Nutrients

22 pages, 370 KB

Open AccessArticle

Knowledge, Attitudes, and Clinical Practices Regarding Food–Drug, Herb–Drug, and Supplement–Drug Interactions: A Pilot Cross-Sectional Study Among Healthcare Professionals in Portugal

by Walter Silva, Maria João Campos and Angelina Pena

Nutrients 2026, 18(16), 2600; https://doi.org/10.3390/nu18162600 (registering DOI) - 8 Aug 2026

Abstract

Background/Objectives: The concomitant use of conventional medicines with foods, food supplements, and herbal products has increased, raising concerns about interactions. Despite this, healthcare professionals’ knowledge and clinical practices in this domain remain incompletely characterised. This study aimed to assess knowledge, attitudes, and [...] Read more.

Background/Objectives: The concomitant use of conventional medicines with foods, food supplements, and herbal products has increased, raising concerns about interactions. Despite this, healthcare professionals’ knowledge and clinical practices in this domain remain incompletely characterised. This study aimed to assess knowledge, attitudes, and clinical practices regarding food–drug, herb–drug, and supplement–drug interactions among healthcare professionals (HPs) in Portugal. Methods: A cross-sectional pilot study was conducted among 311 HPs using an online questionnaire; participants were recruited through convenience and snowball sampling. The instrument evaluated perceptions, practices, and knowledge (22 items; score 0–22). Descriptive statistics and non-parametric tests were used for group comparisons. Results: Most participants (90.6%) recognised the clinical relevance of herb–drug interactions; however, only 57.6% reported routinely asking patients about food supplements or herbal product use, and 46.0% about teas or infusions. The median knowledge score was 9.00 (interquartile range 9.00), with a mean of 9.34 ± 5.91. Significant differences were observed between professions (p < 0.001): pharmacists achieved the highest scores and nurses the lowest. In exploratory analyses, academic training and continuing education were associated with higher knowledge, whereas professional experience was not. Conclusions: Among the professionals studied, a discrepancy exists between perceived clinical relevance and actual practice, with important gaps in technical knowledge. Within the limits of this sample, the findings point to a need for improved education and structured clinical approaches to enhance patient safety when medicines and natural products are used concomitantly. Full article

(This article belongs to the Special Issue The Role of Food Supplements in Human Health)

26 pages, 1587 KB

Open AccessReview

Natural Products Targeting Airway Inflammation and Mucus Hypersecretion: Molecular Mechanisms and Therapeutic Potential for Respiratory Health

by Sung-Gyu Lee, Jae-Ho Lee and Hyun Kang

Nutrients 2026, 18(16), 2599; https://doi.org/10.3390/nu18162599 (registering DOI) - 8 Aug 2026

Abstract

Chronic respiratory diseases, including asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis, cystic fibrosis, and chronic bronchitis, are characterized by persistent airway inflammation and mucus hypersecretion, leading to airway remodeling and progressive pulmonary dysfunction. Although current therapies improve disease control, they often fail to [...] Read more.

Chronic respiratory diseases, including asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis, cystic fibrosis, and chronic bronchitis, are characterized by persistent airway inflammation and mucus hypersecretion, leading to airway remodeling and progressive pulmonary dysfunction. Although current therapies improve disease control, they often fail to adequately target the complex molecular mechanisms underlying chronic airway diseases and may cause adverse effects during long-term use. Natural products have therefore emerged as promising multitarget therapeutic agents because they simultaneously regulate oxidative stress, inflammatory signaling, epithelial dysfunction, and mucus production. Recent evidence demonstrates that marine-derived bioactive compounds and plant-derived phytochemicals modulate key signaling pathways, including nuclear factor-kappa B (NF-κB), mitogen-activated protein kinases (MAPKs), phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt), Janus kinase/signal transducer and activator of transcription (JAK/STAT), the NOD-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome, and nuclear factor erythroid 2-related factor 2 (Nrf2), thereby suppressing airway inflammation, oxidative stress, goblet cell differentiation, and MUC5AC overexpression. Advances in nanoformulation, pulmonary drug delivery, multi-omics, artificial intelligence-assisted drug discovery, and network pharmacology are expected to accelerate clinical translation. Collectively, natural products represent promising candidates for the development of evidence-based functional foods, nutraceuticals, and novel therapeutic strategies for chronic respiratory diseases. Full article

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

16 pages, 241 KB

Open AccessArticle

Expanded Newborn Screening Metabolites as Potential Biomarkers of Extrauterine Growth Restriction in Very-Low-Birth-Weight Preterm Infants

by Marco Scaglione, Maria Grazia Calevo, Sara Pessano, Francesca Nastasia Perri, Stefano Mariani, Paolo Massirio, Michela Cassanello, Michela Perrone Donnorso, Elvira Sondo, Mariya Malova, Maria Cristina Schiaffino, Mohamad Maghnie and Luca Antonio Ramenghi

Nutrients 2026, 18(16), 2598; https://doi.org/10.3390/nu18162598 (registering DOI) - 8 Aug 2026

Abstract

Background: Expanded Newborn Screening (NBS) allows screening for more than 50 inborn errors of metabolism (IEMs), thanks to the use of tandem mass spectrometry (MS/MS). Beyond its primary diagnostic function, NBS offers a valuable opportunity to obtain comprehensive information regarding the nutritional status [...] Read more.

Background: Expanded Newborn Screening (NBS) allows screening for more than 50 inborn errors of metabolism (IEMs), thanks to the use of tandem mass spectrometry (MS/MS). Beyond its primary diagnostic function, NBS offers a valuable opportunity to obtain comprehensive information regarding the nutritional status of each newborn. This aspect is particularly significant in very-low-birth-weight (VLBW) preterm infants, who are at increased risk of multiple perinatal complications. The objective of the present study was to leverage the extensive dataset generated from NBS samples of VLBW infants to explore potential correlations with longitudinal extrauterine growth restriction (EUGR). Methods: We retrospectively analyzed 155 VLBW newborns hospitalized in the neonatal intensive care unit (NICU) and screened at IRCCS Giannina Gaslini Children’s Hospital between May 2021 and December 2023. Forty-six NBS metabolites were evaluated at 48–72 h of life (T0), 30 days of life (T1), and at a body weight of 1800 g (T2). Results: Several metabolites showed significant differences between infants with and without longitudinal EUGR in the univariate analyses across the three sampling time points. However, after adjustment for multiple comparisons using the Benjamini–Hochberg procedure, no metabolite remained significantly associated with longitudinal EUGR. Conclusions: Although several metabolites initially appeared to be promising candidates, no independent metabolic signature of longitudinal EUGR was identified after adjustment for multiple testing. Nevertheless, the biological plausibility of several metabolic pathways potentially implicated in postnatal growth provides a rationale for future prospective studies with larger cohorts and more targeted metabolic panels to better elucidate the biological mechanisms underlying longitudinal EUGR. Full article

(This article belongs to the Section Pediatric Nutrition)

15 pages, 1245 KB

Open AccessArticle

Preconception Partner-Specific Vitamin D Biomarkers and Risk of Preeclampsia Among Couples Undergoing Fertility Treatment: A Secondary Cohort Analysis of FAZST

by Zeina M. Alkhalaf and Neil J. Perkins

Nutrients 2026, 18(16), 2597; https://doi.org/10.3390/nu18162597 (registering DOI) - 8 Aug 2026

Abstract

Background/Objectives: Maternal vitamin D deficiency has been associated with preeclampsia, but evidence regarding preconception partner-specific vitamin D biomarkers is limited. We evaluated associations between preconception maternal and paternal vitamin D biomarkers and the odds of preeclampsia. Methods: This secondary prospective cohort analysis used [...] Read more.

Background/Objectives: Maternal vitamin D deficiency has been associated with preeclampsia, but evidence regarding preconception partner-specific vitamin D biomarkers is limited. We evaluated associations between preconception maternal and paternal vitamin D biomarkers and the odds of preeclampsia. Methods: This secondary prospective cohort analysis used data from the Folic Acid and Zinc Supplementation Trial (FAZST), a multicenter study conducted in the United States between 2013 and 2017. Of the 2370 enrolled couples who were seeking infertility treatment, 1054 couples achieved a documented pregnancy. Because preeclampsia can only be ascertained among pregnancies progressing beyond 20 weeks of gestation, the primary analytic population was restricted to 826 pregnancies that reached ≥20 weeks, including 98 with preeclampsia and 728 without preeclampsia. Preconception serum total 25-hydroxyvitamin D (25(OH)D), vitamin D-binding globulin (VDBG), albumin, free 25(OH)D, and bioavailable 25(OH)D were assessed in both partners. Multivariable logistic regression models estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Results: In categorical analyses, maternal total 25(OH)D findings were consistent with a possible U-shaped pattern. Compared with concentrations of 30–< 50 ng/mL, concentrations ≤20 ng/mL were associated with higher odds of preeclampsia (aOR = 2.58, 95% CI: 1.13–5.88), as were concentrations ≥50 ng/mL (aOR = 5.45, 95% CI: 1.71–17.41). Similar categorical patterns were observed for maternal free 25(OH)D, with higher odds at concentrations ≤8.25 pg/mL (aOR = 2.23, 95% CI: 1.13–4.43) and ≥12.5 pg/mL (aOR = 4.71, 95% CI: 1.97–11.29), and for maternal bioavailable 25(OH)D concentrations ≤3.5 ng/mL (aOR = 2.61, 95% CI: 1.19–5.72) and ≥5.0 ng/mL (aOR = 5.38, 95% CI: 2.15–13.46). Lower paternal bioavailable 25(OH)D was associated with lower odds of preeclampsia in the fully adjusted model (aOR = 0.50, 95% CI: 0.28–0.89); however, this finding should be considered exploratory. Conclusions: Among pregnancies progressing to ≥20 weeks, lower and higher categories of maternal total, free, and bioavailable 25(OH)D were associated with the odds of preeclampsia relative to intermediate categories. These categorical findings are consistent with a possible U-shaped pattern but do not establish a nonlinear dose–response relationship. Paternal findings were limited and should be considered exploratory. Full article

(This article belongs to the Special Issue Nutrition for Fertility: Dietary Strategies to Improve Reproductive Health)

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20 pages, 585 KB

Open AccessReview

Protective Effects of Allicin and Garlic-Derived Interventions Against Metabolic Dysfunction-Associated Steatotic Liver Disease: Current Evidence and Mechanistic Insights

by Niuniu Sun, Yongqiang Gao, Yu Xing, Mingyang Guo, Xinyu Xu, Jingxi Hu, Zitong He, Jiapeng Luo, Sheng Li, Zhaozhao Hui and Shunming Zhang

Nutrients 2026, 18(16), 2596; https://doi.org/10.3390/nu18162596 - 7 Aug 2026

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease worldwide and poses a significant public health challenge. Allicin, a major bioactive organosulfur compound derived from garlic, has emerged as a promising candidate for MASLD prevention and management due to [...] Read more.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease worldwide and poses a significant public health challenge. Allicin, a major bioactive organosulfur compound derived from garlic, has emerged as a promising candidate for MASLD prevention and management due to its antioxidant, anti-inflammatory, and metabolic regulatory properties. Despite its potential, evidence regarding allicin’s efficacy on MASLD remains limited and heterogeneous because existing studies have evaluated different garlic-derived interventions across diverse experimental settings. This review therefore distinguishes studies of purified allicin from those of raw garlic, garlic powder, aged garlic extract, black garlic, garlic essential oil, and individual garlic compounds. Preclinical studies using allicin suggest beneficial effects on hepatic steatosis, inflammation, glucose homeostasis, and lipid metabolism. Human studies, however, have evaluated raw garlic consumption or garlic powder supplementation rather than allicin alone. Findings from other garlic preparations and individual compounds are attributed only to the intervention tested, because differences in composition, stability, bioavailability, metabolism, and pharmacological activity preclude their attribution to allicin. Moreover, the available clinical trial evidence comprises five publications derived from only two randomized controlled trials conducted in Iran, both lasting 12–15 weeks. In addition, preclinical evidence most consistently supports regulation of hepatic lipid metabolism, particularly the AMP-activated protein kinase/sterol regulatory element-binding protein-1c-related signaling, as a potential mechanism underlying the anti-steatotic effects of allicin. Additional pathways may involve inflammatory signaling, oxidative stress, gut microbiota, and bile acid-related regulation, although the evidence for several of these mechanisms remains suggestive. Nevertheless, the precise molecular targets and signaling networks underlying these effects remain incompletely understood, and the relevance of allicin to aging-related MASLD is largely unexplored because previous studies have used young animals. Future studies should incorporate aged models and long-term randomized controlled trials across diverse populations to clarify the mechanisms, therapeutic potential, and safety of allicin in MASLD. Full article

(This article belongs to the Special Issue Nutrient Interaction, Metabolic Adaptation and Healthy Aging)

22 pages, 4922 KB

Open AccessArticle

Integrating Metabolomics and Transcriptomics Reveals the Multi-Target Mechanisms of Fermented Portulaca oleracea L. (Purslane) in Attenuating Acute Diarrhea

by Rui Chen, Chunnan Yan, Xiyu Li, Xiaona Pang, Junhua Jin, Hongxing Zhang and Yuanhong Xie

Nutrients 2026, 18(16), 2595; https://doi.org/10.3390/nu18162595 - 7 Aug 2026

Abstract

Background: Current understanding of the biotransformation of bioactive compounds in Portulaca oleracea through probiotic fermentation remains limited, and the anti-diarrheal mechanisms of the resulting fermented products have yet to be fully elucidated. Methods: In this exploratory study, we employed untargeted metabolomics together with [...] Read more.

Background: Current understanding of the biotransformation of bioactive compounds in Portulaca oleracea through probiotic fermentation remains limited, and the anti-diarrheal mechanisms of the resulting fermented products have yet to be fully elucidated. Methods: In this exploratory study, we employed untargeted metabolomics together with a senna-induced acute diarrhea mouse model to investigate P. oleracea co-fermented with Lactiplantibacillus plantarum and Bacillus subtilis. Results: Metabolomic profiling identified 220 metabolites significantly altered by fermentation, predominantly comprising increased levels of lipids, phenylpropanoids, and polyketides. Compared with the unfermented P. oleracea control, fermented P. oleracea (FP) effectively reduced the diarrhea index, lowered serum levels of inflammatory cytokines (IL-1β, IL-6, TNF-α) and neurotransmitters (5-HT, substance P), and restored Na⁺/K⁺ balance as well as ileal histomorphology. Transcriptomic analysis and RT-qPCR validation further demonstrated that FP modulated the expression of genes involved in focal adhesion, PI3K-Akt, cGMP-PKG, and mineral absorption pathways. Conclusions: Fermented P. oleracea (FP) alleviates acute diarrhea through multi-target mechanisms. Notably, fermentation endows P. oleracea with markedly superior intestinal protective effects relative to the unfermented counterpart. These findings provide preliminary experimental evidence supporting the potential of fermented P. oleracea as a candidate for intestinal protective functional food research. Full article

(This article belongs to the Section Nutrition and Metabolism)

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43 pages, 1423 KB

Open AccessReview

Food-Derived Omega-3 Fatty Acids and Cognitive Aging: Integrating Nutritional Neuroscience and Geroscience

by Noémi Mózes, Ágnes Lipécz, Tamás Csípő, Vince Fazekas-Pongor, Dávid Major, Wei Yi Hung, Virág Zábó, Boglárka Csík, Ágnes Fehér, Bálint Bérczi, Lilla Klesch and Mónika Fekete

Nutrients 2026, 18(16), 2594; https://doi.org/10.3390/nu18162594 - 7 Aug 2026

Abstract

Within the emerging field of nutritional neuroscience, omega-3 fatty acids are among the most extensively investigated dietary bioactive compounds with potential relevance to cognitive aging. As populations continue to age worldwide, identifying modifiable nutritional factors that support cognitive health has become an important [...] Read more.

Within the emerging field of nutritional neuroscience, omega-3 fatty acids are among the most extensively investigated dietary bioactive compounds with potential relevance to cognitive aging. As populations continue to age worldwide, identifying modifiable nutritional factors that support cognitive health has become an important public health priority. Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), obtained primarily from marine sources, are integral components of neuronal membranes and serve as precursors of specialized pro-resolving lipid mediators. This narrative review integrates concepts from nutritional neuroscience and geroscience to examine how dietary omega-3 fatty acids may influence biological pathways involved in age-related cognitive decline. Current evidence suggests that DHA and EPA affect multiple processes linked to brain aging, including neuroinflammation, synaptic plasticity, mitochondrial function, oxidative stress, cerebrovascular integrity, cellular senescence, and gut–brain axis signaling. These mechanisms overlap with several hallmarks of aging and may contribute to the maintenance of cognitive function during later life. Observational studies generally associate higher dietary intake or circulating omega-3 status with better cognitive performance and a lower risk of cognitive decline and dementia. Findings from randomized controlled trials are less consistent, although benefits appear more likely in individuals with low baseline omega-3 status, mild cognitive impairment, or increased biological vulnerability. Beyond their established anti-inflammatory effects, omega-3 fatty acids may influence multiple aging-related pathways, particularly inflammaging, vascular aging, and mitochondrial dysfunction. Although heterogeneity in study design, dosage, intervention timing, and participant characteristics precludes firm conclusions, viewing omega-3 fatty acids through a geroscience lens offers a useful framework for interpreting existing evidence and informing future research. Overall, omega-3 fatty acids represent a promising nutritional strategy for supporting cognitive health across the lifespan, warranting further investigation in well-characterized populations and precision nutrition approaches. Full article

(This article belongs to the Special Issue Omega-3 Polyunsaturated Fatty Acids in Human Health and Disease)

16 pages, 1094 KB

Open AccessOpinion

Evaluating the Gaps in Nutritional Care for Cancer Patients: Insights from the CIPOMO (Collegio Italiano Primari Oncologi Medici Ospedalieri) National Survey

by Federica Grosso, Giuseppe Aprile, Sandro Barni, Sergio Bracarda, Alessandro Bertolini, Gianfranco Filippelli, Carlo Garufi, Silvana Leo, Alberto Scanni, Maria Giuseppa Sarobba, Rosa Rita Silva, Luisa Fioretto and Paolo Tralongo

Nutrients 2026, 18(16), 2593; https://doi.org/10.3390/nu18162593 - 7 Aug 2026

Abstract

Malnutrition, a key factor in oncology, affects 20–70% of cancer patients and influences both cancer risk and outcomes, being linked to decreased treatment tolerance, higher toxicity, lower quality of life, and shorter survival. Although international guidelines recommend early and systematic nutritional screening, its [...] Read more.

Malnutrition, a key factor in oncology, affects 20–70% of cancer patients and influences both cancer risk and outcomes, being linked to decreased treatment tolerance, higher toxicity, lower quality of life, and shorter survival. Although international guidelines recommend early and systematic nutritional screening, its adoption in clinical practice remains inconsistent. This study, promoted by the Italian College of Hospital Medical Oncology Directors (CIPOMO), aimed to provide a national snapshot of current organizational practices regarding nutritional screening, assessment, and management in Italian oncology centers. A 15-item survey was sent to 165 centers to investigate organizational practices and awareness of nutrition and physical activity in cancer care. Data were collected and analyzed as overall percentages. A total of 100 centers responded (61%). Although a nutritional assessment is routinely conducted at diagnosis in 67% of centers (n = 67), only 31 centers perform it for all patients. The remaining centers limit nutritional assessment to high-risk or selected patient groups. Moreover, although 86% of centers have dedicated professionals, multidisciplinary integration remains limited. Validated nutritional screening tools are used in 69% of centers, but follow-up reassessment is rarely systematic (15%). However, awareness of the importance of nutrition is high, with nearly all centers supporting educational interventions and dedicated nutritional pathways. Despite this high level of awareness, a significant gap remains between guideline recommendations and daily clinical practice. Standardizing early nutritional screening, enhancing multidisciplinary collaboration, and ensuring equitable and consistent access to nutritional services are crucial to fully integrating nutrition into oncology care and improving patient outcomes. Full article

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

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20 pages, 984 KB

Open AccessArticle

Dietary Patterns and Cognitive Decline in Older Adults: Findings from the Western Australia Memory Study

by Carolina Blagojevic Castro, Samantha L. Gardener, Farzana Jahan, Juliana Chen, Belinda M. Brown, Ruey L. Loo, Kevin Taddei, Stephanie R. Rainey-Smith, Michael Weinborn, Ana Caroline R. dos Reis, Manohar L. Garg, Ralph N. Martins and Hamid R. Sohrabi

Nutrients 2026, 18(16), 2592; https://doi.org/10.3390/nu18162592 - 7 Aug 2026

Abstract

Background: Preventive strategies, including adherence to specific dietary patterns, have received increasing attention as approaches to reduce cognitive decline and dementia risk. However, findings remain inconsistent, partly due to differences in dietary assessment methods, cognitive outcomes, and THE consideration of genetic susceptibility factors [...] Read more.

Background: Preventive strategies, including adherence to specific dietary patterns, have received increasing attention as approaches to reduce cognitive decline and dementia risk. However, findings remain inconsistent, partly due to differences in dietary assessment methods, cognitive outcomes, and THE consideration of genetic susceptibility factors such as apolipoprotein E (APOE) genotype. Methods: This study examined associations between dietary patterns and longitudinal cognitive change in 185 older adults without dementia from the Western Australia Memory Study. Participants completed a food frequency questionnaire at baseline and underwent comprehensive neuropsychological assessments at baseline and up to five follow-up visits at 18-month intervals. Composite scores were generated for six cognitive domains and the Preclinical Alzheimer’s Cognitive Composite (PACC). Results: Western and Prudent dietary pattern scores were analysed using linear mixed-effects models stratified by APOE ε4 carrier status. Among APOE ε4 carriers, greater adherence to a Western dietary pattern was associated with a faster decline in attention (p = 0.016), whereas no significant associations were observed for the Prudent dietary pattern or among APOE ε4 non-carriers. This association was attenuated after excluding participants with possible baseline cognitive impairment (MoCA < 23). Conclusion: These findings suggest that adherence to a Western dietary pattern may accelerate cognitive decline in individuals genetically at risk for Alzheimer’s disease, highlighting the importance of considering gene–diet interactions when developing dietary strategies for dementia prevention. Full article

(This article belongs to the Section Nutrition and Neuro Sciences)

21 pages, 17644 KB

Open AccessArticle

Cordyceps Polysaccharides Attenuate Post-Ischemic Inflammatory Damage in a Rat Stroke Model with Associated Modulation of the mtDNA/NLRP3 Inflammasome-Related Pyroptosis Pathway

by Yifan Chen, Huizhang Wang, Cong Gai, Xia Li, Yutong Li, Yihui Ma, Huiming Qi, Changhua Shi and Yibo Tang

Nutrients 2026, 18(16), 2591; https://doi.org/10.3390/nu18162591 - 7 Aug 2026

Abstract

Background: Cordyceps polysaccharides (CSP) have shown neuroprotective potential in models of ischemic stroke, but the underlying mechanisms remain to be clarified. Methods: In this study, the effects of CSP were evaluated in MCAO rats and OGD-exposed BV-2 cells. Results: CSP significantly attenuated ischemic [...] Read more.

Background: Cordyceps polysaccharides (CSP) have shown neuroprotective potential in models of ischemic stroke, but the underlying mechanisms remain to be clarified. Methods: In this study, the effects of CSP were evaluated in MCAO rats and OGD-exposed BV-2 cells. Results: CSP significantly attenuated ischemic injury and inflammatory responses in both in vivo and in vitro models. Mechanistically, CSP decreased CMPK2 expression, increased TFAM levels, and reduced 8-OHdG expression, suggesting attenuation of oxidative DNA damage and mitochondrial DNA-associated stress. EdU staining further showed that OGD-induced DNA synthesis-related signals were predominantly extranuclear, supporting the possibility of mtDNA-associated alterations under ischemia-like conditions. Moreover, CSP suppressed the upregulation of NLRP3, Caspase-1, N-GSDMD, IL-1β, and IL-18, and reduced LDH release following OGD exposure, suggesting inhibition of inflammasome-associated pyroptotic signaling. Conclusions: These findings suggest that the neuroprotective effects of CSP in ischemic stroke models may be related to the modulation of CMPK2/mtDNA/NLRP3 inflammasome pathway and reduced pyroptosis. Full article

(This article belongs to the Section Nutrigenetics and Nutrigenomics)

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31 pages, 3204 KB

Open AccessReview

Dietary Inflammatory Index, Physical Activity, and Inflammation-Related Health Outcomes: A Narrative Review and Inflammatory Resilience Framework

by Jing Yang, Jingmei Dong, Hua Yang, Chieh-Chen Wu and Chun-Hsien Su

Nutrients 2026, 18(16), 2590; https://doi.org/10.3390/nu18162590 - 7 Aug 2026

Abstract

How physical activity may modify the health consequences of a pro-inflammatory diet remains an important but unresolved question. This hypothesis-generating narrative review examines this question by integrating evidence on dietary inflammatory potential, physical activity, physiological capacity, and inflammation-related health outcomes, and by proposing [...] Read more.

How physical activity may modify the health consequences of a pro-inflammatory diet remains an important but unresolved question. This hypothesis-generating narrative review examines this question by integrating evidence on dietary inflammatory potential, physical activity, physiological capacity, and inflammation-related health outcomes, and by proposing an Inflammatory Resilience Framework to guide future research. Current evidence strongly supports systemic inflammation, adiposity, insulin resistance, and vascular dysfunction as relevant pathways linking dietary inflammatory exposure to disease vulnerability, while redox- and gut-related mechanisms remain more indirect. Physical activity and higher physiological capacity may influence several of these pathways through metabolic, vascular, muscular, and inflammatory regulation. Preliminary human joint-association evidence suggests that physical activity may partially attenuate selected consequences of pro-inflammatory dietary exposure, but it does not establish a consistent modifying effect or full compensation. The proposed framework positions physical activity, cardiorespiratory fitness, skeletal muscle function, adiposity, metabolic flexibility, vascular function, and baseline health status as factors that may modify the association between dietary inflammatory exposure and disease vulnerability. Rather than asking whether exercise cancels dietary risk, the framework provides a testable structure for future studies integrating objective physical activity, fitness, physiological reserve, inflammatory and metabolic markers, and longitudinal interaction analyses to determine when, how, and in whom physical activity modifies diet-related inflammatory risk. Full article

(This article belongs to the Special Issue Dietary Inflammatory Index: The Inflammatory Potential of Diet and Human Health)

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33 pages, 2597 KB

Open AccessSystematic Review

Association of the Mediterranean Diet, Physical Activity and Related Lifestyle Factors on the Mortality and Major Adverse Cardiovascular Events in Patients with Coronary Heart Disease: A Systematic Review and Meta-Analysis

by Liusheng Mo, Fengyu Qiu, Yueyao Liu, Yuli Zang and Cheng Chen

Nutrients 2026, 18(16), 2589; https://doi.org/10.3390/nu18162589 - 7 Aug 2026

Abstract

Introduction: Evidence linking Mediterranean dietary patterns and physical activity to mortality and major adverse cardiovascular events (MACEs) after coronary heart disease (CHD) diagnosis remains inconclusive. Methods: The search covered PubMed, MEDLINE, Scopus, Embase, and CENTRAL from January 2015 through 15 June 2026. Comparable [...] Read more.

Introduction: Evidence linking Mediterranean dietary patterns and physical activity to mortality and major adverse cardiovascular events (MACEs) after coronary heart disease (CHD) diagnosis remains inconclusive. Methods: The search covered PubMed, MEDLINE, Scopus, Embase, and CENTRAL from January 2015 through 15 June 2026. Comparable hazard ratios (HRs) were pooled using random-effects models; non-equivalent estimands were reported separately. Risk of bias was evaluated with design-appropriate tools and certainty with GRADE. Results: The 40 reports represented 34 data sources and at least 260,354 unique patients, comprising six randomized trials, 30 observational reports, and four comparative nonrandomized studies. In one randomized comparison of Mediterranean and low-fat diets, the HR for MACE was 0.72 (95% CI 0.54 to 0.96; moderate certainty). Observational findings supported inverse associations of closer dietary adherence with all-cause mortality (HR 0.74, 95% CI 0.60 to 0.90; I² = 44%) and MACE, whereas cardiovascular mortality remained uncertain. HRs for maintained or continued physical activity relative to persistent inactivity were 0.64 for all-cause mortality (95% CI 0.55 to 0.74; I² = 29%) and 0.42 for cardiovascular mortality (95% CI 0.28 to 0.64; I² = 72%). MACE findings for diet adherence and habitual physical activity generally favored lower risk. Randomized evidence on exercise or combined dietary and activity programs was sparse. Conclusions: Greater Mediterranean diet adherence and habitual physical activity were associated with more favorable CHD outcomes. Standardized, adequately powered trials are needed, especially for exercise and combined strategies. Full article

(This article belongs to the Special Issue Clinical Outcomes and Emerging Evidence on the Mediterranean Diet)

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28 pages, 1145 KB

Open AccessArticle

Football-Specific Performance and Cognitive Fatigue Resistance Following Supplementation with Two Phosphatidylserine Doses Combined with Taurine and Caffeine in Professional Male Football Players: A Randomized, Triple-Masked, Placebo-Controlled Trial

by Krzysztof Mizera, Dominik Mazurek, Alejandro Martínez-Rodríguez and Anna Kęska

Nutrients 2026, 18(16), 2588; https://doi.org/10.3390/nu18162588 - 7 Aug 2026

Abstract

Background/Objectives: Cognitive fatigue and impaired psychomotor function may contribute to reductions in football-specific performance during prolonged match-like activity. This study evaluated cognitive, psychomotor, sprint, and football-specific locomotor responses to multi-ingredient protocols containing taurine, caffeine, and either 300 or 600 mg·day⁻¹ of phosphatidylserine [...] Read more.

Background/Objectives: Cognitive fatigue and impaired psychomotor function may contribute to reductions in football-specific performance during prolonged match-like activity. This study evaluated cognitive, psychomotor, sprint, and football-specific locomotor responses to multi-ingredient protocols containing taurine, caffeine, and either 300 or 600 mg·day⁻¹ of phosphatidylserine in professional male football players. Methods: In this randomized, triple-masked, placebo-controlled, parallel-group trial, 97 professional male football players were allocated to placebo (PLA, n = 24), taurine plus caffeine (TC, n = 24), taurine plus caffeine plus phosphatidylserine 300 mg·day⁻¹ (TCP-300, n = 24), or taurine plus caffeine plus phosphatidylserine 600 mg·day⁻¹ (TCP-600, n = 25) for 14 days. Taurine and caffeine doses were 1500 mg·day⁻¹ and 200 mg·day⁻¹, respectively. Outcomes included 30 m sprint performance, visual and auditory reaction time, Stroop-task performance, perceived mental fatigue, GPS-derived locomotor variables, and post-intervention first-to-second-half performance-loss indices during a standardized football-specific exercise protocol. Results: The baseline-adjusted ANCOVA demonstrated a significant treatment-group effect on post-intervention 30 m sprint time. After Holm–Bonferroni correction, significant treatment-related effects remained for Stroop reaction time, visual reaction time, and perceived mental fatigue. No statistically significant treatment-related effect was observed for auditory reaction time (unadjusted p = 0.074; Holm-adjusted p = 0.096). During the post-intervention standardized football-specific protocol, baseline-adjusted GPS-derived locomotor outcomes differed significantly between groups. First-to-second-half performance-loss indices also differed between groups, with the smallest post-intervention losses generally observed in TCP-600. Because comparable decline indices were unavailable at baseline, these findings do not represent intervention-related changes in fatigue resistance. Conclusions: Under the present 14-day experimental conditions, the multi-ingredient protocols containing taurine, caffeine, and phosphatidylserine were associated with more favorable selected cognitive and psychomotor outcomes, 30 m sprint performance, and baseline-adjusted GPS-derived locomotor outcomes than placebo. The groups also differed in post-intervention first-to-second-half performance loss during the standardized football-specific protocol. Because corresponding decline indices were not assessed at baseline, these findings do not demonstrate an intervention-related improvement in fatigue resistance. Numerically more favorable values were observed for several outcomes in TCP-600; however, differences between TCP-300 and TCP-600 were modest and not consistently statistically significant, and the study was not specifically powered to establish a dose–response relationship. Because phosphatidylserine was not tested independently, these findings should be interpreted as responses to the combined multi-ingredient supplementation protocols rather than as effects of phosphatidylserine alone. Full article

(This article belongs to the Special Issue Nutrition Strategies to Improve Physical Performance in Team Sports Athletes)

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15 pages, 474 KB

Open AccessArticle

Cross-Sectional and Prospective Associations of Carbonated Soft Drink Consumption, BDNF Val66Met Polymorphism, and Psychological Distress

by Inkyung Baik

Nutrients 2026, 18(16), 2587; https://doi.org/10.3390/nu18162587 - 7 Aug 2026

Abstract

Background/Objectives: Few prospective studies have investigated the association between carbonated soft drink (CSD) consumption and psychological distress (PD) among adults. The current study aimed to examine this association according to the BDNF Val66Met polymorphism and to conduct comparable analyses for coffee and [...] Read more.

Background/Objectives: Few prospective studies have investigated the association between carbonated soft drink (CSD) consumption and psychological distress (PD) among adults. The current study aimed to examine this association according to the BDNF Val66Met polymorphism and to conduct comparable analyses for coffee and green tea consumption. Methods: Cross-sectional data (n = 6244) and 6-year prospective data (n = 1984) comprising participants aged 43–74 years were analyzed. PD was defined as a Psychosocial Wellbeing Index (PWI) score ≥ 27. Beverage consumption was assessed using a food frequency questionnaire. Modified Poisson regression was employed to estimate multivariable prevalence ratios or risk ratios (RRs) and 95% confidence intervals (CIs) for PD. Results: In cross-sectional data, green tea consumption was inversely associated with PD prevalence in the overall study population (p for trend < 0.05), and its dose–response relationship was observed exclusively among BDNF Met allele (CT and TT) carriers. In 6-year prospective data, CSD consumption was positively associated with PD risk among BDNF Met allele carriers only (p for trend < 0.01); multivariable RR (95% CI) for PD among BDNF Met allele carriers was 1.94 (1.21, 3.10)—(95% CI: 1.09, 3.44) after further applying the Bonferroni correction—for those who consumed ≥ 1 cup/week compared with non-consumers. No prospective association was observed for coffee and green tea consumption in the overall study population and genotype-specific analyses. Conclusions: CSD consumption was associated with increased PD risk among individuals carrying the BDNF Met allele, which is known to be associated with various stress-related psychological conditions. These findings suggest that CSD consumption may be particularly harmful to individuals with specific genetic factors. Full article

(This article belongs to the Special Issue Nutrition, Stress, and Psychological Well-Being Across the Lifespan)

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36 pages, 872 KB

Open AccessReview

Post-Diagnostic Diet and Breast Cancer Outcomes: A Comprehensive Systematic Review of Prospective Cohort Studies and Randomized Clinical Trials

by Loubna Enezari, Matteo Della Porta, Serena Mazzucchelli, Fabio Corsi, Jeanette A. Maier and Roberta Cazzola

Nutrients 2026, 18(16), 2586; https://doi.org/10.3390/nu18162586 - 7 Aug 2026

Abstract

Background/Objectives: Diet is increasingly recognized as a modifiable factor in cancer survivorship; however, the impact of post-diagnostic dietary habits on breast cancer (BC) outcomes remains uncertain. This systematic review aimed to evaluate the association between diet after BC diagnosis and clinical outcomes and [...] Read more.

Background/Objectives: Diet is increasingly recognized as a modifiable factor in cancer survivorship; however, the impact of post-diagnostic dietary habits on breast cancer (BC) outcomes remains uncertain. This systematic review aimed to evaluate the association between diet after BC diagnosis and clinical outcomes and to provide an updated synthesis of the evidence, with particular emphasis on dietary assessment methods, methodological heterogeneity, and evidence gaps. Methods: We systematically reviewed randomized controlled trials (RCTs) and prospective cohort studies that investigated post-diagnostic dietary exposures among women with BC. Outcomes of interest included all-cause mortality (ACM), breast cancer-specific mortality (CSM), recurrence (R), overall survival (OS), and disease-free survival (DFS). Sources of methodological heterogeneity were assessed, and findings were synthesized using a structured narrative approach. Results: A total of 39 studies were included (8 RCTs and 31 prospective cohort studies), comprising over 90,000 participants. Evidence from RCTs, including low-fat and multi-component interventions, showed largely null or inconsistent effects on BC-specific outcomes. Findings from cohort studies were heterogeneous. Associations for individual nutrients and food groups were generally inconsistent across studies, whereas healthier dietary patterns and higher diet quality scores were associated with reduced ACM. Associations with BC-specific outcomes were less consistent. Overall, the available evidence was characterized by substantial methodological heterogeneity, overlapping study populations, and low-to-moderate certainty. Conclusions: Current evidence suggests that post-diagnostic dietary habits may contribute more to overall survivorship than to BC-specific prognosis. Methodological heterogeneity, particularly in dietary assessment, should be taken into account when interpreting findings. The principal contribution of this review is the identification of important methodological limitations and evidence gaps that currently limit confidence in the available literature. Future research should employ more accurate dietary assessment methods and comprehensive nutritional evaluation to clarify the role of nutrition in BC outcomes. Full article

(This article belongs to the Section Clinical Nutrition)

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15 pages, 303 KB

Open AccessArticle

Food Preparation Skills, Digital Diet Literacy, Mediterranean Diet Adherence, and Ultra-Processed Food Consumption Among Adults Residing in Istanbul: A Cross-Sectional Study

by Hatice Merve Bayram and Arda Ozturkcan

Nutrients 2026, 18(16), 2585; https://doi.org/10.3390/nu18162585 - 7 Aug 2026

Abstract

Background: Ultra-processed food (UPF) consumption may be associated not only with nutrition knowledge but also with individuals’ practical food-related competencies and overall dietary patterns. Aim: This study investigated how cooking and food skills, dietary literacy, and adherence to the Mediterranean diet were related [...] Read more.

Background: Ultra-processed food (UPF) consumption may be associated not only with nutrition knowledge but also with individuals’ practical food-related competencies and overall dietary patterns. Aim: This study investigated how cooking and food skills, dietary literacy, and adherence to the Mediterranean diet were related to UPF consumption among adults in İstanbul, Türkiye. Methods: This descriptive cross-sectional study included 293 (85.7% female, mean age of 22.63 ± 4.66 years) adults residing in Istanbul, Türkiye between 1 January 2026 and 30 June 2026. Data were collected through an online questionnaire comprising sociodemographic and food-related characteristics, the Cooking Skills and Food Skills Measure, the e-Healthy Diet Literacy Scale (e-HDL), the Mediterranean Diet Adherence Screener (MEDAS), and the Short Screening Questionnaire of Highly Processed Food Consumption (sQ-HPF). Validated Turkish versions of all instruments were used; no measurement tool was developed specifically for this study. Results: 57.0% of participants were classified as having a high level of UPF consumption. The high level of UPF consumption group was younger, cooked at home less frequently, ordered food more frequently, and had lower cooking skills, food skills, and MEDAS scores compared to the low level of UPF consumption group (all p < 0.05). UPF consumption was negatively correlated with food skills (r: −0.33), MEDAS (r = −0.28), cooking skills (r = −0.27), age (r = −0.21), and home-cooking frequency (r = −0.18) and positively correlated with food-ordering frequency (r = 0.18). In the final regression model, younger age (β = −0.144, p = 0.009), lower food skills (β = −0.325, p < 0.001), and lower MEDAS scores (β = −0.252, p < 0.001) were independently associated with higher UPF consumption. E-HDL was not independently associated with UPF consumption. The final model explained 18.4% of the adjusted variance. Conclusions: Among this predominantly young and female sample of adults residing in Istanbul, lower food skills and lower Mediterranean diet adherence co-occurred with higher UPF consumption. Although the direction of these associations cannot be determined, the findings may inform future strategies that integrate nutrition education with practical food preparation support and the promotion of Mediterranean-style food choices. Full article

(This article belongs to the Special Issue Understanding and Reducing Ultra-Processed Foods for Better Health)

26 pages, 32748 KB

Open AccessReview

Zinc and Depression: From Neurobiological Functions to Gut–Brain Interactions

by Haichuan Li, Jiazhang Huang, Tian Zhang, Zhenchuang Tang, Qirui Xu, Di Gong, Liang Wang and Ying Zhang

Nutrients 2026, 18(16), 2584; https://doi.org/10.3390/nu18162584 - 7 Aug 2026

Abstract

The global prevalence of depression and its profound burden on public health create an urgent need to explore novel interventions beyond conventional therapeutic strategies. Zinc, a key regulator in the central nervous system, exerts multiple biological functions beyond maintaining neurotransmitter homeostasis, including inhibiting [...] Read more.

The global prevalence of depression and its profound burden on public health create an urgent need to explore novel interventions beyond conventional therapeutic strategies. Zinc, a key regulator in the central nervous system, exerts multiple biological functions beyond maintaining neurotransmitter homeostasis, including inhibiting neuroinflammation, restoring neuroplasticity, and modulating gut microenvironmental homeostasis. This review summarizes the evidence linking zinc deficiency to the onset and development of depression, with a specific focus on the role of gut microbiota. It also discusses different forms of zinc supplements, highlighting synergistic interventions that combine novel zinc complexes with probiotics. Together, these lines of evidence provide a theoretical basis for innovative adjunctive strategies for depression. Full article

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

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16 pages, 616 KB

Open AccessArticle

Overweight/Obesity and Body Fat Percentage in Relation to Iron Status Among Indonesian Women of Reproductive Age: Evidence from a Case–Control Study

by Qonita Rachmah, Hai Phung and Faruk Ahmed

Nutrients 2026, 18(16), 2583; https://doi.org/10.3390/nu18162583 - 7 Aug 2026

Abstract

Background/Objectives: Obesity-related inflammation may disrupt iron homeostasis and increase the risk of iron deficiency, yet evidence among women in low- and middle-income countries remains limited. This study examined the independent association between overweight/obesity and iron status among Indonesian women of reproductive age. Methods [...] Read more.

Background/Objectives: Obesity-related inflammation may disrupt iron homeostasis and increase the risk of iron deficiency, yet evidence among women in low- and middle-income countries remains limited. This study examined the independent association between overweight/obesity and iron status among Indonesian women of reproductive age. Methods: A case–control study was conducted among 340 nonpregnant women aged 20–29 years in Surabaya, Indonesia. Sociodemographic, dietary, menstrual, and anthropometric data were collected alongside venous blood samples. Logistic regression models were used to examine associations between adiposity measures and iron deficiency (ID), anaemia, and iron deficiency anaemia (IDA), adjusting for potential confounders. Results: Inflammation-adjusted serum ferritin was significantly higher among women with overweight/obesity than among normal-weight women (22.39 ± 21.7 vs. 17.78 ± 17.6 µg/L; p = 0.033). Consistent with this, the prevalence of ID was lower among women with overweight/obesity, likely reflecting inflammation-related ferritin elevation that may influence diagnostic classification. BMI-defined overweight/obesity was not independently associated with ID, anaemia, or IDA. In contrast, higher body fat percentage was inversely associated with ID (AOR 0.93; 95% CI 0.86, 0.99) and IDA (AOR 0.86; 95% CI 0.75, 0.99). Elevated alpha-1-acid glycoprotein (AGP) was independently associated with higher odds of IDA, and menstrual iron loss was an independent predictor of anaemia and IDA. Conclusions: BMI alone is insufficient to capture the relationship between adiposity and iron status in women of reproductive age. Body fat percentage appears to be a more sensitive indicator of adiposity-related iron risk. These findings suggest that inflammation associated with adiposity may alter iron biomarkers, and reliance on BMI alone may obscure the true burden of iron deficiency in this population. Full article

(This article belongs to the Special Issue Tackling Malnutrition: What's on the Agenda?)

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20 pages, 1071 KB

Open AccessArticle

Operational Approach to the Lancet 2025 Obesity Framework in Mexican Adults: Prevalence and Clinical Characteristics

by Daniela L. C. Delgado-Lara, Elizabeth Hernández-Castellanos, Diana J. Mejía-Barajas, Haru C. B. Angel-González, Sofía F. Angulo-Camacho, Omar Graciano-Machuca, Valeria Diaz-Rizo, Liliana Iñiguez-Gutiérrez and Teresita J. Hernández-Flores

Nutrients 2026, 18(15), 2582; https://doi.org/10.3390/nu18152582 - 6 Aug 2026

Abstract

Background/Objectives: The 2025 Lancet Diabetes & Endocrinology Commission proposed a framework that distinguishes preclinical from clinical obesity based on confirmed excess adiposity and evidence of obesity-related organ dysfunction. We estimated the prevalence and clinical characteristics of preclinical and clinical obesity in Mexican adults [...] Read more.

Background/Objectives: The 2025 Lancet Diabetes & Endocrinology Commission proposed a framework that distinguishes preclinical from clinical obesity based on confirmed excess adiposity and evidence of obesity-related organ dysfunction. We estimated the prevalence and clinical characteristics of preclinical and clinical obesity in Mexican adults and quantified their discordance with conventional body mass index (BMI) categories. Methods: Cross-sectional analysis of 5014 adults aged ≥20 years (weighted population 77,915,402) from the 2023 Mexican National Health and Nutrition Survey (ENSANUT). Excess adiposity was confirmed by a BMI ≥ 30 kg/m² plus one altered measure of central adiposity, by two altered measures irrespective of BMI, or by a BMI ≥ 40 kg/m² alone. Obesity-related dysfunction was ascertained from available cardiovascular, metabolic, and functional indicators. All analyses accounted for the complex sampling design. Results: Preclinical obesity affected 30.9% of adults and clinical obesity 19.6%. Among adults with clinical obesity, 4.9% had a normal BMI and 18.3% were overweight so that 23.2% fell below the conventional 30 kg/m² threshold. Cardiovascular dysfunction was the most frequent qualifying domain (78.1%), followed by limitations in activities of daily living (27.6%) and metabolic dysfunction (6.7%). Conclusions: BMI alone underestimates obesity-related clinical severity and misses a substantial share of adults with organ dysfunction, supporting the integration of central adiposity measures and assessment of obesity-related dysfunction into routine obesity surveillance. Full article

(This article belongs to the Special Issue Diet, Health, and Society: Advances in Nutritional Epidemiology for Public Health)

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