Nutrition and Health

Inadequate positioning and attachment in the early postpartum period frequently result in breast soreness, which is among the leading causes of breastfeeding discontinuation. These conditions compromise exclusive breastfeeding and may adversely affect infant nutrition, underscoring the importance of effective antenatal breastfeeding education. Yet, few studies have evaluated clinical approaches to improving breastfeeding technique during pregnancy in this setting.

This study aims to investigate the impact of antenatal breastfeeding education delivered through clinical demonstrations on the incidence of breast soreness among primiparous Indonesian women.

A quasi-experimental design with equivalent-time samples will be used. Participants will be pregnant women in their third trimester, randomized 1:1 into experimental and control groups. The intervention group will receive two 40-minute sessions, including a clinical demonstration of correct breastfeeding positioning and attachment, and an educational electronic booklet (“e-booklet”), while the control group will receive standard educational materials once. Primary outcomes will be evaluated at 7 and 14 days postpartum. Data analysis will include independent t-tests and repeated-measures analysis of variance (ANOVA) to compare mean differences between groups, with multivariate logistic regression used to identify covariates.

This protocol will inform future interventions and programs aimed at strengthening breastfeeding education among primiparous mothers in Indonesian community settings. Findings may also guide the application of evidence-based best practices in similar contexts worldwide, with potential implications for reducing early feeding difficulties.

Family-level interventions can promote early child health. Partnering with community stakeholders, we co-developed Water is K’é, a culturally grounded family intervention delivered in early childhood education settings to promote healthy beverage choices and wellbeing among Navajo. (Diné) children ages two to seven. This manuscript describes the rationale, design, and methods of the study.

To evaluate the impact of Water is K’é on beverage behaviors among children and families, and on family cohesion and cultural connectedness.

Diné and non-Diné researchers and community advisors developed the intervention and study design using community engagement methods. In this cluster-randomized crossover trial, early childhood education sites on Navajo Nation will be enrolled and randomly assigned to begin the intervention in year one or serve as a waitlist control until year two. Child-caregiver dyads will be enrolled at the start of the school year, with optional participation from other family members. The intervention strengthens the cultural connection to water, encourages behavior change, and addresses water access through 4 monthly lesson plans, social media content, and tailored strategies to increase children's access to drinking water throughout the day. Primary endpoints include beverage habits and family cohesion. Collected data includes surveys, optional health measures, and qualitative interviews.

Water is K’é is a multilevel, community-designed intervention emphasizing Navajo language and culture. Innovative features include participant choice of health measures and family member enrollment. If successful, the program could be scaled across Navajo Nation and adapted for other early childhood programs.

Childhood anemia is a very common problem in India, out of which more than one-third is attributed to vitamin B12 deficiency.

To follow up on a girl with recurrent anemia who was later diagnosed with hereditary intrinsic factor deficiency.

An eight-year-old girl presented with recurrent anemia, easy fatigability, poor appetite, and abdominal pain for one month. The hemoglobin was 4.3 g/dL, and the peripheral smear showed a dimorphic picture. Serum vitamin B12 was severely low at <50 pg/mL. After a packed red blood cell transfusion, she was advised to take oral vitamin B12 and iron supplements. Her symptoms and vitamin B12 levels did not improve on follow-up, which led to suspicion of a congenital intrinsic factor deficiency (proven by whole exome sequencing). The child is currently doing well on monthly vitamin B12 injections.

This case highlights the importance of considering rare inherited causes in a child with recurrent severe anemia, even in regions where nutritional deficiencies are common.

People living with severe obesity are at an elevated risk of poor oral health. Contributing factors to poor oral health in this population group include cariogenic dietary behaviours and social determinants of health. There has been minimal discussion of the possible impacts of disordered eating behaviours on oral health particularly for those living with obesity.

This short communication aims to increase the awareness among dental teams of disordered eating behaviours and possible impacts on oral health particularly for patients living with obesity.

A short evidence-based report was developed to highlight the relevance and importance of increasing dental professional awareness of disordered eating behaviours.

Data on prevalence of disordered eating behaviours in the general population and individuals living with severe obesity have been reported. Some studies have revealed there may be a higher prevalence of some forms of disordered eating behaviours among people living with obesity. Potential negative sequelae on oral health include increased risk of missing teeth, periodontal disease, and active dental caries.

Collaboration between the disciplines of oral health and nutrition and dietetics, and with primary care providers such as general practitioners, is important to foster successful nutritional strategies for both general and oral health in patients living with obesity. Suggested approaches include joint professional society statements and increased training for the dental profession on oral health impacts of disordered eating behaviours to facilitate early identification, provision of tailored oral health care and signposting for support. The integration of the dental team into current obesity management will add to their supportive role in the overall management of people living with severe obesity.

Early nutrition is critical to later health outcomes. Infants exposed to maternal incarceration are a marginalized population and may be at elevated risk for suboptimal feeding.

To assess adherence to recommended timing of complementary food introduction among infants exposed to maternal incarceration in utero.

We analyzed data from 69 infants and caregivers in Georgia. Formerly incarcerated mothers (n = 17) and nonmaternal caregivers (n = 52) reported timing of complementary food introduction. Regression analyses assessed associations with independent variables, including poverty, food insecurity, Supplemental Nutrition Assistance Program receipt, and caregiver education, psychological distress, and age.

Approximately 47.8% of infants received complementary foods early, defined as before four months of age. The mean age of introduction was 3.6 months. Caregiver distress was associated with earlier introduction.

This population of caregivers requires tailored nutrition education, financial assistance, and mental health and social support services to promote optimal infant feeding practices.

The relationship between dairy consumption and breast cancer remains controversial, with studies reporting protective, neutral, and adverse associations.

To synthesize current evidence on the association between dairy consumption and breast cancer risk through a systematic review.

We conducted a systematic review of observational studies and meta-analyses published between 2015 and 2025 using PubMed, Scopus, and Cochrane Library. Data extraction followed PRISMA guidelines, focusing on study design, population, dairy type, intake levels, and outcomes.

Eleven eligible studies were included, involving over 2 million participants across diverse populations. Yogurt and low-fat dairy were generally associated with reduced breast cancer risk, while high-fat milk and processed cheese showed trends toward increased risk. Subgroup analyses revealed differences by estrogen receptor (ER) status and menopausal stage.

The impact of dairy on breast cancer risk varies by product type and patient characteristics. Further research is needed to delineate these relationships and inform dietary recommendations.

Malnutrition and weight loss (WL) are frequent in patients with head and neck cancer (HNC) during radiotherapy (RT), affecting treatment tolerance and outcomes. Nutritional interventions aim to minimize WL and support therapy completion, yet the prognostic value of WL during RT remains unclear.

To systematically evaluate the prognostic impact of WL before, during and after RT in patients with HNC.

This systematic review included studies from 2012 involving adult patients treated with definitive or postoperative RT for HNC, studies were eligible if WL/body mass index (BMI) change was analysed versus survival outcomes (overall survival (OS), disease-specific survival (DSS)/cancer-specific survival, disease-free survival (DFS)). A structured PubMed and Cochrane search was conducted and results were synthesized narratively.

Eight studies met the inclusion criteria. Pretreatment WL > 10% consistently predicted inferior OS and disease-specific survival (DSS). WL during RT varied widely between studies: most reported no association with OS, whereas single studies reported worse DSS with critical WL, worse OS with ΔBMI >1 kg/m², or an apparent survival advantage with greater WL. Posttreatment WL ≥ 10% was associated with reduced DFS. Comparability was limited by heterogeneous WL definitions, timing and treatment techniques.

Pretreatment WL is a strong negative prognostic factor in HNC, whereas evidence for WL during or after RT remains inconsistent. Standardized WL assessment and structured nutritional support should be integrated into routine RT care. Future prospective studies using harmonized definitions are needed to clarify prognostic relevance and guide evidence-based nutrition management.

Dietary fructose intake has increased markedly in Western countries, leading to an increase of children with a normal weight suffering from non-alcoholic fatty liver disease. The aim of this study is to examine current knowledge of the association between fructose consumption and hepatic steatosis in non-obese, non-diabetic children and adolescents and raise awareness of a well-known disease in a new cohort of paediatric patients.

This was a narrative literature review with systematic search elements. A literature search of PubMed, MEDLINE, EMBASE, Cochrane Library and Scopus was conducted with the final search completed on 21 September 2024. Eligible studies were peer-reviewed clinical or translational studies (including relevant animal models) reporting hepatic outcomes in paediatric populations without obesity or diabetes.

Thirteen studies met inclusion criteria including experimental (n = 2) and observational (n = 4) studies and reviews (n = 4). Those studies demonstrated that high fructose intake promotes hepatic lipid accumulation via unregulated hepatic fructose metabolism, increased de novo lipogenesis, impaired VLDL secretion, oxidative stress and gut-derived inflammation.

Fructose-associated hepatic steatosis is a clinically relevant phenomenon in children without obesity or metabolic syndrome without symptoms, so paediatricians need to screen their patients for it. This review highlights mechanistic distinctions between fructose and glucose metabolism, discusses the complexity of clinical trials, which explains the current gap in literature, and it underscores the role of misleading health marketing and opaque food labelling in exacerbating this risk. It emphasises the need for targeted preventive strategies and clearer food labelling to reduce hidden fructose exposure in youth.

Rheumatoid arthritis (RA) is a chronic autoimmune disease causing joint damage and disability. Vitamin D (VD) shows immunomodulatory effects in RA, but its causal role and potential mediation by sex hormones remain unclear.

To examine the VD-RA causal relationship and investigate androgen/estrogen mediation using Mendelian randomization (MR).

We conducted two-sample MR analyses using UK Biobank and IEU OpenGWAS data, with genetic variants as instruments. Mediation analyses assessed sex hormone effects.

Dietary VD associated with reduced RA risk (odds ratio (OR) = 0.994, 95%CI 0.992–0.996). Protective effects were stronger in males with seropositive RA (OR = 0.97, 95%CI 0.96–0.99) and females with seronegative RA (OR = 0.99, 95%CI 0.98–0.99). VD significantly lowered female testosterone (OR = 0.54, 95%CI 0.42–0.66), a RA risk factor (OR = 1.03, 95%CI 1.01–1.04), but did not affect male testosterone or female estrogen levels.

VD may reduce RA risk via gender-specific mechanisms, particularly by decreasing female testosterone. While MR supports causality, potential confounding requires cautious interpretation.

Specific foods and nutrients have a significant importance in maintaining healthy hair, which is a crucial aspect of an individual's identity and self-esteem.

To identify, through a literature review, the association between the consumption of specific foods and/or nutrients and the health of the hair.

This review followed the PRISMA guidelines and was registered on the PROSPERO platform (registration number: CRD42024527250). The databases Medline (PubMed), Web of Science and Scopus were consulted between March and June 2024. The following inclusion criteria were considered: individuals aged ≥3 years old; the consumption/intake of specific foods/nutrients; and articles written in English and Portuguese. The search expression combined terms related to ‘diet’, ‘nutrition’ and ‘hair health’ (n = 1287 articles), where language filters and duplicate removal were applied.

The analysis of 17 studies involved 61332 participants, predominantly women (97%). Vitamin D stood out as the most studied nutrient (five studies), while alopecia and hair loss were the most studied hair health parameters (eight and five studies, respectively). Higher levels of vitamin D and iron were inversely related to alopecia. Conversely, a higher intake of alcoholic and sugary beverages was found to be positively correlated with hair loss.

Diet and nutrition play a crucial role in hair health, particularly vitamin D and iron supplementation, while limiting alcohol and soft drinks may be beneficial. Further research is needed to confirm these findings.

Nutrition and health during infancy and early childhood are widely recognized as critical foundations for optimal development. In response, many parents choose to provide dietary supplements to their children in an effort to support growth and prevent illness.

This study aimed to examine the prevalence of dietary supplement use among infants and preschool children, and to assess parental knowledge, attitudes, and behaviors related to supplement use.

A random sample of 716 parents with infants and preschool-aged children enrolled in childcare institutions in Taichung City, Taiwan, was selected for participation. Parents who provided informed consent were asked to complete a structured questionnaire regarding dietary supplement consumption. The results revealed that 80% of infants and toddlers had consumed dietary supplements—specifically, 74% of infants and 84% of preschool-aged children.

Among children who consumed dietary supplements, over 70% were reported to be in generally good health, while the remainder had conditions such as allergies. The primary reasons for supplement use included enhancing immune function and reducing the frequency of common colds. Parental knowledge, attitudes, and behaviors toward dietary supplements were found to be at moderate to moderately high levels.

Children whose parents used dietary supplements were more likely to consume them as well. The three most commonly used supplements among infants and preschoolers were probiotics, calcium powder or tablets, and goat milk tablets.

Breastfeeding positively influences glucose regulation in postpartum women with diabetes.

This study aimed to describe breastfeeding barriers and facilitators in postpartum women with type 2 diabetes mellitus (T2DM).

This qualitative analysis utilized data from a parent study with a convergent parallel mixed-methods design. We interviewed postpartum women with T2DM and extracted fasting plasma glucose levels from medical records taken at 4 to 6 weeks after childbirth.

Eight postpartum women with T2DM participated. Those who exclusively breastfed had normal fasting plasma glucose levels. Six themes emerged as breastfeeding barriers and facilitators across individual, interpersonal, and societal levels. Individual barriers included low milk production, dietary cravings, and emotional challenges of first-time motherhood. Interpersonal barriers involved lactation issues, baby conditions, and mother–baby separation post-birth. Societal barriers included short maternal leave, workplace difficulties with pumping, baby's location, and healthcare costs. Individual facilitators included breastfeeding intention and dietary practices to boost milk. Interpersonal facilitators were understanding baby cues and family support. Societal facilitators were involved in Thai postpartum traditions, health literacy, and lactation rooms in hospitals.

Our findings highlighted the importance of identifying women's barriers and facilitators in breastfeeding, addressing physical and emotional challenges, and conducting lactation assessments. The study emphasized the need for increased workplace support for ongoing breastfeeding and individualized support that considers cultural beliefs and hospital practices.

Alarm fatigue is a growing concern in critical care units (CCUs), where frequent non-actionable alarms contribute to nurse desensitization, stress, and compromised patient safety. In Saudi Arabia's rapidly evolving healthcare system, understanding these dynamics is crucial for improving care quality and staff well-being.

This study aimed to assess the prevalence of alarm fatigue and perceived stress among critical care nurses in Saudi hospitals, explore their interrelationship, and evaluate their impact on perceptions of patient safety.

A descriptive correlational cross-sectional research design was adopted. Using a convenient sampling approach composed of 190 CCU nurses across seven Saudi hospitals. Three validated instruments including the Alarm Fatigue Scale, Perceived Stress Scale, and Safety Attitudes Questionnaire were used in this study. Data were analyzed using descriptive statistics, t-tests, analysis of variance, and Pearson's correlations.

Findings revealed moderate alarm fatigue (mean = 24.34, SD = 8.56) and stress (mean = 16.75, SD = 9.43). Alarm fatigue correlated with stress (r = 0.286, p < 0.01) and negatively with safety climate (r = 0.377) and teamwork climate (r = 0.402).

Alarm fatigue significantly influences stress levels and safety perceptions among critical care nurses, underscoring the need for targeted, context-specific interventions. Standardized alarm management protocols, culturally relevant staff training, and the adoption of intelligent alarm filtering systems are recommended to reduce cognitive overload, enhance nurse well-being, and strengthen patient safety culture in Saudi CCUs.

Coronavirus Disease 2019 (COVID-19) has led to dramatic changes including social distancing, closure of schools, travel bans, and issues of stay-at-home orders. The health-care field has been transformed with elective procedures and on-site visits being deferred. Telemedicine has emerged as a novel mechanism to continue to provide care. However, there remains a paucity of data regarding its efficacy in nutrition support, especially in patients with chronic intestinal failure (CIF).

Describe the utilization of telehealth in the routine management of CIF, particularly in the initiation and training of home parenteral nutrition (HPN).

A case series presenting our experience with the use of telemedicine to provide training for HPN for three patients. The manuscript describes the utility of telehealth in providing remote and adequate training for patients commenced on HPN during COVID-19 pandemic.

Since the onset of the COVID-19 pandemic, we have successfully provided virtual training to three patients, including two who were noted to be severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive and one patient who could not be transferred to our facility for training. For SARS-CoV-2 positive patients, the risk of transmission to nursing staff with 8–10 h of face-to-face training in two cases was felt to be too significant for in-person training. We determined that the best option would be to stabilize parenteral nutrition in the hospital and perform virtual training. Although virtual training was successfully performed, it was felt that training in this manner took much longer, required frequent adjustment of the tablet device to ensure patient remained in field of view, and made it difficult to connect with the patient emotionally.

Telemedicine has significantly improved care provided during COVID-19 as a modality for effective training on HPN, while in-person communication was significantly limited due to the pandemic. However, when possible, it should be used in a manner that complements but does not supplant standard care.

Consumption of mercury during pregnancy is detrimental to life and results in neurodevelopmental delays, foetal development, premature birth, low birth weight, and spontaneous miscarriages. Socio-cultural norms and practices play a critical role in shaping dietary habits and food choices among pregnant women.

To assess the prevalence of mercury consumption, its socio-cultural drivers, and its nutritional implications among pregnant women in urban Mafeteng District, Lesotho.

Using a cross-sectional design, quantitative and qualitative approaches, the study sampled 72 participants (50 pregnant women and 22 traditional healers), drawn from an estimated population of 16,682 using Epi Info software. Data was analyzed using SPSS version 20.

The mean age of pregnant women was 25 years (± 4.7 SD), more than 60% had a high school education, and more than 62% were not married. 48% reported obtaining mercury from the local chemist, with over 60% consuming it for more than 2 months. Mercury was consumed by 36% to reduce pain during childbirth, 24% to protect their unborn child against witchcraft, 28% a cultural practice. Among traditional healers, 95% were males, with a mean age of 34 years (± 12.4 SD). Of these 38% administered mercury to counter witchcraft, 53% to reduce labor pain, and ensure safe and timely delivery.

A high prevalence of mercury consumption among pregnant women existed and was largely influenced by socio-cultural norms and beliefs. Duration of exposure to mercury could affect early fetal development. Furthermore, side effects like nausea and vomiting may compromise maternal nutrition, adding to health risks during pregnancy. Need for urgent public health interventions to address these cultural practices and prevent mercury exposure.

The rapid adoption of artificial intelligence-powered tools like ChatGPT has introduced new avenues for patients to access health information independently. Understanding how patients perceive and engage with such tools is essential to evaluating their trustworthiness, usability, and potential impact on health decision-making.

The purpose of this study is to investigate the facilitators and barriers of using ChatGPT as a health information resource for patients’ health management.

A qualitative research design was adopted in this study. The participants included outpatients at a public hospital. Participants interacted with ChatGPT (version 3.5) for at least 15 min daily over 2 weeks to explore health-related topics before participating in semi-structured interviews. A total of 28 outpatients participated in the interviews.

The findings from this study have indicated both positive and negative aspects of ChatGPT as a health information resource. Among the 28 participants, the most frequently reported facilitators included improved health literacy (reported by 26 participants, 92.9%), effectiveness and efficiency (24 participants, 85.7%), cost-effectiveness (23 participants, 82.1%), accessibility (17 participants, 60.7%), empowerment (13 participants, 46.4%), and anonymity (11 participants, 39.3%). Reported barriers included lack of personalized information (15 participants, 53.6%), limited reliability (9 participants, 32.1%), restricted diagnostic capability (6 participants, 21.4%), lack of human interaction (14 participants, 50%), privacy concerns (4 participants, 14.3%), legal and ethical issues (9 participants, 32.1%), and lack of emotional support (3 participants, 10.7%).

Although ChatGPT has significant benefits of being used as a health information resource, to arrive at specific conclusions, there is a need to extend these kinds of studies across the regions to assess the impact of ChatGPT on different populations for promoting health literacy.