I n t r o d u c t i o n: Despite increased awareness of malnutrition and improved nutrition-related policies, there are still cases of deterioration of nutritional status during hospitalisation. NutritionDay is an audit organised by the European Society for Clinical Nutrition and Metabolism (ESPEN), the Medical University of Vienna and the Friedrich-Alexander University Erlangen-Nürnberg (FAU) to prevent the onset of malnutrition and to improve hospital policies to deal with this problem. The aim of the study was to analyse the results of the audit with regard to factors that may contribute to the deterioration of a patients\' nutritional status in hospital setting. Materials and Methods: This cross-sectional study was performed in a tertiary teaching hospital and was part of an international audit. The questionnaires used were provided by the nutritionDay office, and included information on weight loss, patients\' appetite, dietary restrictions, food intake and reasons for food rejection during hospital stay. R e s u l t s: Of the examined patients, 61% reported weight loss prior to the current hospital stay. We identified 25 patients who did not consume a whole portion of their main meal on the day the audit took place. Approximately 17% of the patients\' complaints could be resolved within a hospital ward. C o n c l u s i o n s: Hospital patients often eat less than a standard meal portion. Identifying the reasons for meal rejection may be helpful for development of standards for nutritional care in the hospitals.

Many patients with diabetes struggle with post-meal high blood glucose due to missed or untimely meal-related insulin doses. To address this challenge, our research aims to: (1) study mealtime patterns in patients with type 1 diabetes using wearable insulin pump data, and (2) develop personalized models for predicting future mealtimes to support timely insulin dose administration. Using two independent datasets with over 45,000 meal logs from 82 patients with diabetes, we find that the majority of people ( ∼ 60%) have irregular and inconsistent mealtime patterns that change notably through the course of each day and across months in their own historical data. We also show the feasibility of predicting future mealtimes with personalized LSTM-based models that achieve an average F1 score of > 95% with less than 0.25 false positives per day. Our research lays the groundwork for developing a meal prediction system that can nudge patients with diabetes to administer bolus insulin doses before meal consumption to reduce the occurrence of post-meal high blood glucose.

Early-life family meal participation has been associated with several aspects of nutritional health, but longitudinal associations with linear growth have not yet been investigated. The aim of this study was to investigate whether family meal participation at 12 months of age associates with anthropometric measures 3 years later. We used follow-up data from children born to mothers in the Norwegian Fit for Delivery trial (NFFD) and included 368 first-borns with dietary and anthropometric data at 12 months and 4 years of age. We treated the sample as a cohort and conducted subgroup analyses by randomization status. A family meal participation score was used as exposure, and weight, height, and body mass index (BMI) as outcomes in crude and multivariable linear regression models adjusted for maternal education, randomization status, and child sex.Higher family meal participation score at 12 months was positively associated with length at 12 months (B = 0.198, 95% CI 0.028, 0.367, p = 0.022) and 4 years (B = 0.283, 95% CI 0.011, 0.555, p = 0.042) in multivariable models. After additional adjustment for maternal height the associations attenuated and were no longer significant. An inverse association with BMI at 4 years of age was observed in children born to mothers that had been exposed to the NFFD intervention (B = -0.144, 95% CI -0.275, -0.014, p = 0.030), but attenuated after adjustment for maternal BMI.The longitudinal association observed between early family meal participation and child height was largely explained by maternal height. The relationship with BMI differed according to maternal participation in a lifestyle intervention trial during pregnancy.

OBJECTIVE: This paper aims to examine the association between meal duration and obesity indicators among Spanish adolescents.
METHODS: We conducted a cross-sectional analysis using data from the Eating Healthy and Daily Life Activities (EHDLA) project involving 755 adolescents aged 12 to 17 years (54.8% girls) from three secondary schools in the Valle de Ricote Region of Murcia, Spain. To evaluate overall meal duration, participants were asked how long (on average) breakfast, morning snacks, lunch, afternoon snacks, and dinner typically last. Subsequently, global meal duration was measured, and the participants were categorized into tertiles. Obesity-related indicators, including body mass index (BMI) z score, waist circumference (WC), and skinfold thickness, were assessed. The analyses were adjusted for potential confounders such as sex, age, socioeconomic status, physical activity, sedentary behavior, diet quality, and energy intake.
RESULTS: Concerning meal duration status, adolescents with long meal durations had the lowest estimated marginal means of BMI z score, WC, and body fat percentage (using the sum of triceps and calf skinfolds). However, significant differences between adolescents with a long meal duration and those with a short meal duration were observed only for BMI z score (p = 0.008), and WC (p = 0.020). Furthermore, significant differences in BMI z score (p = 0.017) between adolescents with a long meal duration and those with a moderate meal duration were identified.
CONCLUSIONS: These findings underscore the importance of promoting slower eating habits as part of obesity prevention strategies. Future studies should explore the causality of this association and its potential for behavioral interventions.

Background: Previous studies have shown that meal timing, poor sleep quality, and chronotype may play a relevant role in the development of type 2 diabetes mellitus (T2DM). However, its relationship with macronutrients by eating occasions has not been explored deeply. Objective: Our aim was to estimate the association between chrono-nutrition, sleep quality, chronotype, and the prevalence of T2DM. Methods: This cross-sectional study included a subset of 3465 middle-aged Caucasian adults (2068 women) from the European Prospective Investigation into Cancer and Nutrition (EPIC) Spain cohort study. In the 2017-18 follow-up, we assessed chronotype, sleep quality, diet, and sociodemographic data using validated questionnaires. Further, we used blood samples to determine serum levels of glucose. We defined a case of T2DM when serum glucose concentration was ≥126 mg/dL or when participants self-reported diabetes. Results: A higher prevalence of T2DM was associated with poor sleep quality (ORpoorvsgood = 2.90, 95% CI = 1.30, 6.28). Carbohydrate intake at breakfast was inversely associated with the prevalence of T2DM (OR = 0.75, 95% CI = 0.66, 0.85). Finally, lipid intake at breakfast was associated with a 13% higher prevalence of T2DM (OR = 1.13, 95% CI = 1.01, 1.26) for each 1 standard deviation (1-SD) increase. Conclusions: This study concludes that a higher content of carbohydrates at breakfast is correlated with a reduced prevalence of T2DM, while higher lipids intake at breakfast is associated with a higher prevalence of T2DM. Furthermore, poor sleep quality is a potential factor associated with an elevated prevalence of T2DM. Our results emphasize the need for prospective studies to validate and strengthen these observed associations.

Healthy lifestyle behaviors are essential in the treatment of type 2 diabetes, and meal registration is therefore important. Manual meal registration is cumbersome and could be automated using continuous glucose monitoring (CGM). If such an algorithm is based on patient-reported meals, potential errors might be induced. Thus, the aim was to investigate potential errors in patient-reported mealtimes and the effect on automatic meal detection. Two healthcare professionals (HCPs) reported the mealtimes of the 18 included patients based on the patients\' CGM data to assess the agreement between HCP- and patient-reported mealtimes. A developed meal detection algorithm based on detecting the post-prandial glucose response using cross-correlation was used to assess the impact of errors in patient-reported meals. The results showed poor disagreement between HCP- and patient-reported meals and that the meal detection algorithm had a moderately better performance on the HCP-reported meals. Therefore, the possibility of errors in patient-reported mealtimes should be considered in the development of meal detection algorithms. However, more research is needed to confirm the results of this study.

The relationship between negative emotions and avoidance is widely theorized as a bidirectional cycle implicated in a range of psychopathology. Historically, research on this cycle has examined one type of negative emotion: anxiety. Yet, a broader range of internal experiences may be implicated in the maintenance of unhealthy avoidance cycles in psychopathology. This study examines prospective relationships among anxiety, guilt, physical discomfort, and experiential avoidance during mealtimes for individuals with eating disorders (EDs). Participants (N = 108) completed ecological momentary assessments four times a day for 25 days. We computed multilevel models to examine between- and within-person effects of negative emotions and physical discomfort on experiential avoidance. When including guilt and anxiety in one model, guilt, but not anxiety, explained the significant variance in experiential avoidance at the next meal. Mealtime physical discomfort and experiential avoidance evidenced reciprocal prospective relationships. Future research should test whether interventions targeting experiential avoidance and physical discomfort at mealtimes disrupt guilt.

While an intensity-dependent post-exercise decrease in energy intake (EI) has been described in adolescents with obesity, studies invariably used ad libitum meals, limiting then any conclusions regarding the effect of exercise on post-meal appetitive responses that can be also impacted by the ad libitum nature of the meal. This study analyses appetite and food-reward related responses to a fixed meal after an acute exercise, also exploring the associations between substrate use during exercise and overall daily EI in adolescents with obesity. Thirteen adolescents with obesity (12-16 years, 5 males) randomly complete 2 experimental sessions: (i) a control condition (CON); (ii) a 30-min moderate intensity (65% VO2peak) cycling condition (EX). Energy expenditure and substrate oxidation were measured during both 30 min of rest (CON) or exercise (EX). Ad libitum EI, macronutrient intake and relative EI were assessed at dinner, subjective appetite sensations taken at regular intervals and food reward measured before and after lunch as well as before dinner. Energy and macronutrient intake did not differ between conditions, as well as appetite feelings. A time effect (p = 0.012) was observed between pre and post meal for choice fat bias in both conditions but was only significant within the CON condition (p = 0.004). CHO oxidation during exercise was found correlated with both EI (r = 0.586, p = 0.045), pre-lunch hunger (r = 0.624, p = 0.030), daily AUC for hunger and DTE (r = 0.788, p = 0.002 and r = 0.695; p = 0.012 respectively). This exploratory study highlights that acute exercise might not affect subsequent appetite responses when using a fixed test meal in adolescents with obesity.

The COVID-19 pandemic altered daily family routines, with the family food environment especially likely to be affected. Little is known about how families have adapted over time. The objective of the current study was to explore how family food habits evolved three years after COVID-19 was designated a pandemic. Mothers participated in an interview between March and April 2023. Reflexive thematic analysis was used to analyze the transcripts. Thirty mothers participated (97% lived in the Central Valley in California; 43% Hispanic). Themes were identified around changes in mealtime frequency, eating habits including snacking, screen time during mealtimes, and weight gain. While some unhealthy habits established during the pandemic improved, others persisted three years later. Maternal snacking, concerns about child weight gain, and overall screen time lessened after the pandemic ended, but child snacking behaviors, maternal weight gain concerns, and screen time during mealtimes continued. This research expands on the existing COVID-19 literature by examining lingering effects of the pandemic on family food habits. Findings may be helpful for health practitioners working with families to understand food related changes post-pandemic, especially those that have been particularly resistant to change.

BACKGROUND: Organization of food services within hospitals has been identified as a determinant of hospitalized patients\' nutritional intake and associated food waste. Whereas hospital food service systems in the Netherlands traditionally consist of 3 fixed mealtimes each day, we recently implemented a new 3-channel concept that provides patients the opportunity to order extra meals or snacks in-between their 3 main mealtimes or even have dinner with their visitors in a bistro located on their ward.
OBJECTIVE: This study investigates the impact of transitioning from a traditional paper-based to a patient-centered, digital hospital food service system on food waste production patterns and its associated financial implications.
METHODS: Plate waste (served but uneaten food) measurements were performed at baseline for all served meals during a one-week period within the traditional system and follow-up measurements were conducted annually after implementation of the new system during 3 consecutive years. Measurements were conducted at two hospital floors, each comprising four wards. Average grams of plate waste per served meal, daily meal frequency per patient and the associated production and disposal costs of the collected waste were calculated and compared between the two systems.
RESULTS: A total of 4361 meals served within the traditional system were compared with 7815 meals served within the new digital system. Meal frequency increased from an average of 2.5 meals per patient per day in the old system to an average varying between 3 and 3.3 meals per patient per day in the consecutive years. Within the traditional system, average plate waste was 81 grams per served meal, whilst it ranged between 33 and 49 grams per served meal during the following years, with the 3-channel concept in place (p < 0.001, p = 0.010). Dinner demonstrated the largest reduction in plate waste at all measurement points. Following this reduction of plate waste, estimated associated costs of plate waste production and disposal decreased in a similar pattern.
CONCLUSIONS: Transitioning from a traditional, paper based to a patient-centered and digital hospital catering system results in significantly higher daily meal frequency and less food waste per served meal.