School-based multicomponent interventions have shown promise in improving children's lifestyle behaviours, but evidence on their feasibility in Asia remains limited. The Promoting hEalthy Diet and Active Lifestyle intervention was developed for primary school children (ages 10-11 years) in Singapore to improve diet and activity behaviours (fruit and vegetable intakes, moderate-to-vigorous physical activity (MVPA) time, and recreational screen time), through lessons, take-home activities, parental engagement, and environmental modifications. This pilot study evaluated six feasibility dimensions: recruitment; data collection; implementation fidelity; practicality; social validity; and potential effectiveness, particularly of our theory-based approach, which focuses on ideations and their impact on behaviour. A concurrent mixed-methods study design was employed in two public co-educational schools. This involved a pre-post survey of students' self-reported behaviours (n = 139) and to generate healthy eating (HE) and physically active (PA) ideation scores, focus group discussions with students (n = 20) and teachers (n = 11), teacher-reported feedback forms (n = 13 classes), short interviews with canteen vendors (n = 11), and observation to evaluate environment modifications. Student survey completion rate was low (57%) due to insufficient time, although lessons were well-liked by students and teachers, with high student attendance (97%). Teachers delivered 83% of the planned activities, with time constraints being a barrier. There were no significant changes in the behaviours or HE ideation scores, although PA ideation scores improved (+ 0.3, 95% CI: 0.03-0.6) due to increased knowledge scores (+ 0.5, 95% CI: 0.4-0.7). While this increase in knowledge did not result in behavioural changes, the association between ideation scores and behaviours aligned with theoretical expectations. Higher HE ideation scores correlated with greater fruit and vegetable intake, while higher PA ideation scores were associated with more MVPA and less recreational screen time. Poor fidelity in take-home activities and parental engagement, along with students' inertia and perceived lack of need for change, explained the absence of significant behavioural change. The study identified key conditions for better implementation, including stronger stakeholder buy-in, flexible lesson delivery, and digital data tracking. It highlighted the complexity of behaviour change in Singapore primary schools, emphasising the need for long-term, tailored interventions. ISRCTN16114046. Registered 16/10/2022, prospectively.

This protocol describes a pilot randomized controlled trial (RCT) designed to assess the feasibility of a multidisciplinary, multimodal intervention for sarcopenia prevention in patients with nasopharyngeal carcinoma (NPC) undergoing concurrent chemoradiotherapy (CCRT). The intervention was developed using the Medical Research Council (MRC) framework and incorporates personalized immunonutrition, structured exercise, side effect management, behavior monitoring, and guidance. This pilot trial aims to evaluate the feasibility of implementing a multimodal intervention model in this patient population. This study will be a single-site RCT including 30 patients with NPC undergoing definitive treatment. The trial will be conducted from September 2025 to May 2026 in Ningxia, China. Patients will be randomly assigned to either the intervention or control group. The intervention integrates head and neck and gastrointestinal cluster symptom management, immunonutrition management, and exercise based on the Theory of Planned Behavior. The primary outcome is feasibility, assessed through acceptability, demand, fidelity, and practicality. Secondary outcomes include changes in skeletal muscle index, sarcopenia prevalence, body composition, composite biomarkers (Global Immune-Nutrition-Inflammation Index [GINI], Hemoglobin–Albumin–Lymphocyte–Platelet Score [HALP], and Prognostic Nutritional Index [PNI]), symptom burden (Head and Neck Symptom Checklist), nutritional status (Patient-Generated Subjective Global Assessment [PG-SGA]), and adherence to exercise and dietary interventions. Exploratory outcomes include behavior change mechanisms assessed using a Theory of Planned Behavior–based questionnaire. This pilot study is designed to evaluate the feasibility of implementing a comprehensive multimodal intervention for sarcopenia in NPC patients undergoing CCRT. The outcomes will provide preliminary evidence to guide the design of future large-scale RCTs and advance multidisciplinary care models for sarcopenia management in oncology. UMIN Clinical Trials Registry, UMIN000059146.

Fatty pancreas disease (FPD) is closely associated with the pathogenesis of pancreatic cancer (PC) and diabetes mellitus (DM). However, current imaging modalities for assessing intra-pancreatic fat deposition (IPFD) have limitations and are not widely used in clinical practice. Developing a practical prediction tool for FPD would facilitate the evaluation of pancreatic health. A total of 852 subjects were included in the model construction cohort, and 202 PC patients were included to investigate the association between fat deposition and PC. Quantitative assessment of IPFD and diagnosis of FPD were based on the pancreas-to-spleen attenuation ratio (P/S ratio) from CT scans. Multivariate logistic regression was used to identify risk factors associated with FPD, and a web-based application was deployed based on these factors. The performance of the model was validated in an internal cohort with respect to discrimination, calibration and clinical benefit. The incidence of PC and DM significantly increased as the P/S ratio decreased, particularly when P/S ratio fell below 0.8. Multivariate analysis identified seven independent risk factors: age > 65 years, abnormal waist circumference, abnormal gamma-glutamyl transferase, fasting plasma glucose > 6.1mmol/L, NLR > 1.97, fatty liver index > 24.7, and mFIB-4 > 3.05. A web application was deployed based on these risk factors. The model demonstrated good discrimination, with an AUC of 0.750 (95% CI: 0.707–0.793) in the development cohort and 0.723 (95% CI: 0.652–0.795) in the validation cohort, along with satisfactory calibration and clinical net benefit. Furthermore, regression analysis revealed significant correlations between model-predicted risk values and IPFD severity, indicating that the FPD model effectively captures the severity of fat deposition in the pancreas. This multidimensional predictive model enables comprehensive evaluation of FPD risk using routinely available clinical parameters, which can serve as an effective preliminary screening tool to guide subsequent examinations and interventions.

The Planetary Health Diet (PHD), developed by the EAT–Lancet Commission, provides a comprehensive framework to promote human and planetary health through dietary transformation. Despite its benefits, adoption of the PHD remains limited in high-income countries like France. This study aimed to evaluate knowledge, attitudes, and behaviors (KAB) related to the PHD across diverse French populations and identify determinants of inadequate KAB. This cross-sectional quantitative study was conducted between April and June 2024 under the BIOQUALIM protocol. Eligible participants were adults (≥ 18 years) fluent in French and included healthcare professionals and patients from the Hospices Civils de Lyon (HCL), as well as farmers-bakers’ customers from the Rhône-Alpes region. A validated 89-item questionnaire was administered via paper and digital formats using a convenience sampling strategy. KAB levels were calculated from a structured scoring system. Descriptive statistics and multivariate logistic regressions were used to assess KAB levels and their sociodemographic determinants. Among 10,500 individuals approached, 1,388 completed the survey (79.6% HCL professionals, 6.4% patients, 14% farmers-bakers’ customers). Only 3% demonstrated an adequate overall KAB score; knowledge adequacy was observed in 61%, while attitude and behavior adequacy remained critically low (3.5% and 0.2%, respectively). Inadequate KAB was significantly associated with omnivorous diets (OR = 3.38), female gender (OR = 2.54), patient status (OR = 13.84), while low food budgets increased risk (≤ 50 €/week, reference OR = 1) and higher weekly expenses were protective (OR range 0.42–0.57). Protective factors included older age (≥ 60 years; OR = 0.17) and higher weekly food expenses (>€100). Although awareness of sustainable diets is rising, behavioral adherence to the PHD remains poor, highlighting a pronounced knowledge–action gap. Cultural norms, economic limitations, and institutional structures still delay dietary change. Policy efforts must extend beyond education to include economic answers, culturally adapted messages, and systemic reforms to enable a fair and sustainable food transition.

Inflammatory diets are associated with obesity and cardiometabolic dysfunction, nevertheless, it remains unclear whether overall dietary inflammation or the timing of pro-inflammatory meals yields a greater metabolic impact. This study utilizes the energy-adjusted dietary inflammatory index (EDII) to examine associations of both habitual/meal-specific with metabolic risk among women. In this cross-sectional study, 562 Iranian women (aged 20–60) from Tehran were assessed. Habitual and four meal-specific EDII scores (breakfast, lunch, afternoon snacks, dinner) were calculated from three non-consecutive 24-hour dietary recalls using 29 pro- and anti-inflammatory parameters. Anthropometric variables, fasting blood assays, body mass index (BMI), Visceral Adiposity Index (VAI), Cardiometabolic Index (CMI), and Atherogenic Profile Index (API) were measured. Multivariable linear and logistic regression models, adjusted for potential confounders, were used to estimate associations. Habitual-EDII showed the strongest association with afternoon snack-EDII (R² = 0.36), followed by Dinner (0.29), Lunch (0.25), and Breakfast (0.20). Habitual-EDII in T (tertile) 3 vs. T1 was associated with increased odds of overweight/obesity BMI [OR 2.38, 95% CI (1.51–3.81)], CMI [1.95 (1.23–3.04)], VAI [1.92 (1.21–3.03)], and API [2.53 (1.57–4.08)]. Afternoon snack-EDII was associated with higher odds of overweight/obesity [OR 1.93 (1.21–3.11)]. Finally, dinner-EDII was associated with an elevated risk of VAI [OR 1.85 (1.17–2.92)] and CMI [OR 1.77 (1.12–2.80)]. Pro-inflammatory diets, especially during afternoon and dinner, are strongly associated with cardiometabolic risk, highlighting a meal-specific inflammation relationship. Accordingly, prospective cohort studies and interventions studies are required to confirm the veracity of these findings.

BackgroundProcessed meat (PM) consumption is an established risk factor for colorectal cancer (CRC). It has been hypothesized that nitrosyl-heme, formed by the addition of nitrites during meat processing, may enhance the carcinogenic effects of PMs. This study aims to investigate the association between nitrosyl-heme intake and CRC risk within the European Prospective Investigation into Cancer and Nutrition(EPIC) study.MethodsThis prospective study included 367,463 participants(70.3% women) from seven countries from the EPIC-study. Dietary data were collected via baseline questionnaires, and nitrosyl-heme exposure was estimated using biochemical data from 52 Spanish PMs, extrapolated to country-specific items. Sex-specific multivariable-adjusted hazard ratios(HRs) and 95% confidence intervals(CIs) were calculated using Cox proportional hazards models.ResultsOver a 15-year median follow-up, 5,115 incident CRC cases were identified. Comparing the highest vs. the lowest sex-specific tertile of nitrosyl-heme intake we found no significant association with CRC risk (HRT3vsT1:1.01;95%CI:0.93–1.09). Subgroup analyses by tumor subtype and interactions with lifestyle factors also showed no associations.ConclusionsThis study offers insights into nitrosyl-heme exposure in European populations but found no link to CRC risk. Further research is needed to understand nitrosyl-heme's role in CRC.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12937-025-01266-7.

BackgroundThe association between relative fat mass (RFM), a sex-specific adiposity index derived from waist circumference and height, and incident cardiovascular diseases (CVDs) remains underexplored in Chinese populations. This study aimed to evaluate the predictive value of RFM for CVD risk in Chinese adults, addressing a gap in evidence for Asian cohorts with unique adiposity patterns.MethodsWe analyzed 7,027 adults aged≥45 years without baseline CVD from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2020). RFM was calculated using validated sex-specific equations. Cox regression models assessed RFM-CVD associations, with comprehensive subgroup analyses conducted to evaluate effect modification. The incremental predictive value of RFM beyond conventional Framingham risk factors was evaluated using area under the curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). ResultsOver a median 9-year follow-up, 24.6% participants developed CVDs. Each 1-unit RFM increase conferred a 3% higher CVD risk (adjusted HR=1.03, 95% CI: 1.02-1.05). Participants in the highest RFM quartile had 46% greater CVD risk versus the lowest quartile (adjusted HR=1.46, 95% CI: 1.05-2.03; P-trend=0.004). Sex-stratified analyses revealed consistent associations in both genders, though stronger effects were observed in males. Subgroup analyses confirmed robust associations across age groups and those without comorbidities. RFM significantly improved CVD prediction when added to Framingham risk factors (AUC 0.640 vs. 0.634; NRI=0.140, IDI=0.004; P<0.001).ConclusionsHigher RFM independently predicts incident CVDs in Chinese adults and enhances conventional risk stratification. RFM represents a practical anthropometric index for CVD prevention in clinical and public health settings, particularly valuable for resource-limited environments.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12937-025-01267-6.

BackgroundThe quest towards more feasible, low-cost yet accurate dietary assessment methods has led to the development of the new Experience Sampling-based Dietary Assessment Method (ESDAM). ESDAM is an app-based quantitative dietary assessment method to assess habitual dietary intake over a period of 2 weeks. ESDAM prompts three 2-hour recalls daily requesting to provide dietary intake on meal and food group level. The ESDAM allows to measure dietary intake near real-time in a rapid, low-cost and feasible manner. Following the user experience evaluation of the ESDAM, the validity of the ESDAM will now be assessed against objective biomarkers.MethodsThis protocol describes the validation of the ESDAM against three 24-hour dietary recalls (24-HDR), doubly labeled water, urinary nitrogen, serum carotenoids, and erythrocyte membrane fatty acids. The primary outcomes include energy intake and protein intake measured by the ESDAM in relation to energy expenditure measured by the doubly labeled water method and protein intake derived from urinary nitrogen analysis respectively. Secondary outcomes include nutrient and food group consumption derived from ESDAM and repeated 24-HDR’s, beta-carotenoids as biomarker of fruit and vegetable consumption and erythrocyte membrane fatty acid composition as biomarker of dietary fatty acid composition. Blinded continuous glucose monitoring will serve as method to assess compliance to ESDAM prompts. A target sample of 115 healthy volunteers will be recruited. Validity will be evaluated by mean differences and spearman correlations between nutrient and biomarker reference values. Bland-Altman plots will be developed to assess agreement. Method of triads will allow quantifying measurement error of the ESDAM, 24-HDR’s and biomarkers in relation to the (unknown) ‘true dietary intake’.DiscussionThis protocol describes an extensive validation study of a newly developed Experience Sampling-based Dietary Assessment Method against both self-reported and objective reference methods. The main strength is the use of the state-of-the-art validation techniques using doubly labeled water, urinary nitrogen, carotenoids and erythrocyte membrane fatty acids as biomarkers for dietary intake. A limitation of the study is that the evaluation of reproducibility of the ESDAM is not included.RegistrationThis study is registered at ClinicalTrials.gov on (NCT06485960, date: 07/02/2024).