Nutrients doi: 10.3390/nu18182945

Authors: José Luis Pino-Villalón Bastian Parada-Flores Miguel Arredondo Roberto Fuentealba Jessica Noack Exal Garcia-Carrillo

Background/Objectives: Dietary fiber supplementation has been associated with blood pressure (BP) reduction, but evidence comparing soluble (SDF) and insoluble (IDF) fiber types in high-risk populations is limited. This study aimed to compare the effects of SDF and IDF supplementation on BP and to explore correlations between changes in BP and alterations in gut microbiota composition and serum biomarkers in adults with type 2 diabetes (T2D) and hypertension. Methods: This secondary analysis was based on a 12-week, randomized, double-blind, parallel-group clinical trial. Thirty-five adults with T2D and hypertension were assigned to receive either 5 g/day of oat β-glucan (SDF, n = 19) or microcrystalline cellulose (IDF, n = 16). BP, gut microbiota composition (quantitative polymerase chain reaction; qPCR), and inflammatory biomarkers were assessed at baseline and after the intervention. Results: The mean age of the participants was 50.7 ± 5.7 years, and 77% were female. Both groups exhibited comparable reductions in systolic blood pressure (SBP) (SDF: −11.2 ± 20.9 mmHg; IDF: −11.6 ± 17.0 mmHg; p = 0.965 between groups). In the SDF group, significant positive correlations were observed between increases in Firmicutes abundance and changes in diastolic blood pressure (DBP) (r = 0.90, p < 0.01), as well as between increases in Bifidobacterium spp. abundance and changes in DBP (r = 0.90, p < 0.05). Conclusions: Supplementation with either soluble or IDF was associated with reductions in SBP in this sample of adults with T2D and hypertension. The observed associations between changes in gut microbiota composition and BP should be considered exploratory and interpreted with caution. Placebo-controlled studies are required to confirm these findings and elucidate the underlying biological mechanisms.

Nutrients doi: 10.3390/nu18182943

Authors: Dana Popescu-Spineni Leila Karimi Laima Brazionis Elena Philippou Audrey Tierney Jelena Helene Cvejić Linda Errington Labros Sidossis Catherine Itsiopoulos

Background: The Mediterranean diet (MD) has well-established health benefits, yet modern food systems are driving a nutrition transition. Quantifying how Mediterranean countries have shifted relative to global trends is essential for evidence-based public health. Aim: Dietary changes between 1990 and 2018 were examined in Mediterranean coastline countries (MED) in comparison with high-income non-Mediterranean countries (HIC non-MED) and middle-/low-income non-Mediterranean countries (MLIC non-MED). Methods: Using the Global Dietary Database, within-country changes (1990 vs. 2018) for 13 food categories were analysed across 185 nations in three groups: MED countries (n = 21), HIC non-MED (n = 18), and MLIC non-MED (n = 146). MED countries were further grouped into Southern Europe (SE), Western Asia (WA), and North Africa (NA). Paired unweighted country-level analyses were the primary analyses; population-weighted analyses were sensitivity checks. Benjamini–Hochberg’s false-discovery-rate correction and centred log-ratio compositional analysis were applied. Results: MED seafood intake rose from 20.5 to 33.8 g/day (Δ = +13.3 g/day; 95% CI: +6.2 to +18.4; q = 0.003), and non-starchy vegetables increased from 135.5 to 173.6 g/day (Δ = +38.0 g/day; q = 0.626). Refined/starchy carbohydrate intake rose by 63.3 g/day in MED countries while declining by 33.6 g/day in HIC non-MED countries (between-group divergence +96.9 g/day; q = 0.006). Nuts and seeds rose across all groups; legumes declined modestly in MED countries. Saturated fatty acids + omega-6 polyunsaturated fatty acids (% kcal) rose by +0.6 percentage points in MED countries but fell in HIC non-MED countries. Monounsaturated fatty acids were stable. MED-WA showed the greatest overall divergence from the SE 1990 pattern. Conclusions: These findings highlight a public health paradox: the MD is globally promoted as a model of healthy eating, yet adherence within its region of origin is declining. Targeted, region-specific strategies are urgently needed to preserve beneficial MD elements while addressing emerging diet-related risks.

Nutrients doi: 10.3390/nu18182942

Authors: Rajalakshmi Ramashetty Rimshia Naaz Ramya C M SubbaRao V. Madhunapantula Chinnappa A. Uthaiah

Introduction: Vitamin D status has been investigated as a modifiable risk factor with cognitive decline. However, studies pertaining to this remain inconsistent across populations, and there are fewer studies associating vitamin D status, cognitive decline, amyloid markers and oxidative stress markers in older adults. Therefore, this study was conducted to analyze the association between these parameters. Methodology: This cross-sectional study included 145 older adults aged between 51 and 80 years. Participants were categorized based on serum vitamin D levels into sufficient (n = 53), insufficient (n = 61), and deficient (n = 31) groups. Cognitive performance was assessed using the Modified Mini Mental State (3MS) test. Plasma levels of Aβ 1-40 and Aβ 1-42 and oxidative stress markers (TBARS, GPx, SOD) were measured. Statistical analysis was performed using ANOVA and Spearman’s correlation. Results: Results showed that the vitamin D concentrations did not differ significantly between cognitively impaired and normal individuals within vitamin D strata (vitamin D sufficient, insufficient and deficient groups). Plasma Aβ 1-40 levels were significantly elevated in cognitively impaired participants across all vitamin D groups. A reduced Aβ 1-42/Aβ 1-40 ratio was observed in sufficient and insufficient Vitamin D groups. Additionally, GPx levels were significantly higher in the vitamin D-deficient group. Correlation analysis showed that 3MS scores were negatively associated with age (r = −0.2607, p = 0.0015), Aβ 1-40 (r = −0.4016, p = 0.0001), and Aβ 1-42 (r = −0.3025, p = 0.0002), and positively correlated with Aβ 1-42/Aβ 1-40 ratio (r = 0.2176, p = 0.0086). Conclusions: These findings suggest that cognitive impairment in older adults is strongly associated with amyloid burden, oxidative stress, and age, whereas vitamin D status was not directly correlated with cognitive performance in this cohort.

Nutrients doi: 10.3390/nu18182941

Authors: Linxi Huang Jihyun Yoon

Background/Objectives: This study aimed to identify demographic factors associated with perceived food label literacy and use among adults in Seoul and to examine differences in food consumption across perceived food label literacy and use groups. Methods: This study analyzed secondary data from the Seoul Food Survey 2025, which included 3024 adults aged ≥18 years. Perceived food label literacy and use were each dichotomized into high and low levels, yielding four groups based on their combination. Logistic regression and analysis of covariance were used to examine demographic factors and differences in food consumption. Results: The proportions of the high literacy–high use, high literacy–low use, low literacy–high use, and low literacy–low use groups were 37.5%, 21.4%, 12.1%, and 28.9%, respectively. Compared with the high literacy–high use group, men were more likely than women, and individuals with lower educational levels were more likely than those with a college graduation or higher to belong to both the high literacy–low use and low literacy–low use groups. The low literacy–low use group reported more frequent consumption of several processed foods, such as high-fat bread/snacks and sugar-sweetened beverages, and less frequent consumption of several fresh foods, such as fruits and whole grains, than at least one other group (p < 0.05). Conclusions: Men and individuals with lower educational levels emerged as potential priority populations for food label interventions addressing both perceived food label literacy and use. Those with low literacy and low use showed less favorable food consumption patterns.

Nutrients doi: 10.3390/nu18182940

Authors: Julia Śnieżek Ewelina Polak-Szczybyło

Introduction: Selective serotonin reuptake inhibitors (SSRIs) remain the first-line pharmacological treatment for depressive disorders. However, long-term treatment is often accompanied by weight gain, which negatively impacts medication adherence and cardiometabolic health. Emerging evidence suggests that, in addition to their effects on the central nervous system (CNS), SSRIs may alter the composition and metabolic activity of the gut microbiome, potentially contributing to metabolic disorders. However, the mechanisms linking SSRI-induced microbial changes to weight regulation remain poorly understood. Methods: This narrative review summarizes the current evidence regarding the interactions between SSRIs, the gut microbiome, host metabolism, and weight regulation. Experimental, translational, and clinical studies were critically assessed, with particular emphasis on recent systematic reviews, meta-analyses, randomized controlled trials, and mechanistic studies. A conceptual mechanistic framework was developed based on the available evidence. Results: Experimental and clinical studies indicate that SSRIs can modify both the taxonomic composition and functional activity of the gut microbiota. These changes may influence the production of microbiota-derived metabolites, including short-chain fatty acids, bile acids, and tryptophan metabolites, thereby influencing gut barrier integrity, low-grade inflammation, gut hormone secretion, appetite regulation, and energy homeostasis. Current evidence also suggests that dietary interventions—including increased dietary fiber intake, adherence to a Mediterranean diet, and microbiota-targeted strategies using prebiotics, probiotics, synbiotics, and postbiotics—can beneficially modulate these pathways. However, no randomized, controlled trials have specifically assessed whether such interventions prevent SSRI-associated weight gain. Conclusions: Taken together, the available evidence raises the possibility that gut microbiota alterations may contribute to SSRI-associated weight gain, although this hypothesis has not yet been directly tested in studies evaluating the complete mechanistic pathway.

Nutrients doi: 10.3390/nu18172939

Authors: Samar El Sherbiny Valeria Bellisario Emilie Marion Canuto Andrea Puppo Luca Marozio Roberto Bono

Background: Diet during pregnancy plays a crucial role in promoting healthy dietary behaviours and positive maternal and child health outcomes. However, evidence regarding the factors associated with healthy dietary behaviours among pregnant women is limited. The SaperePer study aims to assess the dietary behaviours of pregnant women and identify the sociodemographic, lifestyle, and health-related factors that influence their choices. Methods: This cross-sectional analysis included 1254 pregnant women recruited from two Northern Italian centres (Turin and Cuneo). Dietary behaviour was assessed using a questionnaire, which generated a diet-related scores. Associations between these scores and participants’ characteristics were investigated using multivariable regression models. Results: Overall, participants reported relatively favourable dietary habits and a low prevalence of risky behaviours. Higher socioeconomic position was found to be one of the strongest contributing factors to dietary behaviour (medium vs. low β (95% CI) = 1.18 (0.93, 1.42); high vs. low β (95% CI) = 1.57 (1.10, 2.04), both p < 0.001). Higher dietary behaviour scores were positively associated with older maternal age, moderate physical activity, and better perceived physical and psychological health, whereas smoking and alcohol consumption were associated with lower scores. Conclusions: Dietary behaviour during pregnancy appears to be shaped by a complex interplay of socioeconomic, behavioural, and health-related factors rather than by nutritional knowledge alone. These findings highlight the need for tailored interventions that address the social and contextual features of dietary behaviour to encourage healthier habits during pregnancy.

Nutrients doi: 10.3390/nu18172938

Authors: Hannah Sabados Sandra Möwius Ute M. Stern Maurice Michel Jörn M. Schattenberg Verena Keller

Background: Obesity is frequently accompanied by metabolic dysfunction and micronutrient deficiencies, yet data on individuals with severe obesity (BMI ≥ 50 kg/m2) remain limited. Understanding how vitamin and mineral status changes across the adiposity continuum may optimize personalized nutritional management in severe obesity. Methods: We analyzed anthropometric, metabolic, hepatic, and micronutrient parameters in a retrospective, single-center cohort of adults evaluated before bariatric surgery, with a BMI range of 30 to 91 kg/m2 (mean 48.7 ± 8.7). Measurements included bioimpedance-derived body composition, liver elastography (CAP and stiffness), and fasting laboratory parameters, vitamins B1, B6, B12, D, and folate and minerals (iron, selenium, and magnesium). Correlation analysis, principal component analysis (PCA), and random forest (RF) classification were applied to identify the variables most strongly associated with BMI and metabolic phenotypes. Results: Several micronutrient concentrations, most notably vitamin D, folate and vitamin B6, declined progressively with increasing BMI. Vitamin D additionally correlated inversely with HbA1c. PCA revealed a separation of participants with extreme obesity driven by anthropometric and hepatic parameters, while micronutrients clustered inversely. RF classification identified HbA1c, hepatic enzymes (ALAT and γ-GT) and body-composition measures (waist circumference and visceral fat) as the strongest discriminators of T2DM, MASLD and high BMI, respectively. Combined MASLD and T2DM was associated with the most pronounced vitamin B6 depletion, whereas vitamin D was low across metabolic subgroups. Conclusions: Severe obesity is associated with distinct micronutrient depletion patterns that mirror metabolic deterioration. Integrating nutritional and metabolic profiling enables refined risk stratification and may, pending prospective validation, inform targeted supplementation strategies in individuals with severe obesity.

Nutrients doi: 10.3390/nu18172937

Authors: Ayusha Pandey Dasol Park Suyong Shin Jungsang Kim Minwhee Kang Donghun Lee Junho Kim Chunghee Kim Jiyoung Son Seonghyeon Jeon Minwoo Bang Byungsoo Kang Jungtae Leem

Background and Objectives: Although herbal medicine-based obesity treatment programs are used in obesity management, empirical research on patient acceptability remains limited. This study examined acceptability of a Korean medicine-based obesity treatment program (KM-OBP) among patients who achieved predefined weight-loss targets in routine clinical care. Materials and Methods: Medical records and satisfaction survey data routinely collected during clinical practice at a single Korean medicine clinic were retrospectively analyzed. Patients had baseline body mass index (BMI) ≥ 30 kg/m2 and achieved both ≥10% weight loss and BMI ≤ 23 kg/m2 during follow-up. BMI trajectories and adverse-event occurrence were summarized descriptively. Satisfaction ratings were reported on a 5-point Likert scale, and free-text responses were retrospectively analyzed using the Theoretical Framework of Acceptability. Results: Of 3798 patients with a baseline BMI ≥ 30 kg/m2 and at least two BMI measurements, 37 (0.97%) met the predefined targets; 16 completed the satisfaction survey. Mean BMI change from the first to last measurement was −8.9 kg/m2, and median change was −8.8 kg/m2 (interquartile range, −9.6 to −7.7). Common documented adverse events were constipation, nausea, and dizziness. Satisfaction ratings were descriptively high for the overall program, perceived helpfulness for obesity treatment, and herbal medicine. Among the 16 survey respondents, perceived weight-loss benefits, program structure, safety, and health improvement were described as facilitators of acceptability, whereas post-treatment weight regain, dietary burden, and financial concerns were described as barriers. Conclusions: The findings characterize satisfaction and reported acceptability experiences among survey respondents within a highly selected target-achieving cohort. Interpretation is limited by outcome-based selection, potential non-response bias, the small survey sample, and the single-center design.

Nutrients doi: 10.3390/nu18172936

Authors: Zhiyue Chen Ailing Liu Shuran Bian Zhize Zhou Dong Zhang

Background/Objectives: Obesity is frequently associated with chronic low-grade inflammation, which contributes to metabolic dysfunction. However, the comparative effects of nutritional supplements on inflammatory biomarkers in adults with overweight or obesity remain unclear. To address this gap, this paper presents a systematic review and network meta-analysis comparing 14 supplementation strategies for their effects on inflammatory biomarkers in this population. Methods: PubMed, Embase, EBSCO, Web of Science, and the Cochrane Library were searched for randomized controlled trials published between January 2000 and January 2026. A frequentist random-effects network meta-analysis was conducted. Effects were reported as mean differences (MDs) with 95% confidence intervals (CIs), and interventions were ranked using the surface under the cumulative ranking curve (SUCRA). The confidence in network estimates was assessed using the Confidence in Network Meta-Analysis (CINeMA) framework. Results: A total of 60 randomized controlled trials were included. Green tea extract (MD = −2.57, 95% CI [−3.99, −1.15]) and curcumin (MD = −1.75, 95% CI [−2.74, −0.76]) both significantly reduced IL-6 levels. Synbiotics (MD = −12.25, 95% CI [−16.7, −7.8]), curcumin (MD = −2.59, 95% CI [−3.83, −1.35]) and probiotics combined with omega-3 (MD = −6.19, 95% CI [−9.12, −3.26]) had a favorable effect on TNF-α. Probiotics combined with omega-3 (MD = −1.74, 95% CI [−3.03, −0.46]), synbiotics (MD = −1.19, 95% CI [−1.85, −0.53]), zinc (MD = −1.18, 95% CI [−2.24, −0.11]), and curcumin (MD = −1.11, 95% CI [−2.14, −0.07]) all reduced CRP levels. Synbiotics (MD = 15.37, 95% CI [12.13, 18.61]) increased adiponectin levels. In contrast, no nutritional supplement significantly reduced leptin levels. Exploratory meta-regression suggested that age, exercise co-interventions, and the proportion of male participants may partly explain heterogeneity in selected outcomes. Conclusions: Nutritional supplements showed biomarker-specific effects. Probiotics combined with omega-3 fatty acids, synbiotics, green tea extract, and curcumin may improve selected inflammatory biomarkers. However, differences in supplement dose, intervention duration, and participant characteristics warrant cautious interpretation and call for further high-quality trials.

Nutrients doi: 10.3390/nu18172935

Authors: Mengwei Cheng Tianyan Liu Xixian Wang Situ Xue

Camel milk has long been used as a traditional health-promoting food, and growing biomedical evidence now supports its modulatory effects across multiple age-related conditions. This narrative review evaluates current experimental and clinical findings on the effects of camel milk across major categories of age-related disease, spanning metabolic dysregulation, cardiovascular pathology, neurological dysfunction, and immune-inflammatory conditions. Across these conditions, camel milk has been reported to modulate oxidative stress, chronic inflammation, and metabolic homeostasis through shared molecular pathways, including NF-κB, MAPK, PI3K/AKT, and PPAR-α/γ signaling. Mapping these effects against the twelve hallmarks of aging reveals particular engagement with chronic inflammation, deregulated nutrient sensing, and dysbiosis. Collectively, the available evidence supports a biologically plausible role for camel milk in modulating key pathological processes associated with age-related disease. However, the clinical evidence remains limited across most disease areas, and future research should prioritize standardized clinical trials and systematic mechanistic validation, with particular attention paid to the bioavailability and dose–response characterization of key bioactive components. This review provides an integrative synthesis of camel milk research within the hallmarks of the aging framework, offering a cross-disease mechanistic perspective that extends beyond single-disease or compositional approaches.

Nutrients doi: 10.3390/nu18172934

Authors: Haoyu Wang Zhiyuan Ma Han Gong Yang Zou Haijiao Zhang Xiaohong Chen Xueying Mao

Background: Stigmasterol (St) holds promise as a natural cholesterol-lowering agent, yet its poor aqueous solubility and low bioaccessibility severely constrain its application in functional foods. Methods: In this study, we exploited whey protein peptides (WPP) with intrinsic cholesterol esterase (CEase) inhibitory activity to construct St-loaded self-assembled nanoparticles. Subsequently, we investigated its physicochemical properties and formation mechanism and evaluated its hypocholesterolemic activity through animal experiments. Results: Driven by non-covalent hydrophobic and hydrogen-bonding interactions, the optimized St-loaded WPP nanoparticles (St@WPP) ((234.47 ± 1.36) nm) achieved a high encapsulation efficiency (EE) of 74.73% ± 2.19%. This nano-encapsulation markedly improved St dispersibility and storage stability, and significantly elevated its bioaccessibility from 9.00% ± 0.14% to 19.41% ± 0.69% after simulated gastrointestinal digestion. St@WPP administration effectively ameliorated dyslipidemia, as evidenced by reduced serum total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), which may be associated with reduced intestinal cholesterol availability and increased fecal cholesterol content. Moreover, St@WPP alleviated hepatic steatosis, attenuated systemic inflammation, and rebalanced gut microbiota architecture. Conclusions: Collectively, the WPP shell functions as a delivery carrier that improves the water solubility and bioaccessibility of St, thereby broadening its potential for application in low-fat or aqueous-based food systems. The resulting St@WPP exhibits notable cholesterol-lowering activity, positioning it as a promising functional food ingredient with potential benefits for cholesterol management.

Nutrients doi: 10.3390/nu18172933

Authors: Alfredo Caturano Edoardo Mocini Luca Titi Francesco Leva Daniele Cannavaro Maria Grazia Tarsitano Caterina Conte

Background/Objectives: Clinically meaningful weight loss reduces fat mass but is commonly accompanied by loss of fat-free mass (FFM). Ketogenic diets are of interest because ketone bodies have plausible anabolic and anti-catabolic actions. This narrative review examined whether these mechanisms translate into preservation of lean compartments or skeletal muscle during weight loss in clinical studies. Methods: MEDLINE was searched via PubMed from database inception to 14 August 2026 using terms related to ketogenic exposure, body composition, muscle metabolism, and weight loss. Evidence was synthesised according to dietary context, energy and protein intake, population, exercise exposure, measurement modality, and timing relative to carbohydrate restriction or reintroduction. Results: Acute human studies demonstrate biological effects of ketone bodies on muscle protein turnover and signalling, but these findings do not establish long-term tissue preservation during ketogenic weight-loss diets. Supervised very-low-energy ketogenic diets generally produce weight loss composed predominantly of fat mass; however, comparative meta-analyses report small yet larger reductions in FFM or lean body mass than non-ketogenic regimens. Because most studies used hydration-sensitive compartment methods rather than direct anatomical imaging of skeletal muscle, the contributions of glycogen, water, and non-muscle lean tissues remain uncertain. Energy deficit, protein intake, resistance exercise, baseline adiposity, age, metabolic health, and training status may modify the observed response. Conclusions: Current evidence is insufficient to determine whether ketosis itself has either a protective or harmful effect on contractile skeletal muscle during weight loss. Ketogenic diets may be effective short-term options for selected adults with obesity, particularly within supervised protocols, but adequate protein, resistance exercise, and monitoring of strength and physical function remain the best-supported muscle-preserving strategies.

Nutrients doi: 10.3390/nu18172930

Authors: Vicente Javier Clemente-Suárez Jan Florian Rodrigo Yáñez-Sepúlveda Julio A. Ceniza-Villacastín Jose Francisco Tornero-Aguilera Alexandra Martín-Rodríguez

Background/Objectives: Active-duty military personnel may use caffeinated and sweetened beverages to manage alertness and fatigue, but co-occurring beverage behaviours are rarely examined. We identified beverage-frequency co-consumption profiles in Spanish Army personnel and tested their cross-sectional associations with self-reported sleep and habitual physical fatigue. Methods: This cross-sectional study included 1155 active-duty Spanish Army personnel. Latent classes were estimated from ordinal frequencies of caffeinated beverages, sugar-sweetened beverages, and energy drinks; these indicators represented frequency categories rather than caffeine dose, sugar intake, or standardized serving size. Adjusted outcome models incorporated classification uncertainty and controlled for demographic, occupational, training, hydration, alcohol, smoking, and recruitment-cohort covariates. Results: A three-class solution identified lower-frequency (47.7%), intermediate-frequency (28.3%), and higher-frequency (24.0%) profiles. Compared with the lower-frequency profile, the higher-frequency profile was associated with 0.230 h less sleep per night (95% CI −0.416 to −0.045; q = 0.022), 2.129 percentage points lower sleep efficiency (95% CI −4.177 to −0.082; q = 0.041), and 0.395 points greater habitual physical fatigue (95% CI 0.077 to 0.714; q = 0.022). Sensitivity analyses were directionally consistent. Conclusions: Beverage-frequency responses clustered into three profiles. The higher-frequency profile was cross-sectionally associated with shorter self-reported sleep, lower sleep efficiency, and higher habitual physical fatigue. The sleep-duration contrast was approximately 13.8 min/night, but the clinical or perceptible relevance of the sleep-efficiency and fatigue differences cannot be established from these self-reported measures. Prospective studies with product-specific dose and timing data are required to establish temporality and practical relevance.

Nutrients doi: 10.3390/nu18172932

Authors: Paweł Bryła Beata Ciabiada-Bryła

Background/Objectives: Dietitians play a pivotal role in promoting healthy eating, yet their perspectives on effective communication channels and campaign priorities remain under-researched, particularly in cross-national contexts. This study compared European dietitians’ opinions on communication channels and priority topics for healthy eating campaigns targeting different age groups. Methods: A cross-sectional survey was conducted among 131 dietitians from Poland (n = 56), France (n = 36), the United Kingdom (n = 26), and Germany (n = 13). Participants rated the importance of 19 communication channels on a 5-point scale and selected three priority topics from 16 options for children, adults, and elderly populations. Data were analysed using one-way ANOVA with Bonferroni post-hoc tests and Chi-square tests (significance at p < 0.05). Results: Interpersonal channels—dietitians’ own recommendations (M = 4.10) and recommendations from family/friends (M = 4.02)—were rated the highest across all countries. Significant national differences emerged for digital channels: Polish dietitians rated social media the highest, while British dietitians were the most sceptical (apps: Poland 3.73 vs. UK 2.81, p < 0.001). Limiting processed foods (60.3%) and increasing fruit/vegetable consumption (59.5%) were top child priorities, with national variations for fast food (Poland 28.6% vs. France 5.6%, p = 0.006). For elderly populations, dietary diversity (49.6%) and fruit/vegetable intake (42.7%) led in terms of priorities; salt limitation was prioritised only in Poland (23.2%) and France (16.7%), p = 0.017. Conclusions: While European dietitians agree on interpersonal communication and core nutritional messages, national contexts shape digital tool perceptions and campaign priorities. Culturally sensitive, targeted nutrition communication strategies are needed to address diverse population needs across Europe.

Nutrients doi: 10.3390/nu18172931

Authors: Çiler Özenir Canan Altınsoy Mihrican Çubuk Fatma Nişancı Kılınç Biriz Çakır

Background/Objectives: This study aimed to examine the association between e-healthy diet literacy (e-HDL) and general attitudes toward artificial intelligence (AI) among adults. Methods: This cross-sectional study included 610 adults aged 19–64 years. Data were collected through face-to-face interviews using a questionnaire consisting of five sections, including sociodemographic characteristics, digital nutrition information practices, AI use in nutrition and dietetics, the e-Healthy Diet Literacy Questionnaire (e-HDLQ), and the General Attitudes toward Artificial Intelligence Scale (GAAIS). Descriptive statistics, validity and reliability analyses, correlation analyses, and Partial Least Squares Structural Equation Modeling (PLS-SEM) were performed. Statistical significance was accepted at p < 0.05. Results: The mean age of the participants was 33.07 ± 11.36 years, and 50.8% were female. The measurement model demonstrated acceptable reliability and convergent validity. Structural model analysis showed that positive attitudes toward AI were positively associated with e-HDL (β = 0.243, p < 0.001), whereas negative attitudes toward AI were negatively associated with e-HDL (β = −0.232, p < 0.001). Among the e-HDLQ dimensions, the strongest loading was observed for finding e-healthy diet information (β = 0.844), followed by applying e-healthy diet information (β = 0.641), digital healthy eating literacy (β = 0.636), judging e-healthy diet information (β = 0.308), and understanding e-healthy diet information (β = 0.277). Together, positive and negative attitudes toward AI explained 12.2% of the variance in e-HDL (R2 = 0.122), indicating a modest explanatory contribution. Conclusions: Positive and negative attitudes toward AI were independently associated with e-HDL among adults. Although the explained variance was modest, AI attitudes may represent one of several factors associated with digital nutrition literacy, warranting further investigation in future studies.

Nutrients doi: 10.3390/nu18172929

Authors: Miaolin Han Yixi Zhang Na Zhang Changyou Zhao Limin He Jingyue Guo Qiuyun Cheng Guotian Lin Fan Zhang

Objectives: To examine the joint association of hydration status and sleep quality with prevalent type 2 diabetes mellitus (T2DM) and to quantify their additive and multiplicative interactions. Methods: This cross-sectional study included 4762 participants from the baseline Hainan Prospective Cohort Study. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the four combinations of hydration status and sleep quality. Additive interaction was assessed with the relative excess risk due to interaction (RERI), the attributable proportion (AP), and the synergy index (S); multiplicative interaction was assessed with a product term. Predicted probabilities were estimated by g-computation. Results: The prevalence of T2DM was 8.13% (387/4762). Compared with non-dehydration and good sleep quality, the combination of dehydration and poor sleep quality was associated with substantially higher odds of prevalent T2DM (adjusted OR 9.92, 95% CI 7.14 to 14.00). All three additive interaction measures were statistically significant (RERI 7.74, 95% CI 4.99 to 10.50; AP 78.04%, 95% CI 69.28 to 86.80; S 7.57, 95% CI 3.49 to 16.42), as was the multiplicative interaction (OR 3.96, 95% CI 2.30–6.90). On the absolute risk scale, the interaction contrast was 14.53 percentage points (95% CI: 11.01 to 18.34), with an attributable proportion of 80.5% (95% CI: 66.3 to 94.6) and a synergy index of 5.14 (95% CI: 2.94 to 17.25). The predicted probability of prevalent T2DM was highest in the combined dehydration and poor sleep group. Conclusions: The combination of dehydration and poor sleep quality was associated with higher odds of prevalent T2DM than either condition alone, and a statistically significant additive interaction was observed. Because these additive interaction measures were derived from odds ratios for a non-rare outcome, their absolute magnitude may be overestimated on the odds-ratio scale; the risk-difference-scale measures confirmed the interaction. Given the cross-sectional design, reverse causation cannot be excluded, and longitudinal data are needed to clarify the temporal sequence of these associations.

Nutrients doi: 10.3390/nu18172928

Authors: Chiara Cesari Carla Maria Grimaldi Matteo Motta Viola Carzaniga Chiara Maria Trovato Giovanna Zuin Lorenzo D’Antiga Naire Sansotta

Background/Objectives: Malnutrition is common in paediatric inflammatory bowel disease (IBD) and may affect growth, disease severity, and clinical outcomes. The aim of our study was to assess nutritional status and linear growth at diagnosis and during follow up and to evaluate their association with clinical outcomes in paediatric IBD. Methods: This multicentre retrospective cohort study included children diagnosed with Crohn’s disease (CD) or ulcerative colitis (UC) at two paediatric IBD referral centres. Clinical, biochemical, and anthropometric data were collected at diagnosis and throughout follow-up. Underweight was defined as BMI z-score ≤ −2; growth failure (stunting) was defined as height-for-age z-score ≤ −2. Results: Among 128 children with IBD (69 CD, 59 UC; mean age: 157.2 ± 29.5 months), 23% (29/128) were underweight at diagnosis, 68% (87/128) had normal BMI, and 9% (12/128) were overweight at diagnosis. Underweight status was more frequent in the CD than UC groups (30% vs. 15%; p = 0.022). Growth failure affected 7.0% of patients at diagnosis and was observed in 5.3% of patients with available data at 36 months. Stunting was more frequent in CD than UC. Biologic therapy was more frequently initiated in underweight patients (41% vs. 17%, p = 0.06). At a mean follow-up of 29.4 months, 86% (25/29) of underweight patients achieved a normal or elevated BMI. Underweight status was not associated with an increased risk of relapse (adjusted OR 0.52, 95% CI 0.19–1.30; adjusted HR 0.60, 95% CI 0.28–1.29). Conclusions: Malnutrition is frequent at diagnosis in paediatric IBD, particularly in Crohn’s disease, and is associated with increased inflammatory burden. Although most patients showed improvement in nutritional status during follow-up, baseline underweight status was not independently associated with subsequent disease relapse. These findings highlight the importance of early and longitudinal assessment of nutritional status and linear growth as integral components of paediatric IBD management.

Nutrients doi: 10.3390/nu18172926

Authors: Zhenhua Liu

Cancer is a major contributor to global disease burden in the 21st century, accounting for nearly one in six deaths (16 [...]

Nutrients doi: 10.3390/nu18172927

Authors: Mariola Wojciechowska Arkadiusz Łukasz Żurawski Elżbieta Cieśla Anna Zmyślna Dorota Kozieł

Background/Objectives: Physical activity and sedentary behaviour are important components of adolescent lifestyle, but favourable movement behaviour may not correspond to favourable behaviours across other health-related domains. This study aimed to identify empirical physical activity–sedentary behaviour profiles among adolescents and examine their co-occurring dietary, sleep, digital, and general health behaviours. Methods: This cross-sectional, school-based study used data from 3307 Polish adolescents aged 15–17 years. Following final processing of the International Physical Activity Questionnaire–Long Form, 1932 participants had complete and analytically eligible data for sedentary time, walking, moderate-intensity physical activity, and vigorous-intensity physical activity and were included in profile derivation. The four variables were Z-standardised before k-means clustering. Solutions from k = 2 to k = 6 were evaluated using the silhouette coefficient, Calinski–Harabasz index, Davies–Bouldin index, and Adjusted Rand Index (ARI). Co-occurring behaviours were compared using chi-square and Mann–Whitney U tests with effect-size estimates. Results: Cluster assignments were almost identical across repeated k-means runs initiated from different random starting centroids (ARI = 0.999). Because all runs were performed on the same set of participants, this result reflects low dependence on the initial centroid configuration rather than robustness to changes in sample composition. Separation between the two groups was limited (silhouette coefficient = 0.294), while the correspondence between classifications obtained from unstandardised and Z-standardised variables was minimal (ARI = 0.008), demonstrating a strong influence of scaling on cluster membership. The final classification included 1070 adolescents (55.4%) in the Higher Physical Activity profile and 862 (44.6%) in the Lower Physical Activity profile. The profiles showed no clear differences in school-day sleep duration, television/computer use, or internet-related risk. Weekend sleep duration differed between profiles (V = 0.120, p = 0.001). The Higher Physical Activity profile had higher Pro-Healthy Diet Index (r = 0.100, p < 0.001) and Non-Healthy Diet Index scores (r = 0.090, p < 0.001), slightly higher energy-drink intake (r = 0.080, p = 0.001), and more frequent out-of-home meal consumption (V = 0.079, p = 0.002). Effect sizes for co-occurring behaviours were generally small. Conclusions: Empirically distinct movement-behaviour profiles showed only partial correspondence with broader lifestyle characteristics. Higher physical activity coexisted with both more and less favourable dietary characteristics, whereas the Lower Physical Activity profile did not show a consistently adverse sleep or digital-behaviour pattern. These findings indicate that physical activity level alone should not be treated as a proxy for overall adolescent lifestyle quality. Given the exploratory, cross-sectional design and method-dependent nature of the profiles, the findings should be interpreted as hypothesis-generating rather than as evidence for fixed lifestyle types or profile-specific interventions.

Nutrients doi: 10.3390/nu18172925

Authors: Marcus Ting Ian En Kai Mak Yueying Yao Amelia Shan Mei Chng Chin Meng Khoo Jung Eun Kim

Background/Objectives: Protein supplementation may elevate advanced glycation end products (AGEs) through higher dietary AGE (dAGE) content and increase amino acid-driven endogenous formation. Protein supplementation from different sources may differentially affect AGE levels, possibly through differences in amino acid composition, digestion and metabolism, but evidence from randomized controlled trials (RCTs) remains limited. This study aimed to examine the effect of protein supplementation from either casein (animal-based) or soy (plant-based) protein isolates on circulating, skin, and dAGE levels in older adults following a healthy dietary pattern (HDP). Methods: In this 16-week RCT, 55 older adults (mean age: 66 years old) in Singapore were assigned either to control (no supplementation), casein protein isolate supplementation, or soy protein isolate supplementation. This study was registered at clinicaltrials.gov as NCT05400005. Results and Discussion: Overall, there were no alterations in dietary, skin and total circulating AGE levels after protein supplementation when adhering to an HDP such as My Healthy Plate (MHP). However, different sources of protein supplementation resulted in differential changes in specific plasma AGE markers. Two-way ANOVA analysis showed that soy protein supplementation led to a significant increase in plasma N(6)-(1-carboxymethyl)-L-lysine (CML) compared to the other groups (week 0: 0.72 ± 0.10, week 16: 0.80 ± 0.10, pint = 0.040), while a paired t-test showed that casein protein supplementation led to a significant within-group increase in plasma pentosidine (week 0: 0.77 ± 0.06, week 16: 0.80 ± 0.05, p-value = 0.045). Other AGEs showed no significant changes. Conclusions: Protein supplementation while adhering to MHP did not significantly influence overall circulating and skin AGEs in older adults in Singapore. A differential response was observed only for plasma CML levels with soy protein supplementation, whereas the within-group increase in plasma pentosidine following casein supplementation should be interpreted with caution and requires further investigation.

Nutrients doi: 10.3390/nu18172924

Authors: Didem Güneş Kaya Elvan Bayramoğlu Hande Turan Olcay Evliyaoğlu Murat Bas

Background/Objectives: Bedtime snacks are frequently used in youth with type 1 diabetes (T1D) to reduce nocturnal hypoglycemia risk; however, the optimal macronutrient composition remains uncertain, particularly in those treated with multiple daily injections (MDI). This randomized crossover study evaluated whether standardized whole-food bedtime snacks with different macronutrient profiles yield distinct overnight continuous glucose monitoring (CGM) patterns. Methods: Twelve children and adolescents with T1D using glargine/lispro-based MDI completed four bedtime snack protocols: carbohydrate-only (CHO), carbohydrate-plus-protein (CHO + PRO), carbohydrate-plus-fat (CHO + FAT), and carbohydrate-plus-fiber (CHO + FIB). Each snack was consumed for three consecutive nights at 21:00 without additional bolus insulin. Blinded CGM data were analyzed for 21:00–09:00 and for predefined postprandial intervals. Because no a priori sample size calculation was performed, the study was conducted as an exploratory pilot trial. Nights per snack were averaged before within-subject comparisons. Results: Overnight time in range (TIR; 70–180 mg/dL) varied across protocols (p = 0.014), with the highest TIR following CHO + PRO (85.8% ± 12.1%) and the lowest following CHO + FAT (70.9% ± 19.1%); however, adjusted whole-night pairwise comparisons were not statistically significant. Differences were more pronounced during the first 6 h following snack consumption, when CHO + PRO was associated with higher TIR than CHO + FAT (91.2% ± 7.6% vs. 71.4% ± 20.8%; adjusted p = 0.011). Moreover, CHO + PRO was associated with lower peak-to-nadir glucose amplitude than CHO + FAT (88.1 ± 24.9 vs. 123.9 ± 36.5 mg/dL; adjusted p = 0.041). Hypoglycemic and hyperglycemic event rates did not significantly differ across protocols. Conclusions: In children and adolescents with T1D using MDI, bedtime snack composition was associated with differences in early nocturnal glycemic stability. CHO + PRO demonstrated higher early night TIR and lower glucose amplitude than CHO + FAT; however, event-based safety outcomes did not significantly differ. Because only two pairwise comparisons remained significant after correction for multiple testing and the four snacks were not matched for energy content, these findings should be regarded as preliminary and hypothesis-generating; in particular, they do not demonstrate that any snack composition protects against nocturnal hypoglycemia. Confirmation is required in larger, adequately powered studies that include energy-matched snacks and a no-snack control condition.

Nutrients doi: 10.3390/nu18172923

Authors: Ligia J. Dominguez Francesco Saverio Ragusa Nicola Veronese Giovanna Di Bella Stefano Ciriminna Flavia Seminara Salvatore Maria Baio Mario Barbagallo

Bariatric surgery is the most effective treatment for severe obesity, leading to significant and sustained weight loss and improvement in metabolic comorbidities. However, it is also associated with substantial changes in body composition and nutritional status, including the risk of sarcopenia and sarcopenic obesity. This review aims to summarize current evidence on the interplay between metabolic and bariatric surgery, nutritional alterations, and skeletal muscle health. The recent literature highlights a high and increasing prevalence of muscle loss after surgery, driven by reduced protein intake, micronutrient deficiencies, hormonal changes, and decreased mechanical loading. Despite these challenges, improvements in metabolic health and physical function are often observed, suggesting a complex relationship between muscle mass and functional outcomes. A multidisciplinary approach, including nutritional optimization and structured exercise interventions, is essential to mitigate muscle loss and function and improve long-term outcomes. Further research is needed to standardize diagnostic criteria and develop targeted strategies for prevention and management.

Nutrients doi: 10.3390/nu18172922

Authors: Hyun-Jung Kwon Suryeon Lee Yong-Hee Park Sujung Park Sung Moon Jeong Dae Wook Hwang Seihee Min

Background/Objectives: Major hepatobiliary surgery elicits substantial inflammatory and catabolic stress, which may be aggravated by prolonged preoperative fasting. We evaluated the association of preoperative fasting strategy with postoperative inflammatory–nutritional trajectories and clinical outcomes after elective hepatobiliary surgery. Methods: This retrospective cohort study included 1409 adults who underwent elective hepatobiliary surgery between January 2020 and December 2025. Patients were classified according to the interval from last caloric intake to anesthesia induction as <6 h or ≥6 h. All patients in the <6 h group were managed under an Enhanced Recovery After Surgery (ERAS) pathway with preoperative carbohydrate loading. Postoperative trajectories of the C-reactive protein-to-albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), and prognostic nutritional index (PNI) were analyzed using linear mixed-effects models. Results: The <6 h group showed more favorable postoperative CAR and NLR trajectories (group × time interaction, both p < 0.001). Although the overall PNI trajectory also differed between groups (p = 0.003), between-group differences were inconsistent across individual time points. In fully adjusted models, longer fasting duration was associated with higher postoperative day (POD) 3 CAR and NLR, but not with PNI. After additional adjustment for ERAS implementation, the CAR and NLR associations were attenuated and no longer statistically significant. Clinical outcomes did not differ between groups. Conclusions: An ERAS-associated shortened-fasting strategy incorporating preoperative carbohydrate loading was associated with more favorable postoperative CAR and NLR trajectories. These findings reflect associations with the overall perioperative strategy rather than an independent effect of fasting duration.

Nutrients doi: 10.3390/nu18172921

Authors: Beata Walczyk Agnieszka Białek

Background/Objectives: Dietary supplement use is common in middle and later adulthood, but factual safety knowledge may not necessarily translate into safety-related behavior. This pilot study examined supplement use, supplement safety knowledge, information-source pathways, and self-reported safety-related behaviors among adults aged 40 years and older. Methods: A cross-sectional questionnaire study was conducted in Poland between December 2025 and April 2026 in a convenience sample of 150 adults aged ≥40 years. Multivariable logistic regression models assessed associations of a five-item factual supplement safety knowledge score and professional or digital information-source use with proactive supplement safety information seeking and other supplementation behaviors. Results: Current supplement use was reported by 113/150 participants (75.3%); among current users with available supplement count data, 86/111 (77.5%) used at least two supplements simultaneously. The knowledge score was not independently associated with proactive supplement safety information seeking (aOR 0.93 per one-point increase, 95% CI 0.69–1.25; p = 0.641). Professional information-source use was associated with the original composite information-seeking outcome (aOR 4.03, 95% CI 1.51–10.77; BH q = 0.033) and with lower odds of self-initiated supplementation (aOR 0.32, 95% CI 0.13–0.79; BH q = 0.042). However, in an additional non-overlap sensitivity analysis restricted to internet/leaflet safety information seeking, professional-source use was not independently associated with the outcome (aOR 0.80, 95% CI 0.33–1.94; p = 0.627). Conclusions: In this convenience sample, the study-specific factual knowledge score did not show a clear independent association with proactive supplement safety information seeking. Associations involving professional information sources depended partly on outcome definition, while the association with lower self-initiation remained. Given the pilot nature, modest sample size, non-probability recruitment, self-reported measures, and lack of product-level verification, the findings are hypothesis-generating and require confirmation in larger, prospectively characterized samples.

Nutrients doi: 10.3390/nu18172920

Authors: Nokukhanya Thembane Siboniso Sithole Sphamandla Hlatshwayo Phikelelani Siphosethu Ngubane Mlungisi Ngcobo Nceba Gqaleni

Background: Type 2 diabetes mellitus (T2DM) remains a major global health challenge, prompting interest in plant-based interventions with multi-target metabolic effects. This study evaluated the individual and combined effects of Psidium guajava (PG) and Seriphium plumosum (SP) on hepatic and skeletal muscle glucose metabolism. Methods: HepG2 hepatocytes and differentiated C2C12 myotubes were treated with PG, SP, and a 1:1 PG+SP combination. Cell viability, glucose uptake, GLUT2 expression, glycogen content, and AMP levels were assessed. Interactions were evaluated using Bliss Independence, Combination Index (CI), Loewe Additivity, and Zero Interaction Potency (ZIP) models. Results: SP exhibited minimal cytotoxicity, whereas PG induced concentration-dependent reductions in HepG2 viability. The PG+SP combination maintained higher viability than PG alone and demonstrated additive-to-synergistic interactions (CI = 0.51–0.89). In HepG2 cells, all treatments significantly enhanced glucose uptake relative to controls (p < 0.05), with the combination achieving approximately 94% of the metformin response. The combination also significantly reduced GLUT2 expression, with the greatest effect observed at 125 + 125 µg/mL (0.77 ± 0.14-fold, p < 0.0001). In C2C12 myotubes, PG, SP, and PG+SP significantly increased glucose uptake and glycogen accumulation (p < 0.05). SP increased AMP levels at lower concentrations, whereas the PG+SP combination reduced AMP levels below control values. Synergy analyses consistently indicated concentration- and endpoint-dependent interactions ranging from additivity to synergy. Conclusions: The PG+SP combination co-ordinately modulated glucose uptake, glycogen storage, GLUT2 expression, and AMP-related energy status across hepatic and skeletal muscle models. These findings provide mechanistic support for further investigation of this botanical combination as a potential multi-target strategy for T2DM and metabolic dysfunction.

Nutrients doi: 10.3390/nu18172919

Authors: Cristina Saldaña-Ruiz Leticia Gómez-Sánchez Alberto Vicente-Prieto Sara Vicente-Gabriel Cristina Lugones-Sánchez Susana González-Sánchez Sandra Conde-Martín Marta Gómez-Sánchez Manuel A. Gómez-Marcos

Background/Objectives: Gambling disorder is recognized as a behavioral addiction, and gambling-related problems represent an important public health concern among young adults. However, evidence regarding their association with overall diet quality, particularly adherence to the Mediterranean diet (MedDiet), remains scarce. This exploratory secondary analysis examined whether screening indicators of gambling-related problems were associated with MedDiet adherence in young adults. Methods: We conducted a cross-sectional analysis of 496 participants aged 18–34 years from the EVA-Adic study. MedDiet adherence was assessed using the 14-item Mediterranean Diet Adherence Screener (MEDAS-14). Gambling-related indicators were assessed using the Short Pathological Gambling Questionnaire (CBJP), the Lie/Bet Questionnaire, and their six individual items. Independent multiple linear regression models were fitted for each indicator. The fully adjusted Model 2 included age, sex, alcohol consumption, sleep quality, sitting time, marital status, and educational level. Given the secondary nature of the analysis, the absence of an a priori sample-size calculation for the present research question, and the limited number of participants with positive gambling-related indicators, the analyses were considered exploratory and hypothesis-generating rather than confirmatory. Results: The mean age was 26.60 ± 4.41 years; 276 participants (55.6%) were women, and 157 (31.7%) had high MedDiet adherence. In the fully adjusted Model 2, feeling guilty about gambling (Q2) was nominally associated with a lower MEDAS-14 score (B = −1.10; 95% CI, −1.97 to −0.22; p = 0.015). However, this association did not remain statistically significant after Benjamini–Hochberg correction (q = 0.116), and none of the eight primary Model 2 associations met the FDR-adjusted significance threshold. Conclusions: Several gambling-related screening indicators showed nominal inverse associations with MedDiet adherence, with gambling-related guilt showing the most consistent estimate across sensitivity analyses. However, no association remained statistically significant in the fully adjusted model after correction for multiple testing, and formal interaction analyses provided no robust evidence of effect modification by sex. Given the small number of positive screens and the cross-sectional design, these findings should be considered exploratory and hypothesis-generating.

Nutrients doi: 10.3390/nu18172918

Authors: Lucía Riggioni-Saborío Cristina Jardí Nerea Becerra-Tomás Josué Cruz-Rodríguez Victoria Arija

Background/Objectives: Maternal diet plays a crucial role in fetal development and may influence offspring weight development. Although fruits and vegetables provide nutritional and metabolic benefits during pregnancy, evidence regarding their specific role on childhood overweight/obesity remains limited. This study aimed to examine the association between maternal intake of fruits, vegetables, and fruit juices during pregnancy and the risk of overweight/obesity in children at 4 years of age. Methods: We analyzed 252 mother–child pairs from the Mediterranean ECLIPSES cohort in a prospective observational study. Maternal dietary intake was assessed at 12, 24 and 36 weeks of gestation using a semiquantitative food frequency questionnaire previously validated in a Spanish population. Childhood overweight/obesity was defined as a BMI z-score above the 85th percentile for age and sex at age 4. Multivariable-adjusted logistic regression models estimated ORs and 95% CIs. Results: Higher maternal consumption of fruits and vegetables was inversely associated with overweight/obesity in children (OR: 0.31 [0.13–0.74]). No associations were observed for total or natural fruit juice, whereas higher consumption of commercial fruit juice was associated with increased odds of overweight/obesity (OR: 2.48 [1.06–5.78]). Conclusions: Higher maternal combined consumption of fruits and vegetables during pregnancy was associated with lower odds of overweight or obesity in offspring at 4 years of age, whereas the opposite association was observed for commercial, but not natural, fruit juice. These associations may involve both prenatal biological and postnatal behavioral and family dietary pathways; however, the commercial fruit juice finding should be considered exploratory and requires confirmation in larger prospective studies.

Nutrients doi: 10.3390/nu18172917

Authors: Jacek Szołtysek Beata Szymańska Agnieszka Piwowar

Nutritional therapy is an essential component of comprehensive care for cancer patients, playing a vital role in preventing malnutrition, improving treatment tolerance, and maintaining quality of life. In recent years, there has been growing interest in the ketogenic diet as a potential strategy to support cancer therapy. This diet, based on a significant reduction in carbohydrate intake and an increase in fat intake, leads to a state of ketosis that mimics the metabolic changes that occur during starvation. Consequently, the body utilizes ketone bodies as an alternative source of energy. The potential application of the ketogenic diet in oncology stems from the distinct metabolism of cancer cells, which often exhibit an increased demand for glucose. Although the results of preclinical studies suggest a possible anticancer effect of this dietary intervention, clinical evidence remains limited, and its routine use is not currently recommended as a standard of care in oncology. The aim of this study was to analyze the current literature on the use of the ketogenic diet in oncology, with a particular focus on breast cancer. The study assessed the impact of this intervention on metabolic parameters, body composition, and patients’ mental well-being, and analyzed the potential metabolic risks associated with its use. The study discusses the molecular basis of oncogenesis and metabolic adaptation in cancer cells, the mechanisms of action of the ketogenic diet, and the results of preclinical and clinical studies as well as meta-analyses. Importantly, the current evidence base should be interpreted with caution. Most mechanistic evidence supporting ketogenic diet in breast cancer derives from preclinical models, whereas clinical studies remain limited by small sample sizes, short intervention periods, heterogeneous ketogenic diet protocols, substantial attrition, and differences in concomitant anticancer treatment. Therefore, mechanistic plausibility and promising preclinical findings should not be interpreted as evidence of clinical anticancer efficacy.

Nutrients doi: 10.3390/nu18172916

Authors: Marta García-Poblet Isabel Sospedra Brisa Florencia Formilan Esther Soler-Climent Manuel Antonio Alberola-Chazarra José Miguel Martínez-Sanz

Background/Objectives: Adolescents with type 1 diabetes mellitus (T1DM) are particularly vulnerable to psychological distress, disordered-eating (DE) risk and negative self-perceived health status (SPHS), which may compromise metabolic control and self-care. Although these factors have been studied individually, the usefulness of brief and clinically feasible screening tools to detect these dimensions remains underexplored. This study aimed to: (1) examine associations between distress, DE risk and SPHS; (2) explore their relationships with glycemic control, clinical profile and self-care; and (3) assess the influence of age and diabetes duration on these outcomes. Methods: A cross-sectional study was conducted in 37 adolescents with T1DM in Spain. Sociodemographic, anthropometric and clinical variables were obtained from medical records. Distress, DE risk and self-care were assessed using validated questionnaires, while SPHS was measured using single-item question. Pearson and Spearman correlations were performed. Results: Distress was present in 48.6% of participants and DE risk in 29.7%, while 67.6% reported positive SPHS. Distress correlated with higher HbA1c and lower TIR. DE risk correlated with BMI. Lower SPHS was associated with higher HbA1c. Age and diabetes duration were associated with greater glycemic variability, and diabetes duration also correlated with higher glucose and TyG-based insulin resistance indexes. No significant associations were found for self-care behaviors. Conclusions: Distress, DE risk and SPHS, assessed through feasible screening tools, showed meaningful associations with metabolic outcomes in adolescents with T1DM. Integrating brief psychological screening tools into routine care may facilitate early identification of psychological vulnerability profiles in this population during routine practice.

Nutrients doi: 10.3390/nu18172915

Authors: Rita Oliveira Carla M. Lopes Cláudia Silva Rita S. Guerra

Polyunsaturated fatty acids (PUFA) have long been investigated as potential adjunctive therapies for multiple sclerosis because of their immunomodulatory, anti-inflammatory, and neuroprotective properties. However, the available evidence remains heterogeneous and has not been comprehensively mapped. This scoping review aimed to characterize the evidence on PUFA supplementation, identify research trends and knowledge gaps, and contextualize findings from primary studies alongside systematic reviews. This scoping review followed the Joanna Briggs Institute methodology and the PRISMA-ScR guidelines. MEDLINE (via PubMed), Scopus, Web of Science, ScienceDirect, Cochrane CENTRAL, ClinicalTrials.gov, WHO ICTRP, and EU CTR/EudraCT were searched up to June 2026. Eligible evidence included randomized and non-randomized intervention studies, longitudinal cohort studies, systematic reviews, and clinical trial registry records evaluating omega-3, omega-6, or combined PUFA supplementation in persons with multiple sclerosis. Data were descriptively charted and narratively synthesized. Thirty reports representing 24 independent evidence sources (18 primary studies and 6 systematic reviews) were included. Research evolved from early omega-6 interventions, which demonstrated biological activity but limited clinical benefit, to omega-3 supplementation, where mechanistic evidence expanded despite inconsistent clinical outcomes. More recent studies investigated combined PUFA formulations, reporting the most promising findings for relapse-related outcomes and inflammatory biomarkers, while evidence remains limited by a small number of studies and heterogeneous interventions. Systematic reviews consistently interpreted the evidence more cautiously than individual primary studies. PUFA research in multiple sclerosis has progressed from exploratory studies to more sophisticated intervention strategies integrating clinical and mechanistic outcomes. Although PUFAs show biological activity and favorable safety profiles, consistent evidence of clinically meaningful disease modification remains limited. This evidence map highlights methodological advances, persistent heterogeneity, and priorities for future well-designed randomized controlled trials.

Nutrients doi: 10.3390/nu18172914

Authors: Russell Keast Andrew Costanzo Claudia Hartley Lynn Riddell

Taste contributes to food selection by integrating sensory information with physiological state and prior experience. Sodium is essential, continually lost, and homeostatically regulated, yet it is abundant and frequently overconsumed in contemporary food environments. This conceptual narrative review proposes the Sodium Priority Hypothesis, as follows: sodium may function as a nutritional target whose acquisition and food acceptance are supported by several partly independent sensory routes. Sodium chloride provides the dominant dietary route to saltiness, although the molecular basis of human salt taste remains unresolved and may involve both sodium- and chloride-dependent mechanisms. Sodium salts can also suppress bitterness and modify taste mixtures in concentration- and matrix-dependent ways. A further, more speculative proposition is that sodium-bearing umami stimuli may have behavioural relevance beyond glutamate-derived umami quality. The framework is intended to connect two timescales: the physiological and evolutionary pressures that promoted sodium acquisition when availability was variable, and the contemporary food environment, in which abundant, inexpensive sodium is widely used to enhance food palatability. It does not claim that sodium alone explains modern excess intake, that prehistoric populations routinely added salt, or that sodium is required for activation of umami receptors. Evidence is strongest for sodium physiology, sodium appetite, salt taste, and selected mixture effects; direct evidence for a sodium-specific contribution to umami liking or intake remains limited. The hypothesis is therefore an organising and falsifiable framework that requires experimental validation. It is explanatory rather than prescriptive.

Nutrients doi: 10.3390/nu18172913

Authors: Sarah A. Roscoe Scott P. Allen Christopher J. McDermott Theocharis Stavroulakis

Background: Malnutrition and metabolic dysregulation are common in motor neuron disease (MND) and contribute to accelerated functional decline and reduced survival. Routine serum biochemical analytes can be used to assess nutritional status; however, their interpretation in MND is confounded by systemic inflammation and disease-related metabolic changes. This study investigated the relationship between serum biochemical analytes, inflammatory status, disease severity, progression, and body composition in people living with MND. Methods: In this single-centre, longitudinal prospective cohort study, 19 participants with confirmed MND were assessed at enrolment and at three-month intervals up to nine months. Serum concentrations of albumin, prealbumin, creatinine, transferrin, ferritin, retinol-binding protein, and lipid fractions were measured alongside routine inflammatory markers. Disease severity and progression were assessed using the revised ALS functional rating scale and King’s College Staging System. Anthropometry included percentage weight change, body mass index, mid-upper arm circumference, triceps skinfold thickness, arm muscle area, and calf circumference. Participants with evidence of baseline inflammation were excluded from nutritional analyses. Results: Low-grade systemic inflammation was present in 9/19 (47%) of participants at enrolment, most commonly reflected by elevated fibrinogen. In the non-inflammatory sub-cohort (n/N = 10/19), serum creatinine was positively correlated with muscle-related functional subscores (p = 0.007) and declined between enrolment and three months (p = 0.02), showing predominantly negative trajectories by nine months. HDL cholesterol also declined over the nine-month follow-up (p = 0.03) and lipid fractions correlated positively with disease stage (p <0.001–0.02), suggesting evolving metabolic stress. Elevated serum retinol-binding protein was observed in 90% (n/N = 9/10) of participants without inflammation. Biochemical evidence of malnutrition (low transferrin and/or creatinine) was detected in one-third of participants, accompanied by weight loss and reductions in limb anthropometric parameters. Malnutrition risk was identified in 1/10 (10%) of the non-inflammatory sub-cohort using a modified ESPEN-based framework, and in 2/10 (20%) participants using GLIM criteria. Conclusions: Routine serum biochemical analytes provide complementary information on nutritional and metabolic status in MND when interpreted alongside inflammatory markers and anthropometry. Serum creatinine emerged as a longitudinal marker of muscle wasting, reflective of denervation and nutritional depletion, while lipid and retinol-binding protein alterations highlight non-nutritional disease mechanisms that may confound standard biomarker interpretation, informing more targeted nutritional assessments. These findings support a multimodal approach to nutritional monitoring in MND and emphasise the importance of accounting for inflammatory status in biomarker interpretation. Given the small sample size and the limited representation of non-ALS phenotypes, these findings should be regarded as hypothesis-generating and require confirmation in larger, multicentre cohorts with balanced phenotypic representation.

Nutrients doi: 10.3390/nu18172912

Authors: Brendon Yi Neng Wong Irving Yu Le Shua Rahmania Putri Dewinta Vedhavaishnavi Sugumaran Kaleeswaran Shaminidevi Nadia Loh Ting Wei Jimmy Lee Max Lam John Chambers Theresia Mina

Background: Memory influences decision-making regarding eating behaviour. However, marketing utilises our memory to exploit our consumptive habits. Whether we have an inherent bias towards memorising visual cues associated with high-calorie foods and how such bias contributes to our health outcomes remains to be determined. We therefore aimed to develop and validate a computerized, image-based Food Memory Bias Task (FMBT) for use in multiethnic Asian populations. Methods: In the development phase involving 172 participants, 91.9% rated the instrument as user-friendly and we optimised the instrument format into 12 visual food cues and 30-min delay period to avoid a ceiling effect. In the validation phase involving 184 multi-ethnic Asian participants (49.3 (14.5) years old, 44.6% male, 71.7% Chinese), FMBT memory score was associated with the brief assessment of cognition memory (β(p) = 0.23 (5.1 × 10−6)), and general cognition score ‘g’ (β(p) = 0.30 (6.5 × 10−9)). Results: Higher memory bias was associated with lower memory score in the low-calorie bias group (r=−0.33, p=0.002), but not in the hig h-calorie bias group. In this present study, despite randomly administering two versions of the test across visits, the FMBT bias score demonstrates a significant learning effect and low reproducibility (r(p) = −0.14 (0.11) across visits). Food memory bias score is associated with higher food approach traits according to the Adult-Eating Behaviour Questionnaire (β(p) = 0.23(0.015)), independent of age, sex, and ethnicity. Conclusion: FMBT provides an opportunity to address epidemiological questions on how food memory bias influences dietary habit and cardiometabolic health, and how it is in turn shaped by our built environment.

Nutrients doi: 10.3390/nu18172910

Authors: Orlando Meneses Quelal

Background/Objectives: This study characterized compositional variation among 996 foods and beverages retained from the Universidad San Francisco de Quito Food Chemical Composition Table after record-level quality control. Methods: Nineteen nutritional variables were evaluated using descriptive statistics, heteroscedastic one-way analysis of variance, rank correlations, principal component analysis, and hierarchical clustering. Missingness was substantial and non-random across food groups; 427 records contained all 19 variables and were used for multivariate analyses. Results: Welch tests with Holm correction identified food-group differences for all variables, although the magnitude of group separation ranged from small for vitamin A (η2 = 0.029, 95% CI 0.016–0.061) to large for carbohydrates (η2 = 0.590, 95% CI 0.555–0.632) and energy (η2 = 0.588, 95% CI 0.530–0.654). Spearman analysis showed strong expected compositional associations between total fat and monounsaturated fatty acids (ρ = 0.956) and between total fat and saturated fatty acids (ρ = 0.937), together with non-arithmetic associations involving protein, phosphorus, zinc, cholesterol, and vitamin B12. Parallel analysis retained four principal components, which explained 61.4% of total variance; the first two accounted for 40.2% and primarily represented energy-lipid-mineral covariation and lipid composition. Ward clustering in the full 19-dimensional standardized space supported a three-cluster solution (silhouette = 0.482; median subsampling adjusted Rand index = 0.845), comprising a broad mixed profile, a fiber- and mineral-dense profile, and an oil-dominant profile. Conclusions: These results describe compositional patterns within the USFQ database and provide a reproducible basis for database harmonization, nutrient profiling, and hypothesis generation. They do not estimate dietary intake, food availability, nutritional adequacy, or health outcomes in the Ecuadorian population.

Nutrients doi: 10.3390/nu18172911

Authors: Ray Wagiu Basrowi Febriansyah Darus I Gusti Ayu Nyoman Partiwi Hilna Khairunisa Shalihat Refani Alycia Kusuma Dessy Pratiwi

Background/Objectives: Cesarean delivery has been linked with breastfeeding difficulties. However, the mechanistic pathways underlying these challenges remain incompletely understood. This systematic review aimed to synthesize evidence regarding the physiological, clinical, psychological, and health system-related mechanisms contributing to breastfeeding challenges following cesarean delivery. Methods: A systematic search was conducted in PubMed/MEDLINE and Scopus for studies published between 2020 and 2026. Studies with observational, interventional, and qualitative designs that examined breastfeeding challenges following cesarean delivery were eligible. A theory-informed narrative synthesis was applied, categorizing challenges into physiological, clinical, psychological, and health system domains and integrating them into a pathway-based conceptual framework. Results: Twenty-six studies were included. Across heterogeneous study designs, commonly reported breastfeeding challenges included delayed lactogenesis, postoperative pain and functional limitations, difficulties with early mother–infant interaction, concerns regarding human milk sufficiency, reduced breastfeeding self-efficacy, and variability in postpartum breastfeeding support. These findings were organized into physiological, clinical, psychological, and health-system domains. Cross-study synthesis suggested potential interactions among these domains, particularly involving delayed breastfeeding initiation, breastfeeding difficulties, lactation-related concerns, maternal perceptions, and subsequent feeding decisions. However, the proposed relationships were not uniformly tested within individual studies. Intervention studies suggested that strategies including skin-to-skin contact, breastfeeding counseling, and enhanced lactation support may improve selected breastfeeding outcomes. Conclusions: The findings suggest that breastfeeding challenges following cesarean delivery may involve interconnected biological, behavioral, clinical, and health-system factors. Understanding these mechanisms is essential for developing supportive and context-sensitive interventions that optimize breastfeeding establishment while maintaining adequate infant nutrition.

Nutrients doi: 10.3390/nu18172909

Authors: Stavroula Asimakopoulou Panagiotis Pipelias Evanthia Kassi Evangelos Oikonomou Gerasimos Siasos Christina Darviri

Background/Objectives: Stress is increasingly recognized as an important modulator of gut microbiome composition and function through the bidirectional microbiota–gut–brain axis. Dietary, psychobiotic, and other lifestyle-oriented interventions have therefore attracted growing interest as potential strategies for simultaneously influencing stress-related outcomes and the gut microbiome. This systematic review aimed to evaluate randomized controlled trials (RCTs) investigating the effects of lifestyle-oriented and psychobiotic interventions on both stress-related outcomes and the gut microbiome in adults. Methods: A systematic literature search was conducted in PubMed, Scopus, and Cochrane CENTRAL for English-language RCTs published between 2016 and April 2026, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Eligible studies included adults (≥18 years), evaluated lifestyle-oriented or psychobiotic interventions, and reported both gut microbiome-related and stress-related psychological or biological outcomes. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. Owing to substantial methodological and clinical heterogeneity, findings were synthesized narratively. Results: Twenty-nine RCTs met the eligibility criteria. Interventions included psychobiotic supplementation, dietary interventions and functional foods, and other lifestyle-oriented approaches. Across intervention categories, microbiome responses were heterogeneous, and no single taxonomic or diversity signature consistently characterized trials reporting favorable stress-related outcomes. Nevertheless, recurrent changes involving Bifidobacterium/Bifidobacteriaceae, Lactobacillus/Lactobacillaceae, Faecalibacterium, Roseburia, and members of the Lachnospiraceae/Ruminococcaceae families were identified across several interventions, together with changes in SCFA-related microbial features. Changes in global microbial diversity were inconsistent, and psychological and microbiome responses did not invariably occur in parallel. Overall, the randomized evidence indicates recurrent taxonomic and functional signals rather than a uniform microbiome response across stress-targeting interventions. Substantial heterogeneity in populations, intervention characteristics, study duration, outcome measures, and microbiome assessment methods limited direct comparisons across trials. Conclusions: Current randomized evidence does not identify a uniform microbiome signature associated with successful stress-targeting interventions but suggests partial convergence involving selected bacterial taxa and functional microbial features. The lack of consistent parallel changes in psychological and microbiome outcomes precludes conclusions regarding whether microbiome alterations mediate improvements in stress-related outcomes. Larger, longer-term RCTs incorporating standardized microbiome methodologies and functional microbial analyses are needed to determine the reproducibility and mechanistic relevance of these signals.

Nutrients doi: 10.3390/nu18172908

Authors: Magdalena Zarlenga Ewa Głuszczak-Idziakowska Justyna Czech-Kowalska Michał Skrzypek Maria Wilińska

Background: An optimal 25OHD level can prevent osteopenia of prematurity (bone health) and premature delivery (non-skeletal activity). Although maternal and fetal vitamin D (25OHD) levels correlate, data on preterm infants’ 25OHD status at birth are limited, with a well-recognized deficiency among term infants. Objectives: To evaluate maternal and neonatal 25OHD status at preterm birth and its determinants in a northern-latitude country, Poland. Design/Methods: Cross-sectional study between August 2015 and September 2016 investigating cord and maternal blood 25OHD levels at delivery in 69 pairs of mothers and newborns ≤ 32 6/7 weeks of gestation, and analyzing correlations between maternal and neonatal 25OHD levels and their influencing factors, with univariable and multivariable linear regression. Results: Median (IQR) 25OHD levels were 25 (16.6–34 ng/mL) in cord blood and 21.2 (15–29 ng/mL) in mothers and correlated positively (r = 0.69, p < 0.0001). 25OHD insufficiency was detected in 84.06% of mothers and 62.32% of newborns. Maternal 25OHD levels were higher in summertime delivery (p = 0.0008). The rate of vitamin D supplementation during pregnancy was 54.4%, increasing maternal (27 ng/mL vs. 16.7 ng/mL, p = 0.0006), cord blood (32.4 ng/mL vs. 17.4 ng/mL, p = 0.0005), and summer seasonal cord blood 25OHD levels (38.89 ng/mL vs. 25.5 ng/mL, p = 0.023), and the percentage of maternal (72.7% vs. 27.3%, p = 0.005) and neonatal 25OHD sufficiency (80% vs. 20%, p = 0.0021). Conclusions: Vitamin D insufficiency is common in mothers and their prematurely born infants at birth; vitamin D supplementation reverses the trend. To avoid inadequate supplementation in preterm newborns and in mothers at risk of preterm delivery, regular assessment of 25OHD levels should be considered.

Nutrients doi: 10.3390/nu18172907

Authors: Alberto Corriero Rossana Soloperto Mariateresa Giglio Fabio Silvio Taccone Filomena Puntillo Jean-Charles Preiser

Background: Acute brain injury, including traumatic brain injury (TBI), stroke, subarachnoid hemorrhage and secondary neurological injury, such as sepsis-associated encephalopathy (SAE) and delirium, is a major cause of morbidity in the intensive care unit (ICU), and few treatments alter its course once it is established. Critical illness, and brain injury in particular, rapidly disrupts the gut microbiome (GM) and the production of its metabolites. This dysbiosis matters most in neurologically injured patients, because microbial metabolites and a leaky intestinal barrier feed neuroinflammation through the gut–brain axis. Feeding timing and fasting affect circadian biology, the daily rhythm of the GM, and host metabolic pathways, such as ketogenesis, insulin signaling and autophagy. This review asks whether time-restricted or fasting-mimicking strategies can preserve these functions and reduce neuroimmune dysregulation after brain injury. Methods: In this narrative review, we searched the literature for randomized trials, crossover pilot studies, mechanistic human research, and guideline statements comparing continuous, cyclic, and intermittent enteral strategies, and evaluated translational pathways for GM-targeted feeding interventions. Results: Available studies showed no consistent difference in mortality between continuous and intermittent gastric feeding in ICU adults on mechanical ventilation, although the largest pooled analyses report more diarrhea, more abdominal distension and longer ICU stay with intermittent schedules, most pronounced in ventilated patients. While intermittent/cyclic regimens were not associated with an improvement of patient-centered outcomes, pilot studies demonstrated that short macronutrient interruptions (e.g., 12 h) reliably induced a metabolic fasting response in patients with a prolonged ICU stay. One randomized controlled trial (RCT) had GM end-points and reported feasible modulation of gut taxa and 58 differentially abundant serum metabolites with sequential (continuous-to-intermittent) feeding. Only five studies enrolled dedicated brain-injured cohorts; none was designed around neurological or gut–brain mechanistic outcomes, and none measured GM or neuroinflammation. Conclusions: Time-restricted, microbiome-protecting approaches are biologically plausible and deserve a phased translational program to test them in clinical trials. Future trials should focus on brain-injured and other neurologically relevant ICU patients, in whom the gut–brain axis is most engaged, and should pair mechanistic endpoints with clinical safety and proper control for confounders. No clinical study has yet tested whether non-continuous feeding alters neuroinflammatory or neurological outcomes after acute brain injury. There is currently no direct evidence supporting the effectiveness of this intervention in this population, and the case made here is mechanistic, not empirical.

Nutrients doi: 10.3390/nu18172906

Authors: Adia Meyer Lauren Makin Karina Allen Kate Tchanturia

Background: Autistic traits are overrepresented among individuals with anorexia nervosa (AN) and are associated with greater eating disorder (ED) psychopathology, psychological distress, and work and social functioning difficulties in this population. However, less is known about the prevalence and clinical associations of autistic traits in other ED presentations, such as bulimia nervosa (BN). This study examined the prevalence of autistic traits and their associations with ED psychopathology, psychological distress, and work and social functioning difficulties in a transdiagnostic ED sample. Methods: A retrospective cross-sectional analysis was conducted using routinely collected clinical data of adults attending a specialist ED service with restrictive AN (AN-R), binge–purge AN (AN-BP), BN, binge eating disorder (BED), atypical AN (A-AN), or avoidant/restrictive food-intake disorder (ARFID). Prevalence rates of elevated autistic traits (AQ-10 ≥6) were described across diagnoses. Multiple linear-regression analyses examined associations between autistic traits and measures of eating disorder psychopathology, psychological distress, and work and social functioning difficulties. Results: Elevated autistic traits were reported by 40.0% of patients with ARFID, 34.2% with AN-BP, 31.9% with AN-R, 27.0% with BN, 26.4% with A-AN, and 16.7% with BED. Higher AQ-10 scores were significantly associated with greater ED psychopathology, psychological distress, and work and social functioning difficulties across the AN-R, BN, and full samples. In the AN-R and full samples, the associations remained significant across all models after controlling for age, gender, and ED duration. In the BN sample, all associations remained significant following adjustment except for ED psychopathology, which was no longer significant after controlling for ED duration. Conclusions: Autistic traits are elevated across multiple ED diagnoses and are associated with greater clinical severity. The findings support the clinical relevance of autistic traits across ED presentations and support the need for further investigation of autism-informed approaches across transdiagnostic ED services.

Nutrients doi: 10.3390/nu18172905

Authors: Brian Hallmark Manja M. Zec Laurel Johnstone Carrie S. Standage-Beier Susan Sergeant Justin M. Snider J. Thomas Brenna Floyd H. Chilton

Background/Objectives: Fatty acids (FAs) are critical mediators of human physiology, yet associations between dietary intake, circulating FA levels, and health outcomes remain debated. Circulating FAs are typically reported as a percentage of total FA (% total), whereas absolute concentrations are measured infrequently. Although mathematically related, these metrics provide distinct information. NHANES 2011–2012 uniquely provided serum FA concentrations, enabling direct comparison of concentration and % total within the same individuals. Methods: Serum FAs measured by electron capture negative-ion mass spectrometry in NHANES 2011–2012 were expressed as both absolute concentrations (µmol/L) and % total. Associations of each representation with lipid and non-lipid cardiometabolic biomarkers were evaluated and compared with total FA concentrations. Results: For multiple FAs and biomarkers, the direction of association differed depending on whether FAs were expressed as concentration or % total. These reversals occurred when total FAs varied more strongly with the biomarker than the individual FA concentration, allowing a FA to increase in absolute concentration while decreasing as a percentage of the total FA pool. Reversals were observed for several major FAs, including linoleic acid (LA), arachidonic acid (ARA), docosapentaenoic acid (DPA), docosahexaenoic acid (DHA), and stearic acid (SA). Total FA concentrations were strongly associated with most biomarkers. Conclusions: FA concentrations and % total are complementary, not interchangeable, measures that capture distinct aspects of circulating FA biology. Associations with outcomes can be in opposite directions when the total plasma FA pool varies. These differences reflect underlying mathematical and biological relationships rather than methodological error. Future studies should routinely evaluate the total FA pool size alongside FA composition. Examining both representations alongside total FA can help distinguish changes in absolute FA abundance from changes in relative composition and provide a more complete interpretation of FA associations.

Nutrients doi: 10.3390/nu18172904

Authors: Zsófia Sziráki Diána Führer Lajos Biró Zsófia Kosik Márta Szmodis

Background/Objectives: Adequate dietary intake is essential for supporting growth, health, and athletic performance in adolescent athletes. Handball is a high-intensity intermittent team sport characterised by repeated running, sprinting, jumping, and physical contact, placing substantial physiological and nutritional demands on young athletes. This study examined associations between eating behaviour dimensions, sport anxiety, resilience, and dietary intake in adolescent elite female handball players. Methods: This cross-sectional study included 74 adolescent elite female handball players; after exclusion of two dietary-intake outliers, 72 participants were included in the analyses (mean age: 15.6 ± 1.7 years; BMI: 21.2 ± 2.4 kg/m2). Eating behaviour, sport anxiety, and resilience were assessed using the TFEQ-R21, SAS-2, and CD-RISC-10, respectively. Dietary intake was estimated using a semi-quantitative food frequency questionnaire. Pearson correlation and linear regression analyses were performed. Results: Cognitive Restraint was negatively correlated with energy (r = −0.266, p = 0.024), fat (r = −0.288, p = 0.014), carbohydrate (r = −0.257, p = 0.029), and sugar intake (r = −0.255, p = 0.031). Uncontrolled Eating was positively associated with energy (β = 0.338, p = 0.030; R2 = 0.134) and fat intake (β = 0.366, p = 0.017; R2 = 0.157) in the regression analyses. Higher resilience was associated with lower sugar intake in the regression analysis (β = −0.318, p = 0.007; model R2 = 0.101) and with lower sport anxiety in the Pearson correlation analysis (r = −0.559, p < 0.001). Conclusions: The findings indicate associations between eating behaviour dimensions, selected psychological characteristics, and dietary intake in adolescent elite female handball players. Uncontrolled Eating and Cognitive Restraint showed distinct patterns of association with dietary intake, while resilience was associated with sugar intake and sport anxiety. Given the cross-sectional and exploratory nature of the study, these findings warrant cautious interpretation and replication in larger independent samples.

Nutrients doi: 10.3390/nu18172903

Authors: Alex Graça Contato Carlos Adam Conte-Junior

Natural products have historically represented an important source of bioactive molecules with applications in nutrition, health promotion, and disease management [...]

Nutrients doi: 10.3390/nu18172902

Authors: William B. Grant Sunil J. Wimalawansa

Vitamin D has been linked to beneficial effects across more than 100 health outcomes, generating substantial interest in its extraskeletal functions. However, because nutrients differ fundamentally from pharmaceuticals in biology and mechanisms of action, conventional pharmaceutical-style randomized controlled trials (RCTs) are often inappropriate for evaluating nutrient efficacy. Instead, well-designed observational studies that have assessed serum 25-hydroxyvitamin D [25(OH)D] concentrations and correlated them with biologically relevant clinical outcomes provide evidence of effectiveness and establish causality. Since vitamin D primarily acts as a preventive agent for chronic diseases, the strongest evidence is derived from large, long-term, ecological and prospective cohort studies. In contrast, many RCTs have failed to demonstrate significant benefits because of methodological limitations, including enrollment of vitamin D-sufficient participants, inadequate dosing regimens, vitamin D supplementation in control groups, short intervention periods, and analyses based on assigned dose rather than serum 25(OH)D concentrations achieved, which determine biological responses. Early ecological studies demonstrated inverse associations between solar ultraviolet B doses and the risks of cancer, cardiovascular disease (CVD), and infectious diseases. These findings have been consistently supported by numerous prospective larger cohort studies linking higher serum 25(OH)D concentrations with improved health outcomes. Observational studies also offer important advantages, including being large and covering diverse populations, wide variations in vitamin D status, longer follow-up, and adjustment for multiple confounding factors. When interpreted within a biological framework using Bradford Hill’s criteria for causality—including consistency, strength and temporality of associations, dose–response relationships, biological plausibility, mechanistic evidence, coherence, and experimental support—the accumulated evidence strongly supports causal relationships that vitamin D sufficiency reduces risks of several diseases. This narrative review critically evaluates the evidence for cancer, CVD, blood pressure, COVID-19, type 1 and type 2 diabetes, periodontal disease, multiple sclerosis, and dementia. For these diseases, the authors concluded that the evidence satisfies Hill’s criteria for causality and aligns with current understanding of vitamin D biology and nutrient–health relationships.

Nutrients doi: 10.3390/nu18172901

Authors: Anna Lewandowska Tomasz Lewandowski Michał Próchnicki Aleksandra Stryjkowska-Góra Tomasz Góra Grzegorz Rudzki Barbara Laskowska Barbara Stawarz Dorota Durda Beata Piwińska Beata Jurek Iwona Maziarek

Background: Malnutrition is a significant clinical problem in patients with cancer, occurring not only during hospitalization but also throughout the recovery phase. It brings severe health and economic consequences, affecting patients on both physical and psychological levels. The American Society for Parenteral and Enteral Nutrition (ASPEN) and the European Society for Clinical Nutrition and Metabolism (ESPEN) emphasize the critical importance of early detection of nutritional disorders and timely intervention in oncology populations. The aim of this study was to determine the prevalence of malnutrition and factors associated with malnutrition among hospitalized Polish oncology patients and to draw attention to the need for early nutritional assessment in patients with cancer so as to ensure appropriate nutritional care. Methods: A multicenter cross-sectional study was conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines among adult patients diagnosed with cancer and undergoing oncological treatment. Data collection involved a structured survey questionnaire, anthropometric measurements, and validated screening tools: Mini Nutritional Assessment (MNA), Nutritional Risk Screening Score 2002 (NRS 2002), and Subjective Global Assessment (SGA). Results: The study group comprised 560 patients with a mean age of 55 ± 13.95 years, including 59% women and 41% men. The mean duration of illness was 3.37 years. Advanced-stage cancer was present in 43% of participants, and 66% were undergoing chemotherapy. The mean Body Mass Index (BMI) for the study group was 23.14 kg/m2, with a mean MNA score of 16.23 points and a mean NRS 2002 score of 2.39 points. Based on Subjective Global Assessment, moderate malnutrition was identified in 45% of patients, whereas severe malnutrition was confirmed in 27% of the study population. Conclusions: The prevalence of malnutrition among oncology patients is high. Early screening and regular monitoring are essential for the prompt identification of patients at risk, enabling the implementation of appropriate nutritional therapy and the improvement of clinical outcomes.

Nutrients doi: 10.3390/nu18172900

Authors: Agnieszka Czerwińska-Osipiak Amelia Julia Sobala Anna Weronika Szablewska Krzysztof Jurek

Background/Objectives: Exclusive breastfeeding (EBF) is associated with multiple individual, interpersonal, and healthcare-related factors. Identifying potentially modifiable factors associated with EBF across different levels of influence may help inform future breastfeeding research and support strategies. This study aimed to identify individual, interpersonal, and obstetric factors associated with exclusive breastfeeding among Polish mothers, using the Socio-Ecological Model (SEM) as a conceptual framework. Methods: A cross-sectional online survey was conducted among 769 Polish mothers of children aged up to 24 months. The questionnaire included sociodemographic and perinatal characteristics, as well as standardized instruments: Multidimensional Scale of Perceived Social Support (MSPSS), Iowa Infant Feeding Attitudes Scale (IIFAS), and Birth Satisfaction Scale–Revised (BSS-R). Hierarchical binary logistic regression was used to identify factors associated with exclusive breastfeeding. Missing data were handled using multiple imputation by chained equations, with 20 imputed datasets, and estimates were pooled according to Rubin’s rules. Results: Exclusive breastfeeding was reported by 610 participants (79.3%). Across the 20 imputed datasets, the final model showed χ2 values ranging from 62.92 to 70.00 and Nagelkerke’s R2 values ranging from 0.123 to 0.136. In the final model, mode of delivery (OR = 1.92, 95% CI: 1.32–2.80, p < 0.001), complications/illnesses during pregnancy (OR = 1.73, 95% CI: 1.14–2.64, p = 0.011), and partner encouragement (OR = 2.81, 95% CI: 1.72–4.59, p < 0.001) were significantly associated with exclusive breastfeeding. A nonlinear association between breastfeeding attitudes and exclusive breastfeeding was observed, with the quadratic IIFAS term remaining statistically significant (OR = 0.99, 95% CI: 0.99–1.00, p = 0.002), whereas the linear IIFAS term was not statistically significant in the final model (OR = 1.04, 95% CI: 1.00–1.08, p = 0.078). Birth satisfaction and the MSPSS Friends, Family, and Significant Other subscales were not independently associated with exclusive breastfeeding in the final model. Conclusions: Among the variables included in the final model, partner encouragement showed the strongest association with exclusive breastfeeding. Mode of delivery and complications/illnesses during pregnancy were also associated with exclusive breastfeeding, while the association between breastfeeding attitudes and exclusive breastfeeding was nonlinear. These findings may inform future prospective and intervention studies examining partner support, breastfeeding attitudes, and perinatal factors in relation to exclusive breastfeeding. Further research is warranted to explore the mechanisms underlying the observed associations.

Nutrients doi: 10.3390/nu18172899

Authors: Csongor István Szepesi Viktor Rekenyi Nóra Horváth Róbert László Nagy Mihály Soós Anita Szemán-Nagy Zoltán Kondé Győző Kurucz Luo Xiaonuo László Róbert Kolozsvári

Background/Objectives: Eating disorders are increasingly conceptualized as information-processing disorders characterized by attentional biases toward food-related stimuli. However, whether such biases are already detectable in subclinical, non-treatment-seeking populations remains unclear. This study examined whether subclinical eating pathology, assessed with the Eating Attitudes Test-26 (EAT-26), is associated with distinct patterns of visual attention toward high- and low-calorie food images in university students. Methods: In this cross-sectional observational study featuring an experimental eye-tracking task, 89 university students completed the EAT-26 and a visual task displaying paired high- and low-calorie food images alongside neutral controls. Oculomotor metrics included first fixation duration (FFD), fixation count (FC), and average fixation duration (AFD). Data were evaluated using EAT-26 threshold-based group stratification (lower-risk vs. risky eating behavior) and Spearman rank correlation analyses. Results: Global EAT-26 scores showed a significant correlation with a directional attentional bias index (rho = 0.29, p = 0.006). The Dieting subscale demonstrated no significant relationships with any oculomotor metrics. Conversely, Oral Control scores were significantly negatively correlated with the directional attentional bias index (rho = −0.27, p = 0.009) and positively tracked with low-calorie fixation counts (rho = 0.30, p = 0.004). Bulimia subscale scores showed a moderate positive correlation with the directional attentional bias index (rho = 0.26, p = 0.013), characterized by a significant decrease in low-calorie fixation counts (rho = −0.32, p = 0.002) and a strong increase in high-calorie fixation counts (rho = 0.36, p < 0.001) during sustained viewing. Conclusions: Subclinical eating pathology tendencies are associated with distinct implicit attentional profiles regarding food caloric density during sustained cognitive evaluation. Oral control drives visual prioritization of low-calorie stimuli to maintain inhibitory control, whereas bulimic tendencies reflect prolonged visual preoccupation with high-calorie reward cues. Eye-tracking represents a promising non-invasive research tool for exploring early cognitive correlates of eating-disorder risk.

Nutrients doi: 10.3390/nu18172897

Authors: Li Xiao Jingjing Chen Wenyan Zhong Fan Peng Chengfu Yuan

Background: Disrupted bile acid homeostasis drives alcoholic steatohepatitis (ASH) progression, which has become a new therapeutic target for ASH. This study examined the impact and underlying mechanisms of polysaccharides from Balanophora harlandii Hook. (BHP) on bile acid synthesis and liver damage in ASH. Methods: A Binge-on-Chronic alcohol exposure model was established to assess the impact of BHP on alcohol-induced liver damage and bile acid (BA) metabolism. Fexaramine and glycine-β-MCA (Gly-MCA) were also utilized to explore a crucial role of intestinal FXR signaling activity in ASH mice. In vitro, intestinal epithelial cells were stimulated with alcohol to impair FXR activity. Results: BHP treatment mitigated weight loss, reduced hepatic lipid accumulation and inflammation in chronic alcohol-fed mice, demonstrating a significant hepatoprotective effect against ASH. Mechanistically, BHP treatment reduced intestinal conjugated BA levels and activated FXR-FGF15 signaling, which inhibited hepatic BA synthesis and mitigated the toxic effects of hepatic BA accumulation in ASH. However, the suppression of intestinal FXR activation notably diminished the ability of BHP to regulate BA synthesis and prevent liver damage in ASH mice. In vitro, BHP treatment also activated FXR signaling in intestinal epithelial cells, counteracting alcohol-induced FXR activity damage. Conclusions: BHP treatment effectively alleviated liver damage in mice with chronic alcohol exposure through reducing hepatic BA synthesis. The mechanisms behind the hepatoprotective effects of BHP suggested that correcting the shift in the intestinal BA profile and/or the intestinal FXR-FGF15 signaling are the potential therapies against alcoholic liver injury.

Nutrients doi: 10.3390/nu18172898

Authors: James Chmiel Aleksandra Kładna

Introduction: Caffeine is a widely consumed psychoactive compound whose central pharmacological effects are mediated primarily through antagonism of adenosine receptors. Wakeful EEG provides a temporally sensitive method for examining caffeine-related changes in oscillatory activity and vigilance-related brain states. This systematic review synthesized evidence concerning the effects of acute and habitual caffeine exposure on non-ERP EEG measures during wakefulness. Materials and Methods: The review followed PRISMA 2020 guidelines. PubMed/MEDLINE, Scopus, Web of Science, Embase, PsycINFO, and the Cochrane Library were searched from database inception to 30 May 2026. Eligible studies included human participants exposed to caffeine, coffee, or caffeine-containing interventions and reported EEG outcomes during wakeful resting-state or task-related conditions. Risk of bias was assessed using RoB 2 for randomized trials and ROBINS-I for non-randomized studies. Findings were synthesized narratively because of substantial methodological heterogeneity. Results: Forty-eight studies were included. Resting-state spectral EEG was the dominant paradigm, although studies also examined task-related activity, prolonged wakefulness, sleep deprivation, withdrawal, driving-related drowsiness, coherence, nonlinear complexity, EEG microstates, and multimodal EEG–fMRI measures. Reductions in alpha power or amplitude were among the more frequently reported findings following acute caffeine administration, while attenuation of theta, delta, or other slow-frequency activity was particularly evident under conditions of sleep pressure, prolonged wakefulness, withdrawal, fatigue, or reduced vigilance. However, neither effect was universal. Beta findings were heterogeneous, and changes in alpha frequency, total EEG power, coherence, asymmetry, complexity, and microstates were less consistently examined. The direction and magnitude of EEG responses varied according to caffeine dose, habitual intake and withdrawal status, baseline vigilance, eye condition, task demands, participant characteristics, scalp region, frequency-band definition, and EEG methodology. Evidence concerning coherence, asymmetry, nonlinear complexity, microstates, and multimodal EEG–fMRI outcomes was preliminary. Conclusions: The available evidence does not establish a single reproducible EEG signature or validated electrophysiological biomarker of caffeine response. Reductions in alpha power and attenuation of slow-frequency activity during states of elevated sleep pressure or caffeine withdrawal were among the more frequently reported findings, but substantial methodological and state-dependent heterogeneity limits their specificity and generalizability. EEG changes should also not be interpreted as direct indicators of improved cognitive performance, because electrophysiological and behavioral effects were not consistently concordant across studies.

Nutrients doi: 10.3390/nu18172896

Authors: Rashida K. Jones Aasha I. Hoogland Bihe Hu Xiaoyin Li Carley Geiss Melinda L. Maconi Rebecca Blackwell Yvelise Rodriguez Crystal Bryant Nathaly Irizarry-Arroyo Laura B. Oswald Brian D. Gonzalez Brent J. Small Andrew Galligan Heather S. L. Jim Marilyn Stern Sylvia L. Crowder

Purpose: Young adult cancer survivors aged 20–30 years are at increased risk for chronic health conditions, influenced by modifiable lifestyle behaviors. Many do not meet the American Cancer Society’s guidelines for physical activity and healthy eating. Guided by Social Cognitive Theory, this qualitative study explored the facilitators and barriers to healthy lifestyle behaviors among a racially and ethnically diverse sample of young adult cancer survivors aged 20–30 years to inform tailored interventions. Methods: Participants were recruited through the Adolescent and Young Adult Oncology Program at Moffitt Cancer Center in Florida, USA. Semi-structured interviews were conducted and analyzed using applied thematic analysis. Transcripts were coded in NVivo 12 Plus and organized into themes reflecting Social Cognitive Theory constructs and intervention preferences. Demographic information was collected via pre-interview surveys. Results: Participants (N = 30) were an average of 26 years (SD = 2.4). Most identified as non-Hispanic (60%), White (60%), unmarried (83%), women (83%), and with annual household income ≥$40,000 (67%). The most common diagnoses were thyroid cancer (20%), lymphoid (17%), and sarcoma (13%). Interviews lasted 30–88 min (M = 52). Five themes emerged: (1) competing demands and time constraints; (2) symptom burden and desire for credible, flexible support; (3) previous habits, self-efficacy, and community building; (4) dual role of social support; and (5) cancer as a catalyst for behavior change. Conclusions: Findings identified facilitators and barriers to physical activity and healthy eating, and intervention preferences among young adult cancer survivors, which can inform the timing, content, and modality of tailored interventions. Implications for Cancer Survivors: Findings can inform tailored, survivor-centered interventions for young adult cancer survivors.

Nutrients doi: 10.3390/nu18172895

Authors: Qi Zhang Yongli Zhao Yifan Duan Guina Luo Jingtao Duan Changqing Liu

Background: Maternal nutritional status before pregnancy may influence offspring long-term health; however, the association between pre-pregnancy dietary patterns and body composition in preschool children remains unclear. Methods: This study used data from the Taicang and Wuqiang Mother–Child Cohort Study (TAWS), comprising 582 mother–child pairs. Dietary intake during the month before pregnancy was assessed using a food frequency questionnaire. Dietary patterns were derived via principal component analysis. Standardized pattern scores (mean = 0, SD = 1) were analyzed as continuous variables (per 1-SD increase) and categorized into quartiles (Q1–Q4, with Q1 as reference). Body composition indicators (percent body fat [PBF], fat mass index [FMI], fat-free mass index [FFMI], and skeletal muscle index [SMI]) were measured by bioelectrical impedance analysis in children aged 3–6 years. Multiple linear regression was used to examine associations under two models: an unadjusted model and a multivariable model adjusted for child characteristics, maternal sociodemographic and gestational factors, family factors, feeding mode, and other dietary patterns. Interaction terms were introduced to test for potential effect modification by child sex and maternal pre-pregnancy BMI. Results: Results showed that five maternal pre-pregnancy dietary patterns were extracted: animal-based food, grain-vegetable-fruit, processed meat-dairy, vegetable-legume, and cured vegetable. In multivariable-adjusted models, the processed meat-dairy pattern was positively associated with FMI (Q4 vs. Q1: β = 0.262, 95% CI: 0.036 to 0.488). The grain-vegetable-fruit pattern was inversely associated with FFMI (Q4: β = −0.265, 95% CI: −0.510 to −0.020) and SMI (Q4: β = −0.256, 95% CI: −0.564 to −0.113). The vegetable-legume pattern was associated with higher PBF (Q3: β = 0.234, 95% CI: 0.007 to 0.461) and lower SMI (Q4: β = −0.338, 95% CI: −0.564 to −0.113). No significant associations were observed for the animal-based food or cured vegetable pattern after adjustment. Sex-stratified analyses showed that the animal-based food pattern was associated with FFMI and SMI in opposite directions between boys and girls (p for interaction = 0.048 and 0.013, respectively). Maternal pre-pregnancy BMI significantly modified only the association between the processed meat–dairy pattern and SMI (p for interaction = 0.032). Conclusions: Maternal pre-pregnancy dietary patterns were selectively associated with body composition in preschool children: the processed meat–dairy pattern was associated with higher fat mass, while the grain-vegetable-fruit and vegetable-legume patterns were associated with lower muscle indices. These associations are observational in nature and do not imply causality. In particular, the associations of plant-based dietary patterns with muscle indices should be interpreted with caution and should not be regarded as negative effects of plant-based diets.

Nutrients doi: 10.3390/nu18172894

Authors: Adam Tawfiq Amawi Walaa Jumah Alkasasbeh Gerasimos V. Grivas Parham Jalali Aida Mohammadi

Taekwondo is a high-intensity, intermittent, weight-category combat sport requiring repeated explosive actions, rapid decision-making, and effective recovery between bouts. These demands, combined with congested competition schedules and weight-management requirements, make nutrition important for both performance and athlete health. This narrative review provides an evidence-informed synthesis of nutritional strategies relevant to taekwondo performance, recovery, and weight management by integrating available taekwondo-specific evidence with findings from comparable combat sports and established sports nutrition guidelines. Particular attention is given to energy and carbohydrate availability, protein intake, hydration and electrolyte balance, selected ergogenic aids, nutritional periodization, and safe weight management. The review also proposes an applied integrative framework illustrating how nutrition may influence interacting physiological, neuromuscular, cognitive, and recovery-related processes. A key limitation is the scarcity of taekwondo-specific intervention studies, meaning that several practical recommendations are necessarily extrapolated from comparable combat sports and broader athletic populations. From an applied perspective, nutritional priorities should include maintaining adequate energy and carbohydrate availability, supporting recovery through appropriate protein and fluid–electrolyte intake, and adopting gradual, individualized weight-management strategies that minimize dehydration, low energy availability, and Relative Energy Deficiency in Sport (RED-S) risk. Overall, nutritional strategies in taekwondo should be individualized and aligned with training load, competition demands, recovery needs, and weight-management goals. Further taekwondo-specific experimental studies are needed to refine these recommendations and strengthen sport-specific nutritional guidance.

Nutrients doi: 10.3390/nu18172893

Authors: Esra Tansu Sarıyer Murat Baş Hatice Çolak Çetinkaya

Background/Objectives: This study evaluated changes in PMS severity, nutrition knowledge, and eating attitudes over a 6-week online nutrition education programme delivered to female university students. Methods: This uncontrolled single-arm pretest/posttest study included 112 female university students recruited by convenience sampling from a women’s dormitory. Nutrition education was delivered daily for 6 weeks via WhatsApp as 42 informational cards. Measurements were taken before and after the programme. Attitudes and behaviours associated with disordered eating were screened using the Eating Attitudes Test-26 (EAT-26), nutrition knowledge using the Nutrition Knowledge Level Scale for Adults (NKLSA), and premenstrual symptom severity using the Premenstrual Syndrome Scale (PMSS). Results: No significant changes occurred in nutrition knowledge (p = 0.409) or eating attitudes (p = 0.654). The PMSS score significantly decreased (mean change = 14.28 ± 46.34; 95% CI 5.60–22.96; p = 0.001, dz = 0.31, 95% CI 0.12–0.50), with decreases across eight subscales (dz = 0.19–0.38; BH q < 0.05), whereas appetite changes were unchanged (p = 0.423); the largest standardized changes were observed for depressive mood and bloating. PMSS change was not correlated with knowledge (r = 0.001) or knowledge with eating attitudes (r = 0.057); PMSS and eating attitude changes were weakly positively correlated (r = 0.187, p = 0.048; exploratory, not corrected for multiplicity). Conclusions: Following a 6-week WhatsApp-based nutrition education programme, self-reported PMS severity decreased, particularly mood and somatic symptoms, without changes in nutrition knowledge or eating attitudes. The uncontrolled single-arm design precludes attributing these changes to the programme.

Nutrients doi: 10.3390/nu18172887

Authors: Richard E. Frye Daniel A. Rossignol

Background: Mandatory folic acid (FA) fortification prevents neural tube defects but generates unmetabolized folic acid (UMFA) in blood, because hepatic dihydrofolate reductase (DHFR) reduces FA only slowly. Whether UMFA itself, as distinct from high total folate, carries biological consequences is unresolved. Methods: We systematically searched six databases (January 1995–May 2026; PROSPERO CRD420261407616) and included 65 publications describing 61 unique primary studies, yielding 71 analytic contributions (15 mechanistic, 24 observational, 32 interventional). The question of whether equimolar (6S)-5-MTHF substitution alters UMFA, erythrocyte folate, or total homocysteine (tHcy) versus FA was evaluated using random-effects meta-analysis with a DerSimonian–Laird estimator for τ2 and Hartung–Knapp–Sidik–Jonkman small-sample confidence intervals and was rated with GRADE. Mechanistic and observational streams were synthesized narratively and classified by exposure metric (UMFA, total folate, FA intake, fortification). Results: 5-MTHF substitution reduced plasma UMFA (SMD +0.99; 95% CI +0.20 to +1.79; I2 = 30%; k = 3; GRADE low). The two trials reporting erythrocyte folate were directionally discordant (Hedges’ g +0.40; +0.08 to +0.73 and −0.38; −0.92 to +0.16; I2 = 83%) and were not pooled. For tHcy, no pooled estimate could be derived; it is reported qualitatively. Observational UMFA–outcome associations were inconsistent, confounded by total folate, and unreplicated. Conclusions: Substitution of (6S)-5-MTHF for FA appears to reduce circulating UMFA. For erythrocyte folate, the two available trials were directionally discordant but insufficient to establish equivalence or non-inferiority. For tHcy, no between-form difference was detected. With two to three trials per outcome, no prespecified margins, and no trial designed for that purpose, the evidence cannot support an equivalence or non-inferiority claim for either outcome and clinical benefit remains unestablished. Current evidence does not establish that UMFA independently causes harm.

Nutrients doi: 10.3390/nu18172892

Authors: Shinichi Nakagawa Akira Yamamoto

Background/Objectives: In food-image nutrient estimation with vision-language models (VLMs), portion size is a dominant source of error, yet how a prompt shifts the estimated amount—and in which direction—remains uncharacterized. We tested whether a Japanese-dietitian prompt acts as a systematic, directional influence on a model’s quantity estimates and what an explicit magnitude instruction does by comparison. Methods: Six VLMs from three vendors were evaluated on two datasets with contrasting portion regimes—NutriImage (Japanese cafeteria dishes; dietitian-calculated ground truth) and SNAPMe (US meal photographs)—under persona conditions (none, Japanese-dietitian, US-dietitian) crossed with two portion-specification levels, with five additional prompt-control conditions, image-level paired statistics with bootstrap confidence intervals, interaction tests, equivalence tests, and a repeated-call variability analysis. Results: The Japanese-dietitian prompt lowered predicted energy in all six models and both datasets (persona main effect p < 10−94), approximately preserving predicted macronutrient composition in relative terms; the US prompt produced only small, sign-inconsistent changes. The effect was not reproduced by an explicit “assume smaller portions” instruction, which shifted estimates further but far less consistently, whereas an “assume larger portions” instruction was followed almost uniformly by four of the six models, with both OpenAI models largely insensitive to explicit magnitude instructions in either direction. Accuracy consequences were dataset-dependent: error decreased on the small-portion dataset (up to ~20 MedAPE points) and was statistically equivalent (±5-point margin) on the larger-portion dataset in 11 of 12 model × portion cells. All principal effects were confirmed in a unified analysis that randomizes model identity over a pooled image set (n = 2159 independent images; Holm-corrected; robust across 1000 random re-assignments). Conclusions: A Japanese-dietitian prompt acts as a consistent downward influence on VLM quantity estimates that is distinct from explicit downscaling instructions; its accuracy value is domain-specific and requires validation on the target domain before any practical use.

Nutrients doi: 10.3390/nu18172891

Authors: Dolores B. Vazquez-Sanroman Liam Longaberger Alondra Chance Michael Anderson Nedra Wilson Gerwald Koehler

Background: Adolescence represents a pivotal, yet understudied, developmental window in which maturation of the gut microbiome, neural circuits, endocrine systems, and behavioral processes converge. Although early-life microbiota–gut–brain interactions are well established, emerging evidence demonstrates that adolescence constitutes a “second sensitive period” during which microbial composition, metabolic output, and immune function undergo substantial restructuring. These microbial transitions parallel key neurodevelopmental events, including synaptic pruning, dopaminergic refinement, and heightened neuroendocrine activity, suggesting a coordinated microbiome–gut–brain developmental program. Cross-species comparisons reveal broad alignment between rodent and human adolescent milestones, though inconsistencies in development staging present challenges for translational interpretation. Environmental influences—such as diet, stress, antibiotics, and physical activity—further modulate microbial and neural maturation during this period, with potential long-term consequences for cognition, emotion, and stress responsivity. Mechanistically, microbial metabolites, vagal pathways, immune mediators, and steroid hormone interactions constitute key interfaces linking the gut microbiome to adolescent brain function. Recognizing adolescence as a mechanistically rich and plastic phase of gut–brain co-development underscores the need for harmonized methodological approaches and developmental alignment frameworks. Methods-Results: This review synthesizes ontogenetic, mechanistic, and translational evidence to highlight conserved microbiome–gut–brain pathways and identifies opportunities for targeted interventions during this critical developmental stage.

Nutrients doi: 10.3390/nu18172890

Authors: Jessica Hine Kirsty Andresen Rose-Marie Satherley Christina J. Jones

Background/Objectives: Food allergy (FA) affects up to 10% of adults and requires ongoing dietary vigilance that may increase vulnerability to eating disorders (EDs), yet evidence in adults remains limited. This study compared ED screening and history between adults with and without food allergy (FA), and explored factors associated with positive screening among those with FA. Methods: This cross-sectional study recruited 371 adults (134 with FA, 237 without) via an online survey. Positive screening required meeting thresholds on both the Eating Attitudes Test-8 (EAT-8) and the Sick, Control, One, Fat, Food (SCOFF); ED history and treatment were assessed via self-report. Group differences were examined using chi-square tests and, for the primary comparison, age- and sex-adjusted logistic regression. Among those with FA, correlations identified candidate predictors of positive screening, which were entered into a further logistic regression. Results: FA status was not associated with positive screening for an ED (37.3% vs. 37.1%; p = 0.972), including after adjusting for age and sex. FA was significantly associated with a greater lifetime history of EDs (36.4% vs. 20.7%; p = 0.001) and ED treatment (17.9% vs. 10.1%; p = 0.032). Among those with FA, positive screening was independently predicted by ED history and shorter allergy duration in a multivariable model (Nagelkerke R2 = 0.14); however, allergy duration and age were highly correlated, so this effect could not be shown to be independent of age. Conclusions: FA alone was not statistically associated with current positive screening but was linked to lifetime history and treatment, suggesting that this relationship may be more evident earlier in the FA experience. ED history and shorter allergy duration were associated with positive screening among those with FA, though the duration effect may partly reflect age; sex was linked to screening only at the bivariate level, given too few male positive cases to model. Findings are preliminary, given the FA-unvalidated screening tools used, warranting longitudinal validated research.

Nutrients doi: 10.3390/nu18172889

Authors: Ruth Nekane Pita Isabel María Fernández Oibar Martínez Jose Miguel Miranda

This review examines the physical foundations, predictive models, emerging technologies and recent research trends in bioimpedance for clinical nutrition. A bibliometric analysis of cumulative scientific production from 1980 to 2025 shows that weighted logistic models provide a good descriptive fit to the evolution of the literature (R2 ≥ 0.999). Bioimpedance research remains in an expanding phase, with its projected inflection point lying beyond 2026. These fits are descriptive and model-dependent: high coefficients of determination on cumulative counts are not in themselves evidence of predictive validity, and inflection points beyond the observation window are extrapolations. We introduce the Measurement-Independent Factor (MIF), which isolates the anthropometric contribution from the bioimpedance measurement in predictive equations. Phase Angle (PhA) has emerged as the most extensively studied bioimpedance descriptor, since it avoids the population-specific prediction equations required for estimates such as FFM or FM, although its absolute value remains dependent on measurement conditions, instrumentation and biological characteristics. Body-composition estimates obtained with devices from different manufacturers should not be interpreted interchangeably. Electrode technologies, bioimpedance wearables, and bioimpedance imaging are reviewed as major emerging research directions. A second bibliometric analysis covering the most-cited literature from 2020 to 2026 and 1655 original articles published during 2025–2026 show that recent research focuses primarily on obesity and adiposity, together with sarcopenia and frailty, whereas critical and acute care remain underrepresented.

Nutrients doi: 10.3390/nu18172888

Authors: Reham I. Alagal

Background: Saudi Arabia maintains official statistics on its food security, in addition to conducting surveys on health parameters and performing national health assessments. Also, several academic papers on dietary patterns are published every year. Many published documents analyze data on food availability, self-reported eating habits, and biomarker-based health risks. However, individually, they represent distinct aspects of nutrition. Hence, this study was undertaken to examine publicly accessible nutrition-related evidence in Saudi Arabia and assess whether existing public food and nutrition datasets consistently align with the biological indicators of nutritional risk. Methods: Searches were conducted using defined criteria in publicly available Saudi and international sources published or updated between 2005 and 2025. These were identified through official reports, global food databases, WHO-aligned surveys, and peer-reviewed articles, with searches conducted and updated during June–July 2026. Sources were classified by representativeness, recency, measurement validity, accessibility, and analytical role. The primary outcome was the completeness and interpretability of public evidence streams rather than a pooled prevalence estimate. Results: SHIS 2013 remains the top public national dietary intake dataset, which shows that only 5.2% and 7.5% of people met their fruit and vegetable intake recommendations, respectively. GASTAT Health Determinants Statistics 2024 indicated that only 10.2% of people aged 15 years and above ate five or more portions of fruits and vegetables daily, yet GASTAT Food Security Statistics 2024 indicated significant per capita availability of rice, milk, poultry, eggs, red meat, onions, tomatoes, and dates. High levels of biological risk were evident in WHS 2019 biomarkers; for example, 42.6% of people had hypercholesterolemia and 50% had low hemoglobin according to the WHS 2019 indicator definition. Recent studies provided additional data on beverages, sugars, dietary habits of adolescents, and diet quality but lacked national food-wide intake data. Conclusions: Public Saudi nutrition data provide complementary but non-equivalent information; indicators show low dietary adequacy and high biomarker-defined risk, supporting the need for integrated individual-level nutrition surveillance. In the future, Saudi national nutrition surveillance must focus on individual-level intake data and biomarker-based measurements.

Nutrients doi: 10.3390/nu18172886

Authors: Hang Wang Yi-Jing Guo Shang-Ta Wang

Background/Objectives: Sarcopenia is an age-associated skeletal muscle disorder that may be aggravated by a high-fat diet (HFD). Given the multifactorial pathogenesis of sarcopenia, single-nutrient interventions may be insufficient. This study investigated whether a specialized multinutrient formula could attenuate muscle dysfunction and intramuscular lipid accumulation in adult mice under standard-diet and HFD-fed conditions. Methods: Male C57BL/6J mice were assigned to five groups: young control (YC), adult control (OC), adult control supplemented with the nutritional formula (OCN), adult HFD-fed mice (OH), and adult HFD-fed mice supplemented with the formula (OHN). A specialized multinutrient formula containing enriched whey protein, β-glucan, antioxidant vitamins, and essential trace minerals was orally administered five times per week for 12 weeks. Body composition, muscle histology, grip strength, intramuscular lipid accumulation, inflammatory gene expression, and protein markers related to caspase-associated apoptosis, proteolysis-related signaling, and tissue remodeling were assessed. Results: Compared with YC mice, adult control and HFD-fed mice exhibited reduced muscle strength and fiber cross-sectional area, increased adiposity, intramuscular lipid deposition, elevated TNF-α expression, and alterations in selected protein markers related to caspase-associated apoptosis, proteolysis-related signaling, and tissue remodeling. Nutritional supplementation improved muscle strength and fiber morphology, reduced intramuscular lipid deposition, lowered TNF-α expression, reduced cleaved caspase marker abundance, decreased p38 MAPK and MuRF-1 expression, and increased collagen type III expression. Conclusions: HFD aggravated muscle dysfunction and sarcopenic obesity-related features in adult mice, as evidenced by impaired muscle function, reduced muscle fiber cross-sectional area, increased intramuscular lipid accumulation, and changes in selected inflammatory, cleaved caspase-, protein turnover-related, and remodeling markers. Nutritional supplementation mitigated these alterations and improved muscle structure and function.

Nutrients doi: 10.3390/nu18172885

Authors: Andrea Giudiceandrea Martina Cocuzza Gianni Gravina Valeria Silvestri Filippo Amore Marco Sulfaro Francesco De Dominicis Simone Bruzio Epifanio Giudiceandrea Matteo Salgarello Grazia Maria Cozzupoli Maria Cristina Savastano Benedetto Falsini Stanislao Rizzo Tommaso Salgarello

Background/Objectives: Nicotinamide (NAM), a form of vitamin B3 and precursor of nicotinamide adenine dinucleotide (NAD), has emerged as a potential metabolic and neuroprotective strategy in glaucoma. This systematic review aimed to evaluate the available human evidence on NAM-containing and NAD-targeted strategies in glaucoma, integrating interventional, observational, and mechanistic evidence with particular attention to clinical outcomes, methodological quality, and safety. Methods: A systematic literature search was conducted in PubMed, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL), with the search updated through 22 August 2026. Eligible studies included randomized and non-randomized interventional studies evaluating NAM-containing or NAD-targeted supplementation strategies, as well as observational human studies investigating NAM/NAD-related biomarkers or mitochondrial metabolic alterations in relation to glaucoma. Risk of bias was assessed according to study design using RoB 2 for randomized trials, ROBINS-I for non-randomized interventional studies, and a domain-based assessment for observational exposure and biomarker studies. Owing to substantial clinical and methodological heterogeneity, findings were synthesized narratively without quantitative pooling. Results: Thirteen eligible reports representing eight unique human studies were included. Randomized trials provided preliminary evidence that NAM-containing interventions may produce short-term functional and electrophysiological effects. NAM supplementation was associated with improvement in inner retinal electrophysiological function in randomized crossover studies, whereas effects on visual field outcomes were inconsistent. A trial combining NAM with pyruvate reported favorable short-term visual field changes, although the specific contribution of NAM could not be isolated. Non-randomized studies provided complementary evidence on vascular, metabolic, structural, electrophysiological, and patient-reported outcomes but were limited by potential confounding and uncontrolled study designs. Observational studies reported associations between glaucoma and altered circulating NAM concentrations and systemic mitochondrial dysfunction. Available studies were generally small and of limited duration, and the evidence was insufficient to establish sustained neuroprotection or modification of glaucoma progression. Conclusions: Human evidence supports the biological plausibility of targeting NAM/NAD metabolism in glaucoma and provides preliminary signals of short-term biological and functional effects. However, current evidence remains insufficient to support routine high-dose NAM supplementation in clinical practice. Larger, adequately powered, long-term randomized controlled trials are required to establish sustained efficacy, optimal dosing, patient selection, and long-term safety.

Nutrients doi: 10.3390/nu18172884

Authors: Frederick Ferguson Michael Baham William J. McCarthy Arleen F. Brown Alejandra Casillas Stefanie Vassar Gloria Moon Julia I. Caldwell Fatinah Darwish-Elsherbiny Dipa Shah Tony Kuo

Background: Free produce distributions at safety-net health center sites represent a promising strategy for mitigating food insecurity. Understanding how these services connect to participant outcomes is essential for optimizing food delivery to the community. Objectives: In this secondary analysis of Los Angeles County FoodRx Clinic’s Produce Distribution Program (PDP), we evaluated the association between attendance frequency and the proportion of produce consumed (“all” versus “less than all”) among returning participants, adjusting for socio-demographic, household, and program characteristics. Additionally, we sought to identify factors contributing to incomplete produce consumption. Methods: Data were collected using intercept surveys at 16 healthcare sites hosting produce distributions from July to October 2024. Among 451 surveyed participants, 368 were repeat attendees who had visited the distribution events more than once in the last 12 months. Results: Among repeat attendees, 64% reported their household consumed all produce received, while 36% consumed only a portion. Higher attendance frequency (4+ times vs. 2–3 times) was associated with significantly higher odds of all produce consumed (adjusted odds ratio: 2.38, confidence interval: 1.43–3.95). Conclusions: These findings provide critical insights for refining PDP operations and minimizing incomplete produce consumption among repeat attendees of this program.

Nutrients doi: 10.3390/nu18172883

Authors: Stefania Greco Giovanni Delli Carpini Abel Duménigo Gonzàlez Gaia Goteri Andrea Ciavattini Pasquapina Ciarmela

Endometriosis is a chronic estrogen-dependent systemic inflammatory disorder characterized by ectopic implantation of endometrial-like tissue, primarily on the ovaries, pelvic peritoneum, and bowel. According to the World Health Organization (WHO) estimate updated in 2025, endometriosis affects approximately 10% (about 190 million) of reproductive-age women worldwide and is a major contributor to chronic pelvic pain, dysmenorrhea, dyspareunia, and infertility. Standard medical therapies focus on ovarian suppression, which alleviates symptoms but precludes conception and carries significant metabolic and skeletal adverse effects. Recent multi-omics research has raised interest in the gut microbiome and the estrobolome, defined as the microbial gene repertoire involved in estrogen metabolism, as potential modulators of systemic estrogen exposure and immune homeostasis. Altered microbiota composition and microbial β-glucuronidase activity may influence enterohepatic estrogen recirculation; however, endometriosis-specific evidence is predominantly associative or preclinical and does not establish a causal pathway. Dysbiosis and increased bacterial β-glucuronidase activity promote enterohepatic recirculation of estrogens, contributing to hyperestrogenism and ectopic lesion proliferation. Concurrently, oxidative stress, peritoneal inflammation, aberrant macrophage polarization, and neoangiogenesis sustain lesion survival and contribute to chronic pelvic pain. This comprehensive review synthesizes mechanistic, preclinical, and clinical evidence regarding microbiome-targeted interventions and nutritional compounds, including probiotics, prebiotics, N-acetyl cysteine (NAC), curcumin, resveratrol, epigallocatechin gallate (EGCG), omega-3 polyunsaturated fatty acids (PUFAs), and vitamin D, in modulating the estrobolome, immune responses, and oxidative microenvironment in endometriosis. We further discuss dietary patterns, bioavailability challenges, and the potential of precision nutrition to optimize reproductive outcomes. These approaches may be considered complementary or investigational adjuncts; current evidence is insufficient to demonstrate disease modification or improvements in spontaneous pregnancy, assisted reproductive technology (ART) outcomes, or live birth. Here, “fertility-sparing” denotes the absence of intentional ovulation suppression rather than proven fertility enhancement.

Nutrients doi: 10.3390/nu18172882

Authors: Mariusz Rudy

Modern nutritional science places increasing emphasis not only on absolute nutrient content, but primarily on bioavailability and interactions with the food matrix. This paper presents a comprehensive comparison of the bioavailability of protein, vitamins (A, D, and B12), and key minerals (iron, zinc, and calcium) from animal-source foods (ASF) and plant-based alternatives. Based on the literature indexed in the Web of Science, Scopus, PubMed, and ScienceDirect databases, this review assessed nutrient absorption and matrix effects, including both antinutritional factors and health-promoting compounds. The analysis shows that while ASF generally exhibit higher baseline bioavailability of several essential micronutrients and protein (measured by PDCAAS and DIAAS) due to the absence of phytates and oxalates, plant-based matrices offer distinct physiological benefits, including dietary fiber and phytonutrients. Moreover, the lower bioavailability in plant sources can be significantly improved through food processing techniques (e.g., fermentation, germination, thermal treatment) and strategic dietary combinations. Therefore, adequate nutrient intake depends not only on the food’s origin but also on its preparation methods and the overall dietary pattern. It is also important that the best diet is both nutritionally adequate and sustainable for the individual and the environment.

Nutrients doi: 10.3390/nu18172881

Authors: Kadriye Elif İmre Aslı Akyol

Background/Objectives: Maternal obesogenic diets may produce persistent developmental alterations in offspring, with response patterns that may differ between males and females. We investigated whether propolis supplementation from preconception through lactation modified metabolic and hepatic outcomes in offspring exposed to a maternal cafeteria diet. Methods: Thirty-two Wistar rat dams received a control diet (CON), cafeteria diet (CAF), or either diet with propolis in drinking water (CONP and CAFP; target exposure, 200 mg/kg/day). One male and one female per litter (n = 8/sex/group) received standard chow after weaning. This design isolated maternal exposure because offspring received no propolis after weaning. At 18 weeks, metabolic and inflammatory biomarkers, liver histopathology, and hepatic lipid-metabolism gene expression were evaluated using groupwise tests and two-way ANOVA. Results: Final body weights were comparable across groups. In males, maternal diet affected glucose (p = 0.034) and HOMA-IR (p = 0.023), with a diet × propolis interaction for glucose (p = 0.042). CAF males had higher TNF-α than CAFP and CONP males. In females, diet × propolis interactions were detected for insulin, total cholesterol, triglycerides, and leptin (all p ≤ 0.049); CAF females had higher triglycerides than CON and CAFP females. Hydropic degeneration was greater in CAF dams than all other groups and in CAF than CONP male offspring; female histopathology did not differ. Male hepatic gene expression did not differ among groups, whereas female PPAR-β and FADS2 showed propolis main effects (p = 0.046 and p = 0.009, respectively). Conclusions: Maternal cafeteria-diet exposure was associated with persistent metabolic and hepatic alterations despite comparable offspring body weights, with different response patterns observed in the separate male and female analyses. Maternal propolis supplementation selectively modified some inflammatory, lipid-related, and histopathological outcomes; however, these effects were heterogeneous and did not consistently normalize the cafeteria-associated phenotype. Overall, the findings support partial, endpoint-specific, and context-dependent modulation rather than uniform metabolic or hepatic protection.

Nutrients doi: 10.3390/nu18172874

Authors: Anton Bahtiar Amelia Novia Angie Tri Wahyuni Sirithon Siriamornpun

Background: Osteoporosis is a multifactorial skeletal disorder characterized by reduced bone mass, impaired bone remodeling, and an increased risk of fractures, particularly under estrogen-deficient conditions. Artocarpus integer (Thunb.) Merr. contains prenylated flavonoids and chalcone derivatives with diverse biological activities; however, its anti-osteoporotic potential remains largely unexplored. This study investigated the phytochemical composition, molecular mechanisms, and anti-osteoporotic effects of A. integer leaf extract in an ovariectomized (OVX) rat model. Methods: Phytochemical profiling was performed using liquid chromatography–high-resolution mass spectrometry (LC–HRMS). Network pharmacology was employed to identify potential osteoporosis-related targets and signaling pathways. The anti-osteoporotic activity of the extract was evaluated in OVX rats through physiological and biochemical assessments, including body weight gain, uterine weight, serum biomarkers, femoral calcium content, and RT-PCR analysis of genes associated with osteogenesis, osteoclastogenesis, and estrogen signaling. Results: LC–HRMS analysis identified several bioactive compounds, including isobavachalcone, artocarpesin, morachalcone A, genistein, apigenin, luteolin, naringenin, catechin derivatives, and mangiferin. Network pharmacology revealed 96 overlapping targets between A. integer phytochemicals and osteoporosis-related genes, highlighting pathways involved in estrogen signaling, PI3K–Akt signaling, osteoclast differentiation, inflammation, and metabolic regulation. In vivo, OVX rats exhibited increased body weight gain, uterine atrophy, elevated leptin levels, reduced adiponectin concentrations, and decreased femoral calcium content. Treatment with A. integer attenuated OVX-induced metabolic alterations, improved adipokine profiles, and increased femoral calcium content, particularly in the medium-dose group. RT-PCR analysis demonstrated the upregulation of the osteogenic markers Runx2 and Osx, together with the downregulation of the osteoclastogenic markers TRAP. Conclusions: Artocarpus integer leaf extract exhibited promising anti-osteoporotic activity through the coordinated regulation of osteogenesis, osteoclastogenesis, estrogen-related signaling, and bone mineral preservation. These findings support the potential development of A. integer as a nutraceutical candidate for the prevention or management of postmenopausal osteoporosis.

Nutrients doi: 10.3390/nu18172879

Authors: Kensaku Fukunaga Toshihiro Kobayashi Takanobu Saheki Takafumi Yoshimura Wenyi Jiang Haotian Zhang Rathana Ly Marino Kumano Ayako Yamashita Hitomi Imachi Koji Murao

Pancreatic β cells require tightly controlled cholesterol distribution to maintain glucose sensing, insulin-granule trafficking, and regulated exocytosis. ATP-binding cassette transporter A1 (ABCA1) exports cellular cholesterol and phospholipids to lipid-poor apolipoprotein A-I and is a central component of β-cell cholesterol homeostasis. β-cell-specific Abca1 deletion causes cholesterol accumulation and impaired glucose-stimulated insulin secretion, whereas human studies of rare ABCA1 loss-of-function mutations have reported heterogeneous secretory phenotypes. Endocrine, metabolic, inflammatory, lipoprotein, and post-transcriptional signals regulate pancreatic ABCA1. Exendin-4 activates CaMKK/CaMKIV/PREB-dependent transcription, insulin-like growth factor-1 acts through PI3K/Akt/FoxO1 signaling, and pemafibrate increases ABCA1 through PPAR-α-dependent regulation in experimental models. Conversely, angiotensin II, tumor necrosis factor-α, oxidized low-density lipoprotein, and N-methyl-D-aspartate suppress ABCA1 through distinct or partially convergent pathways, while miR-33a directly suppresses ABCA1 in human and mouse islets. β-cell function depends on the balance among LDLR-dependent cholesterol uptake, PCSK9-mediated receptor regulation, intracellular sterol trafficking and esterification, ABCG1-dependent handling, and ABCA1-dependent export rather than on total cellular cholesterol alone. Although several regulator-specific mechanisms remain preclinical and await independent replication, this review integrates these pathways and discusses their nutritional and translational relevance in type 2 diabetes.

Nutrients doi: 10.3390/nu18172880

Authors: Cassandra Evans Minh K. Chau Louis Tonnel Jack Landmesser Charles Stull Duncan N. French Jose Antonio Corey A. Peacock

Background/Objectives: Professional mixed martial arts (MMA) athletes routinely partake in practices to elicit rapid weight loss before official weigh-in, followed by aggressive rehydration and nutritional recovery before competition. Although weight-cutting strategies have been widely described, there is limited information characterizing nutrient intake, food group selection, and fluid consumption during the pre-weigh-in, post-weigh-in, and fight-day periods. This cross-sectional study examined self-reported dietary intake of professional MMA fighters during the 24 h before weigh-in, post-weigh-in, and on fight day. Methods: Participants self-reported all foods and beverages consumed during three distinct competition phases: pre-weigh-in, post-weigh-in, and fight day. Changes in energy, macronutrient, fiber, sodium, and fluid intake across competition phases were evaluated using linear mixed-effects models. Results: The pre-weigh-in period was characterized by severe carbohydrate and fiber restriction with reduced fluid intake, whereas post-weigh-in intake shifted toward aggressive carbohydrate, fluid, and sodium replenishment alongside reduced fat consumption. Food group analysis demonstrated systematic elimination of vegetables, dairy products, legumes, whole grains, fried foods, and other high-fiber foods before weigh-in, with continued restriction of high-fat and high-fiber foods throughout the recovery period. Conclusions: These findings provide a comprehensive characterization of nutrient intake, food selection, and fluid consumption across the final stages of professional MMA competition preparation.

Nutrients doi: 10.3390/nu18172878

Authors: Ida Karoline Bach Jensen Caroline Borup Roland Samuel Addison Jack Trammell Signe de Place Knudsen Anne Dsane Jessen Jane Marie Bendix Stig Molsted Trisha Jean Grevengoed Bente Merete Stallknecht Ellen Løkkegaard Ole Hartvig Mortensen

Background: Sulfur-containing amino acids (SCAAs) are essential for fetal growth and development, but their metabolism during pregnancy remains poorly understood, with conflicting reports regarding the effect of exercise training. This study investigates the effects of physical activity (PA) interventions on maternal plasma concentrations of SCAAs and their associations with neonatal outcomes. Methods: The FitMum randomized controlled trial included 220 healthy, inactive, pregnant women enrolled before gestation age (GA) 15+0 weeks. Participants were randomized to supervised exercise training (EXE), motivational counseling on PA (MOT), or standard care (CON). This secondary analysis includes all participants with an eligible blood sample (n = 214). Maternal plasma concentrations of SCAAs were measured at four time points (GA ≤15+0, 28+0-6, 34+0-6, and delivery), and umbilical cord venous plasma was measured at delivery. Results: Longitudinally, maternal methionine and taurine concentrations decreased significantly (p < 0.001 for both) during pregnancy, while total cysteine (tCys) concentrations increased (p < 0.001). At GA 28+0-6 weeks, methionine concentrations were significantly higher in EXE (p = 0.031) and MOT (p = 0.006) groups compared to CON, and tCys was higher in the MOT group (p = 0.017) versus CON. Maternal taurine was positively associated with birth weight (p = 0.034) and birth weight/placental weight ratio (p = 0.010), while maternal tCys was negatively associated with head circumference (p < 0.001). Additionally, increased moderate-to-vigorous intensity physical activity (MVPA) was associated with a smaller maternal–umbilical venous difference for methionine (p = 0.025), suggesting enhanced placental transport. Conclusions: Pregnancy significantly alters maternal metabolism of SCAAs. PA interventions may modulate maternal methionine and tCys concentrations, and our results suggest that maternal taurine status is linked to offspring birth weight, highlighting the potential of PA to influence key nutrients required for fetal development.

Nutrients doi: 10.3390/nu18172877

Authors: Ana Valente Inês Pastor Neto Joana Jesus Cristina Garagarza Aníbal Ferreira

Background: Disturbances in mineral and bone metabolism are common in hemodialysis (HD) patients, increasing the risk of hyperphosphatemia. Dietary phosphorus restriction remains a cornerstone of management, often leading to stringent dietary recommendations. This study aimed to explore whether adopting a Mediterranean-like dietary pattern (Med-LDP), compared to a Western-like dietary pattern (West-LDP) was associated with serum phosphorus levels. Methods: This cross-sectional multicenter study included 564 HD patients from 37 dialysis centers. Dietary intake was assessed using a food frequency questionnaire, and dietary patterns were identified through principal component analysis based on 22 food groups. Associations between dietary patterns, phosphorus intake, and serum phosphorus levels were evaluated using correlations tests and linear regression analyses adjusted for demographic, clinical, nutritional, and dialysis-related factors. Results: Two different dietary patterns were identified: a “Mediterranean-like” pattern characterized by a higher intake of vegetables, legumes, fruit, starchy products, fish, olive oil, eggs, bakery products, and alcohol; and a “Western-like” characterized by a higher intake of soft drinks, red meat, fried and salted foods, fast food, and caffeine. Despite significantly higher intakes of energy, protein, carbohydrates, phosphorus, potassium, and fiber, patients following the Med-LDP exhibited lower serum phosphorus levels, calcium–phosphorus product, and PTHi concentrations. No differences were observed in serum potassium levels. The correlation between phosphorus intake and serum phosphorus was weak and not statistically significant. The West-LDP was positively associated with serum phosphorus levels and remained an independent predictor after adjustment for potential confounders. However, after further adjustment for the prescribed dosages of phosphate binders, vitamin D supplementation and analogs, as well as calcimimetics, the association was no longer statistically significant. Conclusions: HD patients following a Med-LDP exhibited lower serum phosphorus levels despite a higher phosphorus intake. These findings suggest that the overall dietary pattern may be a more important determinant of phosphorus homeostasis than total phosphorus intake alone.

Nutrients doi: 10.3390/nu18172873

Authors: Kim S. Stote David J. Baer Theresa Henderson Gloria I. Solano-Aguilar Anton Terekhov Bruce R. Hamaker Janet A. Novotny

Background/Objectives: Oats and barley are β-glucan-rich grains that may reduce risk factors for cardiovascular disease in adults. This study was conducted to evaluate the effects of products made with either whole grain barley or whole grain oats on CVD risk factors in adults. Methods: A 6-week, double-blind, parallel-design, randomized, controlled feeding trial was conducted with 68 adults. Subjects were randomly assigned to either: (1) a control diet containing 0.8 daily servings of whole grain per 2000 kcal, (2) a diet containing 4 daily servings of whole grain oats per 2000 kcal, or (3) a diet containing 4 daily servings of whole grain barley per 2000 kcal. Markers of cardiovascular disease risk were assessed before and after treatment. Results: LDL cholesterol concentrations show a trend of statistical significance across diets (p = 0.0638), with a lowering of 8.9 mg/dL (barley) and 11.2 mg/dL (oats) compared to the control. Both whole grain diets significantly lowered total VLDL and chylomicron particles (p = 0.0272). The oat diet significantly lowered total LDL particles (p = 0.0014), small LDL particles (p = 0.0008), medium–small LDL particles (p = 0.0008), and very small LDL particles (p = 0.0009) and increased LDL particle size (p = 0.0451). The barley diet significantly lowered diastolic blood pressure (p = 0.0388) and vascular cell adhesion molecule concentrations (p = 0.0320). Conclusions: Diets containing products made from whole grain oats may improve blood lipid profiles, while diets containing products made from whole grain barley may provide additional benefits for blood pressure and inflammation.

Nutrients doi: 10.3390/nu18172875

Authors: József Szabó Gergely Maróti Norbert Solymosi Emese Andrásofszky Tamás Tuboly András Bersényi Geza Bruckner Hedvig Fébel

Background: Although dietary fat and carbohydrates are major determinants of gut microbiota composition, their interactive effects across changing dietary monosaccharide-to-lard energy ratios remain incompletely understood. This study descriptively examined treatment-level cecal microbiome profiles across dietary gradients in which lard (L) was progressively replaced with glucose (G) or fructose (F). Methods: A carbohydrate-free, lard-rich control diet was formulated, and lard was progressively replaced with glucose or fructose while maintaining a constant protein-to-energy ratio. Cecal contents from eight rats per dietary group were pooled in equal amounts, yielding one composite microbiome sample per treatment. Pooled samples were characterized by shotgun metagenomic sequencing. Sequencing/classified read counts (CRs) and relative abundance (RA) were treated as complementary sequencing-derived representations rather than measures of absolute bacterial abundance. Microbiome outcomes were interpreted descriptively at the treatment level. Results: Across the pooled treatment profiles, CRs and RA showed non-linear patterns and did not consistently change in parallel, providing complementary descriptions of treatment-level taxonomic responses. CR patterns indicated a combined effect of L and monosaccharide content, with several mixed L–monosaccharide diets showing lower CRs than both the L6.03 reference and the lard-free endpoints. Differences between the G and F series were most apparent at low L and high monosaccharide levels, particularly under lard-free conditions, although their magnitude and direction varied among taxa. Hierarchical clustering and exploratory correlation networks provided complementary descriptions of treatment-level community organization. Conclusions: The pooled treatment-level microbiome profiles revealed non-linear responses to changing dietary L–monosaccharide composition, with CRs and RA providing partly different information on taxonomic patterns. Differences between the G and F series were most apparent at low L and high monosaccharide levels, particularly under lard-free conditions.

Nutrients doi: 10.3390/nu18172876

Authors: Mei-Hui Tseng Ching-Lin Wu Yi-Jie Shiu Yi-Chun Tsou Hsien-Tsung Lin Chih-Hui Chiu

Background: This study investigated whether caffeinated chewing gum enhances sympathetic activity and improves functional firefighting balance performance after gamma-aminobutyric acid (GABA) supplementation. Methods: Fourteen active-duty elite firefighters (age: 36 ± 5 years; height: 174 ± 5 cm; BMI: 25.2 ± 1.6 kg/m2) participated in a double-blind randomized crossover trial. The participants completed functional firefighting balance tests while wearing approximately 25 kg of full firefighting gear. After a 1 h resting period, the participants ingested GABA and rested for an additional 15 min before chewing either caffeine-containing gum (CAF) or caffeine-free gum (CG) for 10 min. Fifteen minutes after gum ingestion, the participants repeated the functional firefighting balance tests. Completion time and performance index were used as the indicators of the functional firefighting balance tests. Results: The CAF trial demonstrated a significantly better completion time (p = 0.011; Cohen’s d = 0.54) and performance index (p = 0.012; Cohen’s d = 0.43) compared with the CG trial, with small-to-moderate effect sizes. There were no significant interactions in HR, SDNN, RMSSD, LF and HF (condition*time, p > 0.05). There was a significant interaction in LF/HF (p = 0.040); however, further statistical analysis revealed no significant differences across trials or over time (p > 0.05). Salivary α-amylase concentration was also significantly higher in the CAF trial compared with the CG trial after testing (p = 0.040; Cohen’s d = 0.45). Conclusions: These findings suggest that caffeinated chewing gum may enhance functional balance performance with a small effect size after GABA supplementation. The increased activity of the sympathetic nervous system may be one of the reasons for improved functional firefighting balance performance.

Nutrients doi: 10.3390/nu18172871

Authors: Hui-Min Wang Jiun-Hao Wang Kuo-Chen Wu

Background/Objectives: For many schoolchildren—particularly those in low-resource areas—the school lunch is the most reliable balanced meal of the day, so its composition is a direct determinant of dietary equity. The aim of this study was to quantify urban–rural disparities in school lunch food composition at national scale and to test whether they persist once county socioeconomic structure is controlled. Methods: Using 12,688,008 dish records from 3894 schools across all 22 Taiwanese counties over 24 months (May 2024–April 2026), retrieved from the Ministry of Education’s School Food Registry Platform, we constructed four dish-level dietary composition indicators—plant-forward, organic, processed, and whole-grain shares—and analyzed county-month panels (N = 418) using hierarchical regression with weighted least squares and heteroskedasticity-consistent standard errors. Results: The four dimensions followed distinct urban–rural patterns. Plant-forward provision exhibited a stable urban-to-rural decline. Organic and whole-grain provision displayed a suppressor structure: rural disadvantage disappeared—and reversed—once county income was controlled, revealing latent local supply capacity masked by income disparities. Processed-dish use, once income and population density were accounted for, was concentrated in lower-income, more densely populated counties rather than rural ones, indicating an urban concentration pattern rather than a rural deficit. A 2017 traceable-food pilot policy still exhibited a legacy effect on organic procurement seven years after its nationwide rollout. Conclusions: School meal programs thus deliver systematically different dietary environments to children in different places. Narrowing these gaps, rather than raising national averages, should be the core criterion for evaluating school lunch reform, with interventions differentiated across dietary dimensions.

Nutrients doi: 10.3390/nu18172872

Authors: Felicia Trofin Elena Roxana Buzila Irina Roxana Iancu Cristina Gabriela Tuchilus Oana-Raluca Temneanu Luminita Smaranda Iancu Madalina Alexandra Vlad Dana-Teodora Anton-Păduraru Ioana Armasu Aida Corina Badescu Laura Gisca Olivia Simona Dorneanu

Clostridioides difficile infection (CDI) remains a major cause of antibiotic-associated diarrhea, with recurrence largely driven by disruption of the gut microbiota and impaired colonization resistance. Bile acids have emerged as key mediators in this process, as primary conjugated bile acids promote C. difficile spore germination, whereas microbiota-derived secondary bile acids can inhibit germination, vegetative growth, and toxin activity. Diet further modulates CDI susceptibility by shaping microbial composition, short-chain fatty acid production, bile acid transformation, epithelial barrier integrity, and intestinal inflammation. Western-style diets, and low fiber intake, may favor dysbiosis and a bile acid profile permissive to CDI, while fiber-rich and Mediterranean-type dietary patterns may support beneficial anaerobes, microbial metabolites, and mucosal resilience. This narrative review summarizes current evidence on the bile acid–diet–microbiome axis in CDI pathogenesis, recurrence, and therapy. It also discusses standard treatment limitations, microbiome-based therapeutics, dietary interventions, and emerging bile acid-targeted strategies. Understanding this axis may support future precision approaches aimed not only at suppressing C. difficile, but also at restoring microbiota function and durable colonization resistance.

Nutrients doi: 10.3390/nu18172870

Authors: Ana María García-Muñoz Desirée Victoria-Montesinos Juana M. Morillas-Ruiz

Diabetic retinopathy, diabetic kidney disease, and diabetic peripheral neuropathy remain major causes of visual loss, kidney failure, pain, disability, and reduced quality of life despite improvements in glycemic and cardiovascular risk management. Oxidative stress, mitochondrial dysfunction, iron dyshomeostasis, lipid peroxidation, and sterile inflammation are shared features of these complications and converge on regulated cell-death programs. Ferroptosis is driven by iron-dependent phospholipid peroxidation when glutathione peroxidase 4 and complementary antioxidant systems are insufficient, whereas pyroptosis is an inflammatory lytic process executed by gasdermins after activation of inflammasome-associated or other inflammatory caspases. Nuclear factor erythroid 2-related factor 2 (NRF2) connects these pathways by regulating glutathione synthesis, lipid peroxide detoxification, iron handling, mitochondrial homeostasis, and redox-sensitive inflammatory signaling. Dietary polyphenols may influence this network through electrophilic or kinase-dependent NRF2 activation, preservation of the SLC7A11-glutathione-GPX4 axis, modulation of iron and lipid metabolism, and inhibition of NF-kappaB, TXNIP, NLRP3, caspase-1, and gasdermin signaling. This integrative review critically examines mechanistic, preclinical, and human evidence for these effects in the diabetic retina, kidney, and peripheral nerve. The strongest direct preclinical evidence currently concerns corilagin, resveratrol, isoquercetin, quercetin, epigallocatechin gallate, punicalagin, and selected anthocyanin-rich or phenolic extracts. Human studies suggest possible benefits for albuminuria, retinal edema, endothelial function, and neuropathic outcomes, but they rarely measure ferroptosis- or pyroptosis-specific biomarkers and their results are heterogeneous. The proposed ferroptosis–pyroptosis–NRF2 network should therefore be viewed as a biologically plausible integrative framework rather than a clinically validated linear pathway. Future trials require chemically characterized interventions, exposure biomarkers, tissue-relevant pharmacokinetics, prespecified regulated-cell-death panels, and clinically meaningful microvascular endpoints.

Nutrients doi: 10.3390/nu18172869

Authors: Luis Moral-Moreno Ivonne Vizcarra-Bordi Alejandra Benítez-Arciniega Carmen Ceballos-Juárez Edna García-Aguirre Hilda Vargas-Cancino David Velázquez-Muñoz Lucía Collado-Medina Sergio Moctezuma-Pérez Humberto Thomé-Ortiz

Background: University students often report suboptimal dietary practices, but overall diet-quality scores may conceal differences in food-group consumption. This study explored whether distinguishable food-consumption profiles could be identified among university students from Chile, Mexico, Spain, and Italy, and examined, exploratorily, the characteristics associated with profile membership. Methods: In this cross-sectional study, 686 university students completed a dietary assessment using nine component scores of the Healthy Eating Index adapted for the Spanish population (IASE). Profiles were derived by Ward’s hierarchical clustering with k-means refinement and assessed for split-half stability; Exhaustive CHAID explored characteristics associated with profile membership. Results: Internal validity indices favoured no candidate solution (silhouette 0.113–0.126 across two- to five-cluster solutions), and split-half stability was limited throughout, including for the retained four-cluster solution (mean Adjusted Rand Index = 0.30). Four profiles were nonetheless retained: Healthy and Prudent (24.8%), Low Plant-Food (13.0%), Mixed Dietary (36.6%), and Protein-Oriented (25.7%); all occurred in every country. Country was the first CHAID split, followed by living arrangement (Chile/Mexico), year of study (Spain), and post-pandemic PA change (Italy). The model did not outperform the majority-class baseline; the segmentation is therefore exploratory, not predictive. Conclusions: A four-cluster configuration could be derived in each setting, but validity and stability indices indicate it is not robust; country/academic-programme—confounded with institution—was the only characteristic with a non-negligible, though modest, association with profile membership. Findings are hypothesis-generating and require replication in larger, representative, longitudinal samples before profiles are treated as an established typology.

Nutrients doi: 10.3390/nu18172867

Authors: Xiuqing Li Xueyan Lin Lei Feng Zhiyong Hu Qiuling Hou Yun Wang Yizhao Shen Yingyu Mu Zhonghua Wang

Background: Branched-chain amino acid (BCAA) is involved in glucose and lipid metabolism and energy homeostasis, but whether its effects on maternal metabolism and offspring growth during lactation depend on dietary protein level remains unclear. Methods: C57BL/6J lactating dams were randomized after delivery to a normal-protein control group (CN, 20% protein), low-protein group (LP, 10% protein), CN + BCAA group (CNB), or LP + BCAA group (LPB) (n = 11/group). Maternal body composition, glucose and lipid metabolism, hepatic energy status, oxidative stress indices, and pup litter weight gain were assessed. Results: The LP diet reduced maternal body weight, pup litter weight gain, and glucose responses during the intraperitoneal pyruvate tolerance test (IPPTT), and increased hepatic lipid deposition and oxidative stress. BCAA supplementation increased pup litter weight gain under normal-protein conditions, but decreased maternal food intake and offspring growth under low-protein conditions. Metabolically, BCAA supplementation reduced the homeostasis model assessment of insulin resistance (HOMA-IR) and hepatic PEPCK1 activity under normal-protein conditions, while partially restoring IPPTT glucose responses and increasing hepatic PEPCK1 activity under low-protein conditions. In addition, BCAA supplementation reduced hepatic lipid deposition and ATP content at both protein levels. Notably, under low-protein conditions, BCAA supplementation increased serum β-hydroxybutyrate (β-HB), while alleviating hepatic oxidative stress. Conclusions: BCAA supplementation exerted opposite effects on offspring growth during lactation under different maternal dietary protein levels. These effects may be related to differential changes in maternal glucose and lipid metabolism and hepatic energy status, suggesting that BCAA supplementation during lactation should be evaluated according to maternal dietary protein level.

Nutrients doi: 10.3390/nu18172868

Authors: Mackenzie Guettler Tyler Barker

Vitamins are essential micronutrients that regulate numerous physiological responses critical to human health: cellular metabolism, immune function, endocrine signaling, tissue repair, musculoskeletal performance, and more [...]

Nutrients doi: 10.3390/nu18172866

Authors: Fernando Peral-Martínez Bruno Bizzozero-Peroni Valentina Díaz-Goñi Tomás Olivo-Martins-de-Passos Ana María Peraile-Huerta Alejandro Prieto-Ayuso Estela Jiménez-López Vicente Martínez-Vizcaíno Arthur Eumann Mesas

Background/Objectives: Adherence to the Mediterranean diet (MedDiet) has been associated with numerous health benefits, yet it is often suboptimal among university students. Its relationship with academic performance (AP), an outcome with potential long-term implications, has not been quantitatively synthesized in this population. This study aimed to synthesize the available evidence on the associations between MedDiet adherence and AP in university students. Methods: A systematic review and meta-analysis followed PRISMA 2020 and MOOSE guidelines (PROSPERO: CRD42024526903). PubMed, Web of Science, Scopus, and the Cochrane Library were searched from inception to 6 August 2026. AP was examined through objective (grade point average, mean academic grade, or university entrance scores) and subjective measures (academic self-concept or perceived academic progress). Standardized mean differences (SMDs) were pooled using random-effects models. Subgroup, meta-regression, and sensitivity analyses were performed. Methodological quality was appraised with the NIH tool, and certainty of evidence with GRADE. Results: Twelve cross-sectional studies were included (10,931 students; study-level mean ages: 19.0–25.1 years; 56.7% female). A positive association was observed in the primary analysis of objective AP measures (10 studies; SMD = 0.49; 95% CI: 0.04 to 0.94; I2 = 98.2%) and for subjective measures (3 studies; SMD = 0.42; 95% CI: 0.14 to 0.71; I2 = 0.0%). The certainty of the evidence was very low. Conclusions: Higher MedDiet adherence may be associated with better AP in university students. However, considerable between-study heterogeneity and very low certainty of the evidence limit confidence in the pooled estimates. Further high-quality longitudinal and intervention studies are needed.

Nutrients doi: 10.3390/nu18172865

Authors: Sabrina Spiniello Davide Termini Gianluca Tavoletti Gianluca Avallone Silvia Alberti-Violetti Angelo Valerio Marzano Gianluca Nazzaro

Oral zinc supplementation has emerged as a potential ⁠adjunctive strategy in inflammatory follicular disorders, including ⁠acne vulgaris and hidradenitis suppurativa. Beyond its role as an essential micronutrient, zinc modulates several pathways and biological processes directly ⁠relevant to these diseases, including innate immunity, oxidative stress, neutrophil-driven inflammation, antimicrobial defense, wound repair, and possibly sebaceous gland activity and androgen metabolism. In acne, available data support a potential clinical benefit, mainly on inflammatory lesions, with ⁠potential relevance in antibiotic-sparing approaches. In hidradenitis suppurativa, the evidence remains more limited and is largely based on small observational or uncontrolled studies, although a possible adjunctive role has been suggested in mild-to-moderate disease and maintenance therapy. However, differences across studies in zinc formulation, ⁠dose, treatment duration, baseline zinc assessment, and outcome measures make it difficult to draw firm conclusions, and further randomized controlled trials are needed to identify which patients are most likely to benefit. Considering the available evidence, zinc represents an accessible and clinically attractive adjunct in acne vulgaris and hidradenitis suppurativa. This review critically appraises the evidence ⁠on oral zinc in acne vulgaris and hidradenitis suppurativa, with particular attention to biological plausibility, clinical effectiveness, dosing and safety.

Nutrients doi: 10.3390/nu18172864

Authors: Tamás Jarecsny Andrea Lehoczki Tamás Csípő Vince Fazekas-Pongor Noémi Mózes Boglárka Csík Virág Zábó Ágnes Lipécz Dorottya Nyáry Mónika Fekete

Population aging, the rising burden of chronic non-communicable diseases, and environmental degradation are increasingly recognized as interconnected global challenges, underscoring the need for integrated strategies that simultaneously promote human and planetary health. The Planetary Health Diet (PHD), originally proposed to address these challenges, has emerged as a promising dietary framework for supporting healthy aging. Although its health benefits are increasingly supported by epidemiological and clinical evidence, the biological mechanisms underlying these effects remain incompletely understood. This narrative review synthesizes evidence on the interplay among the PHD, the gut microbiome, and biological aging, with emphasis on microbiome-mediated pathways connecting sustainable nutrition with healthspan. Adherence to PHD-consistent dietary patterns is associated with greater microbial diversity and functional capacity, increased production of bioactive microbial metabolites, and more favorable intestinal barrier, immune, and metabolic profiles. These adaptations may modulate several hallmarks of aging and contribute to the preservation of physiological resilience. Evidence from prospective cohort studies, randomized controlled trials, and systematic reviews further indicates that dietary patterns consistent with the PHD are associated with lower risks of cardiometabolic diseases, frailty, cognitive decline, and premature mortality. By integrating findings from nutritional science, microbiome research, geroscience, and public health, this review positions the gut microbiome as an important, although not exclusive, biological interface through which sustainable dietary patterns may support healthspan while contributing to environmental sustainability.

Nutrients doi: 10.3390/nu18172863

Authors: Sabina S. H. Andersen Louise Kjølbæk Jason C. G. Halford Joanne A. Harrold Anne Raben

Background/Objectives: Sweeteners and sweetness enhancers (S&SEs) have been proposed to impair energy metabolism acutely and over time. Methods: This sub-study investigated the acute effects of a mixture of acesulfame potassium and cyclamate (Ace-K/Cyc) versus water on postprandial substrate oxidation, energy expenditure, and glucose and insulin concentrations at baseline, after a 2-month weight loss period, and after a 4-month weight loss maintenance period including or excluding S&SEs in the diet. In both groups, allowed added sugar intake was <10 energy-%. A total of 26 participants (18–65 years; BMI ≥ 25.0 kg/m2) were recruited from the 1-year randomized controlled SWEET trial, and 16 completed the final test day. Fasting measurements were taken (ventilated hood; blood samples) before a standardized breakfast. Hereafter, postprandial measurements were taken until time point 250 min. At time point 120 min, a test drink containing either Ace-K/Cyc or water was served. Result: There were no differences between the two groups in fasting or postprandial fat oxidation (primary outcome), carbohydrate oxidation, energy expenditure, glucose, or insulin (secondary outcomes) on or across the three test days (p > 0.05). Conclusions: There were no statistically significant differences between Ace-K/Cyc and water in postprandial fat oxidation, carbohydrate oxidation, energy expenditure, or glucose or insulin either acutely, after a weight loss period, or after a 4-month period including or excluding S&SEs in the diet. The low number of participants should, however, be considered a limitation of our conclusions.

Nutrients doi: 10.3390/nu18172862

Authors: Catalin Dumitru Cosma Vlad Olimpiu Butiurca Dragos Molnar Cosmin Nicolescu Calin Molnar Marian Botoncea

Background: Nutritional deterioration is a common consequence of gastrectomy for gastric cancer and may persist despite standardized perioperative care. However, prospective longitudinal evidence describing the early course of postoperative nutritional recovery remains limited. This study aimed to characterize nutritional recovery trajectories following curative gastrectomy and to evaluate the influence of the extent of gastric resection on postoperative recovery. Methods: A prospective cohort of 239 consecutive patients undergoing curative-intent subtotal or total gastrectomy for gastric adenocarcinoma was followed between January 2022 and December 2025. The longitudinal complete-case analysis included 217 patients with available assessments at all three predefined time points: preoperatively (T0), at hospital discharge (T1), and three months after surgery (T3). Nutritional–immune biomarker trajectories were assessed preoperatively (T0), at hospital discharge (T1), and three months after surgery (T3) using serum albumin, total cholesterol, absolute lymphocyte count, and the Controlling Nutritional Status (CONUT) score. Longitudinal changes were evaluated using linear mixed-effects models with patient-specific random intercepts. Results: All evaluated nutritional–immune biomarkers changed significantly in an adverse direction after surgery, reaching their most unfavorable values at hospital discharge (all p < 0.001), followed by partial biochemical recovery at three months. Because albumin, lymphocyte count, and CONUT are influenced by the acute inflammatory and metabolic response to surgery, the discharge changes should not be interpreted as direct evidence of acute malnutrition. Nevertheless, none of the evaluated biomarkers returned to its preoperative value. Recovery between discharge and three months represented 65.6% of the initial decline for serum albumin, 50.5% for absolute lymphocyte count, 51.7% for total cholesterol, and 60.9% for the CONUT score. After adjustment for age, sex, neoadjuvant chemotherapy, baseline body mass index, ASA status, pathological T3–T4 stage, and major postoperative morbidity, total gastrectomy was associated with a greater early decline in absolute lymphocyte count at hospital discharge (β = −165.7 cells/mm3; 95% CI, −204.9 to −126.6; p < 0.001). This difference was no longer present at three months (p = 0.955). No significant time-by-gastrectomy interactions were observed for albumin, cholesterol, or corrected CONUT. Conclusions: Nutritional recovery following gastrectomy is a dynamic and prolonged process characterized by marked early nutritional–inflammatory biomarker changes and incomplete biochemical restoration at three months. Resection extent was not independently associated with persistently less favorable albumin, cholesterol, or corrected CONUT trajectories. The findings describe early biochemical changes and should not be extrapolated to body composition, functional recovery, micronutrient status, quality of life, or long-term survivorship. These findings apply primarily to patients who survived and completed the three-month follow-up.

Nutrients doi: 10.3390/nu18172861

Authors: Yang Xiang Zihan Peng Beilun Fu Youling Qian Tao Ma Binghong Gao Huan Zhu

Objectives: This study aims to compare the effects of three interventions, namely hyperbaric oxygen (HBO) therapy, HBO combined with lycopene (LYC) supplementation, and natural recovery, on oxidative stress and inflammatory responses following high-intensity exercise. The goal is to provide a theoretical foundation and methodological reference for strategies that help reduce fatigue after intense physical activity. Methods: Collegiate badminton players (n = 45) were randomly assigned to control, HBO, and HBO+LYC groups. Each group completed a 4-week intervention in accordance with its assigned protocol. The levels of oxidative stress, inflammation-related markers, and exercise-induced fatigue indicators were assessed before and after the intervention. Changes in these markers following high-intensity exercise were analyzed using repeated-measures ANOVA to evaluate the effects of HBO and HBO+LYC. Results: Following the intervention, the control group showed significant increases in malondialdehyde (MDA), interleukin-6 (IL-6), tumor necrosis factor (TNF), C-reactive protein (CRP), creatine kinase (CK), blood urea (BU), and heart rate (HR), along with a significant decrease in testosterone (T) (all p < 0.05). Compared with the control group, both intervention groups had significantly lower MDA, IL-6, TNF, CRP, CK, BU, and HR and higher superoxide dismutase (SOD), catalase (CAT), and total antioxidant capacity (T-AOC) (all p < 0.05). Compared with the HBO group, the HBO+LYC group showed significantly higher CAT and lower IL-6 and CK levels (all p < 0.05). Conclusions: Both HBO alone and HBO+LYC effectively reduced oxidative stress, inflammation, and exercise-induced fatigue, as evidenced by decreased MDA, IL-6, TNF, CRP, CK, BU, and HR, along with increased SOD and CAT, T-AOC, and T. Moreover, HBO+LYC demonstrated superior efficacy over HBO alone for selected outcomes, particularly by further enhancing glutathione peroxidase 3 activity. These findings suggest that HBO, especially when combined with LYC, may be an effective strategy to attenuate oxidative stress and inflammation and promote recovery following high-intensity exercise.

Nutrients doi: 10.3390/nu18172860

Authors: Samantha Christie Adrian F. Gombart Thomas R. Hill Tao You Philip C. Calder

Background: Nutritional safety has traditionally focused on preventing excessive nutrient exposure, yet chronic micronutrient inadequacy may also impair physiological function and health resilience. As the European Commission prepares to harmonise maximum permitted levels for food supplements and fortified foods, understanding long-term population intake trends is increasingly important. We assessed changes in micronutrient intakes and adequacy among adults in four European countries. Methods: Repeated, cross-sectional, secondary analyses of published adult (≥18 years) micronutrient intakes over approximately two decades were conducted using publicly available, non-harmonised national dietary surveys at non-contemporaneous time points in the Netherlands, Ireland, France and the United Kingdom (n = 17,261). Mean, lower-tail (5th centile; UK 2.5th) and upper-tail (95th centile; UK 97.5th) intakes were evaluated against dietary reference values, and changes in population intake estimates over the past two decades were examined. Results: Intakes of several micronutrients declined substantially, with mean and lower-tail intakes of vitamins D and A, riboflavin, folate and of calcium, iron and iodine decreasing by up to 50% in some population groups, indicating widening intake disparities and increasing risk of chronic insufficiency. Although improvements in some micronutrients were consistent with fortification policies and dietary changes, inadequacies remained widespread, including for vitamin D across all countries, iron in women, potassium in UK women, selenium in most populations and copper in Irish women. Folate intake in UK women and vitamin A intake in France were marginal. Conclusions: Declining intakes of several micronutrients and persistent inadequacies indicate emerging nutritional safety concerns in Europe. Population intake trends and chronic insufficiency should be explicitly considered in nutritional safety assessments, maximum permitted level discussions and modelling and future public health policy.

Nutrients doi: 10.3390/nu18172859

Authors: Ksenija Nikolajeva Anna Lece Andrejs Šķesters Vinita Cauce Dzintars Začs Laila Meija

Background: Erythrocyte fatty acid (FA) and oxidative stress levels are influenced by a range of factors. The aim of this study was to evaluate erythrocyte FA profiles and oxidative stress markers and their relationships with each other, nutrition, lifestyle, gestational age, and pregnancy outcomes in pregnant Latvian women. Methods: A total of 74 pregnant and postpartum women were cross-sectionally examined. Dietary intake was assessed using a validated food frequency questionnaire; erythrocyte FA composition was analyzed using gas chromatography with a flame ionization detector; and oxidative status was assessed based on Ferric Reducing Antioxidant Power (FRAP) assays, glutathione peroxidase (GPx) activity, and selenoprotein P (SEPP1) and malondialdehyde (MDA) levels. Results: Dietary fats constituted 42.0% of the total caloric intake. Saturated fatty acids (SFAs) predominated in erythrocytes (55.7%), with the highest concentration observed for 16:0. Although multiple significant correlations between dietary factors and laboratory parameters were identified, none remained significant after correction for multiple comparisons. Erythrocyte 18:3, n-3 was significantly associated with FRAP (p < 0.05). Gestational complications and age did not affect biochemical parameters (p > 0.05), though gestational age correlated with MDA (r = 0.377, p < 0.05) and pre-pregnancy body mass index (BMI) with MUFAs (r = 0.373, p < 0.01). The FA composition differed depending on smoking status and alcohol consumption. Conclusions: Given the exploratory nature of this study, findings should be interpreted with appropriate caution. Several associations retained statistical significance following correction for multiple comparisons, namely between erythrocyte 18:3, n-3 and FRAP, alcohol consumption and smoking with erythrocyte fatty acid profiles, maternal age and plasma MDA concentrations, and pre-gestational BMI and MUFA levels. The remaining associations did not withstand correction and should therefore be regarded as hypothesis-generating, warranting confirmation in larger, adequately powered, confirmatory studies.

Nutrients doi: 10.3390/nu18172856

Authors: Celia María Curieses Andrés José Manuel Pérez de la Lastra Elena Bustamante Munguira Celia Andrés Juan Eduardo Pérez Lebeña

Dietary polyphenols are studied as potential adjuncts for type 2 diabetes (T2D), although many reviews still rely on an antioxidant framework that does not adequately reflect human exposure. This review organises the evidence around two metabolite waves, namely early postprandial phase-II conjugates produced by host enzymes within 0 to 4 h of a polyphenol-rich meal, and microbiome-derived catabolites including urolithins and γ-valerolactones that peak at 6 to 24 h. This biphasic interpretation is advanced as a hypothesis-generating framework rather than as an established explanation, and it offers a testable account of why polyphenol effects may be meal-contingent, metabotype-dependent and heterogeneous across clinical trials. Using randomised controlled trials and meta-analyses published between 2015 and 2025, we review the human evidence for anthocyanins, catechins, stilbenes, cocoa flavanols and olive phenolics, with briefer coverage of isoflavones, curcuminoids and ellagitannins. Anthocyanins show the most consistent glycaemic signal, with a best available pooled estimate of about 0.3% for HbA1c (−0.31%, median exposure eight weeks) derived from trials that did not verify metabolite exposure, an effect that is modest and lies at the lower bound of what is generally regarded as clinically meaningful. Green tea catechins and high-phenolic extra-virgin olive oil are associated with comparable postprandial gains, whereas cocoa flavanols and resveratrol more reliably improve vascular and inflammatory intermediates than glycaemia itself. Most interventions were well tolerated at the nutritional doses tested. Polyphenols are better regarded as meal-timed dietary adjuncts to standard T2D care than as primary glycaemic agents.

Nutrients doi: 10.3390/nu18172858

Authors: Mine Mumcu John K. Lodge Hasan Kaan Kavsara

Background: Omega-3 fatty acids may be relevant to mental health, but evidence among university students remains limited. This small exploratory cross-sectional study examined associations between estimated dietary omega-3 intake and anxiety and depressive symptoms among university students in the UK. Methods: Data were collected between February and May 2025. Habitual dietary EPA + DHA and alpha-linolenic acid (ALA) intakes were estimated using an adapted omega-3 food-frequency questionnaire, while 24-h dietary recall was used to estimate energy intake. Anxiety and depressive symptoms were assessed using the GAD-7 and PHQ-9. The primary association between estimated dietary EPA + DHA intake and GAD-7 score was examined using linear regression adjusted for age, sex, energy intake, and alcohol use. Analyses involving ALA and PHQ-9 were exploratory. Results: Of 96 students recruited, 50 (52.1%) were analysed after 46 exclusions, most commonly for omega-3 supplement use (n = 21) or diagnosed mental-health conditions (n = 16). Mean GAD-7 and PHQ-9 scores were 6.66 ± 4.73 and 7.02 ± 4.76, respectively. In the fully adjusted model, each additional 100 mg/day of estimated dietary EPA + DHA intake was associated with a 0.325-point lower GAD-7 score, but the association was not statistically significant (B = −0.325; 95% CI: −0.725 to 0.074; p = 0.108). Exploratory analyses found no significant associations of estimated dietary EPA + DHA or ALA intake with anxiety or depressive symptoms. The inverse coefficient lost statistical significance after full adjustment, and the log-transformed coefficient reversed direction and remained non-significant, arguing against a consistent dose–response relationship. Conclusions: Estimated dietary EPA + DHA intake showed an inverse but inconclusive association with anxiety symptoms in this small exploratory sample. These preliminary findings are hypothesis-generating and require confirmation in larger longitudinal studies using repeated dietary assessments and biomarkers of omega-3 status.

Nutrients doi: 10.3390/nu18172857

Authors: Adriana Verdezoto Alvarado Berenice Ochoa Nogales Juana María Meléndez Torres Luis Huesca Reynoso Maureen McCoy Sonia Vega-López

Background/Objectives: Diet quality among Mexican-born immigrant women may be influenced by food security (FS) and neighborhood food environment factors; however, these relationships remain understudied. This exploratory study examined differences in diet quality/dietary outcomes by FS status and explored the potential for perceived neighborhood food availability to modify the association between FS and diet quality. Methods: Mexican-born immigrant women (n = 57) self-reported FS, diet, and perceived neighborhood food availability. Diet was assessed using the Southwest Food Frequency Questionnaire to calculate the Healthy Eating Index (HEI-2020) score. The six-item USDA FS Scale was used to dichotomize FS as high or low. Independent t-tests assessed differences in HEI-2020; fast-food frequency; and intake of fruit, vegetables, salty snacks, and sugar by FS status. An exploratory regression analysis examined whether perceived food availability modified the association between FS and diet quality using complementary Bayesian techniques to improve efficiency given the small sample size. Results: Women experiencing low FS had lower HEI-2020 than those with high FS (62 ± 8 vs. 66 ± 6; p = 0.03), as well as non-significantly lower intakes of fruit (236 ± 178 vs. 294 ± 239 g), vegetables (303 ± 188 vs. 331 ± 199 g), and salty snacks (6 ± 5 vs. 8 ± 10 g) and higher intakes of sugar (99 ± 55 vs. 96 ± 56 g) and fast food (2.5 ± 2.5 vs. 1.8 ± 1.7 times/month). No statistically significant evidence of the perceived neighborhood food availability modifying the association between FS and diet quality was observed. Exploratory analysis suggested that among women experiencing low FS, HEI-2020 score varied by perceived neighborhood food availability (low: 57; moderate: 61; high: 65; p = 0.077). Bayesian analyses suggested a greater impact of perceived neighborhood food availability among women with low FS and lower diet quality. Conclusions: In this small sample of Mexican-born women, low FS was associated with lower diet quality. Although evidence of effect modification by perceived neighborhood food availability was not observed, exploratory findings suggest that it may influence diet quality among women experiencing low FS and warrant investigation in larger studies.

Nutrients doi: 10.3390/nu18172855

Authors: Ki-Tae Song Hyuck Lee Jun-Young Sung Jin-Kuk Baek Seong-Won Park Kyu-Jin Hyun Eun-hui Jin Ki-Woong Noh Sok Park

Background/Objectives: Highly branched cyclic dextrin (HBCD) may improve carbohydrate (CHO) availability during soccer-specific intermittent exercise via favorable gastrointestinal properties. Whether co-ingestion with whey protein confers additional ergogenic benefits beyond HBCD alone remains unclear. Methods: Nine male soccer players completed a single-blind, randomized crossover trial (≥7-day washout) with three conditions, Placebo (water), CHO, and isocaloric HBCD plus whey protein isolate (CHOP), during a standardized, ~120-min laboratory-based soccer-specific intermittent exercise protocol (not an actual match). The 500-mL beverage, split into two 250-mL servings, was consumed before exercise and at half-time during the exercise protocol. Respiratory quotient (RQ), substrate oxidation, heart rate, RPE, digestive symptoms, running time, and distance were assessed, with condition effects tested via repeated-measures ANOVA at each cycle. Results: Compared with Placebo, CHO increased RQ (p = 0.042) and carbohydrate oxidation (p = 0.048) while reducing fat oxidation (p = 0.034) at the final cycle, reflecting greater late-exercise CHO utilization without improving endurance performance. Compared with Placebo, CHOP significantly improved both running time (p = 0.019) and running distance (p = 0.025), with no significant difference from CHO on either outcome. RPE was significantly lower in CHOP than in Placebo during the latter stage of exercise (p = 0.016). Conclusions: HBCD ingestion before exercise and at half-time promoted greater late-exercise CHO utilization without increasing cardiovascular or gastrointestinal strain. Co-ingestion of whey protein with HBCD provided ergogenic benefits over Placebo by improving fatigue-limited endurance performance, supporting isocaloric CHOP co-ingestion as a practical nutritional strategy for prolonged soccer-specific intermittent exercise.

Nutrients doi: 10.3390/nu18172853

Authors: Carolina Ciacci Martina Sciberras Yvette Gatt Suneil A. Raju Carlo Soldaini David S. Sanders

Background: The gluten-free diet (GFD) remains the cornerstone of treatment for celiac disease (CeD), yet it is associated with a substantial psychosocial and practical burden. As novel therapies are being developed, understanding patient priorities, and their alignment with physician perceptions, is essential to guide future therapeutic strategies. Methods: We conducted a multicenter, cross-sectional online survey of adults with confirmed CeD followed at tertiary referral centers in Italy (Salerno), the UK (Sheffield) and Malta (La Valletta). The questionnaire collected demographic data, a 0–10 visual analogue scale (VAS) assessing self-reported adherence to the GFD, and responses to a single-choice question exploring what participants missed most since starting the GFD. A parallel survey was administered to healthcare providers to assess their perception of patients’ unmet needs. Descriptive statistics and between-groups comparisons were performed. Results: A total of 486 patients (74.7% female; mean age 43.2 years; 215 from Italy, 196 from the UK and 75 from Malta) and 134 physicians were included. GFD adherence was high, with a median score of 10. The most frequently reported unmet need among patients was the desire for an unrestricted diet (25.9%), followed by a preference for a medication allowing occasional gluten exposure (16.9%), greater availability of gluten-free options during travel (15.0%), and improved safety when eating out (13.6%). Interest in a lifelong pharmacological alternative to the GFD was limited (9.5%). Despite minor differences in the distribution of responses across centers, the overall pattern of patient priorities was remarkably consistent. Among 134 physicians (76 (56.7% from the United Kingdom, 20 (14.9%) from Malta, and 38 (28.4%) from Italy)), the most frequently perceived patient need was also an unrestricted diet (17.9%), but a higher proportion attributed importance to lifelong pharmacological therapy (16.4%). The distribution of responses differed significantly between patients and physicians (χ2 test, p < 0.001). Conclusions: Patients with CeD across different European healthcare systems report consistent unmet needs driven primarily by lifestyle constraints and the burden of maintaining a strict GFD. Importantly, most patients do not seek complete replacement of the GFD, but rather strategies that provide greater flexibility and protection against occasional gluten exposure. A significant mismatch exists between patient priorities and physician perceptions, with clinicians overestimating the demand for a definitive cure and underestimating the importance of day-to-day disease burden. Future efforts should improve GFD practicality and prevent accidental gluten exposure, while an unrestricted diet remains the ultimate therapeutic goal.

Nutrients doi: 10.3390/nu18172854

Authors: Solveig I. N. Watters Christine Henriksen Mia Gjøvik Lisa Garnweidner-Holme Marius Pihl Frederiksen Stephanie Jonassen Ina Ravnanger Mari C. W. Myhrstad Vibeke H. Telle-Hansen

Background/Objectives: The intake of bread has been associated with gastrointestinal discomfort in some individuals. The primary aim of this study was to investigate gut symptoms upon consuming sourdough bread compared to baker’s yeast bread. Secondary endpoints were changes in targeted gut microbial taxa, micronutrient levels, and metabolic markers. Methods: This randomised, controlled, double-blind cross-over study included twenty healthy participants. Sourdough or baker’s yeast bread was consumed for one week before crossing over. Before and after the interventions, participants reported gut symptoms, and they also provided blood samples to analyse micronutrients, metabolic markers, and faecal samples for targeted gut microbial taxa analyses. Results: The breads were made of whole grain wheat with similar macronutrients content. The sourdough bread contained less fructose than the baker’s yeast bread. The consumption of sourdough bread caused a significant reduction in the diarrhoea sub-dimension score (p = 0.016) and a borderline significant reduction in the overall GSRS-IBS score compared to baker’s yeast (p = 0.051). Several gut bacteria were significantly increased after intake of sourdough bread compared to baker’s yeast bread: Alistipes putredinis (p = 0.029), Alistipes shahii (p = 0.015), Bifidobacterium adolescentis (p = 0.042), Bifidobacterium longum (p = 0.010) and Bifidobacterium longum subspecies longum (p = 0.021). There was a significant correlation between changes in diarrhoea score and changes in Alistipes shahii (r= −0.353, p = 0.025). Conclusions: This exploratory cross-over study did not demonstrate a statistically significant difference in the overall GSRS-IBS score between the two breads. A nominal difference in the diarrhoea sub-dimension and selected targeted microbial taxa was observed between the two breads, but these findings require further investigations.

Nutrients doi: 10.3390/nu18172852

Authors: Piotr Religa Magdalena D. Pieczynska-Kovacs Marzena Łazarczyk Bhupinder Kapoor Rajan Logesh Smith B. Babiaka Piotr Poznański Michel-Edwar Mickael Ricardo Lagoa Mariusz Sacharczuk Ibrahim F. Rehan Asmaa Elnagar Ana Petra Cherciu Artur Jóźwik Atanas G. Atanasov Jaroslaw Olav Horbańczuk

Diabetes mellitus is a pervasive global health crisis, with type 2 diabetes (T2D) representing the majority of cases. While conventional pharmacological therapies exist, suboptimal efficacy, adverse effects, and inadequate glycemic control in a substantial proportion of patients highlight the need for complementary strategies. There is growing scientific and clinical interest in plant-based functional foods, including Ribes nigrum L. (blackcurrant), which is rich in bioactive phytochemicals such as anthocyanins, flavonols, and phenolic acids. This review evaluates the antidiabetic and metabolic regulatory potential of blackcurrant, focusing on its multi-target mechanisms of action. Available experimental evidence suggests that blackcurrants may influence glucose metabolism through several mechanisms, including inhibition of carbohydrate-digesting enzymes (α-amylase and α-glucosidase), modulation of intestinal glucose transporters (SGLT1 and GLUT2), and potential modulation of insulin sensitivity involving AMPK signaling and GLUT4 translocation. In addition, blackcurrant constituents may stimulate glucagon-like peptide-1 (GLP-1) secretion, modulate gut microbiota composition, and exert antioxidant and anti-inflammatory effects that counteract key drivers of insulin resistance and β-cell dysfunction. Supporting human studies indicate that blackcurrant consumption has been associated with attenuation of postprandial glycemic and insulinemic responses and modest improvements in cardiometabolic biomarkers, although findings remain limited by study size, duration, and formulation heterogeneity. Overall, Ribes nigrum represents a promising dietary adjunct for the prevention and management of T2D through multi-target metabolic regulation.

Nutrients doi: 10.3390/nu18172851

Authors: Iolanda Chinellato Annamaria Acquaviva Mary Lista Loreto Nemi Eva Da Ros Benedetta Morlupi Manuela Maione Renata Carraro Laura Lodi Alessandra Micozzi Rosa Cipriano Patrizia Serra Monica Turchetto Marco Sandri Francesca Poggiante

Background/Objectives: Several studies have reported a high prevalence of overweight and obesity among children and adults, with relevant implications for long-term health. Digital platforms and social media may support nutrition education when their content is developed and supervised by health professionals. This study evaluated whether dietary habits, lifestyle indicators, body mass index-related measures, and Mediterranean diet adherence differed between baseline and 210-day assessments among participants in a family- and school-mediated multimedia educational program aimed at promoting healthier lifestyles and greater adherence to the Mediterranean diet. Methods: This was an uncontrolled repeated cross-sectional before-and-after evaluation based on online surveys administered at baseline and after 210 days to respondent samples from the same project population. The multimedia educational program was delivered through a dedicated website and social media channels. The analysis included 329 children/adolescents at both assessment waves and 119 and 122 adult female respondents at baseline and 210 days, respectively. Since only 11 adult males responded, analyses of adults were restricted to women. Additionally, Mediterranean diet adherence was assessed using a modified KIDMED-derived score in children/adolescents and the PREDIMED score in adults. Data from the two assessment waves were compared at the group level, rather than as paired longitudinal observations. Results: Among children/adolescents, higher physical activity, lower screen time, and more favorable dietary indicators were observed at 210 days than at baseline. Moreover, daily fruit intake, daily vegetable intake, regular fish consumption, and the modified KIDMED score were higher at 210 days. Good adherence to the Mediterranean diet increased from 46.8% at baseline to 61.4% at 210 days. Among adult female respondents, the median body mass index was lower at 210 days than at baseline, and favorable differences were observed for vegetable, fish/seafood, legume, and nut intake. The median PREDIMED score increased from 7.0 [6.0–8.0] at baseline to 9.0 [7.0–10.0] at 210 days, and good Mediterranean diet adherence increased from 10.9% to 35.2%. Conclusions: Among children/adolescents, physical activity, screen time, and dietary indicators showed more favorable distributions in the 210-day respondent group than in the baseline respondent group. Daily fruit intake, daily vegetable intake, regular fish consumption, and the modified KIDMED-derived score were higher at 210 days, and good Mediterranean diet adherence was more frequent at 210 days than at baseline (61.4% vs. 46.8%). Among adult female respondents, the median body mass index was lower in the 210-day respondent group than in the baseline respondent group, and more favorable distributions were observed for vegetable, fish/seafood, legume, and nut intake. The median PREDIMED score was higher at 210 days than at baseline: 9.0 [7.0–10.0] versus 7.0 [6.0–8.0], respectively. Good Mediterranean diet adherence was also more frequent at 210 days (35.2% vs. 10.9%).

Nutrients doi: 10.3390/nu18172850

Authors: Guido Gembillo Luca Soraci Alberto La Spada Paolo Fabbietti Claudia Lo Re Maria Federica Ricca Andrea Corsonello Domenico Santoro

Background/Objectives: Diet is a modifiable determinant of kidney health, and sex differences in kidney physiology support sex-specific evaluation of dietary patterns. We examined the association of Planetary Health Diet Index (PHDI) adherence with cystatin C-based eGFR decline, and its modification by sex, in US adults aged 50 years and older. Methods: We analyzed 2126 Health and Retirement Study participants (950 men, 1176 women) with diet assessed by food frequency questionnaire in 2013 and cystatin C-based eGFR measured in 2012 and 2016. Survey-weighted regression models, adjusted for baseline eGFR and for demographic, socioeconomic, lifestyle and clinical covariates, related PHDI to eGFR change and to a ≥30% relative eGFR decline; sex interaction was tested on the multiplicative and additive scales. Results: PHDI adherence was nonsignificantly associated with lower eGFR decline (β per 10-point increment 0.218; 95% CI −0.065 to 0.466). Among women, each 10-point-higher score was associated with slower eGFR decline (β 0.355; 95% CI 0.029 to 0.681; p = 0.034) and 20% lower odds of ≥30% eGFR decline (OR 0.799; 95% CI 0.687 to 0.930; p = 0.005); no significant association was observed in men (β 0.080; 95% CI −0.294 to 0.454; OR 1.080; 95% CI 0.901 to 1.295). Sex modified the association with ≥30% eGFR decline on both a multiplicative (p = 0.002) and additive scale (p < 0.001). Conclusions: PHDI adherence was associated with slower kidney function decline in women aged 50 years and older, with non-significant effect in men. Sex merits consideration as a biological modifier when plant-forward diets are evaluated as potentially nephroprotective strategies.

Nutrients doi: 10.3390/nu18172849

Authors: Ege Tohumcu Francesca Sofia Puca Varol Tunali Lucia Cerrito Maria Pallozzi Leonardo Stella Marta Maestri Celeste Ambra Murace Serena Porcari Simone Varca Andrea Severino Antonio Gasbarrini Gianluca Ianiro Francesca Romana Ponziani

Tryptophan (Trp) metabolism lies at the intersection of nutrition, gut microbiota, mucosal immunology, and systemic inflammation—processes that play key roles in many gastrointestinal and extraintestinal diseases. Trp is an essential amino acid obtained through dietary intake. Beyond its role in protein synthesis, it is metabolized through three principal pathways: the kynurenine pathway, the serotonin/melatonin pathway, and microbial metabolism in the gut leading to indole and related derivatives. The kynurenine pathway represents the primary route of Trp degradation and is strongly linked to inflammatory signaling. The serotonin pathway is particularly important for gastrointestinal physiology, influencing motility, secretion, and visceral sensitivity. In parallel, microbial Trp metabolism produces metabolites that regulate epithelial barrier integrity, modulate mucosal immune responses, and contribute to communication along the gut–organ axes. Across different disease states, several recurring patterns emerge. Inflammatory conditions frequently shift Trp metabolism toward the kynurenine pathway through increased IDO1 or TDO activity, resulting in changes in kynurenine metabolites and in the kynurenine-to-tryptophan (Kyn/Trp) ratio. At the same time, reduced microbial production of indole derivatives may impair aryl hydrocarbon receptor signaling and weaken barrier-protective and immunoregulatory mechanisms. Alterations in the serotonin pathway are also associated with disturbances in gastrointestinal motility and gut–brain communication. Together, these observations highlight Trp metabolism as an important framework for understanding interactions between diet, microbiota, and host responses in health and disease. However, it is important to clarify that much of the currently available evidence remains associative or is derived primarily from preclinical models. This narrative review, based on literature retrieved from major biomedical databases (e.g., PubMed/MEDLINE, Scopus, and Web of Science), aims to provide an updated synthesis of current knowledge on Trp metabolism in disease pathophysiology. Furthermore, while we highlight potential translational applications—such as proposed biomarker development and targeted therapeutic strategies—these perspectives have been moderated to acknowledge the limited level of clinical validation established to date.

Nutrients doi: 10.3390/nu18172848

Authors: Yuri Lee Hyun-Young Shin

Objectives: The objective of this paper is to analyse trends in obesity-related legislation in the Republic of Korea (2006–2024) and examine political, institutional, and ideational factors observed in relation to legislative outcomes. Methods: A retrospective policy analysis of 53 obesity-related bills identified through systematic searches of the National Assembly Legislative Information System and independently coded by two researchers. Quantitative trends were examined by policy domain and instrument type, and qualitative analysis applied Kingdon’s Multiple Streams Framework, the Ideas–Interests–Institutions (3I) model, and Policy Instrument Theory. Results: Legislative attention increased unevenly across the study period. Sixteen bills (30.2%) achieved a favorable legislative outcome, comprising direct passage or incorporation into an enacted committee alternative. Regulatory instruments dominated, followed by educational and institutional tools; fiscal measures were rare. Legislative activity clustered in 2013 and 2017–2019, while later proposals increasingly addressed school, digital, and post-pandemic concerns. Conclusions: Korea’s experience shows both progress and fragmentation in obesity governance. Child-focused framing and institutional feasibility were recurrent features among enacted measures, whereas fiscal and structural proposals were less frequently enacted. The findings highlight the importance of considering regulatory, educational, and fiscal approaches within a comprehensive intersectoral policy framework.

Nutrients doi: 10.3390/nu18172847

Authors: Andreea-Sabina Butucaru Iustina-Gabriela Mihăianu Magdalena Iorga Lucian Roman Șipoș Dan Alexandru Slăvescu Raluca Ortensia Cristina Iurcov

Background: Academic pressure during examination periods is frequently reported alongside irregular lifestyle behaviors. The study aimed to explore the interplay between habitual eating behaviors, sleep quality, and self-reported stimulant use and coping adaptations specifically during examination periods among healthcare university students. Methods: This cross-sectional study included 265 university students (Mage = 22.00, SD = 4.46). Dietary behaviors and sleep quality were assessed using the Three-Factor Eating Questionnaire (TFEQ-R21) and the Pittsburgh Sleep Quality Index (PSQI), respectively. Behavioral profiles, substance-use patterns, and attitudes toward academic pressure were examined using bivariate analyses, multivariate logistic regression, and TwoStep cluster analysis. Statistical analyses were performed using IBM SPSS Statistics version 26.0. Results: A high prevalence of poor sleep quality was observed, with 72.8% (n = 193) of participants meeting the clinical criterion for poor sleep (PSQI > 5.0; M = 7.79 ± 3.53), and high sleep disturbances were significantly associated with smoking, energy drink use, coffee escalation, general dietary supplement utilization, and smart-drug use. Multivariate analysis revealed that poor sleep quality (OR = 1.118, 95% CI [1.022, 1.222]) and younger age (OR = 0.843, 95% CI [0.735, 0.967]) were independently associated with higher odds of energy drink use. A distinct cognitive disconnect was observed in tobacco usage: conventional smoking was negatively associated with self-perceived health (OR = 0.401, 95% CI [0.182, 0.884]), whereas electronic cigarette use showed no significant association. TwoStep cluster analysis identified three distinct student typologies during exams: non-users (32.6%), poly-substance users (34.5%), and OTC supplement/caffeine users (33.0%), with active substance-utilizing profiles displaying significantly worse sleep quality and higher emotional eating. Conclusions: These findings highlight distinct cross-sectional lifestyle and coping patterns among healthcare students, emphasizing the need for targeted institutional interventions that support healthy behavioral adaptations and stress management during academic challenges.

Nutrients doi: 10.3390/nu18172846

Authors: Alita Rushton Shelley Roberts Jana Waldmann Trent Payne Norman R. Morris Jack J. Bell

Background: Malnutrition causes complications and adverse effects in older people and is a burden on healthcare systems. Older people with, or at risk of malnutrition who receive nutrition care in hospitals do not appear to be adequately engaged with post-discharge nutrition care processes. Food-based approaches (exclusive of oral nutritional supplements) are commonly considered the ‘first’ or frontline approach by dietetic professionals in the community setting. The aim of this scoping review is therefore to identify and synthesise the literature on food-based nutrition care provided to older community-dwelling adults who have been identified as malnourished or at risk of malnutrition during a recent hospital admission. Methods: This scoping review follows the methodological framework by Arskey and O’Malley, revised by the Joanna Briggs Institute. Results are reported according to the PRISMA-ScR guideline. Studies evaluating food-based nutrition care interventions provided to patients post-discharge from a hospital admission returning to a community setting were included in this review. Results: A total of 4086 records were screened, and eleven articles from seven independent studies were included. Highly heterogeneous findings may suggest improvements in weight, dietary intake, quality of life, physical function, anxiety and/or depressive symptoms, and reduction in readmissions associated with interventions including food-based nutrition care. However, sample sizes were generally small and evaluated as part of multicomponent care. Conclusions: Additional research is required to support frontline, food-based approaches for older community-dwelling adults, with or at risk of malnutrition, who are recently discharged from hospital. In the interim, multi-component nutrition interventions may be considered to improve nutritional intake.

Nutrients doi: 10.3390/nu18172845

Authors: Nel Dąbrowska-Leonik Renata Grzywa-Czuba Monika Wasiak Mikołaj Wasil Weronika Zaczek Maria Żebrowska Małgorzata Pac

Background: Vitamin D plays an important immunomodulatory role, and vitamin D deficiency has been associated with an increased risk of infections and autoimmune disorders. Although patients with some primary immunodeficiency disorders (PID) exhibit higher rates of vitamin deficiency, there are currently no evidence-based recommendations regarding whether children with PIDs require higher vitamin D supplementation than healthy peers. This study aimed to evaluate the nutritional status of vitamin D and vitamin D supplementation in children with PIDs. Methods: The study included 132 children diagnosed with PIDs according to the 2024 update of the phenotypic classification by the International Union of Immunological Societies (IUIS). The following variables were evaluated: body mass index (BMI), 25-hydroxyvitamin D (25(OH)D), calcium, phosphorus, immunoglobulins G, A and M, and number of neutrophils and lymphocytes in the blood. Results: Vitamin D deficiency occurred in 13% of all tested children, and in 22 and 33% of children with predominantly antibody deficiencies and complement deficiencies, respectively, with the median vitamin D supplementation of 1000 IU. The median serum 25(OH)D concentration was 30.75 ng/mL (32.7 ng/mL in girls and 30 ng/mL in boys). The multiple linear regression model showed that the concentration of serum phosphorus level (b = 0.312; p = 0.0497) and immunoglobulin G level (b = 0.433; p = 0.0009) had the greatest influence on the concentration of 25(OH)D. No statistically significant differences in 25(OH)D concentrations were observed among the different IUIS diagnostic groups or between children with normal and low IgG levels. Conclusions: In this retrospective cross-sectional study, children reportedly receiving median 1000 IU supplementation had median 25(OH)D of 30.75 ng/mL with 13% deficiency prevalence; however, causal attribution requires prospective evaluation.