Advances in nutrition (Bethesda, Md.)最新文献

{"title":"Dietary fiber and GLP-1 receptor agonists in obesity management: converging mechanisms, interactions, and strategies for durable weight control.","authors":"Yuxin Wang, Jiaxin Liu, Kristin Verbeke, Naschla Gasaly Retamal, Renate Akkerman, Paul de Vos","doi":"10.1016/j.advnut.2026.100647","DOIUrl":"https://doi.org/10.1016/j.advnut.2026.100647","url":null,"abstract":"<p><p>Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have transformed the management of obesity by producing substantial and durable weight loss. However, gastrointestinal adverse effects, including nausea, vomiting, and constipation, are a common, dose-dependent, and frequent cause of discontinuation. Furthermore, weight regain is typical after drug withdrawal, reflecting the chronic and relapsing nature of obesity. Long-term adherence is essential but often constrained by high cost, injection burden, and patient preference. Moreover, the consequences of chronic GLP-1 receptor activation on gut physiology, microbiota composition, and immune tolerance remain incompletely defined. In parallel, dietary fibers offer a physiological means of engaging the same gut-brain axis through microbial fermentation and the stimulation of endogenous GLP-1. Fibers deliver broad benefits as they strengthen gut barrier function, enrich short chain fatty acid, and recalibrate immunity toward an anti-inflammatory state. Nevertheless, weight loss with fiber alone is typically more modest than with GLP-1RAs and depends on the type, dose, and duration of use. Tolerability can be limited by bloating or gas, particularly if intake is increased too rapidly. This review critically examines the convergence and divergence between GLP-1RAs and dietary fibers. We discuss their mechanistic overlaps in appetite control, metabolism and immune modulation, and highlight potential interactions, such as altered fermentation dynamics during pharmacological slowing of gastric emptying and the potential for GLP-1R desensitization. We explore opportunities for fibers to mitigate GLP-1RA-related adverse effects, support bowel regularity, and stabilize the microbiota during treatment or after discontinuation. A pragmatic framework is raised to place dietary fiber and lifestyle measures as the foundation of care, reserves GLP-1RA therapy for highest-risk individuals, and plans for fiber supplements once pharmacotherapy is reduced. Well-designed trials that combine GLP-1RAs with well-characterized fibers, include microbiome end points, and assess long-term outcomes are needed to optimize efficacy and reduce dependence on costly pharmacotherapy.</p>","PeriodicalId":72101,"journal":{"name":"Advances in nutrition (Bethesda, Md.)","volume":" ","pages":"100647"},"PeriodicalIF":9.2,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diet and the Developing Brain: A Systematic Review of Nutritional Influences on Adolescent Cognitive and Academic Outcomes.","authors":"Hayley A Young, Chantelle M Gaylor, Anthony Brennan, Abigail McIntosh, Amy R Griffiths","doi":"10.1016/j.advnut.2026.100648","DOIUrl":"https://doi.org/10.1016/j.advnut.2026.100648","url":null,"abstract":"<p><p>Adolescence is a critical period of neurodevelopment, yet the role of nutrition in shaping cognitive and academic outcomes during this stage remains underexplored. This systematic review synthesizes evidence from 48 controlled trials and 25 prospective studies examining how diet influences cognitive performance and educational attainment between ages 8 and 19. Four databases (PsycINFO, Scopus, PubMed, Web of Science) were searched up to February 2026. Studies were synthesized by design, with risk of bias assessed using Cochrane and Joanna Briggs Institute tools. Prospective studies beginning in infancy - typically of higher methodological quality - suggest that unhealthy diets in the first three years of life may have lasting adverse effects on intelligence in adolescence. Controlled trials of dietary interventions during adolescence point to potential benefits for cognitive and academic outcomes, though findings vary and are often constrained by methodological limitations. To advance research in this field, we propose seven guiding principles, including adopting a life course perspective, moving beyond nutrient isolation, using biologically valid biomarkers, incorporating puberty and sex-specific analyses, standardizing outcome measures, prioritizing context and population characteristics, and controlling for key confounders. These principles aim to strengthen the design, relevance, and impact of future studies in adolescent nutrition and brain health. This review was pre-registered on PROSPERO (CRD42023413970).</p>","PeriodicalId":72101,"journal":{"name":"Advances in nutrition (Bethesda, Md.)","volume":" ","pages":"100648"},"PeriodicalIF":9.2,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dietary and Nutritional Factors in Systemic Lupus Erythematosus Pathophysiology: A Scoping Review of the Evidence from In-Vitro, In-Vivo and Human Studies.","authors":"Justin N Jaya, Michael Pudjihartono, Nicholas Pudjihartono, Ivan Damara, Fahrul Nurkholis, Felix Zulhendri","doi":"10.1016/j.advnut.2026.100644","DOIUrl":"https://doi.org/10.1016/j.advnut.2026.100644","url":null,"abstract":"<p><p>Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease whose pathogenesis involves interplay between genetic predisposition and environmental factors, including diet. This scoping review maps and synthesizes current evidence from human and animal studies on the relationships between dietary factors and lupus pathophysiology. Following PRISMA guidelines, we identified 139 relevant studies from Scopus, PubMed, and EBSCO published between 2012-2023. Our analysis reveals that specific dietary components significantly influence lupus risk and disease activity. Diets high in sugar, carbohydrates, and sodium were associated with increased inflammation and exacerbated disease severity. Conversely, several factors demonstrated protective effects. Higher intake of omega-3 polyunsaturated fatty acids (PUFAs) was consistently linked to reduced inflammatory markers and improved patient-reported outcomes, while a higher omega-6 to omega-3 ratio correlated with worsened disease activity. Moderate alcohol consumption, particularly wine, was associated with a reduced risk of SLE incidence. Adequate vitamin D levels were connected to attenuated disease progression and immunomodulation. Furthermore, natural products like olive oil phenolic compounds and curcumin showed promise in reducing oxidative stress and inflammatory pathways in murine models. The evidence underscores that dietary modification presents a viable strategy for modulating immune function and inflammation in SLE. Integrating nutritional guidance with conventional therapies could improve disease management. Future large-scale randomized controlled trials are essential to establish precise dietary recommendations and elucidate the mechanisms underlying diet-lupus interactions.</p>","PeriodicalId":72101,"journal":{"name":"Advances in nutrition (Bethesda, Md.)","volume":" ","pages":"100644"},"PeriodicalIF":9.2,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vitamin D Fortification of Dairy Products in the United Kingdom: What are the Barriers?","authors":"Cheuk Lun Wong, D Ian Givens, Daniele Asioli, Anu M Turpeinen, Jia Han, L Kirsty Pourshahidi, Jing Guo","doi":"10.1016/j.advnut.2026.100645","DOIUrl":"https://doi.org/10.1016/j.advnut.2026.100645","url":null,"abstract":"<p><p>Given the inadequate vitamin D intake and status in the United Kingdom (UK) population, the Scientific Advisory Committee on Nutrition recognised the difficulty of achieving a reference nutrient intake of vitamin D (10 μg/day) simply from natural food sources. Therefore, additional food vehicles for vitamin D fortification are needed to improve vitamin D intake and status. Dairy products represent a potential vehicle for fortification, given their status as staple foods in the UK. In recent workshops (October 2024 and March 2025), barriers to vitamin D fortification of dairy products were discussed by a group of experts. The main conclusions from the workshops are presented in this review and position paper and are as follows: 1). There is convincing evidence of the need to improve vitamin D status. 2). Further evidence is required including modelling studies to examine a wide variety of dairy products potentially being fortified using the UK population data, especially those who are at risk of vitamin D deficiency such as children and young female populations, as well as cost evaluation studies of vitamin D fortification. 3). More research on consumer preferences towards vitamin D-fortified dairy products is needed. 4). Vitamin D fortification of dairy products may not be technically difficult, but it may involve additional cost for dairy food manufacturers, such as purchasing specific equipment for vitamin D addition. 5). The retailing and promotion of vitamin D-fortified dairy products are influenced by various factors such as price and customer perceptions. This review further 1). Highlights the barriers to the promotion and legislation of mandatory vitamin D fortification policy of dairy products, 2). Reviews current evidence of each barrier, and 3). Identifies research gaps that need to be addressed in the future.</p>","PeriodicalId":72101,"journal":{"name":"Advances in nutrition (Bethesda, Md.)","volume":" ","pages":"100645"},"PeriodicalIF":9.2,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Promise and Uncertainty of Intermittent Fasting for Aging Populations.","authors":"Hassan S Dashti, Christine S Ritchie","doi":"10.1016/j.advnut.2026.100643","DOIUrl":"https://doi.org/10.1016/j.advnut.2026.100643","url":null,"abstract":"","PeriodicalId":72101,"journal":{"name":"Advances in nutrition (Bethesda, Md.)","volume":" ","pages":"100643"},"PeriodicalIF":9.2,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effective implementation strategies for delivering nutritional interventions through the health system to prevent malnutrition during pregnancy: A Systematic Review and Meta-analysis.","authors":"Selene Pacheco-Miranda, Edith Kim-Herrera, Rafael Peréz-Escamilla, Edgar Denova-Gutiérrez, Hortensia Reyes-Morales, Lucía Hernández-Barrera, Enrique Rios-Espinosa, Alejandra Gonzalez-Rocha, Anabelle Bonvecchio-Arenas","doi":"10.1016/j.advnut.2026.100642","DOIUrl":"https://doi.org/10.1016/j.advnut.2026.100642","url":null,"abstract":"<p><p>Malnutrition during pregnancy is a public health concern. Interventions implemented through the health sector can prevent maternal malnutrition. Our aim is to identify implementation strategies for delivering nutritional interventions through primary health care to prevent malnutrition in all its forms during pregnancy. We followed the Cochrane Handbook for Systematic Reviews and PRISMA guidelines. A search strategy was developed for five databases. The information was systematized using the Template for Intervention Description and Replication. Meta-analyses were performed using a random-effects model. We used the Risk of Bias and the Non-randomized Studies of Interventions tools, and the certainty of the evidence followed the GRADE guidelines. We included 51 studies conducted across high-, middle-, and low-income countries. Multiple micronutrient supplementation (MMS) was more effective than iron-folic acid (IFA) supplementation alone in improving hemoglobin levels and other anemia-related indicators, when initiated during the first or second trimester of pregnancy and delivered with in-person, individualized counseling and follow-up. Our meta-analysis confirmed that MMS improved maternal anemia compared to IFA with a moderate certainty of the evidence. Healthy eating counseling, physical activity, and weight gain monitoring, when combined, were effective in achieving weight gain when the interventions were guided by prenatal care protocols and included materials and resources to support. Our meta-analysis showed a non-significant reduction in excessive weight gain with very low certainty, no meaningful effect on low weight gain with low certainty, and a potentially meaningful increase in the likelihood of gaining weight within the recommended range with very low certainty. A coordinated package of health system-delivered interventions, including MMS, behavioral counseling, and monitoring of maternal weight gain, should be implemented within primary health care, beginning in the first or second trimester, to prevent all forms of malnutrition during pregnancy. Effective implementation strategies to provide these interventions can be adapted to local contexts. The protocol for this review was registered in PROSPERO with the ID CRD4202460299.</p>","PeriodicalId":72101,"journal":{"name":"Advances in nutrition (Bethesda, Md.)","volume":" ","pages":"100642"},"PeriodicalIF":9.2,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Nutritional Index and Cancer Prognostic Outcomes: An Umbrella Review of Systematic Reviews and Meta-analyses of Observational Studies.","authors":"Zhi-Tong Li, Ming-Li Sun, Fang-Hua Liu, Yu Li, Rui-Han Bao, Xiao-Feng Jiang, Jun Liu, Zhao Lu, Ying Yang, Yong Yu, Na Zhao, Qian Chen, Qian Fang, Zan-Fei Feng, Xian-Xian Jia, Dong-Run Li, Meng Luan, Jing Ma, Ying Wang, Yi-Lin Xu, Dan Yang, Miao Yang, Rui Yang, Xue-Li Bai, Jing Yang, Tie-Gang Li, Ting-Ting Gong, Qi-Jun Wu","doi":"10.1016/j.advnut.2026.100641","DOIUrl":"10.1016/j.advnut.2026.100641","url":null,"abstract":"<p><p>Prognostic nutritional index (PNI) has been widely investigated as a predictor of outcomes in patients with cancer; however, a comprehensive synthesis evaluating the breadth, methodological quality, and certainty of this evidence is lacking. We aimed to systematically review and critically appraise existing meta-analyses on the association between PNI and cancer prognostic outcomes. We conducted a comprehensive search of PubMed, Embase, Web of Science, and the Cochrane Database of Systematic Reviews from database inception through 28 February, 2025. Methodological quality of included systematic reviews and meta-analyses was assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR), and the certainty of evidence was graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. The protocol was registered prospectively on the International Platform of Registered Systematic Review and Meta-analysis Protocols platform (INPLASY2025110096). A total of 64 systematic reviews and meta-analyses, comprising 265 quantitative syntheses, were included. Of these, 224 (84.5%) reported statistically significant quantitative syntheses (P < 0.05) under random-effects models. AMSTAR assessment classified 44 (68.8%) systematic reviews and meta-analyses as high quality. GRADE evaluation indicated that 121 (45.7%) quantitative syntheses were supported by high-certainty evidence. Elevated PNI was consistently associated with improved overall survival (OS) across both pan-cancer and cancer-specific analyses. In pan-cancer populations, higher PNI was significantly associated with longer OS, prolonged progression-free survival, and higher objective response rates. Significant prognostic benefits of elevated PNI for OS were also observed in specific malignancies, including pancreatic cancer, gastric cancer, advanced-stage lung cancer, and glioma. Although a higher PNI is robustly associated with favorable prognostic outcomes in diverse cancers, marked heterogeneity in PNI cutoff values across studies underscores the urgent need for standardized, population-specific thresholds validated through prospective diagnostic accuracy studies.</p>","PeriodicalId":72101,"journal":{"name":"Advances in nutrition (Bethesda, Md.)","volume":" ","pages":"100641"},"PeriodicalIF":9.2,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dietary, Food Security and Diabetes Outcomes Associated with Food Is Medicine Programs among Adults with Type 2 Diabetes in the United States: A Rapid Systematic Review.","authors":"Emily D Martin, Nicole Peña, Lydia Porter, Moorea Gailloux, Robert Blew, Douglas Taren, Ahlam Saleh, Holly Bryant, Joy Mockbee, Melanie D Hingle","doi":"10.1016/j.advnut.2026.100638","DOIUrl":"10.1016/j.advnut.2026.100638","url":null,"abstract":"<p><strong>Background: </strong>Food is medicine (FIM) interventions are designed to help manage diet-sensitive diseases. Despite their popularity, it is unclear whether FIM programs significantly impact nutritional and clinical outcomes among adults with type 2 diabetes (T2DM), a highly prevalent chronic disease in the United States.</p><p><strong>Objectives: </strong>This study aimed to evaluate FIM programs focused on diabetes management, dietary intake, and food security outcomes among adults with T2DM.</p><p><strong>Methods: </strong>A systematic search was completed in September 2025. Eligible studies were in English and conducted in the US FIM interventions provided food or increased access to food. Study assessments included diabetes outcomes, diet, and food security. Risk of bias was evaluated.</p><p><strong>Results: </strong>Twenty-three studies were included (21 quantitative, 1 qualitative, and 1 mixed methods). Of 21 quantitative studies, 9 observed statistically significant reductions in hemoglobin A1c (-0.1% to -3.0%); however, only 2 were clinically significant improvements. Improved dietary habits were observed in 14 of 19 studies assessing vegetable and fruit intake (+0.2 to +0.9 mean servings/d) and 4 of 6 studies assessing diet quality (+0.04 to +31.8 points). Of 10 studies, 8 found significant reductions in food insecurity (-8.9% to -53.5%). Qualitative studies suggested perceived improvement in diet quality, food security, and diabetes management by participants. Risk of bias was \"fair\" for most studies.</p><p><strong>Conclusions: </strong>Modest improvements in dietary intake, food security status, and diabetes management were observed in 43% of studies; however, most were not clinically significant changes. The low rigor of many studies suggests caution against drawing conclusions regarding FIM program efficacy. This review was registered at PROSPERO (CRD42021284000).</p>","PeriodicalId":72101,"journal":{"name":"Advances in nutrition (Bethesda, Md.)","volume":" ","pages":"100638"},"PeriodicalIF":9.2,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147724802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Framework for Developing Intake and Use Guidance for Dietary Supplement Bioactives.","authors":"Janet A Novotny, Johanna Dwyer, Mario G Ferruzzi, Bill Gurley, Tasija Karosas, Colin D Kay, Esther Myers, Andrew Shao, Connie M Weaver","doi":"10.1016/j.advnut.2026.100623","DOIUrl":"10.1016/j.advnut.2026.100623","url":null,"abstract":"<p><p>Dietary bioactives, which are commonly found in food, beverages, and dietary supplements, include nonessential food components that can support health beyond preventing nutrient deficiencies. Despite their known health benefits and potential for adverse effects, there is limited guidance on appropriate intake levels, safety, and efficacy of these ingredients, particularly those present in dietary supplements. This lack of guidance can be challenging for individuals attempting to make informed decisions about products marketed for health benefits. A previously published perspective proposed a 4-step framework for developing quantitative intake recommendations for bioactive constituents in food. This framework addressed bioactive characterization, safety evaluation, efficacy assessment, and how to develop intake levels from foods. However, it did not account for the unique considerations of bioactives consumed in dietary supplement form. The current paper builds on the original framework by addressing the specific factors that must be considered when developing intake guidance for bioactive constituents found in dietary supplements. These include differences in dose, matrix, purity, bioavailability, and intended use. In doing so, this paper aims to advance the development of evidence-based recommendations for supplements, while also highlighting the fundamental distinctions between bioactive constituents delivered through food and diet compared with those delivered through dietary supplements.</p>","PeriodicalId":72101,"journal":{"name":"Advances in nutrition (Bethesda, Md.)","volume":" ","pages":"100623"},"PeriodicalIF":9.2,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147535052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthy Diet Metrics for Children and Adolescents and Their Suitability for Global Monitoring: A Critical Review.","authors":"Alissa M Pries, Hope Craig, Vrinda Mehra, Edward A Frongillo, Giles T Hanley-Cook, Chika Hayashi, Kuntal Saha, Isabela Fleury Sattamini, Teresa R Schwendler, Jennifer C Coates","doi":"10.1016/j.advnut.2026.100622","DOIUrl":"10.1016/j.advnut.2026.100622","url":null,"abstract":"<p><p>Healthy diets during childhood and adolescence are paramount for growth, development, and long-term health. However, there is a lack of low-burden standardized metrics to assess and monitor healthy diets among children and adolescents aged 2-19 y on a global scale. This critical review aimed to identify and evaluate existing metrics for assessing healthy diets in this age group and to determine their suitability for global monitoring based on feasibility and adaptability across different contexts. A systematic search was conducted across 3 global databases, encompassing both peer-reviewed and grey literature. A total of 127 distinct healthy diet metrics were identified, many of which were developed or adapted based on national dietary guidelines across various geographical contexts. Only 5 were deemed suitable for global monitoring due to their feasibility and adaptability: the Individual Dietary Diversity Score, 7 food group Minimum Dietary Diversity, 10 food group Minimum Dietary Diversity, Healthy Plate Variety Score, and Adapted ultraprocessed food Nova Score. Among these metrics, diversity was the most commonly measured subconstruct of a healthy diet, whereas only the Adapted Nova Score aimed to capture moderation. These 5 metrics were further evaluated for construct validity, reliability, and cross-context equivalence, which revealed large evidence gaps, particularly regarding sensitivity to change and test-retest reliability. These findings highlight the need for additional research to validate healthy diet metrics globally to ensure their accuracy, sensitivity, and reliability to differentiate populations and changes over time. Developing robust, low-burden metrics is essential for informing effective, timely nutrition policies and interventions aimed at improving the diets of children and adolescents worldwide.</p>","PeriodicalId":72101,"journal":{"name":"Advances in nutrition (Bethesda, Md.)","volume":" ","pages":"100622"},"PeriodicalIF":9.2,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147534982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}