Healthy default beverage (HDB) policies, which require restaurants to offer healthier drinks with children's meals, may reduce child sugar-sweetened beverage consumption. Although they are gaining popularity across the United States, restaurant awareness and compliance remains low, warranting deeper investigation into policy guidance and implementer knowledge. To examine implementing agencies' awareness of HDB policies, the prevalence of implementation and enforcement practices and their alignment with policy documents, and challenges to implementation and enforcement. We used a mixed-methods approach combining an analysis of HDB policy documents and an online survey of implementers across jurisdictions with state or local policies. A codebook was developed to assess implementation and enforcement provisions in policy documents. Descriptive statistics were used to summarize survey-reported practices, and we examined alignment between these practices and the corresponding policy language. Nineteen policy documents (4 state, 15 local) and 64 survey responses from unique jurisdictions were analyzed. Among jurisdictions, 46 (72%) were knowledgeable about their policy. Most state jurisdictions (86%) and all local jurisdictions reported using a communication strategy regardless of inclusion in policy documents. Restaurant compliance was typically assessed through in-person restaurant visits (state: 78%; local: 42%). Equity-related implementation considerations included additional time for policy implementation (state: 43%; local: 60%) and technical support (state: 72%; local: 60%). Most state (67%) and local (73%) jurisdictions reported issuing warnings and fines for enforcement. Equity considerations for enforcement were reported for some state jurisdictions (27%) and included additional time to become compliant (75%) and issuing warnings without escalating to fines (25%). Implementation misalignment between practices and documents often reflected jurisdictions exceeding policy documents, whereas enforcement misalignment between practices and documents often involved inconsistent or incorrect use of the enforcement strategy in the policy document and misalignment of reported funding allocation. Although jurisdictions frequently expanded beyond written implementation requirements, enforcement knowledge and practices inconsistent with policy documents highlight potential gaps in resources, training, and infrastructure. Efforts to bolster implementer capacity and promote equitable approaches may increase the ability of localities to implement and enforce HDB policies.

Dietary data gaps limit the design of effective food policies and programs in low- and middle-income countries. Automated mobile phone-based tools offer an opportunity to fill data gaps using less resources compared with face-to-face methods, especially for high-frequency dietary quality monitoring in resource-constrained environments. This study assessed the validity of automated participant-recorded dietary data via interactive voice response (IVR) on basic mobile phones to assess dietary quality among rural women in a sub-Saharan African context, against same-day gold standard observed weighed food records. Automated IVR collected list-based recalls of food groups consumed in the last 24 h using yes or no push-button response from 156 randomly selected women in rural Northern Uganda (wet season). Inter-method agreement was assessed by comparing mean women's dietary diversity scores (WDDS) using Weighted Cohen's kappa, Bland-Altman plots, and Wilcoxon signed-rank test. Agreement in percentage achieving minimum dietary diversity scores for women (MDD-W) and consumption of unhealthy foods and beverages was tested using Cohen's kappa and McNemar's test. Most women (74.4%) completed the IVR, with completion associated with better network coverage and prior positive mobile phone experience. Compared with the weighed food records, agreement for the IVR was moderate for MDD-W (21.6% compared with 17.2%; kappa = 0.48), fair for mean WDDS (3.3 compared with 3.5; weighted kappa = 0.39), and moderate for unhealthy food (34.5% compared with 23.3%; kappa = 0.44) and beverage consumption (32.8% compared with 31.9%; kappa = 0.43). This study highlights the potential of collecting data from low-literate women in rural resource-scarce settings using IVR via basic mobile phones to estimate population-level MDD-W, WDDS, and percentage consuming unhealthy foods and beverages. Given the need for participant training, IVR may be best suited to high-frequency monitoring of sentinel groups across time. Further refinement of the IVR may improve food group reporting, reducing trade-offs between operational simplicity and accuracy. With appropriate adaptation, we expect this method is generalizable to other settings.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is among the leading causes of chronic liver disease, with few approved treatment options. Vitamin D supplementation has been proposed as a safe and efficacious supplement intervention for MASLD. The current study aimed to systematically evaluate the effect of vitamin D supplementation in any preparation on hepatic (histological, radiological, and biomarker) and metabolic parameters (glucose regulation, lipid profile, and indices of obesity) in patients diagnosed with steatotic liver disease. These effects were compared with patient baseline and/or placebo response, where available. MEDLINE, Scopus, Web of Science, the Cochrane Library, clinicaltrials.gov, and International Clinical Trials Registry Platform were systematically searched for relevant randomized or nonrandomized studies of intervention. Screening and data extraction were completed by independent pairs of reviewers. Effects were pooled using random-effects meta-analyses. One-stage dose-response analysis was performed for alanine aminotransferase (ALT) and γ-glutamyl transferase. The effect of baseline vitamin D, ALT, body mass index, and vitamin D response on treatment response was explored via metaregression. Treatment efficacy was evaluated in subgroup analyses according to patient and intervention characteristics. A total of 28 studies (21 randomized controlled trials) were analyzed. Statistically significant improvements were noted in FibroScan parameters, liver enzymes, insulin resistance, serum triglyceride, and high-density lipoprotein. However, the magnitude of effect regarding these improvements was smaller than thresholds for clinical benefit, and analyses demonstrated inconsistencies. Subgroup analyses failed to identify a specific subset of patients with MASLD benefiting from supplementation. Vitamin D supplementation was safe and well-tolerated, but no meaningful clinical benefit was identified for hepatic or metabolic parameters of interest in MASLD. This trial was registered at PROSPERO as CRD420251125809.

Fermented products derived from Lactobacillus have demonstrated therapeutic potential in the management of metabolic disorders, particularly liver diseases. This study aimed to evaluate the hepatoprotective effects of Lactobacillus-fermented products in a carbon tetrachloride (CCl4)-induced murine model of liver damage, with a focus on analyzing the influence of bioactive compounds on key liver function biomarkers. Two Lactobacillus strains (Lactobacillus acidophilus LB-CARS1 and L. acidophilus ST-CARS2) were isolated from commercial yogurts, and milk was fermented using each strain. A total of 40 male Swiss Albino mice were allocated into 5 experimental groups: control, CCl4-only, CCl4 + silymarin, and 2 treatment groups receiving CCl4 plus 1 of the 2 lactic acid bacteria (LAB)-fermented products. After 6 wk, serum concentrations of aspartate aminotransferase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), bilirubin, and creatinine were measured. A protein-protein network was constructed using the proteins responsible for hepatoprotection. The cellular pathways of these proteins were also visualized by the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway. Molecular docking was performed to assess interactions between identified bioactive compounds and target proteins (superoxide dismutase, catalase, transforming growth factor-β 1, peroxisome proliferator-activated receptor γ, IL-6, and tumor necrosis factor-α). Treatment with LAB-fermented products significantly reduced (P < 0.05) serum AST, ALT, ALP, bilirubin, and creatinine concentrations in the CCl4-treated mice. The 2 products reduced the liver enzymes, though their intensity was different. The interactive pathways of the protein network revealed the most common genes responsible for hepatoprotective activity. Molecular docking revealed strong binding affinities between bioactive compounds and proteins related to inflammation and oxidation. Furthermore, absorption, distribution, metabolism, excretion, and toxicity analysis suggested the potential drug candidates among the docked compounds. The results indicate that LAB-fermented products contain bioactive compounds capable of attenuating liver injury, likely through anti-inflammatory and antioxidant mechanisms, highlighting their potential as functional food interventions in hepatoprotection.

Older adults age 65+ with obesity are a growing population with marked clinical complexity, which is exacerbated by comorbid conditions as they age. To assess clinical heterogeneity in participants in a weight loss intervention to help understanding treatment outcomes. We previously conducted a single-arm, pre/post, 24-wk, telemedicine-delivered diet and exercise intervention in older adults with obesity. Heterogeneity in treatment outcomes was evaluated between baseline and follow-up weight, 30-s sit-to-stand (30STS), 6-min walking test (6MWT), oxygen consumption at rest (resting VO2), and total energy expenditure (TEE). Distributions of differences in physical function before and after the weight loss intervention were evaluated based on participants' weight loss response status. Of the 53 enrolled participants, 44 completed the study, but 31 had full follow-up measures. The mean ± standard deviation age was 72.9 ± 3.9 y (72.7% female). Across all participants, weight decreased from 97.8 ± 16.3 kg to 93.2 ± 15.8 kg, and BMI (in kg/m2) dropped from 36.5 ± 5.2 to 34.7 ± 5.4. Twenty-two individuals were classified as responders to the weight loss intervention, having achieved >5% weight loss. Both groups exhibited significant improvements in physical function, though the magnitude of differences was nonsignificant, other than 6MWT (P = 0.04) at 24-wk. There was variability observed in correlation coefficients (r) between percent weight loss and 30STS (r = ‒0.23), 6MWT (r = ‒0.10), resting VO2 (r = ‒0.16), and TEE (r = 0.058). The coefficient of variation for changes from baseline in physical function measures demonstrated marked variability: 134%, 299%, 260%, and 2310% for 30STS, 6MWT, resting VO2, and TEE, respectively. Although older adults can improve outcomes in weight, body mass, and waist circumference through diet and physical activity interventions, there was marked heterogeneity observed in physical function outcomes.

BackgroundPopular dietary patterns for cardiovascular and cognitive health often emphasize limiting red meat intake. However, evidence specifically examining the effects of minimally processed lean red meat, independent of processed varieties, remains limited.ObjectivesThis study aimed to evaluate the impact of incorporating minimally processed lean red meat into a plant-forward dietary pattern aligned with the 2020–2025 Dietary Guidelines for Americans on markers of age-related cognitive, metabolic, and physical health.MethodsThis 18-wk randomized controlled crossover feeding trial tested a red meat diet with 162 g/d minimally processed pork (MPP) against a macronutrient- and energy-matched no-meat control diet with minimally processed lentils (MPL) in ≥65 y older adults. Metabolic biomarkers related to cognitive and physical health were explored. Primary and secondary endpoints comprised 5 cardiovascular markers, 12 nutritional and neurotransmitter measures, and 2 metrics each of body composition and muscular fitness. Data were analyzed with robust mixed-effects models adjusted for covariates.ResultsThirty-six Midwestern older adults (26/10 females/males; mean age 71.7 y; mean body mass index: 28 kg/m2) completed the study. Cognitive-related metabolic biomarkers improved across both arms. Adoption of the plant-forward diet led to a reduction in fasting insulin after both MPP and MPL phases (P < 0.001), and Single Point Insulin Sensitivity Estimator Index increased after MPP (P = 0.032), with no significant between-diet differences. High-density lipoprotein concentrations were higher post-MPP than post-MPL (P = 0.034). Body weight decreased in both phases (P < 0.05), with a trend toward smaller lean mass loss post-MPP. Grip strength and chair-rise performance were maintained throughout the intervention. Neuroactive metabolites and bioactive amino acid concentrations shifted favorably after both interventions.ConclusionsFindings challenge the perception that red meat is broadly unsuitable for older adults. Including familiar foods like red meat (pork), particularly in minimally processed form and within a healthy overall dietary pattern, may provide age-associated health benefits and improve adherence to plant-forward diets in populations where red meat remains popular.This trial was registered at clinicaltrials.gov as NCT05581953 (12 October, 2022) and NCT06261775 (7 February, 2024).

BackgroundChildren’s eating behaviors influence weight, but the relationships among children’s eating behaviors, caregiver feeding styles, and modifying maternal and child factors remain unclear.ObjectivesThis study aimed to examine the associations between 1) child eating behaviors and body mass index (BMI) z-scores, and 2) caregiver feeding style and child eating behaviors.MethodsData from 290 Hispanic mother–child dyads (children aged 3–9 y) in the Hispanic Community Health Study/Study of Latinos Family Lifestyle Outcomes Research cohort were analyzed cross-sectionally. Child eating behaviors, caregiver feeding styles, and child BMI z-scores were assessed. Linear regression examined: 1) child eating behaviors and BMI z-scores, and 2) caregiver feeding styles and child eating behaviors. Models adjusted for maternal marital status, prepregnancy BMI, child health, Supplemental Nutrition Assistance Program status, poverty level, and study site.ResultsHigher child food responsiveness [β = 0.16; 95% confidence interval (CI): 0.01, 0.32] and enjoyment of food (β = 0.18; 95% CI: 0.02, 0.33) were associated with higher BMI z-scores, while greater satiety responsiveness (β = −0.23; 95% CI: −0.42, −0.04) was associated with lower BMI z-score. Authoritarian feeding style was associated with a lower enjoyment of food (β = −0.72; 95% CI: −1.06, −0.38), greater food fussiness (β = 0.42; 95% CI: 0.09, 0.76), greater satiety responsiveness (β = 0.57; 95% CI: 0.31, 0.84), and greater slowness in eating (β = 0.44; 95% CI: 0.13, 0.76). An indulgent feeding style was associated with a lower desire to drink (β = −0.52; 95% CI: −0.90, −0.13), lower satiety responsiveness (β = −0.36; 95% CI: −0.65, −0.10), and lower emotional undereating (β = −0.55, 95% CI: −0.84, −0.25). An uninvolved feeding style was associated with lower emotional undereating (β = −0.63; 95% CI: −0.97, −0.29).ConclusionsChild food approach behaviors correlate with higher BMI. Findings on caregiver feeding styles and child eating behaviors show complex, sometimes unexpected patterns, highlighting the need for further interdisciplinary research.