Nutrients

15 pages, 2987 KB

Open AccessArticle

Altered Plasma Endocannabinoids and Oxylipins in Adolescents with Major Depressive Disorders: A Case–Control Study

by Akash Chakravarty, Abinaya Sreetharan, Ester Osuna, Isabelle Herter-Aeberli, Isabelle Häberling, Jeannine Baumgartner, Gregor E. Berger and Martin Hersberger

Nutrients 2026, 18(2), 280; https://doi.org/10.3390/nu18020280 (registering DOI) - 15 Jan 2026

Abstract

Background: Pediatric Major Depressive Disorder (pMDD) is one of the leading causes of disability in adolescents. There is currently no single explanation that fully accounts for the cause of the disorder, but various factors, including dysregulation of the immune and stress responses, have [...] Read more.

Background: Pediatric Major Depressive Disorder (pMDD) is one of the leading causes of disability in adolescents. There is currently no single explanation that fully accounts for the cause of the disorder, but various factors, including dysregulation of the immune and stress responses, have been linked to its onset. Oxylipins and endocannabinoids, derived from metabolization of n-3 and n-6 polyunsaturated fatty acids (PUFAs), regulate inflammation and have been suggested to attenuate inflammation associated with depression. This study aims to understand whether adolescents with pMDD have altered baseline levels of oxylipins and endocannabinoids compared to healthy adolescents. Methods: In this case–control study, we measured 60 oxylipins and endocannabinoids in plasma from 82 adolescents with pMDD and their matching healthy controls. Results: A Principal Component Analysis revealed substantial variability within each group and only a moderate degree of separation between them. In a paired analysis, the lipid mediators of controls exhibited higher concentrations of n-6 PUFA-derived prostaglandins and thromboxanes (PGE2, PGD2, PGF2a and TXB2), n-3 PUFA-derived TxB3, and the endocannabinoids AEA, EPEA, and DHEA. In contrast, cases had higher concentrations of the n-6 PUFA-derived 6-keto-PGF1a and the n-3 PUFA-derived PGD3. In addition, we observed a higher percentage of oxylipins and endocannabinoids derived from DHA (5.65 ± 5.46% vs. 4.72 ± 4.94%) and AA (16.31 ± 11.10% vs. 12.76 ± 13.46%) in plasma from controls, in line with the higher DHA and AA levels observed in erythrocytes from controls compared to cases. Conclusions: Overall, our results show lower plasma levels of endocannabinoids and lower DHA- and AA-derived oxylipins in adolescents with pMDD, supporting their role in the pathophysiology of pMDD. To infer a causative role of the n-3 and n-6 PUFA-derived oxylipins and endocannabinoids in pMDD, an intervention study with n-3 PUFA supplementation and monitoring of oxylipins and endocannabinoids would be necessary. Full article

(This article belongs to the Special Issue The Role of Omega-3 Fatty Acids in Depression: From Biological Mechanisms to Clinical Targets)

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27 pages, 2812 KB

Open AccessArticle

Investigating the Role of Diet-Manipulated Gut Bacteria in Pathogenesis of Type 2 Diabetes Mellitus—An In Vitro Approach

by Asha Guraka, Marie Lush, Georgios Zouganelis, Joe Waldron, Subbareddy Mekapothula, Jinit Masania, Gareth Wynn Vaughan Cave, Myra Elizabeth Conway, Gyanendra Tripathi and Ali Kermanizadeh

Nutrients 2026, 18(2), 279; https://doi.org/10.3390/nu18020279 - 15 Jan 2026

Abstract

Background: The human gut microbiome is highly complex, and its composition is strongly influenced by dietary patterns. Alterations in microbiome structure have been associated with a range of diseases, including type 2 diabetes mellitus. However, the underlying mechanisms for this remain poorly understood. [...] Read more.

Background: The human gut microbiome is highly complex, and its composition is strongly influenced by dietary patterns. Alterations in microbiome structure have been associated with a range of diseases, including type 2 diabetes mellitus. However, the underlying mechanisms for this remain poorly understood. In this study, a novel in vitro approach was utilized to investigate the interplay between gut bacteria, dietary metabolites, and metabolic dysfunction. Methods: Two representative gut bacterial species—Bacteroides thetaiotaomicron and Lactobacillus fermentum—were isolated from human faecal samples and subjected to controlled dietary manipulation to mimic eubiotic and dysbiotic conditions. Metabolites produced under these conditions were extracted, characterized, and quantified. To assess the functional impact of these metabolites, we utilized the INS-1 832/3 insulinoma cell line, evaluating insulin sensitivity through glucose-stimulated insulin secretion and ERK1/2 activation. Results: Our findings demonstrate that metabolites derived from high-carbohydrate/high-fat diets exacerbate metabolic dysfunction, whereas those generated under high-fibre conditions significantly enhance insulin secretion and glucose-dependent ERK1/2 activation in co-culture compared to monocultures. Conclusions: This work systematically disentangles the complex interactions between gut microbiota, diet, and disease, providing mechanistic insights into how microbial metabolites contribute to the onset of metabolic disorders. Full article

(This article belongs to the Special Issue The Gut Microbiome: Mechanisms and Therapies in Communicable and Non-Communicable Diseases)

32 pages, 1121 KB

Open AccessReview

Bioactive Phytochemicals in Experimental Models of Multiple Sclerosis: Mechanisms, Efficacy, and Translational Potential

by Weimin Guo, Simin Nikbin Meydani and Dayong Wu

Nutrients 2026, 18(2), 278; https://doi.org/10.3390/nu18020278 - 15 Jan 2026

Abstract

Multiple sclerosis (MS) is a chronic autoimmune disorder of the central nervous system marked by inflammatory demyelination and progressive neurodegeneration. Although current immunomodulatory therapies can reduce relapse rates, they are often associated with limited long-term efficacy and adverse effects, highlighting the need for [...] Read more.

Multiple sclerosis (MS) is a chronic autoimmune disorder of the central nervous system marked by inflammatory demyelination and progressive neurodegeneration. Although current immunomodulatory therapies can reduce relapse rates, they are often associated with limited long-term efficacy and adverse effects, highlighting the need for safer and more comprehensive complementary approaches. Dietary bioactive phytochemicals—notably, the polyphenols epigallocatechin-3-gallate (EGCG), curcumin, and resveratrol—have demonstrated potential to modulate the immune and inflammatory pathways implicated in MS pathogenesis. In addition to their immunomodulatory roles, emerging evidence suggests that these compounds also exert neuroprotective effects independent of immune modulation, including antioxidant activity, mitochondrial stabilization, and enhancement of neurotrophic signaling. Furthermore, recent studies identify the gut microbiota as a central mediator of MS pathophysiology and of how dietary phytochemicals are metabolized and exert their effects. This review examines experimental data evaluating the therapeutic potential of selected bioactive phytochemicals in MS, focusing on their mechanisms of action—including both immune-dependent and immune-independent neuroprotective effects—and interactions with the gut microbiota. Current limitations in translating findings from animal models to clinical settings are also discussed, and future directions for research in this evolving area are highlighted. Full article

(This article belongs to the Special Issue Nutritional Interventions and Dietary Supplements in Chronic Diseases: Mechanisms and Therapeutic Potential)

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24 pages, 524 KB

Open AccessReview

Algae and Algal Protein in Human Nutrition: A Narrative Review of Health Outcomes from Clinical Studies

by Zixuan Wang, Marie Scherbinek and Thomas Skurk

Nutrients 2026, 18(2), 277; https://doi.org/10.3390/nu18020277 - 15 Jan 2026

Abstract

As global interest in sustainable nutrition grows, algae have emerged as a promising functional food resource. This review analyzes the nutritional value of edible algae, with a particular focus on protein-rich microalgae, and synthesizes current clinical evidence regarding their health benefits. Algae have [...] Read more.

As global interest in sustainable nutrition grows, algae have emerged as a promising functional food resource. This review analyzes the nutritional value of edible algae, with a particular focus on protein-rich microalgae, and synthesizes current clinical evidence regarding their health benefits. Algae have been demonstrated to provide a broad spectrum of physiologically active nutrients, encompassing a range of vitamins and minerals as well as polyunsaturated fatty acids, antioxidant molecules and various bioactive compounds including dietary fiber. These nutrients have been linked to improved cardiovascular and metabolic health, enhanced immune function, and anti-inflammatory effects. A particular emphasis is placed on algal proteins as a novel alternative to traditional dietary proteins. Genera such as Spirulina and Chlorella offer high-quality, complete proteins with amino acid profiles and digestibility scores comparable to those of animal and soy proteins, thereby supporting muscle maintenance and overall nutritional status. Recent clinical studies have demonstrated that the ingestion of microalgae can stimulate muscle protein synthesis and improve lipid profiles, blood pressure, and inflammation markers, indicating functional benefits beyond basic nutrition. Algal proteins also contain bioactive peptides with antioxidative properties that may contribute to positive outcomes. This review synthesizes current studies, which demonstrate that algae represent a potent, sustainable protein source capable of enhancing dietary quality and promoting health. The integration of algae-based products into plant-forward diets has the potential to contribute to global nutritional security and long-term public health. However, the available clinical evidence remains heterogeneous and is largely based on small, short-term intervention studies, with substantial variability in algae species, processing methods and dosages. Consequently, while the evidence suggests the possibility of functional effects, the strength of the evidence and its generalizability across populations remains limited. Full article

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

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19 pages, 1271 KB

Open AccessArticle

Adherence to the Mediterranean Diet and Metabolic Gene Expression in Smokers: An Integrative Transcriptomic Approach

by İlayda Öztürk Altuncevahir, Ayşe Büşranur Çelik, Kezban Uçar Çifçi, Mervenur Uslu, Meltem Vural, Alev Kural, Ezgi Nurdan Yenilmez Tunoğlu and Yusuf Tutar

Nutrients 2026, 18(2), 276; https://doi.org/10.3390/nu18020276 - 15 Jan 2026

Abstract

Background: Cigarette smoking disrupts cellular energy metabolism and remains a major global health problem. The Mediterranean diet, characterized by antioxidant and anti-inflammatory properties, has been implicated in the regulation of metabolic pathways. Objective: This study aimed to examine the association between adherence to [...] Read more.

Background: Cigarette smoking disrupts cellular energy metabolism and remains a major global health problem. The Mediterranean diet, characterized by antioxidant and anti-inflammatory properties, has been implicated in the regulation of metabolic pathways. Objective: This study aimed to examine the association between adherence to the Mediterranean diet and the expression of energy metabolism-related genes in smokers aged 18–55 years. Methods: Smokers were classified according to their Mediterranean Diet Adherence Screener (MEDAS) scores into an adhering group (n = 24) and a non-adhering group (n = 24). Participant characteristics were recorded, blood samples were collected, and total RNA was isolated. Gene expression analysis was performed using a custom RT-qPCR array targeting energy metabolism-related genes. Pathway enrichment analysis was conducted using EnrichR Reactome 2024, and gene–metabolite relationships were explored using MetaboAnalyst 6.0 to support pathway-level interpretation. Results: Smoking was associated with coordinated upregulation of genes involved in glycolysis, glucose transport, lipid metabolism, amino acid metabolism, the pentose phosphate pathway, and redox regulation, consistent with a metabolically stressed state. In contrast, adherence to the Mediterranean diet was associated with lower expression of genes related to glycolytic flux, lipid β-oxidation, and amino acid turnover, alongside relatively higher engagement of tricarboxylic acid cycle-related pathways and reduced activation of redox-associated processes. Conclusions: Adherence to the Mediterranean diet was associated with differences in the expression of genes involved in cellular energy metabolism among smokers, suggesting a potential modulatory role of dietary patterns in smoking-related metabolic alterations. Full article

(This article belongs to the Section Nutritional Epidemiology)

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12 pages, 926 KB

Open AccessArticle

Association Between Muscle Quality and GNRI in Patients with Type 2 Diabetes

by Shinta Yamamoto, Yoshitaka Hashimoto, Fuyuko Takahashi, Moe Murai, Nozomi Yoshioka, Yuto Saijo, Chihiro Munekawa, Hanako Nakajima, Noriyuki Kitagawa, Takafumi Osaka, Ryosuke Sakai, Hiroshi Okada, Naoko Nakanishi, Saori Majima, Emi Ushigome, Masahide Hamaguchi and Michiaki Fukui

Nutrients 2026, 18(2), 275; https://doi.org/10.3390/nu18020275 - 15 Jan 2026

Abstract

Background: Type 2 diabetes (T2D) has been linked to impairments in skeletal muscle performance, encompassing reductions in both muscle strength and muscle quality. While malnutrition is a known modifiable factor contributing to muscle quality deterioration, its specific relationship with the Geriatric Nutritional Risk [...] Read more.

Background: Type 2 diabetes (T2D) has been linked to impairments in skeletal muscle performance, encompassing reductions in both muscle strength and muscle quality. While malnutrition is a known modifiable factor contributing to muscle quality deterioration, its specific relationship with the Geriatric Nutritional Risk Index (GNRI) in T2D remains underexplored. Using data from 743 participants in the KAMOGAWA-A cohort, this cross-sectional study evaluated the association between muscle quality and GNRI in individuals with type 2 diabetes. Methods: Muscle quality was defined as handgrip strength divided by arm lean mass. GNRI was calculated using serum albumin and body mass index. Multiple linear regression models were used to assess associations between GNRI and muscle quality. To account for BMI-related dependency in muscle quality measurements, we derived BMI-adjusted GNRI residuals and performed the same regression analysis to evaluate the stability of the observed relationship beyond BMI-induced confounding. Results: In the overall population, GNRI was inversely associated with muscle quality (β = −0.17, p < 0.001). Conversely, residual GNRI demonstrated a significant positive association with muscle quality (β = 0.13, p < 0.001), especially among men, individuals under 65 years of age, and across all BMI categories. Stratified analyses suggested that the strength and direction of associations varied by age, sex, and glycemic control status. Conclusions: The GNRI showed an inverse correlation with muscle quality, whereas residual GNRI showed a consistent positive relationship. These findings suggest that improving nutritional status may support muscle function in T2D, but BMI confounds the interpretation of GNRI in this context. Full article

(This article belongs to the Special Issue Advances in Diabetology: Nutritional Aspects for Diabetic Complications)

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16 pages, 928 KB

Open AccessArticle

Legume Consumption Improves Cellular Health and Autonomic Function in Competitive Swimmers

by Elisabetta Camajani, Valerio Caporali, Stefania Gorini, Alessandra Feraco, Chiara Quattrini, Luigi Procaccio, Andrea Armani, Elvira Padua, Massimiliano Caprio and Mauro Lombardo

Nutrients 2026, 18(2), 274; https://doi.org/10.3390/nu18020274 - 14 Jan 2026

Abstract

Objective: This study evaluated whether higher adherence to the Mediterranean Diet (MD), specifically through increased legume consumption, is associated with improved functional, autonomic, and performance parameters in adolescents and young adult competitive swimmers. Methods: Thirty-nine swimmers (mean age 19.7 ± 2.3 years; [...] Read more.

Objective: This study evaluated whether higher adherence to the Mediterranean Diet (MD), specifically through increased legume consumption, is associated with improved functional, autonomic, and performance parameters in adolescents and young adult competitive swimmers. Methods: Thirty-nine swimmers (mean age 19.7 ± 2.3 years; 22 men, 17 women) monitored over a five-month period under standardized training conditions. Based on baseline dietary assessment, participants were allocated into three groups according to habitual legume intake: Control group (<1 serving/week, no dietary modification), 3Legumes group (~2 servings/week, increased to 3/week), and 6Legumes group (~3–4 servings/week, increased to 6/week). Functional evaluation encompassed bioelectrical impedance parameters (phase angle, extracellular and intracellular water, ECW/ICW ratio), heart rate variability (HRV), cardiac coherence, and critical swimming speed test (CSS) results. Results: After 5 months, the 6Legumes group showed an increase in phase angle (Δ = +0.34 ± 0.35°, p = 0.004), a reduction in extracellular water (Δ = −1.77 ± 0.93%, p < 0.001), and an increase in intracellular water (Δ = +1.77 ± 0.93%, p < 0.001), resulting in a lower ECW/ICW ratio (Δ = −0.051 ± 0.028, p < 0.001). HRV (Δ = +6.92 ± 5.02, p = 0.0003) and cardiac coherence (Δ = +0.40 ± 0.35, p = 0.0015) also demonstrated statistically significant improvements, whereas CSS exhibited a positive trend (Δ = +0.011 ± 0.019 m/s, p = 0.067) without reaching statistical significance. Between-group comparisons confirmed significant differences in phase angle and water-distribution parameters (all p < 0.01). Conclusions: In this cohort of adolescents and young adult competitive swimmers, increased legume consumption within a Mediterranean dietary framework was associated with beneficial adaptations in cellular hydration status, autonomic regulation, and functional performance. Full article

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

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14 pages, 295 KB

Open AccessArticle

The Association Between Composite Healthy Lifestyle Score and Type 2 Diabetes Risk in the Korean Population: The Korean Genome and Epidemiology Study

by Daeyun Kim, Minji Kang, Dongmin Kim, Juyoung Park and Jihye Kim

Nutrients 2026, 18(2), 273; https://doi.org/10.3390/nu18020273 - 14 Jan 2026

Abstract

Background/Objectives: Modifiable lifestyle factors, particularly diet, are important for preventing type 2 diabetes (T2D); however, the evidence regarding this from prospective studies is limited in the Asian population. We therefore evaluated whether a diet-inclusive healthy lifestyle score (HLS) predicts incident T2D in [...] Read more.

Background/Objectives: Modifiable lifestyle factors, particularly diet, are important for preventing type 2 diabetes (T2D); however, the evidence regarding this from prospective studies is limited in the Asian population. We therefore evaluated whether a diet-inclusive healthy lifestyle score (HLS) predicts incident T2D in a community-based cohort. Methods: We analyzed 7185 T2D-free adults from the KoGES Ansan–Ansung cohort, constructing the HLS (range: 0–5) based on five lifestyle factors: non-smoking, ≥30 min/day of moderate-to-vigorous physical activity, low-risk alcohol consumption (≤40 g/day for men; ≤20 g/day for women), BMI of 18.5–24.9 kg/m², and a healthy diet, defined as a healthy plant-based diet index within the top 40th percentile. Cox proportional hazards regression models were employed to examine the association between HLS and incident T2D risk. Results: During a median follow-up of 17.5 years, 1223 cases of T2D were identified. Compared to individuals with a score of 0 or 1, those with a score of 5 had a 56% lower risk of T2D after adjustment for potential confounders (HR: 0.44, 95% CI: 0.32–0.62), and these associations remained consistent across subgroups stratified by age, sex, family history of T2D, hypertension, and residential area. However, the association was stronger among non-users of anti-diabetic medication than among users. Conclusions: Adherence to a healthier lifestyle, as indicated by a higher HLS, was significantly associated with a reduced risk of developing T2D among Korean adults. These findings underscore the importance of promoting integrated healthy lifestyle behaviors to prevent T2D. Full article

(This article belongs to the Section Nutritional Epidemiology)

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16 pages, 1055 KB

Open AccessArticle

Associations Between Consumption of Ultra-Processed Foods and Diet Quality Among Children and Adolescents

by Evgenia Petridi, Emmanuella Magriplis, Sotiria Kotopoulou, Niki Myrintzou, Evelina Charidemou, Elena Philippou and Antonis Zampelas

Nutrients 2026, 18(2), 272; https://doi.org/10.3390/nu18020272 - 14 Jan 2026

Abstract

Background: Ultra-processed foods (UPFs) have emerged as a critical component of diet quality, yet data on the associations between UPF and nutrient intakes remain limited. This study aimed to evaluate nutrient consumption in relation to UPF intake and adherence to international dietary [...] Read more.

Background: Ultra-processed foods (UPFs) have emerged as a critical component of diet quality, yet data on the associations between UPF and nutrient intakes remain limited. This study aimed to evaluate nutrient consumption in relation to UPF intake and adherence to international dietary guidelines for non-communicable disease (NCD) prevention. Methods: Data from 469 individuals aged 2–18 years enrolled in the Hellenic National Nutrition and Health Survey (HNNHS) were analyzed. Intakes were assessed using two 24 h recalls, and foods were classified according to the NOVA system. Participants were categorized by UPF energy intake tertiles. Nutrient adequacy was assessed using Nordic Nutrition Recommendations, European Society of Cardiology guidelines for macronutrients, and the Institute of Medicine’s Estimated Average Requirements and Adequate Intake values for micronutrients. Results: Children in the highest UPF tertile had significantly higher intakes of energy, carbohydrates, added sugars, saturated fats, polyunsaturated fats, and cholesterol, but lower intakes of protein compared to those in the lowest tertile. Fiber intake remained inadequate across all tertiles, with no significant differences. Regarding adherence to NCD prevention guidelines, children in the 3rd UPF tertile had a 2.3 times higher prevalence ratio for exceeding added sugar recommendations, while their protein intake prevalence ratio was 0.8 times lower. For micronutrients, the highest UPF tertile showed significantly elevated intakes of vitamins E, B₁, folate, calcium, iron, copper, and sodium, but lower potassium intake compared to the lowest tertile. Conclusions: Our results underscore the need for effective public health strategies to improve diet quality in children and adolescents and prevent diet-related NCDs. Full article

(This article belongs to the Special Issue Ultra-Processed Foods and Chronic Diseases Nutrients)

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13 pages, 596 KB

Open AccessArticle

Intramuscular Cyanocobalamin Treatment in Patients with Corpus Atrophic Gastritis and Vitamin B₁₂ Deficiency: Efficacy and Predictors of Increased Requirement—A Monocentric Longitudinal Real-Life Cohort Study

by Francesco Paolo Schiavone, Giulia Pivetta, Silvia Scalamonti, Manuela Pompili, Micaela Magnante, Gianluca Esposito, Bruno Annibale and Edith Lahner

Nutrients 2026, 18(2), 271; https://doi.org/10.3390/nu18020271 - 14 Jan 2026

Abstract

Background and Objectives: Corpus atrophic gastritis (CAG) is associated with vitamin B₁₂ deficiency due to impaired gastric acid and intrinsic factor secretion. Untreated vitamin B₁₂ deficiency can lead to pernicious anemia, severe neurological consequences, and acute cardiocerebral-vascular events. Timely vitamin [...] Read more.

Background and Objectives: Corpus atrophic gastritis (CAG) is associated with vitamin B₁₂ deficiency due to impaired gastric acid and intrinsic factor secretion. Untreated vitamin B₁₂ deficiency can lead to pernicious anemia, severe neurological consequences, and acute cardiocerebral-vascular events. Timely vitamin B₁₂ supplementation is relevant; however, the dosage of intramuscular (IM) vitamin B₁₂ supplementation has not been standardized to date. The objective was to assess the efficacy of a 1st and 2nd treatment schedule of IM-cyanocobalamin treatment in CAG patients with vitamin B₁₂ deficiency at long-term follow-up and to identify the predictors of increased cyanocobalamin requirement. Methods: This monocentric real-life cohort study included 213 CAG patients with vitamin B₁₂ deficiency. Inclusion criteria were adult age, histological diagnosis of CAG with vitamin B₁₂ deficiency (<220 pg/mL), and follow-up of more than 12 months. The 1st-treatment-schedule (TxA) was 5000 µg IM cyanocobalamin every 5 days for 3 times, followed by 5000 µg IM cyanocobalamin every 3 mos (20,000 µg/yr); the 2nd-treatment-schedule (TxB) was 5000 µg IM cyanocobalamin every 5 days for 3 times, followed by 5000 µg IM cyanocobalamin every 2 mos (30,000 µg/yr). The treatment endpoint was serum vitamin B₁₂ normalization. Clinical-biochemical follow-up was scheduled every 12 ± 6 mos: patients who satisfied the endpoint maintained the TxA, otherwise, TxB was prescribed. Results: Of the 213 CAG patients with vitamin B₁₂ deficiency, 48.3% had anemia, and 26.3% macrocytosis without anemia. TxA efficaciously corrected vitamin B₁₂ deficiency in 146 (68.5%) patients, maintaining efficacy until the longest available follow-up (42.2 ± 2.6 months). The remaining 67 patients (31.5%) were switched to TxB due to persistent vitamin B₁₂ deficiency observed at 12 (6–36) months and were maintained until the longest available follow-up (50.2 ± 4.1 months). At the longest available follow-up, a significant increase in Hb (TxA: 11.9 ± 0.2 to 13.1 ± 0.1 g/dL, p < 0.001; TxB: 12.2 ± 0.3 to 13.6 ± 0.2 g/dL, p = 0.003) and serum vitamin B₁₂ (TxA: 168 ± 7 to 402 ± 19 pg/mL, p < 0.0001; TxB: 157 ± 12 to 340 ± 24 pg/mL, p < 0.0001) was shown in both schedules. A significant decrease in MCV was shown in TxB only (p = 0.0003). In logistic regression, switching to TxB was significantly associated with severe corpus intestinal metaplasia (OR 11.0, 95% CI 2.8–43.7), macrocytosis at CAG diagnosis (OR 2.7, 95% CI 1.2–6.3), and male sex (OR 2.4, 95% CI 1.1–5.2). Conclusions: In this real-world setting, at long-term follow-up, nearly 70% of CAG patients with vitamin B₁₂ deficiency restored their vitamin B₁₂ levels with 20,000 µg/yr of cyanocobalamin, while the remaining 30% required 30,000 µg/yr. Male vitamin B₁₂-deficient CAG patients with advanced gastric damage and severe macrocytosis required higher dosages of cyanocobalamin. They should be carefully monitored to avoid suboptimal supplementation and potentially dangerous consequences of vitamin B₁₂ deficiency. Full article

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

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15 pages, 243 KB

Open AccessArticle

Caregiver Perceptions of USDA Rural Non-Congregate Summer Meals for Children in California

by Emily Patten, J. Mitchell Vaterlaus, Lori A. Spruance, Christine Betty Crocker, Trevor Merritt and Lauren Wood

Nutrients 2026, 18(2), 270; https://doi.org/10.3390/nu18020270 - 14 Jan 2026

Abstract

Background/Objectives: In 2023, the United States Congress amended Section 13 of the National School Lunch Act to allow non-congregate meal service as an option within the Summer Food Service Program in rural areas, creating “SUN Meals To-Go.” The purpose of this qualitative study [...] Read more.

Background/Objectives: In 2023, the United States Congress amended Section 13 of the National School Lunch Act to allow non-congregate meal service as an option within the Summer Food Service Program in rural areas, creating “SUN Meals To-Go.” The purpose of this qualitative study was to explore caregivers’ perceptions of USDA rural non-congregate summer meal programs in California during the summer of 2024. Methods: This was a cross-sectional, qualitative study using an electronic 20-item survey instrument that was available in English and Spanish. Five school foodservice directors in California shared and/or posted at meal pick-up sites a flyer with a QR code leading caregivers to the survey instrument. A conventional content analysis was conducted with the open-ended responses and descriptive statistics were calculated for close-ended items. Results: Caregivers (n = 827) were primarily married (70.5%) and Hispanic/Latino (54.3%) women (85.5%). They (55%) reported using the 2024 summer meal program “most times” or “every time” it was available. Three themes were constructed through qualitative content analysis: (1) Family support and resource relief, (2) Navigating program accessibility and logistics, and (3) Nourishment and practicality: Reflections on food quality, nutrition, and sustainability. Conclusions: Caregivers highlighted that the program supported their families and provided resource relief. They indicated that accessibility and logistics were effective, provided ideas for fine-tuning the delivery of the program, described this program as supporting their children’s nutrition. Full article

(This article belongs to the Section Pediatric Nutrition)

17 pages, 2213 KB

Open AccessReview

The Differential Effects of Vitamin K Across Glycaemic Outcomes in Prediabetes and Type 2 Diabetes Mellitus

by Syeda Ruwaida Ahmed, Kabelo Mokgalaboni and Wendy N. Phoswa

Nutrients 2026, 18(2), 269; https://doi.org/10.3390/nu18020269 - 14 Jan 2026

Abstract

Background: Vitamin K has emerged as a promising regulator of glucose metabolism in preclinical studies. There is, however, scant evidence to support this promising potential in a clinical setting. Aim: The aim of this study was to confirm the effects of vitamin K [...] Read more.

Background: Vitamin K has emerged as a promising regulator of glucose metabolism in preclinical studies. There is, however, scant evidence to support this promising potential in a clinical setting. Aim: The aim of this study was to confirm the effects of vitamin K supplementation on glycaemic parameters such as fasting blood glucose (FBG), fasting insulin (FI), glycated haemoglobin (HbA1c), insulin resistance (HOMA-IR), and homeostatic model of beta cell function (HOMA-β) across randomised controlled trials (RCTs). Materials and Methods: This meta-analysis used evidence from PubMed, Scopus, and manual screening. Only RCTs were considered for this meta-analysis of interventional studies. The Meta online tool was used to analyse data, with the results reported as either the mean or the standardised mean difference (SMD), alongside 95% confidence intervals (CI). Results: Only eight RCTs were found relevant and analysed; the age of those in the vitamin K group was 50.58 ± 6.91 years, and in the control group, it was 48.19 ± 5.41. The evidence showed a significant reduction in FBG, SMD = −0.22 (−0.39 to −0.05), HbA1c, MD = −1.00%, 95% CI (−1.92 to −0.07), and HOMA-IR, MD = −0.63, 95% CI (−1.20 to −0.06). However, no effect was observed on insulin (SMD = −0.39, 95% CI: −0.91 to 0.13, p = 0.15) and HOMA-β (MD = 6.56, 95% CI (−3.89 to 17.01), p = 0.2184. Low doses of vitamin K2 and vitamin K1 were associated with reduced HbA1c and HOMA-IR, respectively. An intervention of less than 12 weeks was associated with reduced HOMA-IR. Conclusions: This study showed a significant decrease in FBG, HbA1c, and HOMA-IR without affecting insulin or HOMA-β. Nevertheless, the limited number of trials with moderate quality warrants larger, longer-term RCTs with rigorous methodology and direct comparisons of vitamin K isoforms to better assess therapeutic potential. Full article

(This article belongs to the Special Issue Vitamins and Human Health: 3rd Edition)

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13 pages, 1131 KB

Open AccessSystematic Review

The Effect of the DASH Diet on the Development of Gestational Hypertension in Pregnant Women: A Systematic Review and Meta-Analysis

by Anastasios Alatsis, Nikoleta Aikaterini Xixi, Rozeta Sokou, Paraskevi Volaki, Styliani Paliatsiou, Zoi Iliodromiti, Nicoletta Iacovidou and Theodora Boutsikou

Nutrients 2026, 18(2), 268; https://doi.org/10.3390/nu18020268 - 14 Jan 2026

Abstract

Background/Objectives: Gestational hypertension is associated with increased maternal and fetal morbidity. The DASH diet is designed to reduce blood pressure and improve cardiovascular health. Our aim is to evaluate the efficacy of adherence to the DASH dietary pattern during pregnancy on the [...] Read more.

Background/Objectives: Gestational hypertension is associated with increased maternal and fetal morbidity. The DASH diet is designed to reduce blood pressure and improve cardiovascular health. Our aim is to evaluate the efficacy of adherence to the DASH dietary pattern during pregnancy on the incidence of GH. Methods: PubMed, Scopus, Web of Science, Cochrane Library and Embase were systematically searched. All studies including data on the effect of the DASH diet on GH were included in this review. The study is registered in PROSPERO (CRD420251044348). Results: A total of five studies were included in our study. The meta-analysis reported a pooled relative risk (RR) of 1.03 (CI: 0.86–1.23) for the effect of the DASH diet on gestational hypertension. In the subgroup analysis for preeclampsia, the overall relative risk estimate was 0.78 (95% CI: 0.60–1.02). Both analyses did not yield statistical significance. Conclusions: Current evidence, although showing a favorable trend, does not conclude that the DASH diet reduces the risk of gestational hypertension, as the results did not achieve statistical significance. Although potential benefits have been observed, the limited number of available studies does not allow for definitive conclusions. More randomized and multicenter studies are needed to thoroughly investigate the relationship between the DASH diet and gestational hypertension in order to implement this dietary program instead of general dietary recommendations for GH. Full article

(This article belongs to the Section Nutrition in Women)

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32 pages, 2513 KB

Open AccessReview

Therapeutic Effects of the Most Common Polyphenols Found in Sorbus domestica L. Fruits on Bone Health

by Noemi Penzes, Radoslav Omelka, Anna Sarocka, Roman Biro, Veronika Kovacova, Vladimira Mondockova and Monika Martiniakova

Nutrients 2026, 18(2), 267; https://doi.org/10.3390/nu18020267 - 14 Jan 2026

Abstract

The service tree (Sorbus domestica L.) fruits are rich in polyphenols, which exhibit promising therapeutic effects on bone health. This review summarizes the potential benefits of polyphenols identified in Sorbus domestica L. fruits, such as chlorogenic acid (CGA), protocatechuic acid (PCA), rutin, [...] Read more.

The service tree (Sorbus domestica L.) fruits are rich in polyphenols, which exhibit promising therapeutic effects on bone health. This review summarizes the potential benefits of polyphenols identified in Sorbus domestica L. fruits, such as chlorogenic acid (CGA), protocatechuic acid (PCA), rutin, epicatechin, and naringin on bone biology and on bone-related diseases, including osteoporosis and diabetes mellitus. Current evidence suggests that the aforementioned polyphenols may modulate osteoblast and osteoclast activity, enhance mineralization, mitigate oxidative stress and inflammation, thereby supporting overall bone health. Specific studies highlight the anabolic and anti-resorptive effects of CGA, the osteoprotective potential of PCA, and the ability of rutin, epicatechin, and naringin to promote osteogenic differentiation and inhibit osteoclastogenesis. Although the exact mechanisms are still unclear, it is believed that these bioactive metabolites can act through a variety of signalling pathways and epigenetic mechanisms. Despite existing preclinical evidence, there is a significant gap in clinical trials evaluating the direct impact of polyphenols mentioned above on bone health in humans. Therefore, further research is needed to confirm their effectiveness in clinical settings. The therapeutic potential of the most common polyphenols from Sorbus domestica L. fruits has been evaluated by available in vitro and in vivo studies, which highlight their promising potential as dietary interventions to prevent bone loss and improve skeletal integrity in metabolic bone diseases. Based on available information, maximum health benefits may be achieved if mature Sorbus domestica L. fruits are consumed approximately two weeks after harvest or as unripe fruit-based fermented products. Full article

(This article belongs to the Special Issue Bioactive Compounds and Functional Foods in Human Health—2nd Edition)

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16 pages, 302 KB

Open AccessArticle

Physical and Psychological Effects of Nasogastric Tube (NGT) Use in Adolescents with Anorexia Nervosa: An Exploratory Study

by Federico Amianto, Tomaso Oliaro, Francesca Righettoni, Chiara Davico, Daniele Marcotulli and Andrea Martinuzzi

Nutrients 2026, 18(2), 266; https://doi.org/10.3390/nu18020266 - 14 Jan 2026

Abstract

Background: Anorexia nervosa (AN) may require nasogastric tube (NGT) feeding when oral intake is insufficient. Evidence on the psychological impact and prognostic correlates of NGT use in adolescents affected with AN is limited. Methods: Fifty-seven adolescent inpatients (96.5% female; age range 12–18 years; [...] Read more.

Background: Anorexia nervosa (AN) may require nasogastric tube (NGT) feeding when oral intake is insufficient. Evidence on the psychological impact and prognostic correlates of NGT use in adolescents affected with AN is limited. Methods: Fifty-seven adolescent inpatients (96.5% female; age range 12–18 years; and mean age 15.0 ± 1.51 years) affected with AN admitted in a child psychiatry ward and treated with NGT re-feeding in addition to oral nutrition were included in the study. A 21-item VAS questionnaire was administered at intake (T0), after NGT introduction (T1), after one week of NGT use (T2), and after NGT dismissal (T3) to assess the physical and psychological effects. Participants were also assessed with psychometric measures including personality (TCI), eating psychopathology (EDI-2), general psychopathology (BDI-II, SCL-90-R, and TAS), and family functioning (FAD). The measures were compared between each timepoint with paired t-tests and ANOVA for repeated measures. Pearson correlations were performed between the VAS scores and psychometric measures. Results: From admission to discharge, weight increased by +3.2 kg and BMI by +1.2 kg/m². Items 1, 3, 4, 6, 15, 18, and 20 of the VAS questionnaire items showed significant improvement over time. TCI personality traits, EDI-2 eating and BDI, SCL-90 and TAS general psychopathology, and FAD family functioning were related to NGT perception by the AN adolescents. Conclusions: NGT was helpful in weight progression during inpatient treatment. It was generally well tolerated, with progressive improvement in psychological and physical discomfort during treatment. The meaningful associations with specific psychometric features suggest the possibility to tailor the NGT use based on adolescent characteristics. Multidisciplinary care and tailored psychoeducation may enhance NGT acceptance. Full article

(This article belongs to the Section Clinical Nutrition)

19 pages, 405 KB

Open AccessArticle

Understanding Australian Adolescents’ Perceptions of Healthy and Sustainable Diets, and Perceptions and Consumption of Pulses

by Adeline R. Lanham, Ayesha I. T. Tulloch, Jessica R. Bogard and Jolieke C. van der Pols

Nutrients 2026, 18(2), 265; https://doi.org/10.3390/nu18020265 - 14 Jan 2026

Abstract

Background/Objectives: To promote sustainable and healthy diets, increased consumption of pulses (the edible grains of legumes) is recommended. Adolescence is a period in which perceptions and behaviours develop that can impact lifelong dietary behaviours. Therefore, this study aimed to understand how Australian [...] Read more.

Background/Objectives: To promote sustainable and healthy diets, increased consumption of pulses (the edible grains of legumes) is recommended. Adolescence is a period in which perceptions and behaviours develop that can impact lifelong dietary behaviours. Therefore, this study aimed to understand how Australian adolescents perceive healthy, sustainable diets and perceive and consume pulses. Methods: Students (11–17 years old, median = 15 years, n = 33) in Brisbane, Australia, participated in school-based face-to-face focus groups and an online survey. Results: Students’ perceptions of healthy and sustainable dietary behaviours largely focused on the health aspects of food and consideration of food waste. The main factors that adolescents identified as influencing the health and sustainability of their diet were a lack of perceived responsibility for the impact of their meal choices and lack of knowledge of what constitutes a healthy and sustainable diet. Most students were unfamiliar with the term ‘pulses’ and lacked a desire to consume pulses more often. Consumption of pulses was below recommendations in national and international dietary guidelines. The main factors that adolescents identified as influencing pulse consumption related to students’ lack of capability to prepare pulses and the limited opportunities to access pulse-based foods. Conclusions: Perceptions of sustainable diets and pulses were very limited, and a lack of knowledge, skills, and limited availability were identified as barriers to their consumption. Education and cooking classes, in conjunction with increased availability of tasty pulse foods, are recommended to increase students’ pulse consumption as part of a healthy and sustainable diet. Full article

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

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15 pages, 263 KB

Open AccessArticle

Omnivores and Vegetarians Think Alike About Taste, Familiarity, and Price of Meat and Meat Analogs

by Tommaso Querini and Marco Tagliabue

Nutrients 2026, 18(2), 264; https://doi.org/10.3390/nu18020264 - 14 Jan 2026

Abstract

Background/Objectives: The overconsumption of animal-derived proteins represents a threat to both the environment and our health. Although there is widespread agreement that reducing meat consumption represents a more sustainable alternative, few studies have explored the implicit relations guiding these food choices. This empirical [...] Read more.

Background/Objectives: The overconsumption of animal-derived proteins represents a threat to both the environment and our health. Although there is widespread agreement that reducing meat consumption represents a more sustainable alternative, few studies have explored the implicit relations guiding these food choices. This empirical study explores meat consumption and vegetarianism through the lens of Relational Frame Theory. It is hypothesized that people who eat meat have different relational responses to images of meat and plant-based alternatives than vegetarians. Methods: We used the Implicit Attribute Classification Task (IMPACT) to measure relational responses, testing whether omnivores find plant-based proteins (1) less tasty, (2) less familiar, and (3) more expensive than vegetarians do. We registered the response latencies and calculated D-scores from 110 participants who completed an online test. Results: The study failed to find any statistically significant differences in the IMPACT measures between omnivores and vegetarians, given our specific participants and stimuli. Conclusions: Relational responding measures offer a useful approach to understanding consumer choices. However, they are highly sensitive to the task parameters and could be enhanced by further integration with other consumer behavior models when explaining meat consumption. Full article

(This article belongs to the Special Issue Research on the Factors Related to Food Choices to Promote Healthy Eating)

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29 pages, 1084 KB

Open AccessReview

Nutritional Modulation of the Gut–Kidney Axis

by Razvan George Bogdan, Felicia Gabriela Gligor, Paula Anderco, Livia Mirela Popa, Adriana Popescu, Vlad Adam Bloanca, Elisa Leonte, Mihai Iliescu Glaja, Zorin Petrisor Crainiceanu and Cristian Ichim

Nutrients 2026, 18(2), 263; https://doi.org/10.3390/nu18020263 - 14 Jan 2026

Abstract

Background: Chronic kidney disease (CKD) represents a state of persistent, sterile low-grade inflammation in which sustained innate immune activation accelerates renal decline and cardiovascular complications. Diet-induced gut dysbiosis and intestinal barrier dysfunction lower mucosal immune tolerance, promote metabolic endotoxemia, and position the gut [...] Read more.

Background: Chronic kidney disease (CKD) represents a state of persistent, sterile low-grade inflammation in which sustained innate immune activation accelerates renal decline and cardiovascular complications. Diet-induced gut dysbiosis and intestinal barrier dysfunction lower mucosal immune tolerance, promote metabolic endotoxemia, and position the gut as an upstream modulator of systemic inflammatory signaling along the gut–kidney axis. Scope: Most studies address microbiota-derived metabolites, food-derived bioactive peptides, or omega-3 fatty acids separately. This review integrates evidence across these domains and examines their convergent actions on epithelial barrier integrity, immune polarization, oxidative-inflammatory stress, and inflammasome-dependent pathways relevant to CKD progression. Key mechanisms: CKD-associated dysbiosis is characterized by reduced short-chain fatty acid (SCFA) production and increased generation and accumulation of uremic toxins and co-metabolites, including indoxyl sulfate, p-cresyl sulfate, trimethylamine N-oxide, and altered bile acids. Reduced SCFA availability weakens tight junction-dependent barrier function and regulatory immune programs, favoring Th17-skewed inflammation and endotoxin translocation. Bioactive peptides modulate inflammatory mediator networks and barrier-related pathways through effects on NF-κB/MAPK signaling and redox balance, while omega-3 fatty acids and specialized pro-resolving mediators support resolution-phase immune responses. Across these modalities, shared control points include barrier integrity, metabolic endotoxemia, oxidative stress, and NLRP3 inflammasome activation. Conclusions: Although evidence remains heterogeneous and largely preclinical, combined nutritional modulation targeting these convergent pathways may offer greater immunomodulatory benefit than isolated interventions. Future multi-omics-guided, factorial trials are required to define responder phenotypes and translate precision immunonutrition strategies into clinical CKD care. Full article

(This article belongs to the Special Issue Research Progress on Immune and Anti-Inflammatory Effects of Food Active Substances)

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26 pages, 823 KB

Open AccessReview

Underlying Mechanisms of Osteoporosis in the Context of Multimorbidity: Clinical Challenges and Management Strategies

by Alberto Castagna, Carmelo Pujia, Elisa Mazza, Samantha Maurotti, Yvelise Ferro, Valeria Rizzo, Martina Formica, Rosy Conforto, Caterina Mercuri, Angela Sciacqua, Carmine Gazzaruso, Arturo Pujia and Tiziana Montalcini

Nutrients 2026, 18(2), 262; https://doi.org/10.3390/nu18020262 - 14 Jan 2026

Abstract

Osteoporosis and chronic conditions such as type 2 diabetes mellitus, cardiovascular disease, heart failure, and chronic kidney disease share several common biological mechanisms, including chronic inflammation, oxidative stress, hormonal dysregulation, and metabolic alterations. In this context, multimorbidity presents an increasing clinical challenge, particularly [...] Read more.

Osteoporosis and chronic conditions such as type 2 diabetes mellitus, cardiovascular disease, heart failure, and chronic kidney disease share several common biological mechanisms, including chronic inflammation, oxidative stress, hormonal dysregulation, and metabolic alterations. In this context, multimorbidity presents an increasing clinical challenge, particularly in older populations, where osteoporosis remains frequently underdiagnosed and undertreated. This review aims to explore the complex interplay between skeletal fragility and cardiometabolic diseases, emphasizing the role of nutritional deficiencies (such as iron and vitamin C), shared molecular pathways (advanced glycation end-products, Renin–Angiotensin–Aldosterone System, RANK Ligand, RANK), and the systemic impact of chronic inflammation and tissue hypoperfusion. The review also addresses the effects of various drug classes—antidiabetics, antihypertensives, anticoagulants, and anti-osteoporotic agents—on bone metabolism and cardiovascular risk. Special focus is given to the implementation of integrated and personalized care models, particularly multidisciplinary team-based approaches, which have demonstrated significant reductions in mortality and refracture rates, despite their still limited adoption in clinical practice. In conclusion, this review highlights the shared mechanisms between osteoporosis and cardiometabolic conditions in the context of multimorbidity, underscoring persistent clinical challenges related to diagnosis, drug interactions, and care fragmentation that warrant further research into integrated care models. Full article

(This article belongs to the Section Nutrition and Metabolism)

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