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Comparison of Vyntus CPX and Vmax Encore 29N for indirect calorimetry: a randomised crossover study in participants of the German Diabetes Study with type 2 diabetes

Por: Trinks · N. · Pützer · J. · Sutkowski · A. · Burkart · V. · Roden · M. · Kuss · O.
Objectives

This study compared the reliability of two metabolic cart systems, Vyntus CPX and Vmax Encore 29N, to measure whole-body energy metabolism by indirect calorimetry (IC) in individuals with type 2 diabetes (T2D).

Design

Randomised, prospective, crossover study.

Setting

Single-centre study conducted in the clinical research centre of the German Diabetes Study (GDS).

Participants

Five participants (3 men, 2 women, mean age 49±6 years, body mass index (BMI) 32.62±4.2 kg/m²) with T2D completed the study protocol. Eligibility requires existing participation in GDS and availability for four consecutive study days.

Interventions

Participants underwent four IC measurements per day on four consecutive days, totalling 16 measurements per device. On each study day, two measurements with both devices, Vyntus CPX and Vmax Encore 29N, were performed in randomised order. Postcalorimetric gas calibration with normalisation was applied after each measurement.

Primary outcome measures

Reliability of respiratory quotient (RQ) and resting energy expenditure (REE), as assessed from the coefficient of variation (CV) and 95% CIs.

Results

Device comparison showed minor differences in CV (95% CI) for carbon dioxide production (VCO2) (3.5% vs 5.3%; 95% CI –8.2% to 8.0%), oxygen consumption (VO2) (3.4% vs 5.7%; 95% CI –9.3% to 8.2%), RQ (3.6% vs 2.3%; 95% CI –3.5% to 3.7%) and REE (3.1% vs 5.6%; 95% CI –8.4% to 7.8%). Postcalorimetric calibration did not consistently affect RQ or REE. 

Conclusions

Vyntus CPX provides reliable IC measurements comparable to Vmax Encore 29N and may serve as a suitable replacement in clinical settings.

Trial registration number

ClinicalTrials.gov identifier: NCT01055093.

Tiny Bites, a digital health intervention delivered in early childhood education and care centres to support educators and caregivers to prevent childhood obesity: study protocol for a cluster randomised controlled trial

Por: Yoong · S. L. · Lum · M. · Leung · G. K. W. · Pearson · N. · Truby · H. · Dix · C. · Moumin · N. A. · Wolfenden · L. · Ananthapavan · J. · Grady · A. · Wiggers · J. · Delaney · T. · Rychetnik · L. · Romiti · M. · Lamont · H. · Stanley · S. · Lim · M. · Oldmeadow · C. · Mastersson · N. · Suth
Introduction

Infant feeding practices in the first 2 years of life are linked to long-term weight trajectories. Despite the importance of obesity prevention interventions, there are no randomised controlled trials (RCTs) evaluating early childhood education and care (ECEC) and primary caregiver-targeted interventions on child weight and feeding outcomes.

Aim

To assess the efficacy of an 18-month digital health intervention (Tiny Bites) delivered to ECEC services and primary caregivers of children aged 4 to ≤12 months on child age-adjusted and sex-adjusted body mass index-for-age z-score (zBMI) relative to usual care control in the Hunter New England (HNE) region of New South Wales, Australia.

Methods and analysis

This type 1 hybrid cluster RCT will include up to 60 ECEC services and 540 children/caregiver dyads. The intervention supports ECEC services and caregivers to deliver recommended responsive feeding practices to infants. ECEC services will receive access to an online assessment platform, training and resources, and implementation support. Primary caregivers will receive text messages, monthly e-newsletters, online links and direct communication from ECEC services. We will assess the impact on child zBMI at 18-month follow-up. Secondary outcomes include duration of consuming any breastmilk, child diet and caregiver responsive feeding practices. We will also assess ECEC policy and practice implementation related to targeted feeding practices, programme cost effectiveness, adverse effects and engagement with the programme (ECECs and caregivers). For the primary outcome, between-group differences will be assessed for paired data using two-level hierarchical linear regression models.

Ethics and dissemination

Ethics approval has been provided by HNE Human Research Ethics Committee (HREC) (2023/ETH01158), Deakin University (2024-202) and University of Newcastle HREC (R-2024-0039). Trial results will be submitted for publication in peer-reviewed journals, presented at scientific conferences locally and internationally and to relevant practice stakeholders.

Trial registration number

ACTRN12624000576527.

Assessment of dietary practices and nutritional status of children aged 5 to 72 months: study protocol of a nationwide Polish cross-sectional study (PITNUTS 2024)

Por: Sawicki · M. · Kowalkowska · J. · Kułaga · Z. · Socha · P. · Swiader-Lesniak · A. · Swiecicka-Ambroziak · A. · Szajewska · H. · Wadołowska · L. · Weker · H.
Introduction

Optimal nutrition during early childhood is crucial for psychosomatic development and for preventing diet-related diseases. However, evidence from Poland highlights significant deviations from recommended dietary practices. The previous Polish Infants and Toddler Nutritional Study conducted in 2016 (PITNUTS 2016) revealed imbalances in nutrient intake among children aged 5–36 months. The aim of this study (PITNUTS 2024) is to assess the diet and nutritional status of infants and children aged 5–72 months, providing a broader understanding of eating behaviours across critical stages of growth and development and allowing evaluation of how dietary practices changed in recent years.

Methods and analysis

This cross-sectional study will recruit a nationally representative sample of Polish infants and children aged 5 to 72 months using stratified random sampling. Survey interviews will be conducted with parents or legal guardians as proxy reporters for the children. Dietary practices will be evaluated through validated qualitative and quantitative dietary assessments, ensuring a comprehensive evaluation of food consumption and energy and nutrient intake. Dietary data will be collected using the 3 day food record and the survey questionnaire, including a food frequency questionnaire (FFQ). Daily energy and nutrient intake will be compared with national dietary standards and WHO guidelines. Dietary patterns will be derived based on the FFQ data. Nutritional status will be assessed based on measured anthropometric parameters. Energy, macro- and micronutrient intake as well as dietary patterns identified among children will be associated with nutritional status, including body mass index z-score and body weight status.

Ethics and dissemination

The study has been approved by the ethics board of the Institute of Mother and Child. Written informed consent was obtained from all participants’ parents or legal guardians before the interviews began. The results from this study will be presented at scientific conferences and published in peer-reviewed journals, contributing to nutrition policies in Poland and informing educational materials and dietary consultation services.

Trial registration number

NCT06417151, results.

Development, content and planned evaluation of a behavioural support intervention to reduce ultraprocessed food intake and increase physical activity in UK healthcare workers: UPDATE trial stage 2 study protocol

Por: Heuchan · G. N. · Buck · C. · Conway · R. · Dicken · S. · Brown · A. C. · Jassil · F. C. · Makaronidis · J. · Van Tulleken · C. · Gandini Wheeler-Kingshott · C. A. · Batterham · R. · Fisher · A.
Introduction

Diets high in ultraprocessed food (UPF) are associated with poor health outcomes and weight gain. Healthcare workers are particularly at risk of consuming diets high in UPF due to erratic work patterns, high stress and limited access to fresh food at work. Despite this, no interventions to date have specifically targeted a reduction in UPF intake in healthcare workers.

Methods and analysis

This article describes the development and content of a 6-month behavioural support intervention targeting a reduction in UPF intake in UK healthcare workers. The intervention was offered to all participants who took part in the UltraProcessed versus minimally processed Diets following UK dietAry guidance on healTh outcomEs trial—a two-stage study in which Stage 1 was a controlled-feeding crossover randomised controlled trial of provided UPF versus minimally processed food (MPF) diets (published previously) and was completed before the start of Stage 2. Stage 2, reported here, aimed to support participants to reduce their UPF consumption, increase MPF and increase physical activity in real-world settings. The intervention was developed using the behaviour change wheel framework, which systematically links behavioural diagnoses to intervention functions, incorporating the capability, opportunity and motivation model for behaviour change. It included tailored one-to-one and group support sessions, bespoke digital and print resources and a mobile-optimised website. The detailed description is intended to support future replication and adaptation. The acceptability and feasibility of the intervention will be assessed using quantitative and qualitative data in a future paper.

Ethics and dissemination

Sheffield Research Ethics Committee approved the trial (22/YH/0281). Findings will be disseminated through peer-reviewed publications, conference presentations and summaries shared with participants and stakeholders.

Trial registration number

NCT05627570.

Minimum meal frequency and its associated factors among children aged 6-23 months in the cash crop district of Kercha, Southern Ethiopia: a community-based cross-sectional study

Por: Ibrahim · J. J. · Amare · H. H. · Estifanos · M. B.
Objective

Despite efforts to improve feeding practices globally, 48% of children do not meet the recommended minimum meal frequency. Thus, the aim of this study was to assess minimum meal frequency and its associated factors in children aged 6–23 months in cash crop districts of Kercha, Southern Ethiopia.

Design

A community-based cross-sectional design was used to conduct this study from 29 February 2024 to 29 March 2024.

Setting

Kercha district, Southern Ethiopia

Participants

A total of 543 children aged 6–23 months were selected using a multistage sampling technique.

Primary outcome

The primary outcome of this study was minimum meal frequency, defined as the percentage of children aged 6–23 months who consumed solid, semisolid or soft foods (including milk for non-breastfed children) at least the required number of times for their age in the previous day.

Secondary outcome

The secondary outcome of this study was factors associated with minimum meal frequency. Bivariable and multivariable multilevel mixed-effect logistic regression analyses were performed to find factors related to minimum meal frequency. Adjusted ORs (AORs) with 95% CIs and p values

Results

A total of 539 (99.3%) children aged 6–23 months and their mothers participated in this study. The prevalence of minimum meal frequency was 62.3% (95% CI 58.1% to 66.4%) among children in the cash crop district of Kercha. The final model yielded an intracluster correlation coefficient of 7.3%, reflecting unexplained variations in the prevalence of minimum meal frequency among children at the kebele level. Factors associated with higher odds of meeting minimum meal frequency included being a first-born child (AOR 2.91, 95% CI 1.06 to 8.05), mothers (AOR 2.66, 95% CI 1.48 to 4.76) and fathers (AOR 3.43, 95% CI 1.98 to 5.95) with primary education, having mother attending postnatal visits (AOR 2.74, 95% CI 1.52 to 4.94), introducing additional food at 6 months (AOR 4.71, 95% CI 2.79 to 7.94), good maternal knowledge on child feeding (AOR 1.98, 95% CI 1.21 to 3.22) and living in the household with medium (AOR 2.98, 95% CI 1.59 to 5.53) and rich (AOR 2.39, 95% CI 1.37 to 4.18) wealth status.

Conclusions

The study revealed that only three-fifths of children met the recommended minimum meal frequency. Birth order, introducing additional foods at 6 months, parental education, maternal postnatal visits, good maternal knowledge on child feeding and wealth were linked to minimum meal frequency. To improve child nutrition, it is crucial to enhance maternal education, increase access to postnatal healthcare and educate parents about the importance of introducing additional foods at 6 months.

Prevalence and determinants of vitamin D deficiency among pregnant women in Gondar Town 2024: a cross-sectional study from the first and second trimesters

Por: Chane · E. · Teketelew · B. B. · Berta · D. M. · Walle · M. · Angelo · A. A. · Cherie · N. · Tamir · M. · Abriham · Z. Y. · Bitew · G. · Mekuanint · A.
Objective

Vitamin D deficiency during pregnancy is a global health concern, contributing to adverse maternal and fetal outcomes. Despite its importance, limited data exist on vitamin D status and its determinants among pregnant women in Ethiopia. This study aimed to assess the prevalence and determinants of vitamin D deficiency among pregnant women in their first and second trimesters in Gondar Town, Ethiopia, 2024.

Design and setting

A facility-based cross-sectional study was conducted at the antenatal care unit of University of Gondar Comprehensive Specialized Hospital from January to March 2024.

Methods

Eligible participants were selected using a simple random sampling technique. Sociodemographic, behavioural and clinical data were collected through structured questionnaires and medical record reviews. Serum levels of vitamin D, calcium and alkaline phosphatase were analysed using the Beckman Coulter clinical chemistry analyser. Statistical comparisons between pregnant women in the first and second trimesters were performed using the independent t-test. Determinants of vitamin D deficiency were identified using multivariate logistic regression analysis.

Participants

384 pregnant women in their first or second trimester.

Results

The prevalence of vitamin D deficiency (90 mm Hg) (AOR 0.28, 95% CI 0.11 to 0.70), lower dietary diversity (AOR 3.17, 95% CI 1.13 to 8.89), lower fish and fish oil consumption habit (AOR 3.01, 95% CI 1.03 to 8.77; AOR 12.27, 95% CI 1.50 to 100.42) were the key predictors associated with serum vitamin D defiency.

Conclusion and recommendation

Nearly half of the pregnant women in Gondar Town exhibit vitamin D deficiency, showing a challenging public health concern. Thus, targeted interventions, such as dietary supplementation and lifestyle modifications, are urgently needed to address the problem and improve maternal and neonatal health outcomes.

Burden of abnormal nutritional indices among women aged 15-24 years in 40 low-income and middle-income countries: a multilevel multinomial logistic regression analysis

Por: Lahole · B. K. · Wengoro · B. F. · Mare · K. U.
Background

Despite global efforts to improve nutrition, young women aged 15–24 years in low-income and middle-income countries (LMICs) face persistent dual burdens of malnutrition, marked by high rates of underweight and emerging issues of overnutrition, such as overweight and obesity. Current research often emphasises individual-level factors, potentially overlooking broader regional influences.

Objective

To examine the burden of abnormal nutritional indices among women aged 15–24 years in 40 LMICs using the most recent Demographic and Health Survey conducted between 2015 and 2023.

Design

Cross-sectional study design.

Setting

40 LMICs.

Participants

357 587 young women aged 15–24 years.

Primary and secondary outcome measures

A multilevel mixed-effect multinomial analysis was conducted to identify determinants of underweight, overweight and obesity. The adjusted relative risk ratio with 95% CI was used to declare the statistical significance of the association.

Results

Our analysis found that among young women aged 15–24 years in LMICs, the pooled prevalence of underweight was 25.7% (95% CI 25.6% to 25.8%), with substantial country-level variation. The highest prevalence was in Timor-Leste (35.4%) and India (31.6%), while Jordan (2.9%) and Zambia (5.5%) had the lowest rates. Overweight and obesity prevalence was 17.7% (95% CI 15.7% to 19.7%), with the highest rates in Jordan (48.9%) and Zambia (40.9%) and the lowest in Timor-Leste (3.9%) and Ethiopia (4.5%). Furthermore, factors such as household wealth, age at marriage, age, education status, access to media, employment status, parity, contraceptive use, toilet facility, region and place of residence were statistically associated with being underweight, overweight and obese.

Conclusions

Our study highlights significant variations in nutritional status among young women aged 15–24 years in LMICs, with a notable prevalence of underweight and emerging challenges of overweight and obesity. Country-specific strategies addressing socioeconomic disparities and regional differences are crucial for effective public health interventions to improve nutritional outcomes among this vulnerable population.

Association of anthropometry indices and metabolic syndrome in Iranians: a cross-sectional study of the Fasa adult cohort study

Por: Seyhoon · M. · Ahmadi · A. · Zare · M. · Honardoust · M. · Hejazi · N. · Mohsenpour · M. A. · Homayounfar · R.
Objectives

To evaluate the associations between anthropometric indices and components of metabolic syndrome (MetS), including blood pressure, fasting blood sugar (FBS), triglycerides, high-density lipoprotein cholesterol and waist circumference (WC) in Iranian adults.

Design

Cross-sectional analysis of baseline data from a population-based cohort.

Setting

Fasa adults’ cohort study, a rural community-based cohort in Fars province, Iran.

Participants

A total of 1550 adults aged 35–70 years with MetS, identified from among 10 118 cohort participants using the National Cholesterol Education Programme Adult Treatment Programme III criteria.

Primary outcome measures

The anthropometric indices include abdominal volume index (AVI), a body shape index (ABSI), atherogenic index of plasma (AIP), body roundness index (BRI), body adiposity index (BAI), conicity index, ponderal index and visceral adiposity index (VAI).

Results

Participants (56.1% female) with a mean age of 49.8±9.5 years. AVI was significantly associated with systolic blood pressure (SBP) (β=0.010, p

Conclusions

Anthropometric indices, including VAI, AIP, BAI, BRI and AVI, exhibit significant associations with key components of MetS in Iranian adults, particularly blood pressure, glycaemic markers and central adiposity. Among these, BAI showed the strongest correlation with MetS parameters, while ABSI displayed the weakest.

Effectiveness of nutritional intervention provided to older people and nutrients indicating food insecurity in primary care settings in Tehran: protocol of a prospective population-based cohort study

Por: Asghari Hanjani · N. · Olyaeemanesh · A. · Shafiee · G. · Zabihi · M. · Azadbakht · L.
Background and aim

With the growing older population, ensuring effective, accessible nutritional support within primary care as a first line of medical care is becoming increasingly important. Nutritional counselling is a promising approach to enhancing health outcomes and independence among older adults. However, a stronger evidence base is needed to assess its true effect and inform clinical decisions. Additionally, food insecurity remains an under-recognised issue in this population and is often overlooked in primary care settings. This highlights the need for simple, practical methods to identify those at risk. This study aimed to assess the effectiveness of nutritional intervention provided to older people and determine which nutrients may indicate food insecurity in primary care settings in Tehran.

Methods

The study will be conducted in two phases. The first phase is a prospective cohort study (single cohort). The second phase is a cross-sectional study on older people who refer to primary care settings affiliated with the Tehran University of Medical Sciences. In the first phase, the effectiveness of nutritional interventions – including counselling and diet – is evaluated based on anthropometric indicators (weight, waist circumference, calf circumference, arm circumference and waist-to-height ratio), blood pressure and scores from the Mini Nutritional Assessment, health-related quality of life, dietary intake and physical activity. Assessments will be evaluated prospectively at the beginning of the study, after 3 months, and at the end of the study. In the second phase of the cross-sectional study, by examining dietary intake and food insecurity, we will identify the specific nutrient or food group that serves as an indicator of food insecurity in the diet of older individuals. Intakes below 50% and 75% of the recommended daily allowance will be analysed. Through sensitivity and specificity analysis, we will identify which nutrient or food group is strongly associated with food insecurity in older people.

Ethics and dissemination

This study received approval from the Medical Ethics Committee of Tehran University of Medical Sciences, Tehran, Iran (IR.TUMS.MEDICINE.REC.1402.474). Study findings will be disseminated through peer-reviewed journal articles, presentations at national and international conferences and meetings with the Iranian Ministry of Health, facility and community stakeholders.

Registration number

69772

MaxiMoM InForM: individualised fortification of human milk for very low birthweight infants-- protocol of a three-arm randomised clinical trial

Por: Beggs · M. R. · Pichardo · D. · Chrzaniecki · A. · Kotsopoulos · K. · Bishara · R. · Ng · E. · Tomlinson · C. · Campbell · D. · Vaz · S. · Kiss · A. · Unger · S. · OConnor · D. L.
Introduction

To meet the elevated nutritional requirements of very low birthweight (

Methods and analysis

This is a three-arm, pragmatic, multicentre, double-blind, randomised clinical trial of 615 human milk–fed infants born either (1) ≤1250 g or (2)

Ethics and dissemination

Ethical approval was obtained from Clinical Trials Ontario (CTO) and local research ethics boards that are not CTO members. Study findings will be disseminated to clinicians at seminars and conferences and in peer-reviewed publications.

Trial registration number

NCT05308134.

Knowledge, attitude and practice of artificial intelligence among dietitians in Saudi Arabia: a cross-sectional study

Por: Alhazmi · A. · Ibrahem · M. · Dawria · A.
Objectives

This study assesses the knowledge, attitudes and practices (KAP) of licensed dietitians in Saudi Arabia regarding artificial intelligence (AI) in dietetics and identifies sociodemographic factors associated with higher AI knowledge and use, along with perceived benefits and concerns.

Design

Descriptive, cross-sectional study with an analytical component.

Setting

Conducted online across Saudi Arabia, targeting licensed dietitians in public and private healthcare sectors.

Participants

161 licensed dietitians completed the study. Inclusion criteria consisted of current registration and active practice in either clinical or community settings.

Primary and secondary outcome measures

The primary outcomes were levels of AI-related KAPs assessed via a structured questionnaire. The secondary outcomes examined associations between KAP and demographic factors.

Results

Among participants, 62.7% reported using AI in practice; 72.3% found it easy to use and 63.4% believed it improved their work. Higher knowledge was significantly linked to being aged 24–40, female, married, Saudi, a university graduate and employed (p

Conclusions

Dietitians in Saudi Arabia generally recognise AI’s value in dietetic practice, particularly in programme development and personalisation. However, concerns about diminished human interaction remain. Structured training and further longitudinal research are recommended to support balanced AI integration.

Nutritional status and its influencing factors among elderly patients with malignant tumours: a retrospective study from a tertiary hospital in Chengdu, China

Por: Duan · R. · Wang · F. · Zhang · T. · Feng · T. · Ren · T.
Objective

To investigate the nutritional status and its influencing factors in elderly patients aged 60 years and above with malignant tumours.

Design

A retrospective observational study.

Setting

The First Affiliated Hospital of Chengdu Medical College, a tertiary care hospital in Chengdu, China.

Participants

A total of 450 elderly patients with cancer (aged ≥60 years) admitted between January 1, 2022, and January 1, 2023. Patients were selected based on their clinical records, excluding those with communication disorders, mental illness or incomplete data.

Primary outcome measures

Nutritional status was assessed using the Patient-Generated Subjective Global Assessment (PG-SGA). Participants were categorised based on the presence or absence of malnutrition. Multivariate logistic regression was used to identify independent risk factors for malnutrition.

Results

Of the 450 patients included, 63.7% were male and 36.3% female, with a median age of 69 years. The prevalence of severe malnutrition was 46.4%. Univariate analysis showed significant associations between malnutrition and factors such as older age (p

Conclusions

Malnutrition is highly prevalent in elderly patients with cancer and is significantly associated with age, BMI, albumin levels and self-care ability. Early identification and targeted nutritional interventions may improve outcomes and quality of life in this population.

Effect of plant-based foods and (poly)phenol supplementation on gut-microbiota metabolism in participants with overweight or obesity and cardiometabolic risk: a study protocol for a single-blind, parallel and randomised controlled trial

Por: Lanuza · F. · Romero-Lopez · C. · Nova-Luna · R. · Cuyul-Vasquez · I. · Saez-Venegas · M. · Guzman · N. · Diaz-Velis · L. · Zamora-Ros · R. · Martinez-Huelamo · M. · Andres-Lacueva · C.
Introduction

Dietary (poly)phenols have beneficial properties that may play a relevant role in the management of overweight/obesity and cardiometabolic risk factors, modulating physiological and molecular pathways involved in energy metabolism, adiposity and gut microbiota-derived metabolites.

Methods and analysis

The Prevention/Precision Diet in Araucanía (PREDIET-ARAC) trial is a randomised, single-blind, parallel arm, placebo-controlled, clinical trial designed to assess the potential health benefits of (poly)phenol intake through either diet or supplementation. The study will evaluate the effectiveness of a healthy plant-based diet (PBD) rich in (poly)phenols compared with (poly)phenol supplementation during a caloric restriction intervention.

A total of 99 adults (aged 25–45 years) with overweight or obesity (body mass index: 25–35 kg/m²) and cardiovascular risk factors will be recruited from primary health centres in Temuco, Araucanía Region, Chile. Participants will be randomised (stratified by age:

Dietary data will be collected using dedicated software through three 24-hour dietary recalls at baseline and post-intervention. (Poly)phenol intake will be estimated using the Phenol-Explorer database. The main data collection will include general and lifestyle questionnaires, anthropometric and bioimpedance measurements, blood pressure assessments using sphygmomanometers, physical activity monitoring through accelerometers and strength evaluations via dynamometry. Blood samples will be collected at both baseline and after 12 weeks. For the analysis of plasma metabolites, a large-scale targeted metabolomics approach will be employed, specifically utilising ultra-high performance liquid chromatography coupled to tandem mass spectrometry. The healthy PBD will be primarily supplied by the food industry, encompassing a selection of regional and Latin American foods: blueberries, apple, nuts, olive oil and coffee. A descriptive and inferential statistical plan will be conducted, based on comparison tests, regression models and machine-learning algorithms.

Ethics and dissemination

This trial adheres to the Declaration of Helsinki and the CONSORT statement. Signed informed consent will be obtained from all participants. Ethical approval has been granted by the Ethical-Scientific Committee of the Health Service of Araucanía Sur, Chile (Approval No 11250095–58) and the Biosafety Committee of the Catholic University of Temuco. Findings will be disseminated through peer-reviewed publications, conference presentations and engagement with healthcare professionals and policymakers.

Trial registration number

NCT06911346.

Food system determinants of seasonal malnutrition in children under 5 years in sub-Saharan Africa: a scoping review protocol

Por: Nasagre · E. · Dugle · G. · Bawontuo · V.
Introduction

Child malnutrition remains a pressing public health challenge in sub-Saharan Africa (SSA), where approximately 148 million children are stunted and 45 million are wasted. Although often conceptualised as a persistent condition, evidence indicates that malnutrition among children under 5 years frequently follows seasonal patterns shaped by agricultural cycles, climatic variability and socioeconomic conditions. Current interventions have paid limited attention to the food system dynamics that underpin these fluctuations. Adopting a system perspective, this scoping review will synthesise existing evidence on the food system determinants of seasonal malnutrition in children under 5 years in SSA.

Methods and analysis

The review will be conducted in accordance with the Joanna Briggs Institute methodological framework for scoping reviews and reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Extension for Scoping Reviews (PRISMA-ScR) guidelines. A comprehensive search will be undertaken across electronic databases (Google Scholar, ProQuest Central, PubMed, Scopus and African Index Medicus) for literature published from 2015 onwards. Grey literature will also be sought from institutional repositories of the WHO, United Nations Children’s Fund, Food and Agriculture Organization and World Food Programme. Screening of titles, abstracts and full texts will be performed independently by two reviewers using predefined eligibility criteria. Data extraction will capture study characteristics and food system determinants of seasonal malnutrition at micro, meso and macro levels. The Food Insecurity and Vulnerability Information and Mapping Systems framework will guide the analysis and synthesis.

Ethics and dissemination

As this review involves analysis of previously published data, ethical approval is not required. Findings will be disseminated through a peer-reviewed publication and social media engagements. Results will inform the development of integrated system-based approaches to address seasonal malnutrition in children under five in SSA. The full study protocol, datasets and supplementary forms will be published in an open-access repository in compliance with the Findability, Accessibility, Interoperability and Reuse principles.

Registration

This scoping review protocol is registered with the Open Science Framework (https://doi.org/10.17605/OSF.IO/RU4ZX).

Feasibility of an online nutrition intervention to improve adherence to healthy and sustainable diets in young Australian adults: protocol for a pilot pre-post intervention study

Por: Lam · B. T. · Szymlek-Gay · E. A. · Larsson · C. · Margerison · C.
Introduction

Current diets which are commonly high in meat and ultra-processed foods are unhealthy and unsustainable and contribute significantly to climate change, environmental degradation and poor health outcomes. Transitioning to healthy and sustainable diets that are rich in plant-based foods and low in animal products could reduce environmental impacts and improve population health. Young Australian adults are a critical target group for dietary intervention as they are motivated towards climate action and have the lowest diet quality out of all adult age groups. As such, this study proposes a digital nutrition intervention to promote healthy and sustainable diets in this population group.

Methods and analysis

A 4-week pilot pre-post intervention will be conducted on the Deakin Wellbeing mobile application between July and August 2025. 32 young adults (18–25 years old; current student and/or staff at Deakin University; consume less than 260 g/week of legumes or 175 g/week nuts, living in Australia) will receive 4 weeks of the intervention to improve their adherence to a healthy and sustainable diet. Primary outcomes include feasibility (retention rate) and acceptability (engagement and user experience). Secondary outcomes include sustainable food literacy, legume and nut intakes, and adherence to a healthy and sustainable diet. Primary outcomes will be reported with descriptive statistics, while changes in secondary outcomes at each study time point will be measured using repeated measures Analysis of Variance, Friedman tests and McNemar’s tests.

Ethics and dissemination

Ethics approval to conduct the study was granted by the Deakin University Human Research Ethics Committee (2024/HE000163). A summary of findings will be disseminated to key stakeholders, for example, Deakin University Student Engagement groups, and will also be presented to the wider research community at conferences and via peer-reviewed publications. A summary of the results will be sent to all participants via email.

Trial registration number

Australian New Zealand Clinical Trials Registry Registration ID: ACTRN12625000335493p, prospectively registered on 22 April 2025. Universal Trial Number: U1111-1319-0745.

Exploring exhaled breath biomarkers for lactose intolerance diagnosis: the Lactobreath pilot study protocol

Por: Giannoukos · S. · Burton-Pimentel · K. J. · Guillod · R. · Vergeres · G. · Pohl · D.
Introduction

Food intolerances are prevalent in Europe and can cause considerable physical discomfort, dietary restrictions and psychosocial challenges. Among the prominent causes of food intolerance are defects in the digestion and/or transport of short-chain fermentable carbohydrates, fermentable oligo-, di-, monosaccharides and polyols (FODMAPs). A common diagnostic tool for food intolerance is the hydrogen breath test, which monitors the production of H2 gas from the fermentation of ingested FODMAPs by colonic microbiota. However, this method is limited due to its relatively poor correlation with gastrointestinal (GI) symptoms experienced by patients. Diagnosis is complicated as food intolerance is often associated with functional GI disorders, while FODMAPs may exert their effects individually or in combination. Further research on the pathophysiology and the impact of intervention strategies for these conditions is required to improve the diagnosis of food intolerance.

Methods and analyses

The Lactobreath pilot study is a randomised, two-arm, double-blinded controlled study. 120 healthy, free-living adults will undergo 6-hour postprandial tests with lactose or glucose (control) to investigate the molecular composition of human exhaled breath (exhalome) as a potential source of biomarkers associated with clinical and metabolic traits of lactose malabsorption (Lactobreath profiles). This serves as a proof-of-concept for the future application of this technology in diagnosing food intolerance. We will use a sensitive, non-invasive, real-time measurement technique based on secondary electrospray ionisation coupled with high-resolution mass spectrometry to analyse the chemical profile of the postprandial exhalome after lactose ingestion. Symptoms of lactose intolerance will be assessed using a standardised questionnaire and mechanistically linked to specific key metabolites of the discriminating breath profile. In parallel, a solid-state sensor will measure postprandial hydrogen gas in breath samples, while GI gases (CH4, H2, O2) and intestinal transit time will be monitored using a novel ingestible gas sensor (Atmo Gas capsule). Metabolites in urine, including lactose-derived metabolites, will be investigated using gas chromatography coupled with mass spectrometry. Postprandial bowel sounds will be recorded by wearable sensors (DigeHealth AG). Baseline assessments will be completed before the dietary challenge to capture usual dietary intake (repeated 24-hour recall), faecal microbiota (shallow shotgun sequencing) and to evaluate genetic polymorphisms using saliva samples (PCR analysis of selected penetrant single-nucleotide polymorphisms).

Ethics and dissemination

The Lactobreath study has been approved by the Ethics Committee of the Canton of Zurich, Switzerland (#2023-01639). The project results will be published in open-access journals, presented at national and international conferences and communicated to the public and other relevant stakeholders via the communication channels of all investigators and partners. All results derived from the study will be accessible, in line with the Swiss National Science Foundation open access policy.

Trial registration number

NCT06177938.

NutriNet-Brasil, a web-based prospective study on dietary patterns and risk of chronic diseases: cohort profile

Por: Costa · C. d. S. · Gabe · K. T. · dos Santos · F. S. · Leite · M. A. · Quinta · F. P. · Torquato · B. M. d. A. · Martinez Steele · E. · Rauber · F. · Rezende · L. F. M. · da Costa Louzada · M. L. · Levy · R. B. · Monteiro · C. A.
Purpose

Non-communicable diseases (NCDs), such as diabetes, cardiovascular diseases and cancer, are major global public health concerns. Diet quality—particularly the consumption of ultra-processed foods—has been associated with increased risk of NCDs. Traditional cohort studies are often expensive and logistically complex. The NutriNet-Brasil cohort leverages a web-based approach, offering a cost-effective and practical solution for comprehensive data collection and long-term follow-up.

Participants

Recruitments began in January 2020 through mass media, social media campaigns and collaborations with health organisations. Eligible participants are adults (aged ≥18 years) living in Brazil with internet access. Participants complete self-administered online questionnaires covering dietary intake, health status and other health determinants. Dietary assessment is based on the Nova classification system, which categorises foods by their level of processing.

Findings to date

Over 88 000 participants have completed the initial questionnaire. The cohort is predominantly women (79.9%) and highly educated (67.9% had completed higher education). The web-based design enabled the development and application of innovative dietary assessment tools, including the Nova24h and the Nova24hScreener, specifically designed to evaluate food processing levels. These tools have shown good performance in capturing dietary patterns and are central to the cohort’s aim. The online platform facilitates efficient recruitment, data collection and participant retention.

Future plans

NutriNet-Brasil is pioneering the development of web-based cohort methodologies and instruments tailored to food processing research. Future work includes leveraging collaborations with national and international research centres to conduct multidisciplinary analyses and inform public health policies.

Time to full recovery and its predictors among children with complicated severe acute malnutrition admitted to inpatient and subsequently to outpatient therapeutic care, Sanaa city, Yemen, a prospective follow-up study

Por: Al Amad · M. A. · Rajaa · Y. A. · Algendari · K.
Objective

To determine the time to full recovery and its predictors among children with severe acute malnutrition (SAM) admitted to therapeutic feeding centres (TFCs) in Sana’a, Yemen.

Design

A prospective cohort study conducted from August 2023 to November 2024.

Setting

Two public hospitals in Sana’a City (Al-Sabeen and Al-Zubairi hospital) that provide therapeutic feeding services for children with SAM.

Participants

Children aged 6–59 months who were admitted to TFCs based on WHO SAM criteria and successfully transferred to outpatient therapeutic programmes (OTPs).

Outcome measures

The primary outcome was time to full recovery from SAM, defined as the normalisation of both weight-for-height z-score (WHZ) and mid-upper arm circumference (MUAC). Secondary outcomes included identification of predictors associated with recovery time.

Results

Among 267 children, 51% were aged 6 to

Conclusion

Three months and a half were the median time to full recovery from complicated SAM. Concurrent WHZ and MUAC deficits, antibiotic use and the absence of diarrhoea were the significant predictors. Standardising the use of combined WHZ and MUAC recovery is recommended to improve comparability across programmes and better reflect nutritional outcomes.

Has the prevalence of malnutrition and obesity in children from North Korean refugee families improved after resettlement in South Korea? A longitudinal cohort study

Por: Choi · S.-W. · Kim · S.-Y.
Objectives

This study assessed changes in the prevalence of malnutrition and obesity in children from North Korean (NK) refugee families resettling in South Korea (SK).

Design

A longitudinal cohort study.

Setting

This study, conducted between 2017 and 2023, recruited participants through snowball sampling using local Hana Centres, alternative schools, religious organisations, civic groups, and other community-based networks.

Participants

Of the 441 children initially recruited, 406 participated in the baseline survey after excluding 35 with missing height or weight data. Among them, 187 (46.1%) completed a follow-up survey conducted at least 1 year later.

Primary outcome measures

The prevalences of stunting, underweight, wasting and obesity were defined according to the 2017 Korean National Growth Chart: stunting as height-for-age below the third percentile, underweight as weight-for-age below the fifth percentile, wasting as weight-for-height below the fifth percentile for ages 0–23 months or body mass index (BMI)-for-age below the fifth percentile for ages 2–18 years and obesity as BMI-for-age at or above the 95th percentile for ages 2–18 years.

Results

The prevalence of stunting was 7.5% at baseline and 5.4% at follow-up, while those of underweight and wasting were 6.4% vs 5.4% and 11.2% vs 5.9%, respectively; however, none of these changes were statistically significant. In contrast, the prevalence of obesity increased significantly from 11.1% at baseline to 18.8% at follow-up (p=0.045).

Conclusion

Despite residing in SK for an extended period, children from NK refugee families continue to experience malnutrition, while the prevalence of obesity is rising significantly.

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