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Dr. Gao won the Irwin H. Rosenberg Pre-doctoral Award from the Jean Mayor USDA Human Nutrition Research Center on Aging at Tufts(2006), the Wayne A. Hening Sleep Medicine Investigator Award from the American Academy of Neurology (2011), the Leadership/Expertise Alumni Award from the Tufts Nutrition School (2012), and the Samuel Fomon Young Physician Investigator Award from American Society for Nutrition(2015). He was selected into the Tufts Honorable Alumni Registry in 2015.   

Dr. Gao received his M.S. in Epidemiology from Peking Union Medical College and his M.D. from Shanghai Second Medical University. He received his Ph.D. in nutritional epidemiology from Tufts University. 

Qi Sun, MD, Sc.D., Co-Editor-in-Chief

Dr. Qi Sun is Associate Professor of Medicine in Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School. He is also Associate Professor in the Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health. Dr. Sun’s primary research interests include identifying and examining biomedical risk factors, particularly dietary biomarkers, in relation to type 2 diabetes, obesity, and cardiovascular disease through epidemiological investigations. His research is primarily based on several large-scale cohort studies including the Nurses’ Health Studies and the Health Professionals Follow-up Study. Dr. Sun is also interested in understanding the role of environmental pollutants, such as perfluoroalkyl substances and legacy persistent organic pollutants, in the etiology of weight change and type 2 diabetes. In the era of precision nutrition, Dr. Sun develops a new research interest of understanding the role of microbiome in mediating and modulating diet-health associations. Dr. Sun is currently leading a few NIH-funded projects that focus on food biomarker discovery and validation, diet-microbiome-health inter-relationships, as well as associations between obesogens and weight change in human populations.

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EDITORIAL article

Editorial: eating behavior and chronic diseases: research evidence from population studies.

• 1 Department of Clinical Epidemiology, Jiangsu Province Geriatric Institute, Nanjing, China
• 2 Department of Primary Health Management, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
• 3 School of Population Health, The University of New South Wales, Sydney, NSW, Australia
• 4 School of Public Health, Sichuan University, Chengdu, China
• 5 College of Health Sciences, QU Health, Qatar University, Doha, Qatar

Editorial on the Research Topic Eating behavior and chronic diseases: research evidence from population studies

Non-communicable diseases (NCDs), such as overweight/obesity, cardiovascular diseases (CVDs), cancer, diabetes, and chronic respiratory disease, have been becoming a major global public health problem ( 1 ). NCDs account for over 70% of all deaths and impose significant economic burdens worldwide ( 1 ). Therefore, it is in urgent need on a global scale to implement effective and feasible actions against NCDs from either public health or economic viewpoint. NCDs are usually preventable, as they share key modifiable lifestyle and behavioral risk factors, including unhealthy eating behavior ( 1 ).

As a major lifestyle-related modifiable factor of NCDs, eating behavior is particularly important for the prevention of NCDs. Typically, eating behavior refers to not only dietary patterns but also nutrient intake. From the public health nutrition perspective, population-based evidence on healthy eating is of significance for sharpening policies aimed at preventing NCDs. Thus, this Research Topic was designed to provide population-level evidence on the relationship between eating behavior (both dietary patterns and nutrient intake) and selected NCDs across diverse sub-populations, with particular interest in the interactive associations between eating behavior and other lifestyle/behaviors (e.g., physical activity) in relation to NCDs.

In the paper Associations of healthy eating index-2015 with osteoporosis and low bone mass density in postmenopausal women: a population-based study from NHANES 2007-2018 ( Wang et al. ), it was observed that diet quality indicated with healthy eating index-2015 (HEI-2015) was in negative association with the risk of osteoporosis but had no link with low bone mass density (BMD) among postmenopausal women aged 50 years and older in the USA. Osteoporosis, a common metabolic bone disorder, has been emerging as a significant public health issue with a prevalence of 19.7% in the general population worldwide ( 2 ). In addition to existing evidence on the association of nutrients intake with osteoporosis and BMD, this study reported the potential link between overall dietary patterns and osteoporosis as well as BMD. It is of important public health meaningfulness to examine the associations of both overall dietary patterns and nutrients intake with osteoporosis.

The correlation between fruit intake and all-cause mortality in hypertensive patients: a 10-year follow-up study ( Sun et al. ). Based data derived from the National Health and Nutrition Examination Survey (NHANES), this cohort study found that, among the common five fruits (apple, banana, pear, pineapple, and grape), intake of apple or banana was associated with decreased risk of all-cause mortality for American hypertensive people. As one of major types of daily foods, fruit is essential to human health. Previously, it has been well-documented that fruit intake was negatively associated with the risk of developing hypertension ( 3 ). Meanwhile, it is also important to investigate the relationship between eating behaviors and the risk of death. The present study made a contribution to literature, as it provided another scenario of the association between fruit intake and human health in that increased consumption of specific fruits can reduce the risk of all-cause death for hypertensive individuals.

Compliance with the EAT-Lancet diet and risk of colorectal cancer: a prospective cohort study in 98,415 American adults ( Ren et al. ). With a mean follow-up period of 8.82 years, this study identified that the EAT-Lancet diet (ELD) can reduce the risk of colorectal cancer (CRC) among American adults. ELD, a universally applicable dietary pattern introduced in 2019, encourages the intake of plant-based foods (including vegetables, whole grains, fruits, unsaturated oils, legumes, and nuts) and fish, but limits the consumption of meat and animal products (e.g., beef and lamb, pork, poultry, eggs, and dairy), potatoes and added sugar ( 4 ). Different from traditional dietary patterns, the ELD pattern integrated the concepts of nutrition-based health promotion approaches and environmental sustainability ( 4 ). In terms of human health promotion, ELD has been examined that it can decrease the incidence and mortality of NCDs such as stroke, CVDs, and cancers ( 5 – 8 ). On the other hand, in terms of environmental sustainability, compliance with the ELD was investigated to be associated with a significant reduction in either greenhouse gas emissions or freshwater consumption ( 9 ). Therefore, the ELD may be a scientifically optimized dietary pattern for human long-term development on the earth.

Soft and energy drinks consumption and associated factors in Saudi adults: a national cross sectional study ( Aljaadi et al. ). This study reported a high prevalence of weekly consumption of energy-dense drinks among Saudi adults based on nationally representative data collected in 2021. Energy-dense drinks consumption has been examined to be associated with adverse health outcomes, including obesity, type 2 diabetes (T2D), and CVDs ( 10 – 12 ). It is crucial to implement interventions aimed at reducing the consumption of energy-dense drinks to prevent and alleviate NCDs. The findings regarding energy-dense drinks consumption in this study were similar to those documented in a nationwide survey conducted among Saudi adults in 2013 ( 13 ), unfortunately showing that it is not easy for people to modify their preference or habit of food consumption at the population level. Therefore, for the purpose of population-based NCDs prevention through precision lifestyle/behavior intervention, it is important to dynamically investigate population-level eating behaviors and the associated factors.

Patient-centered nutrition education improved the eating behavior of persons with uncontrolled type 2 diabetes mellitus in North Ethiopia: a quasi-experimental study ( Gebreyesus et al. ). This study presented that a 3-month patient-centered nutrition education intervention could significantly improve both specific and overall eating behaviors for T2D patients with HbA1c ≥ 7.0% in Ethiopia. Additionally, the nutritional intervention was effective in lowering the HbA1c levels among the participants in this study. It highlighted that nutrition education as an intervention approach would be effective to improve eating behavior and glycemic control for diabetic patients in a resource-limited country. Adopting and maintaining healthy eating are always encouraged for diabetic patients to effectively manage the blood glucose ( 14 ). However, the biggest challenge is not to have people's eating behaviors modified with an intervention program, but to have the favorably-changed eating behaviors maintained for a lifetime or, at least, as long as possible.

Population-based comprehensive lifestyle and behavior intervention is of particular importance and effectiveness for NCDs prevention, and it is often viewed as a feasible and cost-effective approach for preventing NCDs. It is necessary to document the updated findings on the association of lifestyle and behavior with NCDs from nutritional epidemiological studies. The papers related to our Research Topic could offer valuable information to assist researchers, clinicians and policy-makers in designing and implementing dietary-specific intervention programs or policies, thus contributing to the prevention of NCDs.

In summary, eating behavior is time and economic status dependent, which may change as an individual's age or/and socio-economic status changes. This may occur in both developing societies and economically settled communities. Meanwhile, updating the dietary patterns and nutrient intake levels of different sub-populations is also necessary for precision eating behavior intervention. Therefore, although relationships between eating behaviors (dietary pattern, nutrients intake) and specific NCDs have been examined in different societies, studies are always welcome to continuously investigate population-level associations between eating behavior and NCDs in sub-populations with culturally and linguistically diverse background, and especially to further examine the interaction between eating behavior and other factors, such as physical activity, on NCDs. In future, research in these two areas needs to be encouraged to provide evidence supporting healthy dietary guidelines or policies for the prevention of NCDs.

Author contributions

FX: Conceptualization, Supervision, Writing – original draft, Writing – review & editing. XX: Conceptualization, Writing – original draft, Writing – review & editing. LZ: Conceptualization, Writing – original draft, Writing – review & editing. ZS: Conceptualization, Writing – original draft, Writing – review & editing.

The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Keywords: eating behavior, chronic disease, dietary pattern, nutrients intake, nutritional epidemiology, population-based evidence

Citation: Xu F, Xu X, Zhao L and Shi Z (2024) Editorial: Eating behavior and chronic diseases: research evidence from population studies. Front. Nutr. 11:1454339. doi: 10.3389/fnut.2024.1454339

Received: 25 June 2024; Accepted: 08 July 2024; Published: 16 July 2024.

Edited and reviewed by: Mauro Serafini , University of Teramo, Italy

Copyright © 2024 Xu, Xu, Zhao and Shi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Fei Xu, xufei@njmu.edu.cn

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Assessing the Cost of Healthy and Unhealthy Diets: A Systematic Review of Methods

• Public Health Nutrition (KE Charlton, Section Editor)
• Open access
• Published: 09 September 2022
• Volume 11 , pages 600–617, ( 2022 )

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• Cherie Russell   ORCID: orcid.org/0000-0003-1251-4810 1 ,
• Jillian Whelan   ORCID: orcid.org/0000-0001-9434-109X 2 &
• Penelope Love   ORCID: orcid.org/0000-0002-1244-3947 1 , 3  

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Purpose of Review

Poor diets are a leading risk factor for chronic disease globally. Research suggests healthy foods are often harder to access, more expensive, and of a lower quality in rural/remote or low-income/high minority areas. Food pricing studies are frequently undertaken to explore food affordability. We aimed to capture and summarise food environment costing methodologies used in both urban and rural settings.

Recent Findings

Our systematic review of high-income countries between 2006 and 2021 found 100 relevant food pricing studies. Most were conducted in the USA ( n  = 47) and Australia ( n  = 24), predominantly in urban areas ( n  = 74) and cross-sectional in design ( n  = 76). All described a data collection methodology, with just over half ( n  = 57) using a named instrument. The main purpose for studies was to monitor food pricing, predominantly using the ‘food basket’, followed by the Nutrition Environment Measures Survey for Stores (NEMS-S). Comparatively, the Healthy Diets Australian Standardised Affordability and Price (ASAP) instrument supplied data on relative affordability to household incomes.

Future research would benefit from a universal instrument reflecting geographic and socio-cultural context and collecting longitudinal data to inform and evaluate initiatives targeting food affordability, availability, and accessibility.

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Introduction

Poor diets, described as those low in fruits, vegetables, and whole grains, and high in red and processed meats and ultra-processed foods, are a leading risk factor for chronic disease globally [ 1 ]. In most high-income countries (HIC), poor diets disproportionally affect lower socioeconomic populations, Indigenous Peoples, and those living in rural and/or remote areas [ 2 , 3 , 4 , 5 ]. Rather than solely a consequence of individual behaviours, poor diets are critically informed by broad contextual factors, including social, commercial, environmental, and cultural influences [ 6 , 7 ]. Crucially, the consumption of a healthy diet is constrained by the range, affordability, and acceptability of foods available for sale [ 8 ]. Research suggests that healthy foods are often harder to access, more expensive, and often of a lower quality in rural, remote, or low-income/high minority areas, than in metropolitan or high-income areas [ 9 , 10 , 11 , 12 ]. Such food environments contribute to higher rates of diet-related non-communicable diseases and food insecurity [ 13 , 14 ]. In order to improve population diets, all aspects of the food environment must be addressed to ensure healthy foods are affordable, available, and of adequate nutritional quality [ 15 ].

Price is a primary factor impacting food choice, diet quality, and food security, therefore having affordable, acceptable, healthy food should be a political and social priority [ 8 , 15 , 16 ]. Some research suggests that healthy diets are associated with greater total spending [ 17 , 18 , 19 ], while other studies report that adherence to a healthy diet is less expensive than current or ‘unhealthy’ diets [ 9 , 20 , 21 ]. Regardless, the cost of a healthy diet is a proportionately large household expense (> 30% of household income) and may therefore be considered ‘unaffordable’ [ 22 ]. Additionally, public perception that healthy diets are expensive is high, which itself may be a barrier to the purchase of healthy foods [ 23 ]. Therefore, improving the affordability of healthy food could improve population diets, regardless of context [ 24 ].

To address the issue of food affordability and inform appropriate attenuating policy and intervention strategies, food pricing studies are frequently undertaken. Food pricing, however, is not a universal construct and is highly influenced by country and context. Numerous methods have been developed to measure food pricing, with data therefore not always comparable or replicable, and of limited value to inform appropriate policy [ 25 ]. Most studies that collect food pricing data conclude that food prices are rising, making healthy eating unaffordable for many populations. However, few studies to date have used this data to suggest strategies to improve affordability. Our systematic review aims to capture and summarise food environment costing methodologies used in HIC, in both urban and rural settings, between 2006 and 2021. In addressing this aim, we answer the following questions: (i) What is the stated purpose of collecting data on food prices, including whether the data is used to inform or advocate for interventions? (ii) Which instruments are being used to measure food pricing? (iii) What are the strengths and limitations of each instrument as reported by study authors?

To address the research aim, we undertook a systematic review of the literature, following the Preferred Reported Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 26 ]. We followed four steps: (i) systematic search for relevant literature; (ii) selection of studies, (iii) data extraction, and (iv) analysis and synthesis of results.

Systematic Search Strategy

After consultation with a research liaison librarian, databases used included EBSCOHOST (Academic Search Complete, CINAHL Complete, GlobalHealth, Medline Complete, and PsychINFO) and Informit. We chose these databases for their comprehensiveness and conventional use in the public health nutrition discipline. We identified search terms using a scoping review and key words used in previous food pricing reviews [ 15 , 23 , 27 , 28 ]. We searched both article abstracts and titles using the following search string: ‘food affordability’ OR ‘food cost’ OR ‘food price*’ OR ‘food promotion*’. We completed an initial search for studies published 2016–2021 in October 2021, followed by a search for studies published 2006–2015 in December 2021.

Selection of Studies

Studies were included if they were English, peer-reviewed journal articles presenting original research, monitored food prices in a high-income country/s, and were published between 2006 and 2021. The article by Glanz (2006) [ 15 ] is considered a seminal paper in food pricing research and was therefore chosen as the starting date for our search. Studies prior to this date were considered unlikely to be relevant to the research question and were thus excluded. Review articles, opinion pieces, posters, perspectives, study protocols, viewpoints, editorials, and commentaries were excluded, as well as those assessing middle- or low-income countries.

Study screening involved an initial review of all titles and removal of duplicates by A1 using online Covidence software [ 29 ], followed by abstract screening (A1), and then full text screening of remaining studies (A1). A second reviewer independently screened all articles by abstract and full text to minimise bias (A2 and A3). Disagreements were resolved through discussion between researchers; where no agreement was reached, a third party acted as an arbiter (A2 and A3). Limited hand searching was conducted given the volume of papers identified. Online Resource 1 presents a PRISMA flow chart of the study selection process.

Data Extraction

Included studies were uploaded to an Endnote (V. X9) [ 30 ] library. We systematically extracted details of each study to Microsoft Excel (V. 2112), including the author/s, year published, article title, aim, pricing instrument used (if specified), country and geographical context (e.g. urban or rural), type of data collected, number and type of locations assessed, number and type of food items captured, population (if the study used sales receipts to estimate food prices), time period of study, strengths, limitations, and conclusions.

Data Analysis and Synthesis

The coded data were used to identify major themes that were then synthesised in the results. We used an inductive thematic approach for our analysis, with the results discussed between the research team to limit researcher subjectivity [ 31 ]. We used Microsoft Excel to calculate descriptive statistics and graphical outputs.

Overview of Studies

Database searching identified 2737 studies, with 1882 studies remaining after removal of duplicates. After abstract screening, a total of 287 were identified for full-text screening, with 187 excluded, and a total of 100 studies included in this systematic review (Online Resource 1).

We observed an increasing number of studies each year, with peaks in 2013, 2014, and 2018 (Fig.  1 ).

Frequency of studies published assessing food prices between 2006 and 2021

Most studies measured food prices in the USA ( n  = 47), followed by Australia ( n  = 25). Urban food environments were assessed more frequently ( n  = 74) than rural ( n  = 33). Most studies were cross-sectional ( n  = 77). Most studies included instore price audits ( n  = 59), followed by online price audits (supermarket websites, n  = 13), or electronic point of sale data (consumer receipts, register sales, or electronic scanning of food prices in the home, n  = 12), and a combination of these ( n  = 17). Most studies collected food price data from more than 20 food retail outlets ( n  = 34) (Table 1 ).

Details of all included studies, grouped according to data source used (instore price audits, online price audits, electronic point of sale, and combinations of these), are shown in Tables 2 , 3 , and 4 . Details include instrument used (if applicable), purpose of data collection, country, context, study type (e.g. cross-sectional, longitudinal), healthiness comparisons (between healthy and unhealthy products or diets), study author, and year. The use of a named instrument was captured to identify commonalities in usage of instruments, and not as an indication of study quality. When assessing differentials in ‘healthiness’, studies either presented a comparison of a ‘healthy diet’ with an ‘unhealthy or currently consumed diet’ or a comparison of the cost of ‘healthy’ and ‘unhealthy’ foods or product categories.

Study Purpose for Collecting Data on Food Prices

The studies included in this review had a multitude of aims (Tables 2 , 3 , and 4 ). While most studies were conducted solely to monitor food prices in a specific location/s [ 33 , 39 , 42 , 46 , 47 , 52 , 54 , 56 , 57 , 59 , 64 , 67 , 71 , 75 , 80 , 81 , 88 , 89 , 104 , 106 , 108 , 109 , 114 ], others aimed to monitor food price changes over time [ 53 , 63 , 74 , 83 , 93 , 97 , 111 , 127 ], assess food prices as a function of income, socioeconomic status, or welfare assistance [ 9 , 19 , 20 , 33 , 36 , 37 , 38 , 40 , 41 , 66 , 69 , 70 , 77 , 84 , 85 , 86 , 90 , 91 , 92 , 94 , 100 , 110 , 115 , 116 , 117 , 122 ]; assess food price in relation to geographic distance [ 19 , 77 , 91 , 92 , 94 , 98 ]; compare perceptions of food price with actual food prices [ 68 , 101 , 107 ]; and relate food price with a health outcome [ 34 , 35 , 37 , 40 , 47 , 58 , 70 , 72 , 78 , 105 , 116 , 117 , 124 , 125 ], compare the price of healthy or unhealthy foods/diets [ 9 , 20 , 34 , 43 , 50 , 51 , 55 , 60 , 61 , 62 , 63 , 64 , 65 , 76 , 85 , 86 , 93 , 94 , 95 , 96 , 99 , 102 , 110 , 111 , 112 , 120 , 121 , 123 , 124 , 126 ], assess diet costs for a specific population [ 82 , 118 ], compare food prices between brands [ 79 ], compare approaches for estimating dietary costs [ 32 ], or understand how prices impact consumption [ 44 ]. Only seven studies specifically aimed to collect data to inform policy strategies and/or community interventions to improve population health [ 10 , 11 , 49 , 80 , 87 , 103 , 113 ]. However, 26 studies did discuss their study findings on food price in relation to potential further action to improve food environments [ 9 , 19 , 20 , 33 , 36 , 37 , 40 , 43 , 47 , 49 , 50 , 54 , 55 , 59 , 63 , 64 , 81 , 85 , 86 , 87 , 88 , 103 , 104 , 105 , 110 ]. Specific suggested strategies included those targeting individuals, such as education campaigns to promote healthy and more affordable food choices [ 9 , 36 , 43 , 45 , 49 , 50 , 55 ], and those targeting environmental changes, such as taxes on ‘unhealthy’ foods [ 33 , 49 , 85 , 104 , 110 ], subsidies and exemptions for ‘healthy’ foods [ 9 , 20 , 45 , 62 , 63 , 85 , 104 , 110 ], vouchers for farmer’s markets [ 43 ], establishing more food stores [ 33 , 45 , 48 , 104 ], better public transportation for consumers to access food stores [ 59 ], generating savings at the manufacturer/wholesaler level that can be passed on to customers [ 81 ], establishing community-led food supply options [ 9 ], and increasing welfare support proportionate to food prices and geographic distances to food stores [ 37 , 40 , 50 , 73 , 85 ].

Overview of Instruments Used to Measure Food Prices

Of the 100 included studies, 57 used a named instrument to measure food prices, as described below. The remaining 43 studies did not name a pre-existing data collection instrument; instead, the authors described the data collection methodology used, for example, in store, online, or via electronic sales data.

Food Basket Instruments

The majority ( n  = 30) of studies used a variation of a ‘food basket’ to estimate food prices. Food baskets capture the prices of a pre-defined list of foods, often in quantities representative of the total diet of reference families over a defined timeframe [ 9 ], and is a longstanding methodology used to investigate the availability and affordability of food. Food basket studies were mainly conducted in the USA ( n  = 14) and Australia ( n  = 12) [ 19 , 20 , 80 , 81 , 83 , 87 , 88 , 89 , 90 , 91 , 92 ]. Food basket studies using named instruments were conducted in the USA—using the Thrifty Food Plan Market Basket ( n  = 5), the Fred Hutchinson Cancer Research Center Market Basket ( n  = 3), the University of Washington’s Center for Public Health Nutrition Market Basket ( n  = 3), and the USDA Market Basket ( n  = 2); in Australia—using the Victorian Healthy Food Basket ( n  = 4), the Food Basket informed by the INFORMAS framework ( n  = 2), the Adelaide Healthy Food Basket ( n  = 2), the Illawarra Healthy Food Basket ( n  = 2), the Queensland Healthy Food Access Basket Survey ( n  = 1), and the Northern Territory Market Basket ( n  = 1); and in Canada—using the Ontario Nutritious food basket ( n  = 1), the Revised Northern Food Basket ( n  = 1), and an unspecified market basket ( n  = 1). Food basket studies were conducted in both rural ( n  = 13) [ 19 , 37 , 49 , 50 , 52 , 81 , 83 , 87 , 88 , 90 , 91 , 103 , 110 ] and urban contexts ( n  = 25) [ 19 , 20 , 37 , 38 , 40 , 46 , 49 , 50 , 51 , 52 , 62 , 63 , 64 , 66 , 67 , 70 , 80 , 81 , 83 , 88 , 89 , 92 , 104 , 105 , 111 ].

All but two [ 37 , 40 ] food basket studies collected prices from physical instore locations [ 19 , 20 , 38 , 43 , 46 , 49 , 50 , 51 , 52 , 55 , 62 , 63 , 64 , 66 , 67 , 70 , 73 , 80 , 81 , 83 , 87 , 88 , 89 , 90 , 91 , 92 , 103 , 104 , 105 , 110 ], with four of these studies supplementing the data with online supermarket prices [ 62 , 63 , 64 , 81 ]. Additionally, three instruments compared the cost of a ‘healthy diet’ to either an ‘unhealthy or currently consumed diet’ [ 20 , 88 , 110 ], 13 instruments compared the cost of ‘healthy’ and ‘unhealthy’ individual foods or product categories [ 19 , 38 , 51 , 62 , 63 , 66 , 83 , 87 , 89 , 90 , 103 ], and 14 instruments did not present a comparison [ 37 , 40 , 46 , 49 , 50 , 52 , 64 , 67 , 70 , 80 , 81 , 91 , 92 , 104 , 105 ]. ‘Current’ diets were defined using national survey data [ 20 , 110 ]. Level of healthiness was defined using various benchmarks, namely the NOVA food processing classification system [ 38 ], nutrient composition and energy density [ 38 , 51 , 62 , 63 , 66 , 80 , 83 , 90 ], national Dietary Guidelines [ 19 , 43 , 70 , 87 , 88 , 89 , 90 ], and the Dietary Approaches to Stop Hypertension (DASH) dietary pattern [ 43 ]. Food affordability was benchmarked using household income [ 20 , 49 , 50 , 90 , 91 , 92 , 103 , 105 , 110 ], government subsidies [ 37 , 40 , 87 , 89 , 91 ], and minimum wage [ 38 , 66 , 70 ]; however, most studies ( n  = 13) did not determine relative affordability in their analysis [ 43 , 51 , 52 , 55 , 62 , 63 , 64 , 67 , 73 , 80 , 81 , 83 , 88 ].

Healthy Diets Australian Standardised Affordability and Price (ASAP) Instrument

Following critiques of existing food baskets, the previously described INFORMAS instrument was refined to assess and compare the price and affordability of healthy and current diets in Australia, leading to the development of the Healthy Diets Australian Standardised Affordability and Price (ASAP). This instrument assesses the cost of a ‘recommended’ Australian diet (defined by the Australian Dietary Guidelines and Australian Guide to Healthy Eating) and the cost of the ‘current’ Australian diet (as reported in the 2011–12 Australian Health Survey) using the reference household of two parents and two children (boy aged 14 years; girl aged 8 years) [ 128 ]. Thus, all studies using this instrument present a comparison of the cost of a ‘healthy’ and ‘unhealthy’ diet in their analysis. Intrinsic to the instrument, the relative affordability of a healthy diet is measured against household incomes. The ASAP instrument was used by four studies to collect food price data in physical instore locations [ 9 , 85 , 86 ] or from online supermarkets [ 94 ]. Studies were conducted in both rural ( n  = 2) [ 9 , 85 , 94 ] and urban ( n  = 2) [ 85 , 86 , 94 ] contexts.

Nutrition Environment Measures Survey for Stores (NEMS-S) Instrument

The Nutrition Environment Measures Survey for Stores (NEMS-S) and its variants were also frequently used throughout food pricing studies ( n  = 15). These included NEMS-S-Rev (Nutrition Environment Measures Survey for Stores Revised), TxNEAS (Texas Nutrition Environment Assessment), NEMS-S-NL (Nutrition Environment Measures Survey for Stores Newfoundland and Labrador), and The Bridging the Gap Food Store Observation Form. This instrument was used mostly in the USA ( n  = 11) [ 11 , 33 , 36 , 44 , 47 , 48 , 54 , 57 , 68 , 71 , 107 ]. Studies were conducted in both rural ( n  = 4) [ 10 , 11 , 56 , 106 ] and urban ( n  = 11) [ 33 , 36 , 44 , 47 , 48 , 54 , 57 , 68 , 71 , 107 , 108 ] contexts. Compared to the food basket methodology, the NEMS-S instrument compares products in the same category that are considered ‘healthy’ or ‘unhealthy’ based on American Dietetic Association (ADA) recommended dietary guidelines, focusing on availability, price, and quality. All studies using the NEMS-S instrument collected food price data in physical instore locations. While the instrument itself does not include a calculation of relative affordability, approximately half the NEMS-S studies included this step in their methods [ 33 , 36 , 44 , 47 , 48 , 54 , 57 ], while all others did not [ 10 , 11 , 56 , 68 , 71 , 106 , 107 , 108 ].

Other Instruments

Several other named instruments were identified, used in single studies. These included the Diet and Nutrition Tool for Evaluation (DANTE) [ 101 ], the Flint Store Food Assessment Instrument [ 60 ], the Food Label Trial registry tool [ 76 ], the New Zealand Food Price Index [ 111 ], the USDA Food Store Survey Instrument [ 73 ], USDA Low-cost food plan [ 55 ] and audit forms developed by the Yale Rudd Center [ 39 ], the Hartford Advisory Commission on Food Policy [ 59 ], and the USDA Authorized Food Retailers’ Characteristics and Access Study [ 43 ]. Only three instruments compared healthy and unhealthy products [ 43 , 76 , 111 ] and none analysed the relative affordability of food.

Instrument Strengths and Limitations

The strengths and limitations of instruments commonly used across studies, as identified by study authors, are presented in Online Resource 2 . Commonly cited limitations, regardless of instrument used, included that actual purchasing behaviours were not captured (unless electronic point of sales data was utilised); culturally important and region-specific products were often not captured; tools were cross-sectional in nature, thus seasonality or changes overtime were not considered; and out-shopping, described as food purchases undertaken outside the local residential geography, including internet orders or foods purchased during travel to other communities, could not be accounted for. While some food basket studies and those using the ASAP instrument did contextualise the relative affordability of healthy foods and/or diets, this was not a part of the methodology for NEMS-S. Other limitations specific to NEMS-S included the length of the survey, and a low convergence between NEMS-S results and consumer perceptions of affordability. Specific limitations for food basket studies included results being constrained by the reference family used and the assumption that food is shared equally among household members. Additionally, most instruments did not capture geographical information regarding access to food retail outlets or availability of foods within food retail outlets.

Authors less commonly described instrument strengths. For NEMS-S, cited strengths included the ability to compare food prices between healthy and unhealthy options, that it has strong inter-rater and test-re-test reliability, and that it has been validated in multiple countries. ASAP studies, and some food basket studies, included a comparison between healthy and current (‘unhealthy’) diets (based on actual consumption) and included alcohol in the survey.

Our systematic review details the key purposes, and methodologies used, for measuring food prices in HIC between 2006 and 2021. While most studies were conducted solely to monitor food prices in specific locations, some sought to report price changes over time, and others collected data to assess comparability of food costs to healthier alternatives, average earnings, welfare payments, rurality, and socioeconomic position. Most studies measured food prices in urban areas, using instore food price audits, with an emerging use of online data collection evident. The most frequently used instruments were ‘food baskets’, used predominantly to monitor food prices; the NEMS-S instrument, used to provide data on relative cost and availability; and the ASAP instrument, use to provide data on relative affordability.

Our review differs from previous reviews of food price and affordability instruments [ 23 , 28 ] by taking a broadened focus on food pricing measures used in HIC globally and including new technology that is affording opportunities for electronic food pricing data collection. While a previous review critiqued food pricing measures for relevance specific to a rural context, our review includes both rural and urban contexts [ 28 ]. Another review [ 23 ] also describes the components of individual instruments, such as the identification of differently sized ‘food baskets’, ranging between 30 and 200 food items. Such critique was beyond the scope of our research questions.

Despite emerging options for electronic methodologies, the predominance of in person, instore data collection continues, notwithstanding the time-consuming and resource-intensive nature of this method. Studies indicate that these instore instruments can be targeted and applied within multiple contexts, such as rural [ 9 , 10 , 11 , 12 ], Indigenous [ 129 , 130 ], and low socioeconomic areas [ 85 ]. Perhaps researchers consider instore data collection as providing real-world insights at a community and population health level. Our review identified that food pricing instruments were mostly used to monitor food prices at a single point in time (cross-sectional) rather than changes at different time points (longitudinal). Instruments that enable the comparison of food prices in terms of a healthy diet (as recommended by dietary guidelines) compared with current dietary patterns (as reported through population health surveys) [ 128 ], and relative affordability for families, appear to provide data of greater practice and policy relevance with regard to community strategies, taxes, and subsidies that have potential to enhance food affordability, availability, and accessibility.

Technological innovations are an emerging alternative to in person data collection, facilitating the acquisition of online supermarket prices, a less labour-intensive method for capturing food prices [ 131 ]. To date, this method has been used within major chain-supermarkets, with a recent study reporting similar results when comparing pricing data obtained instore versus online [ 94 ]. This method therefore holds potential where an online supermarket presence exists, which was increasingly the case during the COVID-19 pandemic [ 53 ], providing rapid feedback to inform price promotions. However, for smaller and/or independent food retail outlets, frequently located in rural areas, online data collection does not appear to capture the contextual nuances of instore price promotions.

Our review found an over-representation of food pricing studies within urban areas. This is consistent with multiple studies that reflect inequities experienced within rural environments [ 132 ], and rural food environments are no exception [ 133 ]. The predominance of research within urban areas may also reflect a pragmatic researcher response to the physical proximity of stores (ease of measurement) and larger population reach (potential for greater population impact). Previous research shows significant differences in income-based variables, food environments, and the affordability of healthy food between urban and rural settings [ 134 ]. There is therefore a need for rural-specific food pricing studies, using appropriate instruments, to evaluate and inform rural-specific food environment initiatives [ 28 ].

During the period covered by this review, high level experts from the World Health Organization [ 135 ], the Lancet Commission [ 136 ], and the Food and Agricultural Organisation of the United Nations [ 137 ] have identified the potential benefits that initiatives located within food retail environments can provide in nudging dietary choices towards healthier options through instore food pricing and promotion, with the overall aim of improving population level diets [ 14 ]. Measures of food pricing, and the relative affordability of a healthy diet, are important to both inform and measure the effectiveness of such initiatives. However, few studies in our review explicitly aimed to inform initiatives or strategies, either at the community or policy level. Assessment of author-reported strengths and limitations of food pricing instruments and methodologies also identified a need for a universal instrument that reflects contextual geographic and socio-cultural information; is intended to be used repeatedly over time; and is adaptable to different country/cultural/contextual settings [ 17 , 23 ]. Future research would benefit from linking the purpose of undertaking food pricing data collection more explicitly to potential initiatives. Our review supports this call and suggests that the instrument selected should suit the context and collect longitudinal data to provide greater insights into the design and effectiveness of initiatives that make healthy food not only affordable but also available and accessible.

Strengths and Limitations

This systematic review provides a current and comprehensive overview of international food pricing studies across HIC. We acknowledge that while food prices are an important factor influencing food choice, it is only one component of the food environment; however, analysing instruments that assess food acceptability, availability, and accessibility was beyond the scope of this review. This review focused on HIC and a similar review on food pricing studies in low- and middle-income countries would be informative. This review may have missed additional relevant data as it only included English language studies and did not include grey literature or hand searching of reference lists.

Food security has come under heightened scrutiny given the food supply interruptions experienced worldwide during the COVID-19 pandemic. While studies providing a snapshot of food prices can be useful to identify areas impacted by rising food prices, much of this cross-sectional data is known. This review raises questions regarding the purpose of collecting food price data, and how this data can best be used to inform change through practice and policy strategies. We suggest that longitudinal studies using a consistent methodology, which acknowledges contextual nuances and demonstrates temporal changes in food pricing, are needed to inform and to evaluate community-based or legislative strategies to improve the relative affordability of a healthy diet.

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Open Access funding enabled and organized by CAUL and its Member Institutions CR is supported by an Australian Government Research Training Scholarship. This funder had no involvement in any aspect of the study. JW is funded by a Deakin University Dean’s Postdoctoral Research Fellowship. JW is also supported by the National Health and Medical Research Council (NHMRC) funded Centre of Research Excellence in Food Retail Environments for Health (RE-FRESH) (APP1152968). The opinions, analysis, and conclusions in this paper are those of the authors and should not be attributed to the NHMRC.

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Russell, C., Whelan, J. & Love, P. Assessing the Cost of Healthy and Unhealthy Diets: A Systematic Review of Methods. Curr Nutr Rep 11 , 600–617 (2022). https://doi.org/10.1007/s13668-022-00428-x

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Psychological effects of nasogastric tube (ngt) in patients with anorexia nervosa: a systematic review.

1. Introduction

• Severe Malnutrition and Weight Loss: When patients present with severe malnutrition or have lost a significant amount of weight (typically more than 15–20% of their body weight), nutritional support through an NGT may be necessary to prevent further health deterioration and to stabilize the patient’s condition. This is especially critical when oral intake is insufficient to meet the caloric and nutritional needs required for recovery.
• Failure of Oral Refeeding: If patients are non-compliant with dietary therapy or oral refeeding plans, an NGT can ensure that they receive the necessary nutrients. This approach helps in overcoming the resistance to eating commonly observed in AN, thereby facilitating weight gain and nutritional rehabilitation.
• Critical Clinical Condition: In cases where patients are in a life-threatening condition due to complications such as electrolyte imbalances, cardiovascular instability, or severe organ dysfunction, immediate nutritional intervention via NGT is crucial to support vital functions and initiate the recovery process.

2. Review Methodology

2.1. search strategy, 2.2. inclusion and exclusion criteria, 2.3. study selection, 2.4. data extraction, 2.5. quality assessment, 3.1. analytic description of the studies, 3.2. general comments on the studies, 3.3. quality of studies, 4. discussion, 4.1. study characteristics, 4.2. ngt tolerability, 4.3. ngt treatment steps, 4.4. others’ points of view: parents and medical staff, 4.5. recommendations for further research, 4.6. limits of the study, 5. conclusions, author contributions, data availability statement, conflicts of interest.

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Amianto, F.; Oliaro, T.; Righettoni, F.; Davico, C.; Marcotulli, D.; Vitiello, B. Psychological Effects of Nasogastric Tube (NGT) in Patients with Anorexia Nervosa: A Systematic Review. Nutrients 2024 , 16 , 2316. https://doi.org/10.3390/nu16142316

Amianto F, Oliaro T, Righettoni F, Davico C, Marcotulli D, Vitiello B. Psychological Effects of Nasogastric Tube (NGT) in Patients with Anorexia Nervosa: A Systematic Review. Nutrients . 2024; 16(14):2316. https://doi.org/10.3390/nu16142316

Amianto, Federico, Tomaso Oliaro, Francesca Righettoni, Chiara Davico, Daniele Marcotulli, and Benedetto Vitiello. 2024. "Psychological Effects of Nasogastric Tube (NGT) in Patients with Anorexia Nervosa: A Systematic Review" Nutrients 16, no. 14: 2316. https://doi.org/10.3390/nu16142316

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• v.4(5); 2013 Sep

Nutrition research to affect food and a healthy lifespan 1, 2

Sarah d. ohlhorst.

3 American Society for Nutrition, Bethesda, MD

Robert Russell

4 NIH Office of Dietary Supplements, Bethesda, MD, and Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA

Dennis Bier

5 USDA/Agricultural Research Service Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX

David M. Klurfeld

6 Human Nutrition Program, USDA/Agricultural Research Service, Beltsville, MD

Zhaoping Li

7 Center for Human Nutrition, University of California Los Angeles, and David Geffen School of Medicine at UCLA, Los Angeles, CA

Jonathan R. Mein

8 Monsanto Center for Food and Nutrition Research, Monsanto Vegetable Seed, Kannapolis, NC

John Milner

9 NIH National Cancer Institute, Bethesda, MD

A. Catharine Ross

10 Department of Nutritional Sciences, Pennsylvania State University, University Park, PA; and

Patrick Stover

11 Division of Nutritional Sciences, Cornell University, Ithaca, NY.

Emily Konopka

Proper nutrition offers one of the most effective and least costly ways to decrease the burden of many diseases and their associated risk factors, including obesity. Nutrition research holds the key to increasing our understanding of the causes of obesity and its related comorbidities and thus holds promise to markedly influence global health and economies. After outreach to 75 thought leaders, the American Society for Nutrition (ASN) convened a Working Group to identify the nutrition research needs whose advancement will have the greatest projected impact on the future health and well-being of global populations. ASN’s Nutrition Research Needs focus on the following high priority areas: 1 ) variability in individual responses to diet and foods; 2 ) healthy growth, development, and reproduction; 3 ) health maintenance; 4 ) medical management; 5 ) nutrition-related behaviors; and 6 ) food supply/environment. ASN hopes the Nutrition Research Needs will prompt collaboration among scientists across all disciplines to advance this challenging research agenda given the high potential for translation and impact on public health. Furthermore, ASN hopes the findings from the Nutrition Research Needs will stimulate the development and adoption of new and innovative strategies that can be applied toward the prevention and treatment of nutrition-related diseases. The multidisciplinary nature of nutrition research requires stakeholders with differing areas of expertise to collaborate on multifaceted approaches to establish the evidence-based nutrition guidance and policies that will lead to better health for the global population. In addition to the identified research needs, ASN also identified 5 tools that are critical to the advancement of the Nutrition Research Needs: 1 ) omics, 2 ) bioinformatics, 3 ) databases, 4 ) biomarkers, and 5 ) cost-effectiveness analysis.

INTRODUCTION

The attainment of good nutrition depends on and encompasses the entire food supply. Plant and animal foods and their various components are the primary vehicles that provide nourishment to human beings. Nutrition is vital, not only in the growth and development of humans and animals but also in the prevention and treatment of disease. Nutrition is also fundamental to the maintenance of good health and functionality. Basic and applied research on the interrelations between nutrition and noncommunicable diseases, nutrient composition, and nutrition monitoring represents the underpinnings for healthy populations and robust economies. Thus, innovative nutrition research and education provide the basis for solutions to larger health-related issues, allowing individuals to live healthier, more productive lives.

The importance of nutrition, as an integral part of the solution to many societal, environmental, and economic challenges facing the world, has just started to be fully appreciated. The American Society for Nutrition (ASN) has identified the “grand” challenges facing nutrition research and science in the 21st century, termed “Nutrition Research Needs.” Findings from these Nutrition Research Needs will elucidate strategies that can be applied toward the prevention and treatment of both infectious and noncommunicable diseases, including cardiovascular disease, diabetes, and cancer. Nutrition research holds the key to increasing our understanding of the underlying causes of obesity and its related comorbidities and thus holds promise to markedly influence global economies. Knowledge about adequate nutrition also has an important role in reducing or ending global and domestic food insecurity through direct and purposeful agricultural practices. Population growth will undeniably lead to increased global demand for a safe, available, sustainable, and affordable food supply, while continuing to demand nutritional adequacy.

The ASN Nutrition Research Needs project was originally conceptualized by ASN’s Public Policy Committee to identify worldwide nutrition research needs. This effort will be used to educate and communicate to policy makers and other stakeholders the need and value of increased nutrition research funding to meet societal needs. ASN’s Public Policy Committee reached out to nearly 75 thought leaders in September 2011 to develop a draft list of nutrition research needs.

In February 2012, ASN convened a Working Group of nutrition scientists and researchers representing a cross-section of the Society’s membership to determine the nutrition research needs that will have the greatest impact on the health and well-being of global populations. The names of the Working Group members are listed in the Acknowledgments. Starting with the draft list, the Working Group narrowed down and pulled together 6 nutrition research needs for which advancement would have the greatest projected impact on future health and well-being.

The ASN then informed its membership of the 6 priority research needs and sought further member input. A workshop was held during ASN’s 2012 Scientific Sessions and Annual Meeting in San Diego, CA, with nearly 250 attendees. The research needs were also shared via ASN’s member newsletter, which reaches the entire membership base of nearly 5000 individuals, to inform and seek input from members who did not attend the annual meeting or the workshop. Member feedback on the Nutrition Research Needs was incorporated during development of the final document.

THE TOP NUTRITION RESEARCH NEEDS

The top 6 nutrition research needs cut across the entire research spectrum from basic science to health policy, from discovery to application. Specific research areas are listed under each research need. These 6 nutrition research needs are highlighted in the hope that they will prompt scientists from all disciplines to collaborate to advance these challenging research needs that have high potential for translation and public health impact. Although the topics presented focus principally on human nutrition research, the Working Group recognized that nutrition research using animal models is an essential foundation for making new discoveries that can be translated to advances in human nutrition. Further, the importance of animal nutrition research is emphasized within these research needs in particular: “Understanding the role of nutrition in health maintenance” and “Understanding the food supply/environment.” The research community will benefit from clearly articulated nutrition research priorities that will lead to science-based information, help to shape policy and enhance future funding for nutrition research, and thereby further promote the field of nutrition science.

1) Understanding variability in individual responses to diet and foods

A top priority for future nutrition research is the need to better understand variability in metabolic responses to diet and food. Enormous variability exists in individual responses to diet and food components that affect overall health. Discoveries underpinning this variability will lead to advances in personalized nutrition interventions and will better inform health and food policies, including Dietary Reference Intakes (DRIs) for nutrient needs and, ideally, future recommendations for known bioactive food components. Research in the following areas is necessary to determine the origins and architecture of variability and to explain similar or dissimilar responses to diet and food components by subpopulations, as influenced by genetic, epigenetic, and ethnic and/or racial differences.

Omics research, such as nutrigenetics and nutrigenomics (e.g., epigenetics, transcriptomics, proteomics, and metabolomics), will help to determine how specific nutrients interact with genes, proteins, and metabolites to predict an individual’s health. Omics provide information on individualized nutrient requirements, including how nutrients are digested, absorbed, and metabolized, and their functions in the body. Omics will help to determine and reflect an individual’s nutritional status and will aid in the creation of new nutritional and disease biomarkers.

Microbiome.

Diverse microbes, such as bacteria and viruses, live in and on the body and contribute to the microbiome, which is estimated to have 10 times as many cells as the body itself ( 1 ). Microbes can vary in type and quantity, making each organism’s microbiome unique—although subpopulations may have similar microbiome characteristics. The microbiota needs to be better defined, and changes due to diet, age, physiologic state, and disease need to be determined. Research is needed to determine the microbiome’s role in varying biological responses to diet and food components and its importance in disease prevention and progression. Conversely, research is also needed to determine how the microbiome is influenced by diet and other environmental factors.

Biological networks.

Basic research is needed to provide a better understanding of biological networks, such as an individuals’ genome (DNA/RNA protein profiles), and how these networks affect metabolic responses to diet and food. Environmental interactions, including nutrients and other dietary components, bacteria, viruses, and chemical contaminants, all may affect the responsiveness of biological networks to specific foods and the entire diet.

Tissue specificity and temporality.

Research is needed to describe the mechanisms by which dietary factors affect variability in development and functioning, including which tissues are most influenced by dietary factors and when during the most critical stages in life this influence occurs.

2) Understanding the impact of nutrition on healthy growth, development, and reproduction

Epigenetics/imprinting..

Epigenetics and imprinting research examines how exposures to dietary components during critical periods of development may “program” long-term health and well-being. Research is needed to determine how early nutritional events contribute to disease later in life and alter normal developmental progression.

Early nutrition.

Research is necessary to better understand the role of diet and individual food components on normal growth and development. This includes the role of parent’s preconception diets, the maternal diet during pregnancy, and early nutritional events. Studies indicate that the timing of an infant’s introduction to solid foods may increase the likelihood of becoming obese later in life ( 2 ). These findings are important given that the number of overweight children in the United States has increased dramatically in recent years ( 3 ). Research is now needed to determine the best approaches to influence these factors during early life. The important role of nutrition throughout early life on growth and development, as well as on health and well-being, needs to be continually assessed.

Nutrition and reproductive health.

The impact of nutrition on reproductive health, including before and after conception, requires further research. Nutrition has a direct impact on both maternal and paternal fertility and the ability to conceive and also plays a key role in preventing diseases related to reproductive organs, including prostate and ovarian cancers. Although numerous studies have investigated how fruit and vegetable consumption may affect risk of breast, prostate, and other cancers, there is no clear consensus in the scientific literature. Thus, well-designed controlled intervention studies are needed to determine whether effects are limited to subpopulations, what factors influence a response and what mechanisms may account for changes in health.

3) Understanding the role of nutrition in health maintenance

Health maintenance includes noncommunicable disease prevention and treatment as well as weight management. The role that food components, particularly novel ingredients, contribute to health maintenance requires continuing research. Researchers and the public rely on dietary guidance, including the DRIs, to guide nutrition recommendations and health policy. Research is needed to better define the nutrient needs that best support health maintenance in all populations and their subgroups, from infancy throughout life. Nutrition across life is a fundamental issue that requires investigation so that recommendations will “match” with true biological needs.

Optimal bodily function.

Research is needed to determine the roles that nutrition and fitness, both singularly and together, have in maintaining bodily functions, including cognitive, immune, skeletal, muscular, and other functions. Evolving research areas include prevention of disease-related processes, such as inflammation, and definition of mechanisms that have an important role in health maintenance, such as immunocompetence. Animal models are used to understand the requirements for optimal health in humans and production animals.

Energy balance.

Research is also needed to examine the use of a systems approach to achieve energy balance including and integrating environmental, biological, psychosocial, and food system factors. A systems approach is preferable because the standard experimental approach of varying one factor at a time has accomplished little to address the populationwide problem of energy imbalance. A solution-oriented approach that is comprehensive in nature and takes into account the complexities of achieving energy balance must be created. Although far more research is needed to identify systemwide changes that maximize energy balance, intriguing examples exist. “Shape Up Somerville, MA,” effectively reduced weight gain in high-risk children through a multifaceted community-based environmental change campaign ( 4 ). Shape Up Somerville increased the community’s physical activity and healthful eating through physical infrastructure improvements and citywide policy and programming changes.

4) Understanding the role of nutrition in medical management

The rapid translation of nutrition research advances into evidence-based practice and policy is a priority for ensuring optimal patient care and effective disease management. Nutrition researchers have a key role in bridging the gap between disease prevention and disease treatment by fostering clinical research, providing innovative education for caregivers and patients, and delineating best practices for medical nutrition in primary care settings.

Disease progression.

To improve the medical management of disease, research is needed to determine how nutritional factors influence both disease initiation and progression, as well as how nutrition affects a patient’s response to therapy. Genetic and epigenetic variations among individuals can result in both positive and negative responses to diets, to specific foods, and to novel food components. The issue of individual variability is of considerable importance in refining medical management, including nutrition support, and requires continuing research.

Expanded research will allow us to better understand and minimize unfavorable impacts of both reduced and elevated nutrient intakes on disease progression and overall health. Disease/mortality response curves are U-shaped for many nutrients (that is, there is an increased risk of adverse outcomes if the nutrient is ingested in either too low or too high amounts). The importance of achieving a proper nutrient balance is seen in the example of chronic inflammation. Chronic inflammation contributes to many noncommunicable diseases and can result from high intakes of proinflammatory omega-6 fatty acids in the face of low intakes of anti-inflammatory omega-3 fatty acids ( 5 ). Research will help to determine the desired intake for essential and nonessential nutrients alone and when combined with other nutrients in the diet.

Nutrition support for special subgroups.

Nutrition research is needed to establish the required nutritional needs that best support survival, growth, and development in subpopulations, such as in chronically diseased patients, in children, and in aging adults. With the success of medical advances, as have been seen with in vitro fertilization and neonatal care, caring for preterm infants presents a new challenge in early nutritional management. Preterm infants have special nutrition needs that will greatly affect their future growth and development, as well as their eventual health status as adults.

5) Understanding nutrition-related behaviors

Drivers of food choice..

Understanding the link between behavior and food choices can help tackle obesity and other nutrition-related issues that are a public health priority. Individual food choices can be influenced by a number of different drivers including the following:

• Government policy
• Environmental cues
• Cultural differences
• Communication tools, such as social networking and food marketing

Research is needed to identify the impact of these various drivers and understand how they work alone or together to influence nutrition-related behavior. Research will show how these drivers should be altered to have the highest positive influence on individual behavior and therefore public health. For example, the state of Mississippi recorded a 13% decline in obesity among elementary school students from 2005 to 2011 ( 6 ). Multiple changes in the environment occurred, such as the setting of standards for foods sold in school vending machines, setting a requirement for more school exercise time, mandating healthier environments in childcare settings, and establishing programs that encouraged fruit and vegetable consumption. The challenge now is to determine what effect these combined actions will have on obesity-related behaviors in the long run.

Nutrition and brain functioning.

Further explorations of the biochemical and behavioral bases for food choices and intake over time are essential. Brain function as it relates to food desire and choice needs to be clarified through research, and the multiple hormones that affect eating require further study as well. Factors such as meal frequency and size, speed of meal consumption, and how these factors are influenced by social cues require objective data, which can only be provided by research. Understanding how the marketing of healthy behaviors could help consumers achieve dietary guidance goals should be a priority. As part of this approach, innovative and practical methods for accurately measuring and evaluating food purchases and eating occasions must be developed.

Imprinting.

Because of the high propensity of obese children remaining obese as adults ( 7 ), additional research is needed to determine how eating and satiety behaviors are imprinted during critical periods of development and to show how food components affect neural biochemistry and brain functioning—and therefore shape behavior. This research will provide us with a better understanding of how and why an individual makes particular food choices. Although scientists recently validated the concept that food availability during pregnancy has permanent effects on gene expression in children ( 8 ), human studies are needed to confirm or refute the hypothesis that fetal programming, resulting from maternal obesity, leads to excess weight in children and into adulthood.

6) Understanding the food supply/environment

Food environment and food choice..

Simply knowing or understanding what constitutes a healthy diet is not enough to change an individual’s diet or lifestyle. Understanding how the food environment affects dietary and lifestyle choices is necessary before effective policies can be instituted that will change a population’s diet in a meaningful way. Examples of key questions that should be addressed include the following:

• Is current dietary guidance an effective way of communicating dietary change?
• Do food assistance programs promote positive dietary patterns or have negative dietary and health consequences?
• What role does food advertising play in food decision-making among different age groups and educational levels?
• How do farm-to-fork food systems, with an increased emphasis on local agricultural production and consumption, influence dietary patterns and behaviors?
• How can farm-to-fork food systems ultimately be used to promote healthy behaviors and improve public health?
• How can we most effectively measure, monitor, and evaluate dietary change?

Food composition and novel foods and food ingredients.

Having an affordable, available, sustainable, safe, and nutritious food supply is also an important underpinning for making significant changes to a population’s diet and lifestyle. Examples of key research areas to address include the following:

• Enhancing our knowledge of the nutrient and phytonutrient content and bioavailability of foods produced, processed, and consumed
• Studying how to better align and foster collaboration between nutrition and agricultural production
• Can shifting agricultural focus from principally agronomic to include quality factors (such as taste, flavor, and nutritional value) have positive effects on fruit and vegetable consumption?
• Can we leverage technologies, such as biotechnology and nanotechnology, to develop novel foods and food ingredients that will improve health, both domestically and abroad, and provide credible, tangible functional health benefits?

Public/private partnerships.

To tackle these enormous challenges requires the coordinated efforts of public and private partners. The development of public/private partnerships between food and agricultural industries, government, academia, and nongovernmental organizations has the potential to advance nutrition research, enabling meaningful changes to be made to American and global diets (e.g., increased fruit and vegetable consumption to match government recommendations). We need to examine successful examples of public/private partnerships that have resulted in improved nutritional status and food security in specific populations ( 9 ).

CROSS-CUTTING TOOLS TO ADVANCE NUTRITION RESEARCH

Nutrition research is truly a cross-cutting discipline, and the Working Group identified several tools that are also necessary to advance the priority needs in nutrition research. Adequately powered intervention trials continue to be essential for validating research theories arising from experimental and epidemiologic studies. However, the development of new, impactful tools will help us to more effectively quantify dietary intake and food waste and to determine the effectiveness of nutrition standards, such as DRI values and the Dietary Guidelines for Americans . Although not a traditional tool, multidisciplinary partnerships among scientific societies, government, industry, academia, and others are fundamental to advance the nutrition research agenda. ASN and its membership must be proactive not only in efforts to advance nutrition research (including initiating and leading partnerships) but also in developing the tools needed to enhance the field. ASN recognizes the need to facilitate effective communication among academia, industry, government agencies, consumers, and other stakeholders to advance nutrition.

Omics (especially genomics, proteomics, and metabolomics) will enable us to determine how specific nutrients interact with genes, proteins, and metabolites to predict the future health of an individual. A field of study that encompasses technological advances as well as omics-based research, it is sometimes referred to as personalized nutrition. Omics hold the keys to major nutrition breakthroughs in noncommunicable disease and obesity prevention. Omics provide information on how well nutrients are digested, absorbed, metabolized, and used by an individual. Moreover, omics will lead to new biomarkers that reveal a person’s nutritional status and health status all at one time.

2) Bioinformatics

Bioinformatics is an interdisciplinary field that uses computer science and information technology to develop and enhance techniques to make it easier to acquire, store, organize, retrieve, and use biological data. Bioinformatics will enable nutrition researchers to manage, analyze, and understand nutrition data and to make connections between diet and health that were not previously possible. Databases are necessary to gain the full benefits of bioinformatics, because they make nutrition data easily accessible in a machine-readable format.

3) Databases

Accurate, up-to-date food and nutrient databases are essential to track and observe trends related to the nutrition and health of individuals. Databases link food and supplement composition and intake data to health outcomes. Nutrient databases should be expanded to cover more foods and their bioactive components, including nonessential nutrients. Nutrition data must be incorporated into databases related to novel research areas, such as nutrigenomics and the microbiome, to adequately link these areas with nutrition. Data collection must also be improved with enhancements such as photographic food intake documentation, direct upload of food composition and sensory characteristics (if not proprietary) from food manufacturers, and biological sample collection.

4) Biomarkers

Intake, effect, and exposure biomarkers allow us to determine and monitor the health and nutritional status of individuals and subpopulations, including ethnic and racial minorities. Biomarkers that are responsive to diet and nutrition will help assess disease progression and variability in response to treatment, while improving early diagnosis and prevention. Biomarkers must continue to be developed and validated to accurately track food and nutrient intake given our rapidly changing food supply.

5) Cost-effectiveness analysis

Cost-effectiveness analysis is a tool used to calculate and compare the relative costs and benefits of nutrition research interventions. Cost effectiveness analysis helps to determine the most cost-effective option that will have the greatest benefit to public health.

CONCLUSIONS

The multidisciplinary nature of nutrition research requires collaboration among research scientists with differing areas of expertise, many different stakeholders, and multifaceted approaches to develop the knowledge base required for establishing the evidence-based nutrition guidance and policies that will lead to better health and well-being of world populations. Proper nutrition offers one of the most effective and least costly ways to decrease the burden of chronic and noncommunicable diseases and their risk factors, including obesity. Although there is skepticism about the ability to complete large, well-controlled dietary interventions at a reasonable cost in the United States, the success of the Lyon Diet Heart study in France ( 10 , 11 ) and the PREvención con DIeta MEDiterránea (PREDIMED) study in Spain ( 12 ), both of which used variations of the Mediterranean diet, show this approach can be successful, even in the presence of drug treatment of cardiovascular risks in the latter study. Both of these studies showed significant reductions in cardiovascular disease (and cancer in the Lyon study) after relatively modest dietary changes.

Perhaps the greatest barrier to advancing the connections between food and health is the variability in individual responses to diet; it is also the origin of public skepticism to acceptance of dietary advice and the opportunity for entrepreneurship in the private sector. Imagine being able to identify, with certainty, those most likely to benefit from prescriptive nutrition advice through the various omic technologies and then providing these groups of people with customized nutrition advice based on their metabolic risk profiles. This is the new frontier of the nutritional sciences that offers the opportunity to predictably engineer our physiologic networks for health through diet. The confidence this approach would bring to the skeptical consumer would improve adherence to weight management and disease treatment techniques and improve the chances of success for disease prevention. To realize the full positive impact of achieving good nutrition on disease prevention and the health of populations, we must have the will to invest in and support the 6 key areas of nutrition research that have been outlined above.

Acknowledgments

The Nutrition Research Needs Working Group consisted of Dennis Bier, David M Klurfeld, Zhaoping Li, Jonathan R Mein, John Milner, A Catharine Ross, Robert Russell (Chair), and Patrick Stover. They were supported by ASN staff members Sarah D. Ohlhorst and Emily Konopka.

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It’s difficult to go a day without hearing about the latest fad diet, semaglutide controversies, or the next superfood. Nutrition plays a pivotal role in the health sphere, but it’s also a field of study with a powerful impact across many disciplines.  A human nutrition MS degree doesn't just equip you for a career in dietetics. While the demand for dieticians isn’t stalling, nutrition is a practical education choice for anyone looking to touch any area of healthcare or wellness.  Explore 12 fields where studying human nutrition gives professionals an edge in their careers.

1. Dentistry

Oral health goes beyond brushing and flossing. It's also intrinsically linked to diet.  Dentists with nutritional expertise identify deficiencies contributing to gum disease or tooth decay. They’ll also offer dietary recommendations to support oral health and enhance recovery after dental procedures.

As the first point of contact for patients, a nurse’s understanding of nutrition is vital. They can assess nutritional status, provide dietary education, and tailor care plans to address individual needs.  Appropriate dietary guidance improves wound healing, shortens hospital stays, and results in better overall health outcomes.

3. Optometry

There’s a reason parents tell their kids to eat their carrots. Vitamins A, C, and E and omega-3 fatty acids are crucial in maintaining vision and preventing age-related macular degeneration.  Optometrists with nutritional knowledge can offer targeted recommendations to preserve their patients' eyesight.

4. General medicine

Doctors underutilize nutrition science in patient care. While the CDC estimates that 42 percent of American adults suffer from obesity , primary care physicians often don’t have the training or knowledge to advise their patients and offer individual treatment plans.  Physicians with a strong foundation in nutrition more aptly diagnose and manage obesity, diabetes, and heart disease. They also educate patients about dietary changes that prevent chronic illness and improve overall well-being. 

5. Physical therapy

Recovery from injury or surgery often involves dietary adjustments. Physical therapists with a nutrition background are better positioned to build personalized plans that support muscle repair, reduce inflammation, and optimize energy levels.  Ultimately, these dietary recommendations aid in speeding up recovery and improving patient outcomes.

6. Podiatry

Foot health can be surprisingly affected by diet. Certain foods exacerbate conditions like gout and diabetic neuropathy, while others promote healing and reduce pain.  Podiatrists with nutrition expertise provide comprehensive care that addresses both the physical and nutritional aspects of foot problems.

7. Dietetics

A natural fit for nutrition graduates, registered dieticians are experts in food and diet. They provide counseling, develop meal plans, and manage food service operations in various settings.  These professionals play an essential role in disease prevention, management, and general wellness, often in consultation with the client’s primary care physicians or mental health therapists. 

8. Communications and journalism

Misinformation bombards users on social media daily. ‘Fake news’ around nutrition and weight loss drugs makes clear and accurate communications crucial, particularly for copywriters and public relations professionals in the food and drug industries. Journalists with a background in nutrition use their knowledge to report on food science concepts for newspapers and medical journals. This content informs the medical community and the public about health-related topics. 

9. Administration and public health

Nutrition education heavily influences public health initiatives and the ability to address a community’s needs. Administrators and public health workers rely on their backgrounds to design effective programs that improve community health, widen food access, and promote healthy eating habits at the local level.

10. Research and technology

Nutrition research is constantly evolving, and scientists with a solid knowledge base are needed to conduct cutting-edge studies, develop new products, and translate research findings into practical applications. The Food Research and Action Center (FRAC) notes one in eight U.S. households experience food insecurity , with minorities disproportionately affected twice as often. Research and technology are integral to creating innovative solutions for solving the hunger crisis at the national and global levels. 

11. Business-related fields

Don’t underestimate the use of nutrition studies in business and consulting services. The nutrition app market alone is worth $5.4 billion this year. The wellness industry is booming, and there's a growing demand for professionals with dietary knowledge.  If nutrition-based product and service companies aren’t attractive, corporate wellness programs and their associated roles are another hot area. The monetization of health and wellness means endless possibilities for those with an entrepreneurial spirit and a passion for nutrition.

12. Law and policy

From school lunch policies to food labeling requirements, nutrition-related laws and regulations significantly impact public health. Lawyers and policymakers draw upon their backgrounds to advocate for evidence-based policies promoting healthier food environments and sustainable agriculture. Beyond traditional legal practices, these professionals work at nonprofits, industry groups, or government agencies. Their education brings a unique perspective for shaping the future of food and nutrition systems.

Studying nutrition isn't just a stepping stone to becoming a dietitian. It's a versatile degree that opens doors to many fulfilling and impactful careers.  Whether your interest lies in patient care, research, education, or advocacy, a deep understanding of nutrition enhances your future career. The knowledge gained from a master’s in nutrition benefits any medical field. The practical applications and patient outcomes are far too desirable.  Given the lack of nutritional training in medical school curricula, it’s hard to argue against enrollment into an institution such as Columbia’s Institute of Human Nutrition (IHN).  Our graduates also branch beyond medical-related fields. Bridging the gap from nutrition to public health is as rewarding to our students as it is surprising to undergrads, considering what comes next.  Ready to explore the possibilities of the IHN MS program? See what alumni say about their experiences with the courses and faculty.

IHN’s Culinary Medicine Club Provides Educational Materials for the Community

IHN Alumni Spotlight: Alyssa Kwan, RD

Nutrition in Medicine: A New Review Article Series

Nutrition Education in Action: Chinese Heritage and Identity Through Food and Nutrition Project

Our wellness advice is expert-vetted . Our top picks are based on our editors’ independent research, analysis, and hands-on testing. If you buy through our links, we may get a commission. Reviews ethics statement

Best Vitamins and Supplements for Joint Health of 2024

If you have joint pain, adding a supplement to your diet may be helpful in addition to adding nutrition to your daily diet and an overall management plan.

• Added coconut oil to cheap coffee before keto made it cool.

Feeling aches or stiffness at times is a common experience, but it's always best to be seen by a doctor who knows your health history to ensure you're addressing the root of the aches as well as doing what you can to manage or minimize them by adding nutrition to your diet or other lifestyle or exercise tweaks. For some people, adding a supplement may be an easy way to ensure you're doing everything you can to ease the pain, though keep in mind research tends to be mixed on whether even the best supplements or vitamins for joint pain will ease symptoms.

"Generally, I think it’s hard to find a full-on solution for your joint pain through supplements alone,” said Dr. Navya Mysore , a primary care physician and women's health expert. But save for a review of someone's health history and any medications they're taking that may interact with their supplement of choice, there's also no harm in adding a supplement for joint health, Mysore said.

Best joint supplements of 2024

Glucosamine

While "there's not a ton of evidence out there to firmly say one supplement is going to help you over another," Mysore said, glucosamine likely has the most evidence backing its use. Glucosamine naturally occurs in our bodies -- it's in your cartilage and helps your joints function. A glucosamine supplement is believed to help with arthritis in that it can bring down some of the pain brought on by osteoarthritis or rheumatoid arthritis. According to the Arthritis Foundation, glucosamine is commonly sold in combination with chondroitin as a single supplement, and both are two of the most commonly used supplements for arthritis.

Mysore said people with shellfish and iodine allergies need to be careful about taking this supplement, as it's often made from shellfish, and that it could also affect people with asthma. It has the potential to cause side effects like nausea and heartburn, and there's also a risk of interaction with blood thinners or anticoagulant medications that could cause bleeding issues. Talk with your doctor or dietician before adding it to your diet.

Omega-3s are fatty acids that may alleviate inflammation and joint pain. Some research has shown that these supplements may reduce stiffness in people with arthritis and also combat joint pain; other research has found they may "prevent experimental arthritis and may decrease disease activity in rheumatoid arthritis." If you currently take a blood thinner, speak to your doctor before taking an omega-3 because they may interact and pose health risks.

It's also important to note that it may be more beneficial to get your omega-3s through your food, if possible. One omega-3 rich diet to get you started is the Mediterranean diet .

Turmeric isn't just a spice used in some cuisines, it's been used in traditional medicine as a healing spice, and it's considered one of the more powerful natural ingredients you can add to your meal for a health boost. Specifically, its active ingredient or compound, curcumin, has antioxidant and anti-inflammatory properties .

Mysore says that if you're interested in adding a turmeric supplement for pain relief, make sure it contains curcumin for better absorption. And as an alternative, tastier way to incorporate the spice's wellness properties into your routine, Mysore suggested a meal that contains turmeric and black pepper, which contains a compound that can help the body absorb turmeric's important properties. For example, she said, a smoothie with added turmeric and eggs seasoned with black pepper.

As is true with every supplement on this list, check with your doctor if you're taking prescription medications, as turmeric may interfere with blood thinners and immunosuppressive drugs, according to Johns Hopkins Medicine .

Vitamin D is known to support bone health, which is why some believe a vitamin D supplement could be useful in aiding in joint health. There is some research that suggests taking a vitamin D supplement can help with arthritis pain and inflammation, but the result doesn't necessarily lend itself to a definitive answer.

Overall, vitamin D is a great resource for the body , which aids in other functions like cognitive function, immune function and mood. Take care when adding a vitamin D supplement to your routine, though, as high levels of this vitamin can interact with several drugs. Most notably, high levels of vitamin D can be highly problematic if you're on Lanoxin , as it can put you at risk for hypercalcemia. (Unless your doctor recommends it, most health experts seem to recommend not taking more than 4,000 IU per day.) Other medications mixed with a vitamin D supplement can also affect how your body processes the supplement.

People often turn to vitamin E to support their immune systems, as this vitamin is an antioxidant. And there is some research showcasing vitamin E may slow the progression of osteoarthritis and promote the growth of new cartilage cells . However, much of this research requires further study. That being said, vitamin E is a good supplement to keep in your rotation, as it also promotes good vision and brain health. Just note that it can interact with blood thinners and put you at risk for bleeding.

Chondroitin

You'll often see chondroitin mentioned alongside glucosamine, as they're similarly studied for arthritis and often sold together as a single supplement. Chondroitin is also found in the cartilage in your body, which is why it's believed to be beneficial in boosting joint health. Research into chondroitin has had largely inconclusive results, but it's still accepted as a supplement that could be beneficial in aiding joint health. It's generally viewed as a safe supplement, though, like many others, it can interact with blood thinners like Warfarin and put you at risk for bleeding.

Collagen  is a protein your body makes -- and as you age, you have less and less of it. It's what keeps your skin tight and firm and what keeps your joints working smoothly. But as you get older, there's  less collagen  in your joints, which is where joint supplements could help. Though there isn't a lot of research on  whether collagen can actually help your joints , doctors largely think that it won't hurt either -- if it makes you feel better while paired with low-impact exercises like swimming, then go for it.

How we chose the best supplements for joint health

We didn't test any supplements for joint health ourselves. Rather, we rounded up a list of the leading compounds, supplements and vitamins with some research supporting relief for arthritis symptoms and joint health.

Factors to consider when choosing a supplement for joint health

Cause of joint pain: Before you get started on a joint supplement, it's important to get to the bottom of your symptoms to find the true cause and prevent more health effects. There are over 100 different kinds of arthritis, according to the Arthritis Foundation . The easiest way to find the cause of your symptoms is to go to your doctor, who will also be able to tell you which supplements are recommended and safe for you to take based on your current medications and medical history.

Whether you're taking medications: Common prescriptions, including blood thinners, may interact with certain supplements taken for joint health and cause serious side effects. Always be sure to clear any new dietary supplement with your doctor or pharmacist before adding it to your daily rotation if you're taking any medication, even though you can easily get most dietary supplements over the counter.

Food allergies: Some supplements for joint health may include common food allergens, such as fish, so be sure to check the product's label for ingredients and look into the company from which you want to buy from.

Joint supplement FAQs

What is arthritis.

Arthritis is the most common cause of joint pain, according to the Cleveland Clinic; arthritis is an umbrella term for joint pain and joint disease. According to the Arthritis Foundation, osteoarthritis is the most common type of arthritis and it tends to cause pain in the hands, spine, hips and knees. Osteoarthritis occurs when the cartilage cushioning bones wears down over time, per the Mayo Clinic.

Do joint supplements really work?

Evidence supporting even the best joint supplements appears to be inconclusive , though some research has shown supplements can improve arthritis symptoms. Supplements aren't meant to be used as a remedy for a medical condition, but rather as something that will supplement or complement your diet, especially if you're deficient in a nutrient. The supplements included in this best list were chosen because some research has found a potential benefit for joint health, though whether you decide to take one will depend on the medications you're prescribed and your individual health concerns.

Does the FDA approve dietary supplements?

No, the US Food and Drug Administration doesn't sign off on and investigate supplements like it does medications or drugs. "[The] FDA generally does not approve dietary supplement claims or other labeling before use," it says. However, there are manufacturing practices and marketing rules that companies that make supplements must follow.

For more information, read on about how to read a supplement label .

Vitamins and Supplements Guides

• Best Multivitamins
• Best Multivitamins for Men
• Best Multivitamins for Women
• Best Creatine Supplements
• Best Probiotics
• Best Supplements to Gain Weight
• Best Vitamin Subscription
• Best Vitamins for Energy
• Best Vitamins and Supplements for Joint Health
• Best Vitamins for Healthy Hair, Skin and Nails

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• Published: 08 July 2024

Pathogenicity and transmissibility of bovine H5N1 influenza virus

• Amie J. Eisfeld 1   na1 ,
• Asim Biswas 1   na1 ,
• Lizheng Guan 1   na1 ,
• Chunyang Gu 1   na1 ,
• Tadashi Maemura 1   na1 ,
• Sanja Trifkovic 1 ,
• Tong Wang 1 ,
• Lavanya Babujee 1 ,
• Randall Dahn 1 ,
• Peter J. Halfmann   ORCID: orcid.org/0000-0002-1648-1625 1 ,
• Tera Barnhardt 2 ,
• Gabriele Neumann 1 ,
• Yasuo Suzuki 3 ,
• Alexis Thompson   ORCID: orcid.org/0000-0003-4405-5313 4 ,
• Amy K. Swinford 5 ,
• Kiril M. Dimitrov   ORCID: orcid.org/0000-0002-5525-4492 5 ,
• Keith Poulsen 6 &
• Yoshihiro Kawaoka   ORCID: orcid.org/0000-0001-5061-8296 1 , 7 , 8 , 9  

Nature ( 2024 ) Cite this article

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We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

• Influenza virus
• Viral pathogenesis
• Viral transmission

Highly pathogenic H5N1 avian influenza (HPAI H5N1) viruses occasionally infect, but typically do not transmit, in mammals. In the Spring of 2024, an unprecedented outbreak of HPAI H5N1 in bovine herds occurred in the US, with virus spread within and between herds, infections in poultry and cats, and spillover into humans, collectively indicating an increased public health risk 1-4 . Here, we characterized an HPAI H5N1 virus isolated from infected cow milk in mice and ferrets. Like other HPAI H5N1 viruses, the bovine H5N1 virus spread systemically, including to the mammary glands of both species; however, this tropism was also observed for an older HPAI H5N1 virus isolate. Importantly, bovine HPAI H5N1 virus bound to sialic acids expressed in human upper airways and inefficiently transmitted to exposed ferrets (one of four exposed ferrets seroconverted without virus detection). Bovine HPAI H5N1 virus thus possesses features that may facilitate infection and transmission in mammals.

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These authors contributed equally: Amie J. Eisfeld, Asim Biswas, Lizheng Guan, Chunyang Gu, Tadashi Maemura

Authors and Affiliations

Influenza Research Institute, Dept. of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI, USA

Amie J. Eisfeld, Asim Biswas, Lizheng Guan, Chunyang Gu, Tadashi Maemura, Sanja Trifkovic, Tong Wang, Lavanya Babujee, Randall Dahn, Peter J. Halfmann, Gabriele Neumann & Yoshihiro Kawaoka

Heritage Vet Partners, Johnson, KS, USA

Tera Barnhardt

Department of Biochemistry, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan

Yasuo Suzuki

Texas A&M Veterinary Medical Diagnostic Laboratory, Canyon, TX, USA

Alexis Thompson

Texas A&M Veterinary Medical Diagnostic Laboratory, College Station, TX, USA

Amy K. Swinford & Kiril M. Dimitrov

Wisconsin Veterinary Diagnostic Laboratory, University of Wisconsin-Madison, Madison, WI, USA

Keith Poulsen

Department of Virology, Institute of Medical Science, University of Tokyo, Tokyo, Japan

Yoshihiro Kawaoka

The University of Tokyo Pandemic Preparedness, Infection and Advanced research center (UTOPIA), University of Tokyo, Tokyo, Japan

The Research Center for Global Viral Diseases, National Center for Global Health and Medicine Research Institute, Tokyo, Japan

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Correspondence to Yoshihiro Kawaoka .

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Eisfeld, A.J., Biswas, A., Guan, L. et al. Pathogenicity and transmissibility of bovine H5N1 influenza virus. Nature (2024). https://doi.org/10.1038/s41586-024-07766-6

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Accepted : 28 June 2024

Published : 08 July 2024

DOI : https://doi.org/10.1038/s41586-024-07766-6

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