Nutrients

11 pages, 372 KB

Open AccessArticle

The Simplified Diet for PKU: Practices of Swedish Metabolic Dietitians

by Marika Kanthe, Camilla Widenberg Törnquist and Tom J. de Koning

Nutrients 2026, 18(11), 1835; https://doi.org/10.3390/nu18111835 - 5 Jun 2026

Viewed by 454

Background: Dietary management of phenylketonuria (PKU) focuses on restricting phenylalanine (Phe) intake. The European PKU guidelines and the PKU Dietary Handbook recommend a simplified PKU diet, allowing unrestricted consumption of many low-Phe foods, called free foods. While this approach may reduce the [...] Read more.

Background: Dietary management of phenylketonuria (PKU) focuses on restricting phenylalanine (Phe) intake. The European PKU guidelines and the PKU Dietary Handbook recommend a simplified PKU diet, allowing unrestricted consumption of many low-Phe foods, called free foods. While this approach may reduce the treatment burden for patients, its implementation varies. This study investigated practices of Swedish metabolic dietitians regarding the simplified diet and the use of free foods for classical PKU (cPKU) and compared these with European recommendations. Methods: A survey was distributed to all metabolic dietitians in Sweden. The survey included questions on professional experience, the use of free foods and the classification of 135 low-protein food items as never, sometimes or always counted in cPKU. Data were summarised descriptively. Results: All 13 eligible dietitians participated. The use of free foods was recommended by 8/13 dietitians. Of foods classified as free in the PKU Handbook, about one third were commonly restricted in Swedish PKU practice. For 39% of the foods surveyed, no single response option (never, sometimes or always counted) reached >50%, indicating variation in practice. Classification of individual foods partially aligned with their Phe content, but portion size and concerns about excessive Phe intake also influenced advice. Conclusions: Significant variation exists in the dietary management of PKU in Sweden, and the simplified diet approach is not consistently implemented. Dietitians’ concerns about the safety of increased Phe intake from free foods play a central role in this. These findings highlight challenges in incorporating international guidelines into national practice and underscore the need for further research to address dietitians’ safety concerns related to the simplified diet. Full article

(This article belongs to the Special Issue The Role of Special Diets in Paediatric Metabolic, Neurological and Immune-Mediated Disorders)

► Show Figures

Figure 1

10 pages, 626 KB

Open AccessArticle

Short-Term Gastrointestinal Tolerance and Oxygenation Changes After a Locust Bean Gum-Containing Formula in Preterm Infants: A Retrospective Paired Cohort Study

by Murat Konak, Evrim Kılıçlı, Saime Sündüs Uygun and Havvanur Namal

Nutrients 2026, 18(11), 1834; https://doi.org/10.3390/nu18111834 - 5 Jun 2026

Viewed by 390

Abstract

Background/Objectives: Gastrointestinal dysmotility, abdominal discomfort, and feeding-related respiratory instability are common in preterm infants. Although locust bean gum (LBG)-containing formulas are used for regurgitation, their short-term effects on gastrointestinal tolerance in neonatal intensive care settings are not well defined. We evaluated short-term [...] Read more.

Background/Objectives: Gastrointestinal dysmotility, abdominal discomfort, and feeding-related respiratory instability are common in preterm infants. Although locust bean gum (LBG)-containing formulas are used for regurgitation, their short-term effects on gastrointestinal tolerance in neonatal intensive care settings are not well defined. We evaluated short-term changes in gastrointestinal tolerance and oxygenation after initiation of an LBG-containing formula and explored whether postmenstrual age (PMA) modified the response. Methods: This retrospective paired cohort study included 26 infants who received an LBG-containing anti-regurgitation formula, either alone or combined with human milk. Standardized ordinal scores (0–2) for stool consistency, straining, abdominal distension, gas passage, abdominal tenderness, mean oxygen saturation (SpO₂) category, and desaturation frequency were recorded at baseline (Day 0), Day 3, and Day 7. Paired comparisons were performed using the Wilcoxon signed-rank test, and PMA-stratified differences were explored using Kruskal–Wallis analysis. Results: By Day 7, soft/normal stools were observed in 96.2% of infants (p = 0.00017), severe straining resolved in 87.5% (p = 1.6 × 10⁻⁵), abdominal distension improved in 96.2% (p = 2.4 × 10⁻⁶), and gas passage normalized in all infants (p = 0.00025). Mean SpO₂ category improved significantly (p = 0.0023), and the proportion of infants with rare or no desaturation increased from 61.5% to 96.2%. Growth velocity remained clinically acceptable. Infants with PMA < 34 weeks showed the largest improvements across outcomes. Conclusions: In this retrospective paired cohort, initiation of an LBG-containing formula was associated with short-term improvement in gastrointestinal tolerance and oxygenation indices in preterm infants. Exploratory subgroup analyses suggested possible heterogeneity of response across postmenstrual age strata; these observations require confirmation in adequately powered prospective studies. Full article

(This article belongs to the Topic Functional Foods and Nutraceuticals in Health and Disease)

► Show Figures

Figure 1

19 pages, 1166 KB

Open AccessArticle

Dietary Behaviours and Association with Nutritional Status Among Malaysian School-Based Adolescents: Findings from Adolescent Health Survey 2022

by Lay Kim Tan, Guey Yong Chong, Shi Hui Cheng, Sumarni Mohd Ghazali and Chee Cheong Kee

Nutrients 2026, 18(11), 1833; https://doi.org/10.3390/nu18111833 - 5 Jun 2026

Viewed by 869

Abstract

Background/objective: This study determined the prevalence of dietary behaviours and examined their relationship with nutritional status among Malaysian school-based adolescents. Methods: Data from 33,523 adolescents who participated in the Adolescent Health Survey (AHS 2022) were analysed. Multiple logistic regression was employed to assess [...] Read more.

Background/objective: This study determined the prevalence of dietary behaviours and examined their relationship with nutritional status among Malaysian school-based adolescents. Methods: Data from 33,523 adolescents who participated in the Adolescent Health Survey (AHS 2022) were analysed. Multiple logistic regression was employed to assess associations between dietary behaviours and nutritional status, adjusting for potential confounders. Results: Our findings demonstrated a double burden of malnutrition, with 6.8% stunting, 8.3% thinness, and 30.5% overweight/obese. High prevalence of inadequate daily intake of fruit and vegetables (FV) (83.9%) and insufficient daily dairy consumption (62.7%) was observed. Approximately one-third of adolescents reported frequent fast-food consumption (i.e., at least one day per week) (35.4%) and daily intake of carbonated soft drinks (32.4%). Daily carbonated soft drink consumption was associated with higher odds of overweight/obesity (aOR:1.11; 95% CI:1.04–1.20), highlighting the need to prioritise the public health strategies aimed at reducing sugar intake. Conversely, inadequate FV intake (aOR:0.88; 95% CI:0.81–0.95) and frequent fast-food consumption (aOR:0.87; 95% CI:0.82–0.94) were associated with lower odds of overweight/obesity, while insufficient daily dairy intake was associated with lower odds of thinness (aOR:0.83; 95% CI:0.73–0.94). These negative associations should be interpreted cautiously due to possible reverse causality and reporting bias. Conclusions: The findings highlight the importance of strengthening nutrition education and the food environment among Malaysian adolescents. Full article

(This article belongs to the Special Issue Diet, Health, and Society: Advances in Nutritional Epidemiology for Public Health)

► Show Figures

Figure 1

20 pages, 3811 KB

Open AccessArticle

An Exploratory Study on Beneficial Effect of BE-FD-1 (Mineral-Enriched Raphanus sativus L. Leaf Extract) in High-Fat-Diet- and Streptozotocin-Induced Diabetic Mice

by Sung Jin Kim, Kyeong-No Yoon, Daewon Hwang, Jung Eun Park, Gabsik Yang, You Jeong Moon, Hyun Won Kim, Jeong Eun Jang, Ki Hyun Kim, Minjung Park and Ki Sung Kang

Nutrients 2026, 18(11), 1832; https://doi.org/10.3390/nu18111832 - 5 Jun 2026

Viewed by 666

Abstract

Background/Objectives: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder associated with insulin resistance, β-cell dysfunction, and systemic complications. Methods: In this preliminary study, the metabolic effects of BE-FD-1, a water extract of Raphanus sativus L. leaves cultivated under a mineral-fortification protocol, [...] Read more.

Background/Objectives: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder associated with insulin resistance, β-cell dysfunction, and systemic complications. Methods: In this preliminary study, the metabolic effects of BE-FD-1, a water extract of Raphanus sativus L. leaves cultivated under a mineral-fortification protocol, were investigated in a high-fat-diet/streptozotocin (HFD/STZ)-induced diabetic mouse model. Inductively coupled plasma mass spectrometry analysis confirmed the presence of vanadium, chromium, magnesium, zinc, and calcium in radish leaf. Male C57BL/6 mice (n = 5/group) were orally administered BE-FD-1 at 250 or 500 mg/kg once daily for four weeks, with metformin (250 mg/kg) as a positive reference. Results: BE-FD-1 at 500 mg/kg significantly reduced the oral glucose tolerance test area under the curve and fasting blood glucose levels, significantly restored serum insulin levels, and significantly decreased serum ALT, triglyceride, and total cholesterol levels relative to the HFD/STZ control group. Body weight gain and AST showed non-significant decreasing tendencies. Serum creatinine remained within the normal range, providing a preliminary safety signal that should be interpreted with caution given the absence of additional renal biomarkers and histopathological evaluation. Conclusions: These exploratory findings suggest that BE-FD-1 may warrant further investigation as a candidate functional ingredient for T2DM-related metabolic dysfunction; however, larger studies with comprehensive phytochemical characterization, mechanistic validation, and broader safety evaluation are required. Full article

(This article belongs to the Special Issue Botanicals and Nutritional Approaches in Metabolic Disorders)

► Show Figures

Graphical abstract

18 pages, 13805 KB

Open AccessArticle

Curcumin Induces Pyroptosis-Associated Molecular Changes in Osteosarcoma Cells Correlating with the ROS/NLRP3/CASPASE-1/GSDMD Axis with Concomitant PI3K/AKT Suppression and Apoptosis Activation

by Keqing Yuan, Xingyu Zhao, Jiayi Guo, Yue Lu, Yufei Cui, Wei Zhang and Wenhe Zhu

Nutrients 2026, 18(11), 1831; https://doi.org/10.3390/nu18111831 - 5 Jun 2026

Viewed by 612

Abstract

Curcumin, a natural polyphenolic compound derived from turmeric, exhibits broad-spectrum anticancer activities, but its ability to induce pyroptosis in osteosarcoma remains unknown. Osteosarcoma is the most common primary malignant bone tumor in children and adolescents, and novel therapeutic strategies are urgently needed to [...] Read more.

Curcumin, a natural polyphenolic compound derived from turmeric, exhibits broad-spectrum anticancer activities, but its ability to induce pyroptosis in osteosarcoma remains unknown. Osteosarcoma is the most common primary malignant bone tumor in children and adolescents, and novel therapeutic strategies are urgently needed to overcome osteosarcoma chemoresistance. Aim: This study aimed to investigate whether curcumin induces pyroptosis-associated molecular changes in human osteosarcoma cells and to explore the underlying molecular mechanisms, focusing on the ROS/NLRP3/CASPASE-1/GSDMD axis and the PI3K/AKT signaling pathway. Methods: Human osteosarcoma U2OS and MG63 cells were treated with curcumin (20–40 μmol·L⁻¹ for 24 h). Cell viability was assessed by CCK-8 assay. Pyroptotic morphology was observed by scanning electron microscopy. Lactate dehydrogenase (LDH) release was measured colorimetrically, and IL-1β/IL-18 secretion was quantified by ELISA. Mitochondrial membrane potential (ΔΨm) and intracellular reactive oxygen species (ROS) levels were analyzed by flow cytometry. Protein expression levels of NLRP3, cleaved CASPASE-1, GSDMD-N, PI3K, AKT, p-AKT, Bax, Bcl-2 and cleaved CASPASE-3 were detected by Western blotting. Pharmacological validation was performed using the pan-caspase inhibitor Z-VAD-FMK. Results: Curcumin significantly inhibited the proliferation of U2OS and MG63 cells in a dose- and time-dependent manner. Scanning electron microscopy revealed characteristic pyroptotic features including cell swelling, membrane pore formation, and rupture. Curcumin treatment markedly increased LDH release and elevated IL-1β/IL-18 secretion. Mechanistically, curcumin induced mitochondrial membrane depolarization and ROS accumulation, upregulated NLRP3, cleaved CASPASE-1, and GSDMD-N expression, and concomitantly reduced PI3K/AKT pathway activity. Additionally, curcumin upregulated pro-apoptotic Bax, downregulated anti-apoptotic Bcl-2, and activated cleaved CASPASE-3. The pan-caspase inhibitor Z-VAD-FMK partially reversed curcumin-induced cytotoxicity, confirming that caspase-dependent apoptosis contributes to the overall anticancer effect. Conclusions: This study provides evidence that curcumin induces both apoptosis and pyroptosis-associated molecular changes in human osteosarcoma cells. The pyroptotic effect involves the ROS/NLRP3/CASPASE-1/GSDMD axis, accompanied by PI3K/AKT suppression, while caspase-dependent apoptosis also plays an important role. These findings uncover a previously unreported mechanism of curcumin’s anti-osteosarcoma activity and suggest that targeting multiple cell death pathways may represent a promising strategy to overcome apoptosis resistance in osteosarcoma. Full article

(This article belongs to the Special Issue Botanicals and Nutritional Approaches in Metabolic Disorders)

► Show Figures

Figure 1

15 pages, 774 KB

Open AccessReview

Emotional Eating Under Negative Affect: A Narrative Review from the Perspectives of Emotion Regulation and Reward Processes in Food Choice

by Siwen Fu, Jie Chen and Xiaochun Wang

Nutrients 2026, 18(11), 1830; https://doi.org/10.3390/nu18111830 - 5 Jun 2026

Cited by 3 | Viewed by 1319

Abstract

Emotional eating under negative affect refers to eating responses that occur in brief unpleasant emotional states and are not explained by hunger alone. This narrative review synthesizes representative evidence from experimental, ecological, and neurocognitive studies on emotional eating under negative affect, with emphasis [...] Read more.

Emotional eating under negative affect refers to eating responses that occur in brief unpleasant emotional states and are not explained by hunger alone. This narrative review synthesizes representative evidence from experimental, ecological, and neurocognitive studies on emotional eating under negative affect, with emphasis on two interrelated pathways. (1) Emotion regulation: emotional eating may function as a rapid and accessible regulatory strategy through which food, especially highly palatable food, is used to attenuate negative affect. The immediate soothing effects of eating may reinforce later motivation and habitual responses to regulate emotions through food, whereas more adaptive strategies, such as cognitive reappraisal, may reduce the likelihood and intensity of emotion-related eating. (2) Reward processing and biased decision making: negative affect and affective stress contexts may diminish cognitive control and bias food choice toward immediate rewards. This pathway is reflected in increased attentional bias to food cues, stronger weighting of taste and palatability during value weighing, heightened responsivity to highly rewarding foods, and reduced regulatory influence of health and nutrition attributes. These processes may shift food choice toward energy-dense, nutrient-poor, and ultra-processed foods. The nutritional manifestations of emotional eating are not limited to total intake. Changes in intake quantity are heterogeneous, whereas changes in food choice, diet quality, degree of processing, and eating patterns appear more consistent. Repeated emotional eating may therefore contribute to less stable eating patterns and potential nutritional implications, although links with long-term physiological outcomes remain indirect. Future longitudinal and ecological momentary assessment studies are needed to clarify when emotional eating becomes a stable dietary pattern and which individual or contextual factors increase vulnerability. Full article

(This article belongs to the Special Issue The Relationship Between Dietary Behavior, Food Perception and Psychological State)

► Show Figures

Figure 1

15 pages, 2694 KB

Open AccessArticle

Obesity Triggers Dysregulation of Essential ABC Transporters in Rat Testis and Sperm

by Péter Szatmári, Kata Kira Kemény, Adrienn Seres-Bokor and Eszter Ducza

Nutrients 2026, 18(11), 1829; https://doi.org/10.3390/nu18111829 - 5 Jun 2026

Cited by 1 | Viewed by 597

Abstract

Objectives: Obesity and the associated metabolic dysfunction influence fertility performance at molecular levels and ABC transporters are considered as potential molecular factors affecting fertility both in the testis and sperm; therefore, we aimed to examine the effect of a short-term diet-induced obesity on [...] Read more.

Objectives: Obesity and the associated metabolic dysfunction influence fertility performance at molecular levels and ABC transporters are considered as potential molecular factors affecting fertility both in the testis and sperm; therefore, we aimed to examine the effect of a short-term diet-induced obesity on testicular and spermatic ABC transporters in a rat model focusing on the expressions of P-glycoprotein (P-gp, Abcb1) and breast cancer resistance protein (BCRP, Abcg2). The testicular androgen state involving aromatase enzyme (Cyp19a1), androgen receptor (Ar), and testosterone levels were also evaluated. Methods: Obesity was induced in male Sprague Dawley rats by feeding a high-fat, high-sugar diet (HFHSD) for 10 weeks, and metabolic status was evaluated using a glucose tolerance test. The weight and size of reproductive organs were measured, and Abcb1a/1b, Abcg2, Cyp19a1, and Ar expression in testes or sperm was determined by RT-PCR and Western blotting. At the same time, testosterone levels were measured by ELISA. Results: HFHSD successfully induced higher weight gain with glucose intolerance and reduced reproductive organ size. In obese rats, testicular Abcb1a and Abcb1b mRNA and P-gp protein expression were significantly higher, whereas testicular Abcg2 mRNA levels decreased. Spermatic Abcb1a, Abcb1b and Abcg2 mRNA expression also reduced in obesity. Neither testicular testosterone concentration nor Cyp19a1 and Ar mRNA expression levels changed after the 10-week obesogenic diet compared with controls. Conclusions: Overall, our study revealed infertility-related ABC transporter changes in obese male rats, suggesting that these alterations may predispose obese males to fertility impairments, even before the obesity-induced androgen dysregulation. Full article

(This article belongs to the Special Issue Impact of Diet, Nutrition and Lifestyle on Reproductive Health—2nd Edition)

► Show Figures

Figure 1

18 pages, 2100 KB

Open AccessReview

Impact of Vitamin D Concentration on Postoperative Outcomes and Complications Following Total Knee Arthroplasty: A Scoping Review of the Literature

by Daniel Jaglarz, Tomasz Strzemecki, Rafał Pankowski, Nina Janowska, Piotr Sypień, Ewa Tramś, Rafał Kamiński and Dariusz Grzelecki

Nutrients 2026, 18(11), 1828; https://doi.org/10.3390/nu18111828 - 5 Jun 2026

Viewed by 1059

Abstract

Background/Objectives: Despite its beneficial effect on the healing of bone fractures and in the treatment of osteoporosis, there is still a lack of evidence on the impact of clinical outcomes after a total joint arthroplasty (TJA). This review aims to establish the role [...] Read more.

Background/Objectives: Despite its beneficial effect on the healing of bone fractures and in the treatment of osteoporosis, there is still a lack of evidence on the impact of clinical outcomes after a total joint arthroplasty (TJA). This review aims to establish the role of vitamin D in clinical outcomes after a total knee arthroplasty (TKA). Methods: In this review, PubMed, Scopus and Web of Science databases were cross-checked by two reviewers independently. The inclusion criteria were original human studies published in English from 2014 to 2024. For identification-relevant studies, the search terms used were as follows: “Vitamin D” and “total knee arthroplasty” or “total knee replacement” or “total joint arthroplasty” or “total joint replacement”. Case reports, letters and expert consensuses were excluded from the analysis. Finally, 19 studies were included in this review. Results: A literature review shows that vitamin D may have an impact on patients treated for osteoarthritis (OA) of the knee with a significant prevalence of hypovitaminosis in orthopedic patients. The influence was observed for periprosthetic joint infections: PJI patients have significantly lower vitamin D levels than primary ones. Also, a greater incidence of revision knee surgery due to PJIs in the deficient group compared to the non-deficient group at a one-year follow-up was found, of up to a 2-fold increase. This affects the clinical outcome with a lower Knee Society Score (KSS) functional score in the vitamin D-deficient group. Conclusions: The current data suggest that the vitamin D metabolism pathway and its implications in orthopedic patients, especially those treated with TKA surgery, may be a significant factor that improves clinical and functional outcomes. A possible relation between a low preoperative concentration of vitamin D and its impact on the outcomes, such as the length of the hospital stay, implant survival, and risk of complications, is needed to support these findings in multicenter, prospective studies and randomized controlled trials. Full article

(This article belongs to the Special Issue Vitamin D Status and 25(OH)D Thresholds: From Musculoskeletal to Systemic and Beyond)

► Show Figures

Figure 1

17 pages, 2674 KB

Open AccessArticle

Nutritional and Metabolic Health Profiling in a Large Clinic-Based Sample of Mexican Adults: A Cross-Sectional Study

by Marco Antonio Luna-Ruiz-Esparza, Abraham García-Gil, Efren Encinas-Torres, Humberto Gómez-Campaña, Arely Sarahi Ramos-González, Diana Yadira Calva-Espinoza, Gerardo Benitez-Iturrios, Luis Fernando Hernández-Lezama, Abraham Campos-Romero and Jonathan Alcántar-Fernández

Nutrients 2026, 18(11), 1827; https://doi.org/10.3390/nu18111827 - 5 Jun 2026

Viewed by 435

Abstract

Background/Objectives: Obesity is a chronic, multifactorial condition characterized by excessive adipose tissue that adversely affects health and continues to rise worldwide. It is strongly associated with cardiometabolic abnormalities that increase the risk of adverse outcomes, including type 2 diabetes and coronary heart disease. [...] Read more.

Background/Objectives: Obesity is a chronic, multifactorial condition characterized by excessive adipose tissue that adversely affects health and continues to rise worldwide. It is strongly associated with cardiometabolic abnormalities that increase the risk of adverse outcomes, including type 2 diabetes and coronary heart disease. Methods: We conducted a multicenter, clinic-based cross-sectional analysis of electronic health records from 200,022 adults aged ≥20 years, who accessed nutritional and clinical laboratory services at Salud Digna between 1 January 2022 and 31 December 2025. Nutritional status was classified as normal weight or overweight/obesity using body mass index criteria. Metabolic health was assessed using five components of the National Cholesterol Education Program Adult Treatment Panel III criteria. Individuals were defined as metabolically unhealthy if they met three or more metabolic syndrome criteria. Results: Among participants, 78.17% of males and 79.73% of females were classified as overweight or obese. Metabolic unhealthiness was observed in 50.74% of males and 55.42% of females. The prevalences of metabolically healthy normal weight, metabolically healthy overweight/obesity, metabolically unhealthy normal weight, and metabolically unhealthy overweight/obesity were 18.55%, 31.09%, 3.90%, and 44.20%, respectively. Conclusions: These findings highlight a high burden of overweight/obesity and metabolic abnormalities in a large clinic-based sample of Mexican adults. While not nationally representative, this study provides important insights into the distribution of nutritional and metabolic health profiles in individuals accessing healthcare services, supporting the need for targeted prevention, early detection, and management strategies in clinical settings. Full article

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

► Show Figures

Figure 1

25 pages, 6816 KB

Open AccessReview

The Nutri-Exposome Intelligence Framework: Integrating Multi-Omics, Machine Learning, and Digital Nutrition for Precision Chronic Disease Prevention

by Mia Yang Ang and Siew Woh Choo

Nutrients 2026, 18(11), 1826; https://doi.org/10.3390/nu18111826 - 5 Jun 2026

Viewed by 1301

Abstract

Background/Objectives: Precision nutrition is moving beyond population-based guidance and isolated gene–diet interactions toward integrative models of dietary response. However, current approaches remain fragmented across nutrigenomics, microbiome research, multi-omics profiling, digital health, and machine learning. This review proposes the Nutri-Exposome Intelligence Framework as a [...] Read more.

Background/Objectives: Precision nutrition is moving beyond population-based guidance and isolated gene–diet interactions toward integrative models of dietary response. However, current approaches remain fragmented across nutrigenomics, microbiome research, multi-omics profiling, digital health, and machine learning. This review proposes the Nutri-Exposome Intelligence Framework as a conceptual, data science-driven model for integrating cumulative dietary, environmental, microbial, molecular, clinical, and digital exposures for precision chronic disease prevention. Methods: This conceptual review synthesizes the literature on precision nutrition, nutrigenetics, nutrigenomics, exposomics, gut microbiome research, multi-omics integration, wearable and biomarker-based monitoring, and machine learning in nutrition studies. Evidence was organized into a framework linking exposure assessment, host susceptibility, microbiome-mediated biotransformation, molecular response profiling, computational modelling, personalized intervention, and longitudinal feedback. Results: The proposed framework consists of seven interconnected layers: diet, environment, and lifestyle exposures; host genome and microbiome; multi-omics molecular responses; machine learning-based integration; risk prediction and responder stratification; personalized dietary intervention; and wearable and biomarker-based feedback. It positions the nutri-exposome as a cumulative exposure–response system and highlights how machine learning can support data harmonization, feature engineering, predictive modelling, responder classification, explainable interpretation, and adaptive refinement of dietary recommendations. Key applications include obesity, type 2 diabetes, cardiovascular disease, metabolic dysfunction-associated steatotic liver disease, cardiovascular–kidney–metabolic syndrome, and broader cardiometabolic prevention. Conclusions: Nutri-exposome intelligence offers a structured pathway for transforming complex nutrition data into predictive, explainable, and adaptive precision nutrition strategies. Implementation will require longitudinal and multi-ethnic cohorts, standardized metadata, causal validation, interpretable machine learning, ethical governance, and equitable access to support responsible clinical and public health translation globally. Full article

(This article belongs to the Special Issue Data Science and Machine Learning for Nutrition Studies)

► Show Figures

Figure 1

14 pages, 1329 KB

Open AccessArticle

1,5-Anhydro-D-Mannitol Is a Potentially Low-Energy Carbohydrate: A Dual-Model Approach in Rats and a Randomized, Three-Way Crossover Trial in Humans

by Kenichi Tanabe, Ikuma Tanaka, Hiromi Hayashi, Kazuhiro Yoshinaga and Sadako Nakamura

Nutrients 2026, 18(11), 1825; https://doi.org/10.3390/nu18111825 - 5 Jun 2026

Viewed by 635

Abstract

Background/Objectives: We hypothesized that orally ingested 1,5-anhydro-D-mannitol (AM) would be absorbed from the gut but poorly metabolized, and it may have low fermentability by gut microbiota based on the breath hydrogen test. Methods: We used a dual-model approach in this study. In animal [...] Read more.

Background/Objectives: We hypothesized that orally ingested 1,5-anhydro-D-mannitol (AM) would be absorbed from the gut but poorly metabolized, and it may have low fermentability by gut microbiota based on the breath hydrogen test. Methods: We used a dual-model approach in this study. In animal experiments, AM was administered orally to male Wistar rats. In a randomized, three-way crossover trial (UMIN000054040), 15 healthy young adults consumed a single 5 g dose of AM, mannose, or fructooligosaccharide (FOS). Primary outcome was breath hydrogen concentrations; secondary outcomes included plasma AM, blood glucose concentration, and urinary AM excretion. Results: After ingestion of 5 g AM in humans, the 14 h area under the curve for breath hydrogen excretion was markedly lower after AM than that after FOS ingestion (p < 0.05). Plasma AM peaked at 1 h, whereas blood glucose remained unchanged from baseline. Approximately 30% of ingested AM was excreted unchanged in urine within 24 h. Results of animal experiments were similar to those in humans. Fecal excretion in AM was confirmed to be minimal, accounting for ~1% of the administered dose within 24 h in rats. Conclusions: These findings indicate that AM is potentially a low-energy carbohydrate. Full article

(This article belongs to the Section Nutrition and Metabolism)

► Show Figures

Figure 1

13 pages, 1181 KB

Open AccessArticle

Relationship Between Sleep and Meal Timing with Glycemia Parameters in Individuals with Obesity Participating in a Randomized Time-Restricted Eating Study

by Sirimon Reutrakul, Stacey L. Simon, Qi Wang, Emily N. C. Manoogian, Satchidananda Panda, Suryeon Ryu, Zan Gao, Caleb Griffiths, Erika Helgeson, Douglas G. Mashek, Niki Oldenburg and Lisa Senye Chow

Nutrients 2026, 18(11), 1824; https://doi.org/10.3390/nu18111824 - 5 Jun 2026

Viewed by 1424

Abstract

Background/Objectives: Circadian misalignment, including mistimed sleep or eating, is associated with altered glucose metabolism. The importance of eating window timing for time-restricted eating (TRE) is increasingly recognized. This secondary analysis examined associations between meal to sleep timing intervals and glycemic parameters in individuals [...] Read more.

Background/Objectives: Circadian misalignment, including mistimed sleep or eating, is associated with altered glucose metabolism. The importance of eating window timing for time-restricted eating (TRE) is increasingly recognized. This secondary analysis examined associations between meal to sleep timing intervals and glycemic parameters in individuals with obesity across three dietary interventions [TRE, CR: caloric restriction, and UE: unrestricted eating]. Methods: Participants aged 18–65 years with obesity were randomized to a 12-week intervention: TRE (8 h eating window), CR (15% reduction in daily caloric intake), or UE (usual eating habits). CGM and actigraphy were assessed over two weeks at baseline and end-intervention. Mixed effects models examined associations between continuous glucose monitoring (CGM) outcomes and two intervals: last meal to sleep onset (PM meal-Sleep) and awakening to first meal (Awake-AM meal). Results: Each hour increase in the Awake-AM meal interval was associated with lower overnight (1 AM–5 AM) average glucose, lower glycemic variability, lower %time > 180 mg/dL, and greater %time < 70 mg/dL. Each hour increase in the PM meal-Sleep interval was associated with lower overnight (1 AM–5 AM) average glucose. Both associations persisted after adjustment for baseline sleep duration, HbA1c, and randomization assignment. Conclusions: In individuals with obesity, morning (Awake-AM meal interval) and evening (PM meal-Sleep interval) fasting relative to sleep were differentially associated with glycemic control. These findings highlight the relevance of eating and sleep timing to glycemic parameters and may inform eating window selection for individuals practicing TRE. Full article

(This article belongs to the Special Issue Time-Restricted Eating, Circadian Rhythms, and Cardiometabolic Risk)

► Show Figures

Graphical abstract

13 pages, 529 KB

Open AccessArticle

The Effects of Continuous vs. Intermittent Caloric Restriction on Fat Loss: A Randomized Controlled Trial

by Kelly E. Johnson, Briana Curran, Sydney Roberson, Haley Corso, Emily Hoelscher, Bill I. Campbell, Kamryn Rabon, Amelia Lovering and Madison Albert

Nutrients 2026, 18(11), 1823; https://doi.org/10.3390/nu18111823 - 5 Jun 2026

Viewed by 2600

Abstract

Background/Objectives: Obesity remains difficult to treat effectively, not because weight loss cannot be achieved, but because it is difficult to sustain in the face of physiological adaptations to energy restriction, including reductions in resting metabolic rate and loss of fat-free mass. Dietary [...] Read more.

Background/Objectives: Obesity remains difficult to treat effectively, not because weight loss cannot be achieved, but because it is difficult to sustain in the face of physiological adaptations to energy restriction, including reductions in resting metabolic rate and loss of fat-free mass. Dietary strategies that preserve favorable body composition while supporting long-term adherence are therefore needed. The purpose of this study was to compare continuous caloric restriction (CCR) with an intermittent approach incorporating structured diet refeeds and planned diet breaks (DRF) on body composition outcomes in adult women with obesity. Methods: Thirty adult females (18–65 years; BMI 30–45 kg·m⁻²) were randomized to 12 weeks of CCR or DRF following a two-week maintenance phase used to determine individualized caloric needs. Both groups were prescribed a 25% caloric deficit and protein intake of 1.2 g·kg⁻¹·day⁻¹. Body composition, including body fat percentage, fat mass, and fat-free mass, was assessed using air-displacement plethysmography at baseline and post-intervention. Results: Repeated-measures ANOVA revealed a significant main effect of time for body fat percentage (p < 0.001), which decreased by 6.7 ± 2.1% in the CCR group and 6.0 ± 1.9% in the DRF group, with no significant group × time interaction (p > 0.05). Fat mass significantly declined in both groups (p < 0.001), with reductions of 9.30 ± 2.77 kg (CCR) and 9.21 ± 2.63 kg (DRF); between-group differences were negligible (p > 0.05; Cohen’s d = 0.03). Fat-free mass increased over time (p < 0.05); although the interaction was not significant (p = 0.08), the DRF group demonstrated a moderate effect size advantage. Despite similar changes in body composition, analysis of energy balance revealed a significantly greater daily energy deficit in the CCR group compared with DRF (−1005 ± 515 vs. −690 ± 120 kcal·day⁻¹, p = 0.041), indicating a higher achieved level of caloric restriction in CCR. Conclusions: Both dietary strategies effectively reduced fat mass in females with obesity; however, incorporating diet breaks was associated with a nonsignificant trend toward greater preservation or accrual of fat-free mass without compromising fat loss. Future studies should investigate this potential association in larger, adequately powered trials before any conclusions regarding metabolic adaptation or practical advantage can be drawn. Full article

(This article belongs to the Special Issue Dietary and Lifestyle Intervention on Body Mass Index and Overall Health)

► Show Figures

Figure 1

14 pages, 725 KB

Open AccessArticle

Adherence to the DASH Diet in the Spanish Population and Its Environmental Impact: An Ecological Study

by Sergio Rodríguez Núñez, Laura Álvarez-Álvarez, Vicente Martín-Sánchez, Lucia Callejo Quintanilla, Isabel García-Cuesta, Beatriz San-Miguel and Antonio J. Molina

Nutrients 2026, 18(11), 1822; https://doi.org/10.3390/nu18111822 - 5 Jun 2026

Viewed by 480

Abstract

Background/Objectives: Plant-based dietary patterns like the Dietary Approaches to Stop Hypertension (DASH) reduce cardiovascular risk, which is a leading cause of mortality globally and in Spain. Diet is also a major environmental determinant, highlighting the need to evaluate public health alongside environmental sustainability. [...] Read more.

Background/Objectives: Plant-based dietary patterns like the Dietary Approaches to Stop Hypertension (DASH) reduce cardiovascular risk, which is a leading cause of mortality globally and in Spain. Diet is also a major environmental determinant, highlighting the need to evaluate public health alongside environmental sustainability. The aim of this study was to analyze the evolution of adherence to the DASH dietary pattern in Spain between 2006 and 2023 and evaluate its relationship with environmental sustainability indicators. Methods: This was an ecological epidemiological study. Food consumption data were harmonized into daily servings to calculate annual DASH scores using a standard 80-point methodology. Environmental impact was assessed by calculating the comprehensive Ecological Footprint (EF) using the Agribalyse^® 3.2 database. The study utilized open data from the Spanish Household Budget Surveys, capturing the consumption habits of approximately 24,000 randomly selected Spanish households annually from 2006 to 2023. The primary measures evaluated were the annual DASH adherence index score and the overall environmental Ecological Footprint. Temporal trends were evaluated using segmented regression models selected via the Akaike Information Criterion and Davies test. Pareto analysis determined individual food group environmental contributions, and correlations assessed the relationship between DASH scores and the EF. Results: DASH adherence increased by 8.26% over the study period, peaking in 2020. The EF demonstrated an overall decrease over time, largely driven by reduced consumption of meat, fish, and eggs. A strong inverse correlation was found between the DASH score and the EF (r = −0.8237 (95% CI: −0.932 to −0.580; p < 0.001)). Conclusions: A shift toward the DASH dietary pattern in Spain demonstrates potentially convergent health and environmental associations, promoting population cardiovascular health potential while simultaneously mitigating environmental impacts. Full article

(This article belongs to the Special Issue Sustainable Diets: Powering the Future of Food and Planetary Health)

► Show Figures

Figure 1

19 pages, 927 KB

Open AccessArticle

Identifying a Safety Threshold for Parenteral Glucose Intake in the Early Acute Phase of Preterm Neonates

by Maria Di Chiara, Ilaria Mastropasqua, Flavia Gloria, Arianna Di Domenico, Fabiana Russo, Lucia Dito, Paola Favata and Gianluca Terrin

Nutrients 2026, 18(11), 1821; https://doi.org/10.3390/nu18111821 - 5 Jun 2026

Viewed by 511

Abstract

Background/Objectives: The safety of specific parenteral glucose intake values within the range currently recommended by international guidelines for the early acute phase in preterm neonates has not been established. This study aimed to evaluate whether exceeding a data-driven parenteral dextrose intake threshold during [...] Read more.

Background/Objectives: The safety of specific parenteral glucose intake values within the range currently recommended by international guidelines for the early acute phase in preterm neonates has not been established. This study aimed to evaluate whether exceeding a data-driven parenteral dextrose intake threshold during the first week of life is independently associated with hyperglycemia, hypertriglyceridemia, metabolic acidosis, and extrauterine growth restriction (EUGR). Methods: This was a single-center retrospective study involving preterm neonates (gestational age ≤ 34 weeks and/or birth weight ≤ 1500 g) admitted to the Neonatal Intensive Care Unit of Policlinico Umberto I, Rome, between 2015 and 2022. The analysis followed two pre-specified steps: (1) data-driven identification of an exposure threshold by restricted cubic spline logistic regression; (2) multivariable analyses with the dichotomized exposure, adjusting for gestational age, birth weight, enteral nutrition timing, neonatal morbidity, and perinatal compromise. Results: 389 preterm neonates met eligibility. The data-driven inflection point of the spline-derived log-odds curve identified a threshold of 7 g/kg/day. Exceeding this threshold during the first week of life was independently associated with both hyperglycemia (adjusted odds ratio 5.55, 95% confidence interval 2.56 to 12.03; p < 0.001) and hypertriglyceridemia (adjusted odds ratio 4.36, 95% confidence interval 1.41 to 13.45; p = 0.010), but not with metabolic acidosis or with EUGR at 36 weeks postmenstrual age. The divergence in daily parenteral glucose intake between cases and controls was apparent from the second day of life. Conclusions: Exceeding 7 g/kg/day of parenteral dextrose was independently associated with early metabolic complications, but not with growth outcomes. A safety threshold for parenteral glucose may exist within the currently recommended intake range; prospective multicenter studies are needed before clinical recommendations can be drawn. Full article

(This article belongs to the Section Clinical Nutrition)

► Show Figures

Figure 1

12 pages, 263 KB

Open AccessOpinion

Soy Intake During Childhood and/or Adolescence and Adult Breast Cancer: An Examination of the Early Soy Intake Hypothesis

by Mark Messina and Alison M. Duncan

Nutrients 2026, 18(11), 1820; https://doi.org/10.3390/nu18111820 - 4 Jun 2026

Viewed by 628

Abstract

Breast cancer is one of the leading causes of cancer incidence and mortality in many countries worldwide although there is considerable geographic variation. Diet is thought to impact risk of developing breast cancer but identifying specific dietary factors involved in the etiology of [...] Read more.

Breast cancer is one of the leading causes of cancer incidence and mortality in many countries worldwide although there is considerable geographic variation. Diet is thought to impact risk of developing breast cancer but identifying specific dietary factors involved in the etiology of this disease has proven difficult. The two primary factors that initially led to an interest in soy are the historically low breast cancer incidence and mortality rates in Japan and the uniquely high concentration of isoflavones in soybeans and foods derived from this legume. Isoflavones bind to both estrogen receptors although preferentially to estrogen receptor-β. Prospective cohort studies indicate that isoflavone intake is associated with a reduced risk of developing breast cancer, but randomized controlled trials in which the impact of soy and isoflavones on markers of breast cancer risk has been evaluated are not supportive of this protective association. It may be that for isoflavones to reduce risk, intake needs to occur during childhood and/or adolescence. The notion that consuming soy early in life reduces risk of adult breast cancer, herein referred to as the “early soy intake hypothesis” (ESIH), was proposed >30 years ago. The results of rodent studies and retrospective observational studies that examined incidence and/or markers of breast cancer risk support the ESIH. However, a lack of randomized controlled trials precludes a clear recommendation for soy consumption during childhood and/or adolescence specifically for breast cancer prevention. Although soy foods provide high-quality protein and a variety of nutrients and can be part of a healthy diet for young and adolescent girls, more research is needed to advance the ESIH. Full article

(This article belongs to the Section Nutrition in Women)

23 pages, 4704 KB

Open AccessSystematic Review

Potential Neuroprotective Effects of Docosahexaenoic Acid on Glutamate-Induced Neurotoxicity: A Systematic Review of Pre-Clinical Studies

by Muhammad Hani Rahimi Rusleen, Nur Izzati Mansor, Adila A. Hamid, Nurul Hafizah Mohd Nor and Zainah Mohamed

Nutrients 2026, 18(11), 1819; https://doi.org/10.3390/nu18111819 - 4 Jun 2026

Cited by 1 | Viewed by 790

Abstract

Background/Objectives: Excitotoxicity, primarily caused by excessive glutamate signaling, is a significant contributor to the aetiology of several neurological disorders. Docosahexaenoic acid (DHA), a long-chain omega-3 polyunsaturated fatty acid, is known for its neuroprotective properties, including antioxidants and anti-inflammatory effects. However, the existing literature [...] Read more.

Background/Objectives: Excitotoxicity, primarily caused by excessive glutamate signaling, is a significant contributor to the aetiology of several neurological disorders. Docosahexaenoic acid (DHA), a long-chain omega-3 polyunsaturated fatty acid, is known for its neuroprotective properties, including antioxidants and anti-inflammatory effects. However, the existing literature has not sufficiently reviewed its specific role in glutamate-induced excitotoxicity. This systematic review aimed to provide comprehensive information from the literature on the neuroprotective effects of DHA in models of glutamate-induced neurotoxicity. Methods: A systematic search was conducted in the Cochrane Library, Scopus, Web of Science, PubMed, ScienceDirect, and Google Scholar, following PRISMA 2020 guidelines. The following keywords were used: DHA OR docosahexaenoic acid AND excitotoxicity OR glutamate-induced excitotoxicity OR glutamate-induced neurotoxicity. A total of 475 articles were screened, and 13 original articles published between 2003 and 2025 were included for data extraction. These studies included nine in vivo animal studies, three ex vivo studies, and one in vitro study. The risk of bias was assessed using SYRCLE’s methodology. Results: Our findings demonstrate that DHA provides substantial neuroprotection against excitotoxicity through antioxidative, anti-inflammatory, and anti-apoptotic mechanisms. Furthermore, DHA enhances neuronal function and cognitive performance by modulating neurotransmitter levels and glutamate-related signaling pathways. Despite these positive outcomes, heterogeneity across studies suggests that the neuroprotective properties of DHA may be affected by various parameters, such as the source of DHA, treatment dose and duration, age and experimental design. Conclusions: Although previous studies have demonstrated the benefits of DHA in preclinical and clinical settings of neurological disorders, further clinical studies focusing on the modulation of excitotoxicity by DHA are needed to validate its translational efficacy and therapeutic significance. Full article

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

► Show Figures

Figure 1

14 pages, 287 KB

Open AccessArticle

Water Distribution in the Body as a Source of Information on Markers of Skeletal Muscle Ageing

by Anna Skrzek, Małgorzata Słowinska-Lisowska, Agnieszka Dębiec-Bąk and Agnieszka Matylda Schlichtinger

Nutrients 2026, 18(11), 1818; https://doi.org/10.3390/nu18111818 - 4 Jun 2026

Viewed by 445

Abstract

Background/Objectives: Body water, including its distribution between the intracellular (ICW) and extracellular (ECW) compartments, plays an important role in skeletal muscle physiology. The aim of this study was to assess whether body water distribution indices, namely ECW/ICW and ECW/TBW, differ according to age [...] Read more.

Background/Objectives: Body water, including its distribution between the intracellular (ICW) and extracellular (ECW) compartments, plays an important role in skeletal muscle physiology. The aim of this study was to assess whether body water distribution indices, namely ECW/ICW and ECW/TBW, differ according to age and sex, and whether they are associated with skeletal muscle index (SMI) after adjustment for BMI, age, and sex. Methods: The study included 188 healthy individuals: 71 older women (71.6 ± 6.4 years), 37 older men (72.7 ± 4.7 years), 40 female students (22.5 ± 0.9 years), and 40 male students (22.8 ± 1.8 years). Body composition was assessed using a Tanita MC-780 bioimpedance analyser. The ECW/ICW and ECW/TBW ratios were calculated. Nonparametric analyses, Kendall’s rank correlations, and linear regression models adjusted for BMI, age, and sex were used. Results: Older adults had significantly higher ECW/ICW and ECW/TBW values than younger participants, and women had higher values than men within the same age groups. Both indices correlated positively with age and BMI, and negatively with SMI. In multivariate models, ECW/TBW remained negatively associated with SMI after adjustment. BMI and male sex correlated positively with SMI, whereas age was not a significant predictor. Conclusions: Body water distribution indices (ECW/ICW, ECW/TBW) reflect age- and sex-related differences in water distribution and correlate with SMI independently of BMI, age, and sex. They may serve as complementary markers of skeletal muscle ageing. Full article

(This article belongs to the Special Issue Nutrition and Health Outcomes in Older People Eligible for Rehabilitation)

21 pages, 2337 KB

Open AccessReview

Effects of Intermittent Fasting on Male and Female Reproductive Hormones, Fertility, and Sexual Function: A Comprehensive Review with Emphasis on the Existing Evidence Gap in Women

by Sandro La Vignera and Rosita A. Condorelli

Nutrients 2026, 18(11), 1817; https://doi.org/10.3390/nu18111817 - 4 Jun 2026

Cited by 2 | Viewed by 3905

Abstract

Intermittent fasting (IF) has emerged as a popular dietary intervention with potential metabolic and endocrine benefits. However, its effects on sexual function and reproductive health remain incompletely understood. This comprehensive review synthesizes current evidence from human clinical trials and animal studies examining the [...] Read more.

Intermittent fasting (IF) has emerged as a popular dietary intervention with potential metabolic and endocrine benefits. However, its effects on sexual function and reproductive health remain incompletely understood. This comprehensive review synthesizes current evidence from human clinical trials and animal studies examining the impact of various IF protocols—including time-restricted eating (TRE), alternate-day fasting (ADF), and Ramadan fasting—on male and female sexual function, reproductive hormones, and fertility outcomes. In males, limited human data suggest preserved erectile function but reduced sexual desire during Ramadan fasting, with neutral effects on testosterone in obese adults undergoing TRE. Animal studies demonstrate context-dependent effects, with IF protecting against high-fat diet-induced reproductive dysfunction while potentially impairing spermatogenesis under prolonged energy restriction. In females, IF shows promise for improving hyperandrogenism and menstrual regularity in polycystic ovary syndrome (PCOS), mediated by enhanced insulin sensitivity and reduced free androgen index. However, direct measurements of female sexual function domains (libido, arousal, lubrication, orgasm) are largely absent from the literature. Mechanistic pathways involve modulation of the hypothalamic–pituitary–gonadal (HPG) axis, insulin–adipokine signaling, sex hormone-binding globulin (SHBG), and oxidative stress pathways. Evidence quality is limited by small sample sizes, heterogeneous protocols, short follow-up periods, and predominance of animal data. While IF may offer reproductive benefits in metabolically compromised populations, particularly women with PCOS, caution is warranted in young, lean, or energy-deficient individuals. Future research should employ standardized IF protocols, validated sexual function instruments, and long-term fertility endpoints to establish evidence-based clinical recommendations. Full article

(This article belongs to the Special Issue Nutrition for Endocrine Conditions: Tailoring Dietary Approaches)

► Show Figures

Figure 1

18 pages, 804 KB

Open AccessArticle

Dietary Clusters and Mortality Risk in a Chinese Population: The Role of Type 2 Diabetes and Hypertension

by Chuhan Wei, Xikang Fan, Mengxia Li, Zidong Wang, Jiaxi Zhou, Jun Lv, Canqing Yu, Dianjianyi Sun, Pei Pei, Yan Lu, Yujie Hua, Jiang Hua, Jian Su, Jinyi Zhou and Ran Tao

Nutrients 2026, 18(11), 1816; https://doi.org/10.3390/nu18111816 - 4 Jun 2026

Viewed by 769

Abstract

Background: Regional dietary variations in China are well-documented, but their mortality associations in local populations, particularly among individuals with type 2 diabetes (T2D) or hypertension, remain unclear. This study aimed to identify dietary clusters in Suzhou and investigate their associations with mortality. [...] Read more.

Background: Regional dietary variations in China are well-documented, but their mortality associations in local populations, particularly among individuals with type 2 diabetes (T2D) or hypertension, remain unclear. This study aimed to identify dietary clusters in Suzhou and investigate their associations with mortality. Methods: This prospective analysis included 53,269 participants aged 30–79 years from the China Kadoorie Biobank (CKB) Suzhou Wuzhong subcohort. The baseline diet was assessed via a food frequency questionnaire, and three dietary clusters were identified by K-means clustering of 10 food groups. Multivariable Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause, cardiovascular disease (CVD), diabetes-related, and cancer mortality, stratified by baseline health status, T2D, and hypertension. Results: During follow-up, 1263 deaths occurred among healthy adults, 351 in T2D, and 2410 in hypertension. The Traditional/Preserved-Heavy cluster was characterized by lower intake frequencies across most food groups and more frequent preserved vegetable intake; the Meat-Centric cluster by relatively moderate intake frequencies and higher meat and poultry intake; and the Plant-and-Dairy-Abundant cluster by relatively abundant overall dietary intake, more frequent intake of fresh fruit, dairy products, and soybean products, and less frequent preserved vegetable intake. With the Meat-Centric cluster (cluster 2) as the reference, the Plant-and-Dairy-Abundant cluster (cluster 3) in T2D was associated with lower all-cause (HR = 0.61, 95% CI: 0.44–0.85), CVD (0.47, 0.24–0.91), and diabetes-related mortality (0.25, 0.09–0.71). BMI modified the association with all-cause mortality in T2D (p interaction = 0.033). In hypertension, cluster 1 was linked to higher all-cause (1.13, 1.03–1.23) and CVD mortality (1.17, 1.00–1.37), whereas cluster 3 was associated with a lower risk of diabetes-related mortality (0.40, 0.16–0.98). Conclusions: A dietary habit rich in fruit, dairy products, soybean products, and less frequent preserved vegetable intake was associated with lower mortality risk, particularly in T2D patients, whereas a habit with lower overall intake and more frequent preserved vegetable intake was linked to higher mortality in hypertension participants. These findings should be interpreted in light of the accompanying socioeconomic and lifestyle differences across dietary clusters. Full article

(This article belongs to the Special Issue Association Between Nutrition, Diet Quality, Dietary Patterns, and Human Health and Diseases—3rd Edition)

► Show Figures

Figure 1

24 pages, 1441 KB

Open AccessSystematic Review

Effects of Diet and Exercise Lifestyle Interventions on Physical and Psychological Health in Breast Cancer Survivors: A Systematic Review

by Nuria Asencio-Mas, Maria Martínez-Olcina, Belén Leyva-Vela, Manuel Vicente-Martínez, Yolanda Nadal-Nicolás, Jose Manuel Garcia-De Frutos and Alejandro Martínez-Rodríguez

Nutrients 2026, 18(11), 1815; https://doi.org/10.3390/nu18111815 - 4 Jun 2026

Viewed by 965

Abstract

Breast cancer survivors frequently experience adverse changes in body composition, cardiometabolic biomarkers, functional capacity and quality of life that may worsen long-term prognosis, yet the comparative effectiveness of lifestyle interventions across delivery formats and supervision levels remains unclear. Background/Objectives: This systematic review assessed [...] Read more.

Breast cancer survivors frequently experience adverse changes in body composition, cardiometabolic biomarkers, functional capacity and quality of life that may worsen long-term prognosis, yet the comparative effectiveness of lifestyle interventions across delivery formats and supervision levels remains unclear. Background/Objectives: This systematic review assessed the effects of structured diet and exercise interventions on body composition, metabolic and inflammatory biomarkers, functional capacity, dietary habits and quality of life in breast cancer survivors. Methods: Following PRISMA guidelines, Cochrane, PubMed, Scopus and Web of Science were searched for randomized controlled trials and quasi-experimental studies published in English between 2016 and 2026. Risk of bias was assessed with RoB 2 and ROBINS-I and certainty of evidence with GRADE. Results: Of 1413 records, 15 studies (11 RCTs; mean age 46–60 years; mostly overweight or obese post-treatment women) met the inclusion criteria; twelve interventions were supervised and three home-based or web-based. Within the assessed domains, many studies reported significant improvements in body composition, quality of life and metabolic or inflammatory biomarkers. Effects were larger in multimodal supervised programs combining caloric restriction with moderate-to-vigorous aerobic plus resistance training (5–8% weight loss; 19–29% visceral fat reduction; improved insulin, IGF-1, leptin, adiponectin and EORTC QLQ-C30 scores), whereas digital or low-intensity interventions produced smaller, less uniform objective effects despite improving dietary behaviors. GRADE certainty ranged from very low to moderate–high. Conclusions: Multimodal supervised programs offer the most robust benefits; digital formats require additional supervision. Standardized protocols and longer follow-up are needed. Full article

(This article belongs to the Special Issue Nutrition and Lifestyle in Cancer Care, Prevention and Survivorship)

► Show Figures

Figure 1

22 pages, 3441 KB

Open AccessArticle

Effect of Dietary Linoleic Acid Intake on Eicosapentaenoic Acid Status and Lipoxygenase-Mediated Oxylipin Biosynthesis in Healthy Adults: A Randomized Controlled Trial

by Susan Sergeant, Linda H. Easter, Tammy Mustin, Priscilla Ivester, Jimaree A. Legins, Michael C. Seeds, Carrie S. Standage-Beier, Anderson Cox, Cristina M. Furdui, Brian Hallmark and Floyd H. Chilton

Nutrients 2026, 18(11), 1814; https://doi.org/10.3390/nu18111814 - 4 Jun 2026

Viewed by 1691

Abstract

Background/Objectives. The modern Western diet (MWD) provides high linoleic acid (LA) exposure, typically contributing 6–9% of the total caloric intake. These high LA levels have fueled a longstanding debate about whether this dietary pattern confers benefit or risk. Importantly, LA intake is disproportionately [...] Read more.

Background/Objectives. The modern Western diet (MWD) provides high linoleic acid (LA) exposure, typically contributing 6–9% of the total caloric intake. These high LA levels have fueled a longstanding debate about whether this dietary pattern confers benefit or risk. Importantly, LA intake is disproportionately elevated among lower socioeconomic populations due to greater reliance on industrial seed oils and ultra-processed foods. Despite decades of research, controlled dietary intervention studies directly evaluating the biological consequences of varying LA exposure remain limited. Methods. The current randomized, double-blind intervention (ClinicalTrials.gov; NCT02962128; 11 November 2016) compared the effects of a 12-week Low-LA diet (2.5% energy) versus a High-LA diet (10.0% energy) in healthy adults. Outcomes included plasma concentrations of highly unsaturated fatty acids (HUFAs) and ex vivo zymosan-stimulated whole-blood oxylipin generation. Results. Fifty-two participants completed the intervention. High LA exposure resulted in marked reductions in plasma n-3 eicosapentaenoic acid (EPA) and eicosatetraenoic acid (ETA) concentrations compared with the Low-LA arm. Docosapentaenoic acid (DPA) was also significantly lower in weeks 4 and 8. In contrast, levels of the n-6 HUFA arachidonic acid (ARA) did not differ with dietary LA exposure. Conclusions. HUFA and oxylipin analyses revealed that higher dietary LA markedly increased the ratios of ARA to EPA and ARA- to EPA-derived oxylipin species, shifting the lipid mediator balance toward a more n-6-dominant inflammatory profile. Full article

(This article belongs to the Special Issue Nutrition Equity and Community Health: Social, Environmental, and Innovative Approaches)

► Show Figures

Graphical abstract

19 pages, 1574 KB

Open AccessArticle

The Effect of Hyperuricemia on Cognitive Impairment: A Cohort Study and Systematic Review

by Ruei-Ting Su, Jerry Cheng-Yen Lai and Pei-Yu Wu

Nutrients 2026, 18(11), 1813; https://doi.org/10.3390/nu18111813 - 4 Jun 2026

Viewed by 723

Abstract

Background/Objectives: Hyperuricemia may influence cognitive function, but current evidence remains inconsistent. This study examined the association between hyperuricemia/gout and cognitive impairment through a prospective cohort study and a systematic review of cohort studies. Methods: Data from 1959 Taiwan Biobank participants aged ≥60 years [...] Read more.

Background/Objectives: Hyperuricemia may influence cognitive function, but current evidence remains inconsistent. This study examined the association between hyperuricemia/gout and cognitive impairment through a prospective cohort study and a systematic review of cohort studies. Methods: Data from 1959 Taiwan Biobank participants aged ≥60 years without mild cognitive impairment (MCI) or dementia at baseline were analyzed over a mean follow-up duration of 4.47 years (2012–2021). Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Participants were classified by changes in serum uric acid status from baseline to follow-up, and Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). For the systematic review, cohort studies published up to March 2026 were identified from eight databases. Results: During follow-up, 1013 participants developed incident MCI and 132 developed dementia. Compared with participants who maintained normal serum uric acid levels, those who developed hyperuricemia during follow-up had a significantly lower MCI risk (HR = 0.72, 95% CI = 0.57–0.90), as did those with persistent hyperuricemia (HR = 0.78, 95% CI = 0.64–0.95). No significant association was observed for dementia. The systematic review of five prospective cohort studies comprising 2,261,704 participants showed inconsistent findings with considerable heterogeneity (I² = 96.7%). Conclusions: Rising serum uric acid levels were associated with lower MCI risk, but not dementia. These findings should not be interpreted as support for intentionally increasing serum uric acid levels or withholding urate-lowering therapy. Further long-term studies are needed. Full article

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

► Show Figures

Graphical abstract

18 pages, 1703 KB

Open AccessArticle

Adherence to Chinese Dietary Guidelines Is Associated with Better Bone Status in School-Aged Children and Adolescents

by Shiyi Ouyang, Ailing Chen, Yan Li, Wenlong Lu, Jiali Cai, Jiaren Liu, Zhuang Ma, Yuhan Tang, Ping Yao, Ting Xiong, Jingfan Xiong, Yanyan Li and Yuanjue Wu

Nutrients 2026, 18(11), 1812; https://doi.org/10.3390/nu18111812 - 4 Jun 2026

Viewed by 703

Abstract

Background/Objectives: Diet plays a crucial role in bone health; however, most studies have focused on individual nutrients or foods. The relationship between overall dietary quality and bone health in children and adolescents remains unclear. This study aimed to assess the association between diet [...] Read more.

Background/Objectives: Diet plays a crucial role in bone health; however, most studies have focused on individual nutrients or foods. The relationship between overall dietary quality and bone health in children and adolescents remains unclear. This study aimed to assess the association between diet quality scores and bone health in a pediatric population. Methods: A total of 3299 students aged 9–17 participated in this study. Dietary quality was assessed using the Chinese dietary guidelines index for Children and Adolescents (CDGI-Cs). Bone health was evaluated through calcaneal quantitative ultrasound (QUS), utilizing the speed of sound (SOS) as the key indicator. Generalized linear models and binary logistic models were used to analyze the association between CDGI-C scores and bone health outcomes (SOS Z scores and the risk of low SOS), respectively. Results: After full adjustment, CDGI-C scores showed a significant positive association with SOS. A 10-point increase in CDGI-C scores was associated with a 0.08-unit increase in SOS Z score (95% CI: 0.04, 0.11) and a 15% reduction in the risk of low SOS (OR = 0.85, 95% CI: 0.76, 0.94). Compared to participants in the lowest quartile of CDGI-C scores, those in the highest quartile exhibited significantly higher SOS Z scores (β = 0.18, 95% CI: 0.08, 0.29, p for trend < 0.001), and a 29% lower risk of low SOS (OR = 0.71, 95% CI: 0.50, 1.00, p for trend = 0.050). In dietary item analysis, higher intake of dairy and dairy products (β = 0.02, 95% CI: 0.00, 0.03) and seafood (β = 0.01, 95% CI: 0.00, 0.03) remained positively associated with SOS Z scores. Conclusions: Higher diet quality, as measured by CDGI-C, was significantly associated with better bone health in children and adolescents. Dairy, dairy products, and seafood emerged as key dietary components contributing to this positive association. Full article

(This article belongs to the Section Nutrition and Metabolism)

► Show Figures

Figure 1

13 pages, 475 KB

Open AccessArticle

Exploring Subpopulations for Epidemiological Precision Nutrition Research: The Example of Phenylalanine Hydroxylase (PAH) Genetic Variation

by Anoushka Dhawan, Sophia M. Khan, Madison L. Fennell, Clara E. Cho, Jennifer M. Monk and Justine R. Keathley

Nutrients 2026, 18(11), 1811; https://doi.org/10.3390/nu18111811 - 4 Jun 2026

Viewed by 494

Abstract

Background/Objectives: Biological factors such as genetics contribute to nutrition-related outcomes, but nutritional epidemiological studies often lack consideration of genetics despite evidence of their functional impacts on health and cognition. Phenylalanine hydroxylase (PAH) genetic variation has been hypothesized to influence health and cognitive outcomes [...] Read more.

Background/Objectives: Biological factors such as genetics contribute to nutrition-related outcomes, but nutritional epidemiological studies often lack consideration of genetics despite evidence of their functional impacts on health and cognition. Phenylalanine hydroxylase (PAH) genetic variation has been hypothesized to influence health and cognitive outcomes due to evidence of metabolic perturbations in L-phenylalanine to L-tyrosine hydroxylation, including plausible downstream effects on catecholamine neurotransmitters among not only individuals with phenylketonuria (PKU) [homozygotes for PAH mutations] but also PKU carriers [heterozygotes]. Related to these metabolic perturbations, diminished executive functioning has been observed in individuals with PKU, even when treated, but research is lacking exploring this outcome in PKU carriers. The present study aims to detail methods for stratifying populations based on genetic variation, for use in epidemiological precision nutrition research. It further provides an exploratory exemplar of such research through population stratification by PAH genetic variation (i.e., PKU carriers vs. non-carriers), while providing the first descriptive data on executive functioning skills using the validated Executive Skills Questionnaire—Revised (ESQ-R) tool with PAH-genetically stratified groups (PKU carriers and non-carriers). Methods: Participants were ≥18 years of age and PAH heterozygotes (PKU carriers) or non-carriers. Levels of executive functioning were self-reported anonymously online and included the validated Executive Skills Questionnaire—Revised (ESQ-R) tool. Data were analyzed using t-tests, chi-square tests, ANOVAs, and ANCOVAs. Results: Respondents (n = 99, n = 79 carriers and n = 20 non-carriers) consisted of males (22.2%) and females (77.8%), primarily of European ancestry. There were no significant differences between groups (carriers vs. non-carriers) for total scores (mean ± SD ESQ-R score carriers = 17.41 ± 14.01; non-carriers = 14.95 ± 10.00), but carriers scored significantly worse than non-carriers for the ESQ-R item “I have trouble making a plan” in the adjusted model. Conclusions: This study provides a methodological exemplar for exploring genetically stratified subpopulations in epidemiological precision nutrition research. Full article

(This article belongs to the Special Issue Advancing Methodological Rigor in Nutritional Epidemiology)

18 pages, 1106 KB

Open AccessArticle

IgE-Mediated Legume Allergy in Children: Insights from a Single-Center Experience in Italy

by Beatrice Serra, Simona Barni, Claudia Valleriani, Beatrice Coppadoro, Francesco Catamerò, Letizia Ciliberti, Mattia Giovannini, Giulia Liccioli, Lucrezia Sarti, Leonardo Tomei, Antonella Muraro and Francesca Mori

Nutrients 2026, 18(11), 1810; https://doi.org/10.3390/nu18111810 - 4 Jun 2026

Viewed by 738

Abstract

Background/Objectives: Legume allergy is increasingly recognized as plant-based diets expand and legume proteins are widely used in processed foods. We aimed to characterize the clinical features, sensitization profiles, and management outcomes of IgE-mediated legume allergy in Italian children. Methods: This retrospective [...] Read more.

Background/Objectives: Legume allergy is increasingly recognized as plant-based diets expand and legume proteins are widely used in processed foods. We aimed to characterize the clinical features, sensitization profiles, and management outcomes of IgE-mediated legume allergy in Italian children. Methods: This retrospective single-center study (January 2022–January 2024) included children (<18 years) allergic to ≥1 index legume (pea, lentil, chickpea, common bean, or soy). Diagnosis required a compatible clinical history and evidence of IgE sensitization. Clinical and allergy characteristics were analyzed. Results: Fifty-five children (63.6% male) were included; all had atopic comorbidities, and 96.4% had additional food allergies. Median age at first reaction was 18 months; anaphylaxis occurred at onset in 12.7%, most frequently triggered by pea. Pea (70.9%) and lentil (69.1%) were the most prevalent allergies, with pea causing 50% of index-legume anaphylaxis. Multi-legume allergy predominated (74.5%), with frequent co-allergy among pea, lentil, and chickpea (56–86%). Soy allergy was less frequent and mainly associated with Gly m 4 sensitization. Single-legume allergy (25.5%) was associated with later onset (54 vs. 15 months; p = 0.013) and liver transplantation (21% vs. 2%; p = 0.047). Peanut co-allergy occurred in 25.5%. Among 34 oral food challenges (OFCs), 23.5% were positive, including one case of pea-induced anaphylaxis. Of 16 oral immunotherapy (OIT) protocols initiated, 31.3% reached the full target maintenance dose, 37.5% remained on a lower, partial maintenance dose, and 31.3% were discontinued due to oral allergy syndrome (OAS). Conclusions: Pediatric legume allergy is characterized by early onset, frequent multi-legume involvement, and common co-allergies. In this cohort, pea allergy was associated with the highest proportion of severe reactions. Species-specific differences in severity, patterns of multi-legume involvement, and OIT outcomes should be interpreted cautiously given the limited sample size, while highlighting the need for tailored management and improved risk assessment across legume species. Full article

(This article belongs to the Special Issue Insights into Dietary Therapies for Food Allergies)

► Show Figures

Figure 1

16 pages, 1191 KB

Open AccessArticle

by María Diez-Hernández, María Fernanda Zerón-Rugerio, Isabella Parilli-Moser and Maria Izquierdo-Pulido

Nutrients 2026, 18(11), 1809; https://doi.org/10.3390/nu18111809 - 4 Jun 2026

Viewed by 594

Abstract

Background/Objectives: Despite growing recognition of sex as a biological variable that may influence responses to dietary interventions, many studies still pool data from women and men. Moreover, sex-stratified changes in eating behaviors and mental health following dietary interventions remain underexplored. This study aimed [...] Read more.

Background/Objectives: Despite growing recognition of sex as a biological variable that may influence responses to dietary interventions, many studies still pool data from women and men. Moreover, sex-stratified changes in eating behaviors and mental health following dietary interventions remain underexplored. This study aimed to describe sex-stratified changes in adiposity, eating behaviors, and mental health outcomes in men and women following a hypocaloric Mediterranean-style diet. Methods: A 12-week exploratory prospective longitudinal study was conducted in nineteen women and nine men with overweight or obesity. Participants attended two clinical visits (baseline and week 12), where adiposity parameters (body mass index [BMI], body fat, waist and hip circumference), diet quality, eating behaviors, mental health parameters (well-being, perceived stress, flourishing, anxiety and depression) and biochemical parameters were assessed. Analyses were stratified by sex to evaluate changes from baseline to week 12, and repeated-measures correlations were used to explore within-individual associations between concurrent changes in outcomes. Results: Women and men improved significantly in adiposity and diet quality. Uncontrolled eating decreased and cognitive restraint increased in both sexes (p < 0.05). In men, emotional eating decreased (p = 0.011), and mental health improved, with higher well-being (p = 0.043) and flourishing (p = 0.027), and lower stress (p = 0.021), anxiety (p = 0.017), and depression (p = 0.027). Also, in men, anxiety was positively correlated with body fat percentage (p = 0.012) and BMI (p = 0.002) and inversely correlated with diet quality (p = 0.013). Uncontrolled eating was positively associated with BMI in men (p = 0.022) and women (p = 0.006), and cognitive restraint was positively associated with diet quality (both p = 0.003). Conclusions: Women and men achieved similar improvements in adiposity, whereas improvements in mental health variables and emotional eating were observed only in men. These preliminary findings suggest that dietary interventions may benefit from considering sex-sensitive and multidisciplinary approaches, especially psychological support and stress-management components, may be required for women. However, these observations should be confirmed in adequately powered studies. Full article

(This article belongs to the Special Issue Eating Behaviors and Lifestyle in Body Weight and Health)

► Show Figures

Figure 1

16 pages, 1762 KB

Open AccessArticle

Development of a Theory-Based Nutrition Education Program Targeting Varsity Athletes at a Canadian University

by Jana Daher, Jess Haines, Margo Mountjoy and Dalia El Khoury

Nutrients 2026, 18(11), 1808; https://doi.org/10.3390/nu18111808 - 4 Jun 2026

Viewed by 605

Abstract

This paper describes the development and design of Nutrition for Athletes: A Focus on Dietary Supplements, an online educational intervention created for varsity athletes at the University of Guelph. Guided by the Theory of Planned Behaviour (TPB), the program aimed to improve [...] Read more.

This paper describes the development and design of Nutrition for Athletes: A Focus on Dietary Supplements, an online educational intervention created for varsity athletes at the University of Guelph. Guided by the Theory of Planned Behaviour (TPB), the program aimed to improve athletes’ nutrition and dietary supplement-related knowledge while modifying attitudes, subjective norms, perceived behavioral control, intentions, and behaviors associated with dietary supplement use. Formative research with the target population revealed widespread misconceptions, strong social influences, and high perceived benefits of supplement use, which highlighted the need for an intervention focused on reshaping underlying beliefs. The program covered topics related to sports nutrition, hydration, dietary supplements, and risks of supplement use, and was integrated into the university’s learning management system. Each unit was mapped onto relevant TPB constructs, with an emphasis on correcting inaccurate beliefs and promoting a food-first approach. The program’s effectiveness was evaluated through pre- and post-intervention questionnaires assessing knowledge and TPB constructs. This paper outlines the theoretical framework, development process, and content structure of the intervention, and presents a model that can be replicated in future educational programs. Full article

(This article belongs to the Special Issue Educational Behavior-Change Interventions in Nutrition: Theory, Development and Evidence)

► Show Figures

Figure 1

13 pages, 253 KB

Open AccessArticle

Efficacy, Safety, and Hematologic Recovery Following Intravenous Ferric Carboxymaltose in Patients with Iron Malabsorption-Related Iron Deficiency Anemia: A Prospective Clinical Study

by Silvia Scalamonti, Giulia Pivetta, Francesco Paolo Schiavone, Micaela Magnante, Manuela Pompili, Marica Vavallo, Bruno Annibale and Edith Lahner

Nutrients 2026, 18(11), 1807; https://doi.org/10.3390/nu18111807 - 4 Jun 2026

Viewed by 622

Abstract

Background/Objectives: Autoimmune gastritis (AIG), celiac disease (CD), and gastric surgery (GS) often cause iron deficiency anemia (IDA) due to iron malabsorption. In this clinical context, IDA treatment is often challenging. The first-line IDA treatment is oral iron supplementation followed by intravenous (IV) [...] Read more.

Background/Objectives: Autoimmune gastritis (AIG), celiac disease (CD), and gastric surgery (GS) often cause iron deficiency anemia (IDA) due to iron malabsorption. In this clinical context, IDA treatment is often challenging. The first-line IDA treatment is oral iron supplementation followed by intravenous (IV) iron administration when ineffective or not tolerated. Ferric carboxymaltose (FCM) showed efficacy in various clinical settings. Prospective data evaluating the efficacy of IV FCM in IDA patients secondary to iron malabsorption are scant. The aim of the current study was to assess the tolerability, efficacy, and QoL impact of IV FCM for the treatment of IDA patients with iron malabsorption. Methods: Study design: single-center, prospective observational study: n = 37 adults with AIG, CD, or GS with IDA receiving IV FCM were consecutively included. Endpoints were (i) safety tolerability, (ii) efficacy on IDA recovery (Hb normalization), and (iii) QoL impact. At baseline (T0) and 12 weeks after treatment (T12), a QoL-SF12 questionnaire was assessed. Complete blood count (CBC) and iron status (ferritin, iron, transferrin, transferrin saturation (TS)) were assessed at T0, 4 weeks (T4), and T12 after treatment. Results: Of the 37 IDA patients, 19 (51.4%) had AIG, 9 (24.3%) CD, and 9 (24.3%) GS; Based on Ganzoni’s formula, 24 (64.9%) patients received a single IV FCM infusion (mean ± SEM dosage of 975 ± 12 mg); 13 (35.1%) required two IV infusion sessions with a mean ± SEM cumulative dose of 1400 ± 77 mg. One patient (2.7%) experienced mild adverse events without need for treatment interruption or hospitalization. At T0, anemia was moderate in 7 (18.9%) patients and severe in 1 (2.7%). IDA recovery was achieved in 26 (70.3%) patients at T4 and in 29 (78.4%) at T12. At T4, mean ± SEM Hb increased from 10.8 ± 0.2 g/dL to 12.7 ± 0.1 g/dL, ferritin from 28.5 ± 11.2 ng/mL to 188.2 ± 25.7 ng/mL, and TS from 6.7 ± 0.5% to 23.7 ± 1.9% (p < 0.0001). At T12, mean ± SEM Hb further increased to 13.1 ± 0.2 g/dL (p < 0.05 vs. T4), ferritin slightly decreased to 125 ± 26.7 ng/mL, and TS to 22.7 ± 2.8%. At T12, nonsignificant increases in QoL scores relative to baseline were observed. Conclusions: IV FCM is a safe and effective treatment leading to IDA recovery in nearly 80% of patients at T12. Thus, when oral iron treatment is not feasible or has failed, IV FCM treatment might be considered a first-line therapeutic option for IDA consequent to iron malabsorption. Full article

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

26 pages, 498 KB

Open AccessReview

Ginsenosides for the Management of Metabolic Dysfunction-Associated Fatty Liver Disease: A Research Update

by Ke Zhang, Zenghui Qin, Qingjun Guo, Jiazhi Lu, Huiyu Luo and Longying Zha

Nutrients 2026, 18(11), 1806; https://doi.org/10.3390/nu18111806 - 3 Jun 2026

Viewed by 1013

Abstract

Background: Metabolic-associated fatty liver disease (MAFLD) has a high prevalence of 30–40% in China and Asia, with a complex pathogenesis and no specific therapeutic drugs. Phytochemicals have become a research hotspot for MAFLD prevention, and ginsenosides, the core active components of Panax [...] Read more.

Background: Metabolic-associated fatty liver disease (MAFLD) has a high prevalence of 30–40% in China and Asia, with a complex pathogenesis and no specific therapeutic drugs. Phytochemicals have become a research hotspot for MAFLD prevention, and ginsenosides, the core active components of Panax ginseng, show great potential in anti-MAFLD research. This review aims to comprehensively clarify the key mechanisms and targets of ginsenosides in preventing and treating MAFLD, to provide a theoretical basis for their application in metabolic diseases, and to promote the development of natural phytochemical resources. Method: The literature review method was adopted to sort out the regulatory effects and molecular targets of ginsenosides in multiple pathological processes of MAFLD from published studies. Results: Ginsenosides regulated MAFLD through multi-pathway and multi-target effects: antioxidant regulation occurred via Nuclear factor E2-related factor 2 (Nrf2)/Silent information regulator 1/6 (SIRT1/6) pathways, and anti-inflammatory regulation was achieved by inhibiting the Nuclear factor kappa-B (NF-κB)/NOD-like receptor family pyrin domain containing 3 (NLRP3) inflammasome. Additionally, the measures adopted improved insulin resistance and lipid metabolism disorder, suppressed hepatocyte apoptosis/pyroptosis, repaired autophagy, alleviated hepatocyte senescence, and reshaped gut microbiota to restore gut–liver axis homeostasis. Conclusions: Ginsenosides have good potential for MAFLD prevention and treatment, but there is a prominent lack of human clinical evidence as most existing studies are only based on in vitro cell and in vivo animal models, and the synergistic mechanisms among different ginsenoside components remain unclear. Future research needs multi-omics analysis, formulation optimization, and large-sample clinical trials, and ginsenosides have broad application prospects in MAFLD intervention. Full article

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

► Show Figures

Figure 1

Journal Menu

Journal Browser

Nutrients, Volume 18, Issue 11 (June-1 2026) – 190 articles

Further Information

Guidelines

MDPI Initiatives

Follow MDPI