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How the new future of nutrition puts holistic health first

Consumers want healthier and more nutritionally balanced food. Image:  Pexels

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• Consumers are increasingly seeking healthy, affordable food but the market is dominated by unhealthy choices.
• Global issues, such as climate change, geo-political conflicts, and the pandemic, are putting pressure on food and nutrition security.
• The 'Metabolic Matrix' aims to serve as one example of how the food and beverage industry can reengineer its products to improve human and environmental health despite these challenges.

Now is the time for laying out the pathways to a new future for sustainable and healthy food. Simultaneous impacts from accelerating climate change, international conflicts, economic pressures, and supply chain disruptions continue to challenge consumer industries’ progress toward achieving the UN Sustainable Development Goals and pose a significant threat to food and nutrition security.

Waves upon waves of communicable and non-communicable diseases combine to create unprecedented, and unsustainable challenges, to human health. Both COVID-19 and increased levels of metabolic disease are negatively affecting multiple systems of the body and are weakening individual and societal resilience.

Demand for healthy, affordable food

In the midst of these challenges, consumers are increasingly seeking healthy, affordable food (over 70% want to be healthier , and over 50% have prioritized healthy eating as number one on their list). A number of food companies are now working to respond to these increases in demand for healthier food but for many, today’s “default” food environment continues to be dominated by unhealthy choices.

Food companies will need to significantly alter their food portfolios in the coming years to transform the default environment and surround these consumers with healthier and more nutritionally balanced food choices. For many food companies, that means fundamentally changing food portfolios and re-engineering many food products to make them healthy, nutritious, tasty, affordable, and widely available to consumers.

Have you read?

How nutrition can improve societal resilience, how innovative actions can create opportunities to solve the global food and nutrition crisis, food meets health: how a new approach to metabolic health could tackle chronic disease.

One example of a food and beverage company that is taking on the challenge of re-engineering their portfolio to put nutrition and human health first is KDD, a 60-year-old manufacturer in the MENA region and member of the World Economic Forum. It has forged a sustainability strategy featuring three pillars: people, planet, and nutrition.

The centrepiece of KDD’s nutrition strategy is to focus on foods that promote metabolic health. To guide this work, they have developed a science-based framework called the Metabolic Matrix. In June of 2021, the Forum featured this work in an article titled Food meets health: How a new approach to metabolic health could tackle chronic disease. The Metabolic Matrix was also featured in the New Frontiers of Nutrition community paper : Achieving Societal Resilience: The Nutrition Opportunity , released in April 2022.

KDD’s Metabolic Matrix model is an innovative, systemic, and collaborative approach to addressing growing concerns about how the food and beverage industry impacts human and environmental health. In the interest of inspiring other food companies to take similar steps and in the spirit of advancing global health, KDD has published an info site on the matrix and also shared the model at an international medical symposium on metabolic health and nutrition. The matrix is based upon three high-level goals for nutrition: support the brain, protect the liver, and feed the gut.

In order to build a resilient future for all stakeholders, the World Economic Forum's Platform for Shaping the Future of Consumption aims to shape responsible models of consumption that are equitable, promote societal well-being, and protect the planet.

• The Consumers Beyond Waste initiative is empowering consumers to access reuse consumption models at scale. It’s vibrant community of changemakers across leading consumer companies, reuse innovators, civil society, and policymakers have established strategic frameworks to enable an economically viable transition to reuse, along with guidelines for design, health and safety, and municipal considerations to facilitate adoption. In its next phase of impact, the initiative is building a framework for standardized reuse measurement and reporting and advancing the development of reuse policies and legislation at scale.
• The New Frontiers of Nutrition initiative is dedicated to transforming lives through the power of nutrition via system-wide change. Leading experts and researchers in nutrition, companies from multiple industries, and public partners are joining forces to shape transformative solutions to accelerate the availability, access, and adoption of nutritious food choices to empower holistic – physical and mental - health and wellbeing of consumers.
• The Future of Personalized Wellbeing initiative is harnessing the power of digital biology to revolutionize the overall well-being of individuals. It has convened a community of technology innovators, consumer companies, data experts, academics, and progressive public sector actors to establish a future-oriented vision and roadmap for the widespread adoption and use of precision consumption solutions focused on precision nutrition and personal care.
• The Scope 3 Decarbonization: The Consumer Opportunity initiative is identifying the demand-side strategic pathways required for Scope 3 decarbonization within the net-zero commitment framework. It brings together an ecosystem of leading cross-industry actors and public sector organizations to empower citizens in leading net zero lives anchored in new patterns of consumption.

Contact us for more information on how to get involved.

KDD is currently leveraging this evidence-based tool which categorizes products and ingredients according to their impact on metabolic health to apply it across their entire food and beverage portfolio. KDD is now reengineering many of its products and evolving its business model to embrace these changes.

A publicly available methods paper is currently under peer review which will offer a roadmap for other companies to inspire and guide them in potentially undertaking similar portfolio re-engineering efforts to improve metabolic health and mitigate chronic disease at scale, contributing to an improved food environment and improvements in global public health.

Implementing such a comprehensive and systemic approach has come with significant challenges associated with consumer preferences and beliefs, taste appeal of products and costs. Over the course of implementing this work, KDD has maintained its focus on eight “gears of change”.

Professor Klaus Schwab, the Founder and Executive Chairman of the Forum, has called for future food systems to adopt a “platform for action” approach, enabling stakeholders from various sectors and geographies to develop public-private collaborations that meet local needs while collectively aligning and coming together to address global ones. This approach fundamentally has three traits:

• Its focus is on platforms - not institutions, projects or pilots.
• Its energy goes towards bolstering and aligning efforts, rather than duplicating them or approaching them piecemeal or in silos.
• It requires a scaled, collaborative, cross-sector and solution-orientated mindset from the outset.

The goal in sharing the details of the metabolic matrix and the experiences of KDD is to build more momentum towards a “platform of action” through the Forum’s New Frontiers of Nutrition initiative, where many companies come together, along with the public sector, to share critical learnings, remove common barriers, and accelerate industry-wide steps to shift the default environment to an abundance of healthy, nutritious food choices that support individual health and strengthen societal resilience.

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• Published: 13 January 2024

Emerging challenges and opportunities in innovating food science technology and engineering education

• I. S. Saguy   ORCID: orcid.org/0000-0002-1570-8808 1 ,
• C. L. M. Silva   ORCID: orcid.org/0000-0002-0495-3955 2 &
• E. Cohen   ORCID: orcid.org/0000-0003-2342-5418 3  

npj Science of Food volume  8 , Article number:  5 ( 2024 ) Cite this article

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An Author Correction to this article was published on 13 February 2024

This article has been updated

Progress in science, technology, innovation, and digital capabilities call for reassessing food science, technology, and engineering (FST&E) education and research programs. This survey targeted global professionals and students across food disciplines and nutrition. Its main objectives included assessing the status of FST&E higher education, identifying challenges and opportunities, and furnishing recommendations. Seven topics affecting the future of the FST&E curricula were evaluated by the panel as ‘High’ to ‘Very high’, namely: ‘Critical thinking’, followed by ‘Problem-solving projects’, ‘Teamwork/collaboration’, ‘Innovation/Open innovation’ and ‘Multidisciplinary’. The importance of academic partnership/collaboration with the Food Industry and Nutrition Sciences was demonstrated. Significant positive roles of the food industry in collaboration and partnerships were found. Other essential food industry attributes were related to internships, education, strategy, and vision. Collaboration between FST&E and nutrition sciences indicated the high standing of this direction. The need to integrate or converge nutrition sciences and FST&E is emphasized, especially with the growing consumer awareness of health and wellness. The study provides insights into new education and learning opportunities and new topics for future curricula.

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Introduction.

The unabated progress in science, technology, and innovation, combined with the exponential rate of change facilitated by the proliferation of computerized capabilities and artificial intelligence (AI), calls for reassessing the food science, technology, and engineering (FST&E) education. The fourth industrial revolution (i.e., Industry 4.0) highlights significant progress in numerous fields, including robotics, smart sensors, AI, the Internet of Things (IoT), big data, cloud computing, safety, and production efficiency 1 . Climate change, global population growth, high levels of food loss and food waste, and the risk of new disease or pandemic outbreaks are examples of numerous challenges that are potential threats to future food sustainability and the security of the planet that urgently need to be addressed 2 .

The projected global population growth reaching 10 billion people by 2050 highlights the acute need for new evaluations of FST&E education system background to address mounting challenges and opportunities. The complexity and predicted immense size of future tasks call for new paradigms, an open innovation mentality, and a novel mindset promoting multidisciplinary collaborations and partnerships 3 .

Disruptions such as digital agriculture, the fourth industrial revolution (industry 4.0), food agility, big data, and AI have been utilized to characterize the changes in the way agro-food systems evolve and function, as well as in the approach they have been analyzed, measured, and monitored 4 . For instance, Wageningen University, one of the leading influential universities, has also taken an active strategy to align with the developments in IT and AI. Apart from the content-wise shift, skills such as critical thinking, creativity, and problem-solving are addressed by applying project-based evaluations 5 . The industrial revolution (industry 4.0) and moving to industry 5.0 include new enabling technologies (e.g., big data, IoT, cloud computing) besides AI, digital twins, machine learning, virtualization, and others 6 .

Food science and technology (FST) and especially food engineering (FE) in academia face diminishing funding for research, dwindling critical masses in faculties (particularly at universities in the USA), decreasing student enrollment 7 and impacting future cooperative extension education and research needs 8 . This leads to the observation by some food-related education programs to be at a crossroads and the need to reassess their vision and expand the scope to grand societal drivers such as health and wellness (H&W), the mutual host and the microbiome considerations, food security and safety, population growth, aging, water and land scarcity, and environmental concerns 9 . Other reasons for integrating stakeholders outside the food manufacturing industry have been proposed 10 , 11 . Members of the FST&E professions request a broader and more applied education that offers better opportunities for entrepreneurship 12 .

FST&E professions are witnessing significant challenges as well as changes imposed by the accelerated rate of change and digital transformation. The expected changes will most probably affect FST&E education as already projected previously 7 , 10 , 11 , 12 , 13 , 14 , 15 . This forward-looking, combined with the radical changes witnessed during and post-COVID-19, calls for a change in traditional education and curricula paradigms. For instance, the new vision deploys concepts of FST&E in the context of sustainable food processes, products for changing lifestyles and beliefs, innovation for H&W, and novel methodologies that suit audiences of the digital age. Courses on entrepreneurship and innovation, novel education methods, and enforcing quality standards and certification have been also proposed for Europe 14 .

Engineering education is also experiencing dramatic changes. The traditional teaching model, where students are passive in the lecture room, gives way to more active, student-centered, and participatory approaches. Different modern education and learning techniques, such as blended and flip-classroom, active learning, use of technology in teaching, universal design, and student-centered education approach, among others, were previously reported 10 . For instance, active learning utilizing a teaching app called TopHat ( https://tophat.com/ ) to administer a daily quiz, encouraged group work and discussion, and peer evaluation was also reported 16 .

Active engineering learning promotes the acquisition of knowledge and essential soft skills such as teamwork, problem-solving abilities, and entrepreneurial mindsets 17 . It also encourages the utilization of digital technologies such as simulation software and virtual laboratories 17 . It is worth noting the pioneering virtual experiments and laboratories in food science, technology processing, and engineering area 18 .

Among novel methodologies suggested for engineering education are project-based learning, hybrid learning, the flipped classroom, and design thinking 10 , 19 , 20 , 21 .

The role of the food industry and other related sectors in contributing to and assisting educational institutions in designing curricula that provide the skills demanded by the job market was highlighted recently. It emphasized that current Bachelor´s and Master´s degrees follow programs that attempt to offer a practical perspective but still focus on the academic point of view. To bridge the gap between academia and industry, the University Extension Diploma in Food Technology (DEUTA) deepens into the food sector, seeking professional qualifications for participants. This is achieved by both first-hand know-how of food sector professionals and academics, along with an internship period in a food company. Collaborative courses strengthen academia-industry bonds, and employability is boosted thanks to internships and the network created 22 .

Innovation and entrepreneurship are key factors to provide added value for food systems. Based on the findings of the Erasmus+ Strategic Partnership BoostEdu ( https://erasmus-plus.ec.europa.eu/ assessed May 16, 2023), three knowledge gaps were reported: (1) identify the needs for innovation and entrepreneurship (I&E) in the food sector; (2) understanding the best way to organize learning; (3) providing flexibility in turbulent times. The results of the project, in particular during the COVID-19 pandemic, highlighted the need for flexible access to modules that are complementary to other sources and based on a mix of theoretical concepts and practical experiences. The main lessons learned concern the need for co-creation and co-learning processes to identify suitable practices for the use of innovative digital technologies 23 . However, there are experts objecting to entrepreneurship courses being a subject of FST&E curricula or that the curricula should be supported with outside presentations or invited talks on this topic. This contrary position could be probably explained by the contrast between academia and more applied and industrial occupations. As the vast majority of the FST&E graduates are employed in various businesses where innovation and startup activities are becoming essential, entrepreneurship aspects should be considered in future education.

New platforms, such as massive open online courses (MOOCs), webinars, blogs, Facebook, Instagram, and Twitter, have opened up new spaces for disseminating ideas, experiences, and training in food-related matters 24 . Online and open learning permits access anytime and anywhere to formal classes, education modules on specific topics, and informal discussion sites 24 . Thus effectively democratizing learning, disseminating knowledge to vast audiences, and coping with the educational demands during the COVID-19 pandemic 25 .

The overall objectives of this study were: 1. Assessing the current status of FST&E education by using a computerized global survey; 2. Identifying current challenges and opportunities; and 3. Suggest recommendations (if needed) for additional directions and topics for future curricula.

Results and discussion

Respondents.

The total number of respondents that started the questionnaire was 1022. Of these, 703 (68.8%) respondents (the panel) completed the survey. Data from respondents who failed to address all questions and had several missing values were omitted, as they ignored or preferred not to answer some of the questions. The relatively high number of excluded respondents was probably due to the language barrier. Although not explicitly asked, based on respondents’ IP addresses, 88 countries participated in the survey. The overall time for completing the survey was approximately 10–12 min.

Demographics and geographic distribution

Demographic data are presented in Table 1 . The panel was evenly distributed: gender (female/male 1.15:1.00), age (excluding the 18–25 years group, 7.5%). Age distribution indicates good participation of the various groups and experiences.

The geographical location of the respondents indicates a global representation, although some regions were more prevalent by the panel. Respondents from China, the Far East (excluding China), and Oceania also participated, but their overall percentage was relatively low (combined value of 4.4%). However, combining Asia and the Middle East respondents resulted in a significant representation (16.5%). The surprising outcome was the high number of African respondents (14.8), probably due to the good network of IUFoST contacts in Africa. Although participation was quite impressive in terms of global feedback (88 countries), the number of respondents in a specific region was quite low in some cases, and consolidation was necessary for further analysis. Nevertheless, the widespread number of respondents from a wide spectrum of countries demonstrated that the survey had a global distribution, offering a significant improvement compared with a previous study 15 .

Main professional activities and education

The panel (703 respondents) professions consisted of food scientists and technologists (FSTs) 398 (56.6%), food engineers (FEs) 120 (17.1%), microbiologists (HMs) 25 (3.6%), nutritionists (HNs) 35 (5.0%), chemical engineers (CEs) 19 (2.7%), bioengineering/biotechnology (BBs) 7 (1.0%), business/marketing (BMs) 14 (2.0%), consultants (COs) 41 (5.8%), and others (food trade company, regulators, etc.) 41 (5.8%). As 73.7% of the respondents were FSTs and FEs, students, and graduates, the data reflect professional positions within FST&E disciplines, as was also previously shown 15 .

The respondents were also asked to fill in all their degrees in the various education categories using up to 4 options (student, BSc/1st Degree, MSc/equivalent, and Ph.D./DSc). Fig. 1 highlights the panel degrees distribution. The relatively high number of doctoral (Ph.D./DSc, 464, 29.9%) is not surprising considering the academic affiliation of most of the respondents (see Section “Affiliation”). It should be noted that many of the respondents hold more than one degree, explaining the high number of overall degrees of the panel (1550), as also depicted in Fig. 1 .

Overall degrees distribution (small insert).

Affiliation

The combined high majority of the respondents affiliated with educational and private research institutes (71.7%) provides a possible explanation for the extra number of doctoral degrees in the panel. Conversely, based on the respondents in the age group 41–55 and above 55 (37.8 and 28.7%, respectively) and the fact that a high percentage of the majority of the respondents hold a doctoral degree, the data are likely to reflect professional middle to high management levels and leadership positions within educational, institutions and possibly in the food industry. It should be noted that the number of respondents from industrial affiliation (food industry, food service, startups/FoodTech, and consultants, excluding government) was quite high (18.2%), probably projecting that although academia and industry are not equally represented, industrial affiliations are well represented (i.e., 128 responders).

Topics affecting the future of the professional domain curricula

The importance of 10 topics to be included in developing future curricula using the Likert-type scale 26 was evaluated. The topics listed included post-COVID-2019 considerations and several other new concepts. Table 2 shows that 7 topics were evaluated above 4.0 (‘High’) based on the calculated Likert-type scores average. The highest average scores were: ‘Critical thinking’ (4.50), followed by ‘Problem-solving projects’ (4.44), ‘Teamwork/collaboration’ (4.31), ´Innovation/Open innovation’ (4.29), and ‘Multidisciplinary’ (4.24). These data highlight possible changes that the FST&E domains anticipate in the post-COVID-19 and remote or hybrid education/learning, as well as the further proliferation of innovation and OI.

It is important to note that business-related topics were evaluated as less important, with Likert-type scores averaging below 4.0. These included: ‘Soft skills’ (3.90), followed by ‘Entrepreneurship’ (3.77), and ‘Business creation/networking’ (3.70). ‘Entrepreneurship’ and ‘Business creation/network’ could bring many benefits, such as fostering innovation, productivity, competitiveness, new business, OI, and socioeconomic development. Yet, these topics were considered among those of less importance, probably indicating that the panel was less oriented to business-related topics.

The search for professionals with different skills to overcome the current and foreseen challenges relevant to the agri-food sector was previously studied 25 . It was shown that problem-based learning (PBL), described as an instructional approach, promotes interdisciplinary and critical thinking with the potential to meet current challenges. PBL, aligned with an innovation program and contest, integrated into a master’s degree in FE to promote academic entrepreneurship, allowed the development of innovative products intending to solve problems faced by the agri-food sector 27 . The latter information supports the current survey data that show that the highest perceived topics were ‘Critical thinking’ (4.50) and ‘Problem-solving projects’ (4.44). On the other hand, the relatively low perceived importance of entrepreneurship (3.77 ranked #9) could indicate that FSs, FTs, or FEs are currently considering business-related topics as a lower priority. Nevertheless, their Likert average scores were approaching ‘High’. It is important to note that promoting project-based learning by students on developing eco-designed business models and eco-innovated food products seems to be an essential lever for the sustainability transition 10 . Although this is just one example, it highlights the importance of project-based learning 27 , 28 , 29 .

Project-based learning is an integrated part of the flipped classroom (FC) model, based on active learning, and consequently attracts much interest. The FC is a form of blended learning (BL) that reorganizes the workload in and outside the classroom and requires the active participation of students in learning activities before and during face-to-face lessons with teachers 10 , 30 . The FC model has been applied since the 1990s to encourage student preparation before classes: team-based learning, peer or mentor instruction, and just-in-time education, where the teaching information is communicated via electronic means. This allows more class time to be devoted to active learning and formative assessment 31 . A recent study highlighted a case study where an elective FC course on engineering, science, and gastronomy was implemented for undergraduate students that included in-class demonstrations by chefs. New education methodologies call for expanded computational abilities, ample access to online content, active learning, and student-centered approaches 10 .

A comparison between traditional project-based learning and hybrid project-based learning indicated a significant increase in fundamental formative knowledge, enhanced problem-solving abilities, and production of better-performing artifacts regarding the set of design skills for students undergoing hybrid project-based learning 28 .

In light of the feedback by the panel indicating that ‘Critical thinking development’ and ‘Problem-solving projects’ were the highest outcome (#1 and #2, respectively), combined with recent reports on the FC importance, it could be concluded that seeking new directions in learning/facilitating strategies that complement existing methods in order to enrich the learning experience of students is recommended.

Academic partnership/collaboration

The respondents were instructed to rank (from 1 to 5, corresponding to high to low; each rank could appear only once) the importance of partnership(s) and/or collaboration(s) with: ‘Food Industry´, ‘Nutrition sciences’, ‘Government, policymakers and/or local authorities’, ‘Private sector’, and ‘Other academic disciplines’. The ranking distribution is depicted in Fig. 2 .

Ranking importance (‘Very high’, ‘High’, ‘Medium’, ‘Low’, ‘Very low’) distribution of ‘Academic partnerships/collaborations’.

Collaboration with the ‘Food industry’ was ranked the highest, while the collaboration with ‘Other academic programs’ was ranked lower. Furthermore, the top two rankings (‘Very high’ and ‘High’) were ‘Food industry’ (53%), ‘Nutrition’ (38%), ‘Government’ (36%), ‘Private institutes (35%) and ‘Other academic programs’ (33%).

Collaboration with the nutrition sector was highly ranked. This demonstrates that the panel considered collaboration between FST&E and nutrition highly important and is a direction that these domains should consider closely. The need to enhance and probably integrate or converge nutrition sciences and FST&E is underscored due to the lack of present collaboration and the growing consumers’ awareness of H&W and food processing.

The role of the food industry as a key player in academic partnership and collaboration should be considered, particularly due to the negative aspects suggested by the NOVA ultra-food processes food classification. For instance, “ By design, these products are highly palatable, cheap, ubiquitous, and contain preservatives that offer a long shelf life. These features, combined with aggressive industry marketing strategies, contribute to excessive consumption and make these products highly profitable for the food, beverage, and restaurant industry sectors that are dominant actors in the global food system ” 32 . This study demonstrates that the food industry plays significant positive roles in both collaboration and partnerships. It also plays a key part in internships described below (Section “Internships”).

Topics importance to FST&E

The importance of 11 topics for FST&E was assessed as listed in Table 3 .

The data exposed 5 top important topics to FST&E. The topic of highest interest was ‘Sustainability, circular economy, and food waste management,’ followed by ‘Innovation/open innovation’ and ‘New product development’ (no statistically significant difference between these topics), ‘Consumer perception & trust’ and ‘Nutrition sciences’ that were statistically different from the first two topics (one-way ANOVA with post-hoc LSD test, p  <0.05), respectively. Worth noting the significant differences between FSTs and FEs in ‘Sustainability, circular economy, and food waste management’, ‘New product development’, ‘Consumer perception & trust’, and ‘Nutrition Sciences’, where FSTs significantly assigned higher importance to these topics in comparison with FEs. However, no significant difference was found for ‘Innovation/open innovation’.

‘Artificial Intelligence, machine learning’ was only ordered as #9 based on the Likert-type scores averages, and FEs considered it significantly higher than FSTs. It is safe to predict that the importance of AI will increase in the coming years once more and more applications and utilizations will emerge. Suffice to consider recent applications and the global AI market size growth from $65.48 billion in 2020, projected to reach $1581.70 billion by 2030, growing at a CAGR of 38.0% from 2021 to 2030 ( https://www.alliedmarketresearch.com/artificial-intelligence-market ).

Importance to FST&E curricula to meet future challenges and learning opportunities

The importance of the curricula in meeting FST&E future challenges and learning opportunities (in descending order) is highlighted in Table 4 .

Table 4 shows five topics were considered to be of ‘Very high’ to ‘High’ importance: ‘Research project(s)’ (4.34), ‘Apprenticeships (e.g., industrial training)’ (4.28), ‘Adaptability (e.g., adjusting to change in real-time, managing biases, overcome challenges)’ (4.22), ‘Revision current programs’ (4.16), and ‘Employability’ (4.13). The other topics received lower scores.

The significant difference between FSTs and FEs on ‘Research project(s)’, ‘Enhanced integration with nutrition’, and ‘Soft (life) skills’ is worth noting. On these topics, except for ‘Enhanced integration with nutrition’, FSTs scores were significantly higher when compared with FEs. The ´Enhanced integration with nutrition´ by both FSTs and FEs was ‘High’ (4.00) and above, projecting the absolute need for FST&E to enhance its collaboration with nutrition, mainly due to the high importance of H&W and its significant role.

Adaptability is the potential to adjust and learn new skills in response to changing factors, conditions, cultures, and environments. It is a soft skill that both colleagues and superiors highly value. In the ever-changing needs and progress, businesses and employees must adapt quickly to unforeseen dynamic circumstances, innovation, and disruption. Adaptability means being flexible, innovative, open, and resilient, particularly under unforeseen conditions. Some key elements of being adaptable are confident but open to criticism, focusing on solutions rather than problems, collaborating with others, and learning from them ( https://www.walkme.com/glossary/adaptability/ ). For instance, the a daptability of FST developments implies a capacity to continuously change and improve its operations and food quality output in time and space 33 . This explains the #3 place the panel considered adaptability.

The panel perceived both ‘Revision of current programs’ and ‘Employability’ as high priority (#4 and #5, average of 4.16 and 4.13, respectively). These assessments should be considered carefully by academic programs in order to adapt to the fast changes driven by innovation, disruption, and digital progress.

‘Enhanced integration with nutrition’ came in #6. However, FSTs and FEs indicated this topic is highly important (average of 4.00 and 4.21, respectively). Hence, FST&E education programs should seek avenues to enhance integration with nutrition science. Possible collaborations should consider joint research programs and other partnerships and alliances.

‘Business-related activities (e.g., creation, network, partnerships, collaboration)’ and ‘Soft (life) skills’ were #7–8. Nevertheless, their Likert-type average values were close to ‘High’. Hybrid teaching was perceived as the last (3.78). Apparently, this type of education is not very appealing. Yet, this should be reassessed after the Covid-19 pandemic has passed.

Engineering education is also experiencing dramatic changes. The traditional teaching model, where students are passive in the lecture room, gives way to more active, student-centered, and participatory approaches. Different modern education and learning techniques, such as blended and flip-classroom, active learning, use of technology in teaching, universal design, and student-centered education approach, among others, were previously reported 9 . Hence, it is expected that Hybrid teaching and other advanced methods, including AI, will flourish soon and will become the norm.

Internships

The importance of internship to FST&E students was evaluated considering 5 possibilities: ‘Academic internship,’ ‘Food industry internship,’ ‘Start-up/FoodTech company internship,’ ‘Other domains/industries,’ and ‘Internship in other countries.’ The data are depicted in Fig. 3 .

Likert-type averages (1–5 scale) and one side (-) SD of internships importance for FST&E (values with different small letters indicate significant differences between groups; one-way ANOVA with post-hoc LSD test, p  < 0.05).

The internship was categorized into three statistically different groups (one-way ANOVA with post-hoc LSD test, p  < 0.05). The first group was internships in ‘Food Industry’ (4.60), followed by the second group: ‘Start-ups/Food Tech’ (4.04), ‘Other countries’ (3.98), and ‘Academia’ (3.96), and the third group ‘Others domains/industries’ (3.46). Comparing the difference between FSTs and FEs, respondents showed a significant difference (one-way ANOVA with post-hoc LSD test, p  < 0.05) for internships in ‘Food Industry’ (4.65 and 4.52), ‘Start-ups/Food Tech’ (4.11 and 3.89) and ‘Other domains/industries’ (3.46 and 3.26), respectively. It is not surprising that FSTs have consistently assigned higher values to internships, probably due to the possibility that they are more complimentary to hands-on experiences.

Bridging the academia-industry gap in the food sector through collaborative courses and internships was recently studied. More than fifteen years of university extension diplomas in food technology Diplomas demonstrated how collaborative courses strengthen academia-industry bonds, and employability was boosted thanks to internships and the network created 22 . Internships could support students in developing their identity, which is achieved by close contact with their future working tasks 34 , enhancing familiarity with and nearness to their future profession 35 and industry-based projects and governance 36 . Also, student projects in collaboration with the industry make the students face a reality 37 . In light of these benefits, it is clear why the internship in the food industry received such a high Likert-type average. This very high importance given by the panel to industry internships coincides with their ranking, as aforementioned in the previous section, highlighting the core role of the food industry in students’ education.

Professional organization impact on FST&E education

The impact of professional organizations on food science/food technology/food engineering education, as well as strategy and vision data, are depicted in Fig. 4 .

Likert-type averages (1–5 scale) and one side (-) SD of organization/vision impact on FST&E education (values with different letters indicated significant differences between groups; one-way ANOVA with post-hoc LSD test, p  < 0.05).

Data analysis ( t -test) of the impact of the various organizations or vision and strategy on education revealed that the statistically highest Likert-type average scores (one-way ANOVA with post-hoc LSD test, p  < 0.05) were given to the ‘Food industry’ (3.86). ‘IFT (Institute of Food Technologists)’ was in the 2nd statistical group (3.70), followed by the 3rd statistical group that included ‘IUFoST (International Union of Food Science & Technology)’ (3.49), ‘Vision, strategy & leadership of the university’ (3.49), ‘IFST (Institute of Food Science+Technology)’ (3.44), and ‘Government, public interest & support’ (3.42). ‘EFFoST (The European Federation of Food Science and Technology)’ (3.40) was between the 3rd and the 4th group that included ‘ISEKI-Food (European Association for Integrating Food Science and Engineering Into the Food Chain),’(3.27). ‘SoFE (Society of Food Engineering)’ (2.96) was the next statistical group, and the last 6th group was ‘Others’ (2.65).

It is quite surprising that the food industry obtained such a high perceived impact on education, especially because the number of respondents in the panel affiliated with academic and educational institutes was high (69.6%). This could be explained by the fact that most curricula are designed to align with the industrial requirement and/or the need to provide students with the essential tools for the food industry. As no in-depth interviews were conducted, these findings warrant additional consideration.

IFT was in second place, significantly affecting FST&E education. In light of the quite low number of respondents from North America and Canada (13.1%), this finding clearly projects the significant role IFT has in impacting global education and proliferation. The 3rd group included IUFoST, IFST (international and mainly UK organizations, respectively), ‘Vision, strategy & leadership of the university’ and ‘Government, public interest & support´. These different groups and elements were perceived as very important and apparently have a significant role in contributing to the education program. EFFoST was categorized between the 3rd and 4th groups, including ISEKI-Food (3.27). These organizations were perceived as lower compared with the previous organizations. SoFE was classified only in the 5th significantly different group. As SoFE appeals mainly to FEs, many panelists were probably unfamiliar with its activities.

Education impact on professional expectations

The impact of the respondents’ education curricula on their professional success, satisfaction, and meeting expectations data is depicted in Fig. 5 .

Likert-type averages (1–5 scale) and one side (-) SD of ‘Success’, ‘Satisfaction’, and ‘Meeting expectations’ (values with different letters indicated significant differences between groups; one-way ANOVA with post-hoc LSD test, p  < 0.05).

Education curricula showed two different statistical (one-way ANOVA with post-hoc LSD test, p  < 0.05) groups. The first group included ‘Success’ (4.03) and ‘Satisfaction’ (3.95). The second statistical group that was quite lower evaluated was ‘Meeting expectations’ (3.76). This finding could open new avenues for education institutes to conduct in-depth assessments of their alumni and graduates, focusing on improving their performances in order to better meet their graduates’ future expectations. This study also provides insights into new education and learning opportunities and new topics to be included in future curricula.

When comparing FSTs with FEs, it was quite surprising that FSTs consistently rated all three attributes lower than FEs. In two cases, these differences were even significant: ‘Success’ (4.07 vs. 4.15, one-way ANOVA with post-hoc LSD test, p  < 0.05), ‘Satisfaction’ (3.96 vs. 4.06), and ‘Meeting expectation’ (3.78 vs. 3.83, one-way ANOVA with post-hoc LSD test, p  < 0.05). This lower assessment by FSTs highlights that the potential for curriculum improvements is high, and an in-depth evaluation should open new avenues for significant improvements.

In conclusion, these main points are highlighted:

Seven topics affecting the future of the profession domain curricula were evaluated between ‘High’ to ‘Very high’. The highest scores were found for: ‘Critical thinking’, followed by ‘Problem-solving projects,’ ‘Teamwork/collaboration’, ‘Innovation/Open innovation’, and ‘Multidisciplinary’.

The importance of Academic partnership/collaboration showed that ‘Food industry’, and ‘Nutrition’ were ranked the highest.

Significant positive roles of the food industry in collaboration and partnerships with the FST&E domain were demonstrated. Significant findings were also related to internships, education, strategy, and vision effects of the food industry.

Collaboration between FST&E and nutrition sciences indicated its high importance. Integrating or converging nutrition science and FST&E is emphasized based on the lack of actual present collaborations.

Assessing the education curricula contribution showed two statistical groups. The first group included ‘Success’ and ‘Satisfaction’. ‘Meeting expectations’ was the second. New avenues to better meet future graduates’ and students’ expectations were identified.

Insights into novel education and learning opportunities and new topics to be included in future curricula have been identified.

The approach employed encompassed a structured questionnaire, adopting a methodology akin to the one described earlier 12 , 15 . The questionnaire is provided in the Supplementary information data file. The online questionnaire survey utilized the Qualtrics© software ( https://www.qualtrics.com/ ) and targeted global professionals (including students) across the food sector and nutrition. The key questions were formulated to capture the perspectives on professional values held by individuals in the studied fields. The initial questionnaire was pretested (these data were not utilized in the final analysis) using a pilot sample ( n  = 12) of selected food practitioners from academia and the food industry. This panel was selected based on previous personal and professional interactions. The pilot was employed to ensure the questionnaire’s consistency and to seek suggestions on additional topics that should be incorporated into the revised survey.

The link of the webpage of the questionnaire was distributed by e-mails of numerous organizations (e.g., IUFoST, ISEKI-Food Association, SoFE, IFT) and food practitioners globally. The survey was conducted in English, avoiding any possible language ambiguities. It was completely anonymous and was open from the end of May until the end of July 2022. Both mobile and computerized feedback was offered.

A 5-point Likert-type scale 26 was applied and consisted of 1 (‘Very low’), 2 (‘Low’), 3 (‘Medium’), 4 (‘High’), and 5 (‘Very high’). For comparisons, the Likert-type scale assessments were transformed into a calculated average. The Likert-type scale is widely employed as a fundamental and commonly utilized psychometric instrument in educational and social sciences research, marketing research, customer satisfaction studies, opinion surveys, and numerous other fields. One topic included ranking (from 1 to 5; each rank could appear only once).

Apart from the professional questions, the survey included demographic information such as gender, age group, location where the most advanced degree was obtained, or current place for study according to the following geographic categories: Western Europe, Eastern Europe, UK, North America including Canada, Mexico, South America, Asia/Middle East, China, Far East (excluding China), Oceania (Australia, New Zealand), and Africa. The questionnaire ended with an open-ended question asking for the interview’s possible suggestions for curriculum improvements. The data were analyzed using Microsoft Excel© spreadsheet (Redmont, Washington), JASP software (ver. 0.16.4, https://jasp-stats.org/ ), and IBM SPSS Statistics for Windows (version 28; IBM Corp., Armonk, New York). For significant differences ( p  < 0.05) among groups, one-way ANOVA with a post-hoc least significant difference (LSD) test was performed. A two-sided t -test was utilized to identify significant differences ( p  < 0.05) between the averages of the two groups.

The survey was written according to the authorization from the Committee for the Use of Human Subjects in Research through The Robert H. Smith Faculty of Agriculture, Food and Environment of The Hebrew University of Jerusalem (file: AGHS/01.15) as outlined previously 12 . Before starting the study, the participants were informed that the responses were completely anonymous. Also, before starting the questionnaire, the consent of the participants was requested, and only those who agreed were able to start the study.

Reporting summary

Further information on research design is available in the Nature Research Reporting Summary linked to this article.

Data availability

The dataset obtained and analyzed during the current study is available from Prof. Eli Cohen upon request.

Change history

13 february 2024.

A Correction to this paper has been published: https://doi.org/10.1038/s41538-024-00256-z

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Acknowledgements

The authors would like to thank the contribution of IUFoST (International Union of Food Science & Technology), mainly to WG 1.2 ‘Emerging Issues, Key Focus Areas´ working group members, for pretesting, distributing, and spreading the survey. The author, C.L.M. Silva, would like to acknowledge the support by National Funds from FCT - Fundação para a Ciência e a Tecnologia through project UIDB/50016/2020.

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I.S.S., C.L.M.S., and E.C. conceived and developed the questionnaire. E.C. data curation. E.C. and I.S.S. performed the validation and formal statistical analysis. I.S.S. and E.C. conducted the investigation and wrote the paper. C.L.M.S. provided expertize, feedback, and paper revision–supervision and project administration by I.S.S.

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Saguy, I.S., Silva, C.L.M. & Cohen, E. Emerging challenges and opportunities in innovating food science technology and engineering education. npj Sci Food 8 , 5 (2024). https://doi.org/10.1038/s41538-023-00243-w

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Nutrition Trends 2023

Top 2023 food and nutrition trends for education and health professionals.

By: Megan Holdaway, RDN and Bessie O'Connor, RDN

Top Nutrition Trends for 2023

• “Food is medicine” is increasingly viewed as a solution to improving health.

Pregnancy, early childhood and older adulthood are key life stages for nutrition interventions that include nutrient-dense dairy foods.

Economic uncertainty and unpredictability impacts consumers, the workforce and dependability of supportive funding., california dairies build on history of progress toward achieving healthy, sustainable food systems amid increased focus on the plant-based movement as the solution to climate crisis., environmental factors continue to impact nutrition security.

In today’s rapidly changing world, people are reflecting more often on the food choices they make and how those choices impact the world around them. There is passion for food, particularly in younger generations, who share images that express their values and identity to followers on social media. 1 Many people are choosing foods for their perceived long-term impact on health and the environment rather than relying on quick fixes. 2 On the other hand, lack of nutrition security 3 remains a critical issue across the United States, disproportionately impacting Black and Latino households 4 , as well as other groups, including young adults. 5 , 6

Underscoring food choices and climate change are conversations about diversity, equity and inclusion. Latino Americans currently comprise 55.9% of the public elementary and secondary school population in California. 7 Shifting demographics throughout California and the United States create a need to consider unique cultural food preferences and nutritional needs, which will require collaboration and bringing broad perspectives to the table.

Fortunately, there is more momentum for improving population health than ever before and opportunity to come together to create lasting change. The 2022 White House Conference on Hunger, Nutrition, and Health convened in September for the first time in over 50 years and resulted in a federal strategy that outlines specific priorities to end hunger, improve nutrition and physical activity and reduce disparities surrounding them. 8 Promoting equitable access to nutritious food, including milk and dairy, requires long-term investment at all levels. 

"Food is medicine" is increasingly viewed as a solution to improving health. 

Implications: “Food is medicine” programs are rising to the top of solutions, but the long-term impact and feasibility of scaling these programs is not yet known. Professional development to train, educate and support health professionals and educators on the front lines of implementing interventions will be crucial. While many consumers are selecting functional foods, it’s important to remember that underserved communities do not have the same access to such foods. Nutrition education efforts should be broad in focus with emphasis on high-quality, culturally relevant and accessible foods that align with current guidelines and promote improved access for all.

During pregnancy, the inclusion of milk and yogurt in a person’s diet provides iodine and choline, two important nutrients that support neurocognitive growth and development. 22 , 23 Federal nutrition assistance programs provide a safety net to fill in key nutrient gaps and support healthy growth and development for children. With increased efforts to achieve nutrition security by the White House, USDA’s Food and Nutrition Service recently announced proposed changes to the foods prescribed to participants in the Special Supplemental Nutrition Program for Women, Infants, and Children, known as WIC. More than 6 million low-income mothers and children rely on WIC for consistent and equitable access to healthy, safe and affordable foods and beverages. Dairy products like milk, yogurt and cheese play a central role in the WIC program, as well as other federal nutrition assistance programs, ensuring participants get 13 essential nutrients--including calcium, vitamin D and potassium, three of the four nutrients of public health concern as noted by the Dietary Guidelines for Americans. Closing nutrient shortfalls is critical, as a recent survey highlighted that cases of suboptimal intake of vitamin D in children rose 15-fold from 2008 to 2014. 24  

Science reinforces that it is never too late to adopt healthy eating patterns, which include nutrient-dense dairy foods. For example, milk and yogurt reduce risk for overweight or obesity; low-fat dairy and milk reduce risk for hypertension; and yogurt reduces risk for type 2 diabetes. 27 Another study found that those with low milk consumption were able to increase glutathione, an antioxidant responsible for reducing oxidative stress in the brain, by increasing milk consumption to the recommended three servings per day. Milk consumption could be a simple and safe option to improve brain health as people age. 28 Yogurt consumption may also play a role in preventing frailty, a syndrome characterized by deficits in normal function throughout the body, 29 and dairy proteins may have a beneficial effect on muscle mass in older adults. 30   

Implications: Nutrition research continues to affirm the critical role of nutrition during the unique life stages of pregnancy, early childhood and older adulthood. Future dietary recommendations will be more nuanced, with specifications for eating patterns and foods that provide benefits at different life stages. Research also continues to identify the diverse and unique benefits of whole foods, including plant- and animal-sourced foods like dairy, and their synergistic interactions beyond isolated nutrients. Dairy foods provide a unique nutrient package with proven health benefits and positive impacts on disease states and are a key marker for diet quality. Ensuring dairy foods remain a valued part of federal nutrition programs and recommendations is critical for the health of individuals, particularly during the key life stages of pregnancy, early childhood and older adulthood.

Implications: Economic uncertainty and unpredictability are evidenced through inflation, staffing shortages and budget cuts, all of which are converging with the progress made in federal and state funding for nutrition assistance during the pandemic. With fears of a recession looming, long-term funding for federal and state programs that improve nutrition security and increase access to services is far from certain. Despite challenges, there is an opportunity to build on momentum and advocate for continued funding by utilizing data that demonstrates the health, academic and economic benefits of these programs. As consumers grapple with change and uncertainty, nutrition education can help guide healthier eating choices at home, at school and in restaurants to support overall health and well-being.

While California’s dairy industry is a leader in sustainability efforts, implementing environmentally friendly farming practices, dairy’s role in local sustainable nutrition efforts is often overshadowed by advocacy for plant-exclusive dietary patterns as a solution to improve individual and planetary health. Despite a perceived widespread value for plant-exclusive meals, particularly in the school environment 39 , most people are choosing both plant- and animal-sourced foods. For example, a 2022 survey by the Vegetarian Resource Group found that only 6% of Americans are vegetarian or vegan. 40  

Implications: California’s dairy industry is leading the way in climate-smart farming practices. These advances, combined with investments in farm to school programming, provide an opportunity to promote nutrition security, support healthy communities and elevate sustainable nutrition. Farm tours and professional development opportunities can equip school foodservice and health professionals with comprehensive nutrition and agriculture literacy to inform children and families in their communities.

1. Forgrieve J. The changing face of plant-based dining in the digital age. SmartBrief website. https://corp.smartbrief.com/original/2022/09/the-changing-face-of-plant-based-dining-in-the-digital-age . Published September 12, 2022. Accessed February 15, 2023. 

2. Des Jardins S. “Plant-based” has not peaked, but rather grown into a lifestyle. SmartBrief website. https://corp.smartbrief.com/original/2022/12/plant-based-has-not-peaked-but-rather-grown-into-a-lifestyle . Published December 12, 2022. Accessed February 15, 2023. 

3. Mozaffarian D, Fleischhacker S, Andres JR. Prioritizing nutrition security in the US. JAMA. 2021;325(16):1605-1606. DOI:10.1001/jama.2021.1915

4. US Department of Agriculture, Food and Nutrition Service. USDA Actions on Nutrition Security. https://www.usda.gov/sites/default/files/documents/usda-actions-nutrition-security.pdf . Published March 2022. Accessed February 22, 2023. 

5. Mitchell A, Ellison B, Bruening M. Persistent and episodic food insecurity and associated coping strategies among college students. J Nutr Educ Behav. 2022;54(11):972-981. DOI:10.1016/j.jneb.2022.06.003

6. Shi Y, Davies A, Allman-Farinelli M. The association between food insecurity and dietary outcomes in university students: a systematic review. J Acad Nutr Diet. 2021;121(12):2475-2500.e1. DOI:10.1016/j.jand.2021.07.015

7. 2021-22 Enrollment by Ethnicity and Grade. California Department of Education. https://dq.cde.ca.gov/dataquest/dqcensus/EnrEthGrd.aspx?cds=00&agglevel=state&year=2021-22. Accessed March 9, 2023.

8. White House Conference on Hunger, Nutrition, and Health. US Department of Health and Human Services website. https://health.gov/our-work/nutrition-physical-activity/white-house-conference-hunger-nutrition-and-health . Updated December 8, 2022. Accessed February 15, 2023. 

9. Harvard Law School, Center for Health Law and Policy Innovation. Food is Medicine: Peer-Reviewed Research in the US. https://chlpi.org/wp-content/uploads/2013/12/Food-is-Medicine_Peer-Reviewed-Research-in-the-U.S.1.pdf . Published December 2020. Accessed February 15, 2023.

10. Food as Medicine. Academy of Nutrition and Dietetics Foundation website. https://www.eatrightfoundation.org/resources/food-as-medicine#definition . Accessed February 15, 2023.

11. Young A. Medically tailored meals could save US nearly $13.6 billion per year. Tufts University, Tufts Now website. https://now.tufts.edu/2022/10/17/medically-tailored-meals-could-save-us-nearly-136-billion-year . Published October 17, 2022. Accessed February 15, 2023. 

12. USDA invests more than $59M to improve dietary health and nutrition security. USDA website. https://www.usda.gov/media/press-releases/2022/11/22/usda-invests-more-59m-improve-dietary-health-and-nutrition-security . Published November 22, 2022. Accessed March 10, 2023. 

13. Armour S, Peterson K. US begins allowing Medicaid money to be spent on food. Wall Street Journal website. https://www.wsj.com/articles/u-s-begins-allowing-medicaid-money-to-be-spent-on-food-62f78cac . Published February 13, 2023. Accessed February 22, 2023. 

14. The White House. Fact sheet: the Biden-⁠Harris administration announces more than $8 billion in new commitments as part of call to action for White House Conference on Hunger, Nutrition, and Health. https://www.whitehouse.gov/briefing-room/statements-releases/2022/09/28/fact-sheet-the-biden-harris-administration-announces-more-than-8-billion-in-new-commitments-as-part-of-call-to-action-for-white-house-conference-on-hunger-nutrition-and-health . Published September 28, 2022. Accessed February 15, 2023. 

15. Redman R. “Food as Medicine” concept embraced by consumers. Supermarket News website. https://www.supermarketnews.com/issues-trends/food-medicine-concept-embraced-consumers . Published September 26, 2022. Accessed February 15, 2023. 

16. Food as Medicine. Kroger Health website. https://www.krogerhealth.com/food-as-medicine . Accessed February 15, 2023. 

17. Brewster E. Outlook 2023: consumer trends. Institute of Food Technologists website. https://www.ift.org/news-and-publications/food-technology-magazine/issues/2022/december/features/f1-outlook-2023-consumer-trends . Published December 1, 2022. Accessed February 15, 2023.

18. Koletzko B, Godfrey KM, Poston L, et al. Nutrition during pregnancy, lactation and early childhood and its implications for maternal and long-term child health: the early nutrition project recommendations. Ann Nutr Metab. 2019;74:93-106. DOI:10.1159/000496471

19. Blythe T. From evidence to action: uniting around nutrition in the 1000-day window. Am J Public Health. 2022;112(S8):S754-S756. DOI:10.2105/AJPH.2022.307063

20. Vejrup K, Hillesund E, Agnihotri N, et al. Diet in early life is related to child mental health and personality at 8 years: findings from the Norwegian mother, father and child cohort study (MoBa). Nutrients. 2023;15(1):243. DOI:10.33901/nu15010243

21. 2025 Advisory Committee. Dietary Guidelines for Americans website. https://www.dietaryguidelines.gov/2025-advisory-committee . Published January 19, 2023. Accessed February 22, 2023. 

22. Velasco I, Bath SC, Rayman MP. Iodine as essential nutrient during the first 1000 days of life. Nutrients. 2018;10(3):290. DOI:10.3390/nu10030290

23. Korsmo HW, Jiang X, Caudill MA. Choline: exploring the growing science on its benefits for moms and babies. Nutrients. 2019;11(8):1823. DOI:10.3390/nu11081823

24. Tabaie WE. Vegan and vegetarian children. Today’s Dietitian website. https://www.todaysdietitian.com/newarchives/1122p34.shtml . Published December 1, 2022. Accessed February 15, 2023.

25. California All. Master Plan for Aging. California Department of Aging website. https://mpa.aging.ca.gov . Accessed February 15, 2023. 

26. Grootswagers P, de Groot LCPGM. Nutritional concerns later in life. Proceedings of the Nutrition Society. 2021;80(3):339-343. DOI:10.1017/S0029665121001932

27. Feng Y, Zhao Y, Liu J, et al. Consumption of dairy products and the risk of overweight or obesity, hypertension, and type 2 diabetes mellitus: a dose-response meta-analysis and systematic review of cohort studies. Adv Nutr. 2022;13(6):2165-2179. DOI:10.1093/advances/nmac096 

28. Choi IY, Taylor M, Lee P, et al. Milk intake enhances cerebral antioxidant (glutathione) concentration in older adults: a randomized controlled intervention study. Front Nutr. 2022;9:811650. DOI:10.3389.fnut.2022.811650

29. Siefkas AC, Millar CL, Dufour AB, et al. Dairy food intake is not associated with frailty in adults from the Framingham Heart Study. J Acad Nutr Diet. 2022. DOI:10.1016/j.jand.2022.09.012

30. Hanach NI, McCullough F, Avery A. The impact of dairy protein intake on muscle mass, muscle strength, and physical performance in middle-aged to older adults with or without existing sarcopenia: a systematic review and meta-analysis. Adv Nutr. 2019;10(1):59-69. DOI:10.1093/advances/nmy065

31. Sloan AE. Restaurants reset for a rough ride. Institute of Food Technologists website. https://www.ift.org/news-and-publications/food-technology-magazine/issues/2022/november/features/restaurants-reset-for-a-rough-ride . Published November 1, 2022. Accessed February 15, 2023. 

32. Jones C. Teacher shortage? Depends where you look. EdSource website. https://edsource.org/2022/teacher-shortage-depends-where-you-look/677497 . Published August 31, 2022. Accessed February 15, 2023. 

33. Landi H. More than 300k healthcare providers dropped out of the workforce in 2021, report finds. Fierce Healthcare website. https://www.fiercehealthcare.com/providers/more-300k-healthcare-providers-dropped-out-workforce-2021-report-finds . Published November 1, 2022. Accessed February 15, 2023. 

34. Tadayon A. Healthier options on the menu as California begins providing free meals for all students. EdSource website. https://edsource.org/2022/healthier-options-on-the-menu-as-california-begins-providing-free-meals-for-all-students . Published August 16, 2022. Accessed February 15, 2023. 

35. Office of Governor Gavin Newsom. Governor Newsom unveils new plan to transform kids’ mental health. https://www.gov.ca.gov/2022/08/18/governor-newsom-unveils-new-plan-to-transform-kids-mental-health/ . Published August 18, 2022. Accessed February 15, 2023. 

36. Changes to SNAP benefit amounts - 2023. USDA Food and Nutrition Service website. https://www.fns.usda.gov/snap/changes-2023-benefit-amounts . Updated March 2, 2023. Accessed March 10, 2023. 

37. Kebreab E, Mitloehner F, Sumner DA. Meeting the call: how California is pioneering a pathway to significant dairy sector methane reduction. UC Davis CLEAR Center. https://clear.ucdavis.edu/sites/g/files/dgvnsk7876/files/inline-files/Meeting-the-Call-California-Pathway-to-Methane-Reduction_0.pdf . Published December 2022. Accessed February 15, 2023.

38. Resource-smart dairy. Dairy Cares website. https://www.dairycares.com/resource-smart-dairy . Accessed February 15, 2023.

39. Victory! Bill promoting nutritious plant-based school meals passes California assembly [news release]. Sacramento CA: Physicians Committee for Responsible Medicine; January 27, 2022. https://www.pcrm.org/news/news-releases/victory-bill-promoting-nutritious-plant-based-school-meals-passes-california#:~:text=SACRAMENTO%2C%20Calif.,plant%2Dbased%20meals%20and%20beverages . Accessed February 15, 2023.

40. Stahler C, Mangels R. How many vegetarians and vegans are there? Vegan Journal. 2022;(4). https://www.vrg.org/journal/vj2022issue4/2022_issue4_how_many.php . Accessed March 10, 2023. 

41. CA Farm to School Incubator Grant Program. California Department of Food and Agriculture website. https://www.cdfa.ca.gov/caf2sgrant/ . Accessed February 15, 2023.

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Picture this: Snapping photos of our food could be good for us

Research reveals taking pictures of food isn't just content for our social media feeds, but could be the key to improving people's diets.

New Curtin University research reveals taking pictures of food isn't just content for our social media feeds, but could be the key to improving people's diets.

Published in the prestigious American Journal of Clinical Nutrition , the feeding study saw researchers measure the weight of meals, which were then provided to participants over a day for breakfast, lunch and dinner.

Participants compared different technology-assisted methods to recall what they had eaten over the past 24 hours.

One method asked participants to take photos of their meals using the mobile Food Record app.

These photos were then analysed by a research dietitian.

The study found the accuracy of the nutritional intake was far higher for the group who had taken photos of what they ate, compared to participants who were asked to remember what they had eaten.

First author and PhD candidate Clare Whitton said this was the largest feeding study to use the mobile Food Record app and the findings could have a big impact on how we capture what the population is eating.

"Accurate, reliable data about what the population is eating is key to supporting people to optimise their health," Ms Whitton said.

"People can struggle to remember what they have eaten, but this study shows dietary assessment can be accurate -- particularly when you take the burden away from the person when you ask them to take a photo of what they ate."

While the study saw the food photos analysed by experts, there is work underway to streamline the process.

The team is collaborating with Purdue University in the US to use artificial intelligence to automatically analyse the foods in the photos.

Study lead and mobile Food Record App co-creator Professor Deborah Kerr said this was an exciting development in getting the bigger picture of what people are eating.

"It makes it a lot simpler for people to track what they consume when they only have to take photos for the day," Professor Kerr said.

"This will become even easier as we start to fully automate the analysis of the foods in the photos.

"With advances in AI technology this may be just around the corner."

Professor Kerr said as technology advances, it could provide an avenue to not only better capture what populations are eating, but also offer more accurate dietary advice for individuals looking to eat healthier.

"This research shows the benefit of images; that's the pathway we're going down to get an accurate picture of what people are eating."

'Accuracy of energy and nutrient intake estimation versus observed intake using four technology-assisted dietary assessment methods: a randomized crossover feeding study' was published in the American Journal of Clinical Nutrition .

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Materials provided by Curtin University . Original written by Samuel Jeremic. Note: Content may be edited for style and length.

Journal Reference :

• Clare Whitton, Clare E Collins, Barbara A Mullan, Megan E Rollo, Satvinder S Dhaliwal, Richard Norman, Carol J Boushey, Edward J Delp, Fengqing Zhu, Tracy A McCaffrey, Sharon I Kirkpatrick, Christina M Pollard, Janelle D Healy, Amira Hassan, Shivangi Garg, Paul Atyeo, Syed Aqif Mukhtar, Deborah A Kerr. Accuracy of energy and nutrient intake estimation versus observed intake using 4 technology-assisted dietary assessment methods: a randomized crossover feeding study . The American Journal of Clinical Nutrition , 2024; DOI: 10.1016/j.ajcnut.2024.04.030

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Recent Advances in Nutrition and Diabetes

Associated data.

No new data were created or analyzed in this study.

The prevalence of diabetes is on the increase worldwide, being one of the fastest growing international health emergencies in the 21st century. Diabetes that is not well managed can have significant impact on morbidity and mortality, including being a risk factor for stroke, renal dysfunction, leg amputation, cardiovascular diseases, loss of vision, and neuropathy. The economic costs of diabetes can also be quite profound through direct medical costs to individuals, families and healthcare systems, and loss of work and wages. Strategies for managing diabetes often include regular physical activity, smoking cessation, maintaining health body weight, and healthy diet. In addition, nutritional interventions in the management of diabetes may involve reduction of calories in diets, the use of diets with low glycaemic index, and increasing the fibre content of diets.

The role of dietary fibre in health and diseases such as diabetes, cardiovascular disease, colon cancer, and obesity has been the subject of significant interest. While it has been revealed that dietary fibre plays a role in the pathogenesis of chronic diseases, an evolving area of research and attention is its effect on gut microbiota and type 2 diabetes. There is evidence that diets that are high in fat and low in fibre may promote gut microbiota dysbiosis as a result of the loss of beneficial and protective microbes, while a high-fibre diet could inhibit protein fermentation and promote gut microbial eubiosis. Dietary fibre has been reported to be a major energy source for intestinal bacteria and thus can significantly affect the diversity of gut microflora.

Therefore, the current editorial provides an overview of the articles published in the Special Issue on recent advances in nutrition and diabetes. It focuses on the role of diet in the pathophysiology and management of diabetes including its effect on gut microbiota. In this regard, Ojo et al. [ 1 ] conducted a systematic review and meta-analysis of randomised controlled trials and sought to evaluate the role of dietary fibre in modulating gut microbiota dysbiosis in patients with type 2 diabetes. The authors relied on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Electronic databases including EBSCOHost with links to Health Sciences Research Databases, EMBASE, Google Scholar, and reference lists of articles were searched for relevant studies.

Searches were conducted from date of commencement of the database to 5 August 2020, and these were based on the Population, Intervention, Comparator, Outcomes, Studies (PICOS) framework [ 1 ].

There were nine studies which met the inclusion criteria and were selected for the systematic review and meta-analysis. Four distinct areas were identified, namely, the effect of dietary fibre on gut microbiota, the role of dietary fibre on short-chain fatty acids (SCFAs), glycaemic control, and adverse events [ 1 ]. The authors found significant difference ( p < 0.01) in the relative abundance of Bifidobacterium with a mean difference of 0.72 (95% CI, 0.56, 0.89) total SCFAs ( p = 0.02), with a standardised mean difference of 0.5 (95% CI, 0.08, 0.91) between the dietary fibre group compared with placebo. However, there were no significant differences ( p > 0.05) between the groups with respect to acetic acid, propionic acid, and butyric acid [ 1 ].

Furthermore, there was significant improvement ( p = 0.002) in glycated haemoglobin, with a mean difference of −0.18 (95% CI, −0.29, −0.06) in the dietary fibre group compared with placebo, although differences between the two groups were not significant ( p > 0.05) in relation to fasting blood glucose and homeostatic model assessment of insulin resistance (HOMA-IR) [ 1 ]. The two groups were not significantly different ( p > 0.05) in the subjects who reported adverse events.

The promotion of gut microbes which are SCFA producers in greater diversity and abundance by dietary fibre may be responsible for the improvement in glycated haemoglobin, which could be due in part to increased glucagon-like peptide-1 (GLP-1) production. There is evidence that Bifidobacterium lactis could increase glycogen synthesis, decrease expression of hepatic gluconeogenesis genes, improve translocation of glucose transport-4, and promote glucose uptake [ 1 ]. Furthermore, the reduction in body weight of participants in the intervention group compared with control is another area of interest, as this may have contributed to the observed improvement in glycated haemoglobin [ 1 ]. Ojo et al. [ 1 ] concluded that dietary fibre can significantly improve ( p < 0.05) the relative abundance of Bifidobacterium, total SCFAs, and glycated haemoglobin. However, the authors observed that dietary fibre did not appear to have significant effect ( p > 0.05) on fasting blood glucose, HOMA-IR, acetic acid, propionic acid, butyric acid, and adverse events.

In a review by Salaza et al. [ 2 ], it was noted that the dysfunction of the gut microbiota is a contributory factor in the pathophysiology of diabetes. It was also reported that the lipid products derived from the gut microbiota may interact with cells from the immune system, and this may have immunomodulatory effect. In particular, microbiota dysbiosis could cause increased production of lipopolysaccharides leading to damage to the intestinal barrier [ 2 ]. The prevailing pro-inflammatory environment can lead to a state of insulin resistance and hyperglycaemia [ 2 ]. In contrast, the production of SCFAs during eubiosis is useful in maintaining the integrity of the intestinal barrier [ 2 ]. The authors suggested that dysbiosis of the gut microbiota can be reversed through the modification of the eating habits of patients or with the administration of prebiotics, probiotics, and symbiotics.

In a related study, Ren et al. [ 3 ] conducted a randomised controlled trial to determine the effect of an almond-based low carbohydrate diet on depression and glycometabolism, gut microbiota, and fasting GLP-1 in patients with type 2 diabetes. Forty-five participants with type 2 diabetes who were recruited from the diabetes club and the Endocrine Division of the First and Second Affiliated Hospital of Soochow University were randomly assigned to a low-carbohydrate diet (LCD) or a low-fat diet (LFD) [ 3 ]. The dietary intervention was for a period of 3 months, including 22 participants in the LCD group and 23 in the LFD group. The measures of depression and biochemical parameters such as glycated haemoglobin, gut microbiota, and GLP-1 concentration were assessed at baseline and post intervention. The two groups were then compared. Ren et al. [ 3 ] found that LCD significantly improved depression and glycated haemoglobin ( p < 0.01) and increased SCFAs producing bacteria Roseburia , Ruminococcus , and Eubacterium . In addition, the GLP-1 concentration in the LCD group was higher than that in the LFD group ( p < 0.05). The authors concluded that LCD may provide beneficial effect on depression and glycometabolism in patients with type 2 diabetes. It was further suggested that the role of LCD in improving depression in patients with type 2 diabetes may be related to its role in stimulating the growth of SCFAs-producing bacteria, increasing SCFA production and further maintaining GLP-1 secretion [ 3 ].

McKenzie et al. [ 4 ] assessed the effect of type 2 diabetes prevention programme aimed at reducing hyperglycaemia and normalising glycaemia in order to delay or prevent the progression to type 2 diabetes. The study involved 96 patients with prediabetes who received intervention involving carbohydrate restricted nutrition therapy for two years that was delivered through remote care team. It was found that the estimated cumulative incidence of normoglycemia and type 2 diabetes at two years were 52.3% and 3%, respectively [ 4 ]. There was significant decrease in the prevalence of metabolic syndrome, obesity, and suspected hepatic steatosis at two years [ 4 ].

There is evidence that the inflammation due to gingivitis and/or periodontitis tends to worsen during pregnancy due to hormonal changes, and these have implications for maternal health beyond the oral cavity [ 5 ]. For example, this inflammation could lead to a low-grade systemic inflammatory and metabolic disturbances which can have an impact on pregnancy outcomes [ 5 ]. Therefore, there appears to be a relationship between periodontal inflammation and diabetes, and thus managing inflammatory periodontal diseases may improve glycaemic control and associated diabetic complications. In recognition of this, Rodrigues Amorim Adegboye et al. [ 5 ] conducted a randomised controlled trial to explore the effect of a non-pharmacological multi-component intervention on periodontal health and metabolic and inflammatory profiles among pregnant women with periodontitis. The study involved 69 pregnant women receiving prenatal care in a Brazilian public health centre who were randomly allocated to four groups: (1) fortified sachet (vitamin D and calcium) and powdered milk plus periodontal therapy during pregnancy (early PT), (2) placebo sachet and powdered milk plus early PT, (3) fortified sachet and powdered milk plus late PT (after delivery), and (4) placebo sachet and powdered milk plus late PT [ 5 ]. The mean bleeding on probing (BOP) was significantly reduced in the early PT groups, while BOP worsened in the late PT groups. No significant effect of fortification on BOP was observed, and there were also no significant differences in the glucose levels and birthweight among the groups [ 5 ].

The use of dietary interventions such as dietary fibre and low carbohydrate diet in modulating gut microbiota dysbiosis, promoting SCFAs production and glycaemic control in patients with type 2 diabetes is evident. However, as this is an evolving area of research, more studies are needed to further understand the mechanism of the role of diets on gut microbiota.

This research received no external funding.

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Food for thought: study links key nutrients to slower brain aging.

May 22, 2024 · 4 min read

Food for thought: Study links key nutrients to slower brain aging

Scientists have long been studying the brain with a goal of aiding healthier aging. While much is known about risk factors for accelerated brain aging, less has been uncovered to identify ways to reduce cognitive decline.

There is evidence that nutrition matters, and a novel study from the University of Nebraska–Lincoln’s Center for Brain, Biology and Behavior and the University of Illinois at Urbana-Champaign further signals how specific nutrients may play a pivotal role in the healthy aging of the brain. The findings were published in Nature Publishing Group Aging.

The team of scientists, led by Aron Barbey, director of the Center for Brain, Biology and Behavior, with Jisheng Wu, a doctoral student at Nebraska, and Christopher Zwilling, research scientist at UIUC, performed the multimodal study — combining state-of-the-art innovations in neuroscience and nutritional science — and identified a specific nutrient profile in participants who performed better cognitively.

The cross-sectional study enrolled 100 cognitively healthy participants, aged 65-75. These participants completed a questionnaire with demographic information, along with measures of body composition and physical fitness. Blood plasma was collected following a fasting period to analyze the nutrient biomarkers. Participants also underwent cognitive assessments and MRI scans. Analysis of this large set of measures revealed two types of brain aging among the participants — accelerated and slower-than-expected. Those with slower brain aging had a distinct nutrient profile.

The beneficial nutrient blood biomarkers were a combination of fatty acids (vaccenic, gondoic, alpha linolenic, elcosapentaenoic, eicosadienoic and lignoceric acids); antioxidants and carotenoids including cis-lutein, trans-lutein and zeaxanthin; two forms of vitamin E and choline. This profile is correlated with nutrients found in the Mediterranean diet, which research has previously associated with healthy brain aging.

“We investigated specific nutrient biomarkers, such as fatty acid profiles, known in nutritional science to potentially offer health benefits. This aligns with the extensive body of research in the field demonstrating the positive health effects of the Mediterranean diet, which emphasizes foods rich in these beneficial nutrients,” said Barbey, Mildred Francis Thompson Professor of Psychology. “The present study identifies particular nutrient biomarker patterns that are promising and have favorable associations with measures of cognitive performance and brain health.”

Barbey noted that previous research on nutrition and brain aging has mostly relied on food frequency questionnaires, which are dependent on participants’ own recall. This study is one of the first and the largest to combine brain imaging, blood biomarkers and validated cognitive assessments.

“The unique aspect of our study lies in its comprehensive approach, integrating data on nutrition, cognitive function and brain imaging,” Barbey said. “This allows us to build a more robust understanding of the relationship between these factors. We move beyond simply measuring cognitive performance with traditional neuropsychological tests. Instead, we simultaneously examine brain structure, function and metabolism, demonstrating a direct link between these brain properties and cognitive abilities. Furthermore, we show that these brain properties are directly linked to diet and nutrition, as revealed by the patterns observed in nutrient biomarkers.”

The researchers will continue to explore this nutrient profile as it relates to healthy brain aging. Barbey said it’s possible, in the future, that the findings will aid in developing therapies and interventions to promote brain health.

“An important next step involves conducting randomized controlled trials. In these trials, we will isolate specific nutrients with favorable associations with cognitive function and brain health, and administer them in the form of nutraceuticals,” Barbey said. “This will allow us to definitively assess whether increasing the levels of these specific nutrient profiles reliably leads to improvements in cognitive test performance and measures of brain structure, function and metabolism.”

Barbey is also co-editing an upcoming special collection for the Journal of Nutrition, “Nutrition and the Brain — Exploring Pathways to Optimal Brain Health Through Nutrition,” which is currently inviting submissions for consideration, and articles will begin publishing next year.

“There’s immense scientific and medical interest in understanding the profound impact of nutrition on brain health,” Barbey said. “Recognizing this, the Office of Nutrition Research at the National Institutes of Health recently launched a 10-year strategic plan to significantly accelerate nutrition research. Our work directly aligns with this critical initiative, aiming to contribute valuable insights into how dietary patterns influence brain health and cognitive function.”

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Researchers develop easy-to-use screening tool to help improve family access to federal nutrition programs

by Children's Hospital of Philadelphia

Researchers from The Possibilities Project and Clinical Futures at Children's Hospital of Philadelphia (CHOP) have developed, implemented and successfully tested a nutrition screener to improve access to healthy resources for families eligible for federally-funded food benefits. The findings were published this week in the journal Annals of Family Medicine .

Many low-income families rely on the federally-funded Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and the Supplemental Nutrition Assistance Program (SNAP) for nutritional support, and both programs have been linked to improved health outcomes and decreased health care costs . However, many eligible families do not receive these program benefits because of the complex application and enrollment process.

"Prior studies at CHOP show that 50% of people who are eligible for services like WIC might not actually be taking advantage of them," said study co-author George Dalembert, MD, Associate Director of the Center for Health Equity at CHOP.

The Possibilities Project at CHOP aims to design innovative strategies and implement new ideas to better serve patients. In this study, to help eligible families navigate this system, researchers designed and tested a standardized process for linking families to WIC and SNAP during pediatric primary care visits. This nutrition screener was a tablet-based questionnaire that asked eligible families whether they were interested in help applying for WIC or SNAP or wanted information about local food banks.

Caregivers who requested help applying for WIC or SNAP received a phone call within a week offering targeted assistance with benefits enrollment. Information was also printed out during the office visit and linked to their child's patient portal.

In the first month of the pilot in November 2022, 433 families completed the screener (74% in person, 26% via patient portal), and 73 (17%) requested nutrition resources, including 17 who requested information about local food banks, and 56 families who requested benefits application support. Of these 56 families, 25 (45%) were reached by telephone and 21 (38%) were successfully connected to WIC and/or SNAP or given the information they requested. However, many families (55%) could not be reached as they either had incorrect contact information listed in the electronic health record (12%) or did not respond to telephone calls from our resource navigator (43%).

"The approach we developed may be one important way to normalize social needs assessment and provide families with additional nutrition support," said lead study author Aditi Vasan, MD, an attending physician with the Division of General Pediatrics at CHOP.

"To ensure all families in need are able to receive appropriate support, clinics should consider priming caregivers to expect follow-up from a resource navigator, as well as asking about preferred contact method and incorporating additional outreach approaches like text messaging."

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Straight Talk About Soy

The Takeaway: Soy is a unique food that is widely studied for its estrogenic and anti-estrogenic effects on the body. Studies may seem to present conflicting conclusions about soy, but this is largely due to the wide variation in how soy is studied. Results of recent population studies suggest that soy has either a beneficial or neutral effect on various health conditions. Soy is a nutrient-dense source of protein that can safely be consumed several times a week, and probably more often, and is likely to provide health benefits—especially when eaten as an alternative to red and processed meat.

Soy is exalted as a health food by some, with claims of taming hot flashes, warding off osteoporosis, and protecting against hormonal cancers like breast and prostate.

At the same time, soy is shunned by others for fear that it may cause breast cancer, thyroid problems, and dementia, though these claims have not been substantiated.

Whether published in a popular press article or a well-designed clinical study, some debate about soy remains. As a species within the legume family , nutrition scientists often label soy as a food with potential for significant health benefits. However, due to contrary research that suggests possible negative effects of soy in certain situations, there has been a hesitancy to wholeheartedly promote soy.

Part of the uncertainty is due to the intricacy of soy’s effects on the body. Soy is unique in that it contains a high concentration of isoflavones, a type of plant estrogen (phytoestrogen) that is similar in function to human estrogen but with much weaker effects. Soy isoflavones can bind to estrogen receptors in the body and cause either weak estrogenic or anti-estrogenic activity. The two major soy isoflavones are called genistein and daidzein. Soy isoflavones and soy protein appear to have different actions in the body based on the following factors:

• Type of study . Is it being examined in a study with animals or humans? Soy may be metabolized differently in animals, so the outcomes of animal studies may not be applicable to humans.
• Hormone levels . Because soy can have estrogenic properties, its effects can vary depending on the existing level of hormones in the body. Premenopausal women have much higher circulating levels of estradiol—the major form of estrogen in the human body—than postmenopausal women. In this context soy may act like an anti-estrogen, but among postmenopausal women soy may act more like an estrogen. Also, women with breast cancer are classified into hormone type—either hormone positive (ER+/PR+) or hormone negative (ER-/PR-) breast cancer—and these tumors respond differently to estrogens.
• Type of soy . What type of soy is being studied: Whole soy foods such as tofu and soybeans, processed versions like soy protein powders, or soy-based veggie burgers? Fermented or unfermented soy foods? If supplements are used, do they contain isoflavones or soy protein?

Thus, there are many factors that make it difficult to construct blanket statements about the health effects of soy. 

Aside from their isoflavone content, soy foods are rich in nutrients including B vitamins , fiber , potassium , magnesium , and high-quality protein . Unlike some plant proteins, soy protein is considered a complete protein, containing all nine essential amino acids that the body cannot make which must be obtained from the diet. Soy foods are also classified as fermented or unfermented (see table with examples, below). Fermented means that the soy food has been cultured with beneficial bacteria , yeast, or mold. Some believe that fermenting soy improves its digestibility and absorption in the body, as this process partially breaks down soy’s sugar and protein molecules.

Research on Soy and Disease

Learn more about the research on soy and specific diseases or other conditions:

Soy protein took center stage after research showed that it might lower levels of harmful cholesterol. A 1995 meta-analysis of 38 controlled clinical trials showed that eating approximately 50 grams of soy protein a day (no small amount as this translates to 1½ pounds of tofu or eight 8-ounce glasses of soy milk!) in place of animal protein reduced harmful LDL cholesterol by 12.9 percent. [1] Such reductions, if sustained over time, could mean a greater than 20% lower risk of heart attack, stroke, or other forms of cardiovascular disease. In response to this finding, in 1999 the Food and Drug Administration (FDA) allowed companies to claim that diets low in saturated fat and cholesterol that also contain soy “may reduce the risk of heart disease.” [2]

However, a number of studies since have tempered that finding. [3] According to a comprehensive update of soy research by the nutrition committee of the American Heart Association (AHA) published in 2000, eating 50 grams of soy per day lowered LDL by only about 3%. [3] In October 2017, after review of additional scientific studies since the health claim was authorized, the FDA proposed a rule to revoke the claim because numerous studies presented inconsistent findings on the relationship between soy protein and heart disease. [4] Some of these inconsistencies may have resulted because soy was compared with a variety of alternative foods.

Even though soy protein may have only a small direct effect on cholesterol, soy may still benefit the heart in other ways. An epidemiological study following three large cohorts of American men and women who did not have cardiovascular disease at the start of the study found that those who ate the highest amounts of tofu and isoflavones from soy foods, compared with those who ate the least, had an 18% and 13% lower risk, respectively, of developing heart disease. [5] The benefit of tofu was stronger in premenopausal women and postmenopausal women not using hormone therapy.

Soy foods are generally good for the heart and blood vessels because they provide polyunsaturated fat, fiber, vitamins, and minerals, and are low in saturated fat. Replacing red meat with plant proteins including soy foods, beans, and nuts was associated with a 14% lower risk of heart disease, as found in the Health Professionals Follow-up Study, a large long-term epidemiological study of more than 43,000 men. [6] Another large cohort of more than 500,000 Chinese adults with no previous cardiovascular disease found that those with the highest intakes of soy (4+ days a week) compared with those who never ate soy had a 25% lower risk of deaths from heart attack. [7]

Hormone replacement therapy has traditionally been used as an effective treatment for hot flashes and other unpleasant symptoms that accompany menopause, but its long-term use has raised concerns of an increased risk of some diseases including breast cancer and stroke. Soy has been a popular alternative treatment but not clearly supported by research; in theory the potential estrogenic effects of soy isoflavones could help to tame hot flashes by giving an estrogen-like boost during a time of dwindling estrogen levels.

In many Far East Asian countries where soy is eaten daily, women have lower rates of menopausal symptoms, although research is conflicting as to whether soy is a primary contributor. [8] Reports suggest that about 70–80% of U.S. women of menopausal and perimenopausal age experience hot flashes, in comparison with 10–20% of Far Eastern Asian women. [9] Further, the average blood concentration of the isoflavone genistein in Asian women who regularly consume soy is about 12 times higher than that of U.S. women. [9]

Yet several meta-analyses and carefully controlled clinical studies have not found strong evidence of a link. [10,11] An AHA review in 2006 concluded that it was unlikely that soy isoflavones exert enough estrogenic activity to have an important impact on hot flashes and other symptoms of menopause. [3] A JAMA review the same year found highly conflicting results with soy isoflavone extracts and stated that the overall evidence did not support its benefit in relieving hot flashes. [12]

In another review of 43 randomized controlled trials have examined the effects of phytoestrogens on hot flashes and night sweats in perimenopausal and postmenopausal women. Four trials found that extracts of 30 mg or greater of genistein consistently reduced the frequency of hot flashes. Other trials that used dietary soy or soy extracts suggested a reduced frequency and severity of hot flashes and night sweats when compared with placebo, but these trials were small with a possible strong placebo effect. [8] No adverse effects were noted from the soy treatments when followed for up to two years, but the authors did not feel overall there was strong and consistent evidence for a benefit of soy.

Another meta-analysis of 16 studies found that soy isoflavone supplements had a small and gradual effect in weakening menopausal hot flashes compared with estradiol (human estrogen). However, authors noted weaknesses in the analysis due to a small number of participants and high variability in study design. [9]

A more recent review of randomized trials found that some studies showed benefit of soy supplements on hot flashes; the therapeutic dosage ranged from 40-70 mg of isoflavones daily. [13] The authors also observed that the presence of equol (a protective substance made from the breakdown of isoflavones that only some women can produce) may be needed for isoflavones to effectively reduce hot flashes. Despite these results, the study authors did not offer a confident conclusion on the use of isoflavone supplements due to variations in study design and length; differences in the types and dosages of supplements; and the small sample sizes and high drop-out rates.

This area needs further research as questions remain about a possible benefit of soy. Results are conflicting, potentially due to variation in the types of soy preparations used, the quantities given, and for how long they are used.

Phytoestrogens don’t always mimic estrogen. In some tissues and in some people, they may block the action of estrogen. If soy’s estrogen-blocking action occurs in the breast, then eating soy could, in theory, reduce the risk of breast cancer because estrogen stimulates the growth and multiplication of breast and breast cancer cells. Studies so far have not provided a clear answer. Some have shown a benefit with soy consumption and breast cancer while others show no association. [14-17] It appears that the effects of soy may vary depending on menopausal status, the age at which soy is consumed, and type of breast cancer.

In animal and cell studies, high dosages of isoflavone or isolated soy protein extracts tend to stimulate breast cancer growth. [18,19] However, studies that observe people consuming soy foods over time show either a protective or neutral effect. Women from Asian countries appear to receive greater protective benefit from breast cancer with high soy intakes than American and European women, but this may simply be a difference in the amount of soy consumed. [20,21] Asian women may have higher levels of equol, a substance metabolized from the isoflavone daidzein by bacterial flora in the intestines. [22] Equol is believed to block potentially negative effects of human estrogen, but not all women possess the bacteria needed to create equol. [23] It is estimated that 30-50% of all humans are able to produce equol. [24] Eating soy foods starting at an early age (such as those found in many traditional Far East Asian diets) may be why women from some countries find greater benefit from soy foods than others. [19] However, the overall evidence on equol and cancer risk is unsettled. [25]

The Shanghai Women’s Health Study which followed 73,223 Chinese women for more than 7 years has been the largest and most detailed study of soy and breast cancer risk in a population with high soy consumption. [26] In this study, women who ate the most soy had a 59% lower risk of premenopausal breast cancer compared with those who ate the lowest amounts of soy. There was no association with postmenopausal breast cancer. Risk was 43% lower when soy was eaten during adolescence. Seven years later, the study authors published a follow-up analysis from the same cohort over 13 years to evaluate any association between soy foods and specific types of breast cancer defined by hormone receptors and by menopausal status (Estrogen [ER] +/-; Progesterone [PR] +/-). [27] Key highlights of the study:

• A 22% lower risk of breast cancer when comparing the highest to lowest intakes of soy during adulthood.
• A 28% lower risk of hormone positive (ER+, PR+) breast cancer in postmenopausal women.
• A 54% lower risk of hormone negative (ER-, PR-) breast cancer in premenopausal women.
• A 47% lower risk of premenopausal breast cancer when comparing high to low intakes of soy during adolescence and adulthood.

The Breast Cancer Family Registry was a prospective study following 6,235 women for 9 years diagnosed with breast cancer and living in the U.S. and Canada; intake of soy isoflavones was examined in relation to deaths from all causes. [28] Key highlights of the study:

• Women who ate the highest amounts of soy isoflavones had a 21% lower risk of death compared with women with the lowest intakes.
• Women who had ER-/PR- tumors and who were not receiving tamoxifen appeared to receive greatest benefit from the higher soy isoflavone intakes. However, isoflavone intake did not have a negative impact on women who were receiving tamoxifen or who had ER+/PR+ tumors.
• Of all ethnicities, Asian American women tended to have the highest isoflavone intakes at about 6 mg daily, but this amount was still much lower than women living in Asian countries who eat closer to 46 mg daily. The authors noted that American women appeared to benefit from eating smaller amounts of soy.

Another prospective study followed 1,954 American women who were breast cancer survivors for six years. [29] Key highlights of the study:

• Among postmenopausal women treated with tamoxifen, breast cancer recurrence was 60% lower when comparing the highest to the lowest daidzein (a specific type of soy isoflavone) No benefit was observed in women who had never used tamoxifen.
• Recurrence was lower with increasing isoflavone intake among women with tumors that were ER+/PR+ but not ER-/PR-.
• The most frequent sources of soy foods were not whole or minimally processed soy foods, but rather soy sauce, breakfast or diet drinks, tofu, diet bars, and soy protein isolate powder. The mean amount of isoflavones in the “high” category was about 19 mg daidzein and 27 mg genistein daily—a modest amount compared with Asian populations.
• The authors concluded that soy isoflavones eaten at levels comparable to those in Asian populations may reduce the risk of cancer recurrence in women receiving tamoxifen therapy and does not appear to interfere with tamoxifen efficacy. However, the findings need to be confirmed because they were mainly in subgroups and could be due to chance.

Prospective studies also find soy foods to be protective from breast cancer deaths:

• A cohort study of 1,460 Chinese women who were early-stage breast cancer survivors looked at dietary soy isoflavone intakes at baseline and after the breast cancer diagnosis, over a four-year period. [30] Higher soy intakes at baseline were associated with a 66% lower risk of deaths from any cause and a 64% lower risk of deaths from breast cancer. Higher soy intakes after diagnosis were associated with a 64% and 51% lower risk of deaths, from any cause and from breast cancer, respectively. The effects were greater in women who were premenopausal, had ER-/PR- tumors, and were taking tamoxifen.
• A meta-analysis of prospective cohort studies found a 12% reduction in breast cancer deaths with each 5 gram per day increase in soy protein intake. [31]

However, randomized controlled trials do not show an effect of soy foods on risk factors for breast cancer:

• A review of randomized controlled trials (RCTs) looked at isoflavone intakes ranging from 36-235 mg/day from food or supplements, taken from 1 month to 3 years, and breast cancer risk (as measured by breast density, changes in estrogen, and bloodwork) in healthy women. [32] The eighteen RCTs included both pre- and postmenopausal participants. No changes in breast cancer risk factors were found with isoflavone intakes. The authors noted limitations in their analysis in that there were wide variations in numbers of participants and the doses and duration of treatments, which made drawing firm conclusions difficult. Most importantly, these studies did not examine actual incidence of breast cancer.

The incidence of prostate cancer is highest in Western countries and lowest in Asian countries, where soy foods are a regular part of the daily diet. In addition, observational studies have found an increased risk of prostate cancer in Chinese and Japanese men who move to Western countries and adopt a Western diet, but not in those who continue eating a traditional diet. [33] Soy isoflavones, specifically genistein and daidzein, are incorporated in prostate tissue and may act as weak estrogens and inhibit the development of prostate cancer. [34]

In a meta-analysis of 30 case-control and cohort studies from the U.S., Europe, Japan, and China, intakes of total soy foods, genistein, daidzein, and unfermented soy foods were associated with a lower risk of prostate cancer. [34]

A review of eight randomized controlled trials examined the effects of soy in men with or at risk of developing prostate cancer. Two of these studies found that isoflavone supplements or dietary soy protein reduced the risk of prostate cancer in men at high risk of developing the disease. However, none of the studies found a significant effect on prostate specific antigen (PSA) levels, a protein produced by the prostate gland that is used to detect prostate cancer. There were no adverse effects reported with soy supplementation. The authors discussed limitations of the review including the small number of participants, the short duration of studies (less than one year), and variation in dosages and types of soy given. [33]

A small randomized controlled trial in 2021 examined if soy protein supplements could slow down or reverse rising PSA levels in men who had previously been diagnosed and treated for prostate cancer, but who had a recurrence (as evidenced by rising PSA levels). The study found that even though the soy protein supplements increased blood levels of genistein, there was no effect of the supplement versus placebo on PSA levels when given for 6-8 months. [35]

Fermented soy foods commonly eaten in East Asian diets, including natto, tempeh, soy paste, and soy sauce, contain isoflavones and also bacteria that might have benefits for neurological disorders including cognitive decline, Alzheimer’s disease (AD), and Parkinson’s disease (PD). Soy’s antioxidant and anti-inflammatory effects may reduce the oxidative stresses associated with AD and PD. [36] Animal studies have suggest that soy compounds can weaken the progression of AD and prevent nerve cell death. They also find that soy can reduce inflammation and excess free radical production in the brain. AD has been associated with decreased levels of beneficial anti-inflammatory bacteria while harboring increased levels of proinflammatory bacteria.  Fermented soy foods are produced with beneficial bacteria like Lactobacilli, Bifidobacteria, and Bacillus species that produce butyrate, a short-chain fatty acid that regulates immune function and is being investigated for its protective effects on the brain.

Long-term low levels of estrogen the occur in menopausal women can reduce the number of estrogen receptors in the brain that are necessary for specific cognitive functions like memory and learning. [37] The soy isoflavone, daidzein, has been hypothesized to reduce decline in cognitive function or disease processes related to cognition and behavior. Thus, the possibility has been raised that eating soy foods might help prevent age-related memory loss or decline in thinking skills. [38]

Studies in humans, however, are not conclusive on soy’s effects on the brain:

• Trials have yielded contradictory results, with some showing a benefit with soy isoflavone supplementation [39, 40] and others showing no benefit. [41-43] A review of 13 randomized controlled trials found that in about half of the studies, isoflavone supplementation had a beneficial effect on cognition in older men and women compared with controls, including improvements in attention, information-processing speed, and memory. However the results overall were mixed, with other studies not demonstrating a benefit. This may have been due to differing dosages given or the types of cognition tests used. [37]

One large study in men found a detrimental effect on cognitive function. In a prospective cohort study of more than 3,700 Japanese-American men living in Hawaii, those with the highest intakes of tofu (eaten almost daily) at midlife ages had greater cognitive impairment and brain atrophy in late life compared with men with the lowest tofu intakes (almost never eaten). [44] However, the actual number of men eating very high amounts of tofu was small, and past dietary information was collected by relying on the participants’ memory, some of whom may have already experienced cognitive decline. Because of this, the researchers stated that the findings were too preliminary to make recommendations. [45]

A meta-analysis of 18 randomized controlled trials found that although soy supplements raised thyroid stimulating hormone levels slightly, they did not have any effect on actual thyroid hormone production. [46] However, another study found that soy may interfere with thyroid hormone medication used to treat hypothyroidism. In one randomized double-blinded trial, 60 patients with a mild form of hypothyroidism (called subclinical hypothyroidism) were given low or high-dose phytoestrogen supplements (both also contained 30 grams of soy protein), the amount that might be obtained from a vegetarian diet. [47] Risk of developing clinical hypothyroidism was increased in the higher phytoestrogen group (no effect in the lower phytoestrogen group). The authors suggested that female vegetarian patients with subclinical hypothyroidism may need more careful monitoring of thyroid function. However, the authors also found a benefit on of reduced cardiovascular risk factors in the high phytoestrogen group, with a significant reduction in insulin resistance, inflammatory markers, and blood pressure. The effect of soy on thyroid function needs further examination.

• Anderson JW, Johnstone BM, Cook-Newell ME. Meta-analysis of the effects of soy protein intake on serum lipids. New England Journal of Medicine . 1995 Aug 3;333(5):276-82.
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• Sacks FM, Lichtenstein A, Van Horn L, Harris W, Kris-Etherton P, Winston M. Soy protein, isoflavones, and cardiovascular health: an American Heart Association Science Advisory for professionals from the Nutrition Committee. Circulation . 2006 Feb 21;113(7):1034-44.
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• Ma L, Liu G, Ding M, Zong G, Hu FB, Willett WC, Rimm EB, Manson JE, Sun Q. Isoflavone intake and the risk of coronary heart disease in US men and women: results from 3 prospective cohort studies. Circulation . 2020 Apr 7;141(14):1127-37.
• Al-Shaar L, Satija A, Wang DD, Rimm EB, Smith-Warner SA, Stampfer MJ, Hu FB, Willett WC. Red meat intake and risk of coronary heart disease among US men: Prospective cohort study. BMJ . 2020 Dec 2;371.
• Wang X, Yu C, Lv J, Li L, Hu Y, Liu K, Shirai K, Iso H, Dong JY. Consumption of soy products and cardiovascular mortality in people with and without cardiovascular disease: a prospective cohort study of 0.5 million individuals. European Journal of Nutrition . 2021 Jun 2:1-0.
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Eating Disorders and Eating Disorder Awareness

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The present Research Topic wishes to focus on the four recognized eating disorders by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V): Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder (BED), and Avoidant/Restrictive Food Intake Disorder (ARPID). Given the rising incidence of cases of people affected by eating disorders and some studies even suggesting an “epidemic” of eating disorders, we would like to analyze via an interdisciplinary approach the current situation and disseminate the latest findings. Knowledge in this field is constantly expanding, especially in the last 10 years, with authors providing new and fascinating results. However, there are several areas where research is still lacking. We would like to encourage you to share the latest findings in the field. We welcome the submission of manuscripts (original research, brief research report, focused review, hypothesis and theory, perspective, data report, case report, community case study) related, but not limited to: • Causes and risk factors. • Socio-cultural factors. • Psychological factors. • Family factors through enmeshment and criticism. • Peer influence • The impact of the media, by spreading the ideal of thinness. • Negative affect, low self-esteem, and body dissatisfaction. • Biological and genetic bases. • Brain functioning in eating disorders. • Epidemiology, statistics, and mortality. • Diagnostics. • Physiological consequences of eating disorders. • Psycho-therapeutic intervention. • Progresses and challenges related to eating disorders. • Prevention. • Evolution. • Adverse effects. • Eating disorders as coping mechanisms.

Keywords : Eating Disorders, Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, Avoidant/Restrictive Food Intake Disorder (ARPID), Causes, Media, Psychology, Diagnostics, Prevention, Psycho-therapeutic Intervention

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