The research, published in Frontiers in Nutrition by a team at Jinling Hospital, Affiliated Hospital of Medical School of Nanjing University, used a statistical technique called latent profile analysis to sort adolescent patients into hidden subgroups based on their nutritional literacy scores. Rather than treating literacy as a single sliding scale, the method searches the data for natural clusters of individuals who share similar response patterns. The analysis revealed three distinct profiles: a high-literacy group of 159 participants, a moderate group of 95, and, worryingly, a low-literacy group of 179 that was the largest of the three, accounting for 41.3 percent of the sample.

Nutritional literacy, as the researchers define it, is more than memorizing which foods are bad for the kidneys. It is the capacity to access, understand, evaluate and apply nutrition information to guide real dietary decisions. The Chinese version of the Nutrition Literacy Assessment Tool used in the study measured six dimensions, from basic nutrition and health knowledge to the practical skills of reading food labels, measuring household portions and choosing among food categories. Patients scored between 4 and 36 of a possible 38 points, with a mean of 20.36, a level the authors describe as generally low for a population whose disease management depends so heavily on diet.

The statistical detective work behind the classification is worth appreciating. The team built models containing one to four latent classes and compared them using fit indices including the Akaike and Bayesian information criteria, which penalize unnecessary complexity, alongside entropy, a measure of classification accuracy that approaches one when individuals are assigned to their groups with high confidence. The four-class model achieved slightly lower information criterion values, but its Lo-Mendell-Rubin likelihood ratio test failed to reach statistical significance, meaning the extra group added no real explanatory power. The three-class solution, by contrast, showed significant likelihood ratio tests and the highest entropy at 0.907, making it the clear winner on both statistical and clinical grounds.

What makes the study striking is what happened when the researchers compared dietary motivation across the three profiles. Using a 20-item questionnaire adapted from work by Pelletier and colleagues, which spans intrinsic motivation, integrated regulation, identified regulation, introjected regulation and external regulation on a seven-point scale, the team found significant differences across every dimension examined, including eating behavior, physical activity, perceptions and attitudes, psychological adjustment and social support. The high-literacy group scored 126.25 on total motivation, the moderate group 121.47 and the low group 119.43, with the individual dimension differences reaching far more dramatic margins, some with F statistics exceeding 55 and p values below 0.001.

The pattern in the subscales tells a more nuanced story than the totals suggest. Adolescents in the low-literacy group trailed most sharply in psychological coping, scoring 12.79 against 18.71 in the high-literacy group, and in perceptions and attitudes, where the gap was nearly six points. This suggests, as the authors argue, that literacy acts as an internal driver of motivation: young patients who can process nutritional information understand why dietary restrictions matter, develop more positive attitudes toward healthy eating, and feel more capable of coping with the demands of their disease. Those who cannot often fail to set management goals at all, leaving them without a psychological engine for adherence.

But the study also carries a caution: knowledge alone is not enough. The authors note that even low-literacy patients showed some inclination toward healthy behaviors on certain dimensions, implying that simply pouring more information into patients will not automatically change what they eat. They propose moving from the traditional knowledge-transfer model of nutrition education toward a comprehensive knowledge-attitude-motivation-behavior approach, grounded in frameworks such as Self-Determination Theory and the Health Belief Model, that builds autonomy through goal-setting, behavioral feedback and family support.

Who ends up in which group is not random. Multinomial logistic regression, with the moderate-literacy profile as the reference category, identified four independent factors: gender, only-child status, monthly household income and method of medical payment. Male adolescents had roughly 2.7 times the adjusted odds of belonging to the low-literacy group compared with females, consistent with earlier findings that girls tend to be more proactive in seeking health information. Intriguingly, participants who were not only children had lower odds of falling into the low-literacy group, which the authors interpret through the lens of family resources; only-child families may concentrate care on a single patient, while larger families spread attention and support more thinly.

Socioeconomic signals ran through the payment data. In the low-versus-moderate comparison, both self-payment and other payment methods were associated with significantly lower odds of low-literacy membership than medical insurance, while in the high-versus-moderate comparison, other payment methods roughly tripled the odds of high literacy. Households earning between 3,000 and 5,000 yuan per month had higher adjusted odds of high-literacy membership than the poorest families. The authors suggest that families under heavy financial strain may prioritize the immediate costs of treatment over long-term dietary management, and they call for clinics to prioritize socioeconomically disadvantaged patients with targeted guidance.

The findings come with honest caveats. The study was conducted at a single center, the General Hospital of the Eastern Theater Command, between March and September 2025, and relied on self-report questionnaires, both of which invite bias. More fundamentally, the dietary motivation comparisons were unadjusted, so confounding by demographic and clinical characteristics cannot be ruled out, and the cross-sectional design cannot establish whether low literacy causes low motivation or the reverse. Still, the core message stands: adolescent kidney patients are not a homogeneous bloc, and the largest subgroup is the one least equipped to manage the diet their disease demands. The authors urge clinicians to abandon one-size-fits-all education and instead deliver tiered, personalized interventions, reinforcing basic knowledge and practical skills for the low-literacy group while pushing moderate and high-literacy patients toward stronger self-management. For a generation of young patients facing decades of dietary vigilance, that shift could determine whether nutritional advice ever makes it from the clinic handout to the dinner plate.

Subject of Research: Nutritional literacy profiles and dietary motivation in adolescents with chronic kidney disease

Article Title: Nutritional literacy profiles and their association with dietary motivation in adolescents with chronic kidney disease

Article References: Bai, S., Qi, J., Xu, W., Rong, C., & Jia, L. (2026). Nutritional literacy profiles and their association with dietary motivation in adolescents with chronic kidney disease. Frontiers in Nutrition, 13, Article 1965268. https://doi.org/10.3389/fnut.2026.1965268

Image Credits: AI Generated

DOI: 10.3389/fnut.2026.1965268

Keywords: chronic kidney disease, adolescents, nutritional literacy, dietary motivation, latent profile analysis, pediatric nutrition, health literacy, nutrition education, cross-sectional study, clinical nutrition, self-management, dietary behavior

The first of the two resources, the Lifestyle Medicine Medical School Curriculum, is a turnkey program intended to weave evidence-based nutrition and broader lifestyle medicine content through all four years of undergraduate medical training. It arrives as medical schools face encouragement to provide at least 40 hours of nutrition instruction, with the federal expectation beginning in Fall 2026. Rather than leaving schools to build their own courses from scratch, the curriculum functions as a ready-made scaffold that institutions can adapt. It includes 10 learning modules covering all aspects of lifestyle medicine education, including the required nutrition content, delivered through virtual learning units, clinical application opportunities, and assessment tools designed to support competency development.

Importantly, the curriculum does not treat nutrition as an isolated topic. It situates dietary science within the six pillars of lifestyle medicine: nutrition, physical activity, restorative sleep, stress management, social connectedness, and avoidance of risky substances. Students encounter clinical cases, nutrition assessment exercises, behavior change strategies, and patient communication approaches that emphasize real-world application. The goal, according to the college, is to help future physicians understand the interconnected role of these factors in treating, reversing, and preventing chronic disease, and to translate that understanding into clinical practice rather than memorizing isolated nutrition facts for examinations.

Brenda Rea, ACLM’s medical director of education, a physician and registered dietitian nutritionist who also holds credentials as a lifestyle medicine intensivist, framed the need for a longitudinal approach. Medical students, she said, need much more than isolated nutrition lectures; they need an educational experience spread across their training that helps them understand how nutrition and other lifestyle factors influence chronic disease and how to apply that knowledge with patients. She described the college’s goal as making high-quality nutrition and lifestyle medicine education easier for medical schools to implement and more meaningful for the physicians those schools produce.

To lower the barrier to adoption further, the medical school curriculum comes with complimentary access to the ACLM Culinary Medicine Curriculum and the Culinary Medicine Program. These open-source resources provide nearly 15 hours of self-paced video instruction along with a comprehensive teaching toolkit. The culinary medicine materials are designed to prepare clinicians, clinicians in training, and members of the public to incorporate optimal nutrition into daily eating patterns, adding a practical, kitchen-adjacent dimension to what can otherwise remain an abstract classroom subject. The combination of didactic modules, clinical application, and culinary training reflects a growing recognition that teaching patients to change what they eat requires skills that go beyond reciting dietary guidelines.

The second resource targets clinicians who are already in practice. ACLM has launched the third edition of its online course, Food as Medicine: Nutrition for Treatment and Risk Reduction, a 2.75-hour program intended to help health professionals translate nutrition science into concrete strategies for treating and reducing the risk of common chronic diseases. The course examines evidence-based dietary patterns, food groups, and nutrition strategies related to cardiovascular disease, insulin resistance and type 2 diabetes, obesity, and certain cancers. It also explores the roles of carbohydrate, fat, and protein sources in health outcomes and provides practical approaches to patient-centered nutrition counseling and behavior change.

The learning objectives are explicitly practical. Upon completing the course, participants should be able to describe dietary patterns shown to be effective in treating and reducing the risk of common lifestyle-related chronic diseases, discuss how dietary behaviors affect the development and progression of chronic disease, identify how different macronutrient sources may contribute to disease progression or improvement, and apply foundational strategies to support dietary behavior change. Those objectives mirror the technical core of lifestyle medicine itself: identifying which dietary patterns carry the strongest evidence, understanding the physiological mechanisms linking diet to cardiometabolic disease, and mastering the behavioral techniques that make counseling effective in the exam room.

Michelle McMacken, executive director of nutrition and lifestyle medicine at NYC Health + Hospitals, a board-certified lifestyle medicine physician, emphasized the clinical context in which such training matters. Patients, she noted, hear a constant stream of confusing and often contradictory nutrition messages, which presents health professionals with an important opportunity to provide clear, evidence-based guidance. She described the course as giving members of the interprofessional care team a working command of the evidence and practical strategies for delivering meaningful dietary counseling within the realities of clinical care, where time is short and patients arrive with entrenched habits and conflicting information from social media and marketing.

The intended audience for the course is deliberately broad. Although it may support physicians seeking education relevant to state-level nutrition education requirements, ACLM stresses that requirements vary by state and medical board, and physicians should confirm eligibility with their licensing authority before counting the course toward any mandate. The course is also designed for registered nurses, nurse practitioners, physician associates, registered dietitians, pharmacists, physical and occupational therapists, certified health coaches, and other health professionals working in chronic disease treatment and prevention, as well as clinicians still in training. That breadth reflects the reality that nutrition counseling increasingly happens across an interprofessional team rather than solely through the physician. Participants can earn 2.75 continuing education credits, and the course will remain available through September 14, 2029, giving clinicians a multi-year window to complete it.

The launch arrives at a moment when the American College of Lifestyle Medicine has been steadily building infrastructure to scale lifestyle medicine as a standard of care. Since 2004, the organization has trained more than 100,000 health professionals and made more than 1.75 million hours of accredited continuing education available through courses and conferences for physicians and health professionals. With hundreds of institutional partners worldwide, ACLM describes its mission as helping healthcare move from a system designed to manage disease to one capable of restoring health. The new medical school curriculum and the updated food as medicine course represent that strategy applied at two critical points in the professional pipeline: the training of future physicians who will soon be required to learn nutrition at a defined minimum level, and the continuing education of the existing clinical workforce that must counsel patients today. If medical schools adopt the turnkey model at scale, the initiative could accelerate the integration of evidence-based nutrition and whole-person care into mainstream medical training, bringing the treatment of root causes of chronic disease closer to the center of American clinical practice.

Subject of Research: Lifestyle medicine and nutrition education resources for medical schools and practicing clinicians

Article Title: ACLM launches two solutions to advance nutrition and lifestyle medicine education, helping meet federal and state requirements

Article References: ACLM launches two solutions to advance nutrition and lifestyle medicine education, helping meet federal and state requirements. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: American College of Lifestyle Medicine, medical education, nutrition education, lifestyle medicine, food as medicine, continuing education, chronic disease, culinary medicine, medical school curriculum, dietary counseling, health professionals, federal requirements

The research, published in the journal Supportive Care in Cancer, was conducted by a team from the Nutritional Department of the Eye & ENT Hospital of Fudan University in Shanghai. Between April 2023 and January 2025, the investigators enrolled 626 hospitalized patients who were scheduled to receive surgical treatment for head and neck cancer. Using a single-center, cross-sectional design with consecutive sampling, they set out to answer two intertwined questions: how much do these patients know, believe, and practice when it comes to nutrition, and how do those cognitive and behavioral factors relate to objectively diagnosed malnutrition?

To diagnose malnutrition, the team followed a two-step protocol that mirrors international best practice. Every participant first underwent routine nutritional risk screening with the Nutritional Risk Screening 2002 tool, known as NRS-2002, which weighs body mass index, recent weight loss, dietary intake, disease severity, and age. Patients whose scores reached three or higher, indicating significant nutritional risk, then underwent a full diagnostic assessment using the criteria of the Global Leadership Initiative on Malnutrition, or GLIM. The GLIM framework, established by a global consensus of clinical nutrition societies, requires the combination of a phenotypic criterion, such as unintentional weight loss or low body mass index, with an etiologic criterion, such as reduced food intake or inflammation, to formally diagnose malnutrition.

The headline number from the study is sobering but perhaps not shocking for clinicians in the field: 14.9 percent of the 626 patients, or 93 individuals, met the GLIM criteria for malnutrition. That figure sits within the range reported by other research groups using the same diagnostic framework in head and neck cancer populations, where prevalence estimates have varied widely depending on disease stage, treatment setting, and timing of assessment. What distinguishes the new study is not the prevalence count itself but the parallel investigation of the patients’ nutritional knowledge, attitudes, and practices, a triad that researchers abbreviate as KAP.

Each participant completed a structured KAP questionnaire probing three domains: what they understood about nutrition in the context of their disease, how they felt about the importance of nutritional care, and what they actually did day to day to manage their intake. The analysis revealed weak to moderate positive correlations among the three domains, with correlation coefficients ranging from 0.229 to 0.326, all statistically significant. In plain terms, knowing more about nutrition was associated with more favorable attitudes, and both were associated with better practices, but the links were far from airtight. Knowledge alone does not automatically translate into behavior, a gap that has frustrated health educators for decades and one that this data quantifies in a cancer population.

The comparison between nourished and malnourished patients was striking. Those who met the GLIM criteria scored significantly lower across the KAP dimensions than their well-nourished counterparts, with differences reaching statistical significance. But the researchers went further than simple group comparisons. Recognizing that sick patients differ in countless ways beyond their nutritional literacy, they built a multivariable regression model that adjusted for treatment burden and a battery of clinical confounders, allowing each factor’s independent contribution to malnutrition odds to be estimated.

What emerged from that model was a hierarchy of risk. The single strongest driver of malnutrition was cumulative treatment burden. Patients undergoing reoperation for recurrent nasopharyngeal carcinoma after prior radiotherapy and surgery faced the highest odds of all, with an odds ratio of 5.45, meaning their odds of malnutrition were more than five times higher than the reference group. This makes biological sense: repeat surgery in a previously irradiated field compounds tissue damage, impairs swallowing mechanics, and stacks the metabolic demands of healing on top of an already depleted reserve. Comorbidities told a similar dose-dependent story, with patients carrying two or more additional chronic conditions facing roughly 3.6 times the odds of malnutrition compared with those without such burdens.

Yet even after the statistical machinery had accounted for these powerful clinical forces, the cognitive-behavioral pathway remained visible. Every five-point increase in the knowledge score was associated with a 10 percent reduction in the odds of malnutrition, with an odds ratio of 0.90 and a confidence interval that excluded the null value. Every five-point increase in the practice score carried an even stronger association, an odds ratio of 0.86, corresponding to a 14 percent reduction in odds. Attitude scores, by contrast, did not remain independently significant after adjustment, suggesting that positive feelings about nutrition matter mainly insofar as they are converted into concrete dietary practices. The knowledge-practice gap, long a staple of health psychology, thus appears to have real clinical consequences in this population.

The authors are careful, appropriately, to frame these findings as associations rather than causal relationships. A cross-sectional study captures a single moment in time, so it cannot determine whether poor nutritional knowledge and practice lead to malnutrition, whether malnourished patients simply have less energy and capacity to learn and implement good dietary habits, or whether some unmeasured factor, such as social support or socioeconomic status, drives both. Longitudinal and interventional studies would be needed to establish that teaching patients about nutrition actually prevents malnutrition. Still, the consistency of the association after rigorous adjustment, and its alignment with a growing international literature linking KAP scores to malnutrition risk in tumor patients undergoing radiotherapy, lends the finding credibility.

The practical implications are where the study earns its keep. The authors argue for risk-stratified nutritional management: patients with heavy treatment burdens or multiple comorbidities need intensive, often clinical, nutritional support and aggressive symptom management, because education alone cannot overcome a surgically altered swallowing apparatus or the catabolic fire of recurrent disease. For patients at medium or low risk, however, the data suggest a different lever. Educational and behavioral interventions designed to close the gap between knowing and doing, teaching not just what good nutrition is but how to shop for it, prepare it, and sustain it through treatment, may meaningfully reduce malnutrition risk. In an era when head and neck cancer affects hundreds of thousands of people worldwide each year, and when malnutrition is known to worsen surgical outcomes, wound healing, and survival, the idea that a well-designed nutrition education program could shift the odds, even modestly, is a finding worth taking seriously. The Shanghai team’s work does not prove that it will, but it makes a compelling case that the question deserves a proper trial.

Subject of Research: Nutritional knowledge, attitudes, and practices and GLIM-defined malnutrition in hospitalized head and neck cancer surgery patients

Article Title: Nutritional knowledge, attitudes, and practices (KAP) and GLIM-defined malnutrition in hospitalized head and neck cancer patients receiving surgical treatment: A cross-sectional study in china

Article References: Jiang, J., Shi, Q., Xu, Q., Wu, R., & Ma, J. (2026). Nutritional knowledge, attitudes, and practices (KAP) and GLIM-defined malnutrition in hospitalized head and neck cancer patients receiving surgical treatment: A cross-sectional study in china. Supportive Care in Cancer, 34(10), Article 996. https://doi.org/10.1007/s00520-026-11257-x

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11257-x

Keywords: head and neck cancer, malnutrition, GLIM criteria, nutritional KAP, NRS-2002, surgical patients, nasopharyngeal carcinoma, nutritional risk screening, comorbidities, nutrition education, supportive care, cross-sectional study

The research team, led by Sarah O’Donovan and Lisa Ryan of Atlantic Technological University in Galway, Ireland, together with collaborators in Sweden, France, Romania, and Ukraine, undertook a structured curriculum review as part of the Erasmus+ co-funded Nutrition Education for HealthCare Professionals consortium. Their method was deliberately grounded in the documents that actually govern what students learn. The researchers first identified publicly available curricula and programme module descriptions for undergraduate programmes in each target discipline, then mapped nutrition-related learning outcomes and assessments, and finally analysed how well the content covered key thematic areas such as patient-centred care, digital health, behaviour change, and public health. Data were synthesised using descriptive analysis to surface recurrent patterns and gaps across countries and disciplines.

The scale of the review lends it weight. The team analysed 41 medicine programmes, 44 nursing programmes, 37 pharmacy programmes, and 38 physiotherapy programmes across the five countries, dissecting nearly five thousand modules in total. Because the analysis relied on official curricula, module descriptors, and handbooks rather than surveys or interviews, it captures what institutions formally commit to teaching, not merely what educators believe they cover. That distinction matters: a learning outcome that never appears in a module descriptor is unlikely to be reliably taught, timetabled, or examined, and graduates can qualify without ever being formally assessed on it.

The headline finding is stark. Across all 4,964 modules, nutrition was most commonly embedded implicitly within biomedical or clinical subjects rather than delivered as standalone content. In practice, this means a student might encounter a passing reference to malnutrition inside a gastroenterology lecture or a mention of dietary considerations in a pharmacology module, without any guarantee that the underlying nutritional science, assessment skills, or counselling techniques are systematically built upon. Implicit embedding makes nutrition education fragile: it depends on individual lecturers choosing to include it, and it disappears from the record when those individuals move on.

The country comparison revealed striking variation in how visible nutrition is within official curricula. Romania demonstrated the highest proportion of explicit nutrition modules at 14 percent, followed by Sweden at 7 percent, Ireland at 4 percent, Ukraine at 3 percent, and France at just 2 percent. Even the best-performing country in the sample left the overwhelming majority of modules without explicit nutrition content, and the sevenfold spread between Romania and France suggests that national regulatory frameworks, accreditation standards, and professional bodies play a decisive role in determining whether nutrition is treated as a core competency or an optional afterthought. For a single European labour market in which health professionals increasingly move across borders, such divergence raises questions about whether graduates in different countries arrive with comparable baseline capabilities in dietary care.

The disciplinary patterns were equally revealing. Medicine and pharmacy programmes focused primarily on biomedical and disease-related nutrition, emphasising metabolism, nutrient biochemistry, and the role of diet in disease processes. Nursing programmes more frequently incorporated applied, patient-centred content, reflecting the profession’s hands-on role in feeding, monitoring, and supporting patients. Physiotherapy programmes addressed nutrition mainly in rehabilitation and chronic disease contexts, where diet intersects with recovery, exercise, and long-term condition management. Each discipline, in other words, has developed a partial lens on nutrition that mirrors its clinical role, but none appears to provide comprehensive coverage spanning prevention, assessment, intervention, and behaviour change.

That disciplinary siloing has practical consequences at the bedside. Modern nutrition care is inherently interdisciplinary: a malnourished older patient may need a physician to diagnose the underlying cause, a nurse to implement and monitor a feeding plan, a pharmacist to check for drug-nutrient interactions, and a physiotherapist to ensure that nutritional rehabilitation translates into restored muscle function and mobility. If each professional is trained only in their narrow slice of the problem, and if the training is implicit rather than explicit, the seams between professions become points where nutritional risk is missed. The review’s authors argue that the findings highlight the need for more visible and consistent integration of contemporary, practice-oriented nutrition competencies across healthcare curricula.

The gaps extend beyond basic nutritional science into the domains that increasingly define modern diet-related care. The study specifically probed coverage of patient-centred care, digital health, behaviour change, and public health, thematic areas that reflect how nutrition is actually practised in the 2020s. Helping a patient with type 2 diabetes change long-standing eating habits requires counselling and behaviour-change skills, not just biochemical knowledge. Telehealth consultations and nutrition apps are now routine parts of care pathways. And with obesity and diet-related chronic disease dominating the public health burden across Europe, frontline clinicians are expected to engage with prevention at a population level. A curriculum that teaches nutrient metabolism but omits behaviour change leaves graduates technically informed yet practically unequipped for the conversations that determine whether patients actually change what they eat.

Why has nutrition education lagged so far behind its clinical importance? The review’s structure offers clues. Curricula in health professional programmes are notoriously overcrowded, and nutrition competes for hours against disciplines with strong examination traditions and dedicated departments. Because nutrition is frequently dispersed across other subjects, it lacks the institutional ownership, dedicated faculty, and assessment infrastructure that consolidate a topic into the curriculum. The multi-country design of this study also suggests that where national bodies explicitly require nutrition content, as appears to be the case to a greater degree in Romania, programmes respond; where requirements are vague or absent, nutrition quietly evaporates. The authors position their findings as a framework for targeted curriculum enhancement and future collaborative curriculum development across institutions, implying that the remedy lies in deliberate, coordinated design rather than hoping individual educators fill the void.

The implications reach well beyond the five countries studied. Europe faces a rising tide of diet-related disease, ageing populations with complex nutritional needs, and growing recognition that malnutrition, both undernutrition and overnutrition, worsens surgical outcomes, prolongs hospital stays, and drives healthcare costs. Health professional education is the upstream intervention point: every physician, nurse, pharmacist, and physiotherapist trained today will practise for decades, and the nutritional competencies they carry into that practice are being set now, in the module descriptors and handbooks this study dissected. The picture that emerges from nearly five thousand modules is one of fragmented foundations, in the study’s own words, with nutrition present in fragments but absent as a coherent, visible, assessable competency. For educators, regulators, and professional bodies across Europe, the message is that if nutrition is everyone’s business in principle, it is currently no one’s curriculum in practice, and closing that gap will require the kind of systematic, cross-border collaboration this review itself exemplifies.

Subject of Research: Nutrition education in undergraduate medicine, nursing, pharmacy, and physiotherapy curricula across five European countries

Article Title: Fragmented foundations: a comparative review of nutrition education in medicine, nursing, pharmacy, and physiotherapy programmes across five European countries

Article References: O’Donovan, S., McDonagh, M., Willmer, M., Engstrom, M., Fortrat, J.-O., Le Ray, A.-M., Dejeu, I., Saveanu, T., & Ryan, L. (2026). Fragmented foundations: a comparative review of nutrition education in medicine, nursing, pharmacy, and physiotherapy programmes across five European countries. BMC Medical Education. https://doi.org/10.1186/s12909-026-10536-9

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10536-9

Keywords: nutrition education, medical education, curriculum review, nursing, pharmacy, physiotherapy, Europe, healthcare professionals, Erasmus+, public health, behaviour change, patient-centred care

The selection process behind these awards is grounded in the journal’s internal editorial governance rather than external popular vote. Nominated and eligible articles published in the prior year in JNEB are evaluated by members of the Journal Committee and the JNEB Board of Editors, who judge the outstanding contributions in each category. Lead authors of the winning and finalist works receive a monetary award, and the recognized articles are featured on the journal’s website, giving the winning research a prominent platform beyond its original publication. This structure is designed to reward both scientific excellence and practical utility in a field that sits at the intersection of behavioral science, public health, and education.

In the flagship Best Article category, the top honor went to a team led by Caitlyn B. Faul, MPH, RD, LDN, CDCES, together with Stephanie Jilcott Pitts, Eric E. Calloway, Hilary K. Seligman, Heidi Reis, Cheryl Webb Cherry, Irene E. Hatsu, Oyinlola Toyin Babatunde, Alexandra L. MacMillan Uribe, Jared T. McGuirt, and Rebecca A. Seguin-Fowler. Their winning article, titled A Meta-Ethnography to Determine Critical Constructs of Nutrition Security, tackles one of the most consequential conceptual shifts in contemporary nutrition policy: the move from measuring food security alone toward a fuller understanding of nutrition security. Meta-ethnography is a rigorous qualitative synthesis method that interprets findings across multiple qualitative studies, and by applying it to this domain the authors aimed to identify the critical constructs that define what it means for households and individuals to be nutritionally, not merely calorically, secure.

The significance of that work reflects a broader reorientation in American food policy discourse. Where food security has traditionally been assessed by access to sufficient calories, nutrition security emphasizes the consistent availability of foods and beverages that promote well-being and prevent diet-related chronic disease. A meta-ethnographic approach is technically demanding because it requires researchers to translate concepts across studies conducted in different settings with different populations, preserving the interpretive richness of the original qualitative work while producing a coherent synthesis. The award committee’s decision to recognize this article signals the field’s growing interest in frameworks that can guide practitioners and policymakers as they design programs intended to improve dietary quality rather than simply alleviate hunger.

The Best Article Finalist Award was presented to a large collaborative team whose article examined a policy question with immediate relevance to millions of American schoolchildren. Juliana F.W. Cohen, ScD, RD, along with Monica D. Zuercher, Dania Orta-Aleman, Leah E. Chapman, Christina A. Hecht, Kenneth Hecht, Punam Ohri-Vachaspati, Deborah A. Olarte, Anisha I. Patel, Michele Polacsek, Marlene B. Schwartz, Lorrene D. Ritchie, and Wendi Gosliner, were honored for their article Impact of Deimplementing Universal Free School Meals: School Food Authority Perspectives. Deimplementation, the deliberate process of discontinuing an established practice, is an emerging focus in implementation science, and universal free school meals have been among the most widely debated nutrition policies of recent years. By gathering the perspectives of school food authorities, the entities responsible for operating school meal programs, the study captures the operational and practical consequences experienced on the ground when such programs are scaled back.

In the Best Research Brief category, the winning work came from a team led by Eliza Short, PhD, RDN, joined by Ji Li, James P. Selig, Kelsey Bounds, Brett Rowland, Bonnie Faitak, Jazmin Lane, Rosana Solis-Garcia, Holly C. Felix, Krista Langston, Pearl A. McElfish, Juan Mejia-Otera, Lauren Haggard-Duff, and Christopher R. Long. Their article, Medically Tailored Grocery Delivery for Food Pantry Clients with Diabetes, investigates an intervention model that sits at the frontier of food-is-medicine approaches. Medically tailored grocery programs adapt the foods delivered to clients to align with their clinical conditions, in this case diabetes, and deliver them through food pantry channels that already serve people experiencing food insecurity. Research briefs are a distinct article format in JNEB, designed to communicate focused studies concisely, and the recognition of this work highlights how compact study designs can illuminate interventions with direct clinical and programmatic implications.

The Best Research Brief Finalist Award went to Samantha M. Sundermeir, PhD, MS, RDN, and colleagues Mika Matsuzaki, Angela Zhang, Jane C. Obi, Joel Gittelsohn, and Megan R. Winkler for their article Characterizing the Consumer Food Environment of Dollar Stores and Exploring Differences by Neighborhood Racial Composition. Dollar stores have expanded rapidly across the United States and have become a significant source of groceries for many communities, particularly in rural areas and neighborhoods underserved by traditional supermarkets. Systematically characterizing the consumer food environment, the range, price, and quality of foods available to shoppers, within these stores, and then examining how those environments differ according to the racial composition of surrounding neighborhoods, addresses an important equity question in food access research. The study exemplifies the kind of environmental assessment work that underpins effective nutrition education and policy interventions.

The GEM category, dedicated to Great Educational Material, produced its own winner and finalist. The Best GEM Award was presented to Rebecca Brody, PhD, RD, LD, CNSC, Anca Cunningham, MS, RD, and Jason Stevens, DCN, RDN, for their article Prairietown Regional Medical Center: An AI-Driven Simulation for Teaching Leadership and Change Management to Nutrition Graduate Students. This work represents a notable convergence of nutrition education and emerging technology, using an artificial intelligence-driven simulation to immerse graduate students in realistic leadership scenarios. Change management, the structured approach to guiding organizations through transitions, is a competency that dietetics and nutrition professionals increasingly need as they lead program reforms in clinical and community settings, and simulation-based learning offers a low-risk environment in which students can practice these skills before applying them in professional practice.

The Best GEM Finalist Award recognized Jennifer A. Garner, PhD, RD, and coauthors Jennifer C. Shrodes, Katharine Garrity, Songzhu Zhao, Emmanuella Aboagye-Mensah, Amaris Williams, Guy Brock, Jennifer Hefner, Daniel M. Walker, and Joshua J. Joseph for Cooking Matters for Diabetes: A Curriculum to Support Diabetes Self-Management Among Individuals Facing Food Insecurity. Curricula of this kind translate behavioral nutrition science into structured, teachable programs, combining cooking skills with diabetes self-management education for populations where food insecurity complicates disease management. The dual recognition of this curriculum and the AI-driven simulation in the same category illustrates the breadth of educational innovation the GEM award is intended to celebrate, spanning community-based cooking education and technology-enhanced graduate training.

Congratulating the recipients, JNEB Editor-in-Chief Lauren Haldeman, PhD, Professor and Chair of the Department of Nutrition at the University of North Carolina Greensboro, said that the research recognized through these awards demonstrates the innovation, rigor, and dedication of the authors. As nutrition education continues to evolve to meet new challenges and opportunities, she noted, the evidence produced by these researchers is helping educators, practitioners, and communities make informed decisions that improve health outcomes, adding that the journal is proud to celebrate their contributions to the field. Taken together, the 2026 award portfolio paints a picture of a discipline actively grappling with the most pressing questions in food and health: how to define and measure nutrition security, how to manage the consequences of major school meal policy shifts, how food retail environments shape dietary equity, how food-is-medicine interventions can serve people managing chronic disease, and how the next generation of nutrition professionals can be trained with the aid of new technologies. The recognized articles are featured on the journal’s awards page, where readers can explore the full body of honored work.

Subject of Research: 2026 Journal of Nutrition Education and Behavior awards recognizing outstanding nutrition education and behavior research and educational materials

Article Title: Journal of Nutrition Education and Behavior announces 2026 Best Article, Best Research Brief, and GEM awards

Article References: Journal of Nutrition Education and Behavior announces 2026 Best Article, Best Research Brief, and GEM awards. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: Journal of Nutrition Education and Behavior, nutrition education, nutrition security, universal free school meals, food insecurity, medically tailored groceries, dollar stores, diabetes self-management, AI simulation, Society for Nutrition Education and Behavior, research awards, Elsevier

Italy provides an unusually interesting setting for this kind of research. National guidelines establish standards for school catering, but the country’s highly decentralized governance means that responsibility for meal quality, supplier selection, and stakeholder engagement is dispersed across municipalities and regions. The result is a patchwork: two schools in different towns, or even in different neighborhoods of the same city, can operate under markedly different rules, budgets, and catering arrangements. This variability is precisely what makes Italy a natural laboratory for studying how different dimensions of the school food environment relate to children’s diets, because the differences between schools are real, structural, and measurable rather than hypothetical.

The research team, led by Veronica Vitali, Giulia Tiboldo, Alessandro Varacca, and Elena Castellari of the Università Cattolica del Sacro Cuore, designed a questionnaire that probed five broad areas of the school food environment: governance, infrastructure, food provision, educational activities, and family engagement. Teachers, who observe children’s eating habits daily and often participate in mealtime supervision, served as informants about both the characteristics of their schools and the consumption patterns of their students. The survey captured details such as the types of meals offered, the presence of school gardens and kitchen facilities, the involvement of parents and local stakeholders in food decisions, and the frequency of nutrition-related educational activities.

One of the study’s most technically interesting features is its analytical approach. Rather than treating each questionnaire item as a standalone measure, the researchers used Item Response Theory, a family of statistical models originally developed in psychometrics, to construct three latent indices. The first, quality of the offer (QO), captures the overall quality of the food provided by the school. The second, quality of educational activities (QA), measures the richness and frequency of nutrition education. The third, role of stakeholders in governance (RSG), quantifies how actively parents, teachers, and other actors participate in decisions about school food. Latent indices of this kind are valuable because they aggregate many noisy individual indicators into a single, more reliable score, reducing measurement error and allowing researchers to compare schools along meaningful dimensions.

With these indices in hand, the team turned to ordinal logistic regression, a statistical technique suited to outcomes that fall into ordered categories, such as low, medium, and high consumption of a given food group. The models estimated how the three indices, together with school-level characteristics like school type and location, were associated with teacher-reported consumption of fruit, vegetables, and legumes. The sample itself was diverse: sixty percent of respondents taught in kindergartens, sixty-three percent worked in urban areas, and the split between state-recognized private schools and public schools was nearly even, at fifty-four and forty-six percent respectively. This breadth strengthens the case that the patterns observed are not artifacts of a single school type or region.

The headline result concerns the quality of the offer. Across all three food groups, the QO index showed the strongest and most consistent associations with teacher-reported consumption. In other words, schools where the food provision itself scored higher, encompassing the quality and characteristics of the meals served, were also the schools where teachers reported that children ate more fruit, vegetables, and legumes. This is a deceptively simple finding with potentially large implications: it suggests that what schools actually serve may matter more for children’s diets than the educational programming wrapped around it. Children, it seems, respond to their food environment in a fairly direct way, and improving the plate may be the most reliable route to improving the diet.

Governance also emerged as a meaningful factor, though with more modest effect sizes. Higher scores on the stakeholder governance index were associated with a probability of high vegetable consumption higher by 2.5 percentage points, and a probability of high legume consumption higher by 2.0 percentage points. While these shifts may sound small, in a population-level intervention context even a couple of percentage points across an entire school system can translate into substantial changes in dietary intake. The finding aligns with a growing body of work on participatory food governance, which argues that when parents, teachers, and communities have a genuine voice in school food decisions, the resulting environments better reflect local needs and sustain higher standards over time.

Perhaps the most striking negative result involves nutrition education. The quality of educational activities index showed no significant association with consumption of any of the three food groups. For anyone who has assumed that teaching children about healthy eating is the key to changing what they eat, this is a sobering data point. The study does not claim that education is worthless; rather, it suggests that, at least as measured in this survey and in the Italian context, structural and governance-related dimensions of the school food environment carry more weight than classroom-based nutrition activities. It is a finding that echoes a broader theme in behavioral science: environments often shape behavior more powerfully than information does, and a child who is served high-quality meals daily may internalize healthy eating patterns regardless of how many nutrition posters hang in the hallway.

School type mattered as well. Kindergartens showed higher quality-of-offer scores, by 0.132 on the latent scale, compared with primary schools, and children in kindergartens were associated with higher probabilities of high fruit consumption, by 4.0 percentage points, and high legume consumption, by 6.9 percentage points, relative to their primary school counterparts. This pattern is consistent with developmental research showing that early childhood is a critical window for establishing food preferences, and it hints that the Italian system may do a better job of feeding its youngest students than its older ones. Whether the advantage reflects stricter catering standards for younger children, more attentive mealtime supervision, or simply age-related differences in eating behavior is a question the authors flag for future work.

The study’s authors are careful about the limits of what can be concluded. The data are cross-sectional and rely on teacher reports rather than direct dietary measurement, so the associations described cannot be read as causal effects, and the relationships may evolve over time. Still, the research makes a substantive contribution to ongoing debates about school meal governance and public food procurement, particularly in decentralized systems like Italy’s where national guidelines coexist with wide local variation. As policymakers across Europe and beyond grapple with how to build healthier and more sustainable food systems, the Italian evidence offers a clear directional signal: invest in the quality of the food itself and in the engagement of the people who govern it, and treat nutrition education as a complement rather than a substitute. The lunch tray, it turns out, may be the most important classroom in the school.

Subject of Research: The association between school food environment quality, governance, and children's fruit, vegetable, and legume consumption in Italian schools

Article Title: School food environment and healthy eating in Italian schools: evidence from a nationwide teacher survey

Article References: Vitali, V., Tiboldo, G., Varacca, A., & Castellari, E. (2026). School food environment and healthy eating in Italian schools: evidence from a nationwide teacher survey. BMC Public Health. https://doi.org/10.1186/s12889-026-29605-1

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29605-1

Keywords: school food environment, school meals, children's dietary behaviors, school food governance, Item Response Theory, Italy, public health, nutrition education, fruit and vegetable consumption, public food procurement, BMC Public Health, kindergarten

The scale of the problem gives the findings urgency. Chronic kidney disease is defined by structural or functional abnormalities of the kidneys lasting more than three months, or by a decline in the glomerular filtration rate below 60 mL/min/1.73 m². Under the international KDIGO 2012 guidelines, the disease is staged from G1 to G5 by filtration rate and further risk-stratified by albuminuria, with the most advanced cases—those with a filtration rate below 20—requiring renal replacement therapy. Mortality is projected to rise by more than 30 percent between 2022 and 2050, and in Spain, where the review team is based, an estimated one in seven adults lives with the disease, a figure comparable to the United States. Diabetes, hypertension, obesity, cardiovascular disease and age over 60 are the principal risk factors, and lower socioeconomic status compounds the risk.

Quality of life, and specifically health-related quality of life, is the outcome that matters most to patients, yet it is consistently depressed in this population. Compared with healthy individuals, people with chronic kidney disease report reduced physical activity, impaired sexual function, diminished occupational capacity and worse general health, effects that deepen with age and comorbidities. The review’s authors asked a deceptively simple question using the PICO framework: in adults with chronic kidney disease, does health education increase quality of life compared with no education? To answer it, they searched PubMed, the Virtual Health Library and EBSCOhost for studies published between 2014 and 2024, screening 940 records and, after applying inclusion and exclusion criteria, retaining twelve studies for the final synthesis.

The twelve studies fell into four intervention categories that the authors describe as intermediate mechanisms linking education to quality of life: nutrition and fluid management, physical activity, self-management and disease knowledge, and emotional intelligence. Nine were randomized controlled trials, two were quasi-experimental, and one was a single-arm pre-post study. The nutritional trials were among the most revealing. In a randomized trial of 87 hemodialysis patients, individualized dietary advice significantly reduced sodium intake from 90 days onward, along with consumption of packaged seasonings, processed meat and instant noodles, although quality of life itself did not change significantly between groups. Another trial delivered nutrition education virtually, through a Telegram messaging channel, and found that patients not only improved their quality of life but also lowered their serum potassium, sodium, phosphorus and magnesium levels.

The physical activity studies added a striking technological dimension. In the Kidney BEAM trial, 268 patients in the United Kingdom were randomized to a twelve-week digital renal rehabilitation program with live and pre-recorded exercise sessions, or to standard care. The digital group showed significant gains in the mental component of quality of life, patient activation, social function, energy and sit-to-stand performance, and a reduction in the perceived burden of kidney disease—yet the physical component score itself did not change significantly. A Chinese trial of home-based aerobic exercise, by contrast, improved both physical and mental quality of life domains, along with walking capacity, sit-to-stand performance, exercise self-efficacy and anxiety scores. The contrast suggests that intensity and individualization, not the delivery medium, may determine whether physical benefits follow.

Perhaps the most consistent pattern across the synthesis was the divergence between mental and physical improvement. In several studies measuring both components separately—including the digital rehabilitation trial, the self-management program and the peritoneal dialysis retraining study—the mental component of quality of life improved more reliably and to a greater degree than the physical component. The exceptions were instructive: the three studies that found significant gains in both domains combined structured physical activity or nutritional components with individualized, higher-intensity delivery. The authors propose that this differential pattern, rarely addressed explicitly in earlier reviews, reflects the nature of the interventions themselves rather than unexplained inconsistency in the evidence.

Self-management and emotional intelligence programs produced some of the most encouraging results. A twelve-week Australian intervention grounded in social-cognitive theory, combining face-to-face sessions, motivational interviewing and telephone follow-up, improved self-efficacy, disease knowledge, fruit and vegetable consumption and communication with healthcare providers, while reducing alcohol intake, blood pressure and depression and stress scores. In hemodialysis patients, an emotional intelligence program built around self-awareness, self-control, empathy, self-motivation and social skills raised all five domains significantly and improved quality of life at six and twelve weeks. A Bangladeshi trial combining an awareness campaign with mobile health technologies, leaflets and weekly home visits increased disease knowledge and improved blood pressure, body mass index and dietary salinity—though, notably, quality of life measured with the generic EQ-5D-5L instrument showed no significant effect in any analysis.

That last finding points to one of the review’s most practical insights: the choice of measurement instrument matters enormously. In the Kidney BEAM trial, the same patients showed significant improvement on the disease-specific KDQoL-SF questionnaire but not on the generic EQ-5D-5L, suggesting that generic instruments may be less sensitive to change in this population. The authors argue that future trials should adopt validated, kidney-specific quality-of-life measures to avoid false negatives. They also flag findings that did not reach significance rather than burying them: the sodium-restriction trial found no between-group quality-of-life difference, and one Saudi study even reported that the control group scored better on the pain domain of the SF-36, a counter-intuitive result the original publication had not discussed.

The review is candid about the weakness of its evidence base. Applying the Cochrane RoB2 and ROBINS-I tools, the authors rated most studies as having some concerns or high risk of bias, and a simplified GRADE assessment judged the certainty of evidence for the mental component of quality of life to be low and for the physical component very low. Heterogeneity was substantial: six different quality-of-life instruments were used across studies of hemodialysis, peritoneal dialysis and non-dialysis patients, making statistical pooling inappropriate. The review itself was not prospectively registered, was limited to free full-text English and Spanish publications, and could not formally assess publication bias, although the predominance of positive findings raises that possibility. The authors conclude that the results should be interpreted as suggestive rather than conclusive.

Even with those caveats, the direction of the evidence is hard to ignore. Educational interventions were associated with improvements in blood pressure, serum electrolytes, physical function, depression and anxiety in most studies, and patients who received education consistently fared better than those on standard care. The interventions were delivered through remarkably varied channels—Telegram channels, digital rehabilitation platforms, telephone reminders, home visits and bedside counseling—demonstrating that health education can be scaled flexibly and cheaply. The authors note that more frequent and intense interventions produced greater effects, that multidisciplinary teams involving nurses and other professionals could optimize outcomes, and that better-educated patients make more informed decisions about renal replacement therapy. Given that chronic kidney disease already consumes enormous healthcare resources and that its clinical and economic burden is projected to grow through 2027, teaching patients to understand and manage their own disease may prove one of the highest-yield investments available—provided that larger, prospectively registered trials with consistent instrumentation can confirm what these twelve studies only suggest.

Subject of Research: The impact of health education interventions on quality of life in patients with chronic kidney disease

Article Title: Impact of health education on quality of life in patients with chronic kidney disease

Article References: Vicente-Garrido, C., Vicente García, T., Sánchez Aguadero, N., González Sánchez, J., Alonso Domínguez, R., Recio Rodríguez, J. I., Bermejo Gil, B., Coello González, E., & Sánchez-Tocino, M. L. (2026). Impact of health education on quality of life in patients with chronic kidney disease. iScience, 29(10), Article 117555. https://doi.org/10.1016/j.isci.2026.117555

Image Credits: AI Generated

DOI: 10.1016/j.isci.2026.117555

Keywords: chronic kidney disease, health education, quality of life, systematic review, hemodialysis, patient self-management, nutrition education, physical activity, digital health, emotional intelligence, renal replacement therapy, GRADE certainty

The research team, led by corresponding author Shujuan Zhu, MSc, RN, of the Department of Gynecology at The Third Xiangya Hospital of Central South University in Changsha, China, conducted in-depth interviews with 20 women diagnosed with PCOS, 13 doctors, and four nurses at hospitals in Hunan Province. Rather than testing a hypothesis with numbers, the researchers used grounded theory analysis, a qualitative method in which themes and concepts are systematically derived from interview data itself. From this analysis they built a framework describing three progressive stages of health behavior change: intention, adoption, and maintenance. Crucially, they also identified disengagement as a dynamic state that can arise at any point along the way, not merely as a final failure at the end of the process.

The first stage, intention, was found to be driven largely by physical and psychological needs. For many of the women interviewed, the decision to consider healthier eating and increased physical activity was triggered by concerns about fertility, by the burden of PCOS symptoms, and by effects on self-esteem. Changes in knowledge and understanding also played a role, suggesting that how well a patient comprehends the condition and its relationship to lifestyle can influence whether she forms the intention to change at all. In the context of PCOS, a metabolic and endocrine condition affecting many women of reproductive age, these motivators are particularly potent because the syndrome touches fertility, appearance, and long-term health simultaneously.

Moving from intention to actual behavior, what the researchers call the adoption stage, depended on a different set of factors. Self-efficacy, the confidence in one’s own ability to carry out a behavior, emerged as an important support, alongside health information literacy, meaning the capacity to find, understand, and apply health information. Access to resources and social support also helped women translate good intentions into concrete changes in diet and activity. This stage-by-stage distinction matters for clinical practice: the factors that get someone to the point of wanting to change are not necessarily the same ones that allow her to act on that intention, and interventions designed without recognizing this difference may miss their target.

The maintenance stage proved to be the rarest. Only a few participants reached it, and among those who did, the researchers identified several sustaining mechanisms: goal setting, self-regulation, a sense of identity connected to the healthy behavior, and positive feedback that reinforced continued effort. In other words, women who maintained healthy habits over time had internalized those habits as part of who they were, rather than treating them as a temporary project. Positive feedback, whether from the body itself, from clinicians, or from the social environment, appeared to close a loop in which early success fueled ongoing commitment.

Yet the dominant experience reported in the study was not steady progress. Most patients experienced disengagement at some point, and the researchers found that this could occur at any stage of the process. Personal limitations, environmental constraints, disease-related barriers, and the sheer time, cost, and complexity of sustaining healthy behaviors could outweigh the factors supporting change. A woman might form a firm intention and still stall before adoption, or adopt new habits and later slip back, because the balance of supporting and restraining forces shifted around her. This framing reframes relapse not as an endpoint but as a fluctuating state within an ongoing process.

That reframing carries a pointed message for how clinicians and the public interpret setbacks. “Behavioral disengagement should not simply be viewed as a personal failure of willpower,” said Zhu in the news release accompanying the study. “It may reflect a dynamic state in which restraining factors outweigh the factors supporting continued behavior change.” The quote captures the study’s central conceptual contribution: disengagement is best understood as the product of an imbalance between competing influences, rather than as a character flaw. For patients who already contend with the stigma and frustration that can accompany PCOS, this perspective may reduce self-blame and open the door to more constructive problem-solving.

The practical implications the researchers draw from their framework are correspondingly specific. They suggest that health care providers assess where an individual patient currently sits within the behavior change process, whether at intention, adoption, or maintenance, and then address the particular factors affecting her progress at that stage. Tailored interventions that strengthen supportive factors while actively reducing barriers may help women with PCOS move toward sustained healthy behaviors. In practice, this could mean pairing education with resource access for patients still forming intentions, building self-efficacy and social support for those attempting adoption, and reinforcing identity and self-regulation for those working to maintain gains. A one-size-fits-all prescription, the framework implies, is unlikely to serve patients whose obstacles differ so widely by stage.

The authors also flag the limits of what their study can claim. As a qualitative, grounded theory investigation conducted with participants at hospitals in a single Chinese province, its framework was generated from a specific population and context. The researchers call for future research to test the framework in other populations and cultural settings, and to examine more closely how interventions can adapt as individuals’ behavioral status changes over time. Because grounded theory generates explanatory models rather than statistical estimates, quantitative validation will be needed to confirm how generalizable the three-stage structure and its supporting and restraining factors are across different health systems, cultures, and patient groups.

Even with those caveats, the study adds a valuable piece to the broader picture of how chronic-condition self-management actually unfolds. For the estimated millions of women worldwide living with polycystic ovary syndrome, the findings suggest that the path to healthier eating and regular physical activity is less a test of resolve than a negotiation between personal capacity, environment, disease burden, and the practical demands of daily life. For the clinicians who care for them, the message is to meet patients where they are in that negotiation, to expect setbacks as part of the process rather than as its failure, and to design support that shifts the balance of forces back toward progress whenever disengagement begins to take hold.

Subject of Research: Health behavior change processes among women with polycystic ovary syndrome

Article Title: Study reveals complex, nonlinear process of health behavior change among women with polycystic ovary syndrome

Article References: Study reveals complex, nonlinear process of health behavior change among women with polycystic ovary syndrome. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: polycystic ovary syndrome, PCOS, health behavior change, grounded theory, qualitative research, nutrition education, physical activity, behavioral maintenance, disengagement, self-efficacy, patient interviews, Journal of Nutrition Education and Behavior

The stakes are considerable. According to the World Health Organization, 31 major foodborne hazards caused approximately 600 million cases of foodborne disease globally in 2010, resulting in 33 million disability-adjusted life years and 420,000 deaths. Diarrheal diseases account for more than half of these infections, and children are among the most vulnerable groups, with diarrhea remaining the second leading cause of child mortality worldwide. Indonesia reports the highest prevalence of diarrhea among five Southeast Asian countries at 18.21 percent, exceeding Cambodia, Myanmar, the Philippines, and Timor-Leste. Within school environments, the risks are amplified by dietary habits: evidence indicates that 98.9 percent of Indonesian school-aged children consume ready-to-eat foods, increasing their exposure to unsafe food handling practices.

The consequences of these exposures are not hypothetical. The study documents a series of recent food poisoning incidents in Indonesian schools, including cases among elementary students in East Java in 2022 after consumption of candy-shaped snacks, 2,897 poisoning cases reported in Bandar Lampung with eight-year-olds among the most affected, multiple outbreaks classified as extraordinary incidents, and an event involving roughly 30 elementary students in Sukabumi in early 2024. These episodes have been attributed largely to improper food handling and limited consumer awareness of food safety and quality, underscoring the urgency of effective school-based education.

Recognizing these gaps, a research team led by Cica Yulia of Universitas Pendidikan Indonesia, working with colleagues from institutions including Bogor Agricultural University and the National Research and Innovation Agency, conducted a comprehensive qualitative needs assessment between April and November 2025. The study was theoretically grounded in three complementary frameworks: the Health Promoting Schools framework, which integrates health education across school policy, environment, learning, and community engagement; the Theory of Planned Behavior, which links attitudes, social norms, and perceived control to behavior; and Experiential Learning Theory, which emphasizes learning through direct experience and reflection. The work was supported by a Riset Kolaborasi Indonesia 2025 grant and received ethical approval from Universitas Muhammadiyah Surakarta.

The researchers employed a qualitative exploratory design using focus group discussions and semi-structured in-depth interviews in two purposively selected regions: Bandung City in West Java Province, representing an urban setting, and Gunungkidul Regency in the Special Region of Yogyakarta, representing a rural context. Participants were recruited through purposive sampling with maximum variation, spanning regional development planning agencies, district education and health offices, food security and agriculture offices, school principals, teacher working group coordinators, nutrition experts, and curriculum specialists. Discussions lasted 90 to 120 minutes and individual interviews 45 to 60 minutes, with all sessions audio-recorded, transcribed verbatim, and analyzed using Braun and Clarke’s six-phase thematic analysis supported by NVivo 12 software.

The results paint a picture of promising but disjointed activity. Primary schools had established foundational programs, including routine canteen monitoring by health authorities, though participants noted that monitoring quality was not uniform across schools. Many schools had also embraced green economy initiatives such as school gardens, waste banks, and anti-food waste campaigns, which functioned as experiential learning platforms fostering environmental awareness. However, these activities operated largely without a standardized framework, meaning outcomes depended heavily on local leadership and resources. Food safety and nutrition content was embedded across multiple subjects, including Science, Physical Education, Environmental Education, and the Pancasila Student Profile Strengthening Projects, and teachers frequently wove hygiene and nutrition themes into thematic and project-based learning. Yet schools lacked structured modules, clear competency indicators, and assessment rubrics, producing what the authors describe as a curriculum lottery in which instructional depth varied with individual teacher initiative.

Stakeholders were candid about these deficiencies. One school principal emphasized the need for uniform guidance in the form of a dedicated food safety and nutrition module for elementary students, while another noted that annual curriculum reviews allowed adaptation to local contexts but could not compensate for the absence of standardized materials. The analysis identified three priority needs: grade-specific learning modules with explicit outcomes and assessment criteria, formal recognition of food safety and nutrition as core competencies, and behavior-oriented learning strategies grounded in experiential principles. The study also revealed strong multi-sectoral engagement, with health departments supplying pamphlets, videos, and training, and agriculture offices working with extension workers to reduce pesticide use among local food producers. Family involvement emerged as influential but inconsistent, with one teacher coordinator observing that the family role is strong but not uniform across students, highlighting the need for stronger home-school collaboration.

From this five-dimensional needs assessment, the team developed the GREENEDU NEXUS model, an operational adaptation of the whole-school food systems approach tailored to Indonesian primary schools and aligned with the Sustainable Development Goals, particularly SDGs 2, 3, and 12. The model comprises five interconnected pillars. The first, a standardized curriculum, addresses the lack of learning materials through grade-specific modules and behavioral assessment rubrics. The second, experiential learning, translates knowledge into practice through student-led canteen audits, hygiene simulations, and school food gardens. The third, safe and sustainable canteens, targets sanitation and healthy food supply via canteen certification, nutrition labeling, and local food sourcing. The fourth, green behavior and food waste reduction, promotes environmentally friendly consumption through waste banks, zero-leftover initiatives, and composting. The fifth, partnership and advocacy, formalizes cross-sectoral collaboration through parent education, local food procurement, and multi-stakeholder coordination.

The authors argue that the central challenge in Indonesia is not the absence of policy commitment but the limited institutionalization of governance mechanisms that convert national policy into coordinated implementation, monitoring, and accountability at the school level. They contrast the current situation with structured, competency-based food safety education models in Taiwan and China, which have demonstrated sustained improvements in student knowledge and behavior, and note that competency-based school health programs are most effective when curriculum standardization is paired with teacher capacity building, monitoring systems, and supportive school policies. The findings also align with World Health Organization-endorsed Health Promoting Schools frameworks, which recognize that sustainable implementation requires clearly defined governance arrangements and shared accountability across education, health, agriculture, and local government sectors.

The study’s implications extend beyond Indonesia. For policy makers, the research suggests institutionalizing food safety and nutrition education within formal curricula, teacher education, and school food governance through competency-based modules, minimum infrastructure standards, and structured coordination mechanisms. For practitioners, the message is a shift from prohibition-based approaches toward behavioral empowerment supported by enabling food environments, experiential learning, family engagement, and partnerships with local food systems. The authors acknowledge limitations: the findings are context-specific, reflect stakeholder perspectives rather than direct behavioral outcomes, and do not comprehensively explore informal food environments surrounding schools. The GREENEDU NEXUS model has not yet been piloted, and the researchers call for implementation studies using mixed-methods and longitudinal designs to evaluate its effectiveness, scalability, and long-term contribution to school-based food safety, nutrition, and public health. If subsequent trials validate the framework, it could offer a replicable template for low- and middle-income countries grappling with the same gap between food safety policy on paper and protection on the plate.

Subject of Research: Implementation gaps in school-based food safety and nutrition education in Indonesian primary schools

Article Title: Translating food safety and nutrition policy into school-based practice: Evidence from Indonesian primary schools

Article References: Yulia, C., Khomsan, A., Mariana, R. R., Iwansyah, A. C., Rosdiana, D. S., Purwaningtyas, D. R., & Sari, D. R. (2026). Translating food safety and nutrition policy into school-based practice: Evidence from Indonesian primary schools. Public Health in Practice, 12, Article 100844. https://doi.org/10.1016/j.puhip.2026.100844

Image Credits: AI Generated

DOI: 10.1016/j.puhip.2026.100844

Keywords: food safety, nutrition education, primary schools, Indonesia, foodborne disease, GREENEDU NEXUS, Health Promoting Schools, experiential learning, school canteen, green economy, public health policy, qualitative research