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Nutrients, Volume 18, Issue 19 (October-1 2026) – 48 articles

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10 pages, 364 KB  
Article
Prevalence of Hypovitaminosis D and Its Association with Motor Impairment in Spinal Muscular Atrophy
by Dallianny Paulino Martins de Andrade, Antônio Vicente Dias de Andrade, Paloma Katlheen Moura Melo, Thais Araújo Barbosa, Dyego Luiz Pereira Lima de Melo e Silva, José Rodolfo Lopes de Paiva Cavalcanti and Epitácio Leite Rolim Filho
Nutrients 2026, 18(19), 3155; https://doi.org/10.3390/nu18193155 - 24 Sep 2026
Abstract
Background/Objectives: In recent years, the role of vitamin D in the etiology of central and peripheral neurological diseases has been widely investigated, and evidence suggests benefits of vitamin D replacement therapy. However, few studies have evaluated the relationship between serum vitamin D levels [...] Read more.
Background/Objectives: In recent years, the role of vitamin D in the etiology of central and peripheral neurological diseases has been widely investigated, and evidence suggests benefits of vitamin D replacement therapy. However, few studies have evaluated the relationship between serum vitamin D levels and patients with spinal muscular atrophy (SMA). Therefore, this study aimed to analyze serum vitamin D levels in patients with SMA and their relationship with disease type, degree of motor impairment, and the presence of musculoskeletal deformities. Methods: This was a cross-sectional analytical study conducted with patients diagnosed with SMA who were treated at a Rare Diseases Reference Service in Recife, Pernambuco, Brazil. Serum vitamin D levels and their association with clinical characteristics of the disease, including SMA type, motor impairment, and the presence of musculoskeletal deformities were evaluated. Motor impairment was classified according to functional capacity, and an ordinal score was used for correlation analysis. Results: The sample consisted of 36 patients with SMA. The mean serum 25(OH)D concentration was 28.95 ± 10.28 ng/mL, with values ranging from 8.3 to 49.4 ng/mL. Based on the predefined cutoff of 30 ng/mL, 58.3% of participants had serum 25(OH)D concentrations below 30 ng/mL, whereas 41.7% had concentrations ≥30 ng/mL. Serum 25(OH)D concentrations differed significantly across motor function groups (p = 0.002). However, correlation analysis showed a weak and non-significant correlation between motor impairment and serum 25(OH)D concentrations (Spearman r = −0.136; p = 0.431; (n = 36). An association between hypovitaminosis D and the presence of musculoskeletal deformities was also observed. Conclusions: Hypovitaminosis D showed a high prevalence in patients with SMA. Although serum 25(OH)D concentrations differed significantly across motor function groups, the correlation between motor impairment and serum 25(OH)D concentrations was weak and non-significant. These findings reinforce the importance of monitoring serum vitamin D levels and adopting clinical and nutritional follow-up strategies in this population. Full article
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13 pages, 787 KB  
Article
Distinct Dietary Patterns Are Differentially Associated with Dyslipidemia Among Middle-Aged and Older Adults in Southern China
by Shilong Guo, Hailing Su, Miaolin Han, Yixi Zhang, Qiuyun Cheng and Fan Zhang
Nutrients 2026, 18(19), 3154; https://doi.org/10.3390/nu18193154 - 24 Sep 2026
Abstract
Objectives: The objectives of this study were to investigate the association between dietary patterns and dyslipidemia among middle-aged and older adults in Hainan Province and to provide a scientific reference for regional dyslipidemia prevention strategies. Methods: A multi-stage cluster random sampling method was [...] Read more.
Objectives: The objectives of this study were to investigate the association between dietary patterns and dyslipidemia among middle-aged and older adults in Hainan Province and to provide a scientific reference for regional dyslipidemia prevention strategies. Methods: A multi-stage cluster random sampling method was used to conduct questionnaire surveys and physical examinations among 4,748 middle-aged and older adults from five regions in Hainan Province. Dietary patterns were derived using a food frequency questionnaire and factor analysis. Dietary-pattern scores were categorized into quartiles from lowest (Q1) to highest (Q4) adherence, with Q1 as the reference group. Logistic regression models were used to examine the associations between dietary patterns and four types of dyslipidemia. Results: A total of 4,748 participants were enrolled, of whom 3,321 (69.9%) had dyslipidemia. After adjusting for multiple confounders, compared with Q1, the meat-based dietary pattern at Q4 was positively associated with dyslipidemia (OR = 1.380, 95% CI: 1.102–1.729). The fruit-and-vegetable pattern was inversely associated with dyslipidemia at Q2 (OR = 0.800, 95% CI: 0.677–0.945), Q3 (OR = 0.790, 95% CI: 0.663–0.941), and Q4 (OR = 0.630, 95% CI: 0.519–0.765). The cooking-oil and wheat pattern was inversely associated with dyslipidemia at Q2 (OR = 0.843, 95% CI: 0.682–0.980) and Q4 (OR = 0.818, 95% CI: 0.715–0.993). Conclusions: The meat-based dietary pattern was positively associated with dyslipidemia, whereas the fruit-and-vegetable pattern and the cooking-oil and wheat pattern were inversely associated with dyslipidemia. These findings suggest that dietary patterns characterized by higher consumption of fruits, vegetables, and unsaturated fatty acids were inversely associated with dyslipidemia in this population. Full article
21 pages, 1448 KB  
Article
Sex Differences in Hepatic VLDLR Response to Protein Restriction and Its Relationship with Hepatic Lipid Accumulation
by Jiuxiang Cao, Hiromu Morimoto and Asako Takenaka
Nutrients 2026, 18(19), 3153; https://doi.org/10.3390/nu18193153 - 24 Sep 2026
Abstract
Background/Objectives: The very low-density lipoprotein receptor (VLDLR) mediates VLDL uptake in peripheral tissues. This study investigated sex differences in hepatic VLDLR response to protein restriction and its relationship with hepatic lipid accumulation. Methods: Male and female wild-type (WT) and Vldlr knockout [...] Read more.
Background/Objectives: The very low-density lipoprotein receptor (VLDLR) mediates VLDL uptake in peripheral tissues. This study investigated sex differences in hepatic VLDLR response to protein restriction and its relationship with hepatic lipid accumulation. Methods: Male and female wild-type (WT) and Vldlr knockout (KO) mice were fed control (20% protein) or low-protein (2% protein) diets for 20 days. Hepatic VLDLR expression and triglyceride levels were determined, followed by RNA sequencing and Gene Ontology (GO) analysis. Results: Hepatic Vldlr mRNA and protein levels were higher in females than in males. Protein restriction induced 9-fold and 2.5-fold increases in Vldlr mRNA and VLDLR protein, respectively, in males, whereas females showed only a 1.6-fold increase in VLDLR protein without significant Vldlr mRNA induction. The ATF4 target genes Asns and Fgf21 responded similarly to protein restriction in both sexes. Although females had higher hepatic triglyceride levels than males, this difference persisted in Vldlr KO mice. RNA sequencing revealed sex-dependent effects of Vldlr knockout on hepatic gene expression, with inflammation- and immune-related terms predominantly identified in females. Conclusions: Sex differences in hepatic VLDLR expression do not account for sex differences in hepatic lipid accumulation. The sex-dependent VLDLR response to protein restriction may involve mechanisms other than differential ATF4 activation. Vldlr deficiency was associated with sex-dependent hepatic gene expression changes, particularly those involved in inflammation- and immune-related functions in females. These findings suggest that hepatic VLDLR may have functions beyond its established role in lipoprotein uptake and lipid metabolism and may be relevant to sex-dependent hepatic responses to low-protein nutrition. Full article
(This article belongs to the Section Proteins and Amino Acids)
21 pages, 1886 KB  
Review
A Context-Informed Framework for Interpreting Iron Status in Heterogeneous Settings: Insights from Peru
by Jeannett Rivera-Manhualaya, Parminder S. Suchdev, Chris A. Rees, Kenia Lobo, Yi-An Ko, Melissa F. Young, Gustavo F. Gonzales and Cinthya Vásquez-Velasquez
Nutrients 2026, 18(19), 3152; https://doi.org/10.3390/nu18193152 - 24 Sep 2026
Abstract
Iron deficiency (ID), with or without anemia, remains a major global public health challenge, particularly in populations exposed to inflammatory conditions. Accurate assessment of iron status is difficult because ferritin, the primary biomarker of iron stores, is also an acute-phase reactant that increases [...] Read more.
Iron deficiency (ID), with or without anemia, remains a major global public health challenge, particularly in populations exposed to inflammatory conditions. Accurate assessment of iron status is difficult because ferritin, the primary biomarker of iron stores, is also an acute-phase reactant that increases during inflammation, potentially masking underlying ID and leading to diagnostic misclassification. The Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) approach uses regression-based methods incorporating C-reactive protein (CRP) and α1-acid glycoprotein (AGP) to adjust iron biomarkers for inflammation. However, its performance in settings characterized by chronic low-grade inflammation, obesity, altitude-related physiology, and environmental stressors remains insufficiently characterized. We propose a context-informed conceptual framework that complements established BRINDA adjustment by considering chronic low-grade inflammation, candidate composite inflammatory markers, and contextual modifiers that may influence the interpretation of iron status. This framework incorporates established and candidate biomarkers, including CRP, AGP, the systemic immune-inflammation index (SII), and the neutrophil-to-lymphocyte ratio (NLR), together with contextual factors such as altitude, metabolic status, and environmental exposures. We also discuss the complex interplay between inflammation and iron metabolism through hepcidin dysregulation and oxidative stress, which may complicate the interpretation of ferritin and other iron biomarkers. Using Peru as an illustrative setting of heterogeneous epidemiological and environmental conditions, we describe how coastal, high-altitude, and Amazonian populations may be differentially affected by these interactions. This context-informed framework provides a structured basis for investigating whether chronic inflammatory and contextual factors add interpretative value beyond established approaches. Prospective and external validation across diverse populations will be required before clinical or public health implementation. Full article
(This article belongs to the Section Micronutrients and Human Health)
12 pages, 1017 KB  
Article
Aggregation of Fuzzy Nutrient-Level Evaluations Using a Parametric T-Norm: Mathematical Properties, Calibration, and a Proof-of-Concept Analysis
by Jan Wirsam, Bernd Wirsam and Claus Leitzmann
Nutrients 2026, 18(19), 3151; https://doi.org/10.3390/nu18193151 - 24 Sep 2026
Abstract
Backgroumd/Objectives: Since 1995, the intake of individual nutrients has been evaluated using fuzzy logic, with aggregation of the resulting fuzzy sets enabling the weighing of one nutrient against another, and the evaluation and optimization of overall nutrient intake. The aggregation operator used in [...] Read more.
Backgroumd/Objectives: Since 1995, the intake of individual nutrients has been evaluated using fuzzy logic, with aggregation of the resulting fuzzy sets enabling the weighing of one nutrient against another, and the evaluation and optimization of overall nutrient intake. The aggregation operator used in earlier work, defined as the product of the minimum and harmonic mean operators (MIN×H), performed well in practice but had undesirable mathematical properties: it is not associative, model extensions can shift results even when all conditions are fully satisfied, and the resulting evaluation field contains discontinuities inconsistent with biological behavior. Methods: We therefore reviewed the family of parametrized T-norms for an alternative and identified the Schweizer (3) operator, fitting its parameter to best match the existing operator using 246 real-world dietary records from 123 participants (a sustainability study cohort of predominantly students and young adults; mean age 25.3 ± 16.4 years; 54 male, 69 female). Results: Strong agreement was achieved at p = 6 (R2 = 0.9949; RMSE = 0.0187), outperforming p = 4 (R2 = 0.9852) while remaining more balanced than p = 8 (systematic intercept offset). The new operator satisfies all required mathematical properties and produces a smooth, simply structured evaluation field that reveals synergistic and substitution effects among foodstuffs, as well as the essentiality of certain foodstuffs under specific conditions. The resulting evaluation field shows a wide, high-dimensional plateau rather than a sharp peak, interpretable as stability, error tolerance, and a high degree of diversity, offering a new, mathematically robust perspective on healthy nutrition and the interactions among foodstuffs. Conclusions: This work proposes and illustrates a mathematical aggregation framework; its nutritional and clinical validity remains to be established in future studies. Full article
(This article belongs to the Section Nutrition Methodology & Assessment)
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19 pages, 782 KB  
Article
Too Wordy, Too Long and Too Cluttered: User Acceptance Testing, Co-Design, and Early Beta Testing to Adapt the Daily Health Coach for Young Australian Women
by Rajshri Roy, Isabella Hamilton, Demera Khan, Mariah Issa, Jasmin Alami and Jessica A. Malloy
Nutrients 2026, 18(19), 3150; https://doi.org/10.3390/nu18193150 - 24 Sep 2026
Abstract
Background/Objectives: The Daily Health Coach (DHC) is a 12-week Instagram-based nutrition and wellbeing programme originally co-designed and tested in New Zealand to deliver evidence-based, weight-neutral content on nutrition, movement, body image, and wellbeing. This formative, mixed-methods adaptation study examined the acceptability of DHC [...] Read more.
Background/Objectives: The Daily Health Coach (DHC) is a 12-week Instagram-based nutrition and wellbeing programme originally co-designed and tested in New Zealand to deliver evidence-based, weight-neutral content on nutrition, movement, body image, and wellbeing. This formative, mixed-methods adaptation study examined the acceptability of DHC New Zealand content for young Australian women and identified refinements to improve relevance, engagement, and safety before effectiveness evaluation. Methods: Using the CODES framework, we conducted three adaptation phases: user acceptance testing, co-design workshops, and early beta testing. Following data-quality screening, 291 young women aged 18–24 years who completed all 12 survey sections were included in Phase 1. Participants rated 84 Instagram-style posts for understanding and usefulness and provided open-ended feedback. Twelve young women participated in co-design workshops, and seven adapted artefacts were beta-tested with eight target users using cognitive walkthrough and think-aloud methods. Quantitative findings were examined descriptively, with sensitivity analyses undertaken to assess robustness to response-quality and sample-composition concerns. Results: Participant-level mean understanding was 3.99 ± 0.75/5, usefulness was 3.89 ± 0.74/5, and the combined score was 7.87 ± 1.47/10. Post-level combined means ranged from 7.66 to 8.11/10; all 84 posts met a ≥7.5 descriptive benchmark adapted from prior message-testing work, although this is an interpretive aid rather than a validated cut-off. Sensitivity analyses showed a similar overall pattern: ratings were higher in a higher-confidence response-quality sample (n = 199; 8.34 ± 1.20/10), while four posts fell marginally below 7.5 when analysis was restricted to participants not reporting Aboriginal and/or Torres Strait Islander identity (n = 101). Qualitative feedback identified six refinement areas: content features, engagement strategies, clarity, educational accuracy, relevance, and miscellaneous concerns. Co-design and beta testing generated four adaptation priorities: tone, design, engagement, and understanding. Conclusions: DHC New Zealand content was generally well understood and favourably rated but required targeted refinement for the Australian context. Findings provide formative guidance for final adaptation and subsequent effectiveness evaluation. Full article
26 pages, 1210 KB  
Article
Longitudinal Association Between the Change in Serum Procollagen Type III N-Terminal Peptide (PIIINP) and Skeletal Muscle Loss in Patients with Gastrointestinal Cancer Receiving Chemotherapy: A Prospective Cohort Study
by Mehmet Erdinç Esenkaya, Özlem Özdemir, Mustafa Değirmenci, Kaan Kuzu, Kübra Ekiz Seyhan and Gürkan Gül
Nutrients 2026, 18(19), 3149; https://doi.org/10.3390/nu18193149 - 24 Sep 2026
Abstract
Background/Objectives: Sarcopenia predicts increased morbidity and mortality in gastrointestinal (GI) cancer. This study evaluated the longitudinal association between changes in the skeletal muscle index (SMI) and serum procollagen type III N-terminal peptide (PIIINP), together with sarcopenia and malnutrition screening tools (SARC-F, SARC-CalF, [...] Read more.
Background/Objectives: Sarcopenia predicts increased morbidity and mortality in gastrointestinal (GI) cancer. This study evaluated the longitudinal association between changes in the skeletal muscle index (SMI) and serum procollagen type III N-terminal peptide (PIIINP), together with sarcopenia and malnutrition screening tools (SARC-F, SARC-CalF, MUST), during chemotherapy for GI cancer. Methods: In this prospective single-center study, 170 patients with GI cancer were assessed at baseline and month 6; 48 died, and longitudinal analyses included the 122 survivors. SMI was derived from bioelectrical impedance analysis (Tanita SC-330) using the Janssen equation, and serum PIIINP was measured at both time points. The primary endpoint was the association between the percentage changes in SMI and PIIINP. Results: BMI, SMI, and handgrip strength decreased and SARC-F and SARC-CalF scores increased significantly (all p < 0.001); the prevalence of low muscle mass rose from 29% to 52%, and PIIINP increased significantly. The percentage changes in SMI and PIIINP were strongly inversely correlated (ρ = −0.733, p < 0.001). In the parsimonious multivariable model, the percentage change in PIIINP (β = −0.47) and month-6 albumin (β = 0.31) were independently associated with the change in SMI (R2 = 0.37); the albumin association was model-dependent and not retained in the expanded model. Conclusions: In patients with GI cancer receiving chemotherapy, progressive muscle loss over six months was accompanied by a rise in the circulating collagen turnover marker PIIINP. Because the study was observational, restricted to survivors, and based on a non-muscle-specific marker, causal and muscle-specific inferences are unwarranted; PIIINP nonetheless merits further evaluation as a monitoring biomarker. Full article
(This article belongs to the Section Clinical Nutrition)
55 pages, 13896 KB  
Review
Endocrine–Immune Crosstalk in Pediatric Autoimmune Diseases: A Systematic Review of the Role of Micronutrients, with Emphasis on Vitamin D
by Atapattu Navoda and Sunil J. Wimalawansa
Nutrients 2026, 18(19), 3148; https://doi.org/10.3390/nu18193148 - 24 Sep 2026
Abstract
Background: Pediatric autoimmune disorders are increasingly common, yet outcomes remain poor due to delayed diagnosis and lack of appropriate actions. Immune system dysfunction frequently coincides with deficiencies in essential micronutrients and cofactors, including vitamin D. Objectives: This study evaluated the contribution [...] Read more.
Background: Pediatric autoimmune disorders are increasingly common, yet outcomes remain poor due to delayed diagnosis and lack of appropriate actions. Immune system dysfunction frequently coincides with deficiencies in essential micronutrients and cofactors, including vitamin D. Objectives: This study evaluated the contribution of vitamin D and cofactor (e.g., magnesium) deficiencies to impaired endocrine secretion and autoimmune susceptibility, which may trigger or exacerbate autoimmunity in children. Methods: This systematic review examines the complex interactions between micronutrients—particularly vitamin D—and cofactors such as zinc, selenium, probiotics, and omega-3 fatty acids, and their effects on endocrine and immune function. These interactions influence enzymatic activity, immune regulatory mechanisms, and endocrine pathways, potentially causing hormonal disequilibrium and increasing the risk of pediatric autoimmune disorders. Results: The review underscores the importance of early diagnosis, cost-effective non-pharmacological interventions, and targeted micronutrient strategies in reducing the risk, incidence, and severity of these disorders, prior to using expensive patented agents. Proactive supplementation—particularly with vitamin D3 and complementary cofactor micronutrients— known to strengthen immune functions, reduce inflammation and oxidative stress, and mitigate the development of autoimmune disease. Understanding the interconnected roles of micronutrient balance, gut microbiota, and immune dysregulation is essential for effective prevention and management of these conditions in childhood. Conclusions: This review encourages pediatricians and other healthcare professionals to adopt integrative, cost-efficient approaches—including holistic, orthomolecular strategies centered on personalized nutritional therapy—in addition to optimizing general health, to reduce the risk of autoimmune disorders and mitigate associated complications. Such approaches are likely to improve clinical outcomes, reform future research and public health strategy, and reduce healthcare costs. Optimizing micronutrient status may substantially enhance children's well-being and long-term quality of life. Full article
(This article belongs to the Special Issue Micronutrients Intake and Physiological-Disease-Related Outcomes)
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14 pages, 929 KB  
Article
Preoperative Zinc Deficiency as a Novel Prognostic Predictor for Postoperative Recurrence in Hepatocellular Carcinoma
by Yuki Adachi, Shingo Shimada, Shoichiro Mizukami, Tomoki Takizawa, Katsuro Enomoto, Kai Makino, Hiroki Takahata, Hiroyuki Takahashi, Koji Imai and Hideki Yokoo
Nutrients 2026, 18(19), 3147; https://doi.org/10.3390/nu18193147 - 24 Sep 2026
Abstract
Background/Objectives: The impact of preoperative zinc (Zn) status on the survival and recurrence of patients with hepatocellular carcinoma (HCC) after hepatectomy remains unclear. This study aimed to clarify whether preoperative Zn deficiency affects the prognosis of patients with HCC undergoing initial curative [...] Read more.
Background/Objectives: The impact of preoperative zinc (Zn) status on the survival and recurrence of patients with hepatocellular carcinoma (HCC) after hepatectomy remains unclear. This study aimed to clarify whether preoperative Zn deficiency affects the prognosis of patients with HCC undergoing initial curative hepatectomy. Methods: We retrospectively reviewed 105 patients who underwent initial curative hepatectomy for HCC at our institution (2011–2018). Preoperative Zn deficiency was defined as serum Zn < 70 µg/dL. Clinical and tumor parameters were compared between patients with and without Zn deficiency. Disease-free and overall survival were evaluated using the Kaplan–Meier method, and prognostic factors were identified via univariate and multivariate Cox proportional hazards analyses. Subgroup analyses were conducted based on age, gender, and etiology. Results: Among 105 patients, 46 (43.8%) showed Zn deficiency (Zn deficiency group), whereas 59 (56.2%) showed normal Zn (normal Zn group). Compared with the normal-Zn group, the Zn deficiency group showed significantly lower hemoglobin, prothrombin activity, serum albumin, and smaller tumor size (all p < 0.05). The Zn deficiency group experienced significantly worse disease-free survival (p = 0.015) but no difference in overall survival (p = 0.63). On multivariate analysis, zinc deficiency (hazard ratio [HR] 1.83, p = 0.040) and prothrombin activity (HR 0.98, p = 0.042) were independent predictors of worse disease-free survival. Subgroup analysis revealed that Zn deficiency was significantly associated with elevated recurrence risk in patients with HCV-related liver disease (HR 3.67, p = 0.013). Conclusions: Preoperative Zn deficiency is an independent predictor of worse DFS after curative hepatectomy. Although further large-scale studies are required to confirm these findings, evaluating preoperative Zn status may help identify patients at high risk of HCC recurrence. Full article
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34 pages, 618 KB  
Review
Gut Microbiome-Mediated Neuroprotective Effect of the Mediterranean Diet: A Narrative Review of Cognitive Aging, Alzheimer’s Disease, and Parkinson’s Disease
by Kundun Kamalakar, Christa Akerele, Ezequiel Lafont, Lauren R. Koralnik, Caitlin Gilman, Jose Clemente Litran, Jakleen Lee, Jessica Robinson-Papp and Dolores Malaspina
Nutrients 2026, 18(19), 3146; https://doi.org/10.3390/nu18193146 - 24 Sep 2026
Abstract
Background: Alzheimer’s disease (AD) and Parkinson’s disease (PD) are major neurodegenerative disorders for which disease-modifying therapies are limited. Increasingly, evidence suggests that diet influences neurodegenerative risk through interactions among the gut microbiome, immune system, and brain. The Mediterranean diet (MD) is associated [...] Read more.
Background: Alzheimer’s disease (AD) and Parkinson’s disease (PD) are major neurodegenerative disorders for which disease-modifying therapies are limited. Increasingly, evidence suggests that diet influences neurodegenerative risk through interactions among the gut microbiome, immune system, and brain. The Mediterranean diet (MD) is associated with improved cognitive health, but the mechanisms underlying its potential neuroprotective effects remain incompletely understood. Objective: In this narrative review, evidence on microbiome-mediated mechanisms linking MD adherence to neuroprotection was synthesized, and how Mediterranean dietary components influence microbial ecology, metabolites, immune regulation, and neuroinflammation relevant to cognitive aging, AD, and PD was evaluated. Methods: Evidence from experimental, observational, and clinical studies was reviewed, focusing on microbial metabolites, intestinal barrier integrity, immune regulation, and inflammatory pathways. Discussion: Mediterranean dietary components, including fiber, polyphenols, whole grains, legumes, nuts, extra-virgin olive oil, and omega-3 fatty acids, may promote beneficial microbial communities and metabolite production. Short-chain fatty acids, secondary bile acids, indole derivatives, and phenolic metabolites may strengthen the intestinal and blood–brain barriers, regulate immune responses, and suppress neuroinflammation. Conversely, dysbiosis may increase intestinal permeability, lipopolysaccharide translocation, systemic inflammation, and microglial activation. However, evidence remains heterogeneous and largely observational or experimental. Conclusions: The MD may promote neuroprotection through interconnected diet–microbiome–immune pathways. Longitudinal and intervention studies integrating microbiome, metabolomic, inflammatory, neuroimaging, and cognitive measures are needed to establish causality and advance precision nutrition strategies to prevent neurodegenerative disease. Full article
(This article belongs to the Section Nutrition and Neuro Sciences)
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20 pages, 1303 KB  
Article
Exploratory Cross-Sectional Associations of Postpartum Maternal Body Mass Index and Infant Anthropometry with Human Milk Hormones and Cytokines
by Mario Daniel Caba-Flores, Gabriela Cruz-Carrillo, Nereida Montes-Castro, Jorge Iván Zurutuza-Lorméndez, Rocío Ortiz-López, Carmen Martínez-Valenzuela and Alberto Camacho-Morales
Nutrients 2026, 18(19), 3145; https://doi.org/10.3390/nu18193145 - 24 Sep 2026
Abstract
Background/Objectives: Human milk contains hormonal and immune bioactives that may vary with maternal, infant and perinatal characteristics including maternal body mass index (BMI), infant sex and birth mode. However, evidence linking these factors remains inconsistent. This exploratory study evaluated if maternal, infant and [...] Read more.
Background/Objectives: Human milk contains hormonal and immune bioactives that may vary with maternal, infant and perinatal characteristics including maternal body mass index (BMI), infant sex and birth mode. However, evidence linking these factors remains inconsistent. This exploratory study evaluated if maternal, infant and perinatal characteristics were associated with milk composition. Secondarily, hypothesis-generating analyses examined if milk hormones and cytokines were associated with infant anthropometric Z-scores. Methods: This cross-sectional study included 47 healthy term, exclusively breastfed mother–infant dyads with ages ranging from 0.39 to 6.01 months. Milk hormones (ghrelin, leptin, insulin and glucagon) and cytokines (IL-1β, IL-2, IL-4, IL-6, IL-7, MCP-1, IFN-γ and TNF-α) were quantified using multiplex assays and infant anthropometry was evaluated using WHO Z-scores. Adjusted models included infant age, postpartum maternal BMI, infant sex, and birth mode. Analyte-specific complete-case samples ranged from 37 to 44. All p values were nominal, and false-discovery-rate-adjusted q values assessed multiplicity. Results: Postpartum maternal BMI was positively associated with milk leptin (β = 0.152; p < 0.001; n = 39) and cesarean delivery, relative to vaginal delivery, was associated with lower milk glucagon (β = −0.579; p < 0.001; n = 37). Milk IFN-γ showed nominal exploratory positive associations with weight-for-length Z-score (β = 0.188; p = 0.017; n = 39) and BMI-for-age Z-score (β = 0.211; p = 0.032; n = 39). Conclusions: Postpartum maternal BMI and birth mode showed robust adjusted associations with leptin and glucagon, respectively. The cross-sectional design does not establish temporal direction or clinical relevance. The IFN-γ findings require longitudinal evaluation. Full article
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19 pages, 3103 KB  
Review
Do Grape- and Wine-Derived (Poly)Phenols Contribute to the Hallmarks of Healthy Brain Ageing?
by Ayman Ben Mohamed and David Vauzour
Nutrients 2026, 18(19), 3144; https://doi.org/10.3390/nu18193144 - 24 Sep 2026
Abstract
Population ageing is associated with a rising burden of cognitive decline, dementia and late-life affective disorders. Grape- and wine-derived (poly)phenols represent a chemically diverse group of bioactives whose biological relevance is shaped by structural complexity, the intervention matrix, host conjugation and gut microbial [...] Read more.
Population ageing is associated with a rising burden of cognitive decline, dementia and late-life affective disorders. Grape- and wine-derived (poly)phenols represent a chemically diverse group of bioactives whose biological relevance is shaped by structural complexity, the intervention matrix, host conjugation and gut microbial metabolism. Rather than acting as simple antioxidants, these compounds and their derived metabolites may influence interrelated pathways implicated in brain ageing, including neuroinflammation, endothelial function, synaptic plasticity, oxidative stress and gut-brain axis signalling. The gut microbiota is central to this framework as it converts poorly absorbed parent compounds into smaller phenolic metabolites and is modulated by (poly)phenol exposure. This review summarises the chemical and bioavailability features that determine intestinal and colonic availability, evaluates preclinical evidence concerning the neuroprotective potential of grape- and wine-derived (poly)phenols, and integrates clinical evidence from studies of cognitive ageing, mild cognitive impairment and Alzheimer’s disease. Current evidence supports biological plausibility and justifies further investigation, but clinical findings remain heterogeneous. Future studies should prioritise chemically standardised preparations, metabolomic profiling, functional microbiome readouts, and integrated cognitive, vascular and inflammatory endpoints. Full article
(This article belongs to the Special Issue Lifestyle, Diet, Wine and Health)
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13 pages, 247 KB  
Article
Association of Nut Consumption with Dementia and Alzheimer’s Disease
by Ruoling Chen
Nutrients 2026, 18(19), 3143; https://doi.org/10.3390/nu18193143 - 24 Sep 2026
Abstract
Background: Nut consumption reduces risks of cardiovascular disease, respiratory disease and depression. However, its association with dementia and Alzheimer’s disease (AD) remains unclear. Methods: A population-based case–control study was conducted in China, including 466 participants aged 52–100 years (233 with dementia). [...] Read more.
Background: Nut consumption reduces risks of cardiovascular disease, respiratory disease and depression. However, its association with dementia and Alzheimer’s disease (AD) remains unclear. Methods: A population-based case–control study was conducted in China, including 466 participants aged 52–100 years (233 with dementia). Data on socio-demographic characteristics, lifestyle factors, comorbidities, and dietary intake over the past two years were collected through structured face-to-face interviews. Nut consumption was categorised as non-consumption or <monthly, ≥monthly but <weekly, ≥weekly but <daily, daily, and ≥twice daily. Multiple adjusted logistic regression models were employed to examine the association of nut consumption with dementia and AD. Results: Of the 466 participants, 59.0% reported consuming nuts at non-consumption or <monthly, 22.5% monthly, 11.8% weekly, 6.0% daily, and 0.6% ≥ twice daily. Compared with non-consumption or <monthly consumption, the age-adjusted odds ratio (OR) for dementia was 0.31 (95% CI 0.18–0.52) for monthly intake, 0.52 (0.28–0.97) for weekly intake, and 0.32 (0.14–0.72) for daily or higher intake. After further adjustment for gender, education, family income, marital status, smoking, stroke, chronic bronchitis, depression, and other dietary intakes, OR was 0.27 (0.13–0.55) for monthly intake and 0.47 (0.23–0.99) for ≥weekly intake. Among 133 participants with AD, similar associations were observed, with a fully adjusted OR of 0.34 (0.17–0.69) for ≥monthly nut consumption. Conclusions: Higher nut consumption was associated with reduced risks of dementia and AD. Increasing nut intake may represent a potential strategy for dementia and AD prevention. However, large-scale cohort and interventional studies are needed to further clarify the association and determine the magnitude of the effect. Full article
(This article belongs to the Special Issue Dietary Intake and Age-Related Cognitive Decline)
21 pages, 1092 KB  
Review
Maternal n-3 Polyunsaturated Fatty Acid During Pregnancy and Lactation: Linking Brain Lipid Biology to Cognitive Outcomes
by Yasna Muñoz Carvajal, Nicolás Palacios-Avendaño, Daniela Álvarez, Macarena Ortiz, Juan F. Montiel, Rodrigo Valenzuela and Manuel Maliqueo
Nutrients 2026, 18(19), 3142; https://doi.org/10.3390/nu18193142 - 24 Sep 2026
Abstract
Adequate maternal nutrition during pregnancy and lactation is essential for fetal and infant brain development. Among dietary lipids, n-3 polyunsaturated fatty acids (n-3 PUFAs), particularly docosahexaenoic acid (C22:6n-3, DHA), are of major biological relevance because this FA is [...] Read more.
Adequate maternal nutrition during pregnancy and lactation is essential for fetal and infant brain development. Among dietary lipids, n-3 polyunsaturated fatty acids (n-3 PUFAs), particularly docosahexaenoic acid (C22:6n-3, DHA), are of major biological relevance because this FA is preferentially transferred from the mother, accumulates rapidly in the developing brain, and contributes to membrane organization, neuronal differentiation, synaptic maturation, and lipid-mediated signaling. This review integrates current evidence on maternal n-3 PUFA metabolism during pregnancy and lactation, placental and blood–brain barrier transport of DHA, and the mechanisms linking cerebral n-3 PUFA availability to neurodevelopment and cognitive function. Attention is given to selective DHA transport, brain lipid remodeling, synaptic plasticity, neuroimmune regulation, and the translation of experimental findings into human developmental outcomes. Across experimental and human studies, the clearest functional signal emerges under developmental n-3 PUFA deficiency or defined biological challenge, whereas supplementation above nutritional adequacy produces smaller and less consistent cognitive effects. These findings support a context-dependent model in which the functional consequences of n-3 PUFA availability are shaped by baseline nutritional status, developmental timing, brain region, biological challenge, and the assessed cognitive domain. Accordingly, DHA is best understood as an essential component of normal brain development rather than as a nutrient whose supplementation necessarily enhances cognition above nutritional adequacy. Full article
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13 pages, 284 KB  
Article
Vitamin D Status and Depressive Symptoms in Patients Undergoing Hemodialysis: A Cross-Sectional Study
by Nathalia Passos Moura, Djiovana Zanini, Larissa David Soares, Myrella Rosales Teixeira, Caroline Helen Santos Gonçalves Mazala, Eduarda Neutzling Drawanz, Thiago Falson Santana, Isabela Thurow Lemes, André Quincozes-Santos, Carlos Alberto Gonçalves, Mariana Bonati de Matos, Aline Longoni, Diogo Onofre Souza and Adriano Martimbianco de Assis
Nutrients 2026, 18(19), 3141; https://doi.org/10.3390/nu18193141 - 24 Sep 2026
Abstract
Background/Objectives: Depressive symptoms are highly prevalent among patients undergoing maintenance hemodialysis. This study investigated the association between vitamin D status and depressive symptom burden in adults undergoing maintenance hemodialysis. Methods: This cross-sectional study included 91 patients treated at a university hospital in southern [...] Read more.
Background/Objectives: Depressive symptoms are highly prevalent among patients undergoing maintenance hemodialysis. This study investigated the association between vitamin D status and depressive symptom burden in adults undergoing maintenance hemodialysis. Methods: This cross-sectional study included 91 patients treated at a university hospital in southern Brazil. Depressive symptoms were assessed using the Beck Depression Inventory-II (BDI-II), analyzed as a continuous outcome. Serum 25-hydroxyvitamin D [25(OH)D] was measured by chemiluminescence, and deficiency was defined as <20 ng/mL. Linear regression with HC3 robust standard errors was used, adjusting for age, sex, socioeconomic status, antidepressant or anxiolytic use, and vitamin D supplementation. Results: Serum 25(OH)D was available for 90 participants, of whom 19 (21.1%) were vitamin D deficient. Mean BDI-II scores were higher in deficient than non-deficient participants (18.4 ± 12.0 vs. 12.4 ± 9.0). Vitamin D deficiency was associated with a 6.00-point higher BDI-II score in the crude model (95% CI 0.07–11.94; p = 0.047) and a 5.05-point higher score after adjustment (95% CI 0.02–10.07; p = 0.049). In an extended model including sun exposure, hemodialysis duration, and social support, the estimated difference remained similar (β = 4.69; 95% CI −0.16–9.55; p = 0.058), although precision remained limited across the sensitivity analyses. The estimate was attenuated after adjustment for sleep quality, and no linear association was observed when 25(OH)D was modeled continuously. Conclusions: Vitamin D deficiency was associated with greater depressive symptom burden. However, the association was imprecise, attenuated after sleep adjustment, and absent when 25(OH)D was modeled continuously; causality cannot be established. Full article
31 pages, 1653 KB  
Article
A Transparent Rule-Based Decision-Support Prototype for Diabetic Menu Planning and Meal-Combination Optimization: Development and Computational Evaluation
by Mirela Marić, Vesna Antoska Knights, Dardan Bytyqi, Vezirka Jankuloska and Jasenka Gajdoš Kljusurić
Nutrients 2026, 18(19), 3140; https://doi.org/10.3390/nu18193140 - 23 Sep 2026
Abstract
Background/Objectives: Translating medical nutrition therapy guidance into practical meal plans requires consistent application of clinical and dietetic rules while accommodating different therapeutic regimens. This study developed and computationally evaluated a transparent Python-based decision-support prototype for diabetic menu planning. Methods: The prototype combines procedural [...] Read more.
Background/Objectives: Translating medical nutrition therapy guidance into practical meal plans requires consistent application of clinical and dietetic rules while accommodating different therapeutic regimens. This study developed and computationally evaluated a transparent Python-based decision-support prototype for diabetic menu planning. Methods: The prototype combines procedural decision rules, food-exchange patterns, nutritional checks, and mixed-integer linear programming (MILP). Two meal-frequency pathways were represented: a conventional multi-meal pathway and a three-main-meal pathway for people treated with modern basal–bolus insulin regimens. For the multi-meal pathway, a structured dataset containing 42 candidate meals (seven alternatives in each of six meal categories) was used for objective-specific optimization and exhaustive evaluation of all 117,649 possible daily combinations under predefined nutritional constraints. Sensitivity to the allowable energy deviation and trade-offs among nutritional objectives were also examined. Results: The prototype produced deterministic pathway selection, exchange allocation, nutritional summaries, and explicit warnings when required information was unavailable. Under the baseline ±6.5% energy tolerance, 5628 of 117,649 six-meal combinations (4.78%) satisfied all nutritional constraints. Objective-specific optimization identified feasible solutions for minimizing energy, carbohydrate, and saturated fat and maximizing dietary fiber. The proportion of feasible combinations ranged from 2.71% at ±5% energy tolerance to 9.47% at ±10%, while comparison of objective-specific solutions demonstrated measurable nutritional trade-offs. The three-meal basal–bolus pathway generated predefined exchange allocation and clinical-review warnings but was not subjected to the same exhaustive combinatorial optimization. Conclusions: The prototype demonstrates the computational feasibility of integrating explicit dietetic rules, regimen-related meal-pattern selection, food-exchange allocation, and mathematical optimization within an inspectable decision-support framework. The findings establish technical feasibility within the evaluated datasets rather than clinical effectiveness. Independent software testing, expert usability assessment, evaluation using larger and version-controlled meal datasets, and prospective clinical validation are required before routine clinical implementation. Full article
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22 pages, 10378 KB  
Article
Hydroethanolic Montanoa bipinnatifida Leaf Extract Attenuates Acute Ethanol-Induced Gastric Mucosal Injury in Female CD-1 Mice: Associations with Lipid Peroxidation and IL-1β Expression
by Verónica Edith Gallegos-Hernández, Ehekatzin García-Valdés, Margarita Gómez-Chavarín, Maria-del-Carmen Silva-Lucero, Jorge Saldaña-Mancilla, Ruth Bustamante-García, Atonatiu E. Gómez-Martínez, Ana María Vázquez-Alvarez, Mónica Rosalía Jaime-Fonseca and Patricia Vergara-Aragón
Nutrients 2026, 18(19), 3139; https://doi.org/10.3390/nu18193139 - 23 Sep 2026
Abstract
Background/Objectives: Ethanol-induced gastric injury is a widely used experimental model for evaluating gastroprotective interventions because it reproduces key features of gastric mucosal damage, including oxidative stress, lipid peroxidation, inflammation, and epithelial disruption. Previous phytochemical characterization of Montanoa bipinnatifida leaves revealed a rich profile [...] Read more.
Background/Objectives: Ethanol-induced gastric injury is a widely used experimental model for evaluating gastroprotective interventions because it reproduces key features of gastric mucosal damage, including oxidative stress, lipid peroxidation, inflammation, and epithelial disruption. Previous phytochemical characterization of Montanoa bipinnatifida leaves revealed a rich profile of bioactive polyphenols with antioxidant potential. Therefore, this study investigated the gastroprotective effects of a hydroethanolic leaf extract of M. bipinnatifida in female CD-1 mice subjected to ethanol-induced gastric injury. Methods: Animals received the extract orally for seven consecutive days before administration of 50% ethanol. Gastric tissues were subsequently evaluated by macroscopic, histopathological, biochemical, and phytochemical analyses. Results: Ethanol exposure induced severe gastric damage characterized by hemorrhagic lesions, epithelial degeneration, mucosal edema, and inflammatory cell in-filtration. In contrast, pretreatment with the extract significantly reduced gastric injury, preserving tissue architecture, and attenuating histopathological alterations. Biochemical and molecular analyses revealed a marked decrease in malondialdehyde levels and IL-1β expression following extract pretreatment, whereas TNF-α expression was not significantly reduced; SOD2 and catalase protein expression showed no significant treatment-associated changes. HPLC-DAD analysis confirmed the presence of catechin and procyanidin B2 in the extract. Conclusions: Overall, these findings indicate that M. bipinnatifida leaf extract attenuates acute ethanol-induced gastric injury and that this gastroprotective response is associated with reduced lipid peroxidation and selective attenuation of IL-1β rather than generalized suppression of the inflammatory markers examined. These results support further investigation of M. bipinnatifida as a potential source of gastroprotective bioactive compounds. Full article
(This article belongs to the Section Phytochemicals and Human Health)
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42 pages, 3132 KB  
Review
The Gut–Skin Axis in Pediatric Atopic Dermatitis: Nutritional Modulation, Microbiome Interactions, and Emerging Precision Approaches
by Raluca-Gabriela Miulescu, Mihnea Costescu, Ruxandra-Cristina Marin, Alina Mușetescu, Călin Muntean, Ioana Roşca, Iris-Iuliana Adam, Alina Ilici and Oana Andreia Coman
Nutrients 2026, 18(19), 3138; https://doi.org/10.3390/nu18193138 - 23 Sep 2026
Abstract
Background/Objectives: Pediatric atopic dermatitis (AD) is a barrier-driven inflammatory skin disease with systemic immune and microbial correlates. The gut–skin axis offers a biologically plausible framework through which early-life nutrition, gut microbial metabolism, intestinal barrier function, and immune maturation may influence disease risk and [...] Read more.
Background/Objectives: Pediatric atopic dermatitis (AD) is a barrier-driven inflammatory skin disease with systemic immune and microbial correlates. The gut–skin axis offers a biologically plausible framework through which early-life nutrition, gut microbial metabolism, intestinal barrier function, and immune maturation may influence disease risk and expression, but much of the supporting evidence remains associative. This narrative review asks which nutritional strategies are supported by clinical evidence in children with AD, which remain investigational, and how far the field is from precision nutrition. Methods: PubMed/MEDLINE, Scopus, and Web of Science were searched up to 31 July 2026; guidelines, systematic reviews, randomized trials, birth cohorts, and mechanistic studies with pediatric relevance were prioritized and appraised narratively. Results: Breastfeeding when possible, dietary diversity during complementary feeding, avoidance of unnecessary elimination diets, correction of documented nutritional deficiencies, and management of confirmed food allergy are supported by current guidance. Probiotics and synbiotics lower SCORAD in meta-analyses, but the pooled effect is small, heterogeneous, and below the minimal clinically important difference, so they are best described as an optional adjunct rather than a recommended treatment; Mediterranean-style or high-fiber dietary patterns are backed mainly by observational data. Microbiome profiling, metabolomics, multi-omics endotyping, and artificial intelligence remain research tools without validated predictive value for dietary responses. Conclusions: Nutrition is an adjunct to, not a substitute for, established topical and systemic therapy in pediatric AD. Precision nutrition is a promising research direction rather than an established component of routine care, and its clinical value will depend on standardized biomarkers and well-designed longitudinal and interventional studies. Full article
(This article belongs to the Section Clinical Nutrition)
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15 pages, 2273 KB  
Article
Intraperitoneal Isoastragaloside II Attenuated Western Diet-Induced Atherosclerosis in Male ApoE-/- Mice with Lipid-Lowering and Anti-Inflammatory Effects
by Jian Ai, Xin Tang, Haorui Ma, Deshan Ning, Yong Zhou, Bingyong Mao, Qiuxiang Zhang, Jianxin Zhao, Wei Chen and Shumao Cui
Nutrients 2026, 18(19), 3137; https://doi.org/10.3390/nu18193137 - 23 Sep 2026
Abstract
Background: Atherosclerosis is driven by lipid accumulation, vascular inflammation, and macrophage foam cell formation. Nutritional therapy, employing natural products with bioactive compounds, is a potential avenue for treating atherosclerosis. Isoastragaloside II (Iso-AS-II) is a bioactive saponin isolated from the medicinal and edible [...] Read more.
Background: Atherosclerosis is driven by lipid accumulation, vascular inflammation, and macrophage foam cell formation. Nutritional therapy, employing natural products with bioactive compounds, is a potential avenue for treating atherosclerosis. Isoastragaloside II (Iso-AS-II) is a bioactive saponin isolated from the medicinal and edible plant Astragalus membranaceus (Huangqi), but its role in atherosclerosis has not been investigated. Methods: In this study, we investigated the effects of Iso-AS-II (i.p., 5 mg/kg) in male ApoE-/- mice fed a Western diet (WD) and identified potential mechanisms through network pharmacology and transcriptomic analyses. In parallel, oxidized low-density lipoprotein (ox-LDL)-induced RAW 264.7 foam cells were used to evaluate the efficacy of Iso-AS-II in reducing foam cell accumulation and inflammation. Results: Iso-AS-II reduced aortic lesion area, plaque macrophage infiltration, and smooth muscle cell content, and lowered serum lipids (TC, TG and LDL-C) and inflammatory cytokines (TNF-α, IL-6, MCP-1, M-CSF and IL-12). Network pharmacology and transcriptomics suggested modulation of lipid metabolism and inflammatory pathways. In macrophages, Iso-AS-II suppressed foam cell formation, accompanied by downregulation of Cd36 and Msr1 and upregulation of Abca1 and Abcg1, and exerted anti-inflammatory effects by reducing IL-1β, IL-6, and TNF-α levels. Conclusions: This exploratory study provides the first evidence that Iso-AS-II reduces atherosclerotic burden in WD-fed ApoE-/- mice, and suggests that these effects involve improved systemic lipid homeostasis, suppression of inflammation, and inhibition of macrophage foam-cell formation, supporting its potential as a natural anti-atherosclerotic agent. Full article
(This article belongs to the Section Phytochemicals and Human Health)
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23 pages, 3727 KB  
Article
Host–Microbiota Interactions in Adolescents with Severe Anorexia Nervosa: Linking Gut Dysbiosis, Intestinal Barrier Function and Microbial Metabolism
by Livia Gargiullo, Federica Del Chierico, Maria Rosaria Marchili, Mariangela Irrera, Italo Pretelli, Matteo Scanu, Francesca Toto, Annalisa Grandin, Rosaria Marotta, Cristina Mascolo, Flavia Cirillo, Valentina Colistra, Ludovica Ricci, Valeria Zanna, Lorenza Putignani and Alberto Villani
Nutrients 2026, 18(19), 3136; https://doi.org/10.3390/nu18193136 - 23 Sep 2026
Abstract
Background: Anorexia nervosa (AN) is increasingly recognized as a multisystem disorder involving complex host–microbiota interactions, yet prospective pediatric studies with a comprehensive, longitudinal characterization of host–microbiota interactions remain scarce. Methods: In this prospective longitudinal study, 26 adolescents with severe AN were evaluated at [...] Read more.
Background: Anorexia nervosa (AN) is increasingly recognized as a multisystem disorder involving complex host–microbiota interactions, yet prospective pediatric studies with a comprehensive, longitudinal characterization of host–microbiota interactions remain scarce. Methods: In this prospective longitudinal study, 26 adolescents with severe AN were evaluated at hospital admission (T0), after one month (T1), and after three months of inpatient nutritional rehabilitation (T2). Gut microbiota composition was assessed by 16S rRNA sequencing and compared with healthy controls (HC) at the baseline; predicted functional profiling was performed using PICRUSt2. Serum and urinary biomarkers of intestinal barrier integrity and microbial metabolism, routine clinical and biochemical parameters, and psychometric scores (CDI-2, MASC-2) were evaluated longitudinally using linear mixed-effects models. Results: At the baseline, adolescents with AN showed reduced bacterial richness compared with healthy controls, with significantly lower Chao1 diversity (p = 0.00013), whereas the Shannon and Simpson indices did not differ significantly (p = 0.54 and p = 0.27, respectively). Microbial community composition differed significantly between groups based on Bray–Curtis (R2 = 0.0724, FDR-adjusted p = 0.001) and unweighted UniFrac (R2 = 0.0540, FDR-adjusted p = 0.001) distances. LEfSe identified 19 differentially abundant taxa; among the strongest discriminators, Blautia_A_141781, Romboutsia_B, and Clostridium_T were enriched in AN, whereas Akkermansia, Phocaeicola_A_858004, and Bacteroides_H were enriched in the healthy controls. Nutritional rehabilitation was associated with partial microbiota remodeling, alongside significant improvements in BMI and heart rate. Several host-derived biomarkers, including urinary indican, serotonin, nitric oxide, and serum occludin, changed significantly over time, whereas bile acids, short-chain fatty acids, IgA, lipopolysaccharide, and haptoglobin remained stable. Conclusions: Gut microbiota and host-derived biomarkers evolve dynamically during nutritional rehabilitation in adolescents with severe AN, supporting their potential role as complementary tools for monitoring biological recovery. Full article
(This article belongs to the Special Issue Feeding and Eating Disorders: Clinical and Nutritional Perspectives)
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17 pages, 1306 KB  
Article
Association Between Ultra-Processed Food Consumption and Frailty in Korean Older Adults
by Hyewon Lee and Kyong Park
Nutrients 2026, 18(19), 3135; https://doi.org/10.3390/nu18193135 - 23 Sep 2026
Abstract
Background/Objectives: Population aging is accelerating worldwide, and frailty has emerged as an important health concern among older adults. Although ultra-processed food (UPF) consumption has been associated with a range of adverse health outcomes, evidence on its relationship with frailty among Korean older adults [...] Read more.
Background/Objectives: Population aging is accelerating worldwide, and frailty has emerged as an important health concern among older adults. Although ultra-processed food (UPF) consumption has been associated with a range of adverse health outcomes, evidence on its relationship with frailty among Korean older adults remains limited. This study examined the cross-sectional association between the proportion of total energy intake derived from UPFs and frailty among Korean adults aged 65 years or older. Methods: We analyzed data from 9861 adults aged ≥65 years who participated in the 2014–2019, 2022, and 2024 Korea National Health and Nutrition Examination Survey cycles, in which the variables required to assess frailty were available. Dietary intake was assessed using a 24-h dietary recall, and foods were classified according to the NOVA food classification system. Frailty was defined using a modified Fried frailty phenotype. Survey-weighted multivariable logistic regression models were used to examine associations between UPF energy contribution and frailty, and restricted cubic spline models were used to evaluate the dose–response relationship. Results: In the fully adjusted model, participants in the highest quartile of UPF energy contribution had 31% higher odds of frailty than those in the lowest quartile (odds ratio [OR] = 1.31, 95% confidence interval [CI]: 1.08–1.59; p for trend = 0.002). Among the individual frailty components, participants in the highest quartile also had higher odds of low physical activity (OR = 1.31, 95% CI: 1.13–1.51; p for trend = 0.001). Restricted cubic spline analysis showed no evidence of a nonlinear association between UPF energy contribution and frailty (p for nonlinearity = 0.8). Conclusions: Higher UPF consumption was positively associated with frailty among Korean older adults, particularly with low physical activity. These findings highlight the relevance of UPF consumption to frailty in an older population with relatively low levels of UPF intake. Full article
(This article belongs to the Section Nutritional Epidemiology)
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29 pages, 560 KB  
Article
The Effect of a Fortified Date Bar on Perceived Stress and Morning Salivary Cortisol in Female Students: A Pilot Randomized Controlled Trial
by Evgeniya Klein, Daria Velina, Sherzodkhon Mutallibzoda, Svetlana Tefikova, Olga Orlovtseva, Natalia Lebedeva and Igor Nikitin
Nutrients 2026, 18(19), 3134; https://doi.org/10.3390/nu18193134 - 23 Sep 2026
Abstract
Background/Objectives: Chronic stress poses a serious threat to public health and is associated with the rising global burden of mental disorders, including anxiety and depression. University students, particularly young women, represent a highly vulnerable group due to the combination of academic pressure, [...] Read more.
Background/Objectives: Chronic stress poses a serious threat to public health and is associated with the rising global burden of mental disorders, including anxiety and depression. University students, particularly young women, represent a highly vulnerable group due to the combination of academic pressure, social adaptation challenges, and gender-specific stress reactivity. This pilot randomized controlled parallel-group trial aimed to evaluate the effect of a 4-week daily consumption of a date bar fortified with magnesium (240 mg), vitamin C (300 mg), inulin (1000 mg), and grape seed extract (100 mg) on perceived stress and morning salivary cortisol in healthy female university students under natural academic load. Methods: Thirty healthy female students (aged 18–28 years) were randomized in a 1:1 ratio to either the intervention group (fortified date bar) or the control group (placebo bar) for 4 weeks. The primary outcome was the change in morning salivary cortisol levels (measured 30–60 min after awakening), and the secondary outcome was the change in perceived stress assessed by the Perceived Stress Scale (PSS-14). Measurements were performed at baseline and within 24–48 h after the intervention. Adherence was monitored via daily digital reports and weekly in-person meetings. Statistical analysis was performed using non-parametric tests (Mann–Whitney U test, Wilcoxon test) with effect sizes (rank-biserial correlation, r). Per-protocol analysis was applied for the primary outcome (n = 28) and available-case analysis for the secondary outcome (n = 29). Participants and outcome assessors were blinded to group allocation throughout the study. Results: No adverse events were reported. Median adherence was 100% in both groups, with all participants demonstrating ≥ 90% compliance. No statistically significant changes in morning salivary cortisol were observed within or between groups (within-group: p = 0.173 in the intervention group, p = 0.326 in the control group; between-group: p = 0.104), although a consistent trend toward a reduction was observed in the intervention group (median Δ = −0.64 ng/mL) with a moderate effect size (r = 0.43 within-group; r = −0.37 between-group). For perceived stress, a statistically significant reduction in PSS-14 scores was observed within the intervention group (median Δ = −4.0 points; p = 0.009) with a large effect size (r = 0.80), while no significant change occurred in the control group (p = 0.624). Between-group comparison for PSS-14 changes did not reach statistical significance (p = 0.073), although the effect size was moderate (r = −0.40). No significant correlation was found between changes in cortisol and changes in PSS-14 scores (ρ = −0.134; p = 0.496). Conclusions: In this pilot randomized controlled trial, four-week consumption of a fortified date bar was associated with a reduction in perceived stress among healthy female university students, as reflected by a large within-group effect size on PSS-14 scores. However, given the exploratory nature of the study, the small sample size, and the absence of an a priori power calculation, this finding should be regarded as preliminary and hypothesis-generating rather than as evidence of established efficacy. A consistent, albeit non-significant, trend toward reduced morning cortisol was also observed, suggesting a possible modulatory effect on the HPA axis that requires confirmation in larger, longer-term studies with optimized dosages. The dissociation between subjective and objective stress measures underscores the multidimensional nature of the stress response and supports the use of complementary assessment approaches in future research. The fortified date bar may warrant further investigation as a potentially feasible, acceptable, and economically accessible component of primary stress prevention strategies in young populations, although this possibility remains to be tested in adequately powered confirmatory trials. Full article
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25 pages, 1822 KB  
Review
Trendy, but Are They Safe? Current Popular Diets and Their Use in Inflammatory Bowel Diseases: Narrative Review
by Klara Szwarc, Kacper Kamil Zagaja, Alicja Ratajczak-Pawłowska, Dagmara Mahadea, Agnieszka Dobrowolska and Liliana Łykowska-Szuber
Nutrients 2026, 18(19), 3133; https://doi.org/10.3390/nu18193133 - 23 Sep 2026
Abstract
Inflammatory bowel disease (IBD) arises from the interplay between genetic susceptibility, immune dysregulation, microbiota, and environmental exposures, with diet potentially contributing to both pathogenesis and management. Patients frequently modify their diet independently, often using different strategies during remission and active symptoms. This narrative [...] Read more.
Inflammatory bowel disease (IBD) arises from the interplay between genetic susceptibility, immune dysregulation, microbiota, and environmental exposures, with diet potentially contributing to both pathogenesis and management. Patients frequently modify their diet independently, often using different strategies during remission and active symptoms. This narrative review synthesises evidence on patient-accessible dietary patterns and selected structured nutritional therapies across five domains: incident IBD, objective intestinal inflammation, gastrointestinal symptoms and quality of life, nutritional safety, and real-world feasibility. Mediterranean and other minimally processed plant-forward patterns are associated with higher diet quality and potentially favourable microbial and metabolic profiles; however, current trials do not demonstrate consistent superiority for objective remission or mucosal healing. Western and ultra-processed food-rich patterns are associated with incident IBD, whereas evidence for relapse in established disease is less consistent. Low-FODMAP approaches may improve selected symptoms but should not be interpreted as anti-inflammatory therapy. Evidence for ketogenic and intentional carnivore diets remains insufficient for routine use. Exclusive enteral nutrition and the Crohn’s Disease Exclusion Diet have distinct, protocolised therapeutic roles, particularly in Crohn’s disease. Across strategies, affordability, food security, cooking resources, disease phenotype, nutritional risk, and access to specialist dietetic care determine safe and equitable implementation. Full article
(This article belongs to the Special Issue Diet in the Pathogenesis and Management of Inflammatory Bowel Disease)
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21 pages, 594 KB  
Article
Promoting the Mediterranean Diet in the Workplace: An Observational Cross-Sectional Study
by Nicola Magnavita, Igor Meraglia, Giacomo Viti, Martina Gasbarri and Lucia Isolani
Nutrients 2026, 18(19), 3132; https://doi.org/10.3390/nu18193132 - 23 Sep 2026
Abstract
Background/Objectives: The Mediterranean diet (MD) is a set of customs and eating habits developed in countries bordering the Mediterranean Sea thousands of years ago. These habits are frequently proposed as a complement to pharmacological therapies for chronic diseases and could also counteract [...] Read more.
Background/Objectives: The Mediterranean diet (MD) is a set of customs and eating habits developed in countries bordering the Mediterranean Sea thousands of years ago. These habits are frequently proposed as a complement to pharmacological therapies for chronic diseases and could also counteract their onset. This study aimed to investigate adherence to the MD in workers from 22 companies in Latium (Italy) and to evaluate the association of diet with workers’ health. Methods: Workers undergoing their health surveillance examination and routine blood tests (total cholesterol, HDL cholesterol, triglycerides, glucose) were invited to fill in the Mediterranean Diet Adherence Screener (MEDAS), the Effort–Reward Imbalance (ERI) questionnaire for work-related stress, the Sleep Condition Indicator (SCI) for sleep quality, the STOP-Bang questionnaire for obstructive sleep apnea (OSA) risk, the General Health Questionnaire (GHQ12) for low mental health, and the Abdel-Khalek questionnaire (AKQ) for happiness. A total of 1475 out of 1608 workers (91.7%) participated in the study. Results: The prevalence of high adherence to the MD was 53.8% (95% CI 51.3; 56.4). Female workers reported greater adherence to the MD than males (Mann–Whitney U, p < 0.001). MD adherence was positively correlated with age (Spearman’s rho = 0.071, p < 0.01). Workers who had never smoked and those who engaged in physical activity during their leisure time showed significantly higher adherence (p < 0.001). In multiple logistic regression models adjusted for age, gender, smoking status, physical activity, night work, and occupational sector, the MEDAS score was inversely associated with hypertension [aOR = 0.922 (95% CI = 0.856; 0.994)], hypertriglyceridemia [aOR = 0.919 (95% CI = 0.844; 0.999)], and metabolic syndrome [aOR = 0.911 (95% CI = 0.831; 0.999)]. The MEDAS score was positively related to happiness [aOR = 1.074 (95% CI = 1.017; 1.134)]. Conclusions: Although the association between diet adherence and health is weak, the MD remains a useful measure for promoting health in the workplace. Full article
(This article belongs to the Special Issue Mediterranean Diet, Behavioral Addictions, and Lifestyle Patterns)
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25 pages, 544 KB  
Review
Tirzepatide for Weight Recurrence After Metabolic and Bariatric Surgery: A Critical Review of Direct and Indirect Evidence with Emphasis on Sleeve Gastrectomy, Nutritional Safety, and Clinical Implications
by Karolina Ciołkosz and Ewelina Polak-Szczybyło
Nutrients 2026, 18(19), 3131; https://doi.org/10.3390/nu18193131 - 23 Sep 2026
Abstract
Background: Obesity is a chronic, relapsing disease associated with substantial morbidity and healthcare burden. Although metabolic and bariatric surgery (MBS) remains the most effective treatment for severe obesity, weight recurrence after sleeve gastrectomy (SG) represents a significant clinical challenge and may require additional [...] Read more.
Background: Obesity is a chronic, relapsing disease associated with substantial morbidity and healthcare burden. Although metabolic and bariatric surgery (MBS) remains the most effective treatment for severe obesity, weight recurrence after sleeve gastrectomy (SG) represents a significant clinical challenge and may require additional therapeutic strategies. Tirzepatide, a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, has demonstrated substantial efficacy in obesity treatment; however, evidence regarding its use after SG remains limited. This review critically evaluates the current evidence regarding the potential role of tirzepatide in the management of weight recurrence after SG, with particular emphasis on treatment efficacy, safety, body composition, nutritional considerations, and implications for dietetic practice. Methods: A critical review of the literature was conducted using PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, and ClinicalTrials.gov databases. Evidence was analyzed according to the population studied, including direct evidence from patients after SG, data from mixed post-bariatric surgery cohorts, and indirect evidence from clinical trials involving individuals with obesity without previous MBS. Results: Available evidence suggests that tirzepatide may induce clinically meaningful weight reduction in patients experiencing weight recurrence after SG; however, direct evidence remains limited and is derived mainly from short-term retrospective studies. Findings from mixed post-bariatric populations and randomized clinical trials in individuals with obesity provide supportive but indirect evidence. Important uncertainties remain regarding long-term efficacy, treatment durability after discontinuation, effects on body composition, preservation of fat-free mass, and nutritional safety. Conclusions: Tirzepatide may represent a valuable adjunctive therapy for selected patients with weight recurrence after SG, particularly when integrated into multidisciplinary obesity management. Nevertheless, current evidence is insufficient to establish its definitive role after SG. Future prospective studies are warranted to evaluate long-term effectiveness, safety, nutritional outcomes, and changes in body composition using standardized definitions of postoperative weight recurrence. Full article
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18 pages, 354 KB  
Article
Dietary Phytochemical Index and Fasting Plasma Glucose in Adults with Type 2 Diabetes: A Cross-Sectional Study
by Stavroula Maria Konstantopoulou, Alexandra Foscolou, Athanasia K. Papazafiropoulou, Anastasios Makris, Angeliki Dionysia Leftaki, George Panagiotopoulos, Aristea Gioxari, Dimitra Ioanna Lampropoulou, Paraskevi Detopoulou, Georgios I. Panoutsopoulos and Konstantina Argyri
Nutrients 2026, 18(19), 3130; https://doi.org/10.3390/nu18193130 - 23 Sep 2026
Abstract
Background/Objectives: Type 2 diabetes mellitus (T2D) is a major public health challenge. Phytochemicals have gained attention for their potential role in glucose regulation. This study aimed to investigate the association between dietary phytochemical intake, assessed using the Dietary Phytochemical Index (DPI), and [...] Read more.
Background/Objectives: Type 2 diabetes mellitus (T2D) is a major public health challenge. Phytochemicals have gained attention for their potential role in glucose regulation. This study aimed to investigate the association between dietary phytochemical intake, assessed using the Dietary Phytochemical Index (DPI), and fasting plasma glucose in adults with established T2D. Methods: A cross-sectional study was conducted among 340 adults with T2D attending the Diabetes Clinic of the General Hospital of Kalamata, Greece. Dietary intake was assessed using a validated food frequency questionnaire and DPI was calculated as the percentage of total daily energy derived from fruits, vegetables, legumes, whole grains, nuts/seeds and olives/olive oil. Multivariable linear regression was used to examine the association between DPI and fasting plasma glucose, adjusting for demographic, lifestyle, anthropometric and clinical characteristics. The fully adjusted analysis included 199 participants with complete data. Additional models adjusted for Mediterranean diet adherence, total energy intake and socioeconomic factors. Results: Each 1-percentage-point increase in DPI was associated with 0.65 mg/dL lower fasting plasma glucose (b = −0.652, 95% CI: −1.177 to −0.127; and p = 0.015). The association remained after additional adjustment for Mediterranean diet adherence, total energy intake and socioeconomic factors and was supported by multiple-imputation analysis. Food-group component analyses were exploratory; no component remained statistically significant after false discovery rate correction. Conclusions: Higher DPI was associated with lower fasting plasma glucose in adults with T2D after adjustment for measured covariates. Prospective studies and randomized trials are needed to confirm this association and determine its clinical relevance. Full article
(This article belongs to the Special Issue Adherence to the Mediterranean Diet and Health Status)
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15 pages, 674 KB  
Article
Family Mealtimes in Hispanic Households: Associations of General Parenting Styles and Food Parenting Practices with Adolescent Food Group Intake
by Lillie Monroe-Lord, Azam Ardakani, Elmira Asongwed, Dorothy Wakefield, Tia Jeffery, Phronie Jackson and Eyerusalem Beza
Nutrients 2026, 18(19), 3129; https://doi.org/10.3390/nu18193129 - 23 Sep 2026
Abstract
Background/Objectives: Hispanic adolescents experience disproportionately high rates of obesity and diet-related health risks, yet the family and parenting factors that shape their dietary behaviors remain incompletely understood. This study examined associations between parent sociodemographic characteristics and family meal frequency; among general parenting [...] Read more.
Background/Objectives: Hispanic adolescents experience disproportionately high rates of obesity and diet-related health risks, yet the family and parenting factors that shape their dietary behaviors remain incompletely understood. This study examined associations between parent sociodemographic characteristics and family meal frequency; among general parenting styles, food parenting practices, and family meal frequency; and between family meal frequency and adolescent intake across major USDA food groups, among Hispanic parent–adolescent dyads. Methods: A cross-sectional online survey was conducted among 251 Hispanic parent–adolescent dyads (adolescents aged 10–17 years). Parents reported sociodemographic characteristics, general parenting styles (Comprehensive General Parenting Questionnaire), and food parenting practices (Comprehensive Feeding Practices Questionnaire). Adolescents self-reported dietary intake using the Youth/Adolescent Food Frequency Questionnaire. Family meal frequency was categorized as ≤2, 3–6, or ≥7 meals per week. Results: Older parents (p = 0.034) and married parents (p = 0.036) reported more frequent family meals than younger and unmarried parents. In adjusted multivariable models, more frequent family meals were associated with greater parental responsiveness (overall p = 0.009), involvement (overall p = 0.006), expectations (overall p = 0.047), monitoring (overall p = 0.037), and encouragement (overall p < 0.001). None of the five food group outcomes—dairy, fruit, grains, protein foods, or vegetables—showed a significant overall adjusted association with family meal frequency. Conclusions: Frequent family meals appear closely connected with supportive parenting practices among Hispanic adolescents, independent of sociodemographic characteristics, but were not independently associated with intake of any specific food group. Interventions to improve adolescent nutrition in Hispanic families may benefit from promoting both regular family meals and supportive food parenting practices. Full article
(This article belongs to the Section Nutrition and Public Health)
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Graphical abstract

17 pages, 1478 KB  
Perspective
When the Algorithm Becomes the Dietitian: Large Language Model Hallucinations, Algorithmic Food Environments, and the Erosion of Nutritional Autonomy
by Ismail Dergaa, Rym Ben Othman, Hatem Ghouili, Halil İbrahim Ceylan, Nizar Souissi, Souhail Bchini, Valentina Stefanica, Raul Ioan Muntean and Nicola Luigi Bragazzi
Nutrients 2026, 18(19), 3128; https://doi.org/10.3390/nu18193128 - 23 Sep 2026
Abstract
Large language models (LLMs) can answer dietary questions, but their use as substitutes for registered dietitians remains insufficiently quantified. Evaluations have identified inaccurate nutrient targets, incomplete clinical advice, and insufficient personalization, alongside useful performance on some general nutrition tasks. Social media and food-delivery [...] Read more.
Large language models (LLMs) can answer dietary questions, but their use as substitutes for registered dietitians remains insufficiently quantified. Evaluations have identified inaccurate nutrient targets, incomplete clinical advice, and insufficient personalization, alongside useful performance on some general nutrition tasks. Social media and food-delivery interfaces may also influence dietary choices through food cues, social endorsement, and choice architecture. This conceptual perspective presents ADRIFT (Algorithmic Dietary Reconfiguration through Informational, Framing, and Technological mechanisms) to examine how these influences might interact. Drawing on a targeted, nonsystematic synthesis of nutrition, behavioral, neuroscience, and AI literature, ADRIFT distinguishes three axes: informational errors and unsupported advice; framing through content and interface design; and adaptive personalization and cognitive delegation. Direct evidence supports selected component mechanisms, but their convergence into a feedback loop that reduces nutritional autonomy remains hypothetical. We propose a six-category taxonomy covering hallucinations and related nutrition errors, define nutritional autonomy erosion as declining capacity for informed, self-directed dietary decisions, and outline eight testable hypotheses. The framework concerns unsupervised use and does not predict that language models will replace dietetic professionals. Longitudinal validation, platform experiments, and clinical safety evaluations are needed to determine whether, for whom, and under which conditions the proposed harms occur. Full article
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17 pages, 959 KB  
Article
Dietary and Fluid-Intake Habits in Patients with Various Types of Urinary Incontinence: A Preliminary Study
by Aleksandra Piątek, Gabriela Kołodyńska, Krzysztof Nowak, Jarosław Drapała, Felicja Fink-Lwow, Waldemar Andrzejewski and Maciej Zalewski
Nutrients 2026, 18(19), 3127; https://doi.org/10.3390/nu18193127 - 23 Sep 2026
Abstract
Background/Objectives: Urinary incontinence (UI) is common in women, particularly during and after the menopausal transition, and may both influence and be influenced by dietary and fluid-intake behaviours. This exploratory study described self-reported dietary and fluid-intake habits in women with different UI subtypes and [...] Read more.
Background/Objectives: Urinary incontinence (UI) is common in women, particularly during and after the menopausal transition, and may both influence and be influenced by dietary and fluid-intake behaviours. This exploratory study described self-reported dietary and fluid-intake habits in women with different UI subtypes and explored their associations with pelvic floor symptom burden and self-reported fluid restriction. Energy and nutrient intake was not quantified. Methods: This exploratory, cross-sectional, single-centre study included 87 women aged 18–84 years with stress (SUI; n = 23), urgency (UUI; n = 21), or mixed (MUI; n = 43) UI, who reported UI at least weekly. Participants completed a custom dietary and fluid-intake questionnaire, the Incontinence Quality of Life Questionnaire (I-QOL), and the Pelvic Floor Distress Inventory-20 (PFDI-20). Associations were assessed using rank correlations and proportional-odds ordinal logistic regression, with Benjamini–Hochberg correction used to address multiplicity in exploratory item-level analyses. Results: No individual diet-PFDI association remained statistically significant after Benjamini–Hochberg correction across the complete 100-test matrix. In the adjusted model, an urgency component was associated with greater self-reported fluid restriction (adjusted cumulative OR = 2.92; 95% CI, 1.18–7.20), whereas each 10-year increase in age was associated with lower odds of greater restriction (adjusted cumulative OR = 0.68; 95% CI, 0.51–0.92). Conclusions: Greater self-reported fluid restriction was independently associated with an urgency component and with younger age, whereas no individual dietary or fluid-intake item remained statistically significant after correction for multiple comparisons. Given the potential risk of the practice, these findings support asking women with urgency symptoms about fluid restriction during clinical consultations. Prospective studies using a validated quantitative dietary instrument are needed to determine whether dietary and fluid-intake habits affect pelvic floor symptom burden. Full article
(This article belongs to the Section Nutrition in Women)
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42 pages, 6464 KB  
Review
The Role of Herbal Medicines in Cognitive Impairment: A Narrative Review of Neuroprotective Mechanisms and Therapeutic Perspectives
by Aekkhaluck Intharuksa, Anchalee Prasansuklab, Tachpon Techarang, Kamonwan Chaikhong, Warunya Arunotayanun and Rewadee Jenraumjit
Nutrients 2026, 18(19), 3126; https://doi.org/10.3390/nu18193126 - 23 Sep 2026
Abstract
Cognitive impairment encompasses a clinical spectrum ranging from mild cognitive impairment to dementia, particularly Alzheimer’s disease (AD), and involves interconnected pathological processes including cholinergic dysfunction, oxidative stress, neuroinflammation, mitochondrial impairment, amyloid-β accumulation, tau hyperphosphorylation, and synaptic loss. Herbal medicines have attracted increasing attention [...] Read more.
Cognitive impairment encompasses a clinical spectrum ranging from mild cognitive impairment to dementia, particularly Alzheimer’s disease (AD), and involves interconnected pathological processes including cholinergic dysfunction, oxidative stress, neuroinflammation, mitochondrial impairment, amyloid-β accumulation, tau hyperphosphorylation, and synaptic loss. Herbal medicines have attracted increasing attention because their complex phytochemical composition may provide multi-target neuroprotective effects. This narrative review aimed to summarize current preclinical and clinical evidence on herbal medicines and traditional herbal formulations for cognitive impairment, with emphasis on their mechanisms, therapeutic potential, safety, and translational limitations. Relevant evidence from in vitro studies, animal models, randomized clinical trials, systematic reviews, and meta-analyses was narratively synthesized. The review considered single herbal medicines, standardized extracts, isolated phytochemicals, and traditional multi-herbal formulations, together with their reported cognitive outcomes and molecular targets. Preclinical studies suggest that selected herbal preparations may modulate pathways implicated in cognitive impairment through acetylcholinesterase and butyrylcholinesterase inhibition, antioxidant and mitochondrial protection, suppression of neuroinflammatory signaling, modulation of amyloidogenic and tau-related pathways, and enhancement of BDNF/TrkB- and CREB-associated neuroplasticit; however, clinical evidence remains limited and heterogeneous. Clinical studies of Bacopa monnieri, Panax ginseng, Crocus sativus, and several traditional Chinese, Korean, and Persian formulations have reported improvements in memory and global cognitive measures, including MMSE, MoCA, and ADAS-cog scores. However, evidence remains constrained by heterogeneity of products, small sample sizes, short treatment periods, inconsistent outcome measures, limited biomarker integration, and incomplete long-term safety assessment. Herbal medicines show potential as preventive, complementary, or adjunctive approaches for cognitive impairment, but they cannot yet be considered established replacements for conventional therapy. Standardized products, rigorous pharmacokinetic and toxicological evaluation, disease-relevant models, and adequately powered multicenter trials are required to support evidence-based clinical application. Full article
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