Understanding country-level nutrition intake is crucial to global nutritional policies that aim to reduce disparities and relevant disease burdens. Still, there are limited numbers of studies using clustering techniques to analyse the recent Global Dietary Database. This study aims to extend an existing multivariate time-series clustering algorithm to allow for greater customisability and to provide the first cluster analysis of the Global Dietary Database to explore temporal trends in country-level nutrition profiles (1990-2018).

Trends in sugar-sweetened beverage intake and nutritional deficiency were explored using the newly developed program ‘MTSclust’. Time-series clustering algorithms are different from simple clustering approaches in their ability to appreciate temporal elements.

Nutritional and demographical data from 176 countries were analysed from the Global Dietary Database.

Population representative samples of the 176 in the Global Dietary Database.

In a 3-class test specific to the domain, the MTSclust program achieved a mean accuracy of 71.5% (Adjusted Rand Index [ARI]=0.381) while the mean accuracy of a popular algorithm, DTWclust, was 58% (ARI=0.224). The clustering of nutritional deficiency and sugar-sweetened beverage intake identified several common trends among countries and found that these did not change by demographics. Multivariate time-series clustering demonstrated a global convergence towards a Western diet.

While global nutrition trends are associated with geography, demographic variables such as sex and age, are less influential to the trends of certain nutrition intake. The literature could be further supplemented by applying outcome-guided methods to explore how these trends link to disease burdens.

Increased out-of-home consumption may elevate sodium (Na) intake, but self-reported dietary assessments limit evidence. This study explored associations between neighbourhood exposure to fast-food and sit-down restaurants and estimated 24-hour urinary Na excretion.

A cross-sectional analysis from the ORISCAV-LUX 2 study (2016-2017). 24-hour urinary Na was estimated from a morning spot urine sample using the INTERSALT formula. Spatial access to fast-food and sit-down restaurants was derived from GIS data around participants’ addresses within 800-m and 1000-meter road-network buffers by summing up the inverse of the road-network distance between their residential address and all restaurants within the corresponding buffer size. Multi-adjusted linear models were used to assess the association between spatial access to restaurants and estimated 24-hour urinary Na excretion.

Luxembourg

Urban adults age over 18 years (n=464).

Fast-food and sit-down restaurants accounted for 58.5% of total food outlets. Mean 24-hour urinary Na excretion was 3564 mg/d for men and 2493 mg/d for women. Health-conscious eating habits moderated associations between spatial access to fast-food and sit-down restaurants and Na excretion. For participants who did not attach great importance to having a balanced diet, greater spatial access to restaurants, combining both density and accessibility, was associated with increased urinary Na excretion at 800 m (βhighvslow = 259, 95% CI: 47–488) and 1000 m (βhighvslow = 270, 95% CI: 21–520).

Neighbourhood exposure to fast-food and sit-down restaurants influences sodium intake, especially among individuals with less health-conscious eating habits, potentially exacerbating diet-related health disparities.

The Food Quality Observatory synthetizes the nutritional composition of 15 processed food categories commonly purchased in Québec (Canada). We assessed how the new Canadian front-of-pack (FoP) labelling regulation of a ‘high in’ symbol, to be implemented as of January 1st 2026, would be potentially reflected in these categories and how simulations of reformulation would impact the presence of the symbol.

Nutritional information was obtained by collecting food products available in supermarkets and grocery stores in the province of Québec (2016-2022). Sales data were obtained from NielsenIQ company. 15 food categories have been selected, and 3 levels of reformulation were simulated.

The nutritional values of 5132 products were merged with sales data. 3941 products were successfully cross-referenced.

Sixty percent of all products sold (n=2336/3941) would carry the ‘high in’ symbol reflecting a high content in sodium, saturated fat and/or total sugar (39%, 16%, and 17%, respectively). For certain food categories, a slight reduction (5 to 15%) in sodium, saturated fat or total sugar content would allow removing the ‘high in’ symbol in a large number of products. For example, a 5% reduction of the sodium content in sliced breads would allow 22 percentage point (pp) fewer products to display the symbol.

This study presents a portrait of processed foods purchased in Québec (Canada) and the distribution of the FOP ‘high in’ symbol. Such portrait generates important data to monitor the food supply’s nutritional quality, which can ultimately contribute to improve the nutritional quality of processed foods.

Childhood obesity is increasing in many countries, including Kuwait. Currently, adiposity is most commonly assessed from simple anthropometric measurements, e.g. height and weight or combined as body mass index (BMI). This is despite these surrogate measurements being poor indices of adiposity. Bioelectrical impedance analysis (BIA) is a popular method for the assessment of body composition providing a measurement of adiposity as absolute fat mass (FM) or FM expressed as a percentage of body weight (%BF). BIA is, however, an indirect predictive method. This study developed a BIA-based prediction equation for body composition assessment in Kuwaiti children and, additionally, a prediction equation for %BF based on sum of skin-fold (SSF) thickness measurements.

A cross-sectional design was used with primary school recruitment.

School population in Kuwait City; in-clinic assessments.

158 Kuwaiti children aged 7-9 years. Body composition assessed using bioimpedance spectroscopy and skin-folds with prediction equations generate against deuterium dilution measurement of total body water and fat-free mass (FFM) as reference.

The newly developed and cross-validated BIA equation predicted FFM with minimal bias (< 1%) and acceptable 2 standard deviation limits of agreement (±1.6 kg equivalent to ±10%) improving on the predictive performance of comparable published equations. Similarly, SSF predicted %BF with small bias (0.2 %BF) but relatively wide limits of agreement (±7 %BF).

These new equations are suitable for practical use for nutritional assessment in Kuwaiti children, particularly in epidemiological or public health settings although their applicability in other populations requires further research.

Food insecurity (FI) in the higher education setting is a pressing social justice and public health nutrition issue. Persistent FI rates among students suggest that the current programs and institutional policies are inadequate. Engaging the community in co-design practices can enhance research and decision-making, leading to more targeted advocacy and solutions. This review describes and evaluates evidence of co-design approaches and identifies strategies for addressing FI in higher education settings.

A review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Literature was searched in three electronic databases (Scopus, Ovid MEDLINE and Web of Science) and two search engines (Google and Google Scholar).

Only studies based in higher education settings were included.

Higher education students.

The search identified 814 studies, of which 28 met the inclusion criteria. Studies involving co-design and participatory research frameworks had higher participation, leading to increased student awareness of FI, student leadership, and the development of campaigns and collaborative organisational structures. A content analysis approach identified seven categories for strategies targeting student FI: 1) policy and institutional support; 2) strategic partnerships 3) advocacy and awareness; 4) initiatives for student engagement; 5) student skills and knowledge development; 6) program development; and 7) campus food environment.

Co-designed research methodologies are important for addressing student FI, enhancing advocacy, and understanding stakeholder needs. Future studies should prioritise collaborative approaches when exploring solutions to FI and similar social justice issues affecting students.

Use of Online food delivery (OFD) platforms are on the rise and currently there are no public health policies that regulates what and how food is sold on these platforms. Research quantifying and describing the marketing strategies on OFD platforms is limited. Our study aimed to test the consumers’ acceptability of using two screen capture methods to record their food purchasing behaviour on OFD platforms and; to describe consumers’ exposure to, and engagement with, marketing strategies on OFD platforms in real-time.

Semi-structured online interviews on the consumer acceptability of the methods were analysed using thematic analysis. Screen recordings of OFD orders were analysed using content analysis, guided by the marketing mix framework (i.e. product, placement, price and promotion).

Victoria, Australia

Twenty adults using OFD service at least once a month were recruited.

Mean age of the sample was 28 years. 75% were females, over 80% had completed higher education and 20% lived with children <18 years of age. Over half used OFD service two to five times per week. Participants expressed that both smartphone’s in-built screen recording function and third-party screen recording application are easy-to-use and time-efficient with high levels of user satisfaction. A range of marketing strategies were observed on OFD platform. These included presence of, and strategic placement of selected food products, price discounts and promotion strategies. Participants appeared to engage with marketing strategies through multiple clicks to reduce the total cost of their OFD order.

Our study demonstrates that screen recording is an acceptable method for capturing and assessing consumers’ real-time exposure to, and engagement with, a range of marketing strategies on OFD platform. Studies with larger samples are needed to substantiate our findings.

We evaluated the impact of an established nutrition education intervention, ‘PhunkyFoods’ on food literacy, cooking skills, and fruit and vegetable intake in primary school aged children.

A pre-registered cluster randomised controlled trial was used; the intervention group received the ‘PhunkyFoods’ programme and the wait-list control group received the usual school curriculum. Primary outcomes measured were differences in food literacy and cooking skills scores between the intervention and control arms after 12 months adjusted for baseline values.

The trial was undertaken in 26 primary schools in North Yorkshire, UK.

631 children aged 6 – 9 years participated (intervention n = 307, control n = 324) through assemblies, classroom activities and after-school clubs.

There were no significant effects of the intervention compared to control on food literacy, cooking skills, vegetable intake or fruit intake. Adjusting for baseline, the Food Literacy Total Score was 1.13 points lower in the intervention group than the control (95% CI -2.87 to 0.62, p = 0.2). The Cooking Skills Total Score was 0.86 lower in the intervention group compared to the control (95% CI = -5.17 to 3.45, p = 0.69). Girls scored 2.8 points higher than boys in cooking skills across the sample (95% CI = 0.88 to 4.82, p < 0.01).

The intervention did not result in improved food literacy or cooking skills, though sex effects on these outcomes were observed. More practical food preparation hours are needed in primary schools to improve likelihood of an effect on outcomes.

To explore the information available in school food purchase data and to ascertain the potential to assess pupils’ dietary intakes. The proportion of purchased food and drink items that were linked to (i) an Intake24 food group, and (ii) a nutrient code from the UK NDNS Databank, was calculated.

Pupil-level food purchase data covering the whole school day was obtained. Each item purchased was linked to an Intake24 food group and an NDNS Nutrient Databank code. Depending on the level of detail provided, items may have been assigned both a food group and a nutrient code, a food group only or neither for items which did not contain enough information about the type of food or drink purchased.

Five secondary schools in northeast England

Secondary school pupils aged 11-16 years

The data captured 119,125 purchases made by 3466 pupils. 92% of item descriptions were assigned a food group, this equated to 82% of total purchases. 70% were assigned an NDNS Databank nutrient code, which accounted for 60% of total purchases. 8% of items had insufficient information and did not have a food group or a nutrient code assigned.

The methodological challenges of collecting dietary data from pupils in the secondary school setting are significant. Purchase data offers an alternative, objective approach to collecting information on school food choices, across the school day and for a large sample of pupils. With further development the potential to use purchase data to assess intakes could be achieved.

To map out evidence on instruments for evaluating organisational food environments of workplaces and the components and dimensions considered in the identified instruments.

Scoping review that includes studies published as of January 2005, the year of publication of the model developed by Glanz et al. (2005). The databases consulted were PubMed, Embase, Web of Science, PsycINFO, Scopus, and Google Scholar until November 2024, without language restrictions. Studies were included if they evaluated the food environment of workplaces such as companies/factories, universities/post-secondary institutions/technical colleges, and hospitals/health care units. The conceptual model of Castro and Canella (2022), considering its components and dimensions, was used to synthesize the data.

After full reading, 54 articles were selected. Most were conducted in the United States and Brazil, although there were studies from 16 countries. A total of 36 instruments were identified: 19 were used in universities, 8 in hospitals, and 11 in companies. No instrument included all components and dimensions of the conceptual model; however, 3 instruments included most of them. The most evaluated component was the internal level of eating spaces, and the most evaluated dimensions were availability and quality of foods/beverages in eating spaces. Of the 36 instruments, 29 reported some measure of validity or reproducibility. The limitation most reported by the studies was the non-generalization of results because samples are limited.

Evaluations of the organisational food environment of workplaces can be used for monitoring, planning interventions and formulating public policies for such places, thereby enhancing workers’ health.

This research provides the first population-based investigation of IPV and women’s dietary intake of iron and Vitamin A rich foods using representative data from eight low-and-middle-income countries.

Using multivariable logistic regression, we estimated the relationship between various forms of past year IPV (physical, emotional, and sexual) and consumption of Vitamin A and iron-rich foods.

We conducted secondary data analysis of cross-sectional Demographic and Health Surveys from Cambodia (2021, N=5,640), Nepal (2022, N=4179), Sierra Leone (2019, N=3,812), Nigeria (2018, N=8,313), Tajikistan (2017, N=4,800), Cote D’Ivoire (2021, N=3,656), Kenya (2022, N=10,758), and the Philippines (2022, N=12,278).

Women of reproductive age (15-49 years) comprised the analytical sample.

Results revealed distinct relationship patterns between various IPV forms and women’s dietary consumption of micro-nutrient rich foods. The most consistent relationships being that past year (i) sexual IPV (aOR: 0·72, 95%CI: 0·53-0·98), (ii) physical IPV (aOR: 0·86, 95%CI: 0·73-1·01), and (iii) emotional IPV (aOR: 0·81, 95%CI: 0·70-0·94) significantly reduced the odds of consuming iron-rich foods in the pooled analyses. Due to between country heterogeneity concerning the relationship between IPV and Vitamin A, pooled estimates for dietary Vitamin A consumption were non-significant. However, in the Philippines IPV was associated with reduced dietary Vitamin A intake.

IPV is associated with altered dietary intake patterns and between-country differences could be due to different food environments. Mechanisms explaining our findings may involve consequences of IPV that impact diet and dietary practices: depression, control of resources, and physical trauma.

We determined whether Dietary Species Richness (DSR) i) can be robustly measured using four-day food intake data, ii) is dependent on sociodemographic characteristics, and iii) is associated with diet quality.

The National Diet and Nutrition Survey (NDNS) nutrient databank 2018–2019 was expanded to include FoodEx2 food classifications, ingredients, the number and identity of unique species, Nutrient Rich Food 8.3 (NRF8.3) Index scores, and greenhouse gas (GHG) emissions. Four-day food intake data and sociodemographic variables were used to calculate diet quality and DSR on the food and diet level.

The United Kingdom (UK).

Participants from NDNS 9 to 11 (2016-2019).

Composite dishes had the highest DSR (median 8 [Q1=4, Q3=12]), followed by seasoning, sauces, and condiments (median 7, [Q1=4, Q3 =10]) and, grains and grain-based products (median 5, [Q1=2, Q3=7]). Median DSR over four days was 49 [Q1=43, Q3=56; range 14 - 92], with the first two days achieving 80% of DSR measured over four days. DSR was significantly higher in those who were younger, those with a higher household income, or those with a lower level of deprivation (all p<0.001). Higher DSR was associated with a small but significant improvement in nutritional quality (p<0.001). Also, adherence to dietary guidelines such as fibre, fruits and vegetables, and fish was associated with significantly higher DSR (all p<0.001).

We successfully established DSR based on four-day food intake data. We also identified opportunities to improve DSR by increasing the consumption of fruits, vegetables, fibre, and fish.

To use the validated Online Quality Assessment Tool (OQAT) to assess the quality of online nutrition information.

The social networking platform formerly known as Twitter (now X).

Utilising the Twitter search application programming interface (API; v1.1), all tweets that included the word ‘nutrition’, along with associated metadata, were collected on seven randomly selected days in 2021. Tweets were screened, those without a URL were removed and the remainder grouped on retweet status. Articles (shared via URL) were assessed using the OQAT, and quality levels assigned (low, satisfactory, high). Mean differences of retweeted and non-retweeted data were assessed by Mann-Whitney U test. The Cochran-Mantel-Haenszel test was used to compare information quality by source.

In total, 10,573 URLs were collected from 18,230 tweets. After screening for relevance, 1,005 articles were assessed (9,568 were out of scope) sourced from: professional-blogs (n=354), news-outlets (n=213), companies (n=166), personal-blogs (n=120), NGOs (n=60), magazines (n=55), universities (n=19), government (n=18). Rasch measures indicated the quality levels; 0-3.48, poor, 3.49-6.3, satisfactory and, 6.4-10, high quality. Personal and company-authored blogs were more likely to rank as poor quality. There was a significant difference in quality of retweeted (n=267, sum of rank, 461.6) and non-retweeted articles (n=738, sum of rank, 518.0), U = 87475, p=0.006, but no significant effect of information source on quality.

Lower-quality nutrition articles were more likely to be retweeted. Caution is required when using or sharing articles, particularly from companies and personal blogs, which tended to be lower-quality sources of nutritional information.

Examine the extent and nature of food and non-alcoholic drink advertising displayed on public transport and infrastructure on school routes.

Audit of outdoor advertisements on government-controlled public transport and associated infrastructure (e.g., tram shelters, bus stops) on busy school routes in Victoria, Australia. Using a strict protocol, trained field workers collected data on the type and content of outdoor advertising during February 2023 (start of school year). Food/drink advertising was classified (unhealthy or healthy) according to the Council of Australian Governments Health Council National interim guide to reduce children’s exposure to unhealthy food and drink promotion (2018).

Government-controlled buses, trams and public transport infrastructure on routes from eleven of the busiest train stations in metropolitan Melbourne and regional Victoria, Australia to 50 public primary and secondary. Stations were chosen based on annual patronage, area-based socioeconomic status (SEA) and regionality)

156 out of 888 advertisements were for food and non-alcoholic drinks. Of these, almost six in ten (58%) were deemed unhealthy irrespective of SEA or regionality. Marketing appeals most featured were taste (31%), convenience (28%) and emotion (9%). A significantly higher proportion of unhealthy advertisements were displayed within 500m of schools versus outside this radius (91% vs 57%, p<0.01).

Given detrimental impacts of exposure to unhealthy food/drink advertising on children’s diets, the pervasive, powerful presence of such advertising across government public transport assets, particularly around schools, contradicts public health recommendations to protect children from exposure to and influence by this harmful marketing and warrants government action.

Underweight, wasting, and stunting are crucial malnutrition indicators responsible for morbidities among children. Data regarding coexisting forms of malnutrition (CFM) is scarce. We aimed to investigate the prevalence and associated factors of CFM across two survey years among under-5 Bangladeshi children.

Cross-sectional study.

Data were acquired from two rounds of Multiple Indicator Cluster Survey (MICS), Bangladesh conducted in 2012-13 and 2019.

The analysis included 43,946 (2012-13: 20,885; 2019: 23,061) under-5 children.

Binomial proportion test, slope index of inequality, and multinomial logistic regression models were used for analysis. The prevalence of CFM was 27.45% and 18.56% in 2012-13 and 2019, respectively. A significant decrease in the prevalence of CFM was seen across the surveys (p-value<0.001). Children from urban residence [(2012-13:aOR=0.70, 95% CI:0.64,0.77); (2019:aOR=0.71, 95% CI:0.65,0.78], higher maternal education [(2012-13:aOR=0.28, 95% CI:0.24,0.32); (2019:aOR=0.28, 95% CI:0.24,0.32], larger size at birth [(2012-13:aOR=0.62, 95% CI:0.52,0.73); (2019:aOR: 0.60, 95% CI:0.50,0.73], richest wealth quintile [(2012-13:aOR=0.25, 95% CI:0.22,0.28); (2019:aOR: 0.30, 95% CI:0.27,0.34)] had lower odds of suffering from CFM compared to their counterparts. Children from poorer quintiles were more influenced by CFM than richer quintiles (Coef.:-0.175, 95% CI:-0.192,-0.157, p-value<0.001). Higher percentage of CFM was observed among rich families in 2019 compared to 2012-13 (24.50% and 20.15%, respectively; p-value<0.001)

The findings of this study should help the researchers and policymakers to understand CFM more clearly and plan prospective studies to explore CFM outcomes. Targeted interventional approaches are needed among parents of rural communities to control the burden of CFM.

To explore the perceptions, drivers, and potential solutions to consumption of unhealthy, ultra-processed foods (UPF) and foods high in fat, salt and sugar (HFSS), and their contribution to the double burden of malnutrition in adolescents living in urban slums, Kenya.

Qualitative participatory research, through Photovoice, group discussions and community dialogues. Inductive, thematic analysis was undertaken.

Three major slums, Nairobi.

Adolescents 10-19 years (n=102: 51 boys, 51 girls) and adults (n=62).

UPF/HFSS consumption emerged as a predominant theme on the causes of undernutrition and overweight/obesity and foods commonly consumed by adolescents. Adolescents described UPF/HFSS as junk, oily, sugary or foods with chemicals, and associated UPF/HFSS consumption with undernutrition, obesity, non-communicable diseases. They perceived UPF/HFSS as modern, urban, classy, appealing to young people, and minimally processed foods as boring, primitive, for older people, and those in rural areas. Individual-level drivers of UPF/HFSS consumption were organoleptic attributes (taste/aroma), body size/shape, illicit drug use, convenience, adolescents’ autonomy. Social environment drivers were peer-pressure and social status/aspirations. Physical environment drivers were UPF/HFSS availability and accessibility in the slums. Education on healthy eating and adverse effects of consuming UPF/HFSS, through existing structures (youth groups, school, community health strategy) was proposed as potential solution to UPF/HFSS consumption.

UPF/HFSS were perceived as associated with poor nutrition and health, yet were preferred over unprocessed/minimally processed foods. Interventions to promote healthy diets beyond raising awareness are important, while address the underlying perceptions and drivers of UPF/HFSS consumption at individual-level, and social and physical food environments.

To examine associations of Dietary Inflammatory Index (DII) scores with disability and subjective health, which is prognostic of disability, in a large, systematically sampled population of older adults living in non-urban areas in Japan.

Cross-sectional. The Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) was used to assess disability. Both overall disability and disabilities in components of everyday competence (instrumental activities of daily living [IADLs], intellectual activities, and social participation) were examined. Participants who reported an inability to perform one or more activities were categorized as disabled. Subjective health was assessed based on the response to the following question: “In general, how do you feel about your own health?”

Six non-urban municipalities in Japan that differ in terms of regional characteristics.

Adults aged 65–74 years (n = 7930).

DII scores were positively associated with the odds of overall disability (odds ratio [OR] [95% confidence interval {CI}]) = 1.23 [1.19, 1.28]); disabilities in IADLs (OR [95% CI] = 1.10 [1.05, 1.15]); intellectual activities (OR [95% CI] = 1.28 [1.23, 1.33]); social participation [OR (95% CI] = 1.17 [1.13, 1.22)]; and poor subjective health (OR [95%CI] = 1.09 [1.05, 1.14]).

Our results imply the importance of reducing dietary inflammation to prevent both disability and a decline in subjective health, a predictor of disability.

To describe the development and validation of the Nova Food-Frequency Questionnaire (NovaFFQ) for Brazilian adults.

The NovaFFQ is a self-administered, semi-quantitative questionnaire. The food list includes the most consumed foods and drinks based on 2017-2018 National Food Intake Survey data. We identified and differentiated foods that could be classified into multiple Nova groups. We assessed reproducibility and criterion validity using the percent energy contribution of each Nova group. Reproducibility was assessed by comparing NovaFFQ estimates on two occasions. Criterion validity was assessed by comparing the first NovaFFQ estimate against the mean of two Nova24h recalls. We estimated the intraclass correlation coefficients for both analyses and assessed the agreement of classification into quintiles using the prevalence-and-bias-adjusted kappa coefficients for criterion validity analysis.

Nationwide Brazilian study, the NutriNet-Brasil cohort.

There were 243 participants in the reproducibility analysis and 377 in the criterion validity analysis.

Strong reproducibility was observed, with an intraclass correlation coefficient of 0.91 for all the Nova groups. Criterion validity showed a moderate intraclass correlation coefficient, ranging from 0.61 for processed and ultra-processed foods to 0.65 for unprocessed and minimally processed foods. Substantial agreement in ranking individuals across quintiles was found, as indicated by the prevalence-and-bias-adjusted kappa (PABAKs= 0.74, 0.72, 0.70 and 0.73 for unprocessed and minimally processed foods, culinary ingredients, and processed and ultra-processed foods, respectively).

The NovaFFQ is a valid instrument for assessing food consumption by processing level, especially for discriminating individuals according to the magnitude of consumption in all Nova groups.

The study examined the impact of the Diabetes Prevention and Management program on dietary tracking, changes in dietary behavior, glycosylated hemoglobin (HbA1c) and weight loss over six months among rural adults with type 2 diabetes and prediabetes. The program was a health coach (HC)-led, community-based lifestyle intervention.

The study used an explanatory sequential quantitative and qualitative design to gain insight on participant’s dietary behavior and macronutrient consumption as well as experience with food tracking. Five of the 22 educational sessions focused on dietary education. Participants were taught strategies for healthy eating and dietary modification. Trained HCs delivered the sessions and provided weekly feedback to food journals.

Obese adults with type 2 diabetes or prediabetes (n=94) participated in the program and fifty-six (66%) completed dietary tracking (optional) for six months. Twenty-two participated in three focus groups.

Fifty-nine percent consistently completed food journals. At 6 months, average diet self-efficacy and dietary intake improved, and average weight loss was 4.58 ± 9.14lbs. Factors associated with weight loss included attendance, consistent dietary tracking, higher HbA1c, diabetes status, and calorie intake (Adjusted R2 = 43.5%; F=.003). Focus group participants reported the program improved eating habits. Consistency of dietary tracking was cumbersome yet was beneficial for making better choices and key to being honest.

Participants who consistently tracked their diet improved dietary self-efficacy and intake over six months. This model has the potential to be reproduced in other rural regions of the United States.

There have been unsafe levels of unpaired fructose in the high fructose corn syrup (HFCS) in U.S. beverages, and research/case study evidence shows their intake is associated with greater asthma prevalence/risk/incidence, a debilitating disease, likely due to fructose-malabsorption, gut fructosylation, and gut dysbiosis mechanisms. The “unexplained” asthma epidemic has disproportionately affected children and Black individuals, groups with higher fructose-malabsorption prevalence than others, and research to assess disproportionately higher asthma risk/incidence among Black individuals in association with HFCS sweetened beverage intake is lacking.

Demographic, lifestyle, dietary data collected at enrollment/(1985-86), and incident asthma through exam 5/(1995-96), were used in Cox proportional hazards models to assess HFCS intake associations (hazard-ratios) with asthma risk/incidence.

CARDIA-Study participants from Birmingham, AL, Chicago, IL, Minneapolis, MN, and Oakland, CA.

1998 Black and 2104 White young adults.

HFCS sweetened beverage intake >once/wk was significantly associated with higher asthma risk relative to ≤ once/wk, (P-trend=0.04), among Black participants only; risk was 2.8 times higher among 2-4 times/wk consumers (HR=2.8, 95% CI 1.1-7.3, P=0.04), and 3.5 times higher when consumed multiple times/d, independent of sucrose intake/obesity/dietary quality/smoking/in-home smoke-exposure (HR=3.5, 95% CI 1.3-9.9, P=0.02). Intake of orange juice, with nominal unpaired fructose, was not associated with asthma in either group, nor was intake of sucrose, a disaccharide (paired) of fructose/glucose.

Ubiquitous HFCS in the U.S. food supply, with HFCS that contains high/unsafe unpaired fructose, a.k.a. excess-free-fructose, and the fructose/gut/lung/axis are overlooked risk factors in the “unexplained” U.S. asthma epidemic that disproportionately affects Black individuals.