Nutrients — Open Access Journal

The use of Extended Reality (XR) (i.e. Virtual and Augmented Reality) for nutrition education and behavior change has not been comprehensively reviewed. This paper presents findings from a scoping review of current published research. Articles (n = 92) were extracted from PubMed and Scopus using a structured search strategy and selection approach. Pertinent study information was extracted using a standardized data collection form. Each article was independently reviewed and coded by two members of the research team, who then met to resolve any coding discrepancies. There is an increasing trend in publication in this area, mostly regarding Virtual Reality. Most studies used developmental testing in a lab setting, employed descriptive or observational methods, and focused on momentary behavior change like food selection rather than education. The growth and diversity of XR studies suggest the potential of this approach. There is a need and opportunity for more XR technology focused on children and other foundational theoretical determinants of behavior change to be addressed within nutrition education. Our findings suggest that XR technology is a burgeoning approach in the field of nutrition, but important gaps remain, including inadequate methodological rigor, community application, and assessment of the impact on dietary behaviors. Full article

Consumption of vitamin C-rich fruit and vegetables has been associated with greater feelings of vitality. However, these associations have rarely been tested in randomized controlled trials. The aim of the current study was to test the effects of eating a vitamin C-rich food (kiwifruit) on subjective vitality and whether effects are driven by vitamin C. Young adults (n = 167, 61.1% female, aged 18–35) with plasma vitamin C <40 µmol/L were randomized into three intervention conditions: kiwifruit (2 SunGold™ kiwifruit/day), vitamin C (250 mg tablet/day), placebo (1 tablet/day). The trial consisted of a two-week lead-in, four-week intervention, and two-week washout. Plasma vitamin C and vitality questionnaires (total mood disturbance, fatigue, and well-being) were measured fortnightly. Self-reported sleep quality and physical activity were measured every second day through smartphone surveys. Nutritional confounds were assessed using a three-day food diary during each study phase. Plasma vitamin C reached saturation levels within two weeks for the kiwifruit and vitamin C groups. Participants consuming kiwifruit showed significantly improved mood and well-being during the intervention period; improvements in well-being were sustained during washout. Decreased fatigue and increased well-being were observed following intake of vitamin C alone, but only for participants with consistently low vitamin C levels during lead-in. Diet records showed that participants consuming kiwifruit reduced their fat intake during the intervention period. Intervention effects remained significant when adjusting for age and ethnicity, and were not explained by sleep quality, physical activity, BMI, or other dietary patterns, including fat intake. There were no changes in plasma vitamin C status or vitality in the placebo group. Whole food consumption of kiwifruit improved subjective vitality in adults with low vitamin C status. Similar, but not identical, changes were found for vitamin C tablets suggesting that additional properties of kiwifruit may contribute to improved vitality. Full article

Progressive inflammation and anemia are common in tuberculosis (TB) and linked to poor clinical outcomes. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have inflammation-resolving properties, whereas iron supplementation in TB may have limited efficacy and enhance bacterial growth. We investigated effects of iron and EPA/DHA supplementation, alone and in combination, on inflammation, anemia, iron status markers and clinical outcomes in Mycobacterium tuberculosis-infected C3HeB/FeJ mice. One week post-infection, mice received the AIN-93 diet without (control) or with supplemental iron (Fe), EPA/DHA, or Fe+EPA/DHA for 3 weeks. Mice supplemented with Fe or EPA/DHA had lower soluble transferrin receptor, ferritin and hepcidin than controls, but these effects were attenuated in Fe+EPA/DHA mice. EPA/DHA increased inflammation-resolving lipid mediators and lowered lung IL-1α, IFN-γ, plasma IL-1β, and TNF-α. Fe lowered lung IL-1α, IL-1β, plasma IL-1β, TNF-α, and IL-6. However, the cytokine-lowering effects in the lungs were attenuated with Fe+EPA/DHA. Mice supplemented with EPA/DHA had lower lung bacterial loads than controls, but this effect was attenuated in Fe+EPA/DHA mice. Thus, individually, post-infection EPA/DHA and iron supplementation lowered systemic and lung inflammation and mitigated anemia of infection in TB, but not when combined. EPA/DHA also enhanced bactericidal effects and could support inflammation resolution and management of anemia. Full article

The purpose of this study was to conduct a literature review to examine micronutrient deficiencies in laparoscopic sleeve gastrectomy. We conducted a literature review using PubMed and Cochrane databases to examine micronutrient deficiencies in SG patients in order to identify trends and find consistency in recommendations. Seventeen articles were identified that met the defined criteria. Iron, vitamin B12 and vitamin D were the primary micronutrients evaluated. Results demonstrate the need for consistent iron and B12 supplementation, in addition to a multivitamin, while vitamin D supplementation may not be necessary. Additional prospective studies to establish a clearer picture of micronutrient deficiencies post-SG are needed. Full article

Albeit effective, methionine/protein restriction in the management of classical homocystinuria (HCU) is suboptimal and hard to follow. To address unmet need, we developed an enzyme therapy (OT-58), which effectively corrected disease symptoms in various mouse models of HCU in the absence of methionine restriction. Here we evaluated short- and long-term efficacy of OT-58 on the background of current dietary management of HCU. Methionine restriction resulted in the lowering of total homocysteine (tHcy) by 38–63% directly proportional to a decreased methionine intake (50–12.5% of normal). Supplemental betaine resulted in additional lowering of tHcy. OT-58 successfully competed with betaine and normalized tHcy on the background of reduced methionine intake, while substantially lowering tHcy in mice on normal methionine intake. Betaine was less effective in lowering tHcy on the background of normal or increased methionine intake, while exacerbating hypermethioninemia. OT-58 markedly reduced both hyperhomocysteinemia and hypermethioninemia caused by the diets and betaine in HCU mice. Withdrawal of betaine did not affect improved metabolic balance, which was established and solely maintained by OT-58 during periods of fluctuating dietary methionine intake. Taken together, OT-58 may represent novel, highly effective enzyme therapy for HCU performing optimally in the presence or absence of dietary management of HCU. Full article

Intro: Globally, the prevalence of overweight and obesity is increasing among children and younger adults and is associated with unhealthy dietary habits and lack of physical activity. School food is increasingly brought forward as a policy to address the unhealthy eating patterns among young people. Aim: This study investigated the evidence for the effectiveness of school-based food and nutrition interventions on health outcomes by reviewing scientific evidence-based intervention studies amongst children at the international level. Methods: This study was based on a systematic review using the PRISMA guidelines. Three electronic databases were systematically searched, reference lists were screened for studies evaluating school-based food and nutrition interventions that promoted children’s dietary behaviour and health aiming changes in the body composition among children. Articles dating from 2014 to 2019 were selected and reported effects on anthropometry, dietary behaviour, nutritional knowledge, and attitude. Results: The review showed that school-based interventions in general were able to affect attitudes, knowledge, behaviour and anthropometry, but that the design of the intervention affects the size of the effect. In general, food focused interventions taking an environmental approach seemed to be most effective. Conclusions: School-based interventions (including multicomponent interventions) can be an effective and promising means for promoting healthy eating, improving dietary behaviour, attitude and anthropometry among young children. Thus, schools as a system have the potential to make lasting improvements, ensuring healthy school environment around the globe for the betterment of children’s short- and long-term health. Full article

Microalgae have been considered as a renewable source of nutritional, cosmetic and pharmaceutical compounds. The ability to produce health-beneficial long-chain polyunsaturated fatty acids (LC-PUFA) is of high interest. LC-PUFA and their metabolic lipid mediators, modulate key inflammatory pathways in numerous models. In particular, the metabolism of arachidonic acid under inflammatory challenge influences the immune reactivity of macrophages. However, less is known about another omega-6 LC-PUFA, dihomo-γ-linolenic acid (DGLA), which exhibits potent anti-inflammatory activities, which contrast with its delta-5 desaturase product, arachidonic acid (ARA). In this work, we examined whether administrating DGLA would modulate the inflammatory response in the RAW264.7 murine macrophage cell line. DGLA was applied for 24 h in the forms of carboxylic (free) acid, ethyl ester, and ethyl esters obtained from the DGLA-accumulating delta-5 desaturase mutant strain P127 of the green microalga Lobosphaera incisa. DGLA induced a dose-dependent increase in the RAW264.7 cells’ basal secretion of the prostaglandin PGE1. Upon bacterial lipopolysaccharide (LPS) stimuli, the enhanced production of pro-inflammatory cytokines, tumor necrosis factor alpha (TNFα) and interleukin 1β (IL-1β), was affected little by DGLA, while interleukin 6 (IL-6), nitric oxide, and total reactive oxygen species (ROS) decreased significantly. DGLA administered at 100 µM in all forms attenuated the LPS-induced expression of the key inflammatory genes in a concerted manner, in particular iNOS, IL-6, and LxR, in the form of free acid. PGE1 was the major prostaglandin detected in DGLA-supplemented culture supernatants, whose production prevailed over ARA-derived PGE2 and PGD2, which were less affected by LPS-stimulation compared with the vehicle control. An overall pattern of change indicated DGLA’s induced alleviation of the inflammatory state. Finally, our results indicate that microalgae-derived, DGLA-enriched ethyl esters (30%) exhibited similar activities to DGLA ethyl esters, strengthening the potential of this microalga as a potent source of this rare anti-inflammatory fatty acid. Full article

Studies on the interactions between single nucleotide polymorphisms (SNPs) and macronutrient consumption on weight loss are rare and heterogeneous. This review aimed to conduct a systematic literature search to investigate genotype–diet interactions on weight loss. Four databases were searched with keywords on genetics, nutrition, and weight loss (PROSPERO: CRD42019139571). Articles in languages other than English and trials investigating special groups (e.g., pregnant women, people with severe diseases) were excluded. In total, 20,542 articles were identified, and, after removal of duplicates and further screening steps, 27 articles were included. Eligible articles were based on eight trials with 91 SNPs in 63 genetic loci. All articles examined the interaction between genotype and macronutrients (carbohydrates, fat, protein) on the extent of weight loss. However, in most cases, the interaction results were not significant and represented single findings that lack replication. The publications most frequently analyzed genotype–fat intake interaction on weight loss. Since the majority of interactions were not significant and not replicated, a final evaluation of the genotype–diet interactions on weight loss was not possible. In conclusion, no evidence was found that genotype–diet interaction is a main determinant of obesity treatment success, but this needs to be addressed in future studies. Full article

Background: Dietary patterns affect both human health and environmental sustainability. Prior research found a ten-unit course on food systems and environmental sustainability shifted dietary intake and reduced dietary carbon footprint among college students. This research evaluated the impact of a similar, more scalable one-unit Foodprint seminar taught at multiple universities. Methods: We used a quasi-experimental pre-post nonequivalent comparison group design (n = 176). As part of the Menus of Change University Research Collaborative, research was conducted at three university campuses in California over four academic terms. All campuses used the same curriculum, which incorporates academic readings, group discussions, and skills-based exercises to evaluate the environmental footprint of different foods. The comparison group comprised students taking unrelated one-unit courses at the same universities. A questionnaire was administered at the beginning and end of each term. Results: Students who took the Foodprint seminar significantly improved their reported vegetable intake by 4.7 weekly servings relative to the comparison group. They also reported significantly decreasing intake of ruminant meat and sugar-sweetened beverages. As a result of dietary shifts, Foodprint seminar students were estimated to have significantly decreased their dietary carbon footprint by 14%. Conclusions: A scalable, one-unit Foodprint seminar may simultaneously promote environmental sustainability and human health. Full article

Background: Magnesium is a mineral that modulates several physiological processes. However, its relationship with intestinal microbiota has been scarcely studied. Therefore, this study aimed to assess the role of dietary magnesium content to modulate the intestinal microbiota of Wistar male rats. Methods: Rats were randomly assigned one of three diets: a control diet (C-Mg; 1000 mg/kg), a low magnesium content diet (L-Mg; 60 mg/kg), and a high magnesium content diet (H-Mg; 6000 mg/kg), for two weeks. After treatment, fecal samples were collected. Microbiota composition was assessed by sequencing the V3–V4 hypervariable region. Results: The C-Mg and L-Mg groups had more diversity than H-Mg group. CF231, SMB53, Dorea, Lactobacillus and Turibacter were enriched in the L-Mg group. In contrast, the phyla Proteobacteria, Parabacteroides, Butyricimonas, and Victivallis were overrepresented in the H-Mg group. PICRUSt analysis indicated that fecal microbiota of the L-Mg group were encoded with an increased abundance of metabolic pathways involving carbohydrate metabolism and butanoate metabolism. Conclusion: Dietary magnesium supplementation can result in intestinal dysbiosis development in a situation where there is no magnesium deficiency. Conversely, low dietary magnesium consumption is associated with microbiota with a higher capacity to harvest energy from the diet. Full article

To determine the effects of pre-sleep supplementation with a novel low glycemic index (LGI) carbohydrate (CHO) on next-morning substrate utilization, gastrointestinal distress (GID), and endurance running performance (5-km time-trial, TT). Using a double-blind, randomized, placebo (PLA) controlled, crossover design, trained participants (n = 14; 28 ± 9 years, 8/6 male/female, 55 ± 7 mL/kg/min) consumed a LGI, high glycemic index (HGI), or 0 kcal PLA supplement ≥ 2 h after their last meal and <30 min prior to sleep. Upon arrival, resting energy expenditure (REE), substrate utilization, blood glucose, satiety, and GID were assessed. An incremental exercise test (IET) was performed at 55, 65, and 75% peak volume of oxygen consumption (VO_2peak) with GID, rating of perceived exertion (RPE) and substrate utilization recorded each stage. Finally, participants completed the 5-km TT. There were no differences in any baseline measure. During IET, CHO utilization tended to be greater with LGI (PLA, 56 ± 11; HGI, 60 ± 14; LGI, 63 ± 14%, p = 0.16, η² = 0.14). GID was unaffected by supplementation at any point (p > 0.05). Performance was also unaffected by supplement (PLA, 21.6 ± 9.5; HGI, 23.0 ± 7.8; LGI, 24.1 ± 4.5 min, p = 0.94, η² = 0.01). Pre-sleep CHO supplementation did not affect next-morning resting metabolism, BG, GID, or 5-km TT performance. The trend towards higher CHO utilization during IET after pre-sleep LGI, suggests that such supplementation increases morning CHO availability. Full article

Since the implementation of the Nutri-Score on a voluntary basis in 2017 in France, very few studies have evaluated how the label was recognized and used by consumers. The goal of this study was to assess the evolution of awareness, support, and perceived impact on purchasing behaviors of the Nutri-Score in France. Between April 2018 and May 2019, a total of 4006 participants were recruited across three successive waves and answered questions regarding awareness of the Nutri-Score, support of the measure, and change of behavior following the implementation of the Nutri-Score via an online survey. Descriptive analyses to assess the evolution over time were performed, as well as logistic regression models to evaluate associations between the different outcomes and individual characteristics. From April 2018 to May 2019, the awareness of the Nutri-Score increased considerably, reaching 81.5% in May 2019. Since April 2018, a steady proportion of participants—9 out of 10—showed strong support toward the measure and a similar proportion, 87.2%, declared being in favor of making the Nutri-Score mandatory. The impact on purchasing behaviors appeared promising given the limited implementation of the label, with 42.9% of the participants reporting they modified their purchasing behaviors thanks to the measure. Multivariate analyses showed that the impact on purchasing behaviors of the Nutri-Score was greater over time, on younger populations and on frequent labeling readers. Our results suggested that the labeling system was well received and used by all socioeconomic groups, including subgroups who are more likely to have a lower-quality diet. Full article

Compromised oral health can alter food choices. Poor masticatory function leads to imbalanced food intake and undesirable nutritional status. The associations among nutritional status, oral health behavior, and self-assessed oral functions status were investigated using a community-based survey. In total, 701 subjects more than 50 years old living Ebina city located southwest of the capital Tokyo were investigated. The number of remaining teeth was counted by dental hygienists. Oral health behavior and self-assessed oral functions were evaluated by oral frailty checklist. Nutritional status was evaluated by the brief-type self-administered diet history questionnaire using Dietary Reference Intakes for Japanese as reference. More than 80% of subjects’ intakes of vitamin B₁₂, pantothenic acid, copper, and proteins were sufficient. In contrast, only 19% of subjects’ intake of vitamin A was sufficient and 35.5% for vitamin B₁. More than 90% of subjects’ intakes of vitamin D and vitamin K were sufficient. Only 35.5% of subjects’ intakes of dietary fiber were sufficient. Overall, 88.9% of subjects had excess salt. The number of remaining teeth was not correlated with nutritional intakes. Oral health behavior significantly correlated with nutritional intakes. Oral functions are important for food choice; however, oral functions were not directly correlated with nutritional intakes. Comprehensive health instructions including nutrition and oral health education is necessary for health promotion. Full article

Malnutrition is an independent marker of adverse outcomes in older adults. While the Simplified Nutritional Appetite Questionnaire (SNAQ) for anorexia has been validated as a nutritional screening tool, its optimal cutoff and validity in healthy older adults is unclear. This study aims to determine the optimal cutoff for SNAQ in healthy community-dwelling older adults, and to examine its factor structure and validity. We studied 230 community-dwelling older adults (mean age 67.2 years) who were nonfrail (defined by Fatigue, Resistance, Ambulation, Illnesses & Loss (FRAIL) criteria). When compared against the risk of malnutrition using the Mini Nutritional Assessment (MNA), the optimal cutoff for SNAQ was ≤15 (area under receiver operating characteristic (ROC) curve: 0.706, sensitivity: 69.2%, specificity: 61.3%). Using exploratory factor analysis, we found a two-factor structure (Factor 1: Appetite Perception; Factor 2: Satiety and Intake) which accounted for 61.5% variance. SNAQ showed good convergent, discriminant and concurrent validity. In logistic regression adjusted for age, gender, education and MNA, SNAQ ≤15 was significantly associated with social frailty, unlike SNAQ ≤4 (odds ratio (OR) 1.99, p = 0.025 vs. OR 1.05, p = 0.890). Our study validates a higher cutoff of ≤15 to increase sensitivity of SNAQ for anorexia detection as a marker of malnutrition risk in healthy community-dwelling older adults, and explicates a novel two-factor structure which warrants further research. Full article

Dermatitis herpetiformis (DH) is an extraintestinal manifestation of gluten sensitivity, in which an autoimmune response is directed against transglutaminase 3 (TG3), an epidermal transglutaminase. TG2 is the autoantigen in celiac disease (CD), defined by the presence of enteropathy, and TG6 is the autoantigen in neurological manifestations of gluten sensitivity. The interplay between B cell responses to these 3 transglutaminases in developing the clinical spectrum of disease manifestations is not completely understood. Also, the individual or combined diagnostic and predictive value of the respective autoantibodies is not fully explored. We examined the prevalence of TG6 antibodies in a cohort of patients with DH. TG6 positivity was found in 13/33 (39%), with IgA detected in 11 patients, IgG in 3, and both in 1. This was significantly higher compared to what is seen in the classic CD cases (14%) in a Finnish population. TG6 positive baseline samples constituted 60% of DH patients with no enteropathy (n = 10), as opposed to 17% positivity in those with overt enteropathy (n = 12; Marsh IIIB). Repeat testing after adherence to a gluten-free diet for 1 year showed reduced titers for TG6 antibodies in 11/13 (85%), whereby 7 patients were now TG6 antibody-negative. Four patients seroconverted and tested positive for TG6 antibodies at one year, due to the ongoing exposure to gluten. We report another patient who presented with neurological manifestations (encephalopathy) leading to the diagnosis of CD, who was intermittently adhering to a gluten-free diet. Serological testing at baseline showed him to be positive for antibodies to all 3 transglutaminases. Eleven years later, he developed DH. He also subsequently developed ataxia and peripheral neuropathy. Although TG3 and TG6 autoantibodies are linked to certain disease manifestations, TG2, TG3, and TG6 autoantibodies can be present across the spectrum of GRD patients and might develop years before onset of symptoms of extraintestinal manifestations. This is consistent with gluten-dependent adaptive immunity being a necessary but not sufficient pretext to organ-specific damage. TG6 antibodies appear to develop more frequently in patients where tolerance to gluten was broken but, either there was no development of the molecular state driving the tissue destruction at the level of the gut, or perhaps more likely, there was more resistance to developing this phenotype. Full article

Both type 2 prediabetes/diabetes (T2DM) and new-onset prediabetes/diabetes after acute pancreatitis (NODAP) are characterized by impaired tissue sensitivity to insulin action. Although the outcomes of NODAP and T2DM are different, it is unknown whether drivers of insulin resistance are different in the two types of diabetes. This study aimed to investigate the associations between abdominal fat phenotypes and indices of insulin sensitivity in non-obese individuals with NODAP, T2DM, and healthy controls. Indices of insulin sensitivity (homeostasis model assessment of insulin sensitivity (HOMA-IS), Raynaud index, triglyceride and glucose (TyG) index, Matsuda index) were calculated in fasting and postprandial states. Fat phenotypes (intra-pancreatic fat, intra-hepatic fat, skeletal muscle fat, visceral fat, and subcutaneous fat) were determined using magnetic resonance imaging and spectroscopy. Linear regression and relative importance analyses were conducted. Age, sex, and glycated hemoglobin A1c were adjusted for. A total of 78 non-obese individuals (26 NODAP, 20 T2DM, and 32 healthy controls) were included. Intra-pancreatic fat was significantly associated with all the indices of insulin sensitivity in the NODAP group, consistently in both the unadjusted and adjusted models. Intra-pancreatic fat was not significantly associated with any index of insulin sensitivity in the T2DM and healthy controls groups. The variance in HOMA-IS was explained the most by intra-pancreatic fat (R² = 29%) in the NODAP group and by visceral fat (R² = 21%) in the T2DM group. The variance in the Raynaud index was explained the most by intra-pancreatic fat (R² = 18%) in the NODAP group and by visceral fat (R² = 15%) in the T2DM group. The variance in the TyG index was explained the most by visceral fat in both the NODAP group (R² = 49%) and in the T2DM group (R² = 25%). The variance in the Matsuda index was explained the most by intra-pancreatic fat (R² = 48%) in the NODAP group and by visceral fat (R² = 38%) in the T2DM group. The differing association between intra-pancreatic fat and insulin resistance can be used to differentiate NODAP from T2DM. Insulin resistance in NODAP appears to be predominantly driven by increased intra-pancreatic fat deposition. Full article

Obesity, sedentary behaviour, and poor dietary habits amongst young adults are growing concerns, with this age group being in a worse state of health and nutrition than adolescents and adults. This paper presents the procedures for establishing a new instrument for defining behaviours in relation to healthy lifestyle and food choices amongst young adults (Living and Eating for Health Segments: LEHS). The aim of this paper is to outline the instrument design protocol for external validation and to permit replication in other studies. The instrument design process used a multi-step social marketing instrument design method. This approach has previously been used in designing valid and reliable measures in marketing and consumer research, including social marketing. The protocol established six psycho-behavioural LEHS profiles for young adults. These profiles are: Lifestyle Mavens (15.4%), Aspirational Healthy Eaters (27.5%), Balanced-all Rounders (21.4%), Health Conscious (21.1%), Contemplating Another Day (11.2%), and Blissfully Unconcerned (3.4%). Each of these profiles provided insights into psycho-behavioural characteristics that can be used in designing apposite social media social marketing campaigns. Full article

Late eating has been shown to promote metabolic dysregulation and to be associated with obesity in adults. However, few studies have explored this association in children. We compared the presence of obesity, metabolic alterations and circadian-related disturbances between school-aged children who were early dinner eaters (EDE) or late dinner eaters (LDE). School-age children (n = 397; 8–12 years; mean BMI (range): 19.4 kg/m² (11.6–35.1); 39% overweight/obesity) from Spain were classified into EDE and LDE, according to dinner timing (Median: 21:07). Seven-day-dietary-records were used to assess food-timing and composition. Non-invasive tools were used to collect metabolic biomarkers (saliva), sleep and circadian-related variables (body-temperature and actigraphy). Compared to EDE, LDE were less likely to be overweight/obese [OR: 2.1 (CI: 1.33, 3.31); p = 0.002], and had higher waist-circumference and inflammatory markers, such as IL-6 (1.6-fold) (p = 0.036)) and CRP (1.4-fold) than EDE (p = 0.009). LDE had alterations in the daily patterns of: (a) body-temperature, with a phase delay of 26 min (p = 0.002), and a reduced amplitude (LDE = 0.028 (0.001) and EDE = 0.030 (0.001) (Mean (SEM); p = 0.039); (b) cortisol, with a reduced amplitude (LDE = 0.94 (0.02) and EDE = 1.00 (0.02); p = 0.035). This study represents a significant step towards the understanding of novel aspects in the timing of food intake in children. Full article