Journal of the Academy of Nutrition and Dietetics最新文献

{"title":"Housing Insecurity and Disordered Eating Behaviors in Adolescents: A Cross-Sectional Study Using 2022 National Survey of Children's Health Data.","authors":"Namrata Sanjeevi, Kayla Hooker","doi":"10.1016/j.jand.2026.156318","DOIUrl":"10.1016/j.jand.2026.156318","url":null,"abstract":"<p><strong>Background: </strong>Engagement in disordered eating behaviors (DEBs) during adolescence could have long-term implications on health. Previous studies investigating protective and risk factors of DEBs have predominantly focused on individual- and family-level aspects.</p><p><strong>Objective: </strong>The objective of this study is to examine association of housing insecurity with DEBs in a nationally representative sample of adolescents from low-income households.</p><p><strong>Design: </strong>A cross-sectional study design was used.</p><p><strong>Participants/setting: </strong>Using 2022 National Survey of Children's Health data, adolescents, aged 12 years or older, and from households with incomes ≤200% federal poverty level were included (N = 5607). Housing insecurity was defined as experiencing 1 of the following: inability to pay mortgage/rent on time, history of homelessness, multiple moves, and caregiver stress on eviction/foreclosure.</p><p><strong>Main outcome measures: </strong>Main outcome measures were engagement in 1 or more DEB and individual DEBs.</p><p><strong>Statistical analyses: </strong>Logistic regression models, adjusted for demographic covariates and food security status, examined associations of experiencing housing insecurity with engaging in 1 or more DEB as well as individual DEBs (ie, skipping meals or fasting, having low interest in food, extremely picky eating, or binge eating) in male and female adolescents.</p><p><strong>Results: </strong>Housing insecurity was significantly associated with greater odds of engaging in 1 or more DEB in female adolescents (odds ratio [OR] 1.52; 95% CI, 1.07 to 2.15). Housing insecurity also was significantly associated with greater odds of low interest in food (OR 1.64; 95% CI, 1.07 to 2.51) and extremely picky eating (OR 1.89; 95% CI, 1.20 to 2.99) in female adolescents.</p><p><strong>Conclusions: </strong>Study findings indicate that housing insecurity is associated with certain DEBs in female adolescents, independent of food security status. Additional research is needed to elucidate mechanisms linking housing insecurity and DEBs in adolescents.</p>","PeriodicalId":379,"journal":{"name":"Journal of the Academy of Nutrition and Dietetics","volume":" ","pages":"156318"},"PeriodicalIF":4.0,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146256870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Household Water Insecurity Is Associated With Greater Likelihood of Early Exclusive Breastfeeding Cessation and Diarrhea Among Children Aged 6 to 59 Months in Ethiopia: Data From Haramaya University Health and Demographic Surveillance System.","authors":"Kedir Teji Roba, Akililu Abrham Roba, Jemal Yousuf Hassen, Gretchen Thompson, Alexandra Brewis, Asher Y Rosinger","doi":"10.1016/j.jand.2026.156303","DOIUrl":"10.1016/j.jand.2026.156303","url":null,"abstract":"<p><strong>Introduction: </strong>In low-resource settings, exclusive breastfeeding (EBF) and household water security are recognized contributors to child health. Yet few studies have examined how they are related.</p><p><strong>Objectives: </strong>This study aims to (1) test the relationship between domains of household water insecurity and EBF cessation before 6 months, and (2) examine the association between water insecurity and recent child diarrheal disease and stunting.</p><p><strong>Design: </strong>The Haramaya University Health and Demographic Surveillance System is a cross-sectional survey.</p><p><strong>Participants/setting: </strong>Mother-child (aged 6-59 months) dyads (n = 1019) were recruited from smallholder agricultural households in rural Eastern Ethiopia in 2019.</p><p><strong>Main outcome measures: </strong>The primary outcome was EBF cessation before 6 months. Secondary outcomes were children's diarrhea (last 2 weeks) and stunting. Exposure variables assessing water insecurity included time spent fetching water, objective water quality (Escherichia coli presence), water source reliability, and overall household water insecurity status (classified using the Household Water InSecurity Experiences Scale).</p><p><strong>Statistical analyses: </strong>Survey logistic regression models were used to assess associations of water insecurity domains with early EBF cessation, diarrhea, and stunting.</p><p><strong>Results: </strong>Poor water quality (adjusted odds ratio [AOR], 1.42; 95% confidence interval [CI], 1.06-1.98), unreliable water (AOR, 1.44; 95% CI, 1.04-1.98), and water fetching time >30 minutes (AOR, 1.54; 95% CI, 1.15-2.05) were associated with early EBF cessation risk. Children in households classified as moderate (AOR, 1.54; 95% CI, 1.03-2.30) or high water insecurity (AOR, 2.07; 95% CI, 1.33-3.24) had a greater risk of diarrhea. No association was observed between domains of water insecurity and stunting.</p><p><strong>Conclusion: </strong>Multiple domains of water insecurity were associated with early EBF cessation, and overall water insecurity was associated with children's diarrheal risk. Water insecurity has been identified as a key programmatic and policy consideration for early childhood nutrition.</p>","PeriodicalId":379,"journal":{"name":"Journal of the Academy of Nutrition and Dietetics","volume":" ","pages":"156303"},"PeriodicalIF":4.0,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146117298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neonatal Malnutrition Diagnoses Align Differently With Body Composition Outcomes: A Retrospective Cohort Analysis Evaluating 3 Different Growth Standards.","authors":"Louise Perna, Kera McNelis, Jacqueline Wessel, Stephanie Merlino Barr, Chunyan Liu, Shelley Ehrlich, Jae H Kim, Ting Ting Fu","doi":"10.1016/j.jand.2026.156304","DOIUrl":"10.1016/j.jand.2026.156304","url":null,"abstract":"<p><strong>Background: </strong>Proposed neonatal malnutrition criteria exist for nutritional assessment. Recommendations differ regarding which growth chart to use after premature birth.</p><p><strong>Objective: </strong>This study compared malnutrition classification across Fenton, Olsen, and International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH) growth charts; examined their associations with body composition; and evaluated discrepancies in identifying fat-free mass (FFM) deficit and fat mass (FM) excess in preterm infants.</p><p><strong>Design: </strong>This was a retrospective cohort study of preterm infants who underwent air displacement plethysmography.</p><p><strong>Participants and setting: </strong>Two hundred eighty-five preterm infants (<37 weeks) from 4 Ohio neonatal intensive care units (2012-2023) were included. After excluding 22 infants for early air displacement plethysmography assessments (at or before 14 days) and 5 for gestational age <23 weeks + 4 days, 258 remained.</p><p><strong>Main outcome measures: </strong>Main outcomes were malnutrition diagnosis using weight z score decline from birth to air displacement plethysmography assessment for each growth chart and FFM and FM z scores.</p><p><strong>Statistical analyses performed: </strong>Linear regression models compared relationships between weight z score change amongst the 3 growth charts and with FFM and FM z scores. κ Coefficient and Bowker or McNemar test assessed malnutrition agreement between charts. Kruskal-Wallis test compared median body composition z scores across malnutrition categories.</p><p><strong>Results: </strong>The 3 charts demonstrated strong associations between weight z score changes (R² = 0.8 to 0.9) but statistically significant discrepancies in malnutrition classifications (Fenton vs INTERGROWTH κ = 0.46, 95% CI 0.36 to 0.57; INTERGROWTH vs Olsen κ = 0.49, 95% CI 0.36 to 0.61; Fenton vs Olsen κ = 0.69, 95% CI 0.61 to 0.77; P < .05). INTERGROWTH identified fewer cases of malnutrition (P < .0001). Weight z score change and size-for-gestational-age exhibited significant associations with body composition z scores (P < .0001). Fenton classified more malnutrition in infants with low FFM (46.1% vs 16.4%; P < .0001), whereas INTERGROWTH classified more infants with no malnutrition in those with high FM (94.8% vs 69%; P < .0001).</p><p><strong>Conclusions: </strong>Fenton growth chart is more likely than Olsen or INTERGROWTH to categorize infants with low FFM as having malnutrition.</p>","PeriodicalId":379,"journal":{"name":"Journal of the Academy of Nutrition and Dietetics","volume":" ","pages":"156304"},"PeriodicalIF":4.0,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146117279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Scoping Review of Dietary Management for Nondiabetic Gastroparesis: Evidence Limitations and Research Gaps.","authors":"Gemma P Fagan, Reema Rabheru, Danielle E Bear, Miranda C E Lomer","doi":"10.1016/j.jand.2026.156302","DOIUrl":"10.1016/j.jand.2026.156302","url":null,"abstract":"<p><strong>Background: </strong>Dietary management is essential in gastroparesis, but existing guidelines primarily focus on diabetic gastroparesis, highlighting a lack of evidence-based guidelines for patients with nondiabetic gastroparesis, who experience higher malnutrition and mortality rates. Management is complicated by a suggested bidirectional relationship with eating disorders.</p><p><strong>Objective: </strong>To investigate evidence on dietary interventions, patterns, and intake in nondiabetic gastroparesis, including effects on symptoms, nutritional outcomes, quality of life (QoL), and their potential role in disordered eating behaviors.</p><p><strong>Methods: </strong>A scoping review was conducted using the Joanna Briggs Institute methodology. A comprehensive search was conducted across 8 databases: Embase, MEDLINE, Web of Science Core Collection, Global Health, CINAHL, Scopus, CENTRAL and PsycInfo, alongside gray literature and citation searching. English-language studies from 2008 investigating dietary interventions, patterns, and intake in adults with objectively confirmed nondiabetic gastroparesis (idiopathic, autoimmune-related, postviral, or eating disorder-associated causes) were included. Two reviewers independently screened, extracted data, and synthesized findings using a narrative approach.</p><p><strong>Results: </strong>Of 6212 articles screened by title/abstract, 88 underwent full-text review, and 13 met inclusion criteria. Of these, 7 studies examined dietary interventions, 5 assessed dietary patterns, and 2 reported dietary intake. Two were randomized controlled trials (RCTs) including 16 participants with nondiabetic gastroparesis; the remaining 11 observational studies included 679 participants with confirmed nondiabetic gastroparesis and 752 for whom cause was unspecified or delayed gastric emptying could not be confirmed. All included studies assessed symptom burden; 5 reported nutritional outcomes, and 2 evaluated dietary impact on QoL. No studies explored the role of diet in disordered eating. Considerable variation was observed in dietary management strategies across studies.</p><p><strong>Conclusion: </strong>Research on dietary management in nondiabetic gastroparesis is limited, with significant variability in interventions, dietary definitions, and study designs, reflecting lack of standardization across intervention protocols and research methodology. Well-designed trials are needed to clarify the impact of diet on symptoms, nutritional status, and QoL, considering psychosocial effects and potential disordered eating risks.</p>","PeriodicalId":379,"journal":{"name":"Journal of the Academy of Nutrition and Dietetics","volume":" ","pages":"156302"},"PeriodicalIF":4.0,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146117248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effectiveness of Medical Nutrition Therapy in Prevention and Treatment of Chronic Disease: A Position Paper of the Academy of Nutrition and Dietetics","authors":"Lisa Moloney PhD, RDN ,&nbsp;Mary Rozga PhD, RDN ,&nbsp;Alison Steiber PhD, RDN ,&nbsp;Deepa Handu PhD, RDN","doi":"10.1016/j.jand.2025.10.010","DOIUrl":"10.1016/j.jand.2025.10.010","url":null,"abstract":"<div><div>It is the position of the Academy of Nutrition and Dietetics that all individuals with nutrition-related health conditions or risk factors should have access to medical nutrition therapy (MNT) provided by a registered dietitian nutritionist (RDN). MNT provided by RDNs is effective in improving health outcomes for many chronic conditions that are leading drivers of morbidity, mortality, and health care costs in the United States. Widespread access to MNT using an individualized, client-centered, and evidence-based approach has the potential to improve population health, reduce health disparities, and reduce health care costs associated with nutrition-related health conditions. This Academy of Nutrition and Dietetics position paper summarizes recent evidence from systematic reviews on the effectiveness of MNT provided by an RDN for the prevention and treatment of nutrition-related health conditions. A total of 25 systematic reviews published between 2017 and 2024 were summarized and assessed for certainty of evidence. Systematic reviews with high or moderate certainty of evidence demonstrate that MNT is likely effective in improving a range of health outcomes in adults with pre-diabetes, type 1 diabetes, type 2 diabetes, obesity, pre-hypertension, hypertension, dyslipidemia, chronic kidney disease, head and neck cancer, and chronic obstructive pulmonary disease compared with no MNT or standard care. Barriers exist to accessing MNT, including inadequate staffing of RDNs in some areas, a lack of provider referrals to an RDN for MNT, and a lack of payer coverage and reimbursement. This position was approved in September 2025 and will remain in effect until December 31, 2032.</div></div>","PeriodicalId":379,"journal":{"name":"Journal of the Academy of Nutrition and Dietetics","volume":"126 2","pages":"Article 156219"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-Efficacy: The Key to Nutrition Facts Label Use: Theory-Based Findings from the 2019 Food and Drug Administration Food Safety and Nutrition Survey","authors":"Fanfan Wu PhD,&nbsp;Martine Ferguson MS,&nbsp;Amy Lando MPP,&nbsp;Linda Verrill PhD","doi":"10.1016/j.jand.2025.09.007","DOIUrl":"10.1016/j.jand.2025.09.007","url":null,"abstract":"<div><h3>Background</h3><div>The Nutrition Facts label is a useful tool for consumers to achieve a healthy diet.</div></div><div><h3>Objective</h3><div>This study aimed to develop and test a theoretical framework examining factors that may influence consumers’ use of the Nutrition Facts label, using a nationally representative sample.</div></div><div><h3>Design</h3><div>Analyses of cross-sectional, nationally representative 2019 Food and Drug Administration Food Safety and Nutrition Survey data included developing a theoretical framework adopting key constructs from 2 health behavior theories—the Integrated Behavior Model and the Theory of Planned Behavior—to test research hypotheses.</div></div><div><h3>Participants and Setting</h3><div>Participants were 2041 US adults who participated in the 2019 Food and Drug Administration Food Safety and Nutrition Survey, Nutrition Version.</div></div><div><h3>Main Outcome Measures</h3><div>Consumers’ use of the Nutrition Facts label, health habits, self-efficacy, attitude, knowledge and skills, economic conditions, health status, potential exposure to the Nutrition Facts label, age, sex, education, race/ethnicity, and urbanicity were measured.</div></div><div><h3>Statistical Analyses Performed</h3><div>A structural equation model was used.</div></div><div><h3>Results</h3><div>Eighty-seven percent of respondents reported having used the Nutrition Facts labels on food packages. Among all factors tested, self-efficacy has the strongest positive relationship with consumers’ use of the label (standardized regression estimate = .67; <em>P</em> &lt; .001). Findings also suggest that people living in urban areas are more likely to report using the Nutrition Facts label (standardized regression estimate = .11; <em>P</em> = .02). Results suggest that although knowledge and skills and attitude are not directly associated with consumers’ label use, the relationship between these 3 constructs is strongly mediated by self-efficacy (standardized regression estimates = .38; <em>P</em> &lt; .001 and .10; <em>P</em> = .01, respectively). Furthermore, individuals with better health status and more exposure to the Nutrition Facts label are more likely to have higher levels of self-efficacy (standardized regression estimates = .34; <em>P</em> &lt; .001 and .28; <em>P</em> &lt; .001, respectively).</div></div><div><h3>Conclusions</h3><div>This study highlights the vital role self-efficacy plays in the theoretical model determining consumers’ use of the Nutrition Facts label. The results also shed light on the factors that are important to consider when developing strategies to increase self-efficacy for Nutrition Facts label use and target populations for education and intervention.</div></div>","PeriodicalId":379,"journal":{"name":"Journal of the Academy of Nutrition and Dietetics","volume":"126 2","pages":"Article 156205"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145068838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Greenhouse Gas Emission Menu Icons Decrease Service of All Menu Items in Residential Dining Halls at a Large, Midwestern Public US University","authors":"Andrew D. Jones PhD ,&nbsp;Lesli Hoey PhD ,&nbsp;Cindy W. Leung ScD ,&nbsp;Melissa J. Slotnick PhD ,&nbsp;Wei Hao PhD ,&nbsp;Kitty Oppliger MPH ,&nbsp;Alex Bryan ,&nbsp;Steve Giardini MBA ,&nbsp;Ha Young Kim ,&nbsp;Steve Mangan ,&nbsp;Hailey McQuaid MS ,&nbsp;Melanie Reid ,&nbsp;Keith Soster","doi":"10.1016/j.jand.2025.09.008","DOIUrl":"10.1016/j.jand.2025.09.008","url":null,"abstract":"<div><h3>Background</h3><div>Reducing food-related greenhouse gas (GHG) emissions is essential for meeting global climate goals. Consumer information food labels are often associated with healthier diet choices, although less is known about the influence of environment-focused food labels.</div></div><div><h3>Objective</h3><div>Determine the effect of GHG emission menu icons on the service and intake of high-emission menu items in residential dining halls of a large, midwestern public US university.</div></div><div><h3>Design</h3><div>A cluster-randomized mixed-methods study design was employed. Three matched pairs of dining halls were randomized to intervention or control status. Data were collected on the amount of menu items served at dining halls; recent diet intake among a survey of frequent diners; and changes in food choices in response to menu icons among focus group participants.</div></div><div><h3>Participants and Setting</h3><div>The study was conducted in 6 residential dining halls. Foodservice data were based on 1 017 447 entries into dining halls; data were analyzed from 799 frequent diners who submitted survey responses at baseline (January 2022) and follow-up (March to April 2022). Five focus groups were conducted with 23 frequent diners in total across all groups.</div></div><div><h3>Intervention</h3><div>Traffic light-style GHG emission menu icons, representing the life cycle emissions of recipes, were displayed on all menu items in intervention dining halls for 10 weeks following a 4-week baseline period, alongside informational materials explaining the icons.</div></div><div><h3>Main Outcome Measures</h3><div>The difference between treatment groups in the change in per-person service (in grams) of high-emission menu items from baseline to follow-up.</div></div><div><h3>Statistical Analyses</h3><div>Generalized estimating equations using a gamma distribution and log link function were used to model treatment effects.</div></div><div><h3>Results</h3><div>Analyses of all menu items served indicated that per-person service (in grams) of high-, moderate-, and low-GHG emission menu items was lower at follow-up compared with baseline in intervention dining halls. This observed decline in service was statistically significantly greater than the change in service in control dining halls, wherein service declined more modestly or increased. Examining menu items that were exactly matched within dining hall pairs, only the service of low-emission menu items within intervention halls declined to a greater extent compared with control halls. Data from self-reports of recent diet by frequent diners showed no statistically significant treatment effects for the frequency of intake of any food category or overall diet quality.</div></div><div><h3>Conclusions</h3><div>GHG emission menu icons may not be sufficient to shift consumer food choices at scale in university dining settings.</div></div>","PeriodicalId":379,"journal":{"name":"Journal of the Academy of Nutrition and Dietetics","volume":"126 2","pages":"Article 156206"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 2-Group Path Analysis of a Food Environment Conceptual Model by Food Security Status: Home Food Environment Variables Were Associated With Healthy Eating Index 2015 Component Scores for Total Vegetables Among Those With Food Security","authors":"Cerra C. Antonacci PhD, MBE, MHS ,&nbsp;Regine Haardörfer PhD, MEd, MS ,&nbsp;Megan R. Winkler PhD, RN ,&nbsp;Terry J. Hartman PhD, MPH, RD ,&nbsp;Alexandra B. Morshed PhD, MS ,&nbsp;Candace Muncy ,&nbsp;Michelle C. Kegler DrPH, MPH","doi":"10.1016/j.jand.2025.156222","DOIUrl":"10.1016/j.jand.2025.156222","url":null,"abstract":"<div><h3>Background</h3><div>The Model of Community Nutrition Environments is a well-known conceptual model in public health nutrition, although few studies have tested the model as a valid representation of food environment-diet pathways. Further, no study has explored whether the model differs by food security status, despite documented disparities in food environments and diet for those experiencing food insecurity.</div></div><div><h3>Objective</h3><div>To test the Model of Community Nutrition Environments by food security status using multigroup path analysis.</div></div><div><h3>Design</h3><div>This secondary analysis of baseline data from a hybrid-effectiveness implementation trial, Healthy Homes/Healthy Families, which included a home environment survey and 2 unscheduled 24-hour dietary recalls, was merged with the US Department of Agriculture 2019 Food Access Research Atlas.</div></div><div><h3>Participants/setting</h3><div>Participants recruited through 4 United Way 2-1-1 agencies in Georgia were eligible if they were aged 18 to 70 years, spoke English, and self-reported a body mass index ≥20. Baseline data collection occurred from October 2020 to December 2022 (N = 510 participants).</div></div><div><h3>Main outcome measures</h3><div>Main outcomes included Healthy Eating Index 2015 component scores for total fruits and total vegetables.</div></div><div><h3>Analyses</h3><div>Multigroup path analysis compared the unstandardized effects of pathways in the Model of Community Nutrition Environments for those who were food secure and food insecure.</div></div><div><h3>Results</h3><div>The 2-group model had good global model fit (root mean square error of approximation = 0.000, comparative fit index = 1.000, Tucker-Lewis index = 1.000, standardized root mean square residual = 0.047). Home availability (<em>b</em> = .08 ± .04; <em>P</em> = .029) and accessibility (<em>b</em> = .68 ± .27; <em>P</em> = .012) of fruits and vegetables were positively associated with Healthy Eating Index 2015 scores for total vegetables among those with food security. No significant associations were found with either outcome among those with food insecurity. The food secure model explained more variance in the outcomes than the food insecure model (food secure: <em>R</em>²_total _fruits = 0.20, <em>R</em>²_{total vegetables} = 0.36; food insecure: <em>R</em>²_{total fruits} = 0.10, <em>R</em>²_total _vegetables = 0.06).</div></div><div><h3>Conclusions</h3><div>Additional mechanisms need to be added to the Model of Community Nutrition Environments to better explain food environment-diet pathways for those experiencing food insecurity.</div></div>","PeriodicalId":379,"journal":{"name":"Journal of the Academy of Nutrition and Dietetics","volume":"126 2","pages":"Article 156222"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146022959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intersections of Educational Attainment, Indigenous Identity, and Race/Ethnicity Best Predicted Diet Quality Among Adults in Canada: A Conditional Random Forests Analysis","authors":"Natalie Doan MSc ,&nbsp;Martin J. Cooke PhD ,&nbsp;Michael P. Wallace PhD ,&nbsp;Elena Neiterman PhD ,&nbsp;Dana Lee Olstad PhD, RD","doi":"10.1016/j.jand.2025.09.009","DOIUrl":"10.1016/j.jand.2025.09.009","url":null,"abstract":"<div><h3>Background</h3><div>Although it is well-known that diet quality varies according to multiple dimensions of socioeconomic position (SEP), much remains unknown about how these dimensions together shape diet quality. Given that diet quality associated with 1 SEP dimension (eg, income) can systematically differ across another dimension (eg, race and ethnicity), it is necessary to investigate diet quality across SEP intersections.</div></div><div><h3>Objectives</h3><div>The aim of this study was to identify SEP intersections that best predicted lower and higher diet quality among adults in Canada.</div></div><div><h3>Design</h3><div>Population-based data were from the cross-sectional 2015 Canadian Community Health Survey–Nutrition. Data were collected by interviewers who visited selected dwellings to collect household information and administer a general health questionnaire and a 24-hour dietary recall.</div></div><div><h3>Participants/Setting</h3><div>Data from 13 617 adults aged 18 years and older living in Canada’s 10 provinces.</div></div><div><h3>Main Outcome Measures</h3><div>Twenty-four–hour dietary recall data were used to assess diet quality based on the Healthy Eating Index-2015 (HEI-2015) score (range, 0 to 100).</div></div><div><h3>Statistical Analyses Performed</h3><div>Conditional random forests, a supervised machine-learning technique, were used to identify 4 of 12 SEP indicators that best individually predicted HEI-2015 scores. The resulting 4 most important predictors were used to predict diet quality using all possible 2-way intersections.</div></div><div><h3>Results</h3><div>The 4 most important intersectional predictors of HEI-2015 scores based on conditional random forest variable importance measures were (1) educational attainment and Indigenous identity and race/ethnicity, (2) educational attainment and household food insecurity, (3) educational attainment and sex/gender, and (4) household food insecurity and sex/gender. Among these 4 SEP intersections, individuals without a high school diploma living in a severely food-insecure household had the lowest (55.7), and individuals without a high school diploma identifying as Middle Eastern had the highest (64.5) predicted HEI-2015 scores.</div></div><div><h3>Conclusions</h3><div>The SEP intersection defined by educational attainment and Indigenous identity and race/ethnicity was the most important predictor of diet quality among adults in Canada.</div></div>","PeriodicalId":379,"journal":{"name":"Journal of the Academy of Nutrition and Dietetics","volume":"126 2","pages":"Article 156207"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectives on Messaging Strategies to Increase Participation in Universal Free School Meal Programs: A Qualitative Study With Parents of Elementary School-Aged Children","authors":"Amanda B. Zeitlin MPH ,&nbsp;Alix Zuceth Durán Gómez MD ,&nbsp;Cristina J.Y. Lee MPH ,&nbsp;Andrea Pedroza-Tobias PhD, MSc ,&nbsp;Christina A. Hecht PhD ,&nbsp;Anisha I. Patel MD, MSPH, MSHS ,&nbsp;Kenneth Hecht LLB ,&nbsp;Anna H. Grummon PhD, MSPH","doi":"10.1016/j.jand.2025.09.011","DOIUrl":"10.1016/j.jand.2025.09.011","url":null,"abstract":"<div><h3>Background</h3><div>At least 8 states currently have universal free school meal programs that offer school meals at no charge to all students regardless of their household income. Marketing campaigns offer a scalable strategy for motivating parents to encourage their children to participate in these programs, but little is known about what topics campaigns should address.</div></div><div><h3>Objective</h3><div>To explore perceptions of the content and design of messages encouraging school meal participation among parents of elementary school-aged children.</div></div><div><h3>Design</h3><div>Qualitative online semistructured interviews conducted during February and March 2024. Interviews explored parents’ reactions to messages encouraging school meal participation with a variety of topics (eg, saving time, improving nutrition) and design elements (eg, cartoons, photographs).</div></div><div><h3>Participants</h3><div>Parents of children in grades 1 through 5 not frequently consuming school meals and living in states with universal free school meal programs (N = 18; 14 women; 6 Spanish-speaking).</div></div><div><h3>Analysis</h3><div>Discussions were transcribed verbatim. Investigators developed codes in vivo and analyzed transcripts using a thematic approach.</div></div><div><h3>Results</h3><div>Parents perceived messages that focused on how school meals are convenient and save money to be most likely to motivate them to encourage their children to eat school meals. Parents also believed that school meals can foster social and developmental benefits. Parents perceived messages describing the nutritional quality of school meals as likely to be motivating, but only if they perceived school meals to be nutritious. Some parents reported they did not know school meals were free, despite living in states with universal free school meals. In terms of design, parents preferred succinct messages with bold colors, modern layouts, and references or statistics.</div></div><div><h3>Conclusions</h3><div>Campaigns seeking to motivate parents to encourage their children to participate in universal free school meal programs may wish to discuss convenience, saving money, and social and developmental benefits, and to communicate that school meals are free for all students. Future studies will be needed to evaluate whether campaigns discussing these topics successfully promote school meal participation.</div></div>","PeriodicalId":379,"journal":{"name":"Journal of the Academy of Nutrition and Dietetics","volume":"126 2","pages":"Article 156209"},"PeriodicalIF":4.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145256991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}