Nutrients

22 pages, 959 KB

Open AccessReview

Obesity Phenotyping in Children and Adolescents: Next Steps Towards Precision Medicine in Pediatric Obesity

by Leslie Saba, Andres J. Acosta, Aaron S. Kelly and Seema Kumar

Nutrients 2026, 18(2), 303; https://doi.org/10.3390/nu18020303 (registering DOI) - 18 Jan 2026

Pediatric obesity is an increasingly prevalent, chronic, and multifactorial disease. Achieving successful and sustained weight reduction with current interventions remains challenging due to significant heterogeneity in treatment response. This review summarizes current evidence describing variability in outcomes across lifestyle, pharmacologic, and metabolic/bariatric surgery [...] Read more.

Pediatric obesity is an increasingly prevalent, chronic, and multifactorial disease. Achieving successful and sustained weight reduction with current interventions remains challenging due to significant heterogeneity in treatment response. This review summarizes current evidence describing variability in outcomes across lifestyle, pharmacologic, and metabolic/bariatric surgery interventions in children and adolescents, and examines key biological, metabolic, behavioral, environmental, and psychosocial factors that influence response. In adults, recent findings on energy balance obesity phenotypes (characterized by abnormal satiation, abnormal postprandial satiety, abnormal hedonic eating, and reduced energy expenditure) have demonstrated promise in predicting weight loss outcomes and guiding tailored interventions. However, data on obesity phenotyping within children and adolescents remain limited. Addressing this gap is essential for advancing precision medicine approaches in pediatric obesity, with the potential to improve treatment selection, enhance effectiveness, and optimize long-term clinical outcomes. Full article

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

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23 pages, 2154 KB

Open AccessArticle

Does Previous Anaphylaxis Determine Differences Between Patients Undergoing Oral Food Challenges to Cow’s Milk and Hen’s Egg?

by Liliana Klim, Maria Michalik, Paweł Wąsowicz, Ewa Cichocka-Jarosz and Urszula Jedynak-Wąsowicz

Nutrients 2026, 18(2), 302; https://doi.org/10.3390/nu18020302 (registering DOI) - 18 Jan 2026

Abstract

Background: Oral food challenges (OFCs) are still the reference standard for confirming food allergy, yet the influence of previous anaphylaxis on challenge outcomes remains uncertain. Patients with a history of anaphylaxis are often considered at higher risk, which may affect the clinical decision-making [...] Read more.

Background: Oral food challenges (OFCs) are still the reference standard for confirming food allergy, yet the influence of previous anaphylaxis on challenge outcomes remains uncertain. Patients with a history of anaphylaxis are often considered at higher risk, which may affect the clinical decision-making process. This study aimed to identify predictors of OFC failure stratified by a history of anaphylaxis, given that prior investigations have predominantly considered anaphylaxis as an overall risk factor, without delineating distinct risk factor profiles according to anaphylaxis history. Methods: We conducted a retrospective evaluation of standard-of-care pediatric OFCs to cow’s milk and hen’s egg white. Eligible children had suspected or confirmed IgE-mediated allergy to cow’s milk protein (CMP) or hen’s egg white protein (HEWP) and were stratified by the presence or absence of previous anaphylaxis to the challenged food. Clinical data were compared between groups. Open OFCs were conducted under inpatient supervision with full emergency support. Logistic regression models were used to assess the relationship between comorbidities, specific IgE (sIgE) concentrations and OFC outcomes. Receiver operating characteristic (ROC) analysis evaluated diagnostic accuracy of sIgE concentrations in predicting OFC outcomes. Results: The analysis included 192 pediatric patients undergoing OFCs: 106 to CMP and 86 to HEWP. Six challenges (3.1%) were inconclusive, giving 186 valid results. The overall OFC failure rate was 32.3%. Patients with a past history of anaphylaxis more frequently underwent cow’s milk challenges (p = 0.01). Atopic dermatitis was a more common comorbidity in those without prior anaphylaxis (p = 0.04), regardless of the trigger. In hen’s egg challenges, children with a history of anaphylaxis reacted to significantly lower cumulative doses (p = 0.03) than patients without. Atopic dermatitis was identified as a predictor of OFC failure in children without prior anaphylaxis (p = 0.02), and asthma as a borderline predictor in those with previous systemic reactions (p = 0.05). Specific IgE concentrations correlated with OFC outcomes across allergens, with casein-sIgE showing the highest discriminative performance (AUC = 0.81) in children without previous anaphylaxis. Conclusions: Atopic dermatitis and asthma were identified as potential risk factors influencing OFC outcomes, depending on the patient’s history of anaphylaxis. The predictive accuracy of sIgE was different in groups stratified by presence of prior anaphylaxis, and the relationship between sIgE concentration and clinical reactivity was not identical across the two subpopulations. Casein-sIgE showed the highest diagnostic accuracy in children without previous severe reactions to CMP. Presence of anaphylactic reactions in the past is an important consideration when selecting children for OFCs to CMP and HEWP, since it delineates distinct risk factors for challenge failure in these patient populations. Full article

(This article belongs to the Special Issue Dietary Strategies and Mechanistic Insights in Pediatric Allergies)

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20 pages, 1683 KB

Open AccessArticle

Effects of Rosmarinic Acid and Sinapic Acid on the Skeletal System in Ovariectomized Rats

by Maria Zych, Radosław Wolan, Agnieszka Włodarczyk, Piotr Londzin, Weronika Borymska, Ilona Kaczmarczyk-Żebrowska and Joanna Folwarczna

Nutrients 2026, 18(2), 301; https://doi.org/10.3390/nu18020301 (registering DOI) - 18 Jan 2026

Abstract

Background/Objectives: It is believed that some polyphenols, including phenolic acids, may counteract estrogen deficiency-induced bone loss, decreasing oxidative stress. Moreover, some phenolic acids—among others, rosmarinic acid and sinapic acid—have been reported to increase the serum estradiol concentration in rats. The study aimed [...] Read more.

Background/Objectives: It is believed that some polyphenols, including phenolic acids, may counteract estrogen deficiency-induced bone loss, decreasing oxidative stress. Moreover, some phenolic acids—among others, rosmarinic acid and sinapic acid—have been reported to increase the serum estradiol concentration in rats. The study aimed to investigate the impact of rosmarinic acid and sinapic acid on the skeletal system of rats with estrogen deficiency induced by bilateral ovariectomy. Methods: The study was carried out on mature female rats, divided into sham-operated control rats, ovariectomized (OVX) control rats, and OVX rats treated with estradiol (0.2 mg/kg; positive control), rosmarinic acid (10 and 50 mg/kg), or sinapic acid (5 and 25 mg/kg). The compounds were administered orally for 4 weeks. Serum bone turnover markers, bone mass, mineral and calcium content, macrometric and histomorphometric parameters, as well as mechanical properties were examined. Results: Estrogen deficiency induced osteoporotic changes in ovariectomized control rats, which were slightly counteracted by the administration of estradiol. The phenolic acids slightly counteracted some changes caused by estrogen deficiency, but their administration at higher doses led to further worsening of cancellous bone quality. Conclusions: The results demonstrated that administration of high doses of rosmarinic acid or sinapic acid slightly unfavorably affected the rats’ skeletal system under conditions of estrogen deficiency. Full article

(This article belongs to the Special Issue Harnessing Nature’s Power: Antioxidants and Anti-Inflammatory Natural Compounds in Health and Disease)

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14 pages, 558 KB

Open AccessArticle

Alteration in Amino Acid Metabolism After Isocaloric, Energy-Restricted Ketogenic Diet in Women with Overweight and Obesity: Randomized KETO-MINOX Trial

by Natalia Drabińska-Fois, Anna Majcher, Paweł Jagielski, Sebastian Borowicz-Skoneczny and Jerzy Romaszko

Nutrients 2026, 18(2), 300; https://doi.org/10.3390/nu18020300 (registering DOI) - 18 Jan 2026

Abstract

Background/Objectives: Circulating amino acid concentrations and their excretion can provide insights into dietary protein intake and metabolism. Alterations in amino acid homeostasis occur in various disorders due to nutritional imbalances or metabolic changes, including obesity. A ketogenic diet (KD) has gained popularity [...] Read more.

Background/Objectives: Circulating amino acid concentrations and their excretion can provide insights into dietary protein intake and metabolism. Alterations in amino acid homeostasis occur in various disorders due to nutritional imbalances or metabolic changes, including obesity. A ketogenic diet (KD) has gained popularity for weight management; however, its metabolic effects are not fully known. Therefore, the aim of this study was to evaluate the effect of an eight-week, energy-restricted Mediterranean-type KD on the amino acid metabolism in women with overweight and class I obesity. Methods: A randomized, single-center, controlled trial was conducted with 80 women with a BMI of 25.5–35 in age between 18 and 45 years, without any chronic diseases. Randomly divided women received food catering with approximately 1750 kcal daily for eight weeks, containing KD or standard diet (STD), respectively. The concentration of amino acids was assessed by gas chromatography-mass spectrometry after the derivatization with chloroformate in serum and urine collected at the baseline, after 4 weeks, and at the end of the intervention. Results: The results collected from 66 participants were included in the final analyses. Independent of diet type, weight reduction was associated with increased circulating α-aminobutyric acid and decreased proline, glutamate, and tyrosine. The KD led to lower concentrations of alanine, methionine, threonine, and tryptophan, alongside higher levels of branched-chain amino acids (BCAA) and α-aminobutyric acid compared to the STD. Urinary amino acid excretion decreased after weight reduction. KD was associated with higher urinary excretion of BCAA and β-aminoisobutyric acid. Conclusions: In summary, both weight reduction and KD significantly affect the amino acid metabolism, which might have implications for inflammation, oxidative stress, and cardiometabolic risk. Full article

(This article belongs to the Special Issue The Effects of Ketogenic Diet on Human Health and Disease)

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21 pages, 567 KB

Open AccessArticle

Diet and Lifestyle Factors Associated with Gastrointestinal Symptoms in Spanish Adults: Cross-Sectional Analysis of the 2023 Spanish National Health Survey

by Ángel López-Fernández-Roldán, Víctor Serrano-Fernández, José Alberto Laredo-Aguilera, Esperanza Barroso-Corroto, Laura Pilar De Paz-Montón and Juan Manuel Carmona-Torres

Nutrients 2026, 18(2), 299; https://doi.org/10.3390/nu18020299 (registering DOI) - 17 Jan 2026

Abstract

Background/Objectives: Digestive problems are common in the general population and may be influenced by lifestyle, emotional status and diet. This study aimed to estimate the prevalence of digestive problems in Spanish adults and examined associated factors. Methods: Descriptive cross-sectional analysis of [...] Read more.

Background/Objectives: Digestive problems are common in the general population and may be influenced by lifestyle, emotional status and diet. This study aimed to estimate the prevalence of digestive problems in Spanish adults and examined associated factors. Methods: Descriptive cross-sectional analysis of anonymized adult microdata from the 2023 Spanish Health Survey was performed. Data were collected using a mixed-mode design (self-administered web questionnaire with interviewer-administered follow-up). Digestive problems were recoded by combining gastric ulcer, constipation, and prescribed use of laxatives, astringent drugs, and stomach medication. Therefore, digestive problems are primarily defined as the presence of gastric ulcers, diarrhea, and/or constipation. Variables included sociodemographic, Body Mass Index (BMI), smoking, alcohol intake, physical activity, Personal Health Questionnaire Depression Scale (PHQ-8), World Health Organization Well Being Index (WHO-5), and macronutrient intake estimated from a Food-Frequency Questionnaire using the Spanish Food Composition Database (BEDCA). Group comparisons and multivariable logistic regression were conducted (95% CI; significance level set at p < 0.05). Results: Of 34,148 participants, 13,518 provided information on digestive problems; among these respondents, 3860 (28.6%) reported having digestive issues. Prevalence ranged from 5.2% to 36.5% among national territories. Higher odds (OR) of digestive problems were associated with age (OR 1.026, 95% CI 1.023–1.029), female sex (OR 1.168, 1.070–1.276), non-smoking (OR 1.240, 1.005–1.531) and ex-smoking (OR 1.447, 1.272–1.647) compared to current smokers, higher PHQ-8 scores (OR 1.040, 1.029–1.051), greater protein intake (OR 1.016, 1.009–1.023), consumption of sweet pastries (OR 1.058, 1.039–1.077), and dairy products (OR 1.027, 1.002–1.053); in contrast, lower odds were associated with higher WHO-5 scores (OR 0.985, 0.982–0.987), total fiber intake (OR 0.968, 0.949–0.987), and legume consumption (OR 0.894, 0.856–0.933). Conclusions: Digestive problems show considerable variability in prevalence among survey-based Spanish sample. Digestive problems were associated with older age, female sex, depressive symptoms, high-protein intake, and higher consumption of sweet pastries and dairy products, whereas higher well-being scores, higher fiber intake and legume consumption were associated with lower odds of digestive problems. Full article

(This article belongs to the Special Issue Nutrition-Based Counseling and Interventions for Chronic Disease Prevention)

21 pages, 3394 KB

Open AccessArticle

Bacillus amyloliquefaciens BA5 Attenuates Carbon Tetrachloride-Induced Hepatotoxicity in Mice

by Yuanyuan He, Feiran Li, Yangrui Li, Mengen Xu, Chuxian Quan, Shah Nawaz, Md. F. Kulyar, Mudassar Iqbal and Jiakui Li

Nutrients 2026, 18(2), 298; https://doi.org/10.3390/nu18020298 (registering DOI) - 17 Jan 2026

Abstract

Background: The association between liver disease and gut microbiota is being widely investigated. Probiotics, such as Bacillus amyloliquefaciens, are among the most notable microbiomes examined in this study. Bacillus amyloliquefaciens shows potential for promoting growth and effectively regulating gut microbiota, though its [...] Read more.

Background: The association between liver disease and gut microbiota is being widely investigated. Probiotics, such as Bacillus amyloliquefaciens, are among the most notable microbiomes examined in this study. Bacillus amyloliquefaciens shows potential for promoting growth and effectively regulating gut microbiota, though its mechanism of action remains unclear. Methods: The early gavage administration of Bacillus amyloliquefaciens BA5 conferred protection against liver injury in carbon tetrachloride (CCl₄)-induced mice. Growth parameters (body weight and organ index), serum biochemical markers (ALT, AST, T-SOD, MDA, GSH-Px, and T-AOC), liver and jejunum histopathology, and gut microbiota composition were comprehensively evaluated. Results: BA5 supplementation restored serum T-AOC, T-SOD, and GSH-Px levels and attenuated CCl₄-induced increases in ALT, AST, and MDA, suggesting potent anti-oxidant properties. Furthermore, histopathologic assessment showed that CCl₄-induced mice developed acute liver injury and intestinal villi were destroyed, while the BA5 group restored the pathological changes in the tissues to the normal group level. In addition, immunohistochemical staining revealed that BA5 increased the expression level of Claudin-1 which was a key biomarker for assessing the integrity of epithelial/endothelial barriers. Regarding gut microbiota, BA5 significantly enhanced the abundance of beneficial bacteria (Lactobacillus) and decreased the abundance of hazardous bacteria (Fusobacterium, Lachnoclostridium, Phascolarctobacterium, and Escherichia–shigella) caused by CCl₄. Notably, BA5 alone remarkably increased gut microbial diversity compared with that of the Control group. Conclusions: Overall, these findings suggest that BA5 holds promise as a potential therapeutic agent for alleviating CCl₄-induced acute liver injury in mice by mitigating oxidative stress and modulating gut microbiota. Full article

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

31 pages, 425 KB

Open AccessReview

Recent Research on the Role of Lactobacilli Probiotics in Cancer Management

by See-Hyoung Park

Nutrients 2026, 18(2), 297; https://doi.org/10.3390/nu18020297 (registering DOI) - 17 Jan 2026

Abstract

Lactobacilli strains are one of the major groups belonging to probiotics. Lactobacilli strains are known to be beneficial microbes widely studied and utilized for their health benefits and applications in various fields. Recently, Lactobacilli strains have emerged as promising agents in cancer management [...] Read more.

Lactobacilli strains are one of the major groups belonging to probiotics. Lactobacilli strains are known to be beneficial microbes widely studied and utilized for their health benefits and applications in various fields. Recently, Lactobacilli strains have emerged as promising agents in cancer management due to their ability to influence various physiological processes. Lactobacilli strains have shown potential in producing tumor-suppressive compounds, enhancing immune responses, and reshaping gut microbiota balance for the management of various cancer types. Lactobacilli strains demonstrated tumor-suppressive activity through mechanisms including induction of apoptosis, inhibition of migration, and regulation of key oncogenic signaling pathways. However, the effects of Lactobacilli strains appear to be strain- and cancer-type-dependent, necessitating further research to identify the most effective strains for the proper cancer type with the optimal treatment regimens. In this review article, we focus on Lactobacilli strains studied between 2021 and 2025 that have demonstrated tumor-suppressive properties in various experimental models. In addition, this article explores the current limitations in research methodologies and proposes potential avenues for future investigations in this area of study. Full article

(This article belongs to the Special Issue Prebiotics, Probiotics, and Gut Microbiota with Chronic Disease (2nd Edition))

33 pages, 1456 KB

Open AccessReview

Relevance and Safe Utilization of Amino Acids in Supplements for Human Nutrition: Lessons from Clinical and Preclinical Studies

by François Blachier

Nutrients 2026, 18(2), 296; https://doi.org/10.3390/nu18020296 (registering DOI) - 17 Jan 2026

Abstract

Amino acid availability is central for the synthesis of macromolecules and numerous bioactive compounds. Amino acids are also involved in ATP production, cell signaling, and the epigenetic regulation of gene expression in human cells. From clinical and experimental studies, it appears that supplementation [...] Read more.

Amino acid availability is central for the synthesis of macromolecules and numerous bioactive compounds. Amino acids are also involved in ATP production, cell signaling, and the epigenetic regulation of gene expression in human cells. From clinical and experimental studies, it appears that supplementation with specific amino acids may be relevant to correct for amino acid deficiency in the case of insufficient supply from dietary proteins with regards to the amounts needed for optimal metabolism and physiological functions. Clinical and experimental arguments suggest that amino acid supplementation may be indicated in specific situations under a specific nutritional context. However, it is essential not to overdose with excessive quantities of amino acids in supplements beyond the upper levels of safe intake (ULSI). In this narrative review, I recapitulate the protein and amino acid requirements for the general population and for subgroups of the population, and these requirements are compared to the usual consumption. Typical examples of clinical trials showing the benefits from amino acid supplementation in different physiological and pathophysiological contexts are presented together with results obtained from experimental studies. Parameters such as the no-observed-adverse-effect-level (NOAEL) values used to determine the ULSI for amino acid supplementation are defined, and values determined in clinical trials are given and discussed. Finally, prospects for future research in the field are proposed. Full article

(This article belongs to the Special Issue Relevance and Safe Utilization of Amino Acids in Dietary Supplements)

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11 pages, 684 KB

Open AccessArticle

Deceptive Caffeine Shows Limited Impact on Short-Term Neuromuscular Performance

by Fernando Valero, Christian José Viudez, Sergio De la Calle, Fernando González-Mohíno and Juan José Salinero

Nutrients 2026, 18(2), 295; https://doi.org/10.3390/nu18020295 (registering DOI) - 17 Jan 2026

Abstract

Background: Deceptive caffeine ingestion has shown inconsistent effects as an ergogenic aid for short-term exercises. Objective: Therefore, the aim of this study was to evaluate the potential placebo effect of deceptive caffeine ingestion on short-term performance during countermovement and repeated-jump tests, as [...] Read more.

Background: Deceptive caffeine ingestion has shown inconsistent effects as an ergogenic aid for short-term exercises. Objective: Therefore, the aim of this study was to evaluate the potential placebo effect of deceptive caffeine ingestion on short-term performance during countermovement and repeated-jump tests, as well as bench press throw and bench press-to-failure assessments, and to document any associated side effects. Methods: A repeated, randomized, and counterbalanced design was implemented to compare the effects of ingesting a placebo claimed to be caffeine with a control condition in which no substance was consumed. Twenty-five physically active young adults (17 men and 8 women) completed a countermovement jump (CMJ) test, a 15 s repeated-jump test, bench press throws at 25%, 50%, and 75% of 1RM, and a bench press-to-failure test at 75% of 1RM and also completed a questionnaire regarding potential side effects. Results: Performance was similar between the placebo and control in the CMJ (38.1 ± 6.8 vs. 37.5 ± 6.8 cm; p = 0.225; d = 0.25) and in the 15 s repeated-jump test (p > 0.05; trivial–small effects). In the bench press throw, propulsive mean velocity did not differ at 25% 1RM (p = 0.296; d = 0.23) or 50% 1RM (p = 0.626; d = 0.10). However, deceptive caffeine ingestion increased propulsive mean velocity at 75% 1RM (0.500 ± 0.131 vs. 0.480 ± 0.131 m/s; p = 0.024; d = 0.48) and increased repetitions to failure at the same load (11.9 ± 3.7 vs. 11.0 ± 3.1; p = 0.047; d = 0.42). Mean velocity during the first 3 repetitions tended to be higher with the placebo (p = 0.064; d = 0.39), while final repetitions were similar (p = 0.469; d = 0.15). The most common side effects were increased activeness (34.8%) and nervousness (17.4%). Conclusions: In summary, deceptive caffeine ingestion had minimal impact on jump and ballistic bench press performance in physically active individuals. However, repetitions to failure were improved by ≈1 repetition (+8.2%). These findings suggest that the placebo effect of caffeine is unlikely to serve as a reliable strategy for enhancing short-term exercise performance. Full article

(This article belongs to the Special Issue Dietary Supplements’ Impact on Sport Performance and Health Outcomes)

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10 pages, 410 KB

Open AccessArticle

Accommodating Celiac Disease in Higher Education: Evidence-Informed National Recommendations

by Vanessa Weisbrod, Meghan Donnelly McKeon, Emma Kowzun, Marilyn Grunzweig Geller, Jackie Jossen, Marisa Gallant Stahl, Maureen M. Leonard, Mary Shull, Janis Arnold, Jennifer Kumin, Sharon Weston, Anne R. Lee, Mary Vargas, Dale Lee, Allyson West, Catherine Raber, Katherine Vera Sachs and Ritu Verma

Nutrients 2026, 18(2), 294; https://doi.org/10.3390/nu18020294 (registering DOI) - 16 Jan 2026

Abstract

Objectives: We aimed to develop expert-informed recommendations for colleges and universities to support students with celiac disease (CeD) managing a gluten-free (GF) diet. Methods: A multidisciplinary panel of 40 stakeholders, including physicians, dietitians, a disability rights attorney, university staff, and students, was convened [...] Read more.

Objectives: We aimed to develop expert-informed recommendations for colleges and universities to support students with celiac disease (CeD) managing a gluten-free (GF) diet. Methods: A multidisciplinary panel of 40 stakeholders, including physicians, dietitians, a disability rights attorney, university staff, and students, was convened by the Celiac Disease Foundation to create expert-based and experience-informed recommendations. Over a 6-month period, the group conducted literature reviews, stakeholder interviews, and expert consensus discussions to identify common barriers and accommodations aligned with federal disability law. The expert panel collaboratively developed and revised an initial set of recommendations. Two rounds of structured voting were held during which panelists provided feedback to refine content and ensure clarity. All final recommendations were adopted with at least 90% of panelists voting in support. Results: The panel identified 24 accommodations across four domains: academics, housing, dining, and campus life. Academic recommendations include flexibility for illness-related absences, support for remote learning, and classroom modifications. Housing recommendations emphasize access to priority placement, appropriate appliances, and proximity to safe dining. Dining accommodations address GF food availability, ingredient transparency, staff training, and meal plan flexibility. Campus life recommendations ensure full participation in athletics, study abroad, social events, and internships, with supports for psychosocial well-being. Conclusions: This manuscript presents the first expert-informed recommendations focused specifically on the needs of college students with CeD. These recommendations are intended to support institutions as they develop strategies to enhance access to GF food, quality of life, educational supports, and student experience for those living with this chronic autoimmune condition. Full article

(This article belongs to the Special Issue The Implications of Celiac Disease and the GFD on Health Outcomes)

13 pages, 1377 KB

Open AccessArticle

Can Vending Machines Promote Healthy Eating? Evidence from a Hospital Intervention

by Urška Rozman, Anja Kac, Miha Lavrič and Sonja Šostar Turk

Nutrients 2026, 18(2), 293; https://doi.org/10.3390/nu18020293 (registering DOI) - 16 Jan 2026

Abstract

Background/Objectives: Vending machines in hospitals offer convenient access to snacks and beverages for employees, visitors, and patients. However, their contents are typically energy-dense and nutritionally poor, which can potentially reinforce unhealthy eating habits. This study aimed to evaluate the impact of introducing healthier [...] Read more.

Background/Objectives: Vending machines in hospitals offer convenient access to snacks and beverages for employees, visitors, and patients. However, their contents are typically energy-dense and nutritionally poor, which can potentially reinforce unhealthy eating habits. This study aimed to evaluate the impact of introducing healthier vending machine options on purchasing behaviour and consumer perceptions in a hospital setting. Methods: An interventional study was conducted at a university clinical centre in Slovenia. Sales data were collected from a standard vending machine and a pilot machine stocked with healthier products over two 14-day periods. Additionally, a consumer survey assessed factors influencing purchasing decisions and opinions on the healthier offerings. Results: The proportion of healthy items purchased increased from 22% to 39% in the pilot vending machine, indicating a positive shift toward healthier choices. However, total sales declined by 18.81%, suggesting consumer hesitation toward the new product mix. Survey results identified price, ingredients, and visual appeal as the primary factors influencing purchase decisions. Conclusions: The introduction of healthier vending machine options can promote better food choices in hospital environments, though challenges remain regarding consumer acceptance and sales performance. Expanding the variety of healthy items and adopting more competitive pricing strategies may enhance uptake. Further long-term research is needed to assess the sustainability of such interventions and their broader impact on hospital food environments. Full article

(This article belongs to the Special Issue Adopting Sustainable Dietary Patterns: Effects of Food Labeling, Food Choices, and Eating Behaviors (2nd Edition))

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19 pages, 1443 KB

Open AccessArticle

Exploratory Study of Soft Drink Intake, Diet, and Body Size Among Employees at a Japanese University Aged 20–39

by Mioko Ito, Kanako Deguchi, Kiyomi Kaito, Risako Yamamoto-Wada, Chihiro Ushiroda, Hiroyuki Naruse and Katsumi Iizuka

Nutrients 2026, 18(2), 292; https://doi.org/10.3390/nu18020292 - 16 Jan 2026

Abstract

Background: Studies outside Japan have linked sugar-sweetened beverage (SSB) intake with weight gain; however, evidence in Japanese adults is scarce, and no study has examined beverage-derived energy in relation to anthropometric indices and handgrip strength. Methods: The participants were employees of Fujita Health [...] Read more.

Background: Studies outside Japan have linked sugar-sweetened beverage (SSB) intake with weight gain; however, evidence in Japanese adults is scarce, and no study has examined beverage-derived energy in relation to anthropometric indices and handgrip strength. Methods: The participants were employees of Fujita Health University aged 20–39 years (n = 76; male n = 35, average age: 29.97 ± 4.67 years; female n = 41, average age: 27.29 ± 4.53 years). Energy from beverage intake was assessed via the Brief Beverage Intake Questionnaire-15, and energy from alcoholic drinks, milk, SSBs, and total beverages was calculated. The associations of energy from different beverages with nutrient intake, BMI, skeletal muscle mass index (SMI), and handgrip strength were analyzed via ordinary least squares (OLS) regression; quantile regression (QR) and the generalized additive model (GAM) were used for sensitivity analyses. Results: Increased SSB intake was associated with increased BMI (standardized β = 0.35, 95% CI 0.12–0.58, p(OLS) < 0.001; p(QR) = 0.23; p(GAM) < 0.001) and was nonlinearly associated with increased SMI (standardized β = 0.21, 95% CI 0.043–0.37, p(OLS) = 0.02; p(QR) = 0.11; p(GAM) = 0.02), even after adjustment for total energy intake. Modest milk intake was linked to higher protein intake and a higher SMI without a higher BMI (standardized β = 0.18, 95% CI 0.020–0.35, p(OLS) = 0.03; p(QR) = 0.39; p(GAM) = 0.03). Conclusions: A positive association was found between SSB intake and both BMI and SMI and between MILK intake and SMI. Clarification in larger, diverse Japanese populations will be necessary. Full article

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

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24 pages, 1452 KB

Open AccessArticle

Safranal-Standardized Saffron Extract Improves Metabolic, Cognitive, and Anxiolytic Outcomes in Aged Mice via Hypothalamic–Amygdalar Peptide Modulation

by Juan A. Navarro, Ana Gavito, Sonia Rivas, Alonso Rodríguez-Martín, Elena Baixeras, Juan Decara, Pedro J. Serrano-Castro, Yolanda Alfonso, Carlos Sanjuan, Antonia Serrano and Fernando Rodríguez de Fonseca

Nutrients 2026, 18(2), 291; https://doi.org/10.3390/nu18020291 - 16 Jan 2026

Abstract

Background: Population aging increases susceptibility to cognitive decline, anxiety, and metabolic dysregulation, yet safe and effective interventions remain limited. Saffron (Crocus sativus L.) has been traditionally used to enhance mood and cognition, and its main metabolites, crocins and safranal, exert neuroprotective, [...] Read more.

Background: Population aging increases susceptibility to cognitive decline, anxiety, and metabolic dysregulation, yet safe and effective interventions remain limited. Saffron (Crocus sativus L.) has been traditionally used to enhance mood and cognition, and its main metabolites, crocins and safranal, exert neuroprotective, anxiolytic, and metabolic effects. However, variability in extract composition and frequent adulteration hinder reproducibility. Objectives: To clarify the efficacy of genuine saffron preparations in aging, we investigated a saffron extract standardized for safranal and crocin content (SSE). Methods: Safranal bioavailability was first characterized in rats, followed by an evaluation of behavioral, neuroendocrine, and metabolic outcomes after 35 days of oral SSE administration (25 or 200 mg/kg/day) in 25-month-old male C57BL/6 mice. Behavioral performance was assessed using open field and novel object recognition tests, while molecular analyses targeted neuropeptides in the hypothalamus and amygdala, hippocampal plasticity markers, cortical inflammatory proteins, and hepatic lipid metabolism genes. Results: SSE administration induced a rapid but transient increase in the plasma’s safranal, confirming its bioavailability. In aged mice, the low dose prevented age-related weight loss and modulated hepatic lipid metabolism, whereas the high dose reduced anxiety-like behavior and improved recognition memory. The anxiolytic effects are consistent with elevated hypothalamic Npy, an anxiolytic peptide, reduced amygdalar Crh, a key mediator of stress and anxiety, and decreased hypothalamic Hcrt, an arousal modulator. The improvement in memory is associated with modulation of the cortical and hippocampal inflammatory and endocannabinoid proteins involved in neural plasticity. Conclusions: These findings highlight content-standardized saffron extracts as a promising multi-target nutraceuticals for healthy aging. Full article

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28 pages, 840 KB

Open AccessReview

Personalized Nutrition Through the Gut Microbiome in Metabolic Syndrome and Related Comorbidities

by Julio Plaza-Diaz, Lourdes Herrera-Quintana, Jorge Olivares-Arancibia and Héctor Vázquez-Lorente

Nutrients 2026, 18(2), 290; https://doi.org/10.3390/nu18020290 - 16 Jan 2026

Abstract

Background: Metabolic syndrome, a clinical condition defined by central obesity, impaired glucose regulation, elevated blood pressure, hypertriglyceridemia, and low high-density lipoprotein cholesterol across the lifespan, is now a major public health issue typically managed with lifestyle, behavioral, and dietary recommendations. However, “one-size-fits-all” [...] Read more.

Background: Metabolic syndrome, a clinical condition defined by central obesity, impaired glucose regulation, elevated blood pressure, hypertriglyceridemia, and low high-density lipoprotein cholesterol across the lifespan, is now a major public health issue typically managed with lifestyle, behavioral, and dietary recommendations. However, “one-size-fits-all” recommendations often yield modest, heterogeneous responses and poor long-term adherence, creating a clinical need for more targeted and implementable preventive and therapeutic strategies. Objective: To synthesize evidence on how the gut microbiome can inform precision nutrition and exercise approaches for metabolic syndrome prevention and management, and to evaluate readiness for clinical translation. Key findings: The gut microbiome may influence cardiometabolic risk through microbe-derived metabolites and pathways involving short-chain fatty acids, bile acid signaling, gut barrier integrity, and low-grade systemic inflammation. Diet quality (e.g., Mediterranean-style patterns, higher fermentable fiber, or lower ultra-processed food intake) consistently relates to more favorable microbial functions, and intervention studies show that high-fiber/prebiotic strategies can improve glycemic control alongside microbiome shifts. Physical exercise can also modulate microbial diversity and metabolic outputs, although effects are typically subtle and may depend on baseline adiposity and sustained adherence. Emerging “microbiome-informed” personalization, especially algorithms predicting postprandial glycemic responses, has improved short-term glycemic outcomes compared with standard advice in controlled trials. Targeted microbiome-directed approaches (e.g., Akkermansia muciniphila-based supplementation and fecal microbiota transplantation) provide proof-of-concept signals, but durability and scalability remain key limitations. Conclusions: Microbiome-informed personalization is a promising next step beyond generic guidelines, with potential to improve adherence and durable metabolic outcomes. Clinical implementation will require standardized measurement, rigorous external validation on clinically meaningful endpoints, interpretable decision support, and equity-focused evaluation across diverse populations. Full article

(This article belongs to the Special Issue Personalized Nutrition, Gut Microbiome, Metabolic Syndrome and Related Comorbidities)

12 pages, 450 KB

Open AccessReview

Exploring Vitamin E’s Role in Colorectal Cancer Growth Using Rodent Models: A Scoping Review

by Nuraqila Mohd Murshid, Jo Aan Goon and Khaizurin Tajul Arifin

Nutrients 2026, 18(2), 289; https://doi.org/10.3390/nu18020289 - 16 Jan 2026

Abstract

Background: Vitamin E has been studied for its role in reducing the growth of colorectal cancer (CRC). CRC is a worldwide health concern. A meta-analysis reported that CRC patients have a lower concentration of serum vitamin E, suggesting it to be a risk [...] Read more.

Background: Vitamin E has been studied for its role in reducing the growth of colorectal cancer (CRC). CRC is a worldwide health concern. A meta-analysis reported that CRC patients have a lower concentration of serum vitamin E, suggesting it to be a risk factor. Although rodent models are widely used in disease research, their application in studying vitamin E as a preventive or therapeutic agent in CRC is not well characterized. To address this gap, we conducted a scoping review to examine the available evidence, adhering to the PRISMA-ScR checklist. Methods: We searched PubMed, Google Scholar, Scopus, and Web of Science (WoS) for full-text English original articles published before May 2024, using Medical Subject Headings (MeSH) terms and free text. The following search string strategy was applied: (Vitamin E OR tocopherol$ OR tocotrienol$) AND (Colo$ cancer OR colo$ carcinoma) AND (Rodentia OR mouse OR Rodent$ OR mice OR murine OR rats OR guinea OR rabbit OR hamsters OR Animal model OR Animal testing OR animals) AND (neoplasm$ OR “tumor mass” OR tumor volume OR tumor weight OR tumor burden). Data were charted into five categories using a standardized, pretested form. The charted data were synthesized using descriptive and narrative methods. Conclusions: This study highlights that γ- and δ-tocopherols, as well as δ-tocotrienol and its metabolites, were reported to reduce tumor volume and formation in various rodent models. While these results are promising, this scoping review identifies a need for further research to address translational barriers such as dosing, bioavailability, and long-term safety before clinical application. Full article

(This article belongs to the Special Issue Vitamin/Mineral Intake and Dietary Quality in Relation to Cancer Risk)

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17 pages, 1694 KB

Open AccessArticle

Mid-Term Changes in Quality of Life and Nutritional Habits Following Gastric Bypass: A 24-Month Follow-Up Study

by María Antonia Martínez-Sánchez, Inmaculada Ros-Madrid, Virginia Esperanza Fernández-Ruiz, Rosario Paloma Cano-Mármol, Juan José Hernández-Morante, María Ángeles Núñez-Sánchez, Andrés Balaguer-Román, María Dolores Frutos-Bernal, Antonio José Ruiz-Alcaraz, María Isabel Queipo-Ortuño, Mercedes Ferrer-Gómez and Bruno Ramos-Molina

Nutrients 2026, 18(2), 288; https://doi.org/10.3390/nu18020288 - 16 Jan 2026

Abstract

Background/Objectives: Obesity is an increasingly concerning public health issue due to its high prevalence and its association with multiple comorbidities. A significant proportion of patients with obesity who undergo bariatric surgery could exhibit suboptimal mid-term outcomes. This study aims to comprehensively assess anthropometric, [...] Read more.

Background/Objectives: Obesity is an increasingly concerning public health issue due to its high prevalence and its association with multiple comorbidities. A significant proportion of patients with obesity who undergo bariatric surgery could exhibit suboptimal mid-term outcomes. This study aims to comprehensively assess anthropometric, clinical, biochemical, nutritional, and quality of life parameters in patients with severe obesity undergoing bariatric surgery, with a particular focus on outcomes at 24 months post-surgery to capture mid-term effects that may not be apparent during the first year of follow-up. Methods: A prospective study was conducted in 95 patients with obesity undergoing bariatric surgery (Roux-en Y gastric bypass; RYGB) at the Virgen de la Arrixaca University Clinical Hospital (Murcia, Spain) between 2020 and 2023. Participants were followed up at 6, 12, and 24 months after RYGB. The study incorporated anthropometric assessments (BMI, body composition via bioelectrical impedance), full biochemical profiling, dietary analysis (using a validated food frequency questionnaire), and quality of life assessment (SF-36 questionnaire). Results: Our results showed significant weight loss after the intervention, accompanied by improvements in metabolic parameters, and dietary habits. Regarding quality of life, significant improvements were observed in both the physical (baseline: 39.62%; 6 months: 52.40%; 12 months: 53.12%) and mental components (baseline: 42.08; 6 months: 53.40; 12 months: 52.14%) at 6 and 12 months post-surgery. However, our prospective 24-month follow-up revealed that, despite these initial benefits, mental health significantly declined compared with the 12-month follow-up (24 months: 46.85%). In contrast, the physical component remained relatively stable at 24 months (24 months: 50.91%). However, our prospective 24-month follow-up revealed that, despite these initial benefits, there was a decline in mental health compared to the 12-month follow-up. Conclusions: While bariatric surgery is associated with improvements in anthropometric measures and some aspects of quality of life, our findings underscore the need for continued mid-term support to address emerging challenges in mental well-being. Full article

(This article belongs to the Special Issue Nutritional Management and Obesity Resolution Through Bariatric Surgery)

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16 pages, 738 KB

Open AccessArticle

Real-World Evidence of Growth Improvement in Children 1 to 5 Years of Age Receiving Enteral Formula Administered Through an Immobilized Lipase Cartridge

by Alvin Jay Freeman, Elizabeth Reid, Terri Schindler, Thomas J. Sferra, Barbara Bice, Ashley Deschamp, Heather Thomas, David P. Recker and Ann E. Remmers

Nutrients 2026, 18(2), 287; https://doi.org/10.3390/nu18020287 (registering DOI) - 16 Jan 2026

Abstract

Background/Objectives: RELiZORB immobilized lipase cartridge (ILC) is a single-use digestive enzyme cartridge that connects in-line with enteral feeding circuits to hydrolyze triglycerides in enteral formulas. It is cleared by the FDA for pediatric and adult use. Limited data have been published regarding the [...] Read more.

Background/Objectives: RELiZORB immobilized lipase cartridge (ILC) is a single-use digestive enzyme cartridge that connects in-line with enteral feeding circuits to hydrolyze triglycerides in enteral formulas. It is cleared by the FDA for pediatric and adult use. Limited data have been published regarding the effect of ILC use on growth in children younger than 5 years of age. Methods: We performed a retrospective evaluation of real-world data extracted from a third-party reimbursement program database. All patients in the program database who initiated ILC use with enteral formula when 1 to 4 years of age between 2019 and 2023 were included. Baseline and follow-up weight, height/length, and body mass index (BMI) data were collected for up to 12 months. Results: A total of 186 patients from 90 clinics in the United States were included. A subset (143 patients) with baseline and follow-up growth measurements was included in the efficacy analysis population; 76% were diagnosed with cystic fibrosis. Mean weight and BMI z-scores improved significantly (0.63 [p < 0.001] and 0.53 [p = 0.006], respectively) from baseline to 12 months after initiation of ILC use. Significant improvement in the mean weight z-score was observed after 3 months. Among people with cystic fibrosis (pwCF) who initiated ILC use when 2 to 4 years of age, those with a BMI ≥ 50th percentile increased from 22% at baseline to 43% after 12 months (p = 0.021). Improvement in weight-for-length was also observed in 1-year-old pwCF. Conclusions: Real-world evidence showed that initiation of ILC use was associated with significant improvements in mean weight and BMI z-scores among young children. Full article

(This article belongs to the Section Pediatric Nutrition)

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13 pages, 737 KB

Open AccessArticle

Risk Factors for Postnatal Growth Faltering and Undernutrition at Discharge in Very Preterm Infants: A Retrospective Study Applying the ESPGHAN Consensus Definitions

by Isadora Beghetti, Dalila Magno, Ettore Benvenuti, Arianna Aceti and Luigi Tommaso Corvaglia

Nutrients 2026, 18(2), 286; https://doi.org/10.3390/nu18020286 - 16 Jan 2026

Abstract

Background: Postnatal growth failure in very preterm infants remains a major concern in neonatal care and clinical management is complicated by the lack of a standardized definition. This study aims to identify risk factors for growth faltering (GF) and undernutrition (UN) at hospital [...] Read more.

Background: Postnatal growth failure in very preterm infants remains a major concern in neonatal care and clinical management is complicated by the lack of a standardized definition. This study aims to identify risk factors for growth faltering (GF) and undernutrition (UN) at hospital discharge, defined according to the latest consensus definitions established by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). Methods: We conducted a retrospective observational study of 416 preterm infants (gestational age < 32 weeks and/or birth weight < 1500 g). Growth was monitored using the Intergrowth 21st standards. In line with ESPGHAN criteria, GF was defined longitudinally as a weight for age (WFA) z-score decline ≥ 1 SD from birth, while UN was defined cross-sectionally as a WFA or length for age z-score < −2 SD at discharge. Logistic regression models were used to determine independent predictors for both growth phenotypes. Results: At discharge, the prevalence of GF and UN was 45.3% and 33.1%, respectively. In infants born without growth restriction (GR), UN was almost entirely driven by GF (89.7%). In contrast, 85.5% of infants born with GR remained undernourished at discharge. Multivariate analysis identified bronchopulmonary dysplasia and higher maximal postnatal weight loss as major independent risk factors for GF, while female sex and human milk feeding at discharge were associated with a lower risk of GF. For infants born with adequate weight, maternal hypertension, extremely low birth weight, and the co-occurrence of GF were the strongest predictors of UN. Conclusions: Nearly half of very preterm infants experience significant growth impairment before discharge. By assessing the dynamic process of GF and the static endpoint of UN, we identified distinct clinical trajectories. Standardized ESPGHAN criteria allow for the identification of high-risk “phenotypes”—particularly those with GR at birth or severe neonatal morbidity—enabling more targeted and intensive nutritional management during the critical developmental window. Full article

(This article belongs to the Section Pediatric Nutrition)

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13 pages, 693 KB

Open AccessArticle

Adherence to the Mediterranean Diet Is a Strong Predictor of Glycemic and Lipidemic Control in Adults with Type 2 Diabetes: An Observational Study from a Tertiary Hospital in Greece

by Aristeidis Vavitis, Ioanna A. Anastasiou, Dimitris Kounatidis, Eleni Rebelos and Nikolaos Tentolouris

Nutrients 2026, 18(2), 285; https://doi.org/10.3390/nu18020285 - 16 Jan 2026

Abstract

Background/Objectives: Type 2 diabetes (T2D) is a chronic metabolic disorder closely linked to cardiovascular disease and obesity and notably influenced by lifestyle and dietary patterns. The Mediterranean diet has well-established benefits across multiple cardiometabolic risk factors, including those relevant to diabetes. This [...] Read more.

Background/Objectives: Type 2 diabetes (T2D) is a chronic metabolic disorder closely linked to cardiovascular disease and obesity and notably influenced by lifestyle and dietary patterns. The Mediterranean diet has well-established benefits across multiple cardiometabolic risk factors, including those relevant to diabetes. This study aimed to investigate the degree to which adults with T2D adhere to a Mediterranean dietary pattern and to examine how such adherence relates to glycemic and lipidemic regulation. Methods: This cross-sectional study included 100 adults with T2D (54 men and 46 women). Adherence to the Mediterranean diet was assessed using the Mediterranean Diet Score (MDS). Demographic, anthropometric, lifestyle, and clinical data were collected, and glycemic and lipid parameters were analyzed. Associations between Mediterranean diet adherence and metabolic outcomes were examined using correlation analyses and multivariable regression models adjusted for relevant confounders. Results: Most participants showed low adherence to the Mediterranean diet. A significant inverse association was observed between Mediterranean diet adherence and hemoglobin A1c (HbA1c) levels, with individuals scoring ≤35 on the MDS demonstrating higher HbA1c levels. Similar trends were observed in the lowest tertile of adherence. Notably, each one-point increase in MDS predicted a 0.13% reduction in HbA1c. In multivariable regression analyses, Mediterranean diet adherence remained the strongest predictor of glycemic control, independent of age, body mass index (BMI), sex, smoking status, physical activity and the number of antidiabetic treatments. Higher adherence was also significantly associated with lower low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG) levels, as well as higher high-density lipoprotein cholesterol (HDL) concentrations. Conclusions: Greater adherence to the Mediterranean diet is independently associated with improved glycemic regulation and a more favorable lipid profile in adults with T2D. These findings support the Mediterranean diet as a valuable non-pharmacologic strategy for optimizing metabolic outcomes in people with T2D. Full article

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