between food sales at Brazilian schools and ultra-processed food consumption among adolescents. The Study of Cardiovascular Risk Factors in Adolescents (ERICA) was a nationwide, school-based survey conducted from 2013 to 2014, including public and private schools in 121 Brazilian cities. Dietary intake was assessed via a 24-hour recall, and foods were divided according to the Nova Classification based on the degree of processing. Unadjusted and adjusted linear regression models were used to assess the association between exposure to school food sales and intake of ultra-processed food. The prevalence of exposure to food sales was 55.2% and the mean diet share of ultra-processed foods was 34.5%. Exposure to food sales in schools was associated with higher consumption of ultra-processed food (β=0.11; p=0.002). The results were similar when the analyses were stratified according to sex, usual intake of school meals, and public-school attendance (β=0.11; p=0.002). The association between exposure to food sales in schools and higher consumption of ultra-processed food suggests that school sales can influence adolescents’ food choices.

Skinfold calipers are used internationally in research, clinical, and field settings to assess body composition and nutritional status. Notably, currently available instruments differ in important specificities that impact measurement. In this sense, this report proposes a methodological approach that organizes skinfold calipers into three categories (Original, Generic, and Hybrid) and three configurations (Type A, Type B, and Type C) based on physical-mechanical properties and characteristics. Therefore, this concept provides technical support for choosing the most appropriate skinfold caliper in different contexts.

This cross-sectional study examined the association between diet price and diet quality in a national sample of Australian adults (n=1,956). Diet recall data from the 2020 International Food Policy Study (IFPS) was linked with a national food and beverage price dataset. Daily diet price was calculated by summing the median non-promotional prices of all foods and beverages recorded in diet recall data, priced per gram (or millilitre) and adjusted for edible portions. Diet quality was determined using the Australian Dietary Guideline Index 2013 (scored out of 115). Linear regression models tested the association between the diet price (per dollar, and per ten-dollar increments) and diet quality, adjusted for education, age and sex. A positive association was observed, where diet quality increased by 0.09 units (95% CI, 0.05-0.14) for every $AU 1 increase in diet price. Daily diet price explained approximately 8% of the variation in diet quality across the sample (R2=0.08). When categorised in ten-dollar increments, participants with diet prices <$AU 10/day had a lower mean diet quality score (51.96) compared to all other diet price categories, 5-6 points lower than those whose diet was >$30/day. Diet price was a modest, yet significant determinant of diet quality for Australian adults in 2020. Additional analyses are needed to investigate these associations during recent food price inflation. As diet quality appears to be lowest for people who spend the least on food, government action to increase priority communities’ food budgets may help improve the nutritional quality of population diets.

Regular physical activity for adults is associated with optimal appetite regulation, though little work has been performed in adolescents. To address this gap in the literature, we conducted a study examining appetite across a range of physical activity and adiposity levels in adolescent males. Healthy males (N=46, 14-18 years old) were recruited across four body weight and activity categories: normal weight/high active (n=11), normal weight/low active (n=13), overweight, obese/high active (n=14), overweight, obese/low active (n=8). Participants from each group completed a six-hour appetite assessment session on Day 0, followed immediately by a 14-day free-living physical activity and dietary assessment period on Days 1-14, and a fitness test session occurring between Days 15-18. Subjective and objective assessment of appetite, resting energy expenditure, body composition using dual energy absorptiometry‘, and thermic effect of feeding was conducted on Day 0. Physiological variables in the normal weight low active group that were different than their peers included lower fat-free mass, cardiorespiratory fitness, glucose/fullness response to a standardized meal, thermic effect of feeding in response to a standardized meal, lower self-rated fullness and satiety, and higher self-rated hunger to a standardized meal. Conversely, the overweight, obese high active group displayed better subjective appetite responses, but higher insulin responses to a standardized meal. Taken together, these results suggest that physical inactivity during adolescence has a negative impact on metabolic health and appetite control which may contribute to future weight gain.

Shift work-induced circadian disruption has been linked to various cardiometabolic diseases, including obesity, diabetes and cardiovascular disease. Limited studies have explored the impact of different variables such as night work durations, intensities, and chronotype on cardiometabolic risk. This study aimed to determine the impact of circadian disruption on cardiometabolic risk markers in shift workers. This case-control study was conducted with 104 male workers (shift workers; n=52, mean age ±SD; 43.3±10.2, and non-shift workers; n=52, mean age ±SD; 41.2±9.8). Shift work details were determined via an interviewer-administered questionnaire. Cardiometabolic risk was evaluated through anthropometric (height, weight, waist circumference, and body composition), biochemical (fasting glucose and lipid profile), clinical (blood pressure), and dietary assessment (24-hour recalls from working and non-working days). The chronotype was determined via the Munich Chronotype Questionnaire (MCTQ). Shift workers had significantly higher mean body fat percentage (31.7, 22.7% p=0.031), systolic blood pressure (138.6, 128.5 mmHg p=0.009), pulse rate (78.7, 72.3 bpm p=0.015), triglycerides (1.60, 1.30mmol/l p=0.021), and LDL-C (3.90, 3.40 mmol/l p=0.012) than non-shift workers. Evening chronotype shift workers had significantly higher visceral fat levels (12.8, 8.90 p=0.001), systolic blood pressure (137.0, 127.6 mmHg p=0.006), pulse rate (82.7, 73.3 bpm p=0.005), and LDL-C (4.00,3.40 mmol/l p=0.039) than shift workers with a morning chronotype. In conclusion, shift workers exhibited higher metabolic risk markers than non-shift workers. Shift workers with evening chronotypes had higher cardiometabolic risk than morning chronotypes. Further research is warranted to elucidate the underlying mechanisms and inform targeted interventions for individuals engaged in shift work, considering chronotypes.

While increasing seafood consumption may help address micronutrient deficiencies and metabolic disorders, evidence supporting this recommendation in the Indian context remains limited and inconclusive. Using the nationally representative cross-sectional 2019-2021 National Family Health Survey dataset, we investigated the association of fish consumption frequency with anemia and metabolic disorders (overweight/obesity, hypertension, and hyperglycemia) among adult men (aged 15-54 years) and women (aged 15-49 years) in India. A control function (CF) method was employed to examine the association in individuals who consumed fish daily and those who reported consuming fish daily/weekly. The analysis was restricted to conformed non-vegetarians (who reported ever consuming egg, fish, or meat). Overall, 86.9% of men and 74.7% of women were conformed non-vegetarian. CF analysis revealed that both daily and daily/weekly fish consumption were associated with a reduced risk of anemia among both men and women. Daily fish consumers exhibited increased likelihood of overweight/obesity (men: β: 0.405, 95%CI: 0.074, 0.735, p:0.017; women: β: 0.248, 95%CI 0.125, 0.370, p<0.001). Conversely, daily/weekly fish intake was associated with a reduced risk of overweight/obesity in men (β: -0.041, 95%CI: -0.069, -0.013; p:0.004). Daily/weekly fish consumption was associated with a reduced risk of hypertension and increased odds of hyperglycemia among men. Fish consumption demonstrated a potentially protective relationship against hypertension in women, regardless of how often they consumed fish, while also being associated with a higher prevalence of hyperglycemia. Indian adults can improve their health by eating more fish, which can help fight anemia and may also reduce overweight/obesity and high blood pressure.

2,3-Diphosphoglycerate (2,3-DPG), a metabolic intermediate in the Rapoport-Luebering pathway, is primarily present in red blood cells and regulates the affinity of hemoglobin (Hb) to oxygen. As the 2,3-DPG level in the erythrocyte increases, the oxygen dissociation curve shifts to the right, thus decreasing the oxygen affinity of Hb. This alteration in oxygen affinity is crucial for maintaining adequate oxygen supply to peripheral tissues, especially under hypoxic conditions such as high-altitude adaptation and anemia. Despite its crucial role in regulating oxygen affinity and its potential function as a modulator in various physiological and pathological adaptations, much of the research on 2,3-DPG is outdated and has largely been overlooked in recent years. The aim of this review is to compile the existing evidence on 2,3-DPG and highlight the gaps in our current understanding.

The erythrocyte concentration of 2,3-DPG can be determined using chromatography or enzymatic methods. However, assessing 2,3-DPG poses a challenge due to its instability, which can rapidly degrade in the absence of proper storage conditions. Several factors can impact the erythrocyte concentration of 2,3-DPG, including diet, physiological conditions, and pathological conditions. Dietary intake, particularly phosphorus, can acutely influence 2,3-DPG levels in red blood cells. However, no information is available on the postprandial status of 2,3-DPG following the ingestion of meals with varied nutrient composition. Additionally, physiological factors such as age, pregnancy, and physical activity can affect 2,3-DPG levels, but its role during infancy and childhood is still not well understood. Although the levels of 2,3-DPG in various pathological conditions have been widely discussed, the underlying molecular mechanisms regulating these changes are still not well understood and require further investigations.

Blood 25-hydroxyvitamin D (25(OH)D) concentrations vary considerably by season and sex. The present study aimed to determine associations between vitamin D deficiency and mortality in Japanese adults and identify risk thresholds according to 25(OH)D concentrations. This was a cohort study with an 11-year follow-up. Participants were 8,285 community-dwelling Japanese adults aged 40 to 74 years. Plasma 25(OH)D concentrations were measured by chemiluminescent immunoassay at baseline, and divided into quintiles for each of the subgroups stratified by season and sex (denoted as season- and sex-stratified quintiles). The main outcome was all-cause mortality. Hazard ratios (HRs) were calculated using a Cox proportional hazards model. Mean age and 25(OH)D concentration were 59.9 years (SD=9.1) and 50.1 nmol/L (SD=18.1), respectively. Lower season- and sex-stratified quintiles were associated with higher hazards of all-cause mortality (P for trend=0.0015), with the first quintile (median=28.2 nmol/L) having a higher HR (HR=1.46, 95% CI, 1.13–1.88) than the highest quintile (reference). When crude quintiles were used, the overall association was similar (P for trend=0.0027), with the first (median=28.0 nmol/L) and second (median=39.7 nmol/L) quintiles having higher HRs (HR=1.40, 95% CI, 1.06–1.85 and 1.38, 95% CI, 1.07–1.77, respectively) than the reference. The risk threshold difference was estimated to be approximately 10 nmol/L. In conclusion, low blood 25(OH)D concentrations are associated with high mortality risk. Crude blood 25(OH)D concentration may modulate the estimated risk threshold for vitamin D deficiency associated with mortality.

A diet low in fermentable carbohydrates, oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) has been described as an effective nutritional approach in Irritable Bowel Syndrome (IBS). There has been an increased demand for gluten- and lactose-free foodstuffs in the last few years, which are associated with GI symptoms and are consumed by patients with GI disease. This study aims to estimate the FODMAP content of an industrial pre-packaged food products containing the “gluten-free” and “lactose-free” claims. The ingredient lists of the foodstuffs from a Portuguese food retail chain were verified and classified according to their estimated FODMAP content as “low” and “high”, using as a reference the FODMAP cutoff values and the serving sizes established by the Monash University App. Descriptive statistics and the Pearson chi-squared test were applied. From the 436 eligible products identified, most were classified as “low” (53.0%, n=231), 24.3% (n=106) were classified as “high”, and 22.7% (n=99) with “unknown” FODMAP content. “High FODMAP” products accounted for 12.2% of those with ‘lactose-free’ claims and 31.6% of those with ‘gluten-free’ claims. The “ready meals” and “sauces, dressings, creams and soups” were the food categories with the highest proportion of products with high FODMAP sources. This study showed that approximately a quarter of pre-packaged industrial foods targeted to GI pathologies are high in FODMAP. The nutritional information on the label should be more specific, enabling more accurate dosing of FODMAP contents in foodstuff and the establishment of the recommended serving sizes.

Arabinoxylans (AXs), the primary hemicellulose found in cereals and grasses, play a crucial role in regulating immunity, metabolism, and various physiological processes underscoring their value as essential components in dietary nutrition. Considering the extensive research on AXs in piglet nutrition, this paper systematically reviews their impacts on gut health and microbiota in piglets, as well as the underlying mechanisms of action. AXs have been shown to mediate gut barrier fortification through tight junction protein upregulation and orchestrate mucosal immunity homeostasis, consequently ameliorating early-weaning-associated diarrheal pathogenesis in piglets. Additionally, AXs function as microbial ecological modulators through selective enrichment of beneficial commensal microbiota (e.g., Bifidobacterium spp. and Lactobacillus spp.), while simultaneously stimulating microbial biosynthesis of short-chain fatty acids and ferulic acid exhibiting potent antioxidant and anti-inflammatory activity, thereby maintaining the intestinal health of piglets. This review offers valuable insights into their potential as a dietary intervention to support gut health and immune function in early-weaned piglets. However, most studies focus on single-source AXs such as wheat or corn, with limited exploration of novel sources or comparative effects of source combinations. Future research should systematically investigate the molecular mechanisms of AXs action, provide data-driven guidance for selecting AXs sources in feed formulations, and establish optimal inclusion levels in practical feeding regimens. Such efforts will further solidify the precision nutrition potential of AXs in promoting sustainable and healthy growth in piglets.

Using serum biomarkers that reflect fruit and vegetable (FV) intake offers a significant advantage over traditional dietary assessments by providing a more objective, accurate measure, meaningfully minimizing recall bias and misreporting common in self-reported dietary data. This study investigated the relationship between these serum biomarkers and mortality risk using data from 19,168 adults aged 30 and older who participated in the National Health and Nutrition Examination Survey (NHANES) from 1988 to 2006. Mortality follow-up was determined by linkage to the National Death Index through December 31, 2019, and diet by 24-h recalls. Cox proportional hazards models were employed to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality outcomes by tertiles of serum biomarkers of FV intake. Higher serum concentrations of total carotenoids were associated with a reduced risk of all-cause (Tertile 3 vs. Tertile 1 HR=0.69, 95% CI=0.61-0.78) and cancer mortality (HR=0.53, 95% CI=0.39-0.71). Greater serum concentrations of individual carotenoids, such as α-carotene, β-carotene, β-cryptoxanthin, lycopene, lutein and zeaxanthin, were also linked to lower risks of all-cause and cancer mortality. Higher serum potassium concentrations showed a trend toward an association with a greater risk of all-cause mortality. No significant associations were found between serum vitamin C concentrations and mortality outcomes in the overall analysis; however, in sex-stratified analyses, higher vitamin C concentrations were associated with reduced risk of all-cause and cancer mortality in women. These findings suggest that specific serum biomarkers of FV intake, particularly carotenoids and vitamin C, may serve as indicators of reduced mortality risk.

Food refusal behaviors in preschool children can significantly impact their nutritional status and overall quality of life. This study investigated the relationship between food refusal behaviors, compliance with the Mediterranean Diet, and quality of life in preschool children. Conducted as a cross-sectional study, it included 400 children aged 4–6 and their parents. The Child Food Rejection Scale measured food refusal behaviors, KIDMED assessed compliance with the Mediterranean Diet, and the Kiddy-KINDL scale evaluated quality of life. The mean age of the children was 4.80±0.71 years. According to age-based Body Mass Index-Z scores, 71.0% were normal, 15.5% underweight, 9.0% slightly overweight, and 4.5% obese. Parents’ average age was 34.65±5.35 years; 96.8% were married, 88.8% had a nuclear family structure, 58.0% were university graduates, and 69.8% rated their income level as moderate. Girls had higher food refusal scores than boys(p<0.05). Children who frequently fell ill also scored higher in food refusal(p<0.05). Food refusal decreased with higher family income, larger family size, and older parental age(p<0.05). Parental nutrition education significantly reduced food refusal scores(p<0.05). Higher KIDMED scores were associated with lower food refusal(p<0.01), and children with low Kiddy-KINDL scores exhibited higher food refusal behaviors(p<0.01). A positive correlation was found between KIDMED and Kiddy-KINDL scores(p<0.01). No significant associations were detected between BMI Z scores and food rejection and its subscales. The findings suggest that compliance with the Mediterranean Diet reduces food refusal behaviors in preschool children and increases quality of life, while low quality of life is associated with increased food refusal behaviors.

Thyroglobulin (Tg) has been considered a measure of iodine status but there is no global guidance. This analysis examines relationship between serum Tg and spot urinary iodine concentration (UIC) data from Guatemala’s 2018–2019 Epidemiological Health and Nutritional Surveillance System and identify Tg concentrations that correspond to current WHO thresholds for population iodine status among women ages 15–49 years. We analyzed data from non-pregnant Guatemalan women aged 15-49 years who had both UIC and Tg measurements. Correlations were examined. Bootstrap stratified finite sampling with replacement was used to generate cluster k-medians of UIC (mUIC) and Tg (mTg) that served as population unit of analyses. Non-linear restricted cubic spline regression dose-response curve functions and ordinary differential equations were then used to derive Tg threshold corresponding to WHO definitions for UIC. Serum Tg and UIC data were available for 730 non-pregnant women. Mean age was 30.2 ± 9.3 years. mTg was 10.4 ng/mL (9.9, 10.8) and mUIC was 148.7 μg/L (139.1, 161.0). Correlations between spot UIC and Tg were not significant at individual-level, but correlations based on population k-medians were significant (Spearman r = -0.21 to -0.06 each p<0.0001) and demonstrated U-shaped relationship according to WHO categories. Derived mTg cut-offs were 14.2 ng/mL predictive of UIC insufficiency, 10.2 ng/mL for UIC adequacy, 8.5 ng/mL for UIC above adequate and 10.8 ng/mL for UIC excess. The significant and graded mUIC-mTg correlations suggests that Tg concentrations predictive of UIC categories are obtainable for non-pregnant Guatemalan women aged 15–49 years. The newly derived mTg cut-off may be more discriminant at lower spectrum of UIC in terms of identifying iodine deficient women more so than those in the UIC excess category. Further studies could inform if Tg could be a potentially viable biomarker for assessing population iodine status in women.

Increasing prevalence of diet-related non-communicable diseases in India is attributed to overconsumption of energy-dense, nutrient-poor diets and ultra processed foods (UPFs) may potentially contribute to this consumption pattern. Applying standard UPF definition and developing appropriate tools can better capture its consumption among Indians. This cross-sectional study aimed to validate the ‘Nova-UPF Screener (for India)’ and explore its potential to objectively capture UPF consumption among Indian adults. The screener, adapted in prior formative research study from a tool for Brazilian population, was subjected to content, face, and concurrent criterion validation. Subject matter experts (n=74) participated in online consultations to determine its content validity. Adults (18-60 years) from different geographical regions of India were included for face (n=70) and concurrent criterion (n=304) validations. The screener comprised 24 UPF categories specific to Indian food environment. Critical inputs from experts on screener’s appropriateness were incorporated to enhance its content. For face validation, overall percentage agreement of 99.4% for all questions indicated a strong agreement for retaining screener attributes in each question. Half the participants (49.4%) who were administered the finalized screener had Nova-UPF scores between 2 to 4 out of 24. There was almost perfect agreement (Pabak index = 0.85) between distribution of participants based on Nova-UPF scores and fifths of dietary share of UPFs (as energy %) assessed by 24-hour dietary recall. Nova-UPF Screener (for India) is a valid tool to capture UPF consumption in India that can be used for rapid assessment of UPF consumption and informing policies to improve Indian diets.