Digital Commons Network^™

Impact Of Suaahara, An At-Scale Multisectoral Nutrition Programme, On Health Workers’ Maternal And Child Health, And Nutrition Knowledge And Skills In Nepal, Deependra K. Thapa, Edward A. Frongillo Jr. Ph.D., Shalini Suresh, Ramesh P. Adhikari, Bhim Pun, Karuna L. Shakya, Raj Mandal, Subir K. Kole, Kenda Cunningham

Faculty Publications

Suaahara, an at-scale multisectoral nutrition programme in Nepal, aimed to advance knowledge and skills of frontline health workers to improve the quality of nutrition and health services at health facility and community levels. This study assessed the impact of Suaahara interventions on knowledge and skills of health facility workers and Female Community Health Volunteers (FCHVs). The study used a quasi-experimental design in which four Suaahara intervention districts were compared with pair-matched comparison districts. One health facility worker and three FCHVs from each survey cluster were included. Baseline survey consisted of 93 health facility workers (2015) and 118 FCHVs (2012), and …

Wellness Connection Newsletter March 2026, Roger Williams University School Of Law

Life of the Law School (1993- )

No abstract provided.

Improving Rural Health Through Nutrition Incentives: A Mixed Methods Evaluation Of The First Year Of The Appalachian Farmacy Program, Bethesda O'Connell, Harrison Ihrig, Andrea D Nutsugah, Ignacio Garcia, Michael Rice, Ashley Cavender

Journal of Social, Behavioral, and Health Sciences

Food insecurity remains a critical public health concern, particularly in rural, low-income communities. In 2023, 13.5% of United States households experienced food insecurity, with rates in Tennessee (15.6%) exceeding the national average. Produce prescription programs have emerged as a strategy to improve food access and promote healthier eating behaviors. This study presents an evaluation of Appalachian Farmacy, a produce prescription program in Northeast Tennessee designed to increase fruit and vegetable consumption among individuals receiving Medicaid, Medicare, or Supplemental Nutrition Assistance Program (SNAP) benefits. Program evaluation methods included semi-structured interviews for process evaluation and pre- and post-surveys for outcome evaluation. Interviews …

Sex Differences In Carbohydrate Quality: Assessing The Carbohydrate-To-Fiber Ratio In Middle-Aged Hispanic Adults, Cristina Graña Gedrange, Mia I. Perez, Marcela Guadiana, Nicole Cantu, Jose M. Moris

International Journal of Exercise Science: Conference Proceedings

Hispanic adults in the United States face disproportionate rates of cardiometabolic disease, yet sex-specific disparities in diet quality remain understudied. PURPOSE: To determine diet quality among middle-aged Hispanic adults, assessing carbohydrate quality based on the carbohydrate-to-fiber ratio (CFR) and protein density as indicators of metabolic risk. METHODS: A total of 30 males and 49 females between 40 to 70 years old participated in a cross-sectional analysis of body composition and dietary behavior. Participants underwent girth measurements, a dual-energy X-ray absorptiometry scan, and completed a paper-based 3-day dietary recall log. Dietary data were manually entered by researchers using an …

Discordant Visceral Adiposity Phenotypes Reveal Hidden Cardiometabolic Risks, Mia I. Perez, Marcela Guadiana, Grecia V. Morales, Marianna Gamboa, Jose M. Moris

International Journal of Exercise Science: Conference Proceedings

Body Mass Index (BMI) is widely used to screen for cardiometabolic risk but fails to account for Visceral Adipose Tissue (VAT), the metabolically active fat depot linked to cardiovascular disease. Consequently, individuals with a low BMI but high VAT (“Occult Obesity”) may face unrecognized health risks that limit the opportunity for early engagement in necessary lifestyle modifications. PURPOSE: To investigate the independent effects of BMI-VAT discordance on body composition, vital signs, and dietary intake in Hispanic adults. METHODS: Seventy-nine adults (Age 51.9 ± 7.8 yrs) underwent dual-energy X-ray absorptiometry scans for body composition analysis. Participants were stratified into six phenotypes …

Enhancing The Professional Well-Being Of Us Nurses Through Healthy Nutrition, Emily Daly Matthews, Emma Kurnat-Thoma

Creating Healthy Work Environments (CHWE)

Poor diet is the leading cause of mortality in the U.S. due to the direct relationship with diet-related chronic diseases including cardiovascular disease (CVD) and type 2 diabetes (T2D) which disproportionally affects underserved communities and exacerbates U.S. health disparities. ^1,2,3 The U.S greatly needs effective, evidence-based policy solutions to significantly improve nutrition and foster an equitable and sustainable food system to improve health and reduce diet related chronic disease.⁴ Approximately half of nurses in the United States have poor diet according to a 2018 systematic review.⁵ Healthy nutrition policy solutions should be implemented in the nursing workplace to …

Supporting Latine Older Adults’ Nutrition And Physical Health Goals In Counseling, Zachary Mcniece, Jacqueline Bergman

Adultspan Journal

Latine older adults face disproportionate risk of chronic nutrition-related conditions and food insecurity, which can exacerbate or contribute to mental health-related concerns. Cultural stigma toward mental illness can result in Latine clients, especially older adults, somatizing symptoms and focusing on physical health goals in counseling. Despite these intersecting needs, counselors often overlook their clients' physical health goals due to limited training and the assumption that medical providers alone should address these needs. This article advocates for the integration of basic, culturally responsive nutrition information into counseling practice to support client well-being while remaining within the scope of practice. We offer …

Modern Home Cooking Practices, The Role Of New Media, And Implications For Culinary Medicine: A Qualitative Study Among Mothers With Low Income, Margaret Raber, Maria Vazquez, Syeda Khan, Sahiti Myneni, Debbe Thompson

Faculty, Staff and Student Publications

Culinary medicine offers a practical, experiential approach to nutrition education, but in-person programs are resources intensive. Digital interventions may offer a scalable, acceptable approach to culinary medicine in populations that are at increased risk for poor diet, such as parents with low income. The purpose of this study was to examine modern home cooking behavior and the role of new media from the perspective of parents with low income and identify implications for culinary medicine research. Twenty parents from 6- to 11-year-old children that qualify for free/reduced school lunch programs completed a survey and interview examining online cooking information seeking …

Nutritional Care For Adults With Obesity Treated With Glp-1and Dual Gip/Glp-1 Receptor Agonists: A Review Of Evidence, Gaps, And Clinical Implications, Carolina Mcguane

Department of Nutrition Student Projects

Abstract

Background:

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 receptor agonists (GIP/GLP-1 RAs) have revolutionized obesity management, producing unprecedented weight loss outcomes. Their widespread use has outpaced research on nutritional implications, adverse events, and evidence-based guidance for dietitians. Given the central role of nutrition practitioners in supporting adults with obesity, understanding the mechanisms, risks, and nutrition-related outcomes of GLP-1 therapies is critical.

Methods:

A comprehensive literature search was conducted utilizing PubMed, Embase, and Google Scholar to identify relevant peer-reviewed articles on the topic of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) use and nutrition-related …

Food Insecurity. A Factor In Criminal Behavior?, Jerrod Brown, Jeremiah Schimp, Leanne Skehan, Janina Cich

Nutritional Neurocriminology Today

This article examines how food insecurity and limited access to nutritionally adequate foods impair cognitive function, emotional regulation, decision-making, and impulse control. Emerging research purports that individuals experiencing food insecurity face increased risks of mental and physical health problems, violent behavior, delinquency, heightened childhood vulnerability, and criminal justice involvement across the lifespan. The article advocates for increased awareness, routine screening, and specialized training for professionals in mental health, social services, and the criminal justice system to address food insecurity, thereby supporting long-term policy and community-level strategies that reduce criminal behavior and improve outcomes for vulnerable populations.

Conclusions Are Not Supported By The Published Statistical Analysis Comment On López-Toledo Et Al Flaxseed Improves Glucose And Lipid Metabolism In Mexican Subjects With Type 2 Diabetes: A Parallel Randomized Clinical Trial, Robert W Spitz, Deependra K Thapa, Thirupathi Reddy Mokalla, Wasiuddin Najam, Andrew W Brown, David B Allison

Children’s Nutrition Research Center Staff Publications

López-Toledo et al [...].

Low Energy Availability (Lea) And Its Relationship To Nutritional Status And Bone Health In Collegiate Athletes, Anthony Dempsey

UNH URC Open (2026 and after)

This project aims to identify low energy availability in a sample of collegiate athletes and explore the relationship with bone mineral density and nutrient deficiencies. Participants (n=3,407) were recruited from a northeast university and self-reported athlete status and physical activity via online questionnaire. Food records were used to calculate energy and nutrient intake. Anthropometrics including height, weight, body composition and bone mineral status were measured in duplicate. Energy availability (EA) was calculated as (Energy Intake (EI) -Exercising Energy Expenditure) (EEE)) /Fat Free Mass (FFM) (kg) and categorized as optimal (>45 kcal/kg FFM), subclinical, or clinically low (< 30 kcal/kg FFM). Fifteen percent of participants were characterized as athletes (club or division I varsity); mean EA was lower among athletes vs. nonathletes (17.90.7vs.21.90.3, p< .001). Males were more likely to have optimal EA status vs. females (8.8vs4.7%, p< .001). Most females (75.1%) were categorized as clinically LEA; 20.3% had subclinical LEA. Among men, athletes’ EA was similar to nonathletes (21.11.2vs22.20.5, p=.4); among females, athletes had lower EA vs. nonathletes (16.220.9vs21.70.3, p< .001). Males with clinically low EA were most likely to consume inadequate intakes of potassium, fiber, iron, and vitamin D (77.1,94.0,10.4 and 97.3%, respectively); similarly, females with clinically low EA, were most likely to consume inadequate intakes (81.9,87.6,88.3, and 99.5%, respectively). Bone z-scores were higher among athletes vs. non athletes (-.27±.06vs-.67±.02, p< .001) but were not different by EA status. Given the prevalence of LEA within the college athlete and nonathlete populations, further research and tailored nutritional education is needed for this at-risk population.

Crab And Lobster Shell Meal Taste Preferences Of Dairy Heifer Calves, Summer R. Pescinski, Peter S. Erickson

Honors Theses and Capstones

Objective: This preference study was conducted to evaluate the palatability of crab shell meal (CM) and lobster shell meal (LM) when added to calf starter for post-weaned dairy heifer calves.

Materials and methods: Six calves were used for a sequential elimination experiment to rank their taste preferences when offered control calf starter, calf starter mixed with 50 g of CM, and calf starter mixed with 50 g of LM.  The calves were kept on the study for a total of 5-d split into two feeding segments.  Preference was determined by calculating the total intake of each treatment …

Accuracy Of The Nestlé Mini Nutritional Assessment® (Mna®) Screen In Identifying Prealbumin–Defined Malnutrition Amongst Spine Surgery Patients, Stylianos Mysirlidis, Luke Fischbach, Matthew Giammanco, Alex Zhang, Phillip Alexeev, Ryan Snowden

SPARK Symposium Presentations

Abstract:

Background:

Malnutrition is a significant risk factor for patients undergoing surgery, including those receiving spine surgery. These patients are at greater risk of adverse postoperative outcomes, impaired wound healing, and spinal fusion failure. Therefore, it is essential to identify at-risk, malnourished patients prior to intervention to mitigate any complications such as surgical site infections, unplanned readmissions, and reoperations. The primary focus of this study was to assess the accuracy of the Nestlé Mini Nutritional Assessment® (MNA®) on identifying true malnutrition amongst those patients undergoing spine surgery.

Methods:

We conducted a retrospective cohort study of 674 consecutive …

Physique Development And Management Shape Experiences Of Low Energy Availability Risk In Elite Professional Male Rugby Union Players, Gary Sweeney, Siobhain Mcardle, Nessan Costello, Kieran Collins

Research Outputs: 2025-Present

This study aimed to explore elite male rugby union players’ perceptions and lived experiences of physique development and management in relation to low energy availability risk. Semi-structured interviews (29 ± 8 min) were conducted with 18 players (senior: n = 9; academy: n = 9; mean age: 23 ± 3) across four professional rugby union clubs in Ireland. Through reflexive thematic analysis, the following themes were constructed. Players had limited awareness of low energy availability, yet described experiences consistent with symptoms, including fatigue, low mood and reduced libido. A pervasive physique culture, characterised by body composition ‘ideals’ and weight or …

Exploring The Acceptability Of Integrating Dietitians Into Primary Care Dental Services For Children, Lauren Hallewell, Raul Bescos, Zoe Brookes, Tracey Parkin, Robert Witton, Patricia Casas-Agustench

School of Health Professions

BACKGROUND: Dental caries is a common childhood non-communicable disease strongly associated with high sugar intake. Beyond oral health, a poor diet can affect children's growth, development, and overall well-being. While dietary advice is central to preventive dental care, some primary care dental clinics have introduced body mass index (BMI) assessments and further dietary advice to address wider nutritional concerns in children. However, these efforts are often constrained by limited nutrition training, time constraints and concerns about sensitivity. Integrating dietitians into primary dental care may help overcome these barriers by enhancing dietary guidance, supporting broader nutritional needs and facilitating structured BMI …

The Impact Of Defunding The Supplemental Nutrition Assistance Program Education (Snap-Ed) In Louisiana, Virginia Bordelon, Senlin Chen, Yuxin Nie, Denise Holston, Jessice Stroope

Distinguished Undergraduate Researcher Program

The Supplemental Nutrition Assistance Program Education (SNAP-Ed) was a federally funded initiative that aims to improve nutrition knowledge, promote physical activity, and provide education through Policy, System, and Environmental (PSE) strategies. This study examined the relationship between the defunding of SNAP-Ed and how nutrition and physical activity were affected among low-income families. Data for this study originated an interview with a Department of Children and Family Services (DCFS) economist, an interview with SNAP-Ed field agent, and survey responses from 32 adult participants familiar with SNAP. The SNAP recipients use the education program resources to assist in healthy recipes, physical
education …

Smarter Nutrition: Right-Sizing Nutritional Monitoring In Patients On Crrt, David Zolezzi, Elizabeth Journey, Jayne Walters

2026

No abstract provided.

Colostrum As A Protective Factor Against Peanut Allergy: Evidence From A Birth Cohort, Maheshwar Bhasin, Matthew Cooper, Patricia Macchiaverni, Ravisha Srinivas Joys, Therese A. O'Sullivan, Jeffrey A. Keelan, Carina Venter, Debra J. Palmer, Adrian J. Lowe, Susan L. Prescott, Desiree Silva, Valerie Verhasselt

Research outputs 2022 to 2026

Background: Food allergy affects families' quality of life, can be lifelong and life-threatening, urging the identification of early modifiable risk factors. Formula feeding in the first days of life may increase the risk of cow's milk allergy, a risk often attributed to cow's milk allergens exposure. Early formula feeding also reduces the colostrum intake, the first 3 days' milk, which is rich in bioactive compounds critical for immune and gut health. This study investigates whether partial colostrum feeding increases the risk of food allergy beyond cow's milk. Methods: Data from 666 mother-infant pairs in the Australian ORIGINS cohort categorised neonates …

Association Between Protein Intake From Animal And Plant Sources And The Presence Of Frailty In Community-Dwelling Australian Women, Trent Bozanich, Jack Dalla Via, Simone Radavelli-Bagatini, Cassandra Smith, Elsa Dent, Anthony Villani, Robin M. Daly, Michael Tieland, Jonathan M. Hodgson, Kun Zhu, Richard L. Prince, Marc Sim

Research outputs 2022 to 2026

We investigated the cross-sectional association between total, animal and plant protein intake with the presence of a multidimensional measure of frailty in older women. Participants included 1380 community-dwelling Australian women, mean (SD) age 75.1 (2.7) years. A validated food frequency questionnaire was used to determine total, plant, and animal protein intake. Frailty was assessed using a frailty index across numerous health domains (scored 0–1, ≥0.25 indicating frailty). Cross-sectional associations were analysed using multivariable-adjusted logistic regression models. In total, 275 (19.9%) women were identified as frail. A non-linear inverse association was observed between higher intakes of total protein and the odds …

Diet, Gut Microbiota, And Intestinal Permeability: Emerging Mechanisms In Hypertension Pathogenesis, Esha Vashisht, Helen Nguyen, Francine Z. Marques, Matthew Snelson

Research outputs 2022 to 2026

Hypertension is a leading contributor to global morbidity and mortality, arising from the interplay of genetic and environmental risk factors together with the dysregulation of multiple physiological systems involved in blood pressure control. Recent advances have established the gut as a central regulator, implicating the intestinal microbiota and barrier integrity in the modulation of blood pressure. Alterations in the gut microbial consortium, along with changes in levels of metabolites produced by the microbiota, have been associated with blood pressure regulation in animal models and human studies. Key microbial metabolites, including short-chain fatty acids, trimethylamine-N-oxide, and bile acids influence endothelial function, …

The Gut Microbiome Mediates The Association Between A Flavonoid-Rich Diet And Masld In A Population-Level Analysis, William Bell, Amy Jennings, Nicola P. Bondonno, Andre Franke, Corinna Bang, Marcus Both, Jan Kassubek, Hans Peter Müller, Jan Borggrefe, Wolfgang Lieb, Tilman Kühn, Aedín Cassidy

Research outputs 2022 to 2026

Purpose: A growing body of evidence suggests diets rich in flavonoids may protect against metabolic-dysfunction associated steatotic liver disease (MASLD) development and progression. As the gut microbiome is important in the biotransformation of flavonoids to their constituent bioactive metabolites, studies on the potential mediating role of the gut microbiome in the association between dietary flavonoid intakes and MASLD are warranted but lacking. Thus, this study aims to examine the associations between a diet rich in flavonoids and MASLD, and assess the potential mediating role of the gut microbiome. Methods: In a cross-sectional analysis (n = 531), using the FlavoDiet score …

The Best Practice Guide For Early Childhood Education And Care Food Environment: Module 3: Food Education (Version 1.0), Helen Alexiou, Lennie Barblett, Fiona Champion, Penelope Clark, Lochie Clark, Kathy Cologon, Wendy Cook, Amanda Devine, Katie Dix, Audrey Elford, Leanne Elliston, Amanda Ferguson, Ricky Gelman, Jodie Gray, Natalie Gulberti, Connie N. Ihlein, Debbie Jordan, Karen Krist, Deana Leahy, Stacey Mckenzie, Sandra Murphy, Merryn Netting, Ciara O’Flaherty, Asha Rojahn, Ros Sambell, Blake Stewart, Aimee Sullivan, Suzanne Tamone, Henry Tan, Sandra Vale, Danielle Waterson, Jill Whelan

Research outputs 2022 to 2026

Food education (FE) in early learning settings is more than cooking – it is an opportunity to experience food in ways that include cooking but go far beyond. Food education gives children the opportunity for exploration, experimentation, learning, teamwork, skill building and much more. At the same time, services must balance safety, regulatory requirements, diverse developmental and cultural needs, family expectations and practical constraints such as time and staffing.

The FE module has been developed to support Early Childhood Education and Care settings (ECEC), for children from birth to 5 years, to create food experiences that are safe, engaging, inclusive …

Photovoice Exploration Of Afghan Refugee Background Women's Food-Related Well-Being, Eileen C. Lindemann

Graduate Research Theses & Dissertations

More than 117,000 Afghans have been relocated to the United States following the U.S. military withdrawal in August 2021. Research indicates that Afghan refugees resettled in the U.S. are at increased risk of psychological distress, with Afghan women particularly susceptible compared with Afghan men, and diet-related chronic disease. However, research also shows that traditional food and eating customs foster cultural identity, social support, integration, and well-being. The purpose of this study was to collaboratively explore the food-related well-being and daily life contexts of resettled refugee participants through the photovoice method, a participatory research strategy in which participants photograph aspects of …

Learning In The Open: Empowering Employability And Social Justice Through Open Pedagogy, Karina Christopher

Pedagogicon Conference Proceedings

Open Pedagogy (OP) is a practice which enhances comprehension and employability skills by allowing teachers and learners to be co-creators in learning experiences and scholarship. This didactic practice is used in a variety of degree programs. This article provides examples of OP adopted in multiple food and nutrition courses.

Dietary Micronutrients And The Risk Of Gestational Diabetes: Evidence From A Tertiary Care Setting In India, Sujatha Mahadevarao Premnath, Moneesh Sivasoupramaniane, Maghida S

Digital Journal of Clinical Medicine

Background: Gestational Diabetes Mellitus (GDM) is a significant health concern in India, affecting nearly 22.4% of pregnant women. While macronutrient roles are well explored, the impact of micronutrients on GDM risk, particularly with the Indian ethnic phenotype, requires exploration

Objectives: To compare the micronutrient intake between GDM and non-GDM pregnancies and evaluate the association between specific dietary micronutrients and GDM risk

Methods: An observational cross-sectional study was conducted among 115 South Indian pregnant women. Dietary history was taken using 24-hour recalls on two occasions and analysed via the Indian Food Composition Table (IFCT). GDM was diagnosed using International Association of …

Large Language Model-Assisted Research Question Development In Public Health: A Case Study In The Special Supplemental Nutrition Program For Women, Infants, And Children (Wic), Qi Zhang, Bidusha Neupane, Priyanka Patel, Futun N. Alkhalifah, Yi He, Leslie Hodges

Health Behavior, Policy & Management Faculty Publications

Objective:

To assess the feasibility of using large language models (LLMs) to develop research questions about changes to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food packages.

Design:

We conducted a controlled experiment using ChatGPT-4 and its plugin, MixerBox Scholarly, to generate research questions based on a section of the USDA summary of the final public comments on the WIC revision. Five questions weekly for three weeks were generated using LLMs under two conditions: fed with or without relevant literature. The experiment generated 90 questions, which were evaluated using the FINER criteria (Feasibility, Innovation, Novelty, Ethics, …

Gastrointestinal Symptoms Associated With Sodium Bicarbonate Supplementation Protocols: A Systematic Review, Ian P. Winter, Paul Sarac, Patrick B. Wilson

Exercise Science Faculty Publications

Sodium bicarbonate positively impacts performance, but its associated gastrointestinal symptoms (GIS) may limit use. This systematic review synthesized literature that has evaluated GIS with sodium bicarbonate supplementation. Literature searches were performed from February 2024-March 2026. Eligible studies provided ≥ 5 g of sodium bicarbonate within a 24-h period or, if a multi-day protocol, at least one day involving ≥ 5 g. Included studies had a placebo group/condition or a comparison group/condition that created a contrast related to delivery method, form, or dose. In total, 101 investigations were summarized in six categories: acute single dosing (n = 35); acute spread dosing …

Perspective: Radiotherapy And Body Composition: Unmet Needs In Low- And Middle-Income Countries, Alexia J Murphy-Alford, Aaron J Grossberg, Vickie E Baracos, Maha Barbar, Judy Bauer, Jonathan P Bennett, Elena Fidarova, Clifton D Fuller, Anastassia Löser, Amy C Moreno, Anurima Patra, Deepa Puttaswamy, David I Rosenthal, Judy Schoeman, Yavuz Anacak

Faculty, Staff and Student Publications

Radiotherapy plays a vital role in cancer treatment, yet its effects on patients' nutritional status can precipitate muscle loss, with significant implications for treatment tolerance and outcomes. Evidence from high-income countries increasingly links radiation-induced muscle loss to adverse clinical outcomes. In contrast, low- and middle-income countries face a stark evidence gap, despite the heightened vulnerability of cancer patients in these settings due to delayed diagnosis, limited access to care, and high rates of co-morbidities. This paper highlights the critical gaps in nutritional care for radiotherapy patients in low- and middle-income countries.

Application Of Current Enteral Nutrition Support Recommendations To Infants Born Less Than 750 Grams Or Less Than 25 Weeks' Gestation: A Critical Review, Mar Romero-Lopez, Mamta Naik, Teresa Hartman, Ann Anderson-Berry, Melissa Thoene

Journal Articles: Pediatrics

Clinicians face a paucity of evidence-based recommendations for provision of enteral nutrition in infants born < 750 g or < 25 weeks' gestation, termed "nano-preterm." Current enteral nutrition recommendations for extremely low birth weight infants may not be broadly applicable to nano-preterm infants due to physiological and developmental differences, while others may be appropriate. Key enteral nutrition-related considerations include: the unique anatomy and physiology of the gastrointestinal tract, altered metabolic capacity, availability of maternal milk and use of alternative substrates, detailed methods of initiation and advancement of enteral feeding, methods of human milk fortification, targeted requirements for macronutrient and micronutrients, and the safety and efficacy of enteral nutrition support management to optimize the growth and development of the nano-preterm infant. This comprehensive review focused on enteral nutrition provision in nano-preterm infants, thoroughly evaluating available literature and identifying knowledge gaps about the unique physiology and metabolism of the nano-preterm infant as it pertains to enteral nutrition. Ultimately, prospective multicenter research is needed to establish evidence-based guidelines to promote optimal growth and development while minimizing complications of extreme prematurity.