Journal of Human Nutrition and Dietetics最新文献

Aims: To quantify the content, understandability, actionability, readability, and overall quality of food chemical intolerance dietary information for patients available online and via mobile applications.

Methods: Content analysis was undertaken between August 2023 and August 2024 of eligible webpages and mobile applications. Online material was evaluated for quality using the DISCERN tool, clarity using the Centre for Disease Control and Prevention's Clear Communication Index and health literacy demand using the Patient Education Material Assessment Tool and the Hemingway readability calculator. Mobile applications were evaluated for quality using the Mobile App Rating Scale.

Results: A total of 169 websites and four mobile applications were eligible for analysis. Almost all (95%) resources recommended an elimination diet for the management of food chemical intolerance, but only 56% advised food reintroduction. Overall, diet information regarding food chemical intolerance found online and in mobile applications was mostly of poor quality. Information found online was also of low clarity and written with a high health literacy demand. Of the information scored as being of good quality, these were written by health/medical organisations and dietitians.

Conclusion: Future revision and development of online and mobile applications should aim to improve the quality and reduce the health literacy demand of food chemical intolerance diet information. Additionally, online information and applications should include food reintroduction instructions, as prolonged dietary restrictions, especially without supervision, may increase the risk of nutrient deficiencies and disordered eating behaviours, and impact quality of life.

Introduction: UK guidance recommends adults living with coeliac disease (CD) receive annual care from a dietitian. However, many CD provisions have difficulties meeting these demands. The study aimed to evaluate a digital virtual annual review (VAR) tool as an alternative method of reviewing clinically stable adults with CD annually.

Methods: This single-centre retrospective study analysed data between September 2022 and March 2024. Adults living with CD, diagnosed for > 3 years and deemed clinically stable by a specialist CD dietitian, received a link to complete the digital VAR tool. Chi-squared analysis assessed the relationship between demographics and engagement with the tool. Median value indicated clinician triage time. Outcomes of the triage process were presented as frequency and percentages. Ethical approval was obtained from local higher education institute, and information governance approval was received through local processes.

Results: The majority (81.7%, n = 165) of service users engaged with the digital VAR tool. The demographics did not influence engagement. The specialist CD dietitian required 14 min on average to triage a singular digital VAR tool. Following triage, 72.4% (n = 102) did not require interim input prior to their routine annual review. Only 22% (n = 31) were deemed to require a follow-up clinic appointment with the specialist CD dietitian to discuss symptoms or GF dietary adherence. Service users mainly preferred the digital VAR tool for future reviews (55%, n = 78).

Conclusions: Our study provides supportive evidence for the effectiveness of a digital annual review tool to improve the efficiency of dietetic service provision for stable adults living with CD.

Background: Adolescence is a critical period for mental health, with anxiety disorders becoming increasingly prevalent. Sugar-sweetened beverages (SSBs) have been identified as a potential dietary factor influencing mental health outcomes. This systematic review aims to critically appraise the literature around the association between SSB consumption and anxiety disorders among adolescents.

Methods: A systematic search was conducted across electronic databases, including Medline Complete, CINAHL Complete, Scopus, Cochrane Library, Web of Science, and ScienceDirect for studies published between 2000 and 2025. Data on SSB intake and anxiety outcomes were extracted, and the quality of the studies was evaluated using the Risk of Bias in Non-randomised Studies from the Cochrane Handbook of Systematic Reviews of Exposure. Meta-analysis was conducted using random-effect model to estimate the odds ratios to assess the relationship between SSB intake and anxiety disorders with 95% confidence interval (CI).

Results: Nine studies meeting the inclusion criteria were selected, including seven cross-sectional studies and two longitudinal studies. Of the nine studies, seven reported a significant positive association between SSB consumption and anxiety, while two found no significant relationship. The longitudinal studies showed small but persistent associations over 1 year. The studies using multiple linear regression demonstrated a consistent, small positive relationship between SSB intake and anxiety symptoms. The meta-analysis random effects model which is limited to studies reporting anxiety disorder as binary outcome revealed that higher sugar-sweetened beverage consumption was associated with increased odds of anxiety disorders (OR: 1.34, 95% CI: 1.14-1.59).

Conclusion: Given the predominance of observational designs, these findings should be interpreted as associations rather than evidence of causality. Public health initiatives and clinical interventions aimed at reducing SSB intake may help mitigate the rising prevalence of anxiety disorders, specifically among adolescents.

Background: Glaucoma is the leading irreversible cause of blindness worldwide. Dietary hexadecenoic acid is a monounsaturated fatty acid with anti-inflammatory and lipid-modulating properties. However, its association with glaucoma remains unclear. This study aimed to investigate the association between dietary hexadecenoic acid intake and glaucoma among adults.

Methods: This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES) 2005-2008, including 705 participants aged ≥ 40 years. Dietary hexadecenoic acid intake was assessed through two 24-h dietary recalls, and glaucoma diagnosis was based on expert grading of optic disc images. Multivariate logistic regression analyses were performed to evaluate the relationship between dietary hexadecenoic acid intake and glaucoma prevalence. Dose-response relationships between dietary hexadecenoic acid intake and glaucoma were explored using restricted cubic spline (RCS) curve analysis. The subgroup analysis evaluated the consistency of the association across different populations.

Results: Participants with higher dietary hexadecenoic acid intake showed a significantly lower prevalence of glaucoma. In fully adjusted models, each 1 g/day increase in hexadecenoic acid intake was associated with a 39% reduction in glaucoma prevalence (OR = 0.61, 95% CI: 0.41-0.91, p = 0.018). Quartile analysis revealed that participants in the highest quartile of hexadecenoic acid intake had a lower glaucoma prevalence compared to the lowest quartile. RCS curve analysis demonstrated a linear negative correlation. Subgroup analyses indicated that the negative effects of dietary hexadecenoic acid intake on glaucoma were stronger in males, low-education and non-diabetic individuals.

Conclusion: Higher dietary hexadecenoic acid intake is associated with reduced glaucoma prevalence. Given the limitations of cross-sectional studies, in the future, prospective studies should be conducted to verify the protective effect of hexadecenoic acid on glaucoma.

Background: Artificial intelligence (AI) chatbots are increasingly used in various fields, including nutrition. Despite their growing popularity, there is limited evidence regarding the accuracy and reliability of clinical nutrition education potential. This study aimed to assess the performance of basic versions of AI chatbots in answering multiple-choice questions related to clinical nutrition.

Methods: The four AI chatbots (ChatGPT, DeepSeek, Gemini and AI Clinical Nutritionist) were evaluated based on the accuracy of their responses to multiple-choice questions. Two hundred and seventy-six multiple-choice questions were developed using Krause's Food & the Nutrition Care Process textbook, covering 16 adult disease topics related to pathophysiology, aetiology, medical treatment and nutritional treatment. The test-retest reliability of responses given to the same set of multiple-choice questions at two different time points was evaluated using Cohen's Kappa (κ), and the reliability of the four AI tools was evaluated using the intraclass correlation coefficient (ICC).

Results: The ICC value was 0.901 (0.880-0.918) and κ value was 0.766 and above for each AI tools (p < 0.001). In the first round, the accuracy rates were 72.8% for ChatGPT, 73.9% for DeepSeek, 69.6% for Gemini and 73.2% for AI Clinical Nutrition. In the second round, these rates were 71.4%, 72.5%, 69.3% and 70.3%, respectively. The highest overall accuracy was observed with DeepSeek (73.18%), while Gemini showed the lowest performance (69.3%). When analysed by topic, the highest accuracy was found in 'Diabetes mellitus and non-diabetic hypoglycemia' and 'Upper GI Diseases' (100%), while the lowest was in 'Anaemia' (36.4%). Among the fields, the lowest accuracy was observed in medical treatment (63.6%), followed by nutritional treatment (67.4%). The mean accuracy of AI chatbots in responding to clinical nutrition multiple-choice questions was 71.6%, with similar performances across platforms.

Conclusion: While the notable accuracy in certain topics and high reliability demonstrate the potential of AI chatbots for clinical nutrition, it highlights the need for continuous updates and performance optimization in topics where accuracy is lower.

Background: Dietary management is integral to the irritable bowel syndrome (IBS) pathway. Triage facilitates the decision-making process for the right dietetic intervention; however, telephone triage is time intensive. Digital advances provide an opportunity to target waiting times and clinical capacity. The aim of this work was to develop and implement a novel semi-automation virtual triage, assess its impact in the IBS pathway and to investigate attitudes towards the use of artificial intelligence (AI) in triage and dietetic healthcare.

Methods: The Consolidated Framework for Implementation Research (CFIR) provided a structure to develop and implement virtual triage into the IBS pathway. A digital triage questionnaire was developed using experience-based co-design. The efficacy of virtual triage was compared with telephone triage for waiting times from referral to triage, clinicians' time taken to triage and clinical capacity. Using qualitative interviews, views on AI in virtual triage and the IBS pathway were collected from three patients and two dietitians who had experience of the newly developed virtual triage process. An exploratory survey in seven gastroenterology dietitians was used to assess attitudes and experiences of AI in clinical practice.

Results: A digital questionnaire was developed and embedded into the IBS pathway for virtual triage. Following implementation, 643 patients received virtual triage with 83% completing the digital questionnaire. From telephone triage to virtual triage, mean waiting times reduced from 56.6 days to 17.5 days, mean clinician time to triage decreased from 20 min/patient to 11 min/patient, and clinical capacity increased from 400 to 1000 appointments/year (all p < 0.001). Views on AI in healthcare were mixed, and three key themes emerged: potential benefits; concerns about its use and criteria for application.

Conclusions: Virtual triage increases clinical capacity and reduces waiting times without increasing clinician burden. Attitudes towards AI show interest; however, there is a need for validation to determine confidence and acceptability for both clinicians and patients in terms of problem-solving and healthcare efficiency.