Nutrients

15 pages, 523 KiB

Open AccessArticle

Eating Attitudes, Body Appreciation, Perfectionism, and the Risk of Exercise Addiction in Physically Active Adults: A Cluster Analysis

by Bettina F. Piko, Tamás L. Berki, Orsolya Kun and David Mellor

Nutrients 2025, 17(13), 2063; https://doi.org/10.3390/nu17132063 - 20 Jun 2025

Abstract

Background/Objectives:Although regular physical exercise is protective for health, excessive engagement can contribute to the development of addiction. Further, the co-occurrence of exercise addiction (EA) and disordered eating (DE) is very frequent among athletes with several common risk factors. Our study focused on [...] Read more.

Background/Objectives:Although regular physical exercise is protective for health, excessive engagement can contribute to the development of addiction. Further, the co-occurrence of exercise addiction (EA) and disordered eating (DE) is very frequent among athletes with several common risk factors. Our study focused on the associations between exercise addiction, eating attitudes, body appreciation, and perfectionism in a sample of physically active adults. Methods: Using a sample of Hungarian adults who were regular exercisers (n = 205, aged 18–70 years, mean age = 30.59 years; 77.1% females), cluster analysis was applied to identify participants’ profile according to their level of EA, DE attitudes, body appreciation, and dimensions of perfectionism. Results: Healthy exercisers had the second lowest level of EA and highest level of body appreciation, and they were not prone to DE (31.22%). Another cluster had a relatively low risk of EA but were potentially prone to DE, with poor body appreciation and a medium level of socially prescribed and other-oriented perfectionism (29.8%). Third, a group of exercisers was characterized by the highest risk of both EA and DE, who also reported relatively high levels of personal standards and organization (25.36%). Finally, those with the second highest risk of EA with a high tendency for dieting and bulimia and poor body appreciation were prone to socially prescribed and other-related perfectionism (13.66%). Conclusions: Symptoms of exercise addiction are not necessarily pathological, but they can serve as signals for the overuse of sports and undue achievement orientation, particularly when being associated with disordered eating attitudes. Full article

(This article belongs to the Special Issue Effects of Exercise and Diet on Health)

24 pages, 5468 KiB

Open AccessArticle

Pretreatment with Citrus reticulata ‘Chachi’ Polysaccharide Alleviates Alcohol-Induced Gastric Ulcer by Inhibiting NLRP3/ASC/Caspase-1 and Nrf2/HO-1 Signaling Pathways

by Huosheng Liang, Yiyao Liang, Lipeng Wu, Long Lin, Yunan Yao, Jinji Deng, Jiepei Xu, Huajian Li, Fangfang Gao, Wenlong Xing, Meng Yu, Xuejing Jia, Minyan Wei, Chuwen Li and Guodong Zheng

Nutrients 2025, 17(13), 2062; https://doi.org/10.3390/nu17132062 - 20 Jun 2025

Abstract

Objectives: This study was designed to investigate the gastroprotective effects of Citrus reticulata ‘Chachi’ polysaccharide (CRP) against alcohol-induced gastric ulcers (GUs) and to elucidate its underlying mechanisms. Methods: CRP was extracted, purified, and structurally characterized. BALB/c mice (50/250 mg/kg CRP) and GES-1 cells [...] Read more.

Objectives: This study was designed to investigate the gastroprotective effects of Citrus reticulata ‘Chachi’ polysaccharide (CRP) against alcohol-induced gastric ulcers (GUs) and to elucidate its underlying mechanisms. Methods: CRP was extracted, purified, and structurally characterized. BALB/c mice (50/250 mg/kg CRP) and GES-1 cells (1 mg/mL CRP) were subjected to alcohol-induced injury. Oxidative stress (SOD, MDA, ROS), inflammation (TNF-α, IL-1β, NLRP3 inflammasome), mucosal barrier proteins (ZO-1, occludin, Claudin-5), and Nrf2/HO-1 signaling were analyzed via histopathology, Western blot, flow cytometry, and immunohistochemistry. Results: CRP pretreatment significantly alleviated gastric lesions, decreased oxidative stress, and suppressed inflammatory responses in alcohol-induced mice. Mechanistically, CRP induced the Nrf2/HO-1 antioxidant pathway while inhibiting the activation of the NLRP3 inflammasome. CRP also restored tight junction protein expression, enhanced mucosal repair, and reduced epithelial apoptosis. In vitro, CRP promoted cell proliferation, migration, and survival of GES-1 cells under alcohol stress. Conclusions: CRP mitigated alcohol-induced GU via dual antioxidant, anti-inflammatory, and barrier-protective mechanisms, positioning it as a considerable agent for GU. Full article

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

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25 pages, 1911 KiB

Open AccessReview

A Comprehensive Perspective on the Biological Effects of Intermittent Fasting and Periodic Short-Term Fasting: A Promising Strategy for Optimizing Metabolic Health

by Barbara Ciastek, Karolina Kapłon and Przemysław Domaszewski

Nutrients 2025, 17(13), 2061; https://doi.org/10.3390/nu17132061 - 20 Jun 2025

Abstract

It is well established that different fasting strategies offer a range of benefits and may even serve as potential therapeutic approaches for metabolic diseases. The biological effects of intermittent fasting (IF) are multidimensional, involving the induction of metabolic switching from glucose to fatty [...] Read more.

It is well established that different fasting strategies offer a range of benefits and may even serve as potential therapeutic approaches for metabolic diseases. The biological effects of intermittent fasting (IF) are multidimensional, involving the induction of metabolic switching from glucose to fatty acid and ketone utilization, thereby enhancing fat metabolism and improving glucose tolerance and insulin sensitivity. In addition, IF modulates the growth hormone/insulin-like growth factor 1 (GH/IGF-1) axis by lowering IGF-1 levels, a change associated with enhanced cellular protection, reduced tumorigenesis, and delayed aging. Moreover, IF modulates key signaling pathways, including mitogen-activated protein kinases, Notch, and nuclear factor kappa B, which collectively contribute to reduced oxidative stress, attenuated inflammation, and hepatoprotection. Although fasting may present certain challenges, it is essential to be adequately informed about its potential benefits and appropriate preparatory strategies before undertaking various fasting protocols. This review summarizes the current knowledge on various IF protocols and periodic short-term fasting (PSTF) lasting more than 24 h and up to 72 h, highlighting the signaling pathways through which these interventions affect metabolic processes. Additionally, it aims to provide a practical guide for the safe preparation for PSTF lasting more than 24 h and up to 72 h. Full article

(This article belongs to the Special Issue Intermittent Fasting: A Heart-Healthy Dietary Strategy?)

10 pages, 458 KiB

Open AccessArticle

Energy Expenditure in Critically Ill Obese Patients—A Prospective Observational Study

by Geraldine de Heer, Christoph Burdelski, Constantin Ammon, Anna Leonie Doliwa, Pascal Hilbert, Stefan Kluge and Jörn Grensemann

Nutrients 2025, 17(13), 2060; https://doi.org/10.3390/nu17132060 - 20 Jun 2025

Abstract

Introduction: In critically ill obese patients, both overfeeding and underfeeding have been associated with worsened outcomes, especially in mechanically ventilated patients. While indirect calorimetry (IC) is recommended to measure energy expenditure (EE), it is not widely available, and predictive formulas often lack accuracy. [...] Read more.

Introduction: In critically ill obese patients, both overfeeding and underfeeding have been associated with worsened outcomes, especially in mechanically ventilated patients. While indirect calorimetry (IC) is recommended to measure energy expenditure (EE), it is not widely available, and predictive formulas often lack accuracy. This study aimed to assess EE in critically ill obese patients and compare it with septic, non-obese patients as controls using IC. Methods: This prospective observational study was conducted at the University Medical Center Hamburg-Eppendorf, Germany, with 116 intensive care beds. EE was measured using IC at three timepoints: day 2–3 (acute phase), day 5–7 (end of acute phase), and day 10–15 (post-acute phase). Different reference weights were used to calculate EE, including ideal body weight (IBW), adjusted body weight (ABW), and total body weight (TBW). Nitrogen balance was also assessed to evaluate protein requirements. Results: We included 50 patients (28 obese and 22 controls). Equivalence between groups was found when ABW was calculated using 18% of excess body weight (EBW) at a mean of 24.4 kcal/kg/d for both groups. EE at the respective timepoints was 24.0 (95% confidence intervals: 22.1; 25.9), 24.2 (22.0; 26.5), 25.1 (21.4; 28.8) in obese and 24.9 (22.7; 27.0), 23.2 (20.7; 25.6), and 25.3 (21.8; 28.7) kcal/kg/d in control patients. Both groups exhibited a negative nitrogen balance, with the control group achieving nitrogen equilibrium by the post-acute phase. Conclusions: This study supports the ESPEN recommendation to base nutrition on ABW with 20% of EBW in obese critically ill patients when IC is unavailable. Further research is needed to determine optimal protein supplementation strategies and their timing to improve outcomes in this patient population. Full article

(This article belongs to the Special Issue Nutritional Intervention in the Intensive Care Unit: New Advances)

30 pages, 949 KiB

Open AccessReview

The Impact of Egg Consumption on Gastrointestinal Health: A Systematic Literature Review and Meta-Analysis

by Nessmah Sultan, Caroline J. Tuck, Edellyne Cheng, Nicole J. Kellow and Jessica R. Biesiekierski

Nutrients 2025, 17(13), 2059; https://doi.org/10.3390/nu17132059 - 20 Jun 2025

Abstract

Objective: Eggs are a valuable source of nutrients and bioactive compounds that may influence the gastrointestinal tract by modulating the microbiome, promoting the production of gastrointestinal-related metabolites, and mediating inflammation. Limited human studies have explored the effects of whole egg intake on indices [...] Read more.

Objective: Eggs are a valuable source of nutrients and bioactive compounds that may influence the gastrointestinal tract by modulating the microbiome, promoting the production of gastrointestinal-related metabolites, and mediating inflammation. Limited human studies have explored the effects of whole egg intake on indices of gastrointestinal health. This systematic literature review aimed to synthesise research investigating the impact of whole egg consumption on markers of gastrointestinal health. Methods: Five databases were searched from inception until July 2024. Studies were included if they examined the link between whole egg consumption and gastrointestinal markers, including symptoms, gut microbiome composition, inflammation, colonic fermentation, and egg-derived metabolites such as trimethylamine N-oxide (TMAO) in healthy adults. Two reviewers independently conducted title and abstract and full-text screening, with conflicts resolved by a third reviewer. Similarly, two authors conducted data extraction, which was verified by a third. A risk of bias assessment was conducted using validated tools. Random effects meta-analyses were performed to summarise the effect of egg consumption on TMAO, choline, and C-reactive protein (CRP). Results: Twenty-two studies were included in a narrative synthesis and ten in the meta-analyses. Nine were randomised controlled trials (RCTs), three were non-randomised intervention trials, eight were cross-sectional, and two were prospective cohort studies. Meta-analyses indicated that egg consumption did not impact plasma TMAO (n = 6, p = 0.22) or CRP (n = 3, p = 0.45) concentrations but did increase plasma choline (n = 5, p < 0.001) in the short term (≤4 weeks). Four studies found correlations between habitual egg consumption and specific gut bacteria, although results varied as egg consumption was both positively and negatively associated with butyrate-producing genera. Conclusions: This review found conflicting results regarding egg consumption and most gastrointestinal outcomes, highlighting that future studies are needed to explore links between habitual egg intake and plasma TMAO, microbial diversity, and inflammation (PROSPERO registration: 408532). Full article

(This article belongs to the Special Issue Why Animal-Derived Foods Have Been, Are and Will Be Essential for Human Nutrition)

12 pages, 795 KiB

Open AccessArticle

Life’s Simple 7 and Risk of Peripheral Artery Disease: Results from the PREDIMED Study and an Updated Meta-Analysis

by Nieves López-Laguna, Estefanía Toledo, María S. Hershey, Nancy Babio, José V. Sorlí, Emilio Ros, Miguel Ángel Muñoz, Ramón Estruch, José Lapetra, Carlos Muñoz-Bravo, Miquel Fiol, Inmaculada Bautista-Castaño, Xavier Pinto, Carolina Ortega-Azorín, Javier Hernando-Redondo, Jordi Salas-Salvadó, Lucas Tojal-Sierra, Miguel A. Martínez-González and Miguel Ruiz-Canela

Nutrients 2025, 17(13), 2058; https://doi.org/10.3390/nu17132058 - 20 Jun 2025

Abstract

Background: Peripheral artery disease (PAD) is a major vascular condition often overlooked in prevention strategies. We aimed to evaluate the association between cardiovascular health, measured by Life’s Simple 7 (LS7), and the risk of PAD in a high-risk Mediterranean population. Methods: This prospective [...] Read more.

Background: Peripheral artery disease (PAD) is a major vascular condition often overlooked in prevention strategies. We aimed to evaluate the association between cardiovascular health, measured by Life’s Simple 7 (LS7), and the risk of PAD in a high-risk Mediterranean population. Methods: This prospective analysis included 7122 participants from the PREDIMED study (Prevención con Dieta Mediterránea) at high cardiovascular risk but free of cardiovascular disease at baseline. LS7 scores (0–14 points) were calculated using seven metrics: smoking status, body mass index, physical activity, blood pressure, total cholesterol, glucose metabolism, and adherence to the Mediterranean diet. Participants were categorized into inadequate (0–5), average (6–8), and optimal (9–14) cardiovascular health. Multivariable Cox regression models and Nelson–Aalen curves assessed the association between LS7 and PAD incidence over a median 4.8-year follow-up. A meta-analysis combining these results with three prior studies was also performed. Results: A total of 87 incident PAD cases were identified. Compared to participants with inadequate cardiovascular health, those with average and optimal LS7 scores exhibited significantly lower PAD risk (adjusted hazard ratio [HR] 0.37; 95% confidence interval [CI]: 0.22–0.61, and HR 0.25; 95% CI: 0.10–0.65, respectively). Each one-point increase in the LS7 score (range 0 to 14) was associated with an 18% lower PAD risk (HR 0.78; 95% CI: 0.68–0.90). The meta-analysis yielded a pooled HR of 0.81 (95% CI: 0.76–0.87), confirming consistent inverse associations across populations. Conclusions: Greater adherence to LS7 metrics is associated with a significantly reduced risk of PAD in high-risk Mediterranean individuals. Promoting LS7 adherence may represent an effective strategy for preventing both cardiovascular disease and PAD. Full article

(This article belongs to the Special Issue Nutrition and Exercise Interventions on Vascular Function and Adaptation)

13 pages, 307 KiB

Open AccessArticle

Nutritional and Morphofunctional Assessment in a Cohort of Adults Living with Cystic Fibrosis with or Without Pancreatic Exocrine and/or Endocrine Involvement

by Ana Piñar-Gutiérrez, José Luis Pereira-Cunill, Andrés Jiménez-Sánchez, Silvia García-Rey, María del Carmen Roque-Cuéllar, Antonio J. Martínez-Ortega, Irene González-Navarro, Esther Quintana-Gallego, Ángeles Pizarro, Francisco Javier Castell, Manuel Romero-Gómez and Pedro Pablo García-Luna

Nutrients 2025, 17(13), 2057; https://doi.org/10.3390/nu17132057 - 20 Jun 2025

Abstract

Objectives: To describe the results of nutritional and morphofunctional assessment in a cohort of adults with cystic fibrosis; to evaluate differences in nutritional status between patients with and without exocrine and/or endocrine pancreatic involvement. Methods: Cross-sectional study: A cohort of adults with cystic [...] Read more.

Objectives: To describe the results of nutritional and morphofunctional assessment in a cohort of adults with cystic fibrosis; to evaluate differences in nutritional status between patients with and without exocrine and/or endocrine pancreatic involvement. Methods: Cross-sectional study: A cohort of adults with cystic fibrosis evaluated in a multidisciplinary unit was analyzed. Pancreatic status was examined, and malnutrition was diagnosed according to GLIM criteria. Morphofunctional assessment consisted of nutritional ultrasound, bioelectrical impedance, handgrip dynamometry, and anthropometry. Qualitative variables are expressed as n (%), quantitative variables as median (IQR). For group comparisons, Fisher’s exact test was used for qualitative variables and the non-parametric median comparison test for quantitative variables. Results: n = 101 participants were recruited, of whom 44 (43.6%) were women. Median age was 33 (25–40.5) years. A total of 64 participants (63.4%) had exocrine pancreatic insufficiency (EPI), 44 (43.6%) had endocrine pancreatic insufficiency, and 28 (27.7%) had cystic fibrosis-related diabetes (CFRD). Median BMI was 23.4 (20.1–24.89) kg/m². A total of 48 patients (47.5%) were malnourished. Males with EPI had a higher prevalence of undernourishment than those without (56.4% vs. 16.7%, p = 0.005), but not women. CFRD patients displayed no differences in morphofunctional assessment. Conclusions: Almost half the sample was undernourished using GLIM criteria. Males with exocrine pancreatic insufficiency had worse nutritional status. Endocrine pancreatic involvement did not affect nutritional status. Full article

(This article belongs to the Section Clinical Nutrition)

18 pages, 1430 KiB

Open AccessArticle

BMI-Specific Nutritional Education Priorities for Weight Management in Osteoarthritis

by Ashley N. Buck, Danae C. Gross, Jieun (Jenna) Kim, Erica L. Rauff, Jennifer M. Dinallo, Lauren M. Abbate, Todd A. Schwartz, Nicholas J. Beresic, Connie B. Newman and Sarah P. Shultz

Nutrients 2025, 17(13), 2056; https://doi.org/10.3390/nu17132056 - 20 Jun 2025

Abstract

Background/Objectives: The educational needs of individuals with OA and obesity can drive personalized resources for effective dietary interventions that align patient interests with weight and disease management. Therefore, the purpose of the present study was to evaluate differences in nutritional education topics [...] Read more.

Background/Objectives: The educational needs of individuals with OA and obesity can drive personalized resources for effective dietary interventions that align patient interests with weight and disease management. Therefore, the purpose of the present study was to evaluate differences in nutritional education topics of interest between patients with OA who are characterized as having higher (≥30 kg/m²; HBMI) and lower BMI (<30 kg/m²; LBMI). Methods: Cross-sectional survey data (n = 296) were dichotomized into HBMI (n = 172; BMI: 38.67 ± 6.59 kg/m²) and LBMI (n = 124; BMI: 25.59 ± 3.00 kg/m²) groups. A mixed-method approach examined group differences across four primary domains: (i) strategies for weight management and healthy lifestyle, (ii) interest in vitamins and supplements, (iii) foods and nutrient with anti-inflammatory properties, and (iv) dietary patterns for weight loss. Logistic regression models compared topic interests between groups. Thematic analysis of open-ended responses captured additional insights. Results: Compared to LBMI participants, those in the HBMI group showed greater interest in weight loss strategies, emotional eating, and diets such as low-carbohydrate and ketogenic approaches, but less interest in general supplement information and plant-based diets. HBMI also had greater interest in practical strategies (e.g., feeling full, affordable foods) and reduced interest in certain anti-inflammatory foods. Both groups expressed a desire for evidence-based resources on foods that promote joint health. Conclusions: BMI-specific differences in nutritional education preferences highlight the need for tailored, patient-centered strategies in OA management. Addressing these differences may improve the effectiveness of education interventions and enhance patient–provider communication around diet and lifestyle in OA care. Full article

(This article belongs to the Special Issue The Role of Physical Activity and Diet on Weight Management)

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17 pages, 1416 KiB

Open AccessArticle

The Interplay Between Summer Meals, Food Insecurity, and Diet Quality Among Low-Income Children in Maryland, USA: A Multiphase Cross-Sectional Study

by Yuyi Chen, Erin R. Hager, Julia Gross and Susan M. Gross

Nutrients 2025, 17(13), 2055; https://doi.org/10.3390/nu17132055 - 20 Jun 2025

Abstract

Background: Food insecurity and poor diet quality disproportionately affect U.S. children from low-income households, with summer school closures exacerbating risks. Federally funded programs like the Summer Food Service Program (SFSP) and SUN Bucks (Summer EBT) aim to address these challenges, yet evidence of [...] Read more.

Background: Food insecurity and poor diet quality disproportionately affect U.S. children from low-income households, with summer school closures exacerbating risks. Federally funded programs like the Summer Food Service Program (SFSP) and SUN Bucks (Summer EBT) aim to address these challenges, yet evidence of their post-pandemic dietary impact remains limited. Objectives: This study examines the relationship between policy innovations, summer meal participation, food insecurity, and diet quality among children from low-income households in Prince George’s County, Maryland. Methods: A cross-sectional design analyzed data from 158 households in Prince George’s County Public Schools across two waves (early fall 2022 and 2023). Validated tools (USDA’s Six-Item Short Form and Dietary Screener Questionnaire) assessed food security and diet quality. Sociodemographic factors, program participation, and dietary deviations from the 2020–2025 Dietary Guidelines were analyzed. Multivariate logistic regression identified determinants of poor diet quality (≥2 guideline deviations), adjusting for ethnicity, age, and housing stability. Results: Only 32.28% of eligible households participated in summer meal programs, with non-participation driven by lack of awareness (53.68%) and transportation barriers (11.58%). Significant dietary gaps included inadequate whole grain intake (0.8 vs. 3.0 servings/day) and excessive added sugars (14% of daily calories). Summer meal participation was associated with reduced odds of poor diet quality (OR = 0.23, p = 0.030), while older age (OR = 52.97, p < 0.001) and very low food security (OR = 8.42, p = 0.036) increased risk. Hispanic ethnicity had lower odds (OR = 0.17, p = 0.019) despite higher baseline food insecurity. Conclusions: Summer meal participation was associated with improved dietary outcomes but faced systemic participation barriers. Findings support policy reforms, such as multilingual outreach and mobile meal distribution, to address identified gaps. Full article

(This article belongs to the Special Issue Nutrition in Vulnerable Population Groups)

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13 pages, 488 KiB

Open AccessArticle

Analysis of Food Perception in Slim, Overweight, or Obese Individuals

by Anna Celina Durma, Maja Sosnowska, Adam Daniel Durma, Adam Śmiałowski and Leszek Czupryniak

Nutrients 2025, 17(13), 2054; https://doi.org/10.3390/nu17132054 - 20 Jun 2025

Abstract

Introduction: Obesity is a systemic disease leading to many complications. One of the causes of obesity is excessive energy intake in relation to its expenditure. Assessing portion sizes and estimating caloric intake is crucial in maintaining a healthy body weight and combating obesity. [...] Read more.

Introduction: Obesity is a systemic disease leading to many complications. One of the causes of obesity is excessive energy intake in relation to its expenditure. Assessing portion sizes and estimating caloric intake is crucial in maintaining a healthy body weight and combating obesity. Objectives: To evaluate the impact of BMI on the perception of portion sizes and their estimated caloric content. Patients and methods: The anonymous survey was filled out by 205 patients. The survey contained questions regarding different meals. Pictures of main meals were presented and individually assessed by the study participants. Next, they were divided into groups, individuals with normal weight (BMI < 25 kg/m²), who were overweight (BMI 25–29.9 kg/m²), and with obesity (BMI ≥ 30 kg/m²), to analyze the differences in food perception and caloric estimation. Results: The study did not demonstrate significant differences in the subgroups’ estimated portion sizes of most main meals. No statistical significance was found in the estimated caloric content of the indicated main meal portions across the studied groups. Obese, overweight, and normal-weighted patients assess food portion size similarly. Conclusions: BMI has no significant impact on caloric estimation. The majority of the population estimate the caloric value of the meals inappropriately. Nevertheless, patients with excessive body weight (overweight and obesity) have a tendency (but not statistically significant) to underestimate the caloric value of full meals compared with people with normal BMI. Incorrect calorie estimation may lead to consuming bigger meal portions in patients with overweight and obesity. Full article

(This article belongs to the Special Issue Hot Topics in Clinical Nutrition (3rd Edition))

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26 pages, 722 KiB

Open AccessReview

Lifestyle Interventions to Tackle Cardiovascular Risk in Thyroid Hormone Signaling Disorders

by Simone Rodolfi, Giuditta Rurale, Federica Marelli, Luca Persani and Irene Campi

Nutrients 2025, 17(13), 2053; https://doi.org/10.3390/nu17132053 - 20 Jun 2025

Abstract

Thyroid hormones (THs) play a central role in cardiovascular and metabolic regulation, influencing lipid metabolism, insulin sensitivity and resting energy expenditure. Inherited disorders of impaired sensitivity to THs—including resistance to thyroid hormone alpha (RTHα) and beta (RTHβ), monocarboxylate transporter 8 (MCT8) deficiency and [...] Read more.

Thyroid hormones (THs) play a central role in cardiovascular and metabolic regulation, influencing lipid metabolism, insulin sensitivity and resting energy expenditure. Inherited disorders of impaired sensitivity to THs—including resistance to thyroid hormone alpha (RTHα) and beta (RTHβ), monocarboxylate transporter 8 (MCT8) deficiency and selenoprotein deficiency—lead to complex, multisystemic clinical features. Although these conditions are rare, with RTHβ being the most common and affecting about 1 in 20,000 newborns, they share clinical features with more prevalent thyroid disorders, such as hypothyroidism and hyperthyroidism, as well as neurological manifestations including muscle wasting and spasticity. These conditions present abnormal patterns of thyroid function and are associated with tissue-specific comorbidities such as arrhythmias, heart failure, dyslipidemia, hepatic steatosis, insulin resistance, and metabolic syndrome. To date, no targeted or controlled studies have evaluated the impact of lifestyle modifications in these patient populations. Therefore, this narrative review proposes plausible management strategies based on pathophysiological insights into the effects of thyroid hormones on target organs, combined with clinical reasoning and evidence extrapolated from related disorders. Physical exercise and diet may complement pharmacological treatments (e.g., levothyroxine or TRIAC) to improve cardiovascular and metabolic outcomes. In RTHβ, aerobic exercise enhances cardiovascular health, while a Mediterranean diet supports lipid control and glycemic parameters. In RTHα, physical exercise may aid neuromotor development, and a fluid-rich, fiber-moderated diet can alleviate constipation. In MCT8 deficiency, physiotherapy may improve mobility and relieve contractures, while nutritional support (e.g., feeding tube, gastrostomy) can be necessary to tackle feeding difficulties and reduce pulmonary complications. In selenoprotein deficiency, low-to-moderate physical exercise and an antioxidant-rich diet may protect against oxidative stress at several tissue levels. Although quantitative evidence is limited, this narrative review synthesizes current insights, providing a meaningful basis for future validation and research. Full article

(This article belongs to the Special Issue Exercise and Nutrition: Implications for Weight Management and Cardiometabolic Prevention)

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16 pages, 7376 KiB

Open AccessArticle

Betulinic Acid Reduces Intestinal Inflammation and Enhances Intestinal Tight Junctions by Modulating the PPAR-γ/NF-κB Signaling Pathway in Intestinal Cells and Organoids

by Xu Zheng, Zhen Cao, Mingqi Wang, Ruqiang Yuan, Yinhe Han, Ang Li and Xiuli Wang

Nutrients 2025, 17(13), 2052; https://doi.org/10.3390/nu17132052 - 20 Jun 2025

Abstract

Background: Intestinal epithelial barrier (IEB) dysfunction is related to multiple gastrointestinal disorders, notably inflammatory bowel disease (IBD). Betulinic acid (BA), a compound derived from birch bark, has demonstrated potential therapeutic benefits in IBD. Nevertheless, the impact of BA on IEB function has not [...] Read more.

Background: Intestinal epithelial barrier (IEB) dysfunction is related to multiple gastrointestinal disorders, notably inflammatory bowel disease (IBD). Betulinic acid (BA), a compound derived from birch bark, has demonstrated potential therapeutic benefits in IBD. Nevertheless, the impact of BA on IEB function has not been fully elucidated. Methods: The current study aimed to explore the potential underlying mechanisms of BA in dextran sodium sulfate (DSS)-induced IBD in mice and co-culture models involving Caco-2/HT29-MTX-E12 cell monolayers or mouse intestinal organoids (IOs) in conjunction with macrophages stimulated by lipopolysaccharide (LPS). Results: In vivo, BA treatment significantly improved body weight and colon length, alleviated disease activity index (DAI) scores, and reduced colonic histopathological injury in IBD mice. In vitro, BA reduced the flux of FITC-dextran; increased the TEER; and decreased the production of IL-6, IL-1β, and TNF-α while increasing IL-10 mRNA levels. Additionally, BA enhanced IEB formation by upregulating ZO-1, occludin (OCLN), and claudin-1 (CLDN1). Molecular docking studies revealed significant docking scores and interactions between BA and PPAR-γ. Moreover, BA significantly upregulated PPAR-γ protein expression, decreased NF-κB and MLC2 phosphorylation, and reduced MLCK protein expression. However, this effect was reversed by GW9662, an effective PPAR-γ antagonist. Conclusions: The findings reveal that BA mitigates IBD by safeguarding the intestinal barrier against dysfunction. This effect may be attributed to its ability to suppress inflammation and enhance the expression of tight junction proteins by modulating the PPAR-γ/NF-κB signaling pathway. Full article

(This article belongs to the Special Issue Exploring the Role of Bioactive Compounds in Immunonutrition)

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18 pages, 1157 KiB

Open AccessSystematic Review

Effect of Dietary and Physical Activity Interventions Combined with Psychological and Behavioral Strategies on Preventing Metabolic Syndrome in Adolescents with Obesity: A Meta-Analysis of Clinical Trials

by Claudia C. Jiménez-Peláez, Ángel Fernández-Aparicio, Miguel A. Montero-Alonso and Emilio González-Jiménez

Nutrients 2025, 17(13), 2051; https://doi.org/10.3390/nu17132051 - 20 Jun 2025

Abstract

Bacground/Objectives: Obesity in adolescents is escalating, accompanied by comorbidities such as insulin resistance and cardiovascular disease, which favor the early onset of metabolic syndrome (MetS). There is an urgent need for effective interventions to prevent and treat MetS. We aimed to analyze intervention [...] Read more.

Bacground/Objectives: Obesity in adolescents is escalating, accompanied by comorbidities such as insulin resistance and cardiovascular disease, which favor the early onset of metabolic syndrome (MetS). There is an urgent need for effective interventions to prevent and treat MetS. We aimed to analyze intervention studies targeting lifestyle improvements in adolescents with obesity. We also determined the effect of combining dietary and/or physical activity interventions with educational, psychological, and emotional support-based interventions compared to traditional interventions in preventing MetS in adolescents with obesity. Methods: The PubMed, Cochrane, Web of Science, CINAHL, and Scopus databases were consulted. Ten clinical trials were included in the systematic review, of which six were eligible for the meta-analysis. Results: Combined interventions significantly decreased body weight (−1.10 [−1.64, −0.55], p < 0.001). Although not statistically significant improvements were observed in the meta-analysis for zBMI and waist circumference. The results indicate that diet- and exercise-based interventions are associated with a further decrease in body composition and non-anthropometric variables associated with MetS when combined with educational, psychological, and behavioral interventions. Conclusions: Some studies suggest potential long-term benefits, but further research is necessary to define effective interventions for improving body composition and preventing MetS in obese adolescents, addressing the inconsistencies in current clinical trials. Systematic Review Registration (PROSPERO CRD42023463428). Full article

(This article belongs to the Special Issue Food Habits, Nutritional Knowledge, and Nutrition Education)

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16 pages, 2691 KiB

Open AccessArticle

d-Allulose Ameliorates Fructose-Induced Skeletal Muscle Insulin Resistance via Regulation of Ectopic Lipid Accumulation Independent of Body Weight Changes

by Shahriar Kamal, Yang Gou, Takamasa Tsuzuki, Linlin Fu, Takako Yamada, Ryoichi Banno and Teruhiko Koike

Nutrients 2025, 17(12), 2050; https://doi.org/10.3390/nu17122050 - 19 Jun 2025

Abstract

Background/Objectives: The consumption of fructose-sweetened beverages, especially when combined with a high-fat (HF) diet, substantially contributes to obesity, diabetes, and metabolic dysfunction-associated steatotic liver disease. Ectopic fat accumulation in skeletal muscles is a critical factor in the development of insulin resistance, a key [...] Read more.

Background/Objectives: The consumption of fructose-sweetened beverages, especially when combined with a high-fat (HF) diet, substantially contributes to obesity, diabetes, and metabolic dysfunction-associated steatotic liver disease. Ectopic fat accumulation in skeletal muscles is a critical factor in the development of insulin resistance, a key feature of these metabolic disorders. We aimed to investigate the effects of the rare sugar, d-allulose, on fructose-induced insulin resistance. Methods: Male Wistar rats were randomly assigned to fructose-free control diet (CD), HF/fructose-free diet (HF), or HF/fructose diet (HFF) groups. After 4 weeks, an intraperitoneal glucose tolerance test (IPGTT) was performed, followed by a two-step hyperinsulinemic–euglycemic clamp (HE-clamp) test at 5 weeks. Blood, skeletal muscle, and liver samples were collected after 6 weeks, and triglyceride (TG) levels were measured. Additionally, Western blot was performed on skeletal muscle samples. The same protocol was repeated for the HFF group supplemented with either 5% d-allulose or 5% cellulose. Results: Compared to the CD and HF groups, the HFF group exhibited increased blood glucose levels during the IPGTT and greater systemic and skeletal muscle insulin resistance in the HE-clamp. Furthermore, plasma, liver, and muscle TG levels were significantly elevated in the HFF group. However, d-allulose supplementation improved insulin resistance in the HFF group and reduced blood, liver, and muscle TG levels. Additionally, insulin-stimulated AKT phosphorylation and acetyl-CoA carboxylase phosphorylation were enhanced in the skeletal muscle following d-allulose administration. Conclusions: d-allulose may improve insulin resistance by reducing TG accumulation in the skeletal muscle, potentially independent of its anti-obesity properties. Full article

(This article belongs to the Special Issue Hypoglycemic Properties and Pathways of Natural Substances)

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18 pages, 3942 KiB

Open AccessArticle

High Dietary Phosphorus Impairs Bone Microarchitecture and Induces Alterations in the LGR4–R-Spondins Axis in Rats with Normal Renal Function

by Sara Fernández-Villabrille, Francisco Baena-Huerta, Laura Suárez-Fernández, Elena Nefyodova, Paula Calvó, Nerea González-García, Helena Gil-Peña, Carlos Gómez-Alonso, Cristina Alonso-Montes, Manuel Naves-Díaz, Christa Maes, Natalia Carrillo-López and Sara Panizo

Nutrients 2025, 17(12), 2049; https://doi.org/10.3390/nu17122049 - 19 Jun 2025

Abstract

Background: The increasing prevalence of processed foods has significantly elevated dietary phosphorus intake globally, posing a risk to skeletal health. Elevated serum phosphate promotes parathyroid hormone (PTH) release, leading to bone resorption and decreased bone formation. Objective: This study investigated the influence [...] Read more.

Background: The increasing prevalence of processed foods has significantly elevated dietary phosphorus intake globally, posing a risk to skeletal health. Elevated serum phosphate promotes parathyroid hormone (PTH) release, leading to bone resorption and decreased bone formation. Objective: This study investigated the influence of chronically elevated phosphorus intake on bone structure in rats with normal renal function, focusing on the Receptor Activator of Nuclear factor Kappa-B (RANK)/RANK ligand (RANKL)/osteoprotegerin (OPG) pathway and its related components, leucine rich repeat containing G protein-coupled receptor 4 (LGR4), and R-spondins (RSPOs). Methods: Rats were fed a high-phosphorus diet, followed by assessment of the bone microstructure and of the expression of key signalling molecules. Results: Elevated phosphorus intake induced significant bone deterioration, particularly in the trabecular bone compartment, associated with alterations in the RANK/RANKL/OPG pathway and in the LGR4 and RSPO1 and RSPO4 signalling components in bone. Moreover, we also observed changes in RANKL, RSPO1 and RSPO4 serum levels in the rats that had received a high-phosphorus diet. Conclusions: These findings highlight the detrimental impact of excessive dietary phosphorus on skeletal health, even without renal impairment, and suggest that components of this pathway, particularly RSPO1 and RSPO4, could serve as potential biomarkers of bone deterioration. The widespread consumption of phosphorus-rich processed foods underscores the importance of nutritional education to mitigate these skeletal risks in industrialized populations. Full article

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

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20 pages, 912 KiB

Open AccessArticle

Adherence to the EAT-Lancet Diet Among Urban and Rural Latin American Adolescents: Associations with Micronutrient Intake and Ultra-Processed Food Consumption

by Rulamán Vargas-Quesada, Rafael Monge-Rojas, Sonia Rodríguez-Ramírez, Jacqueline Araneda-Flores, Leandro Teixeira Cacau, Gustavo Cediel, Diego Gaitán-Charry, Tito Pizarro Quevedo, Anna Christina Pinheiro Fernandes, Alicia Rovirosa, Tania G. Sánchez-Pimienta and María Elisa Zapata

Nutrients 2025, 17(12), 2048; https://doi.org/10.3390/nu17122048 - 19 Jun 2025

Abstract

Background/Objectives: Adolescents in Latin America are experiencing rising rates of overweight/obesity and non-communicable diseases, while public health nutrition efforts targeting this group remain limited. This study explores adherence to the EAT-Lancet diet and its relationship with micronutrient adequacy and ultra-processed food (UPF) consumption. [...] Read more.

Background/Objectives: Adolescents in Latin America are experiencing rising rates of overweight/obesity and non-communicable diseases, while public health nutrition efforts targeting this group remain limited. This study explores adherence to the EAT-Lancet diet and its relationship with micronutrient adequacy and ultra-processed food (UPF) consumption. Methods: Cross-sectional data from national nutrition surveys of 19,601 adolescents across six Latin American countries were analyzed. Data on sociodemographics, anthropometrics, and dietary habits were collected using standardized questionnaires and 24 h dietary recalls or food records. Nutrient intake was estimated via statistical modeling, and nutrient adequacy ratios were based on age- and sex-specific requirements. UPF intake was classified using the NOVA system, and adherence to the EAT-Lancet diet was assessed with the Planetary Health Diet Index. Results: Overall adherence to the EAT-Lancet diet was low (mean score: 28.3%). Rural adolescents had higher adherence than urban adolescents, and those aged 10–13 and 17–19 showed better adherence compared to adolescents aged 14–16. Adolescents from lower socioeconomic backgrounds adhered more than those from higher socioeconomic backgrounds. Adherence varied from 20.2% in Argentina to 30.2% in Brazil and Chile. Higher adherence was associated with lower UPF intake. Among urban adolescents, greater adherence was linked to a higher risk of inadequate riboflavin, niacin, and cobalamin intake, a trend not observed in rural adolescents. Conclusions: Adherence to the EAT-Lancet diet is low among Latin American adolescents, particularly in urban areas. Public health efforts should prioritize reducing UPF consumption, improving access to nutrient-dense, culturally appropriate foods, and supporting fortified staple foods. Full article

(This article belongs to the Section Nutritional Epidemiology)

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19 pages, 840 KiB

Open AccessArticle

Modulation of Gut Microbiota by Whole Encapsulated Brown Seaweed (Himanthalia elongata) in Overweight Subjects: A Randomized Double-Blind Placebo-Controlled Trial

by Aroa Lopez-Santamarina, Alejandra Cardelle-Cobas, Alicia del Carmen Mondragon, Alberto Cepeda, Jose A. Rodriguez and Jose Manuel Miranda

Nutrients 2025, 17(12), 2047; https://doi.org/10.3390/nu17122047 - 19 Jun 2025

Abstract

Background/Objectives: Brown seaweeds, such as Himanthalia elongata, are a promising source of dietary fiber. However, in vivo evidence regarding the effects of H. elongata intake on the human gut microbiota remains limited. This study aimed to evaluate the impact of daily [...] Read more.

Background/Objectives: Brown seaweeds, such as Himanthalia elongata, are a promising source of dietary fiber. However, in vivo evidence regarding the effects of H. elongata intake on the human gut microbiota remains limited. This study aimed to evaluate the impact of daily H. elongata consumption on the gut microbiota composition and short-chain fatty acid production in overweight adults. Methods: A randomized, double-blind, placebo-controlled trial was conducted in which 10 overweight adult participants consumed 2 g/day of whole H. elongata for 30 days. Fecal samples were collected before and after the intervention for 16S rRNA sequencing and short-chain fatty acid analysis. Dietary intake was evaluated using a 24 h recall and a 3-day dietary record. Nutritional assessment was performed to determine habitual macronutrient consumption. Results: Baseline dietary analysis revealed an imbalanced macronutrient profile characterized by high intakes of total and saturated fats and protein, along with low carbohydrate and fiber consumption. In addition, 50% of the participants were obese, and 50% were overweight based on the BMI. Notable changes in the gut microbiota composition were observed after the intervention, including increases in short-chain fatty acid-producing species, such as Parabacteroides distasonis, Bacteroides eggerthii, Bacteroides uniformis, and Bacteroides obeum. Conclusions: This study provides the first clinical evidence in humans that whole H. elongata can beneficially modulate the gut microbiota composition. These results support the potential use of this seaweed as a functional prebiotic ingredient in dietary strategies aimed at enhancing gut health. Full article

(This article belongs to the Special Issue Interaction Between Gut Microbiota and Obesity)

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Graphical abstract

15 pages, 1012 KiB

Open AccessArticle

Energy Requirements in the Post-ICU Period: An Exploratory Multicenter Observational Study

by Marialaura Scarcella, Emidio Scarpellini, Ludovico Abenavoli, Andrea Ceccarelli, Rita Commissari, Riccardo Monti, Jan Tack, Antonella Cotoia and Edoardo De Robertis

Nutrients 2025, 17(12), 2046; https://doi.org/10.3390/nu17122046 - 19 Jun 2025

Abstract

Background: There is limited knowledge about nutritional intake and energy needs during the post-intensive care unit (ICU) period and their relationship with clinical outcomes and physical recovery. Aims and Methods: Thus, this observational multicenter study (Azienda Ospedaliero-Universitaria “Santa Maria”, Terni and “Madonna del [...] Read more.

Background: There is limited knowledge about nutritional intake and energy needs during the post-intensive care unit (ICU) period and their relationship with clinical outcomes and physical recovery. Aims and Methods: Thus, this observational multicenter study (Azienda Ospedaliero-Universitaria “Santa Maria”, Terni and “Madonna del Soccorso” General hospital, San Benedetto del Tronto, Italy) aimed, firstly, to measure energy expenditure via indirect calorimetry (IC) (Q-NRG+^® Metabolic Monitor, Cosmed, Rome, Italy), derived respiratory quotient (R/Q1) and, malnutrition risk via Mini Nutritional Assessment (MNA) test and body composition through bioimpedance vector analysis (BIVA-Akern, Pontassieve, Italy); secondly, to assess their effect on energy needs, body composition and physical rehabilitation steps in critically ill adults after ICU discharge. The provision of nutrients (PIS test) was also recorded. Oral nutritional supplementation was used to reach the optimal nutritional intake. All patients followed a standardized rehabilitation program. Results: A total of 43 patients were enrolled from January 2024 until February 2025 at the beginning of their post-ICU period. The mean age was 65.7 ± 1.0 years, the mean BMI was 20.73 ± 0.8 kg/m² at the recovery ward, and 60.4% (n = 26) were male. The mean admission period was 19.5 ± 1.7 days. The resting energy expenditure (mREE) was 1591 ± 71.2 at the admission and 1.856 ± 62.7 kcal/kg/d at the discharge (p < 0.05). The median phase angle value was 4.33 ± 0.15 at the admission and 5.05 ± 0.17° at the discharge (p < 0.05); R/Q1 at the admission was 0.7 ± 0.1 and 1.086± 0.11 at the discharge (p < 0.05). Improved energy expenditure significantly correlated with R/Q1 and phase angle (r = 0.81 and r = 0.72, respectively). Interestingly, there was no significant correlation between improved metabolism and improved PIS test scores (r = 0.18). Improved metabolism and nutritional status showed a tendency to correlate with shorter post-ICU courses and earlier physical recovery, without reaching statistical significance. Conclusions: Measurement of energy expenditure and caloric intake, along with the assessment of body composition is feasible and provides an objective tool to guide and possibly enhance the functional recovery in patients during the post-ICU period. Full article

(This article belongs to the Section Clinical Nutrition)

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27 pages, 631 KiB

Open AccessSystematic Review

Efficacy of a Low-FODMAP Diet on the Severity of Gastrointestinal Symptoms and Quality of Life in the Treatment of Gastrointestinal Disorders—A Systematic Review of Randomized Controlled Trials

by Laura Kuźmin, Katarzyna Kubiak and Ewa Lange

Nutrients 2025, 17(12), 2045; https://doi.org/10.3390/nu17122045 - 19 Jun 2025

Abstract

Background: A low-FODMAP diet is considered as a potential supportive treatment approach in some gastrointestinal disorders. The aim of this study was to systematically review the literature for randomized controlled trials assessing the efficacy of the low-FODMAP diet on the severity of gastrointestinal [...] Read more.

Background: A low-FODMAP diet is considered as a potential supportive treatment approach in some gastrointestinal disorders. The aim of this study was to systematically review the literature for randomized controlled trials assessing the efficacy of the low-FODMAP diet on the severity of gastrointestinal symptoms and quality of life in patients with gastrointestinal disorders. Methods: This review was conducted in accordance with CASP tool and PRISMA guidelines. A comprehensive search of the PubMed, Scopus, and Web of Science databases resulted in the identification of fourteen randomized controlled trials. Results: Ten studies examined the effect of the low-FODMAP diet in patients with irritable bowel syndrome (IBS), three with inflammatory bowel disease (IBD), and one with symptomatic proton pump inhibitor (PPI) refractory gastroesophageal reflux disease (GERD). All interventions compared the low-FODMAP diet with another diet and lasted from 3 to 12 weeks. Most studies on IBS showed significant improvements in abdominal pain, bloating, and quality of life compared to control diets. In IBD, improvements were mainly observed in functional gastrointestinal symptoms, while no clear benefit was demonstrated in GERD. Heterogeneity in study designs, intervention durations, comparator diets, and outcome measures limited the ability to conduct a meta-analysis. Conclusions: Although a low-FODMAP diet may reduce symptoms in selected individuals, it is not universally necessary. Importantly, the diet’s restrictive nature and potential long-term effects—such as nutritional deficiencies and alterations in gut microbiota—highlight the need for clinical supervision by dietitians with expertise in gastrointestinal disorders. Furthermore, in some cases, symptom improvement may be achievable through less restrictive changes, such as improving food hygiene and reducing intake of processed or high-sugar foods. Further high-quality randomized controlled trials with standardized endpoints and longer follow-up are needed to clarify the efficacy and safety of the low-FODMAP diet across various gastrointestinal conditions. Full article

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

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