Nutrients

19 pages, 2798 KB

Open AccessArticle

Mapping Data Availability and Assessing Nutritional Adequacy in Standardised Institutional Feeding: A Cross-National Analysis of Military Operational Rations from 69 Countries

by Rodica Siminiuc and Dinu Țurcanu

Nutrients 2026, 18(16), 2647; https://doi.org/10.3390/nu18162647 - 13 Aug 2026

Abstract

Background: Standardized institutional feeding systems determine nutritional adequacy entirely through how the provided diet is formulated, yet how completely that formulation is documented is rarely examined. Military operational rations are the most widely deployed example of such a system. Objectives: We aimed to [...] Read more.

Background: Standardized institutional feeding systems determine nutritional adequacy entirely through how the provided diet is formulated, yet how completely that formulation is documented is rarely examined. Military operational rations are the most widely deployed example of such a system. Objectives: We aimed to map the global availability of publicly accessible ration composition data; to assess the compositional adequacy of rations with complete profiles; and to test whether dietary diversity predicts micronutrient adequacy where dietary choice is absent. Methods: A standardized seven-step search was applied across 69 countries grouped into ten geopolitical clusters. All analyses used planned ration composition from official and published sources, not the food actually consumed. Compositional adequacy was quantified as mean per-nutrient coverage of the Dietary Reference Intake, and a separate diversity score was correlated with this aggregate measure. Results: Complete micronutrient profiles were publicly accessible for only 8 of 69 countries (11.6%), with post-conflict states showing the highest data-absence rate (80.0%). Vitamin D was the only nutrient critically low across all eight complete-data rations, ranging from 2.9% to 30.0% of the Dietary Reference Intake—a compositional feature, not a measure of personnel status. The correlation between aggregate adequacy and dietary diversity was negligible (r = −0.042). Pakistan’s high aggregate score (90.29%) coexisted with vitamin D at 2.9%, showing how aggregate scores mask single-nutrient deficiencies. Conclusions: Per-nutrient compositional assessment is essential for evaluating standardized institutional feeding; low public data availability does not imply absent nutritional planning. Full article

(This article belongs to the Section Micronutrients and Human Health)

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23 pages, 508 KB

Open AccessArticle

Parents’ Instrumental Family Support, Diet Quality, and Satisfaction with Food-Related Life: A Dyadic Approach in Dual-Earner Parents and Their Adolescent Children

by Berta Schnettler, Andrés Concha-Salgado, Ligia Orellana-Calderón, Mahia Saracostti, Katherine Beroíza, Héctor Poblete, Leonor Riquelme-Segura, Germán Lobos, Cristian Adasme-Berríos and María Lapo

Nutrients 2026, 18(16), 2646; https://doi.org/10.3390/nu18162646 - 13 Aug 2026

Abstract

Background: Research on family support has primarily focused on emotional aspects, paying less attention to instrumental support and its concurrent association with food-related well-being. Aim: To explore direct and indirect actor and partner effects among parents’ instrumental family support, diet quality, and satisfaction [...] Read more.

Background: Research on family support has primarily focused on emotional aspects, paying less attention to instrumental support and its concurrent association with food-related well-being. Aim: To explore direct and indirect actor and partner effects among parents’ instrumental family support, diet quality, and satisfaction with food-related life (SWFoL) in dual-earner families with adolescents. Methods: Online surveys were conducted with 860 dual-earner parent dyads and one adolescent child (mean age 12.7 ± 1.8 years; 49.8% female) in Chile. Family members completed the Adapted Healthy Eating Index and the SWFoL Scale; parents also answered an Instrumental Support subscale. Analyses were conducted using a mediation Actor–Partner Interdependence Model via structural equation modeling. Results: Mothers’ and fathers’ instrumental support was positively associated with their own SWFoL, both directly and indirectly via their diet quality. Parents’ support was also positively related to adolescents’ SWFoL directly and indirectly via adolescents’ diet quality. Symmetrical crossover effects between instrumental support and SWFoL emerged for both parents. Mothers’ support was additionally associated with fathers’ SWFoL indirectly through fathers’ diet quality. Conclusions: Instrumental support operates as a vital systemic resource within dual-earner households. By enhancing diet quality, tangible support protects family food-related well-being and embeds adolescents’ nutritional health within the parental resource ecosystem. Full article

(This article belongs to the Special Issue Nutrition in Children's Growth and Development: 2nd Edition)

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12 pages, 365 KB

Open AccessArticle

Antibodies to Transglutaminase-6 Identify Ataxia Responsive to Gluten-Free Diet

by Marios Hadjivassiliou, Richard A. Grünewald, Iain D. Croall, Nigel Hoggard, Graeme Wild, Panagiotis Zis, Priya Shanmugarajah and David S. Sanders

Nutrients 2026, 18(16), 2645; https://doi.org/10.3390/nu18162645 - 13 Aug 2026

Abstract

Background: Gluten ataxia (GA) is the most common neurological manifestation of gluten sensitivity. GA is identified by serological evidence of gluten sensitivity when other defined causes for ataxia have been excluded. Whilst there are several serological markers for gluten sensitivity, antibodies against transglutaminase [...] Read more.

Background: Gluten ataxia (GA) is the most common neurological manifestation of gluten sensitivity. GA is identified by serological evidence of gluten sensitivity when other defined causes for ataxia have been excluded. Whilst there are several serological markers for gluten sensitivity, antibodies against transglutaminase enzyme 6 (anti-TG6) are of particular interest as it is the autoantigen in GA. Our objective was to assess the value of a commercial anti-TG6 ELISA assay in routine clinical practice for the investigation and management of patients with progressive ataxia. Methods: Patients with progressive ataxia underwent standardized clinical and detailed investigative workup. Anti-TG6 was measured using a commercial ELISA assay. Patients with ataxia who were seropositive for any gluten sensitivity-related antibody were offered dietary advice for a gluten-free diet. All patients underwent baseline and follow-up MR spectroscopy scans of the cerebellum. Results: 155/161 (96%) patients with GA diagnosed on the basis of circulating antigliadin antibodies (the original definition of gluten ataxia) were also positive for anti-TG6. In total, 329/425 (77%) patients with idiopathic sporadic ataxia, all other causes of ataxia excluded, were positive for anti-TG6 alone. 115/296 (39%) patients with ataxia due to genetic causes were positive for anti-TG6, as were 17/59 (29%) patients with a clinically established cerebellar variant of multi-system atrophy. Amongst patients with other neurological conditions (non-ataxia), anti-TG6 was found in 13%, compared with 50% of patients with coeliac disease presenting to gastroenterologists. Overall, 146 patients with ataxia and anti-TG6 alone responded to a gluten-free diet, with a reduction/elimination of TG6 antibodies and improved MR spectroscopy. Patients with an identified genetic ataxia and anti-TG6 did not show a significant response to a gluten-free diet. Conclusions: Anti-TG6 appears to be a more sensitive diagnostic marker for GA when compared to antigliadin antibodies. Patients with ataxia and isolated anti-TG6 benefit from a strict gluten-free diet. Full article

(This article belongs to the Section Nutrition and Neuro Sciences)

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20 pages, 916 KB

Open AccessArticle

Effects of Omega-3 and Omega-9 Fatty Acid Supplementation on HOMA-IR and Inflammatory Markers in Children with Obesity and Insulin Resistance: A Triple-Blind RCT with Post-Intervention Follow-Up

by Javier Alonzo Campos-González, Dana Fernanda Vasquez-Solorio, Samuel Flores-Huerta, Jenny Vilchis-Gil, César Navarro-Hernandez, Carlos Juárez-López, Miguel Klünder-Klünder and Nancy Lucero Martínez-Rodríguez

Nutrients 2026, 18(16), 2644; https://doi.org/10.3390/nu18162644 - 13 Aug 2026

Abstract

Background/Objectives: Omega-3 and omega-9 fatty acid supplementation has shown metabolic and immunomodulatory benefits, but evidence in pediatric insulin resistance is limited, and the persistence of effects after treatment discontinuation remains uncharacterized. This study evaluated the independent and combined effects of omega-3 and omega-9 [...] Read more.

Background/Objectives: Omega-3 and omega-9 fatty acid supplementation has shown metabolic and immunomodulatory benefits, but evidence in pediatric insulin resistance is limited, and the persistence of effects after treatment discontinuation remains uncharacterized. This study evaluated the independent and combined effects of omega-3 and omega-9 supplementation on the metabolic and inflammatory profile of children with obesity and insulin resistance, during and after active treatment. Methods: This prespecified secondary analysis of a multicenter, randomized, triple-blind, three-arm parallel trial (NCT05488223) included 97 children (8–17 years) with overweight/obesity and baseline insulin resistance (HOMA-IR > 3.0). Participants received 1.8 g/day of omega-3 (n = 32), omega-9 (n = 34), or combined supplementation (n = 31) for 3 months, followed by a 2-month post-intervention follow-up. Metabolic and inflammatory markers were assessed at baseline (T1), end of treatment (T2), and follow-up (T3). The primary outcome was the change in HOMA-IR from T1 to T2. Results: Active supplementation significantly reduced fasting insulin and HOMA-IR in the Combined (p < 0.001) and Omega-9 (p = 0.010 and p = 0.006) groups; at month 5, only the Combined group maintained significant reductions in both. IL-6 and leptin decreased across all groups during intervention and remained reduced at follow-up. Multivariable regression (n = 96) showed the metabolic response was most strongly associated with baseline metabolic status and concurrent BMI reduction rather than intervention group, which was not an independent predictor of metabolic response, nor consistently of inflammatory outcomes (one exception: a smaller IL-4 increase with omega-9, p = 0.043, unconfirmed in GEE). Conclusions: Within-group reductions in HOMA-IR and fasting insulin persisted after discontinuation only in the Combined group, but without significant between-group differences at any timepoint, consistent with response magnitude reflecting baseline status and adiposity reduction rather than treatment group per se. This positions combined supplementation as a potential metabolic adjuvant—not a standalone therapy—for HOMA-IR-defined insulin resistance in pediatric obesity, assessed here via anthropometric and biochemical rather than imaging-based measures. Full article

(This article belongs to the Section Pediatric Nutrition)

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24 pages, 962 KB

Open AccessReview

Do Patients Receiving GLP-1 Receptor Agonists for Weight Loss Require Structured Dietetic Care? Lessons from Metabolic and Bariatric Surgery (MBS) Pathways

by Vignesh Balasubaramaniam, Megan Scobie, Mary O’Kane, Yitka Graham, Andrew G. Robertson and Kamal Mahawar

Nutrients 2026, 18(16), 2643; https://doi.org/10.3390/nu18162643 - 13 Aug 2026

Abstract

Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual incretin therapies have significantly advanced obesity management by facilitating clinically significant weight loss and enhancing cardiometabolic outcomes. Nevertheless, their growing application calls for careful consideration of nutritional and behavioural factors, including decreased dietary intake, [...] Read more.

Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual incretin therapies have significantly advanced obesity management by facilitating clinically significant weight loss and enhancing cardiometabolic outcomes. Nevertheless, their growing application calls for careful consideration of nutritional and behavioural factors, including decreased dietary intake, gastrointestinal symptoms, loss of lean mass, micronutrient deficiencies, and potential weight regain following treatment cessation. Methods: This narrative review synthesises evidence from clinical trials, observational studies, reviews, professional guidelines, and MBS nutrition protocols to evaluate the role of structured dietetic care in adults receiving GLP-1 RAs or related incretin-based therapies for weight management. MBS pathways provide a comparative framework for investigating how established principles of nutritional assessment, monitoring, and dietetic follow-up may inform pharmacological treatments of obesity. Results: The literature indicates that pharmacological weight-loss treatments should not be administered solely as prescription-based treatments. Structured dietetic care can facilitate nutritional assessment, personalised dietary interventions, the management of gastrointestinal symptoms, protein optimisation, behavioural counselling, physical activity support, and long-term weight maintenance. MBS pathways illustrate the role of dietitians in pre-, peri-, and post-major weight-loss interventions through assessment, guidance on supplementation, dietary progression, biochemical monitoring, and long-term maintenance. Although these principles require adaptation rather than direct application to GLP-1 RA pathways, they offer a valuable system for integrating dietitians into comprehensive obesity pharmacotherapy. Conclusions: Structured dietetic care should be regarded as a fundamental component of the pharmacological management of obesity, especially as GLP-1 RAs and incretin-based therapies become more prevalent. Dietitians are well positioned to help optimise nutritional adequacy, preserve lean mass, manage gastrointestinal symptoms, and support sustained weight maintenance. Future research should investigate effective models for delivering dietetic care alongside incretin-based therapies, including strategies to identify patients who need more intensive support. Full article

(This article belongs to the Special Issue Diet and Nutritional Management of Patients After Metabolic and Bariatric Surgery and Other Therapies)

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18 pages, 547 KB

Open AccessArticle

Psychological Distress Is Associated with Emotional Overeating in Multiple Sclerosis: The Role of Perceived Disease Impact and Illness Acceptance—A Cross-Sectional Study

by Maciej Wilski, Jarosław Gabryelski and Waldemar Brola

Nutrients 2026, 18(16), 2642; https://doi.org/10.3390/nu18162642 - 12 Aug 2026

Abstract

Background/Objectives: Emotional overeating may be relevant to nutritional self-management in people with multiple sclerosis (MS), but its links with disease-related appraisals and psychological adjustment remain unclear. This study examined associations between perceived physical impact of MS and emotional overeating, considering illness acceptance and [...] Read more.

Background/Objectives: Emotional overeating may be relevant to nutritional self-management in people with multiple sclerosis (MS), but its links with disease-related appraisals and psychological adjustment remain unclear. This study examined associations between perceived physical impact of MS and emotional overeating, considering illness acceptance and psychological distress. Methods: This secondary cross-sectional study included 382 adults with MS recruited from specialist clinical centres in Poland. Emotional overeating, perceived physical impact, illness acceptance, and psychological distress were assessed using the My Eating Habits Questionnaire, Multiple Sclerosis Impact Scale-29 physical subscale, Acceptance of Illness Scale, and 12-item General Health Questionnaire. Hierarchical regression and serial indirect-association models were adjusted for disease duration and Expanded Disability Status Scale score. Indirect associations were evaluated using 5000 bootstrap resamples. Results: Greater perceived physical impact was associated with emotional overeating at the bivariate level. In the adjusted regression model, greater psychological distress was associated with higher emotional overeating (B = 0.169, β = 0.312, p < 0.001); the model explained 20.1% of outcome variance. The total association between physical impact and emotional overeating was statistically significant (B = 0.038, p < 0.001), whereas the direct association was not (B = 0.010, p = 0.216). Indirect associations were supported through psychological distress alone (estimate = 0.016, 95% CI 0.009–0.025) and sequentially through lower illness acceptance and greater psychological distress (estimate = 0.006, 95% CI 0.003–0.009). Conclusions: Emotional overeating was more closely associated with psychological distress and illness adjustment than with perceived physical disease impact alone. Nutritional care may benefit from attention to emotional triggers for eating and psychological distress; longitudinal studies are needed to establish temporal relationships. Full article

(This article belongs to the Special Issue Nutritional Psychiatry: Eating Behaviors and Mental Health Outcomes)

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45 pages, 6838 KB

Open AccessReview

Medicinal Plant Polysaccharides as Microbiota-Directed Modulators of Immunosenescence: Structural Determinants, Metabolite Reprogramming, and Host Immune Regulation

by Kailang Mu, Meihui He, Ruiqi Liao, Changliu Shao, Pingxuan Xie, Junli Xie, Yuchen Liu, Zhigang Ju, Ke Zhong, Yuan Yuan and Yuxin Pang

Nutrients 2026, 18(16), 2641; https://doi.org/10.3390/nu18162641 - 12 Aug 2026

Abstract

Immunosenescence is a major contributor to age-associated morbidity, yet microbiota-directed strategies capable of restoring immune homeostasis remain insufficiently validated. Medicinal plant polysaccharides (MPPs) are structurally diverse macromolecules that often resist host digestion and undergo microbial transformation in the colon, but their effects cannot [...] Read more.

Immunosenescence is a major contributor to age-associated morbidity, yet microbiota-directed strategies capable of restoring immune homeostasis remain insufficiently validated. Medicinal plant polysaccharides (MPPs) are structurally diverse macromolecules that often resist host digestion and undergo microbial transformation in the colon, but their effects cannot be interpreted as those of a homogeneous intervention class. In this structured narrative review, we critically synthesize evidence across structural carbohydrate biology, microbial ecology, metabolite signaling, and immune aging and propose a structure–microbiota–metabolite–immunity framework for evaluating how MPPs may influence immunosenescence. Monosaccharide composition, glycosidic linkages, molecular-weight distribution, branching, uronic acid content, chemical substitutions, and higher-order conformation can shape microbial carbohydrate-active enzyme activity, polysaccharide utilization, and ecological cross-feeding. The resulting changes in short-chain fatty acids, secondary bile acids, tryptophan-derived indoles, and other metabolites may affect epithelial barrier integrity, regulatory T-cell/T helper 17-cell (Treg/Th17) balance, macrophage polarization, nuclear factor-κB (NF-κB) signaling, NLR family pyrin domain-containing 3 (NLRP3) inflammasome activation, and systemic inflammatory tone. However, evidence from in vitro systems and young disease models primarily supports mechanistic plausibility and should not be treated as direct evidence of immunosenescence modification. Translation will require structurally defined preparations, causal validation in aging-relevant models, comparison with established fermentable fibers, identification of responder phenotypes, and adequately powered trials in older adults. Full article

(This article belongs to the Special Issue Disease-Associated Gut Microbiota Patterns, Nutritional Factors, and Host Immunity)

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12 pages, 1216 KB

Open AccessArticle

Perception–Adoption Gap of an AI Dietary Management App in Real-World Dining Settings: A Field Study

by Shupeng Mai, Jinji Xu, Zihan Hu, Chengdi Shan, Yuqi Zhao, Hongwei Liu, Qi Song and Zhenni Zhu

Nutrients 2026, 18(16), 2640; https://doi.org/10.3390/nu18162640 - 12 Aug 2026

Abstract

Background/Objectives: Although efficacious in randomized trials, the real-world adoption of AI-driven dietary management applications remains uncertain across diverse dining contexts and populations. Methods: This field-based observational study was conducted over 18 days at three real-world dining sites in Shanghai, China, enrolling [...] Read more.

Background/Objectives: Although efficacious in randomized trials, the real-world adoption of AI-driven dietary management applications remains uncertain across diverse dining contexts and populations. Methods: This field-based observational study was conducted over 18 days at three real-world dining sites in Shanghai, China, enrolling 181 participants stratified into three groups based on food service style and customer attribute. A cross-sectional survey was administered on day 9, followed by a 9-day prospective usage tracking period. Results: After adjusting for sex, Group 2 (staff cafeteria with fixed-portion dishes) had the highest adjusted mean usability score at 71.20 (p < 0.001). Group 3 (community canteen) had the highest mean scores for information quality (16.57, p = 0.03) and perceptions of intended use in nutrition (12.01, p = 0.08). However, Group 3 recorded zero active usage sessions despite favorable initial perceptions. Conclusions: Favorable user perceptions of this AI-driven dietary management tool did not automatically translate into adoption. Scenario-specific usability and digital divide constraints define the boundary of real-world efficacy; moreover, AI may amplify existing dietary self-management behaviors rather than creating them de novo. Full article

(This article belongs to the Special Issue Artificial Intelligence-Enhanced Nutritional Approaches: Dietary Innovations and Chronic Disease Management)

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21 pages, 1261 KB

Open AccessReview

Vitamin A Status in Cystic Fibrosis in the Current Era of CFTR-Directed Therapies

by Senthilkumar Sankararaman, Terri Schindler, Kay Vavrina and Maria Mascarenhas

Nutrients 2026, 18(16), 2639; https://doi.org/10.3390/nu18162639 - 12 Aug 2026

Abstract

Vitamin A plays an important role in multiple homeostatic functions such as vision, immunity, epithelial cell integrity and differentiation, cell signaling, pulmonary function, reproduction, growth, and development. Vitamin A deficiency was described in people with cystic fibrosis (pwCF) due to a multitude of [...] Read more.

Vitamin A plays an important role in multiple homeostatic functions such as vision, immunity, epithelial cell integrity and differentiation, cell signaling, pulmonary function, reproduction, growth, and development. Vitamin A deficiency was described in people with cystic fibrosis (pwCF) due to a multitude of causes, such as suboptimally managed exocrine pancreatic insufficiency, advanced cystic fibrosis-related liver disease (aCFLD), and a history of intestinal resection, and is generally rare in contemporary practice. Apart from true vitamin A deficiency, low vitamin A levels may also be noted in various inflammatory states, as vitamin A is a negative acute-phase reactant. In the current era of cystic fibrosis (CF) transmembrane-conductance regulator (CFTR)-directed therapies, there is a paradigm shift in vitamin A status, with deficiency statuses becoming rarer, and instead higher serum vitamin levels (in some cases, even in the hypervitaminosis range) are increasingly reported. People with aCFLD, renal insufficiency, post-lung transplantation, and pregnancy are prone to vitamin A toxicity. Hence, CF clinicians should be proactive in evaluating these abnormalities and proficient in managing both deficiency and toxicity, as both these conditions can be associated with adverse outcomes. In this review, we detailed the basics of vitamin A metabolism, manifestations of both vitamin A deficiency and excess, and their clinical implications in pwCF. Full article

(This article belongs to the Special Issue Optimizing Nutritional Strategies for Cystic Fibrosis: Mechanisms, Interventions, and Clinical Outcomes)

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28 pages, 877 KB

Open AccessReview

Artificial Intelligence in Clinical Nutrition: Current Uses, Challenges, and Opportunities

by Kasuen Mauldin, Anthony D. Pham, Sneha Dodaballapur and Berkeley N. Limketkai

Nutrients 2026, 18(16), 2638; https://doi.org/10.3390/nu18162638 - 12 Aug 2026

Abstract

Artificial intelligence (AI) is increasingly being applied in healthcare, with growing relevance to clinical nutrition. This narrative review examines current and emerging uses of AI in nutrition care within the Nutrition Care Process framework, with attention to assessment, monitoring and evaluation, diagnosis, intervention, [...] Read more.

Artificial intelligence (AI) is increasingly being applied in healthcare, with growing relevance to clinical nutrition. This narrative review examines current and emerging uses of AI in nutrition care within the Nutrition Care Process framework, with attention to assessment, monitoring and evaluation, diagnosis, intervention, and clinical support tools. Current applications include AI-assisted dietary assessment using image recognition, wearable sensors, analysis of continuous glucose and other physiologic data for early risk detection, and support for malnutrition screening and diagnosis. AI is also being explored for identifying micronutrient deficiencies and complications of nutrient excess, as well as for screening and early intervention in eating disorders. In nutrition intervention, AI has potential to support personalized dietary planning, nutrition support in intensive care settings, behavioral interventions, and precision nutrition approaches such as digital twins. Additional applications include clinical decision support and documentation assistance. However, despite its usefulness, concerns about AI systems exist. Its performance depends on the quality of the data used to train it; it can introduce bias, and it can produce inaccurate or misleading outputs. In addition, overreliance on AI may also reduce clinician attentiveness and contribute to cognitive errors. For these reasons, AI should be regarded as a support tool rather than a replacement for human clinical care. Overall, AI offers substantial opportunities to improve the personalization, efficiency, and scalability of clinical nutrition practice, but its safe and effective implementation will require continued validation, careful oversight, and integration with clinical expertise. Full article

(This article belongs to the Special Issue Artificial Intelligence-Enhanced Nutritional Approaches: Dietary Innovations and Chronic Disease Management)

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Graphical abstract

20 pages, 295 KB

Open AccessArticle

Development and Validation of the Food Consumption Rate Questionnaire (FCRQ): A Behaviorally Informed Measure of Eating-Rate Regulation

by Maria P. Koliou, Chrysoula Karaiskou, Charalampos Eleftheriadis and Dimitris Skalkos

Nutrients 2026, 18(16), 2637; https://doi.org/10.3390/nu18162637 - 12 Aug 2026

Abstract

Background: Eating-rate regulation is a multidimensional behavioral process shaped by oral-processing dynamics, interoceptive cues, sensory engagement, and contextual influences. Despite its relevance, no validated self-report instrument currently assesses these mechanisms. Methods: The Food Consumption Rate Questionnaire (FCRQ) was developed as a behaviorally informed [...] Read more.

Background: Eating-rate regulation is a multidimensional behavioral process shaped by oral-processing dynamics, interoceptive cues, sensory engagement, and contextual influences. Despite its relevance, no validated self-report instrument currently assesses these mechanisms. Methods: The Food Consumption Rate Questionnaire (FCRQ) was developed as a behaviorally informed tool for measuring eating-rate regulation. Item generation followed a theory-driven process supported by expert review, forward–backward translation, and pilot testing. Structural validity was examined through Exploratory Factor Analysis (Principal Axis Factoring, Promax rotation) and a theory-driven Confirmatory Factor Analysis evaluating the proposed four-domain model. Reliability was assessed using Cronbach’s α and corrected item–total correlations. Behavioral heterogeneity was explored using hierarchical and k-means cluster analysis. Results: A clear four-factor structure emerged—Slowness, Awareness of Eating Rate, External Factors, and Awareness & Enjoyment—explaining 42.77% of the variance. CFA indicated acceptable model fit (CFI = 0.93, TLI = 0.91, RMSEA = 0.052), supporting the adequacy of the theoretical structure. Reliability indices were consistent with the multidimensional nature of the construct. All four domains were positively correlated. Cluster analysis identified distinct behavioral profiles, illustrating the instrument’s discriminative capacity. Conclusions: The FCRQ provides the first behaviorally informed, psychometrically evaluated framework for assessing eating-rate regulation. The instrument demonstrates a coherent theoretical structure, satisfactory early-stage validity, and the ability to differentiate meaningful behavioral patterns. Continued refinement and validation across diverse populations will further establish the FCRQ as a robust measure for behavioral-nutrition research and practice. Full article

(This article belongs to the Section Nutrition and Public Health)

24 pages, 2115 KB

Open AccessArticle

Clustering of Unhealthy Diets, Inflammation Levels, and Depressive Symptoms in Chinese Adolescents: A Longitudinal Study

by Honglv Xu, Dongyue Hu, Xiaoxiao Li, Jiaxing Yang, Danyun Rui, Na Liu, Huijuan Wu, Jieru Yang, Litao Chang and Feng Jiao

Nutrients 2026, 18(16), 2636; https://doi.org/10.3390/nu18162636 - 12 Aug 2026

Abstract

Background/Objectives: Studies suggest a potential link between dietary behaviors, inflammation, and depressive symptoms in adolescents, but longitudinal evidence remains scarce. This study examines the longitudinal associations among unhealthy diets, inflammatory markers, and depressive symptoms in Chinese adolescents. Methods: This prospective longitudinal study enrolled [...] Read more.

Background/Objectives: Studies suggest a potential link between dietary behaviors, inflammation, and depressive symptoms in adolescents, but longitudinal evidence remains scarce. This study examines the longitudinal associations among unhealthy diets, inflammatory markers, and depressive symptoms in Chinese adolescents. Methods: This prospective longitudinal study enrolled 1693 middle school students (52.3% female) from Yunnan Province, China. Participants were assessed at five waves: October 2022 (T1), June 2023 (T2), October 2023 (T3), June 2024 (T4), and October 2024 (T5). Unhealthy dietary behaviors were assessed using a Food Frequency Questionnaire, and depressive symptoms were measured with the Children’s Depression Inventory. Blood samples were collected to measure inflammatory markers. Generalized estimating equations, generalized linear models, and path analysis were applied to examine the associations and mediating pathways. Results: Prevalence of depressive symptoms increased from 26.3% to 37.3% over 2 years. Compared with Q1 (the lowest quartile), Q4 of unhealthy dietary scores was significantly associated with an increased risk of positive depression symptoms (adjusted OR = 1.20). IL-4 (β =−0.26–−0.17) and CRP (β = 0.64–1.07) were associated with depressive symptoms. However, the mediating role of inflammation in the association between unhealthy dietary scores and depressive symptoms was not statistically significant. Conclusions: Chinese adolescents exhibit both a high clustering of unhealthy dietary behaviors and notably elevated levels of inflammation. Our longitudinal study indicates that the clustering of unhealthy diets and inflammation levels are associated with depressive symptoms among Chinese adolescents. Full article

(This article belongs to the Topic Lifestyle, Health and Mental Well-Being Across the Lifespan)

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25 pages, 2354 KB

Open AccessReview

The Lectin Pathway of Complement as a Sentinel for Nutritional and Metabolic Status: From Molecular Immunomodulation by Nutrients to Public Health Perspectives

by Tomasz Olszowski and Dariusz Chlubek

Nutrients 2026, 18(16), 2635; https://doi.org/10.3390/nu18162635 - 12 Aug 2026

Abstract

The lectin pathway (LP) of complement activation functions as a crucial effector of innate immunity and a homeostatic sensor operating at the intersection of systemic metabolism, nutritional status, and endothelial integrity. This review provides a comprehensive synthesis of current molecular, clinical, and epidemiological [...] Read more.

The lectin pathway (LP) of complement activation functions as a crucial effector of innate immunity and a homeostatic sensor operating at the intersection of systemic metabolism, nutritional status, and endothelial integrity. This review provides a comprehensive synthesis of current molecular, clinical, and epidemiological literature regarding the environmental and metabolic regulation of this pathway. First, we summarize the biophysical, structural, and stoichiometric requirements for divalent cations in fluid-phase activation and macromolecular assembly, integrating the contrasting roles of calcium (Ca²⁺) and zinc (Zn²⁺) into an explanatory Dual-Cation Dichotomy Framework. Second, we evaluate the transcriptomic mechanisms of nutrigenetic licensing, reviewing how fat-soluble vitamins sustain endoplasmic reticulum chaperone networks and mucosal barrier competence. We discuss how these micronutrient-driven axes interact with host genetic diversity, presenting a Nutrigenetic Rescue Framework to contextualize the environmental modulation of low-expressing MBL2 alleles. Third, the LP responds to metabolic and endocrine shifts, focusing on its biomarker value in gestational diabetes and its clinical patterns in type 1 diabetes. These connections to metabolic disease and related microvascular complications are further integrated into a broader Somatotropic-Gestational Sentinel Hypothesis. Fourth, we connect these metabolic profiles with public health challenges, reviewing LP hyperactivation in viral infections and discussing localized surface plasmon resonance (LSPR) biosensors, at present a conceptual, preclinical technology, as a candidate approach for future point-of-care population screening. In conclusion, bridging nutritional biochemistry with metabolic endocrinology and diagnostic technologies that remain largely preclinical outlines a potential shift from empiric management toward biomarker-driven, point-of-care stratification, which could help mitigate both infectious thromboinflammation and chronic microvascular failure once these technologies undergo further mechanistic and clinical validation. Full article

(This article belongs to the Section Nutrition and Metabolism)

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15 pages, 870 KB

Open AccessArticle

Mapping Knowledge Gaps: A Needs Assessment of Sorghum, Whole Grains Knowledge and Prediabetes Risk

by Andrea Sosa-Holwerda, Surya Raj Niraula, Wilna Oldewage-Theron, Naima Moustaid-Moussa, Leslie Thompson and Oak-Hee Park

Nutrients 2026, 18(16), 2634; https://doi.org/10.3390/nu18162634 - 12 Aug 2026

Abstract

Objectives: The objective of this cross-sectional online survey was to determine university students’ knowledge about whole grain (WG), sorghum, and prediabetes risk. Methods: The survey included 45 items to learn about the students’ WG perception, practices, primary nutrition information source, and [...] Read more.

Objectives: The objective of this cross-sectional online survey was to determine university students’ knowledge about whole grain (WG), sorghum, and prediabetes risk. Methods: The survey included 45 items to learn about the students’ WG perception, practices, primary nutrition information source, and physical activity level (PAL). Recruitment was carried out using the university’s official email announcement and data was collected through Qualtrics. Two-hundred-and-forty-eight undergraduate and graduate students, aged 18–44 years, completed the questionnaire. Results: Sixty-three percent of the students were at risk of prediabetes based on the CDC Prediabetes Risk Test, a recommended screening tool by the National Diabetes Prevention Program. Compared to females, males were at a significantly higher risk of prediabetes and T2DM. Males had a mean ± sd score of 1.70 ± 0.93 versus females (0.64 ± 0.92), (t(246) = −9.07, p < 0.001). Participants scored low on overall knowledge (sorghum and WG combined) (4.21 ± 2.04), WG knowledge (2.82 ± 1.03) and sorghum knowledge (3.21 ± 1.23). Despite reporting a high PAL, less than half had a very good health status, with 45.2% of them having overweight or obesity. Social media was the main nutrition information source for 60% of participants. Logistic regression showed that students with obesity had almost four times greater odds compared to those with normal weight (OR = 3.97, 95% CI: 1.66–9.45, p = 0.002). Conclusions: These results have important public health implications, providing the rationale for our future research on a theory-based nutrition education intervention emphasizing sorghum consumption and metabolic effects on individuals with overweight and obesity, aiming to combat diet-related diseases. Full article

(This article belongs to the Section Nutrition and Public Health)

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21 pages, 17165 KB

Open AccessArticle

Kaempferol Alleviates Aflatoxin B1-Induced Liver Injury by Mitigating Oxidative Stress

by Zongmin Shu, Qingyi Zhou, Mao Zhu, Lan Yang, Yujie Chen, Yongyun Zhang, Junlong Bi, Weizhen Li and Ming Li

Nutrients 2026, 18(16), 2633; https://doi.org/10.3390/nu18162633 - 12 Aug 2026

Abstract

Background Aflatoxin B1 (AFB1) is a potent hepatotoxic mycotoxin that induces severe oxidative liver damage. Kaempferol (Kae), a natural flavonoid with known antioxidant properties, has unclear protective effects against AFB1-induced hepatotoxicity. This study aimed to evaluate the hepatoprotective role of Kae and elucidate [...] Read more.

Background Aflatoxin B1 (AFB1) is a potent hepatotoxic mycotoxin that induces severe oxidative liver damage. Kaempferol (Kae), a natural flavonoid with known antioxidant properties, has unclear protective effects against AFB1-induced hepatotoxicity. This study aimed to evaluate the hepatoprotective role of Kae and elucidate its underlying mechanism using integrated in vivo, in silico, and in vitro approaches. Methods: In vivo (AFB1-challenged mice) and in vitro (hepatocyte) models were employed, combined with network pharmacology, molecular docking, and molecular dynamics simulations. Liver injury indices, oxidative stress markers, antioxidant enzyme activities, and Keap1/Nrf2 pathway expression were assessed. Results: Kae co-treatment reversed AFB1-induced increases in liver index, serum ALT/AST, histological lesions, and reduced antioxidant capacity in mice. Network pharmacology revealed 59 common targets, with NFE2L2 (Nrf2) as a key node. In vitro, Kae pretreatment significantly lowered AFB1-elevated ROS, MDA, ALT, and AST, while restoring GSH and total antioxidant capacity. Kae reversed AFB1-induced Keap1 upregulation and Nrf2 downregulation, and increased mRNA levels of HO-1, NQO1, SOD, GPX1, and CAT. Molecular docking and simulation showed stable Kae–Keap1 binding (−9.6 kcal/mol) with critical hydrogen bonds (VAL-606) and van der Waals contacts. Conclusions: Kae directly binds Keap1, activates Nrf2 signaling, upregulates antioxidant gene expression, and mitigates AFB1-induced oxidative liver injury. These findings support Kae as a promising candidate for preventing AFB1 hepatotoxicity. Full article

(This article belongs to the Section Nutrition and Metabolism)

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16 pages, 1658 KB

Open AccessArticle

Effects of a Multi-Component Nutraceutical (NUT2) on the Lipid Profile in Adults with Low-to-Moderate Cardiovascular Risk: A Randomized Placebo-Controlled Trial

by Vincenzo De Leo, Claudio Citterio, Adam B. Smith and Neil Fawkes

Nutrients 2026, 18(16), 2632; https://doi.org/10.3390/nu18162632 - 12 Aug 2026

Abstract

Background: Lifestyle intervention is recommended as first-line management for individuals with low-to-moderate cardiovascular (CV) risk and elevated low-density lipoprotein cholesterol (LDL-C), although dietary intervention alone often produces only modest lipid reductions. NUT2 is a proprietary multi-component nutraceutical formulated to target complementary pathways involved [...] Read more.

Background: Lifestyle intervention is recommended as first-line management for individuals with low-to-moderate cardiovascular (CV) risk and elevated low-density lipoprotein cholesterol (LDL-C), although dietary intervention alone often produces only modest lipid reductions. NUT2 is a proprietary multi-component nutraceutical formulated to target complementary pathways involved in lipid metabolism, oxidative stress and cardiometabolic risk. This study evaluated its efficacy and safety as an adjunct to dietary intervention. Methods: In this randomized, double-blind, placebo-controlled, parallel-group study, 90 adults with low-to-moderate CV risk and elevated LDL-C were randomized to receive NUT2 (n = 45) or placebo (n = 45) for 12 weeks, together with standardized dietary advice. The primary endpoint was a change in LDL-C at Week 12. Secondary outcomes included changes in total cholesterol, triglycerides, fasting glucose, fasting insulin, high-sensitivity C-reactive protein (hsCRP), homocysteine, anthropometric parameters, blood pressure and metabolic syndrome prevalence. Results: Baseline characteristics were generally comparable, although baseline lipid values differed between groups and were accounted for using baseline-corrected change scores. At Week 12, LDL-C decreased by 13.2% with NUT2 and increased by 1.6% with placebo; the baseline-corrected between-group difference was −23 mg/dL (95% CI −29 to −16; p < 0.001). Total cholesterol was also significantly reduced (corrected difference −26 mg/dL, 95% CI −36 to −17; p < 0.001). Significant reductions in homocysteine and lower fasting insulin concentrations were observed with NUT2. Metabolic syndrome prevalence was 13.3% with NUT2 versus 37.8% with placebo at Week 12 (p = 0.008), although this exploratory finding was based on small participant numbers. No significant between-group difference was observed for hsCRP. NUT2 was well tolerated, with no serious treatment-related adverse events. Conclusions: In adults with low-to-moderate cardiovascular risk whose LDL-C remained suboptimal despite dietary intervention, NUT2 produced significant and clinically relevant improvements in LDL-C and total cholesterol over 12 weeks. The significant reduction in homocysteine further supports the broader biological activity of the multi-component formulation. Favourable changes in insulin and metabolic syndrome status suggest potential additional metabolic effects, although these findings warrant further investigation in larger studies specifically designed for populations with metabolic dysfunction. NUT2 was safe and well tolerated. (Clinical trial registry: NCT07492264; trial registration number: NCT07492264, registration date: 23 March 2026.) Full article

(This article belongs to the Section Phytochemicals and Human Health)

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18 pages, 17431 KB

Open AccessArticle

Maternal Excessive Lard Versus Palm Oil Intake in Mice Drives Sex-Specific Reproductive Dysfunction in Offspring

by Yan Xu, Yue Zhang, Kaile Guan, Qi Chen, Chenchen Geng, Lingfeng Dan, Jiaxin Zhao, Yansong Zhang and Huimin Lu

Nutrients 2026, 18(16), 2631; https://doi.org/10.3390/nu18162631 - 12 Aug 2026

Abstract

Objectives: This study clarified sex-specific short- and long-term impacts of maternal excessive palm oil (plant-derived saturated) and lard (animal-derived saturated fat) intake on offspring reproductive health and underlying mechanisms. Methods: Female mice were randomized to control, palm oil, or lard diets [...] Read more.

Objectives: This study clarified sex-specific short- and long-term impacts of maternal excessive palm oil (plant-derived saturated) and lard (animal-derived saturated fat) intake on offspring reproductive health and underlying mechanisms. Methods: Female mice were randomized to control, palm oil, or lard diets during gestation and lactation. Offspring received a control diet post-weaning until adulthood, followed by an optional 16-week HFD rechallenge. Gonadal weight and organ index, sperm quality, ovarian follicle number, serum sex hormones, metabolic phenotypes (serum lipid profiles, glucose and insulin tolerance), oxidative stress, apoptosis, proliferation, and transcriptomic profiles were detected at weaning, early and late adulthood. Results: In males, excessive maternal lard intake significantly induces sperm malformation and reduces seminiferous tubule diameter and spermatogenic epithelium thickness upon HFD rechallenge during adulthood, with no changes in oxidative stress, proliferation, and apoptosis. Transcriptomics identified Slc24a5 upregulation as a potential correlate through metal ion transmembrane transporter activity and cellular calcium ion homeostasis. Under normal adult diets, reduced sperm motility resulting from maternal excess lard may be mediated by apoptosis, whereas that induced by maternal high palm oil likely arises from suppressed proliferation and thinner spermatogenic epithelium. GO analysis revealed palm oil-specific Ugt1a5 upregulation associated with altered steroid hormone metabolism. In females, maternal palm oil intake reduced primordial follicles and increased atresia, with sequencing predicted to involve Nedd4 downregulation; lard intake elevated ovarian oxidative stress and atresia only upon HFD rechallenge, with Lamc3 upregulation predicted as a putative regulatory factor. Conclusions: Maternal excessive intake of saturated fat exerts offspring reproductive damage in a sex-specific and source-dependent manner with distinct mechanisms. This work provides novel insights into fat source-dependent and sex-specific effects of nutritional interventions during pregnancy and lactation. Full article

(This article belongs to the Section Lipids)

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16 pages, 1259 KB

Open AccessArticle

Low-Protein Diet Supplemented with Ketoanalogues and Progression of Chronic Kidney Disease in Diabetic Patients: A Multicenter Randomized Controlled Trial

by Ramón Paniagua, Marcela Ávila-Díaz, Julia Nava, Renata Romero-Salas, Juan Carlos H Hernández-Rivera, Oliva Mejía-Rodríguez, Giorgina B Picolli and Mexican Nephrology Collaborative Study Group

Nutrients 2026, 18(16), 2630; https://doi.org/10.3390/nu18162630 - 12 Aug 2026

Abstract

Background/Objectives: Low-protein diets (LPD) and very-low-protein diets supplemented with Ketoanalogues (sVLPD) delay initiation of dialysis in non-diabetic patients with chronic kidney disease (CKD). sVLPD is not recommended in patients with type 2 diabetes mellitus (T2DM), and information about LPD supplemented with Ketoanalogues [...] Read more.

Background/Objectives: Low-protein diets (LPD) and very-low-protein diets supplemented with Ketoanalogues (sVLPD) delay initiation of dialysis in non-diabetic patients with chronic kidney disease (CKD). sVLPD is not recommended in patients with type 2 diabetes mellitus (T2DM), and information about LPD supplemented with Ketoanalogues (LPD + KA) is scarce or inconclusive. The objective of this study is to provide further evidence on the benefits and safety of LPD supplemented with KA (LPD + KA) compared with LPD alone in reducing CKD progression in patients with T2DM. Methods: T2DM patients in stages 3b-4 of CKD (n = 149) were included in a multicenter, randomized, controlled trial and received LPD + KA or LPD, 1 year follow-up. Evaluations were carried out bimonthly. In both groups, protein intake was 0.6 g/kg/day, and the LPD + KA group received KA at the recommended dose. The primary outcome was a decline in eGFR, calculated with Creatinine and with Cystatin C. Secondary outcomes were dialysis requirement, deterioration in nutritional status, hospitalization, morbidity, and mortality. Results: During follow-up, protein nitrogen appearance was 0.556 ± 0.119 and 0.576 ± 0.134 g/kg/day in LPD + KA and LPD, respectively (p = 0.002). The decrease in eGFR_CysC from the baseline was −4.29 ± 0.96 mL/min in LPD + KA and −8.54 ± 2.19 mL/min in LPD (using linear mixed-effects model, p = 0.012). eGFR_Cr did not show differences. There were no differences in nutrition status, metabolic control, adverse events, hospitalizations, or hospital days. Conclusions: Ketoanalogues slow the decline in eGFR_CyC but not eGFR_Cr in T2DM patients, even without differences in protein intake. LPD + KA may be considered useful and safe; however, due to limitations in sample size and follow-up, as well as observed changes in Cr metabolism, the results warrant confirmation with a more robust design and a longer follow-up period. Full article

(This article belongs to the Section Nutrition and Diabetes)

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14 pages, 1189 KB

Open AccessArticle

Association of Mediterranean Diet Adherence with Self-Reported Muscle-Related Functional Status and Fracture Probability in Postmenopausal Women Evaluated for Osteoporosis: A Cross-Sectional Study

by Cecilia Oliveri, Herbert Ryan Marini, Nunziata Morabito, Letteria Minutoli, Giovanni Squadrito, Silvia Migliaccio, Agostino Gaudio and Antonino Catalano

Nutrients 2026, 18(16), 2629; https://doi.org/10.3390/nu18162629 - 12 Aug 2026

Abstract

Background: Osteoporosis and sarcopenia frequently coexist in older adults and jointly contribute to increased risk of falls and fragility fractures. While adherence to the Mediterranean diet (MD) has been broadly associated with favorable health outcomes, its potential role in modulating muscle-related functional status [...] Read more.

Background: Osteoporosis and sarcopenia frequently coexist in older adults and jointly contribute to increased risk of falls and fragility fractures. While adherence to the Mediterranean diet (MD) has been broadly associated with favorable health outcomes, its potential role in modulating muscle-related functional status and, indirectly, fracture risk remains incompletely understood. Objective: To investigate the association between adherence to MD and SARC-F-assessed functional status, and to explore their interplay with FRAX-estimated fracture probability in postmenopausal women evaluated for osteoporosis. Methods: Adherence to the MD was assessed using the Medi-Lite questionnaire. Muscle-related functional status was evaluated through the SARC-F questionnaire and objectively measured by handgrip strength. Fracture probability was estimated using the FRAX tool. Correlation and multivariable analyses were performed to evaluate associations among study variables. In addition, an exploratory indirect-effect analysis was conducted to investigate whether functional status might represent a potential intermediate pathway linking MD adherence and FRAX-estimated fracture probability. Results: A total of 96 participants (median age 66 years) were consecutively recruited. Greater adherence to the MD was associated with lower SARC-F scores (r = −0.292; p = 0.005), indicating better muscle-related functional status. SARC-F scores were inversely correlated with handgrip strength (r = −0.264; p = 0.013) and positively correlated with the estimated 10-year probability of major osteoporotic fractures (r = 0.289; p = 0.005) and hip fractures (r = 0.277; p = 0.008). No significant associations were observed between MD adherence and FRAX-estimated fracture probability, bone mineral density, or prevalent fractures. In the exploratory indirect-effect analysis, a significant indirect association between MD adherence and FRAX-estimated fracture probability through SARC-F score was observed, whereas the direct association was not significant. Conclusions: In postmenopausal women referred for osteoporosis evaluation, greater adherence to the MD was associated with better self-reported muscle-related functional status but not directly with FRAX-estimated fracture probability. These findings are consistent with the hypothesis that functional status may represent an intermediate link between dietary habits and estimated fracture risk. However, because dietary adherence, functional status, and fracture risk were assessed simultaneously, no causal or temporal inferences can be drawn. Consequently, the indirect-effect findings should be regarded as exploratory and hypothesis-generating, requiring confirmation in adequately powered longitudinal and mechanistic studies. Full article

(This article belongs to the Special Issue Nutritional Epidemiology of Osteoporosis: From Peak Bone Mass to Healthy Aging)

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