Nutrients

17 pages, 2039 KB

Open AccessArticle

Short-Term Effects of Broccoli-Derived Glucoraphanin on Recovery from Eccentric Muscle Damage: A Double-Blind Randomized Crossover Study

by Leonardo Cesanelli, Thomas Rono, Mickevičius Mantas, Sniečkus Audrius, Dalia Mickevičienė, Tomas Venckūnas, Stasiulis Arvydas and Sigitas Kamandulis

Nutrients 2026, 18(4), 710; https://doi.org/10.3390/nu18040710 - 23 Feb 2026

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Abstract

Background/Objectives: Broccoli-derived glucoraphanin (a sulforaphane precursor that activates Nrf2 defenses) may aid repair; however, its short-term effects in humans remain unknown. This study aimed to evaluate whether short-term supplementation with broccoli-derived glucoraphanin improves recovery from exercise-induced muscle damage. We hypothesized that short-term [...] Read more.

Background/Objectives: Broccoli-derived glucoraphanin (a sulforaphane precursor that activates Nrf2 defenses) may aid repair; however, its short-term effects in humans remain unknown. This study aimed to evaluate whether short-term supplementation with broccoli-derived glucoraphanin improves recovery from exercise-induced muscle damage. We hypothesized that short-term supplementation with broccoli-derived glucoraphanin would attenuate exercise-induced muscle damage and accelerate recovery. Methods: In a randomized, double-blind, placebo-controlled crossover design, fifteen participants consumed either high-glucoraphanin broccoli powder (320 μg) or placebo for two weeks, followed by elbow flexor eccentric exercise. Strength, soreness, creatine kinase (CK), range of motion (ROM), arm girths, and ultrasound-assessed muscle and tendon morphology were measured at baseline, immediately post-exercise, and at 48 and 96 h post-exercise. Results: Significant main effects of time were observed for isometric and isokinetic torque (p < 0.05), CK (p < 0.05), soreness (p < 0.05), and structural swelling markers (p < 0.05), confirming exercise-induced muscle damage. However, there were no significant Time × Supplement interactions for any variable (p > 0.05), indicating that glucoraphanin did not influence recovery dynamics. Conclusions: These findings suggest that short-term high-dose broccoli supplementation reconstituted with hot water does not modulate recovery following eccentric muscle damage under the conditions tested, including the chosen preparation method and experimental context. Full article

(This article belongs to the Special Issue Nutrition Strategy and Resistance Training)

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18 pages, 525 KB

Open AccessArticle

Quality of Anthropometric Data for Child Nutrition Monitoring in India: A Comparative Assessment Using Two Rounds of the National Family Health Survey

by Laxmi Kant Dwivedi, Somnath Jana, Rupalee Singh Chauhan and Mrigesh Bhatia

Nutrients 2026, 18(4), 709; https://doi.org/10.3390/nu18040709 - 23 Feb 2026

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Abstract

Background: High-quality anthropometric data are critical for accurately monitoring child nutritional outcomes and informing policy decisions, yet inconsistencies in measurement and reporting across large-scale surveys continue to challenge data reliability. Method: This research assesses the quality of height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height [...] Read more.

Background: High-quality anthropometric data are critical for accurately monitoring child nutritional outcomes and informing policy decisions, yet inconsistencies in measurement and reporting across large-scale surveys continue to challenge data reliability. Method: This research assesses the quality of height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height (WHZ) z-scores based on a repeated cross-sectional analysis of two rounds of the National Family Health Survey (NFHS-4, 2015–2016 and NFHS-5, 2019–2021), examining improvements, persistent gaps, and regional disparities. We have used WHO-recommended diagnostics including digit preference, age-heaping, completeness of measurements, biologically implausible values, and distributional properties of z-scores to evaluate the plausibility of anthropometric data and generate state-level rankings to compare transitions across rounds. Results: The results indicate modest national-level improvements in data quality in NFHS-5, particularly reductions in digit preference and implausible values; however, substantial inter-state variation remains, with some states demonstrating clear progress while others continue to exhibit measurement anomalies. The completeness of date of birth improved from 99.0% in NFHS-4 to 99.9% in NFHS-5, while completeness of anthropometric measurements declined from 98.5% to 96.6%. Digit preference for height decreased from 15.2% to 14.4%, and the proportion of biologically implausible HAZ values declined from 3.4% to 2.3%. However, the standard deviation of HAZ increased from 1.77 to 1.85 and that of WHZ from 1.40 to 1.50, indicating persistent measurement variability. Transitions in HAZ rankings further reveal mixed patterns of advancement and stagnation, with regional clustering of improvements more evident in certain parts of the country. Overall, while NFHS-5 reflects progress in anthropometric data quality, key challenges persist related to inconsistent adherence to measurement protocols, variable field performance, and inadequate supervisory oversight. Conclusions: Strengthening training, standardizing procedures, and reinforcing monitoring mechanisms are essential for achieving more reliable anthropometric data, thereby enhancing the accuracy of child nutrition estimates and supporting more evidence-based policy interventions in India. Full article

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

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13 pages, 1410 KB

Open AccessArticle

Validity of an AI-Assisted Dietary Recording Application for Family-Based Nutritional Management in Young Patients with Anorexia Nervosa

by Nao Shiraishi, Rieko Kawase, Haruka Ogawa and Tatsuo Akechi

Nutrients 2026, 18(4), 708; https://doi.org/10.3390/nu18040708 - 23 Feb 2026

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Abstract

Background: Evidence regarding the validity of digital dietary recordings in the family-based nutritional management of anorexia nervosa (AN) remains limited. This study evaluated the validity of an AI-assisted dietary recording application (app) used by the parents of young patients with AN, with [...] Read more.

Background: Evidence regarding the validity of digital dietary recordings in the family-based nutritional management of anorexia nervosa (AN) remains limited. This study evaluated the validity of an AI-assisted dietary recording application (app) used by the parents of young patients with AN, with total energy intake as the primary outcome and major nutrient intake as the secondary outcome. Methods: During hospital leave prior to discharge, one day of dietary intake was recorded by parents using the app based on meal photographs. The energy and nutrient intakes estimated by the app were compared with a registered dietitian using visual estimation of the photographs. Differences were examined using the Wilcoxon signed-rank test, associations were assessed using Spearman’s correlation coefficients, and agreement was evaluated using Bland–Altman analysis. Sensitivity analyses excluding extreme outliers were performed. Results: Thirty female inpatients with AN (mean age: 14.8 ± 2.9 years) and their mothers participated. The median total energy intake did not differ significantly between the app and reference method (2462 vs. 2439 kcal/day). Moderate to high correlations were observed for total energy (ρ = 0.62) and major nutrient intakes. The app tended to overestimate these intakes; however, Bland–Altman analyses indicated no systematic bias. Exclusion of two outliers strengthened correlations for total energy intake (ρ = 0.74) and narrowed the limits of agreement. Conclusions: The app demonstrated an acceptable agreement for estimating energy and major nutrient intake in the therapeutic context of AN. Careful attention to dish type and portion size may further support its clinical use. Full article

(This article belongs to the Special Issue Eating Behaviors and Eating Disorders: Prevention, Clinical Characterization, and Treatment)

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18 pages, 842 KB

Open AccessArticle

D-Allulose Reduces Weight More Persistently than Oral Semaglutide While Both Equally Elevate Grip Strength in Diet-Induced Obese Mice

by Yermek Rakhat, Seiya Banno, Dauren Zhantleu, Shin Tsunekawa, Daisuke Yabe, Yutaka Seino, Yusaku Iwasaki and Toshihiko Yada

Nutrients 2026, 18(4), 707; https://doi.org/10.3390/nu18040707 - 23 Feb 2026

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Abstract

Background: Rare sugar D-Allulose, a zero-calorie sweetener, markedly ameliorates obesity. It reportedly stimulates the release of endogenous glucagon-like peptide 1 (GLP-1) to activate vagal afferent and directly influences the neurons in hypothalamic arcuate nucleus (ARH), thus evoking vagal and central nervous routes. D-Allulose [...] Read more.

Background: Rare sugar D-Allulose, a zero-calorie sweetener, markedly ameliorates obesity. It reportedly stimulates the release of endogenous glucagon-like peptide 1 (GLP-1) to activate vagal afferent and directly influences the neurons in hypothalamic arcuate nucleus (ARH), thus evoking vagal and central nervous routes. D-Allulose can now be produced substantially, being expected for diet therapy. Oral form GLP-1 receptor agonist (GLP-1RA), Oral semaglutide (O-Sema), without injection markedly ameliorates obesity. It evokes only central nervous route. Thus, these GLP-1-based substances utilize common/distinct routes, suggesting common/distinct effects on obesity and related disorders including sarcopenia. To address it, this study precisely compared their effects. Methods: O-Sema and D-Allulose were administered to diet-induced obese mice under identical conditions, equivalent doses, oral gavage, and food/water deprivation. Acute and sub-chronic effects on food intake, body weight and grip strength were measured. Results: Acutely, D-Allulose rapidly and O-Sema slowly reduced feeding. Sub-chronically, D-Allulose and O-Sema profoundly reduced food intake and weight in the early period (0–3 days) of treatment. The weight loss was diminished with O-Sema but maintained with D-Allulose in the late period (4–10 days) and after termination of treatment. D-Allulose and O-Sema increased muscle strength. Mechanistically, D-Allulose and semaglutide similarly activated anorexigenic leptin-responsive neurons while only D-Allulose significantly inhibited orexigenic ghrelin-responsive neurons in ARH. Conclusions: D-Allulose and O-Sema equally elicit weight reduction possibly via the central nervous route including ARH anorexigenic neuron activation. The weight loss is rebounded with O-Sema, while it is maintained with D-Allulose possibly via combined vagal afferent and central nervous routes including ARH orexigenic neuron inhibition. Their optimal use potentially provides precise control of obesity and related disorders. Full article

(This article belongs to the Section Nutrition and Obesity)

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16 pages, 864 KB

Open AccessArticle

Association Between Nutritional Status and Extranodal Extension of Lymph Node Metastases in Head and Neck Squamous Cell Cancers

by Kornél Dános, Mátyás Majoros, Lili Tóth, Benedek Besenczi, Mohammad Aouf, Angéla Horváth, László Tamás and Imre Uri

Nutrients 2026, 18(4), 706; https://doi.org/10.3390/nu18040706 - 22 Feb 2026

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Abstract

Introduction: Extranodal extension (ENE) is a well-established adverse prognostic factor in head and neck squamous cell carcinoma (HNSCC), associated with reduced survival and the need for intensified therapy. Nutritional status—commonly assessed using the Prognostic Nutritional Index (PNI) and Body Mass Index (BMI)—also influences [...] Read more.

Introduction: Extranodal extension (ENE) is a well-established adverse prognostic factor in head and neck squamous cell carcinoma (HNSCC), associated with reduced survival and the need for intensified therapy. Nutritional status—commonly assessed using the Prognostic Nutritional Index (PNI) and Body Mass Index (BMI)—also influences outcomes in HNSCC. However, whether or not ENE correlates with nutritional status has not been previously investigated. Methods: We conducted a retrospective cohort study of 109 treatment-naïve HNSCC patients with pathologically confirmed nodal metastases who underwent primary tumor resection and neck dissection between 2014 and 2025 at a national tertiary center. ENE status was determined histologically. Nutritional status was evaluated using BMI, PNI, serum albumin, and percentage of weight loss at diagnosis. Statistical analyses included t-tests, Chi-square tests, ANOVA, Cox regression, Kaplan–Meier survival analysis, and Full Factorial General Linear Models. Results: ENE was present in 54.1% of patients and significantly reduced overall survival (Kaplan–Meier p = 0.006; Cox regression RR = 1.927, p = 0.008). No significant differences in BMI, PNI, weight loss, or serum albumin were observed between ENE-positive and ENE-negative groups. ENE prevalence varied significantly by tumor origin (p = 0.018), being highest in hypopharyngeal cancers (75.8%) and lowest in oral cavity tumors (25.0%). ENE status was independent of tobacco use, alcohol abuse, and all nutritional markers across TNM 8/9 subgroups. Conclusions: ENE is a strong prognostic marker in HNSCC, appearing to be independent of nutritional status. The demonstrated heterogeneity of ENE prevalence among tumor subsites supports the need for individualized management approaches. Full article

(This article belongs to the Special Issue Nutritional Approaches to Cancer Prevention and Therapeutic Support)

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15 pages, 1018 KB

Open AccessArticle

Does Vitamin D Concentration Matter? The Consequential Effects of Serum Vitamin D Concentration and Supplementation on Paediatric Fracture Risk

by Tan Si Heng Sharon, Eunice Anastasia Wilianto, Andrew Kean Seng Lim and James Hoipo Hui

Nutrients 2026, 18(4), 705; https://doi.org/10.3390/nu18040705 - 22 Feb 2026

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Abstract

Objective: The association between vitamin D status and paediatric fracture risk remains controversial, with inconsistent findings across existing studies. This study aimed to evaluate the relationship between serum 25(OH)D concentrations, vitamin D sufficiency, insufficiency and deficiency, vitamin D supplementation and fracture risk in [...] Read more.

Objective: The association between vitamin D status and paediatric fracture risk remains controversial, with inconsistent findings across existing studies. This study aimed to evaluate the relationship between serum 25(OH)D concentrations, vitamin D sufficiency, insufficiency and deficiency, vitamin D supplementation and fracture risk in a large Southeast Asian paediatric cohort. Methods: This retrospective cross-sectional study included children under 18 years whose serum 25(OH)D concentrations were measured between 2014 and 2022. One-way ANOVA determined statistical significance between 25(OH)D concentrations in fracture and non-fracture groups. Prevalence of vitamin D insufficiency, deficiency and supplementation was compared between the two groups. Chi-square tests evaluated the association between 25(OH)D concentrations and supplementation against fracture risk. Results: A total of 4530 children were included (157 fracture cases, 4373 controls). Mean serum 25(OH)D concentration was lower in the fracture group than in the controls (27.44 ± 12.26 vs. 30.75 ± 15.21 ng/mL; p = 0.007). Sub-sufficient vitamin D status (<30 ng/mL) was more prevalent among fracture patients (p = 0.001), and suboptimal (p = 0.001), insufficient (p = 0.001), and deficient (p = 0.014) categories were each significantly associated with fractures. An association between vitamin D supplementation and fracture risk was observed. However, the dataset did not permit the determination of causality and a protective effect cannot be inferred. Conclusions: Higher serum 25(OH)D concentrations were associated with lower fracture risk, suggesting that optimisation of vitamin D status may represent a modifiable factor in paediatric bone health. Healthcare institutions should aim to maintain adequate 25(OH)D concentrations (>30 ng/mL). An association between vitamin D supplementation and fracture risk was observed; however, causality cannot be inferred from this retrospective dataset. Full article

(This article belongs to the Section Pediatric Nutrition)

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16 pages, 293 KB

Open AccessArticle

Skipping Breakfast and Lunch, as Well as Reducing Milk and Dairy Intake, Is Associated with Depressive Symptoms in Pregnant Adolescents

by Reyna Sámano, Estefania Aguirre-Minutti, Hugo Martínez-Rojano, Gabriela Chico-Barba, Ricardo Gamboa, Carmen Hernández-Chávez, María Eugenia Mendoza-Flores, Erika González-Medina and Primavera Pérez-Romero

Nutrients 2026, 18(4), 704; https://doi.org/10.3390/nu18040704 - 22 Feb 2026

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Abstract

Background and objective: Depression is the most common mental health problem in women during pregnancy, associated with psychological, social, and medical factors characteristic of this stage. However, a lack of knowledge and limited attention to this condition can aggravate its consequences and restrict [...] Read more.

Background and objective: Depression is the most common mental health problem in women during pregnancy, associated with psychological, social, and medical factors characteristic of this stage. However, a lack of knowledge and limited attention to this condition can aggravate its consequences and restrict access to appropriate treatment. This research seeks to fill a gap in the scientific literature by exploring the association between eating habits and dietary diversity with depressive symptomatology in a group with high psychosocial vulnerability: pregnant adolescents. Material and methods: A cross-sectional analytical study was conducted with a sample of 344 pregnant adolescents attending prenatal care at the National Institute of Perinatology (INPer), a tertiary care center. Non-probabilistic sampling was used for recruitment. Relevant information was collected using a pre-validated structured questionnaire administered via interview. Depressive symptomatology was assessed using the Edinburgh Postnatal Depression Scale (EPDS), with a score of ≥12 considered indicative of a higher risk of depression. Eating habits were evaluated based on meal omission, activities performed during meals, and dietary diversity, comparing them with national recommendations. Food group consumption was assessed using a semi-quantitative Food Frequency Questionnaire (FFQ). Robust variance Poisson regression models were employed to evaluate the independent association between undesirable eating habits, inadequate food group intake, and the presence of depressive symptomatology. Results: A significant association was observed between the presence of depressive symptoms (EPDS ≥ 12) and the omission of main meals. Specifically, skipping breakfast was associated with a higher prevalence of EPDS scores ≥ 12 (aPR = 1.55; 95% CI: 1.10–2.19; p = 0.013). Similarly, adolescents who skipped lunch showed a higher prevalence of depressive symptomatology compared to those who did not (aPR = 2.02; 95% CI: 1.11–3.68; p = 0.022). Regarding food groups, only insufficient intake of milk and dairy products was significantly associated with the presence of depressive symptoms (aPR: 1.78; 95% CI: 1.16–2.73; p = 0.008). Conclusions: This cross-sectional study found a significant association between breakfast skipping, distraction while eating, and inadequate dairy intake with a higher prevalence of depressive symptoms in socially vulnerable pregnant adolescents treated at a tertiary care center. However, due to the study’s design, causality or the direction of the relationship cannot be established (it could be bidirectional), and it cannot be affirmed that modifying the diet will necessarily reduce depression. Furthermore, the results are not generalizable to all pregnant adolescents, and future research (longitudinal or interventional) is needed to better understand these associations before developing specific dietary interventions. Full article

(This article belongs to the Special Issue The Relationship Between Nutrition and Mental Health)

21 pages, 920 KB

Open AccessArticle

Long-Term Outcomes of Multimodal Prehabilitation with High Protein Oral and HMB Supplementation in Sarcopenic Surgical Patients: The HEROS Study

by Irving Yu Le Shua, Yong Yi Tan, Vanessa Yik, Jing Han Hong, Yun-Xia Liu, Shuen-Ern Chin, Shawn Shi-Xian Kok, Hui-Bing Lee, Cherie Tong, Phoebe Tay, Esther Chean, Yi-En Lam, Shi-Min Mah, Li-Xin Foo, Clement C. Yan, Wei-Tian Chua, Haziq bin Jamil, Khasthuri Ganesh, Lester Wei-Lin Ong, Alvin Yong-Hui Tan, Koy-Min Chue, Leonard Ming-Li Ho, Cheryl Xi-Zi Chong, Jasmine Ladlad, Cheryl Hui-Min Tan, Nathanelle Ann Xiaolian Khoo, Jia-Lin Ng, Winson Jianhong Tan, Fung-Joon Foo, Bin Tean Teh, Yibin Wang and Frederick Hong-Xiang Koh Show full author list Hide full author list

Nutrients 2026, 18(4), 703; https://doi.org/10.3390/nu18040703 - 22 Feb 2026

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Abstract

Background: Sarcopenia is associated with adverse surgical outcomes. Recent literature suggested that pre-surgery prehabilitation, nutrition and β-Hydroxy β-methylbutyric acid (HMB) supplementation improve myological and functional outcomes. However, long-term outcomes remain uncertain. Thus, we aimed to analyse findings from the long-term follow-up of surgical [...] Read more.

Background: Sarcopenia is associated with adverse surgical outcomes. Recent literature suggested that pre-surgery prehabilitation, nutrition and β-Hydroxy β-methylbutyric acid (HMB) supplementation improve myological and functional outcomes. However, long-term outcomes remain uncertain. Thus, we aimed to analyse findings from the long-term follow-up of surgical patients undergoing oral supplementation and prehabilitation. Methods: A prospective single-centre pilot cohort study was conducted to evaluate the effects of multimodal prehabilitation using high-protein oral nutritional supplementation (HP-ONS) with HMB. Sarcopenic patients between 40 and 90 years old and undergoing gastrointestinal surgery were included from June 2022 to January 2024. Patients were followed up from two to four weeks pre-operatively to six months post-operatively. Paired Wilcoxon signed-rank tests were conducted to evaluate outcomes between time points. Results: 36 patients were included with a median age of 71.5 years (IQR: 55–90), and 50% were male. 12 (33.3%) patients were sarcopenic, while 24 (66.7%) were severely sarcopenic. No significant difference in IMAT% was observed at post-operative six months. Number of chair rise repetitions (Median:15 vs. 11, p < 0.001) and six-min walk test (Median: 387 m vs. 349 m, p = 0.020), mid-arm muscle circumference (Median: 23.7 cm vs. 22.5 cm, p = 0.013), mid-arm muscle area (Median: 44.8 cm² vs. 39.3 cm², p = 0.005), weight (Median: 51.6 kg vs. 50.8 kg, p = 0.023) and BMI (Median: 23.2 kg/m² vs. 21.8 kg/m², p = 0.025) increased significantly at six-months post-operatively from surgery. Conclusions: Our findings suggest that improvements in anthropometric and functional outcomes from prehabilitation may persist beyond the acute recovery period. If supported by future works, multimodal prehabilitation has the potential to optimise postoperative recovery amongst sarcopenic older adult surgical patients. Full article

(This article belongs to the Section Proteins and Amino Acids)

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19 pages, 321 KB

Open AccessReview

Consumer Perceptions Influence Supplement Choice: A Narrative Review of Clinically Studied Weight-Management Supplements in Obesity

by Hyeonseok Lee and Jung Hyun Kwak

Nutrients 2026, 18(4), 702; https://doi.org/10.3390/nu18040702 - 22 Feb 2026

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Abstract

Obesity is a major public health problem with a continuously increasing global prevalence and is associated with various chronic diseases and substantial social and economic burdens. As dietary modification and physical activity alone often have limited effectiveness in achieving sustained weight loss, dietary [...] Read more.

Obesity is a major public health problem with a continuously increasing global prevalence and is associated with various chronic diseases and substantial social and economic burdens. As dietary modification and physical activity alone often have limited effectiveness in achieving sustained weight loss, dietary supplements intended for weight reduction are widely used. However, evidence on the efficacy and safety of these supplements is inconsistent, and consumer use intentions tend to be driven by subjective beliefs and insurance-like perceptions. Accordingly, this study reviewed recent evidence on L-carnitine, green tea extract, glucomannan, and Garcinia cambogia, supplements for which weight loss effects have been proposed, to assess their efficacy and safety and to highlight the importance of supplement selection aligned with consumer use contexts. PubMed, MEDLINE, and Google Scholar databases were searched for studies published between 1 January 2020 and 10 October 2025. Although some studies have reported improvements in weight and metabolic indicators, consistent scientific evidence has not yet been established. This review emphasized the need for purpose-driven supplement selection that integrates efficacy, safety, usage context, and evidence level, and the importance of consumers’ critical information appraisal capacity, supported by structured information provision and education. Full article

(This article belongs to the Special Issue Nutritional Perspectives in Obesity Treatments)

16 pages, 1468 KB

Open AccessArticle

Temporal Dietary Patterns and Frailty in Korean Older Adults: Evening-Skewed and Morning–Evening Eating Patterns Associated with Frailty Risk

by Han Byul Jang, Sarang Jeong, Min-Ju Kim, Hyun-Joung Lim and Kyung Eun Lee

Nutrients 2026, 18(4), 701; https://doi.org/10.3390/nu18040701 - 22 Feb 2026

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Abstract

Background: Meal timing has emerged as a potential determinant of healthy aging; however, evidence linking temporal dietary patterns (TDPs) with frailty remains limited. We aimed to identify distinct TDPs among older adults and examine their associations with frailty and its components. Methods: In [...] Read more.

Background: Meal timing has emerged as a potential determinant of healthy aging; however, evidence linking temporal dietary patterns (TDPs) with frailty remains limited. We aimed to identify distinct TDPs among older adults and examine their associations with frailty and its components. Methods: In this cross-sectional study, 4184 adults aged ≥ 65 years from the Korea National Health and Nutrition Examination Survey (2016–2018) were analyzed. Temporal energy-intake trajectories from 24 h recalls were clustered using dynamic time warping-based kernel k-means. Frailty was defined using a modified Fried phenotype, and diet quality was assessed employing the Healthy Eating Index. Survey-weighted logistic regression and mediation analyses were performed. Results: Five distinct patterns were identified as follows: balanced (n = 1665, 38.8%), steady (n = 735, 17.8%), midday (n = 737, 18.0%), evening (n = 627, 15.2%), and morning–evening (n = 420, 10.2%). Among these, the evening-skewed (characterized by a disproportionate concentration of energy intake in the late evening; adjusted odds ratio [OR] = 1.48, 95% confidence interval [CI] = 1.03–2.10) and morning–evening (characterized by higher energy intake in both the morning and evening; OR = 1.43, 95% CI = 1.01–2.03) patterns were associated with higher frailty risk than the balanced pattern. Mediation analysis showed that higher total energy intake had a protective role in the evening-skewed pattern; however, this benefit was offset by the adverse impact of late-night eating, resulting in increased frailty risk. In the morning–evening pattern, both a direct association with frailty and an indirect pathway mediated by lower energy intake and poorer diet quality contributed to the increased frailty risk. Conclusions: Older adults with evening-skewed or morning–evening TDPs had greater frailty risk than those with balanced eating patterns. Optimizing meal timing—by reducing late-day energy loading and ensuring adequate overall intake and dietary quality—may represent a feasible chrono-nutrition strategy for frailty prevention. Full article

(This article belongs to the Section Geriatric Nutrition)

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22 pages, 679 KB

Open AccessReview

Therapeutic Potential and Mechanistic Pathways of Plant-Based Supplements and Exercise Training in Blood Pressure Management: An Evidence-Based Review and Research Agenda

by Behzad Taati, Georgian Badicu and Jolita Vveinhardt

Nutrients 2026, 18(4), 700; https://doi.org/10.3390/nu18040700 - 22 Feb 2026

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Abstract

Hypertension (HTN) remains a leading modifiable risk factor for cardiovascular disease, and non-pharmacological strategies combining exercise training with plant-derived bioactive supplementation are increasingly recognized as promising adjuncts for blood pressure (BP) management. This evidence-based review synthesizes findings from 31 clinical studies investigating selected [...] Read more.

Hypertension (HTN) remains a leading modifiable risk factor for cardiovascular disease, and non-pharmacological strategies combining exercise training with plant-derived bioactive supplementation are increasingly recognized as promising adjuncts for blood pressure (BP) management. This evidence-based review synthesizes findings from 31 clinical studies investigating selected plant-based supplements with the strongest available clinical evidence, namely beetroot juice (BRJ), green tea (GT), curcumin (CN), resveratrol (RSV), and garlic, administered alone or in combination with different exercise modalities across acute, short-term, and long-term interventions. Collectively, the evidence indicates that BRJ exerts the most consistent BP-lowering effects, particularly during aerobic training performed at ~50% heart rate reserve (HRR), or ~60% peak oxygen consumption (VO_2peak) in individuals with early-stage vascular dysfunction. CN and garlic also enhance exercise-induced BP reductions, especially in older or metabolically compromised populations. GT shows variable outcomes depending on caffeine content, exercise modality, and participant health status, while RSV provides modest vascular support, often contingent on concurrent training. Mechanistically, these botanicals and exercise converge on key vascular-regulatory pathways, including enhanced nitric oxide (NO) bioavailability, reduced oxidative stress and inflammation, attenuated renin–angiotensin–aldosterone system (RAAS) and sympathetic activity, and improved mitochondrial function through Sirtuin 1 (SIRT1)/AMP-activated protein kinase (AMPK) signaling. Together, these integrated mechanisms improve endothelial function, lower vascular resistance, and ultimately reduce BP. From a translational standpoint, combining exercise with targeted plant-based supplementation offers a safe, accessible, and physiologically synergistic strategy for BP control in clinical populations. Future research should define optimal dosing, timing relative to exercise, and population-specific efficacy to inform precision-based, integrative interventions for HTN management. Full article

(This article belongs to the Special Issue Nutrition and Exercise in the Prevention and Treatment of Chronic Diseases)

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19 pages, 352 KB

Open AccessReview

Nutritional Management of Irritable Bowel Syndrome

by Luigi Colecchia, Giovanni Marasco, David Meacci, Cesare Cremon, Alessandra Pivetti, Giulia Manni, Arianna Gobbato, Mira Xhuveli, Anna Rita Di Biase, Antonio Colecchia and Giovanni Barbara

Nutrients 2026, 18(4), 699; https://doi.org/10.3390/nu18040699 - 22 Feb 2026

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Abstract

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder characterized by recurrent abdominal pain and altered bowel habits that significantly impair patients’ quality of life. Dietary triggers of IBS symptoms are common, and consequently, diet-based treatments are often prescribed. We conducted a review [...] Read more.

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder characterized by recurrent abdominal pain and altered bowel habits that significantly impair patients’ quality of life. Dietary triggers of IBS symptoms are common, and consequently, diet-based treatments are often prescribed. We conducted a review of current evidence on dietary interventions for IBS, focusing specifically on the evaluation of the scientific rationale and effectiveness of the most commonly adopted diets. Clinical trials and guideline recommendations were analyzed to assess each diet’s efficacy in symptom relief and patient adherence. Traditional dietary advice, although not a structured diet, but rather a set of lifestyle and dietary recommendations, is commonly recommended as first-line therapy and provides a solid base for symptom improvement in almost half of patients with IBS. Conversely, the low-FODMAP diet is a strict dietary pattern characterized first by the exclusion and then by the gradual and personalized reintroduction of several foods. Several clinical trials have demonstrated the efficacy of a low-FODMAP diet in reducing global IBS symptoms, and due to the established evidence, it is now incorporated into many clinical guidelines as a second- or even first-line approach for patients with IBS. Limited data supports the starch- and sucrose-reduced diet as an option for symptom relief, with evidence stemming from the relatively recent finding of hypomorphic variants of the sucrose-isomaltase gene in a subset of patients with IBS. Nonetheless, its application in clinical practice is still very limited. Data on gluten-free diet is more controversial as although it may benefit a subset of patients with IBS, strong evidence is still lacking for identifying the best candidates for a restrictive diet with a high burden in terms of economical, psychological and social costs. Beyond exclusion diets, a few studies on the Mediterranean diet suggest it may be a potential option with benefits that go beyond IBS symptom relief. Overall, dietary modification can significantly alleviate IBS symptoms. Tailoring recommendations to individual patient triggers may further enhance outcomes. Full article

(This article belongs to the Section Nutritional Immunology)

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24 pages, 2910 KB

Open AccessArticle

Simulated Gastrointestinal Digestion Modulates Anticholinesterase, Antioxidant, and Anti-Inflammatory Activities of Vegan Soups Rich in Natural Cholinesterase Inhibitors

by Dorota Gajowniczek-Ałasa, Roman Paduch, Ewa Baranowska-Wójcik, Oskar M. Szczepaniak and Dominik Szwajgier

Nutrients 2026, 18(4), 698; https://doi.org/10.3390/nu18040698 - 21 Feb 2026

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Abstract

Background/Objectives: Dietary strategies targeting oxidative stress, neuroinflammation and cholinergic dysfunction are increasingly investigated as supportive approaches for maintaining cognitive health. Soups constitute a practical functional food matrix due to their compositional complexity and suitability for regular consumption. However, their bioactivity may be substantially [...] Read more.

Background/Objectives: Dietary strategies targeting oxidative stress, neuroinflammation and cholinergic dysfunction are increasingly investigated as supportive approaches for maintaining cognitive health. Soups constitute a practical functional food matrix due to their compositional complexity and suitability for regular consumption. However, their bioactivity may be substantially altered during digestion. Methods: Previously, we created optimized mushroom, asparagus, leek, and sea buckthorn vegan lunch soups rich in cholinesterase inhibitors. This study evaluated digestion-induced changes in anticholinesterase, antioxidant, and anti-inflammatory activities using a standardized static in vitro digestion model (INFOGEST). Results: Fresh soups contained 90.43–247.36 µg GAE/cm³ of total polyphenols, which significantly decreased during oral–intestinal digestion, followed by stabilization or partial recovery during the colonic phase. Acetylcholinesterase and butyrylcholinesterase inhibitory activities showed soup-specific and digestion stage-dependent patterns, with an overall decline after bacterial incubation. Antioxidant capacity assessed by DPPH^•, ABTS^•+, and cyclic voltammetry revealed dynamic redox shifts across digestion stages, while endogenous antioxidant enzymes (SOD, CAT, GR, GPx) and COX-2 activity were differentially modulated. Cell-based assays demonstrated low cytotoxicity and moderate, concentration-dependent cytokine modulation. Conclusions: Overall, gastrointestinal digestion and microbial activity markedly reshape the bioactivity of plant-based soups, indicating that the colonic phase is critical for realistic evaluation of functional food potential and supporting digestion-aware assessment of dietary strategies relevant to cognitive and inflammatory health. Full article

(This article belongs to the Special Issue Plant-Based Diets Regulate Antioxidant-Inflammatory Balance)

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18 pages, 1996 KB

Open AccessArticle

Immediate Effects of Brief Exposure to the Healthy Eating Plate on Adults’ Nutrition Knowledge: A Cross-Sectional Survey

by Justyna Malinowska, Magdalena Jodkiewicz and Karolina Marek-Woźny

Nutrients 2026, 18(4), 697; https://doi.org/10.3390/nu18040697 - 21 Feb 2026

Viewed by 927

Abstract

Introduction: The Healthy Eating Plate is a graphical presentation of Polish healthy eating recommendations introduced in 2020. This study evaluated the extent to which the model and its accompanying materials improve adults’ short-term recall and comprehension of healthy eating principles. Materials and Methods: [...] Read more.

Introduction: The Healthy Eating Plate is a graphical presentation of Polish healthy eating recommendations introduced in 2020. This study evaluated the extent to which the model and its accompanying materials improve adults’ short-term recall and comprehension of healthy eating principles. Materials and Methods: A cross-sectional online survey was conducted in Poland (19–30 September 2025) using the MNForce Poland research panel. The sample comprised 200 adults aged 18–65 years. Participants completed an author-developed questionnaire including demographics, a pretest, exposure to the Healthy Eating Plate and the “In 3 Steps to Health” material, an immediate post-test aligned thematically with the pretest, and items evaluating perceptions of the Healthy Eating Plate. Results: The overall knowledge index increased from 64.3% (SD 17.6) pre-exposure to 81.0% (SD 19.4) post-exposure, representing a 16.7 percentage-point improvement. This increase in short-term knowledge scores was statistically significant. The largest residual knowledge deficit concerned identifying the components of a balanced meal (38.0% correct post-test). The highest post-test performance was observed for recommendations on increasing whole-grain intake and reducing salt consumption to 5 g/day (both 91.5%). Baseline knowledge was associated with prior use of dietetic services and with self-assessed knowledge. Conclusions: Exposure to the Healthy Eating Plate and accompanying materials resulted in significant immediate improvements in recall and comprehension of healthy eating recommendations. These findings reflect short-term knowledge transfer under real-world dissemination conditions and should not be interpreted as evidence of sustained learning or behavioural impact, while highlighting the need to strengthen communication of the balanced-meal concept. Full article

(This article belongs to the Section Nutrition Methodology & Assessment)

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30 pages, 873 KB

Open AccessReview

Current Concepts in Probiotic Safety and Efficacy

by Alexey A. Churin, Ludmila O. Sokolyanskaya, Anastasia P. Lukina and Olga V. Karnachuk

Nutrients 2026, 18(4), 696; https://doi.org/10.3390/nu18040696 - 21 Feb 2026

Viewed by 315

Abstract

Background/Objectives: Advances in molecular biology, genetics, and microbiome research have significantly expanded our understanding of probiotic microorganisms and their interactions with human health, stimulating the development of both traditional and next-generation probiotic products. Although probiotics are widely used and generally considered safe [...] Read more.

Background/Objectives: Advances in molecular biology, genetics, and microbiome research have significantly expanded our understanding of probiotic microorganisms and their interactions with human health, stimulating the development of both traditional and next-generation probiotic products. Although probiotics are widely used and generally considered safe for healthy individuals, accumulating evidence indicates that their safety profile varies significantly depending on the strain, dose, host, and context, with rare but clinically significant adverse events reported in vulnerable populations. Methods: This review summarizes current knowledge on the efficacy and safety of probiotics, analyzes limitations in clinical safety reporting, and compares regulatory frameworks governing the use of probiotics as dietary supplements, medicinal products, and live biotherapeutics. Particular attention is given to new genomic and computational approaches to safety assessment. Conclusions: Overall, the review emphasizes the need for coordinated regulation, rigorous clinical evidence, and integrated, modern safety assessment strategies to support the responsible expansion of probiotic use. Full article

(This article belongs to the Section Prebiotics, Probiotics and Postbiotics)

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17 pages, 936 KB

Open AccessSystematic Review

Effectiveness of Whey Protein Supplementation in Weight Loss Interventions for Patients with Obesity: A Systematic Review

by Juan José López-Gómez, Beatriz Ramos-Bachiller, Daniel Rico-Bargues and Daniel A. De Luis-Román

Nutrients 2026, 18(4), 695; https://doi.org/10.3390/nu18040695 - 21 Feb 2026

Viewed by 1182

Abstract

Background: Obesity is traditionally defined by excess fat mass; however, the preservation of fat-free mass (FFM), particularly skeletal muscle, has gained increasing relevance due to its metabolic, endocrine, and functional roles. Weight loss interventions, including hypocaloric diets, pharmacological treatments, and bariatric surgery, [...] Read more.

Background: Obesity is traditionally defined by excess fat mass; however, the preservation of fat-free mass (FFM), particularly skeletal muscle, has gained increasing relevance due to its metabolic, endocrine, and functional roles. Weight loss interventions, including hypocaloric diets, pharmacological treatments, and bariatric surgery, are frequently associated with unintended loss of skeletal mass, increasing the risk of sarcopenic obesity and related complications. Objective: This study aimed to systematically evaluate the effectiveness of whey protein supplementation in preserving fat-free mass and muscle-related outcomes in adults with obesity undergoing weight loss interventions. Methods: A systematic review was conducted in accordance with PRISMA guidelines. Randomized controlled trials published in English were identified through searches of PubMed/MEDLINE, CENTRAL, Embase, Scopus, ClinicalTrials.gov, and WHO ICTRP, searched up to September 2025. Eligible studies included adults (>18 years) with obesity receiving whey protein supplementation as part of a hypocaloric diet, compared with placebo or standard interventions. Primary outcomes were changes in fat-free mass assessed by validated methods (DXA, BIA, MRI), while secondary outcomes included body weight, fat mass, metabolic parameters, adherence, and safety. Risk of bias was assessed using the Cochrane RoB 2.0 tool, and certainty of evidence was evaluated with GRADE. The abstract was registered in PROSPERO with code CRD420251069996. There was no funding and no conflicts of interest. Results: Fourteen randomized controlled trials were included. Whey protein supplementation generally supported the maintenance or modest improvement of fat-free mass, particularly when combined with resistance exercise or anabolic-enriched formulations such as leucine or vitamin D. Several trials, however, reported neutral effects, especially in the absence of structured physical activity. Overall, effect estimates ranged from small gains to null or uncertain differences, and the certainty of evidence was frequently downgraded due to limited sample sizes, wide confidence intervals, heterogeneity across interventions and assessment methods, short follow-up periods, and methodological limitations including open-label designs and inconsistent adherence monitoring. Conclusions: Whey protein supplementation may support fat-free mass preservation during weight loss in adults with obesity, particularly as part of a multimodal intervention. Further high-quality trials are needed to define optimal dosing strategies and target populations. Full article

(This article belongs to the Special Issue Diet and Nutrition in Bariatric Interventions)

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15 pages, 1285 KB

Open AccessArticle

Redox Water Consumption Attenuates Exercise-Induced Inflammation and Oxidative Stress in Physically Active Adults: A Randomized Controlled Trial

by Anna Stolecka-Warzecha, Tomasz Zając, Marcin Gandyk, Maciej Kostrzewa and Ewa Sadowska-Krępa

Nutrients 2026, 18(4), 694; https://doi.org/10.3390/nu18040694 - 21 Feb 2026

Viewed by 260

Abstract

Background: Acute high-intensity exercise induces transient inflammatory and oxidative stress responses, mediated by redox-sensitive signaling pathways and reflected by elevations in interleukin-6 (IL-6) and lipid peroxidation products. Modulation of these responses through hydration-based redox interventions remains insufficiently characterized at the biochemical level. Objective: [...] Read more.

Background: Acute high-intensity exercise induces transient inflammatory and oxidative stress responses, mediated by redox-sensitive signaling pathways and reflected by elevations in interleukin-6 (IL-6) and lipid peroxidation products. Modulation of these responses through hydration-based redox interventions remains insufficiently characterized at the biochemical level. Objective: This randomized controlled trial investigated whether regular consumption of redox (alkaline) water influences exercise-induced inflammatory and oxidative stress markers in physically active adults. Methods: Forty physically active adults were randomized into an experimental group (EG; n = 20) and consumed redox water subjected to molecular-level modification, yielding alkaline hydrogen-enriched water (pH 9.2–9.4), or a control group (CG; n = 20) that consumed standard water. After eight weeks of intervention, participants performed a standardized maximal aerobic exercise test. Plasma IL-6 and malondialdehyde (MDA) concentrations were measured at baseline and immediately post-exercise. Statistical analyses included two-way repeated measures ANOVA and ANCOVA. Results: A pronounced group × time interaction was observed for IL-6 (F(1,38) = 36.89, p < 0.001). The EG exhibited a significant post-exercise reduction in IL-6, whereas the CG demonstrated a robust increase. A significant group × time interaction was also detected for MDA (F(1,38) = 4.98, p = 0.029), reflecting stable lipid peroxidation levels in the EG and increased levels in the CG; however, baseline-adjusted analyses indicated that post-exercise MDA differences were largely attributable to initial variability. Hematological and coagulation parameters remained within physiological ranges in both groups. Conclusions: Redox water intake was associated with lower immediate post-exercise IL-6 compared with controls after baseline adjustment; however, pronounced baseline imbalance limits causal interpretation and warrants confirmation in larger trials with balanced inflammatory profiles. These findings highlight a potential biochemical mechanism linking hydration redox properties with inflammatory regulation during physical stress. Full article

(This article belongs to the Special Issue Molecular Insights in Sports Nutrition: Synergistic Mechanisms for Performance Optimization)

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29 pages, 2092 KB

Open AccessReview

Training–Fuel Coupling (TFC): A Molecular Sports Nutrition Framework for Energy Availability, Chrono-Nutrition, and Performance Optimization

by Mirela Stoian and Dan Cristian Mănescu

Nutrients 2026, 18(4), 693; https://doi.org/10.3390/nu18040693 - 21 Feb 2026

Viewed by 373

Abstract

In sports nutrition, performance adaptation emerges from the coordinated molecular interaction between physical training and nutrient availability. This narrative review with conceptual synthesis advances Training–Fuel Coupling (TFC) as a systems physiology framework that conceptualizes nutrient availability, timing, and recovery feeding as molecular control [...] Read more.

In sports nutrition, performance adaptation emerges from the coordinated molecular interaction between physical training and nutrient availability. This narrative review with conceptual synthesis advances Training–Fuel Coupling (TFC) as a systems physiology framework that conceptualizes nutrient availability, timing, and recovery feeding as molecular control variables proposed to govern exercise-induced adaptation. Integrating evidence from exercise metabolism and nutritional science, the model conceptualizes how substrate availability may modulate the dynamic crosstalk between AMP-activated protein kinase (AMPK) and mechanistic target of rapamycin (mTOR), shaping metabolic flexibility, anabolic recovery, and long-term performance optimization. Low-energy and low-glycogen contexts preferentially activate AMPK-dependent pathways supporting mitochondrial remodeling and oxidative efficiency, whereas nutrient-replete states facilitate mTOR-mediated protein synthesis and structural restoration. When strategically alternated through chrono-nutrition and nutritional periodization, these energetic states are hypothesized to generate oscillatory signaling patterns that enhance adaptive efficiency while limiting chronic metabolic strain. From a sports nutrition perspective, TFC provides a mechanistic rationale for energy availability management, recovery nutrition, and the prevention of maladaptive states such as Relative Energy Deficiency in Sport (RED-S). By reframing nutrients as regulatory signals rather than passive fuel, this framework integrates molecular nutrition with performance physiology, offering a unifying, systems-level and hypothesis-generating perspective on training–nutrition interactions that delineates testable pathways for future empirical investigation. Full article

(This article belongs to the Special Issue Molecular Insights in Sports Nutrition: Synergistic Mechanisms for Performance Optimization)

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15 pages, 478 KB

Open AccessArticle

Periconception Maternal Vitamin D Status on Nausea and Vomiting Symptoms in Early Pregnancy Among Women with a History of Pregnancy Loss

by Zeina M. Alkhalaf, Sunni L. Mumford, Enrique F. Schisterman, Robert M. Silver and Marie E. Thoma

Nutrients 2026, 18(4), 692; https://doi.org/10.3390/nu18040692 - 21 Feb 2026

Viewed by 237

Abstract

Background/Objectives: Sufficient preconception vitamin D may promote robust implantation and higher human chorionic gonadotropin (hCG) levels, potentially increasing nausea and vomiting in pregnancy. We assessed associations between maternal serum 25-hydroxyvitamin D (25(OH)D) at both preconception and 8 weeks’ gestation with nausea and vomiting [...] Read more.

Background/Objectives: Sufficient preconception vitamin D may promote robust implantation and higher human chorionic gonadotropin (hCG) levels, potentially increasing nausea and vomiting in pregnancy. We assessed associations between maternal serum 25-hydroxyvitamin D (25(OH)D) at both preconception and 8 weeks’ gestation with nausea and vomiting during early pregnancy. We hypothesized that women with sufficient vitamin D status or those who improved their levels in early gestation, would have higher odds of nausea and vomiting compared to women who were deficient or insufficient. Methods: This secondary analysis of the randomized EAGeR Trial included women with 1–2 prior pregnancy losses and 25(OH)D measured at preconception (n = 774) and 8 weeks’ gestation (N = 641). Nausea and vomiting were captured via medical records and daily symptom diaries. 25(OH)D was categorized as deficient (≤20 ng/mL), insufficient (21–29 ng/mL), or sufficient (≥30 ng/mL). Logistic regression and generalized estimating equations (GEE) estimated associations. Results: Women who improved from deficient/insufficient preconception to sufficient by 8 weeks had higher odds of nausea and vomiting in early pregnancy compared to those remaining sufficient (aOR: 1.71; 95% CI: 1.12, 2.61). Conversely, those remaining deficient/insufficient (aOR: 0.34; 95% CI: 0.20, 0.60) or declining to deficiency (aOR: 0.44; 95% CI: 0.22, 0.87) had lower odds. In longitudinal models, deficiency was associated with lower odds of daily vomiting (aOR: 0.54; 95% CI: 0.28, 1.04), though estimates were imprecise. Conclusion: Dynamic changes in vitamin D status from preconception to early pregnancy appear to be associated with nausea and vomiting in early pregnancy. Improvement of sufficiency increased emesis odds, while persistent deficiency correlated with fewer symptoms. These findings suggest vitamin D may be associated with nausea and vomiting through hormonal or placental signaling mechanisms in early gestation. Full article

(This article belongs to the Special Issue Nutrition, Diet and Metabolism in Pregnancy)

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19 pages, 923 KB

Open AccessReview

The Role of Dietary Fibers in the Management of Type 2 Diabetes: A Synthesis of Current Evidence and Clinical Implications

by Finta Hajnal, Ruța Florina, Avram Călin, Toncean Florentina Simona and Georgescu Mihai

Nutrients 2026, 18(4), 691; https://doi.org/10.3390/nu18040691 - 21 Feb 2026

Viewed by 447

Abstract

Type 2 diabetes (T2D) represents a major public health challenge, being associated with significant metabolic and cardiovascular complications. Evidence-based nutritional interventions are essential for the prevention and management of the disease. Dietary fibers, particularly soluble fibers such as psyllium, β-glucan, inulin, and fermentable [...] Read more.

Type 2 diabetes (T2D) represents a major public health challenge, being associated with significant metabolic and cardiovascular complications. Evidence-based nutritional interventions are essential for the prevention and management of the disease. Dietary fibers, particularly soluble fibers such as psyllium, β-glucan, inulin, and fermentable fiber blends, have demonstrated beneficial effects on glycemia, glycated hemoglobin (HbA1c), lipid profile, body weight, and medication requirements. This narrative review synthesizes the results of recent clinical trials and meta-analyses, highlighting the underlying physiological mechanisms, including colonic fermentation and short-chain fatty acid (SCFA) production, as well as the impact on gut microbiota composition. The findings support the integration of soluble fibers into a personalized dietary plan as part of a multidimensional strategy for T2D management. Further long-term randomized studies are warranted to standardize doses and assess the metabolic and microbiota-mediated effects of dietary fibers. Full article

(This article belongs to the Special Issue Dietary Regulation of Glucose and Lipid Metabolism in Diabetes)

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19 pages, 777 KB

Open AccessReview

Dietary Fiber in Endometriosis: Mechanisms, Evidence, and Potential Clinical Benefits—Up-to-Date Review

by Justyna Czerniak, Michał Ciebiera, Natalia Zeber-Lubecka and Piotr Olcha

Nutrients 2026, 18(4), 690; https://doi.org/10.3390/nu18040690 - 21 Feb 2026

Viewed by 399

Abstract

Background: Endometriosis is a chronic, estrogen-dependent inflammatory disorder. It is associated with hormonal dysregulation, pelvic pain, and a reduced quality of life. Dietary factors may influence disease development and symptom severity. Objective: This article aims to summarize current evidence on the role of [...] Read more.

Background: Endometriosis is a chronic, estrogen-dependent inflammatory disorder. It is associated with hormonal dysregulation, pelvic pain, and a reduced quality of life. Dietary factors may influence disease development and symptom severity. Objective: This article aims to summarize current evidence on the role of dietary fiber in endometriosis and to discuss the underlying biological mechanisms and clinical implications. Methods: A narrative review of the literature was conducted using peer-reviewed original research articles and review papers published in English. Studies examining dietary fiber intake, fiber-rich dietary patterns, and their associations with endometriosis risk, symptoms, estrogen metabolism, gut microbiota, and inflammation. Results: Observational studies suggest that higher dietary fiber intake, particularly from fruits, vegetables, and whole grains, may be associated with a reduced risk of endometriosis. Interventional evidence remains limited. However, available studies indicate that fiber-rich dietary patterns may contribute to pain reduction and improvements in quality of life. Conclusions: Current evidence suggests that dietary fiber may play a supportive role in the prevention and management of endometriosis through multiple interconnected biological pathways. Nevertheless, the limited number of high-quality interventional studies highlights the need for further well-designed clinical trials to clarify the therapeutic potential of fiber-rich diets as an adjunct to standard endometriosis care. Full article

(This article belongs to the Special Issue Nutrition, Dietary Patterns, and Biochemical Mechanisms in Endometriosis)

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14 pages, 903 KB

Open AccessArticle

Fasting-Induced Changes in Serum Kynurenines Do Not Always Reflect Their Urinary Excretion

by Zuzanna Margas, Andżelika Borkowska, Konrad Kowalski, Ulana Juhas, Joanna Reczkowicz, Jakub Kortas, Anna Pilis, Inga Cytrych, Ewa Ziemann and Jędrzej Antosiewicz

Nutrients 2026, 18(4), 689; https://doi.org/10.3390/nu18040689 - 20 Feb 2026

Viewed by 1123

Abstract

Background: The effects of fasting on serum kynurenines (KYNs) have been reported; however, no data are available on whether fasting also modifies their urinary excretion. Kidney organic anion transporters are involved in KYNs excretion, suggesting that changes in serum levels may result from [...] Read more.

Background: The effects of fasting on serum kynurenines (KYNs) have been reported; however, no data are available on whether fasting also modifies their urinary excretion. Kidney organic anion transporters are involved in KYNs excretion, suggesting that changes in serum levels may result from altered urinary elimination. Considering the important role of KYNs in regulating various physiological processes, it is crucial to understand the factors that determine their blood concentrations. The present study aimed to determine the effect of an 8-day fasting period on the concentrations of KYNs in both serum and urine. Methods: Thirteen participants underwent an 8-day fast. The exercise test was performed at baseline after an overnight fast and after 8 days of fasting. Results: Fasting increased the serum concentrations of 3-hydroxykynurenine (3-HK), anthranilic acid (AA), picolinic acid (PA), kynurenic acid (KYNA), and xanthurenic acid (XANA). Conversely, serum kynurenine (KYN) and quinolinic acid (QA) decreased, while 3-hydroxyanthranilic acid (3-HAA) remained unchanged. In urine, KYN, 3-HK, XANA and QA increased after fasting, whereas AA and PA did not change. Conclusions: In conclusion, these findings indicate that fasting generally increases serum kynurenines (KYNs), which are associated with enhanced urinary excretion, suggesting that fasting may stimulate their synthesis. In the case of anthranilic acid (AA) and picolinic acid (PA), their increase in serum does not influence their urinary excretion. Conversely, a decrease in serum KYN and quinolinic acid (QA) may result from enhanced urinary excretion. Full article

(This article belongs to the Special Issue The Interplay Between Nutrition, Fasting, and Metabolic Health)

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11 pages, 223 KB

Open AccessArticle

Oxidative Balance Score Is Associated with Social Involvement and Weight-Adjusted Appendicular Skeletal Muscle Mass in Middle-Aged and Older Japanese Women

by Tamami Odai, Masakazu Terauchi, Yuka Enokuchi and Naoyuki Miyasaka

Nutrients 2026, 18(4), 688; https://doi.org/10.3390/nu18040688 - 20 Feb 2026

Viewed by 166

Abstract

Background: The oxidative balance score (OBS) is an indicator for assessing total oxidant status. This cross-sectional study aimed to investigate the relationships between OBS and factors associated with well-being among middle-aged and elderly women. Methods: Dietary habits, lifestyle factors, and factors associated with [...] Read more.

Background: The oxidative balance score (OBS) is an indicator for assessing total oxidant status. This cross-sectional study aimed to investigate the relationships between OBS and factors associated with well-being among middle-aged and elderly women. Methods: Dietary habits, lifestyle factors, and factors associated with well-being, including physical, mental, and social health, were assessed based on the first-visit medical records in 385 Japanese women. The OBS was calculated using pro-oxidant factors (fat, saturated fatty acids, n-6 polyunsaturated fatty acids, iron, alcohol, smoking, body mass index, and waist circumference) and antioxidant factors (zinc, vitamins C, E, A, n-3 polyunsaturated fatty acids, genistein, and exercise). Results: After adjusting for age, menopausal status, and background factors, social engagement and weight-adjusted appendicular skeletal muscle mass (ASM/Wt) were found to be significantly associated with OBS (social involvement, odds ratio = 0.882, 95% confidence interval [CI] = 0.817–0.949, p = 0.001; ASM/Wt, odds ratio = 0.983, 95% CI = 0.974–0.990, p < 0.001). Conclusions: Higher oxidative stress was associated with a low level of social involvement and ASM/Wt. These findings indicate that oxidative balance is linked to social and physical aspects of well-being among middle-aged and older women. However, because of the cross-sectional design, causal relationships cannot be inferred, and the possibility of reverse causation should be considered. Full article

(This article belongs to the Section Clinical Nutrition)

10 pages, 309 KB

Open AccessArticle

Long-Term Efficacy of Limosilactobacillus reuteri DSM17938 in the Prevention of Functional Abdominal Pain Disorders

by Flavia Indrio, Antonio Di Mauro, Giacomo Perrone, Annamaria Greco, Simona Filoni, Enea Vincenzo Napolitano and Luca Pecoraro

Nutrients 2026, 18(4), 687; https://doi.org/10.3390/nu18040687 - 20 Feb 2026

Viewed by 272

Abstract

Introduction: Pediatric Functional Gastrointestinal Disorders (FGIDs), including infantile colic and constipation, may persist into later childhood and adulthood, sometimes manifesting as functional abdominal pain (FAP). Early exposure to probiotics during critical developmental windows may influence long-term susceptibility to disease. Background/Objectives: Building on our [...] Read more.

Introduction: Pediatric Functional Gastrointestinal Disorders (FGIDs), including infantile colic and constipation, may persist into later childhood and adulthood, sometimes manifesting as functional abdominal pain (FAP). Early exposure to probiotics during critical developmental windows may influence long-term susceptibility to disease. Background/Objectives: Building on our original randomized controlled trial, which demonstrated that Lactobacillus reuteri DSM 17938 reduced acute infantile FGID symptoms, a 10-year follow-up study was performed to evaluate whether this early intervention provided lasting protection against FAP in childhood. Methods: Two hundred participants from the original RCT cohort completed follow-up assessments at age ten. The primary outcome was the presence of FAP, analyzed according to the original randomization group (probiotic vs placebo). FAP was diagnosed at age 10 using the Rome IV criteria, based on a standardized clinical assessment by a pediatric gastroenterologist who was blinded to the original allocation. Results: FAP was diagnosed in 13/99 (13.1%) children in the probiotic group and 81/101 (80.2%) in the placebo group, corresponding to an absolute risk reduction of 67.1% (95% CI 56.8–77.3) and a relative risk of 0.16 (95% CI 0.10–0.27) (p < 0.001). Conclusions: Early supplementation with L. reuteri DSM 17938 was associated with a markedly lower prevalence of FAP at age 10. However, the long-term follow-up was observational and characterized by a 57.2% attrition rate. In addition, longitudinal data on potential confounders were unavailable; therefore, the findings should be interpreted as an association rather than proof of causality. Full article

(This article belongs to the Section Prebiotics, Probiotics and Postbiotics)

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23 pages, 1066 KB

Open AccessArticle

Developing an Empirical Theory of Planned Behavior Model of Healthy Dietary Choice and Evaluating Gamified Feedback Among Japanese Young Adults

by Yutaka Akitsu, Yoko Yamakata and Eiji Yamasue

Nutrients 2026, 18(4), 686; https://doi.org/10.3390/nu18040686 - 20 Feb 2026

Viewed by 304

Abstract

Background/Objectives: Dietary behaviors among young adults in Japan have become increasingly polarized, highlighting the limitations of traditional knowledge-based health education. Behavioral science-based approaches such as nudging and gamification may offer alternative strategies. This study aimed to develop and examine a Theory of Planned [...] Read more.

Background/Objectives: Dietary behaviors among young adults in Japan have become increasingly polarized, highlighting the limitations of traditional knowledge-based health education. Behavioral science-based approaches such as nudging and gamification may offer alternative strategies. This study aimed to develop and examine a Theory of Planned Behavior (TPB)-based path model of healthy dietary choice behavior among young Japanese adults and to examine patterns associated with a star-rating gamification feature embedded in a nutrition management mobile application. Methods: A total of 188 participants aged 18–39 years completed an online survey assessing TPB constructs and normative factors. Participants used either a star-rating or non-rating version of the FoodLog Athl application. Composite-score-based path analysis and conditional process analyses were conducted to examine relational patterns among constructs. Results: Intention and self-efficacy jointly explained 48% of the variance in dietary behavior, with self-efficacy emerging as the strongest predictor. Several moderation patterns were observed, including those of gender, university year, diet app use, awareness of consequences, and ascription of responsibility. Compared with users of the non-rating version, star-rating users were observed to show higher nutrient scores but lower self-efficacy and dietary behavior scores, along with greater awareness of dietary consequences. These post-intervention findings are exploratory. Conclusions: Self-efficacy plays a central role in healthy dietary choice behavior among young adults, and its association with behavior appears to be shaped by perceived consequences and responsibility. By applying a composite-score-based path analysis within an SEM framework, this study clarifies the structural relationships among TPB components in everyday dietary choice behavior among Japanese young adults. Star-rating feedback may enhance reflective awareness and shows potential as a gamified nudging tool but further research is needed to clarify its effects. Full article

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

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41 pages, 1174 KB

Open AccessReview

Obesity, Bariatric Surgery, and Cancer Risk: Nutritional Perspectives and Long-Term Clinical Implications

by Claudia Reytor-González, Gerardo Sarno, Martha Montalvan, Ludovica Verde, Giuseppe Annunziata, Luigi Barrea, Giovanna Muscogiuri and Daniel Simancas-Racines

Nutrients 2026, 18(4), 685; https://doi.org/10.3390/nu18040685 - 20 Feb 2026

Viewed by 489

Abstract

Obesity is recognized as a causal risk factor for the development of multiple cancers, with risk magnitude varying by tumor site, sex, life stage, and adipose tissue distribution. This narrative review synthesizes recent epidemiological evidence linking excess body fatness with cancer incidence and [...] Read more.

Obesity is recognized as a causal risk factor for the development of multiple cancers, with risk magnitude varying by tumor site, sex, life stage, and adipose tissue distribution. This narrative review synthesizes recent epidemiological evidence linking excess body fatness with cancer incidence and mortality and integrates the biological mechanisms that explain this association. Chronic low-grade inflammation, insulin resistance with compensatory hyperinsulinemia, dysregulation of adipose-derived hormones and sex steroids, impairment of anti-tumor immune responses, alterations in the gut microbiota, and remodeling of the tumor microenvironment collectively create conditions that favor tumor initiation and progression. Bariatric surgery is the most effective clinical intervention for achieving substantial and sustained weight loss in individuals with severe obesity, and growing evidence indicates that it is associated with a reduction in overall cancer risk and cancer-related mortality, particularly for malignancies strongly linked to obesity. However, the extent of this benefit differs by surgical technique and remains less consistent for colorectal cancer. Beyond metabolic improvements, bariatric surgery produces long-term changes in nutritional physiology that may also influence oncologic outcomes. Persistent deficiencies of micronutrients such as iron, folate, vitamin B12, vitamin D, and calcium can affect DNA synthesis, methylation, oxidative balance, and cellular repair. Altered protein and energy intake may contribute to loss of lean mass and reduced metabolic resilience, while changes in alcohol absorption and metabolism can increase systemic exposure to ethanol and its carcinogenic metabolites. In addition, bariatric surgery induces sustained remodeling of the gut microbiome and bile acid metabolism, which may further modulate tumorigenic signaling. Overall, the oncological impact of bariatric surgery reflects a balance between metabolic improvement and long-term nutritional management, underscoring the need for structured follow-up and targeted nutritional strategies to optimize cancer risk reduction. Full article

(This article belongs to the Section Nutrition and Obesity)

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15 pages, 1386 KB

Open AccessSystematic Review

Adherence to the EAT-Lancet Diet and Its Association with Depression and Anxiety: A Systematic Review and Meta-Analysis of Observational Studies

by Ke-Hong Fang, Ye Lv, Xu-Hui Zhang, Hui Liu, Bing-Zhong Zhai, Yuan Yao, Tian Hu and Hong Xu

Nutrients 2026, 18(4), 684; https://doi.org/10.3390/nu18040684 - 20 Feb 2026

Viewed by 295

Abstract

Background/Objectives: High-quality diets are increasingly recognized as a promising strategy for alleviating mental health problems. This study aimed to evaluate the association between adherence to the EAT-Lancet diet (ELD) and depression and anxiety using a systematic review and meta-analysis of observational studies. Methods: [...] Read more.

Background/Objectives: High-quality diets are increasingly recognized as a promising strategy for alleviating mental health problems. This study aimed to evaluate the association between adherence to the EAT-Lancet diet (ELD) and depression and anxiety using a systematic review and meta-analysis of observational studies. Methods: A comprehensive literature search of PubMed, Web of Science, and Embase was conducted. Two independent reviewers screened titles, abstracts, and full texts and extracted data, with any discrepancies resolved by consensus. Results: Ultimately, eight unique studies (10 comparisons) met the predefined inclusion criteria. Adjusted effect estimates (odds ratios (ORs) or hazard ratios (HRs)) and corresponding 95% confidence (95%CI) intervals were extracted and pooled using random-effects meta-analysis. Between-study heterogeneity was quantified with the I² statistic. Compared with the lowest ELD adherence, the highest adherence was associated with a lower risk of depression (OR = 0.78, 95% CI 0.73–0.85; I² = 85.0%); a similar inverse association was observed for anxiety (OR = 0.83, 95% CI 0.79–0.86; I² = 0%) and the co-occurrence of depression and anxiety (HR = 0.76, 95% CI 0.68–0.85; I² = 0%). Conclusions: Our findings indicate that, compared with low adherence, high adherence to the ELD is associated with beneficial effects on mental health and may inform dietary recommendations for the early prevention and intervention of depression, anxiety, and their co-occurrence. Full article

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

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27 pages, 2418 KB

Open AccessReview

Prebiotics and Synbiotics in Asthma: An Integrative Review of Human Trials and Murine Meta-Analysis

by Louise C. Bonnard, Graham R. Sharpe, Matthew Martin, Georgina F. Dodd and Neil C. Williams

Nutrients 2026, 18(4), 683; https://doi.org/10.3390/nu18040683 - 20 Feb 2026

Viewed by 254

Abstract

Background/Objectives: The objectives of this study were to systematically review the literature on the effects of prebiotics and synbiotics on asthma control, lung function and asthma-associated inflammation from murine and human trials. Methods: A systematic review was performed following the PRISMA guidelines across [...] Read more.

Background/Objectives: The objectives of this study were to systematically review the literature on the effects of prebiotics and synbiotics on asthma control, lung function and asthma-associated inflammation from murine and human trials. Methods: A systematic review was performed following the PRISMA guidelines across multiple databases. A meta-analysis was performed on murine trials assessing asthma-associated inflammation and airway hyperresponsiveness, whilst a narrative review of human studies assessed asthma control, lung function, and inflammation. Results: Seventeen studies met the eligibility criteria for inclusion; eleven murine studies were included for meta-analysis and six human studies were for narrative review. The meta-analysis revealed significant effects of prebiotics and synbiotics on multiple markers of asthma-associated inflammation. Prebiotic intervention significantly reduced airway hyperresponsiveness (AHR) and type 2 cytokines (IL-4, IL-5, IL-13) and various cell counts, including neutrophil, macrophage, lymphocyte, eosinophil, and total bronchoalveolar (BALF). Synbiotics were also effective in reducing type 2 cytokines, including, IL-4, IL-5, IL-13, and lymphocytes, eosinophils, and total BALF cell count. A narrative review of human intervention trials of prebiotics and/or synbiotics revealed improvements in lung function, asthma control, and systemic and airway inflammation. Conclusions: This review indicates that dietary prebiotics and synbiotics may be suitable adjunct treatments to support asthma management, but further well-controlled human RCTs are required. Full article

(This article belongs to the Section Prebiotics, Probiotics and Postbiotics)

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14 pages, 391 KB

Open AccessArticle

Effects of a Text Message-Based Lifestyle Intervention on HbA1c and Health Behaviors in Older Adults with Prediabetes

by Jung Hun Lee, Hee Jin Kim and Kang Hyun Lee

Nutrients 2026, 18(4), 682; https://doi.org/10.3390/nu18040682 - 20 Feb 2026

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Abstract

Background/Objectives: Prediabetes (PD) does not always progress to type 2 diabetes; however, lifestyle modification and weight loss are recommended to prevent disease progression. This study aimed to determine whether a text message-based intervention for older adults with PD in South Korea could reduce [...] Read more.

Background/Objectives: Prediabetes (PD) does not always progress to type 2 diabetes; however, lifestyle modification and weight loss are recommended to prevent disease progression. This study aimed to determine whether a text message-based intervention for older adults with PD in South Korea could reduce glycated hemoglobin (HbA1c) levels and promote healthy habits. Methods: A randomized controlled trial with two parallel groups was conducted and approved by the Institutional Review Board of Wonju Severance Christian Hospital (IRB No: CR321379). A text message intervention was provided only to the intervention group for six months, while the control group was advised to maintain their usual daily routines. The text messages covered the following categories: nutrition, exercise, medical knowledge, lifestyle, and self-reflective thoughts. Results: A total of 96 participants aged 50 years and older underwent clinical measurements, completed the Korean Health Habits Questionnaire, and were assessed for quality of life at baseline and after the intervention. HbA1c, waist circumference, and fasting blood glucose decreased significantly in both groups (p < 0.05). The intervention group demonstrated significant improvements in body mass index, low-density lipoprotein cholesterol, total cholesterol, and milk consumption. In contrast, instant food consumption increased significantly in the control group, resulting in significant between-group differences (p < 0.05). In addition, the frequency of late-night eating increased significantly within the control group (p < 0.05). Conclusions: Text message-based interventions may serve as an effective adjunctive self-management strategy to improve HbA1c levels and promote healthy habits in older adults with prediabetes. Full article

(This article belongs to the Special Issue The Role of Nutrition, Physical Activity, and Alternative Therapies in Diabetes and Obesity)

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27 pages, 964 KB

Open AccessReview

Cross-Cultural Nutritional Epigenomics: Diet and Microbiome Interactions Shaping Type 2 Diabetes in Arab and Western Populations

by Tarek Arabi, Arshiya Akbar, Ahmed Yaqinuddin, Mohammed Imran Khan and Itika Arora

Nutrients 2026, 18(4), 681; https://doi.org/10.3390/nu18040681 - 20 Feb 2026

Viewed by 345

Abstract

In the Middle East and North Africa (MENA) region, the prevalence of Type 2 Diabetes (T2D) is 17–18%, substantially higher than the ~9–10% reported in Western populations, with some Gulf states approaching 25% in adults. Historically, Arab diets, characterized by high fiber intake [...] Read more.

In the Middle East and North Africa (MENA) region, the prevalence of Type 2 Diabetes (T2D) is 17–18%, substantially higher than the ~9–10% reported in Western populations, with some Gulf states approaching 25% in adults. Historically, Arab diets, characterized by high fiber intake from whole grains, legumes, and fermented dairy products, have contrasted markedly with the Western dietary pattern increasingly prevalent among urbanized Arab populations. These nutritional shifts have been associated with changes in gut microbial composition, including lower representation of short-chain fatty acid–producing bacteria and higher abundance of dysbiosis-associated taxa. Concurrently, diet-derived compounds and microbial metabolites have been associated with changes in DNA methylation, histone modifications, and non-coding RNA expression. Epigenome-wide association studies revealed both shared and population-specific methylation signatures in patients with T2D. However, integrated multi-omics studies remain limited in Arab populations, where the disease burden is highest. This review integrates emerging evidence on diet-linked epigenetic alterations, microbiome-associated metabolic pathways, and their intersection in potentially contributing to T2D risk and progression. Given the heterogeneity of T2D across populations, there is a pressing need for culturally contextualized precision medicine frameworks that integrate population-specific diet–microbiome–epigenome dynamics rather than extrapolating findings across populations. Additionally, this review synthesizes evidence that dietary patterns are associated with T2D-relevant pathways through the diet–microbiome–epigenome axis, with emphasis on Arab/MENA populations and Western comparator cohorts. Full article

(This article belongs to the Section Nutrigenetics and Nutrigenomics)

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Nutrients, Volume 18, Issue 4 (February-2 2026) – 160 articles

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