Nutrients

Open AccessArticle

Vegetarian and Plant-Based Nutrition in Belgian Hospitals: A Cross-Sectional Study Revealing Gaps and Opportunities for Healthier Food Environments

by Evelien Mertens, Peter Deriemaeker, Tom Peeters and Katrien Van Beneden

Nutrients 2026, 18(11), 1654; https://doi.org/10.3390/nu18111654 (registering DOI) - 22 May 2026

Abstract

Background/Objective: Transitioning towards plant-based dietary patterns is essential to improve health and reduce environmental impact. Hospitals represent a key setting to implement such dietary shifts, yet data on the availability of plant-based meals in healthcare institutions remain scarce. Methods: A cross-sectional survey was [...] Read more.

Background/Objective: Transitioning towards plant-based dietary patterns is essential to improve health and reduce environmental impact. Hospitals represent a key setting to implement such dietary shifts, yet data on the availability of plant-based meals in healthcare institutions remain scarce. Methods: A cross-sectional survey was conducted across Dutch-speaking hospitals in Belgium to assess the meal plans and whether vegetarian or fully plant-based meal options were available for patients. Besides availability, the frequency and perceived barriers were assessed. Furthermore, the meal plans were analyzed to get an overview of the vegetarian and plant-based food options that were offered in different types of Belgian hospitals. Results: The availability of plant-based meal options was limited across hospitals. No meaningful differences were observed between general hospitals and other hospital types, including psychiatric, rehabilitation, and specialized hospitals. While plant-based fats and oils were widely available, key protein-rich plant foods such as legumes and minimally processed meat alternatives were rarely offered in all types of hospitals. Knowledge gaps among food service staff were observed, and structural barriers—including the need to accommodate diverse dietary requirements—were reported. Conclusions: Belgian hospitals currently underutilize the potential of vegetarian and plant-based nutrition to support patient health and sustainability goals. Strengthening institutional food environments by increasing the availability of nutritionally adequate plant-based meals represents a feasible and impactful strategy to align hospital practice with dietary guidelines and preventive healthcare priorities. Full article

(This article belongs to the Special Issue Vegetarian Dietary Patterns in the Prevention of Metabolic Syndrome)

19 pages, 631 KB

Open AccessArticle

Assessing Bone and Adipose Tissue Biomarkers in 5–6-Year-Old Polish Children Adhering to Vegetarian and Traditional Diets

by Jadwiga Ambroszkiewicz, Joanna Gajewska, Joanna Mazur, Grażyna Rowicka, Witold Klemarczyk and Magdalena Chełchowska

Nutrients 2026, 18(11), 1653; https://doi.org/10.3390/nu18111653 (registering DOI) - 22 May 2026

Abstract

Background/Objectives: Plant-based diets are increasingly adopted by families with young children, yet their potential effects on bone development and metabolic regulation during early childhood remain insufficiently understood. This study aimed to evaluate body composition, bone mineral density (BMD), biochemical markers of bone turnover, [...] Read more.

Background/Objectives: Plant-based diets are increasingly adopted by families with young children, yet their potential effects on bone development and metabolic regulation during early childhood remain insufficiently understood. This study aimed to evaluate body composition, bone mineral density (BMD), biochemical markers of bone turnover, and adipokine profiles in healthy children aged 5–6 years adhering to lacto-ovo-vegetarian or omnivorous diets. Methods: A cross-sectional analysis was conducted in a well-characterized cohort of 90 healthy normal-weight children consuming either lacto-ovo-vegetarian or omnivorous diets. Body composition and bone mineral density were measured using dual-energy X-ray absorptiometry, and circulating markers of bone formation, resorption, and adipokines were determined using ELISA methods. Correlation analyses were performed to examine the relationships between anthropometric variables, bone parameters, and adipokines. Results: No significant differences were observed between vegetarian and omnivorous diets in anthropometric characteristics, bone mineral content (BMC), or BMD, indicating comparable skeletal status. However, vegetarian children exhibited significantly higher levels of bone turnover markers, including bone alkaline phosphatase (BALP) (p = 0.023) and C-terminal telopeptide of type I collagen (CTX-I) (p = 0.035), and a lower osteocalcin OC/CTX-I ratio (p = 0.027). These findings may suggest a subtle imbalance in bone remodeling dynamics in these children, although their clinical significance remains uncertain. Additionally, higher levels of carboxylated osteocalcin (Gla-OC) (p = 0.022) and an increased carboxylated to undercarboxylated OC (Gla-OC/Glu-OC) ratio (p = 0.005) were observed in vegetarian children. Among adipokines, vegetarian children showed lower HMW adiponectin levels (p = 0.05) and a lower HMW/total adiponectin ratio (p = 0.012). Correlation analyses revealed distinct metabolic patterns between groups. In vegetarian children, bone parameters were primarily associated with lean mass, indicating the predominant role of mechanical factors in skeletal development. In contrast, omnivorous children demonstrated a more integrated relationship between bone indices and adipokines. Conclusions: In conclusion, while a lacto-ovo-vegetarian balanced diet supports normal bone mass in early childhood, it may be associated with subtle alterations in bone metabolism and its regulatory pathways, including adipokine profiles. These findings highlight the importance of adequate dietary planning and underscore the need for longitudinal studies to determine long-term effects on bone status. Full article

(This article belongs to the Special Issue Bone-Health-Promoting Bioactive Nutrition)

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21 pages, 5160 KB

Open AccessArticle

Prophylactic and Therapeutic Anti-Hyperglycemic Effects of Heat-Killed Mycobacterium aurum in STZ-Induced Diabetic Mice

by Ali Ali, Hanin-Khaula Hakam, Alaa Eter, Samer Bazzi, Amani Chahine, Charles Akle, Georges M. Bahr and Karim S. Echtay

Nutrients 2026, 18(11), 1652; https://doi.org/10.3390/nu18111652 (registering DOI) - 22 May 2026

Abstract

Background/Objectives: Exploiting the metabolic properties of postbiotics is a novel strategy for managing metabolic disorders, including diabetes. Inactivated microorganisms, a major class of postbiotics, improve glycemic control in preclinical and clinical studies. Here, we examined whether heat-killed (HK) Mycobacterium aurum (M. [...] Read more.

Background/Objectives: Exploiting the metabolic properties of postbiotics is a novel strategy for managing metabolic disorders, including diabetes. Inactivated microorganisms, a major class of postbiotics, improve glycemic control in preclinical and clinical studies. Here, we examined whether heat-killed (HK) Mycobacterium aurum (M. aurum) exerts prophylactic or therapeutic anti-hyperglycemic effects in diabetic mice. Methods: Diabetes was induced in male BALB/c mice by streptozotocin (STZ; 150 mg/kg) injection. HK M. aurum (1 mg) was given orally (three prophylactic doses before STZ) or intradermally (six weekly therapeutic doses after STZ). We assessed glycemic parameters, serum C-peptide/insulin (ELISA), and tissue protein expression (Western blot). Results: Neither route altered body weight or glucose homeostasis in non-diabetic mice. In STZ-diabetic mice, oral prophylactic treatment significantly attenuated hyperglycemia (39–60% reduction weeks 5–8 post-STZ) and showed a trend toward improved serum C-peptide, but did not affect dysregulated expression of skeletal muscle (SM), hepatic, pancreatic and renal proteins involved in glucose transport (GLUT2, GLUT4, and SGLT2), glycolysis (α-LDH), mitochondrial uncoupling (UCP2 and UCP3), and antioxidant defense (CAT). Therapeutic intradermal administration significantly decreased blood glucose (~30% at week 5, ~40% at week 6) and modestly enhanced insulin secretion. Hepatic UCP2 and α-LDH and SM UCP3 protein levels were normalized toward non-diabetic levels, whereas hepatic GLUT2 and SM GLUT4 remained largely unchanged. These correlative findings suggest effects independent of insulin-dependent glucose transport, but do not demonstrate direct functional improvement in mitochondrial or redox status. Conclusions: HK M. aurum exerts partial anti-hyperglycemic effects in STZ-induced diabetic mice, but the associated protein changes require functional validation before its role as a postbiotic in β-cell dysfunction can be established. Full article

(This article belongs to the Special Issue Functional Foods in the Prevention and Treatment of Metabolic Disorders)

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20 pages, 332 KB

Open AccessReview

Sport Participation and Nutrition in Students: A Scoping Review of Neuroendocrine and Autonomic Mechanisms Linking Lifestyle Behaviors to Cognitive and Academic Outcomes

by Maria Giovanna Tafuri, Vincenzo Monda, Marco La Marra, Francesco Tafuri, Antonietta Messina, Antonietta Monda, Maria Casillo, Girolamo Di Maio, Domenico Tafuri, Francesca Latino, Fiorenzo Moscatelli, Rita Polito and Giovanni Messina

Nutrients 2026, 18(11), 1651; https://doi.org/10.3390/nu18111651 (registering DOI) - 22 May 2026

Abstract

Background/Objectives: Sport participation and nutrition are increasingly recognized as key determinants of cognitive function and academic achievement in student populations. However, the biological mechanisms underpinning these associations remain only partially understood. This scoping review aimed to map and synthesize the current evidence on [...] Read more.

Background/Objectives: Sport participation and nutrition are increasingly recognized as key determinants of cognitive function and academic achievement in student populations. However, the biological mechanisms underpinning these associations remain only partially understood. This scoping review aimed to map and synthesize the current evidence on neuroendocrine and autonomic mechanisms linking physical activity, sport participation, and nutrition to cognitive and academic outcomes in students. Methods: A systematic search of electronic databases was performed following PRISMA-ScR guidelines. Studies involving student populations that examined physical activity, sport participation, or dietary patterns in relation to cognitive function and/or academic performance were included. Particular attention was given to studies reporting biological or physiological indicators of underlying mechanisms, including neuroendocrine, autonomic, and brain-based measures. Data were extracted and synthesized qualitatively, with studies categorized according to the type of mechanistic evidence. Results: A total of 76 studies met the inclusion criteria. The available evidence was more extensive for physical activity, sport participation, and fitness-related exposures than for nutrition-related variables or integrated lifestyle models. Cognitive outcomes, particularly executive function, attention, working memory, and memory performance, were assessed more frequently and showed more consistent associations with lifestyle behaviors than academic outcomes, which were less commonly and more heterogeneously evaluated. Mechanistic evidence was unevenly distributed: only a limited subset of studies included direct biological or psychophysiological measures, mainly neuroimaging, brain-derived neurotrophic factors, cortisol-related indices, or heart rate variability. In contrast, inflammatory, metabolic, and gut microbiota-related mechanisms were mostly discussed at a conceptual or indirect level. Overall, the findings indicate a broad associative literature but a relatively small body of studies directly testing biological pathways linking physical activity, nutrition, cognition, and academic performance. Conclusions: Current evidence indicates potential associations between sport participation, nutrition, cognitive outcomes, and multiple biological pathways. However, the scoping nature of the review, the predominance of observational designs, and the limited use of direct mechanistic assessments prevent firm causal conclusions. Future research should prioritize longitudinal and intervention studies integrating behavioral, nutritional, cognitive, academic, and biological measures within the same design. Full article

(This article belongs to the Special Issue Sport and Nutrition: Promoting Healthy Minds and Academic Achievement)

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14 pages, 1045 KB

Open AccessArticle

Feeding Mode Is Associated with Infant Night Sleep Trajectories During the First Postnatal Year

by Magdalena Olson, Li Liu, Elizabeth Reifsnider, Dean V. Coonrod, Sarada S. Panchanathan, Megan E. Petrov and Corrie M. Whisner

Nutrients 2026, 18(11), 1650; https://doi.org/10.3390/nu18111650 (registering DOI) - 22 May 2026

Abstract

Background: Short sleep and formula feeding during infancy are associated with increased risk of childhood obesity. Feeding practices and sleep arrangements vary during infancy and may also be dynamic, yet their impact on infant night sleep duration remains unclear. Understanding these relationships is [...] Read more.

Background: Short sleep and formula feeding during infancy are associated with increased risk of childhood obesity. Feeding practices and sleep arrangements vary during infancy and may also be dynamic, yet their impact on infant night sleep duration remains unclear. Understanding these relationships is crucial for formulating recommendations to support breastfeeding and address sleep concerns. Objective: We examined the association between feeding mode and parent-reported infant night sleep duration during the first postnatal year, while additionally evaluating night-weaning and bedsharing as contextual sleep-related practices. Methods: Infants in the Phoenix Metropolitan Area (n = 193) were followed up at 3, 8, 13, 26, 39, and 52 weeks post-birth. Sleep and feeding questionnaires were answered at each visit. A multilevel growth model estimated infant night sleep duration trajectories by feeding mode (ordinal: exclusive formula, mixed, exclusive breastfeeding), night-weaning, and bedsharing as time-variant predictors. Maternal education and household income were covariates to account for differences in study attrition. Results: Infant night sleep duration followed a curvilinear trajectory, starting at 7.92 h (95% CI: 5.78, 10.06) and increasing by 0.40 h/month (95% CI: 0.21, 0.60), with a deceleration over time (0.02 h/month², p < 0.001). Each increase in levels of breast milk consumption was associated with an increase in infant night sleep duration (B = 0.87 h, p < 0.001), but the association weakened as the infant aged (B = −0.07 h/month, p < 0.001). Despite 59.7% of bedsharing infants being exclusively breastfed, bedsharing was not significantly associated with infant night sleep duration. Similarly, night-weaning was not significantly associated with infant night sleep duration. Conclusions: Breastfeeding is associated with longer infant night sleep duration, whereas bedsharing showed no association despite its correlation with breastfeeding. This research highlights the importance of breastfeeding in early life, not only for its developmental benefits but also for its relationship with infant night sleep duration, an essential component of healthy infant growth. Full article

(This article belongs to the Special Issue Infant and Toddler Feeding and Development)

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17 pages, 402 KB

Open AccessReview

Geroprotective Potential of Centella asiatica: Modulation of Cellular Aging

by Kinga K. Borowicz

Nutrients 2026, 18(11), 1649; https://doi.org/10.3390/nu18111649 (registering DOI) - 22 May 2026

Abstract

C. asiatica (L.) Urban is a medicinal plant widely used in traditional Asian medicine with potential geroprotective properties. Its major bioactive compounds—including asiaticoside, madecassoside, asiatic acid, and madecassic acid—exhibit antioxidant, anti-inflammatory, regenerative, neuroprotective, and cytoprotective activities. Experimental studies demonstrate modulation of signaling pathways [...] Read more.

C. asiatica (L.) Urban is a medicinal plant widely used in traditional Asian medicine with potential geroprotective properties. Its major bioactive compounds—including asiaticoside, madecassoside, asiatic acid, and madecassic acid—exhibit antioxidant, anti-inflammatory, regenerative, neuroprotective, and cytoprotective activities. Experimental studies demonstrate modulation of signaling pathways involved in oxidative stress, inflammation, apoptosis, extracellular matrix remodeling, and cellular survival, including NF-κB, PI3K/Akt/mTOR, MAPK, Nrf2/HO-1, and TGF-β/Smad pathways. Preclinical evidence further indicates attenuation of cellular senescence, improvement of mitochondrial function, enhanced collagen synthesis, and regulation of cytokine production. In experimental models, C. asiatica has shown beneficial effects on wound healing, skin aging, neuroinflammation, β-amyloid aggregation, neuroplasticity, metabolic dysfunction, and vascular protection. Preliminary preclinical findings also suggest possible effects on telomerase activity and telomere maintenance. However, clinical translation remains limited due to insufficient randomized controlled trials, low oral bioavailability of triterpenoids, variability in extract standardization, and limited pharmacokinetic and long-term safety data. This narrative review summarizes the phytochemistry, molecular mechanisms, pharmacological activities, and potential geroprotective applications of c. asiatica, highlighting its translational relevance in healthy aging and age-related disorders while emphasizing the need for standardized clinical studies. Full article

(This article belongs to the Special Issue Advances in Anti-Aging Strategies: From Phytochemicals to Clinical Applications)

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20 pages, 2076 KB

Open AccessArticle

Awareness, Knowledge, and Self-Reported Clinical Experiences Related to Glucose-6-Phosphate Dehydrogenase Deficiency in Sardinia (Italy): A Descriptive Cross-Sectional Survey

by Gabriele Serreli, Maria Paola Melis, Claudia Guerriero and Monica Deiana

Nutrients 2026, 18(11), 1648; https://doi.org/10.3390/nu18111648 (registering DOI) - 22 May 2026

Abstract

Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzymatic disorder of red blood cells, with particularly high prevalence in Sardinia, where it is strongly associated with favism. Public awareness remains incomplete and misconceptions persist—particularly regarding symptom onset from fava bean pollen or [...] Read more.

Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzymatic disorder of red blood cells, with particularly high prevalence in Sardinia, where it is strongly associated with favism. Public awareness remains incomplete and misconceptions persist—particularly regarding symptom onset from fava bean pollen or odors. This cross-sectional survey assessed G6PD self-reported deficiency, population knowledge, and persistence of false beliefs in Sardinia. Methods: A 16-item structured questionnaire was disseminated online (May–June 2025) to adults across diverse age groups and educational backgrounds. Results: Among 536 respondents (74.25% female; 97.39% Sardinia residents), 43.47% of respondents self-reported as G6PD-deficient, a figure substantially above the expected population estimate of 8–15% and consistent with affected-network recruitment. Moreover, 49.07% self-reported as non-deficient, and 7.46% were unaware of their status. While 99.07% correctly identified fava bean ingestion as a trigger and 74.25% identified certain medications, 62.50% incorrectly attributed hazard to pollen inhalation and 25.93% to pea consumption. Only 3.92% reported a hemolytic crisis, whereas 25.93% reported feeling unwell after smelling beans or inhaling pollen. Family and friends (49.81%) and healthcare providers (42.16%) were the primary information sources; schools (25.75%) and online resources (14.55%) were underrepresented. Overall, 90.45% perceived public information as insufficient—uniformly across G6PD strata (χ² = 0.09, p = 0.955). Exploratory analyses suggested lower perceived information adequacy among younger respondents (Cochran–Armitage Z = 2.92, p = 0.002) and, less robustly, among female respondents (χ² = 3.90, p = 0.048; borderline significance, unadjusted). Conclusions: Although recognition of fava bean ingestion as the principal dietary trigger is nearly universal, substantial gaps persist regarding non-ingestive exposures, less-recognized dietary triggers, and pharmacological risks. Perceived information insufficiency was independent of G6PD status but associated with younger age and female sex. Integrating targeted nutritional education into school curricula, primary care, and digital platforms is warranted for these priority groups and for G6PD-endemic populations worldwide. Full article

(This article belongs to the Section Nutritional Policies and Education for Health Promotion)

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16 pages, 369 KB

Open AccessReview

Effects of Non-Nutritive Sweeteners and Sweet Taste Exposure on Weight Management, Biomarkers of Health and Sweet Taste Preference—A Review of the Evidence from Recent European Consortia Studies

by Eva Marija Čad, Katherine M. Appleton, Ellen E. Blaak, Clarissa Dakin, Kees de Graaf, Graham Finlayson, Ciarán G. Forde, Jason C. G. Halford, Louise Kjølbæk, Monica Mars, J. Alfredo Martinez, Santiago Navas-Carretero, Anne Raben, Corey Scott and Joanne A. Harrold

Nutrients 2026, 18(11), 1647; https://doi.org/10.3390/nu18111647 (registering DOI) - 22 May 2026

Abstract

Non-nutritive sweeteners (NNSs) are consumed to reduce intake by providing a sweet taste with little to no energy. Despite regulatory approval and extensive use, uncertainty remains about their long-term role in weight management and health, and about whether exposure to sweet taste itself, [...] Read more.

Non-nutritive sweeteners (NNSs) are consumed to reduce intake by providing a sweet taste with little to no energy. Despite regulatory approval and extensive use, uncertainty remains about their long-term role in weight management and health, and about whether exposure to sweet taste itself, independent of energy, influences these outcomes. This narrative review synthesizes evidence from three recent European consortia: SWEET, SWITCH and Sweet Tooth, which together provide complementary data from acute, short- and long-term randomized controlled trials. The studies examined the effects of NNSs and dietary sweet taste exposure on body weight, health-related biomarkers, sweet taste preference, and eating behavior. Across studies, replacing sugars with NNSs appeared to support weight loss maintenance, while NNS consumption and dietary sweet taste exposure showed no adverse changes in body weight, glucoregulatory and endocrine biomarkers, cardiometabolic risk factors, gut microbiota, or liver enzymes. Likewise, neither NNS use nor different dietary sweet taste exposure altered sweet taste liking, appetite sensation, energy intake, or food choice. However, interpretation should consider the characteristics of the included studies, including selected populations, intervention context, outcome heterogeneity, and the fact that several behavioral and biomarker outcomes were secondary or exploratory. Overall, the reviewed evidence suggests that replacing sugar intake with NNSs may support weight management strategies, while differences in habitual dietary sweet taste exposure per se appear largely neutral with respect to health-related biomarkers and sweet taste preferences. Full article

(This article belongs to the Special Issue Advances in Sweeteners and Human Health: Metabolic, Molecular, and Epidemiological Perspectives on Safety, Efficacy, and Public Health Impact)

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14 pages, 883 KB

Open AccessArticle

Recruitment and Retention of Rural-Dwelling Young Adults into a Digital Healthy Eating Intervention: Lessons Learned from a Randomized Controlled Trial of the Veg4Me Study

by Katherine M. Livingstone, Stephanie R. Partridge, Jonathan C. Rawstorn, Kathleen M. Dullaghan, Yuxin Zhang, Stephanie L. Godrich, Sarah A. McNaughton, Gilly A. Hendrie, Lauren C. Blekkenhorst, Ralph Maddison, John C. Mathers and Laura Alston

Nutrients 2026, 18(11), 1646; https://doi.org/10.3390/nu18111646 (registering DOI) - 22 May 2026

Abstract

Background/objectives: The study aimed to identify the key methodological challenges and solutions related to recruitment and retention of rural-dwelling young adults into a randomized controlled trial that tests the feasibility of a digital healthy eating intervention (Veg4Me). Methods: Digital registration for [...] Read more.

Background/objectives: The study aimed to identify the key methodological challenges and solutions related to recruitment and retention of rural-dwelling young adults into a randomized controlled trial that tests the feasibility of a digital healthy eating intervention (Veg4Me). Methods: Digital registration for a 12-week study was set up as a one-step process without researcher involvement. Participant registrations and recruitment rates were monitored daily using predetermined online preventative measures to identify fraudulent responses and to amend the digital registration process where necessary. Retention rates were monitored daily to identify any necessary amendments to the follow-up protocol. Results: During data collection, n = 279 fraudulent responses were identified from n = 536 total responses (52%). One month into recruitment, amendments were made to the registration process to reduce fraudulent responses. To address bot attacks, Qualtrics passwords and a two-factor authentication process were added to the Veg4Me landing page. Targeted recruitment strategies, such as unpaid social media posts, corresponded to peaks in recruitment. In the final recruitment month, a question was embedded within follow-up correspondence to encourage completion of the post-intervention survey. This resulted in an additional n = 8 (7%) participants completing the intervention. Conclusions: Empirical observations made in this study suggest that digital recruitment protocols without direct researcher involvement should consider multiple in-built strategies for identifying and preventing fraudulent responses. This includes a two-factor authentication process and minimizing the over-promotion of financial incentives in recruitment strategies. Recruitment strategies should consider the use of social media posts in local community groups, while the use of reminders and notifications could support retention. Full article

(This article belongs to the Special Issue Smart Nutrition: Harnessing AI for Personalized Nutrition)

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Nutrients, Volume 18, Issue 11 (June-1 2026) – 9 articles

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