Montserrat Rabassa

Background: Social media, especially Instagram, spreads nutrition-related information that often lacks scientific rigor. Many women report feeling inadequately informed about women’s health by healthcare professionals, turning to social media, increasing exposure to misinformation. Objectives: The NutriWomen platform aims to assess the quality, methodological soundness, and credibility of nutritional health claims and dietary recommendations on Instagram targeting women across different life stages. Its goal is to develop a systematic and scientifically grounded evaluation framework to assess Instagram nutrition-related claims and the methodological quality and interpretability of their supporting evidence, and to translate the results into accessible outputs that help women make informed nutrition decisions across life stages. Methods: This study follows a five-stage design Stage 1 involves a retrospective content analysis of Instagram posts containing nutrition-related claims targeted at women, identified through the “Top posts” function and screened using predefined criteria. Stage 2 assesses information quality using a validated 14-item tool. Stage 3 evaluates the scientific accuracy of claims by formulating PI(E)CO(TS) questions, selecting key outcomes, retrieving evidence from PubMed and the Cochrane Database, and appraising systematic reviews with a modified AMSTAR-2 tool incorporating GRADE ratings, when available. Stage 4 develops the NutriWomen website platform to translate assessments into accessible visual summaries. Stage 5 conducts a mixed-methods study with peri-, meno-, and postmenopausal women to explore information needs and evaluate platform usability through focus groups. Conclusions: The NutriWomen platform will be the first website to systematically publish the results of evaluations assessing the scientific quality of nutritional health claims on Instagram targeted at women across different life stages. It will provide a replicable methodology, and a digital tool designed to empower women with trustworthy nutrition information, with the potential to enhance health literacy and promote better health outcomes.

Background: Health is not the only aspect people consider when choosing to consume meat; environmental concerns about the impact of meat (production and distribution) can influence people’s meat choices. Methods: We conducted a mixed-methods systematic review, searched six databases from inception to June 2020, and synthesised our findings into narrative forms. We integrated the evidence from quantitative and qualitative data sets into joint displays and assessed the confidence in the evidence for each review finding following the GRADE-CERQual approach. Results: Of the 23,531 initial records, we included 70 studies: 56 quantitative, 12 qualitative, and 2 mixed-methods studies. We identified four main themes: (1) reasons for eating meat; (2) reasons for avoiding meat; (3) willingness to change meat consumption; and (4) willingness to pay more for environmentally friendly meat. The overall confidence was low for the reasons for eating and/or buying meat, for avoiding meat, and for willingness to change meat consumption, and was moderate for willingness to pay more for environmentally friendly meat. Conclusions: Regardless of people’s general beliefs about meat and its impact on the environment, most people may be unwilling to change their meat consumption. Future research should address the current limitations of the research evidence to assess whether people are willing to make a change when properly informed.

Objective To examine the certainty of the evidence supporting health claims about probiotics, yoghurt, kefir, kombucha, fibre and prebiotics, and to assess the quality of online information in Spanish. Design Content analysis. Methods We compiled a data set of 114 web pages by searching six popular search phrases in Spanish relating to probiotics, yoghurt, kefir, kombucha, fibre and prebiotics on Google.es and coded them for typology and health claims. We examined the certainty of the evidence for health claims from systematic reviews. Information quality was assessed according to 10 criteria, where a web page: mentions scientific publications and reports their conclusions; quantifies relative and absolute effects; acknowledges some limitations; discusses certainty of evidence; reports the potential harms, alternatives and costs; and does not argue based on personal experiences. Results Gastrointestinal health (86.0%), general health (57.9%), cardiovascular health (53.5%) and immune system health (50.9%) were the most widely mentioned topics. Half of claims (52.6%, 70/133) were supported by evidence from systematic reviews. Probiotics had the highest number of claims supported by evidence and kombucha the lowest. The highest certainty was found for antibiotic-associated diarrhoea, necrotising enterocolitis and otitis (moderate) in probiotics and yoghurt, infectious diarrhoea and hepatic encephalopathy (moderate) in prebiotics, and cardiovascular health (high to moderate) and colorectal cancer (moderate) in fibre. On a scale of 0–10, the median information quality score for all web pages was 3. Only 18.4% reported study conclusions, 7.9% quantified the effects, 28.9% acknowledged some limitations in the research and 42.1% reported potential harms. Conclusions Most online health claims for dietary interventions intended for improving health through the gut microbiome are supported by low or very low certainty of evidence. Online information does not align with the evidence and is incomplete or unbalanced.

Background. In addition to social and environmental determinants, people’s values and preferences determine daily food choices. This study evaluated adults’ values and preferences regarding unprocessed red meat (URM) and processed meat (PM) and their willingness to change their consumption in the face of possible undesirable health consequences. Methods. A cross-sectional mixed-methods study including a quantitative assessment through an online survey, a qualitative inquiry through semi-structured interviews, and a follow-up assessment through a telephone survey. We performed descriptive statistics, logistic regressions, and thematic analysis. Results. Of 304 participants, over 75% were unwilling to stop their consumption of either URM or PM, and of those unwilling to stop, over 80% were also unwilling to reduce. Men were less likely to stop meat intake than women (odds ratios < 0.4). From the semi-structured interviews, we identified three main themes: the social and/or family context of meat consumption, health- and non-health-related concerns about meat, and uncertainty of the evidence. At three months, 63% of participants reported no changes in meat intake. Conclusions. When informed about the cancer incidence and mortality risks of meat consumption, most respondents would not reduce their intake. Public health and clinical nutrition guidelines should ensure that their recommendations are consistent with population values and preferences.

Background & objectives Food-based dietary guidelines (FBDGs) have been developed to promote healthy diets and prevent chronic diseases. However, the methodological quality of Spanish FBDGs has not been systematically assessed yet. The objective of this review is to identify and assess the methodological quality of Spanish FBDGs, as well as to describe their food guides and key recommendations. Methods We conducted a systematic search to identify Spanish FBDGs targeted at the general population using multiple sources. Two authors independently screened the references, extracted data, and assessed the quality of the FBDGs using the Appraisal of Guidelines for Research and Evaluation (AGREE) II and the Recommendation Excellence (AGREE-REX) instruments. We performed a descriptive analysis of the FBDGs. Results We included 19 FBDGs, published between 2007 and 2019. The median scores for each AGREE II domain were: “scope and purpose” 44% (Q1–Q3: 33–61%); “Stakeholder involvement” 31% (11–44%), “rigor of development” 3% (1–14%); “clarity of presentation” 42% (33–47%), “applicability” 0% (0–6%); and “editorial independence” 0% (0–8%). Six FBDGs (32%; 6/19) were categorized as “recommended with modifications”, and the rest (68%; 13/19) as “not recommended”. None of the FBDGs scored ≥60% in three or more domains, including the “rigor of development” domain. FBDGs indexed in literature databases scored significantly higher in overall rating than those not indexed (P = 0.023). The majority of FBDGs (74%; 14/19) used the pyramid as a food guide representation with a larger number of food levels (3–7 levels). The majority of FBDGs recommended a daily intake of cereals and grains, vegetables, fruits, olive oil and dairy products; a weekly intake of vegetable and animal proteins; and the occasional and limited intake of other food groups (e.g., ultraprocessed foods). Conclusions Overall, the methodological quality of FBDGs is poor showing that only 32% of FBDGs are “recommended for use with modifications”. Our results highlight the need to revise, systematize and improve FBDG development processes in Spain.

Purpose: Clinical guidelines’ (CGs) adherence supports high-quality care. However, healthcare providers do not always comply with CGs recommendations. This systematic literature review aims to assess the extent of healthcare providers’ adherence to breast cancer CGs in Europe and to identify the factors that impact on healthcare providers’ adherence. Methods: We searched for systematic reviews and quantitative or qualitative primary studies in MEDLINE and Embase up to May 2019. The eligibility assessment, data extraction, and risk of bias assessment were conducted by one author and cross-checked by a second author. We conducted a narrative synthesis attending to the modality of the healthcare process, methods to measure adherence, the scope of the CGs, and population characteristics. Results: Out of 8137 references, we included 41 primary studies conducted in eight European countries. Most followed a retrospective cohort design (19/41; 46%) and were at low or moderate risk of bias. Adherence for overall breast cancer care process (from diagnosis to follow-up) ranged from 54 to 69%; for overall treatment process [including surgery, chemotherapy (CT), endocrine therapy (ET), and radiotherapy (RT)] the median adherence was 57.5% (interquartile range (IQR) 38.8–67.3%), while for systemic therapy (CT and ET) it was 76% (IQR 68–77%). The median adherence for the processes assessed individually was higher, ranging from 74% (IQR 10–80%), for the follow-up, to 90% (IQR 87–92.5%) for ET. Internal factors that potentially impact on healthcare providers’ adherence were their perceptions, preferences, lack of knowledge, or intentional decisions. Conclusions: A substantial proportion of breast cancer patients are not receiving CGs-recommended care. Healthcare providers’ adherence to breast cancer CGs in Europe has room for improvement in almost all care processes. CGs development and implementation processes should address the main factors that influence healthcare providers' adherence, especially patient-related ones. Registration: PROSPERO (CRD42018092884).

Scope: The association between self‐reported dietary intake and urinary metabolomic markers of habitual nut exposure with cognitive decline over a 3‐year follow‐up in an older Italian population is prospectively evaluated.Methods and results: A total of 119 older participants are selected, based on self‐referred nut intake: the non‐nut consumer (n = 72) and the regular consumer (≥2.9 g d⁻¹, n = 47). Nut exposure is measured at baseline either with the use of a validated food frequency questionnaire or with an HPLC‐Q‐ToF‐MS metabolomic approach. Three years after, 28 from the nonconsumers and 10 from the consumers experienced cognitive decline. Dietary nut exposure is characterized by urinary metabolites of polyphenols and fatty acids pathways. Nut consumption estimated either by the dietary marker or by the urinary marker model is in both cases associated with less cognitive decline (OR: 0.78, 95% CI: 0.61,0.99; p = 0.043 and OR: 0.995, 95% CI: 0.991,0.999; p = 0.016, respectively) with AUCs 73.2 (95% CI: 62.9, 83.6) and 73.1 (62.5, 83.7), respectively.Conclusions: A high intake of nuts may protect older adults from cognitive decline. Metabolomics provides accurate and complementary information of the nut exposure and reinforces the results obtained using dietary information.

Dietary guidelines generally recommend limiting intake of red and processed meat. However, the quality of evidence implicating red and processed meat in adverse health outcomes remains unclear. To evaluate the association between red and processed meat consumption and all-cause mortality, cardiometabolic outcomes, quality of life, and satisfaction with diet among adults. EMBASE (Elsevier), Cochrane Central Register of Controlled Trials (Wiley), Web of Science (Clarivate Analytics), CINAHL (EBSCO), and ProQuest from inception until July 2018 and MEDLINE from inception until April 2019, without language restrictions, as well as bibliographies of relevant articles. Cohort studies with at least 1000 participants that reported an association between unprocessed red or processed meat intake and outcomes of interest. Teams of 2 reviewers independently extracted data and assessed risk of bias. One investigator assessed certainty of evidence, and the senior investigator confirmed the assessments. Of 61 articles reporting on 55 cohorts with more than 4 million participants, none addressed quality of life or satisfaction with diet. Low-certainty evidence was found that a reduction in unprocessed red meat intake of 3 servings per week is associated with a very small reduction in risk for cardiovascular mortality, stroke, myocardial infarction (MI), and type 2 diabetes. Likewise, low-certainty evidence was found that a reduction in processed meat intake of 3 servings per week is associated with a very small decrease in risk for all-cause mortality, cardiovascular mortality, stroke, MI, and type 2 diabetes. Inadequate adjustment for known confounders, residual confounding due to observational design, and recall bias associated with dietary measurement. The magnitude of association between red and processed meat consumption and all-cause mortality and adverse cardiometabolic outcomes is very small, and the evidence is of low certainty. None. (PROSPERO: CRD42017074074)