Annarita Formisano

The planetary health diet proposed by the EAT-Lancet Commission provides a global framework to integrate human health and environmental sustainability through plant-based dietary patterns. Its 2025 update refined quantitative targets and emphasised the need for regional adaptation. This study compares the EAT-Lancet reference diets, the FAO/WHO Sustainable Healthy Diets, and Mediterranean dietary models represented by national guidelines from Italy, Spain, Greece, and Portugal, alongside the Italian Mediterranean Diet Pyramid proposed by the Italian Society of Human Nutrition. Quantitative recommendations were harmonised into weekly intakes, and qualitative features were systematically analysed. Overall, strong convergence was observed, particularly for whole grains, fruits, vegetables, and unsaturated fats. However, the EAT-Lancet model recommends higher intakes of legumes and nuts than the Mediterranean guidelines. Differences also emerged for dairy products and olive oil, reflecting regional adaptations. The Mediterranean Diet represents a culturally grounded and feasible model for translating planetary health principles into practice.

Background/Objectives: Nutritional research emphasizes evaluating food processing levels alongside nutrient content. The Nova system categorizes foods as minimally processed foods (MPFs), processed culinary ingredients (PCIs), processed foods (PFs), and ultra-processed foods (UPFs). High UPF consumption is linked to adverse health outcomes in older adults. Traditional Food Frequency Questionnaires (FFQs) often fail to capture processing differences. This study evaluated the reproducibility and relative validity of a Nova-based FFQ (NFFQ-Elderly) in Italian healthy older adults aged ≥65 years. Methods: A total of 111 older adults (73.7 ± 5.9 years; 56.8% women) completed the NFFQ-Elderly twice (4–6 weeks interval). Relative validity was compared with a three-day weighed food record. Foods were categorized by Nova groups and analyzed for absolute intake, energy and weight percentages. Pearson correlation (r), intraclass correlation coefficients (ICCs), and Bland–Altman plots were used. Results: Reproducibility was satisfactory for MPFs (r = 0.75; ICC = 0.74), UPFs (r = 0.87; ICC = 0.85), and PFs (r ≈ 0.73; ICC ≈ 0.66–0.67). Relative validity was moderate for MPFs (r = 0.57; ICC = 0.53) and UPFs (r = 0.48; ICC ≈ 0.37), but lower for PCIs. Accuracy generally improved when intakes were expressed as percentages of total energy or weight. Bland–Altman analyses showed limited mean bias for MPFs and PFs, but higher variability for PCIs and absolute energy intake. Conclusions: The NFFQ-Elderly appears to be a suitable tool for ranking older adults according to their relative intake of MPFs and UPFs. Estimates for PCIs are less reliable, indicating caution when interpreting absolute intake values.

To examine the associations between BMI trajectories and changes in fat-free mass index (FFMI) and fat mass index (FMI), assessed via bioelectrical impedance analysis (BIA) and skinfold thickness (ST). The study included 4708 European children with BIA data and 3627 with ST data, aged 2-9.9 years at baseline, participating in two waves of the IDEFICS (IDEFICS (Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants))/I.Family (I. Family (Determinants of eating behavior in European children, adolescents, and their parents)) studies (w0: 2007/08; w2: 2013/14). Children were classified into three BMI trajectory groups: retained normal weight (RNW), remained overweight/obese (ROO), and excessive weight gain (EWG). Analyses of covariance evaluated differences in BMI z-score changes, FFMI, and FMI across groups. Mixed-effects linear regression assessed associations between BMI z-score changes and FFMI/FMI over time. BMI z-score changes were more strongly associated with FMI (β = 1.16-1.70 in boys; 1.17-1.62 in girls, p < 0.05) than with FFMI, for both BIA and ST. In ROO and EWG groups, associations with FMI were consistently stronger, except among girls 6 years showed stronger associations with FFMI. Associations between BMI changes and FFMI/FMI vary by BMI trajectory and body composition method. BIA showed closer alignment with BMI changes than ST. These findings suggest that BMI alone may not adequately capture changes in specific body compartments. While convenient, BMI should be interpreted with caution, especially when fat or fat-free mass plays a differential role in disease risk or health outcomes.

Background: External factors, including digital media (DM), promote body ideals that can shape adolescents’ body image, but studies across European countries are scarce. Therefore, the aim of the study was to examine the relationship between daily DM duration and body image dissatisfaction (BID) in adolescents from nine European countries. Methods: Participants from the I.Family study self-reported daily DM duration and BID in 2013/2014 ( n = 3,608; 51% female; mean age 13.6 years (standard deviation: 1.1). DM duration was measured in hours/day, including television viewing (TV), computer/game console (PC), smartphone, and internet use. Linear regression models were used to examine associations of self-reported DM duration with BID and unstandardised regression coefficients were reported. Daily time spent with these technologies was categorised into < 1, 1–2, and ≥ 2 h, and underlying patterns of DM use were identified using latent class analyses. Furthermore, the interaction term between family environment and DM was included in the latent class analyses. Results: Increasing daily DM duration, particularly for smartphone (adjusted β = 0.44, 95%CI: 0.31, 0.57) and internet (adjusted β = 0.40, 95%CI: 0.29, 0.50), was associated with higher BID in all adolescents. Associations were more pronounced in underweight, normal weight, and female participants. Adolescents with high internet and smartphone duration in combination with medium/low TV/PC duration showed higher positive associations with BID score compared to those with low duration of all DM types (adjusted β = 1.24, 95%CI: 0.73, 1.74). A positive family environment attenuated the association in adolescents with high internet/smartphone and medium/low TV/PC duration. Conclusion: The results highlight a positive association between longer daily DM duration and BID in adolescents, especially for internet-enabled media. A positive family environment seems to play a role in this association and should be further investigated in future research. Additionally, understanding the potential mechanisms explaining these associations can inform future interventions promoting healthy body image in adolescents.

Background/Objectives: There is a lack of food frequency questionnaires (FFQs) specifically designed to assess food consumption based on processing levels in younger populations. This study evaluates the validity and the reliability of a 107-item FFQ (NFFQ-Kids) in estimating the intake (g/day) and the weight and energy ratios of Nova groups in Italian children and adolescents aged 2–18 years. Methods: The NFFQ-Kids was administered twice (T0 and T1), with a four-week interval. A total of 73 participants completed the questionnaire at T0, and 53 completed it at T1. Participants were selected from the ICARO Study (December 2023–April 2024), a web-based cohort study in Southern Italy. Questionnaire validity was assessed by comparison with a 3-day food record (two weekdays and one weekend day) collected between the two NFFQ-Kids administrations. Test–retest reliability was evaluated to assess the consistency of the questionnaire over time. Results: A moderate correlation was found between the NFFQ-Kids and the 3-day food record for the energy ratio of ultra-processed foods (UPFs) (r = 0.48; p < 0.001; ICC = 0.46; 95% CI 0.29–0.64) and the weight ratio for both unprocessed or minimally processed foods (r = 0.49; p < 0.001; ICC = 0.50; 95%CI 0.33–0.66) and ultra-processed foods (UPFs) (r = 0.58; p < 0.001; ICC = 0.58; 95%CI 0.42–0.72). Overall, the NFFQ-Kids showed good test–retest reliability across all Nova group intakes, total food, and relative energy and weight ratios of UPFs (r = 0.71, ICC = 0.67; and r = 0.79, ICC = 0.67, respectively), indicating stable measurements over time. Conclusions: The NFFQ-Kids demonstrated acceptable validity and good reliability, proving useful for assessing food intake by processing level in Italian youth.

Background/Objectives: Ultra-processed foods (UPFs) constitute a large proportion of the daily energy intake of Europeans, particularly among children and adolescents. High UPFs consumption is associated with poor dietary quality and adverse health outcomes. This study aimed to examine whether high UPFs consumption is associated with metabolic health in children, adolescents, and adults, using data from the I.Family study. Methods: This cross-sectional analysis (2013/2014) included 2285 participants: 147 children (6–9 years), 645 adolescents (10–19 years), and 1493 adults (≥20 years). For the children and adolescents, a metabolic syndrome (MetS) z-score was calculated, consisting of age- and sex-standardized z-scores of WC, HOMA index, HDL-C, TRG, systolic blood pressure (SBP), and diastolic blood pressure (DBP). For the adults, MetS was defined according to the criteria of the International Diabetes Federation Task Force and other societies. The participants completed at least one 24 h recall, from which their UPFs consumption was estimated using the NOVA classification. The consumption levels were divided into age- and sex-specific quintiles based on the relative energy contribution of these foods. Multivariable regression analyses were conducted to evaluate the associations between UPFs consumption and MetS or its components. Results: No statistically significant associations were found between UPFs consumption and MetS or its components in any age group. The effect sizes were negligible across the quintiles (η² = 0.0065 in children, 0.015 in adolescents, and 0.0009 in adults). While the mean MetS score showed little variation, the prevalence of MetS scores above the 90th percentile increased in the highest UPFs quintile among the children. The diet quality decreased with increasing UPFs consumption. Conclusions: UPFs consumption was not associated with MetS or its components across the age groups. However, a decline in diet quality was observed with increasing UPFs intake, highlighting the importance of public health strategies to reduce UPFs consumption and improve dietary patterns, particularly among younger populations.

Background/Objectives: Diet significantly influences gut microbiota (GM), with variations in GM responses linked to the type and quantity of food consumed. These variations underscore the need for personalized nutrition. The Stance4Health (S4H) project developed the S4H Food Frequency Questionnaire (S4H-FFQ) and the i-Diet S4H app to assess dietary intake of foods affecting GM. This study aimed to validate the S4H-FFQ against the validated I.Family-FFQ and the i-Diet S4H app; Methods: The S4H-FFQ, with 200 food items across 14 food groups, evaluates dietary intake over the past month. Qualitative validation compared food group consumption frequencies from the S4H-FFQ and the I.Family-FFQ, while quantitative validation assessed nutrient and energy intake using the i-Diet S4H app. The S4H-GM score, a measure of GM-relevant food consumption, was evaluated through the S4H-FFQ and i-Diet S4H app; Results: Pearson correlations between the S4H-FFQ and the I.Family-FFQ ranged from 0.3 to 0.7 and were statistically significant across all the food groups. Quantitative validation showed lower but consistent correlations, comparable with other studies, confirming the S4H-FFQ’s ability to estimate food intake. A positive correlation was also found between the S4H-GM scores from the S4H-FFQ and the i-Diet S4H app (p < 0.001); Conclusions: The S4H-FFQ is a reliable tool for assessing dietary patterns that influence GM. Its application in nutritional studies can enhance personalized nutrition and support future research aimed at optimizing GM and improving health outcomes.

Advanced glycation end products (AGEs) have been implicated in chronic diseases in adults, but their role in paediatric populations remains uncertain. This study, conducted on the Italian sample of the I.Family project, aimed to investigate the relationship between dietary and urinary fluorescent AGEs in children and adolescents. The secondary objective was to investigate the sources of dietary AGEs (dAGEs) and their association with dietary composition and anthropometric parameters. Dietary data were collected from 1048 participants via 24 h dietary recall in 2013/2014 to estimate dAGEs intake, while urinary fluorescent AGE levels were measured in 544 individuals. Participants were stratified based on dAGEs intake and compared with respect to urinary fluorescent AGE levels, anthropometric measurements, and dietary intake. The results showed no significant correlation between dietary and urinary fluorescent AGE levels, nor between dAGEs and anthropometric parameters. Notably, higher dAGEs were associated with a diet richer in protein (especially from meat sources) and fat and lower in carbohydrates. In addition, the consumption of ultra-processed foods was lower in participants with a higher DAGE intake. This study highlights the lack of a clear association between dietary and urinary fluorescent AGEs in children, but suggests a distinctive dietary pattern associated with increased dAGEs intake. Further investigation is warranted to elucidate the potential health implications of dAGEs in paediatric populations.

Dietary diversity (DD) plays a crucial role in fostering high-quality diets, but its association with health outcomes, particularly body adiposity and non-communicable diseases (NCDs), is inconsistent. This may be due to a lack of a standardized method for estimating DD. Our study investigates the association between two DD indices, namely the dietary diversity score (DDS) and food variety score (FVS), and anthropometric measures, biochemical parameters, and diet quality in a large population sample from the I.Family study across research centers in eight European countries. In our cross-sectional analysis of 3035 participants, DDSs varied among countries, with a higher prevalence in the third DDS tertile among those with higher education. DDS showed a positive association with diet quality across all age groups. Higher DDS tertile individuals showed increased fiber, fruit, and vegetable intake, greater meal frequency, and lower ultra-processed food consumption. No relevant biochemical differences were observed across DDS tertiles, and a higher DDS was associated with lower overweight/obesity prevalence only in adults. No significant associations were found with FVS. Our findings emphasize the need to consider food groups for a more accurate estimation of diet quality. This aligns with studies suggesting DDS alone is not an independent risk factor for obesity in children and adolescents. Public health programs should prioritize food diversity to promote improved nutrition and overall well-being in communities.