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Advances in Nutritional Status, Interventions, and Care in Gastroenterology

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: closed (15 April 2026) | Viewed by 20774

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Prof. Dr. Marta Stelmach-Mardas

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Department of Obesity Treatment, Metabolic Disorders and Clinical Dietetics, Poznan University of Medical Sciences, 60-569 Poznan, Poland
Interests: diet-related diseases; gut microbiota; life quality assessment tools
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Special Issue Information

Dear Colleagues,

All innovative studies across all areas of gastroenterology and hepatology are welcome! The management of gastrointestinal and hepatic diseases has been made possible through a better understanding of their underlying mechanisms. A proper diet and the use of pre- and probiotics may reduce the clinical symptoms of the diseases, abdominal discomfort, or influence the treatment outcome. The side effects related to oncological treatment directly influence the digestive system and liver function, leading to changes in body composition. Furthermore, the gut microbiota plays a significant role; the incidence of metabolic fatty liver disease (MASLD) is increasing due to the obesity epidemic; and the number of patients whose chronic metabolic liver disease leads to the development of hepatocellular carcinoma (HCC) is increasing.

Finally, the COVID-19 pandemic was a challenge for practitioners and patients in the medical world.

Prof. Dr. Marta Stelmach-Mardas
Guest Editor

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Keywords

diet
management, metabolic fatty liver disease
cancer
gut microbiota
clinical symptoms
quality of life
body composition

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Published Papers (8 papers)

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Research

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12 pages, 350 KB

Open AccessArticle

Real-Life Data of Tirzepatide Use to Support Lifestyle Modification in Patients with Metabolic Syndrome

by Joanna Śledziona, Wojciech Warchoł, Marcin Mardas, Bogna Grygiel-Górniak, Michał Nowicki, Radosław Osmański and Marta Stelmach-Mardas

Nutrients 2026, 18(8), 1275; https://doi.org/10.3390/nu18081275 - 17 Apr 2026

Viewed by 675

Abstract

Background: Tirzepatide is a novel therapeutic option for the management of metabolic disorders which has started to be implemented in routine practice. The study aimed to analyze the effectiveness of tirzepatide use and patient education in the field of healthy eating and weight loss, based on real-life data from the practice of a primary care physician, in metabolic syndrome (MetSyn) patients during a one-year follow-up period. Methods: This is a retrospective study based on real-life data of 118 MetSyn patients who were under the supervision of a general practitioner (GP). Analysis was conducted on 62 patients supported by trizepatide (2.5 mg for 4 weeks, then 5 mg for 4 weeks and 7 mg for 46 weeks) with dietary education and 56 patients that underwent dietary education with motivation only. Lipid profile, glucose level and blood pressure were assessed. Body Mass Index (BMI), waist-to-height ratio (WHtR), A Body Shape Index (ABSI), Lipid Accumulation Product (LAP), Visceral Adiposity Index (VAI) and Body Roundness Index (BRI) were calculated. The KomPAN^® questionnaire was used for dietary assessment and WHO Quality of Life-BREF for the quality of life assessment at 52 weeks. Results: Patients from both groups significantly reduced their body weight and WC and the values of the following indices: BMI, WHtR, ABSI, LAP and BRI. A significant increase in LDL cholesterol and triglyceride values was observed in both groups and a significant decrease in glucose level only in the group with tirzepatide combined with dietary modification. Energy value, energy density of food and nutrient intake did not differ between groups, while the intensity of beneficial nutritional features (pHDI-10) was low. Significant differences in patients’ QoL were observed, especially in the domain related to mental health (higher in trizepatide + diet group). Conclusions: Support in primary care by a physician was successful from a long-term perspective in the group using tirzepatide in combination with diet modification as well as in the group based on dietary modification only. The data do not indicate a significant advantage of any one approach for patients, prioritizing an individualized approach to treatment. Full article

(This article belongs to the Special Issue Advances in Nutritional Status, Interventions, and Care in Gastroenterology)

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14 pages, 1202 KB

Open AccessArticle

Body Composition and Survival in Locally Advanced Rectal Cancer Patients Treated with Neoadjuvant Radiochemotherapy

by Piotr Kolenda, Marcin Mardas, Piotr Radomyski, Maciej Trojanowski, Maria Litwiniuk, Wojciech Warchoł and Marta Stelmach-Mardas

Nutrients 2025, 17(20), 3309; https://doi.org/10.3390/nu17203309 - 21 Oct 2025

Cited by 2 | Viewed by 1343

Abstract

Background: Nutritional status is a recognized determinant of treatment tolerance and clinical outcomes in oncology. This study aimed to assess body composition using computed tomography (CT) and to evaluate its association with progression-free survival (PFS) and overall survival (OS) in patients with locally advanced rectal cancer (LARC) undergoing curative multimodal therapy. Methods: A total of 216 patients with LARC who underwent neoadjuvant chemoradiotherapy (CRT) were retrospectively assessed. Two radiochemotherapy protocols were used: long-course chemoradiotherapy (lcCRT) (radiation therapy administered daily at doses of 1.8 or 2.0 Gy, for a total dose of 50.4–55.8 Gy) with concurrent chemotherapy: either 5-FU with leucovorin or capecitabine and total neoadjuvant chemoradiotherapy (tnCRT)—short-course radiotherapy (5 × 5 Gy) followed by sequential chemotherapy with CAPOX or FOLFOX. Surgery was performed 6.5 weeks after completing CRT. Radiotherapy was delivered using linear accelerators based on the Intensity-Modulated Radiation Therapy technique. CT scans were used to assess nutritional status. Survival analyses were performed. Data on food consumption frequency were collected using the Dietary Habits and Nutrition Beliefs Questionnaire (KomPAN^®). Non-Healthy-Diet-Index-14 (nHDI-14) was calculated. Results: Median observation time was 58 months (range 4–118 months). VATI level and OS (HR: 0.4618 95% CI: 0.2194–0.9719, p = 0.0419), as well as SATI and OS (HR: 0.4707 95% CI: 0.2286–0.9693, p = 0.0409) were significantly associated. This association was not significant for PFS (VATI: HR: 0.7084 95% CI: 0.4055–1.2376, p = 0.2259; SATI: HR: 0.6864 95% CI: 0.3932–1.1981, p = 0.1855). SMI and PMI values were not significantly related either PFS (SMI-HR: 0.6728, 95% CI: 0.4031–1.1231, p = 0.1295; PMI-HR: 0.7385, 95% CI: 0.4628–1.1785, p = 0.2036) or OS (SMI-HR: 0.9128, 95% CI: 0.4703–1.7720, p = 0.7876; PMI-HR: 0.6592 95% CI: 0.3684–1.1794, p = 0.1603). No significant association was found between sarcopenia development and PFS (HR: 1.2733 CI: 0.7589–2.1363; p = 0.3602) or OS (HR: 1.1207; CI: 0.5681–2.2107; p = 0.7424). Significant differences between men and women in alcohol intake and nHDI-14 were observed. Conclusions: Low visceral and subcutaneous adipose tissue index were significantly associated with worse OS in patients with LARC undergoing multimodal treatment. The nHDI-14 was negatively correlated with the duration of observation and patients’ age. Full article

(This article belongs to the Special Issue Advances in Nutritional Status, Interventions, and Care in Gastroenterology)

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11 pages, 757 KB

Open AccessArticle

Is There Any Association Between Fat Body Mass and Bone Mineral Density in Patients with Crohn’s Disease and Ulcerative Colitis?

by Alicja Ewa Ratajczak-Pawłowska, Michał Michalak, Aleksandra Szymczak-Tomczak, Anna Maria Rychter, Agnieszka Zawada, Kinga Skoracka, Agnieszka Dobrowolska and Iwona Krela-Kaźmierczak

Nutrients 2025, 17(3), 466; https://doi.org/10.3390/nu17030466 - 28 Jan 2025

Cited by 1 | Viewed by 2179

Abstract

Background: The study aimed to investigate the association between fat body mass and bone mineral density (BMD) of the lumbar spine (L1–L4), femoral neck, and total body. Methods: We studied 95 patients with Crohn’s disease (CD), 68 with ulcerative colitis (UC), and 40 healthy adults (control group—CG) aged 18–50 years old. The BMD of lumbar spine and femoral neck was assessed as well as body composition. Results: A lower fat mass percentage was observed in about 8% of CD, 13% of UC, and 3% of CG. An increased percentage of fat mass was common, and occurred above 50% of CD, 40% of UC, and about 60% of CG. Body fat mass and fat mass percentage were significantly lower among UC compared with the CG (p-value < 0.001) and CD (p-value < 0.01) in women. Body fat mass correlated positively with the BMD and T-score of L1–L4 and total body mass in men with UC. We found a positive correlation between the fat body mass and BMD and T-score of L1–L4, femoral neck, and total body in women with IBD. Among CG, positive correlations occurred between the fat body mass and BMD of L1–L4, BMD of total body, and T-score of total body, but only in men. CRP (C-reactive protein) correlated negatively with fat body mass only in men with CD. Conclusions: A higher fat mass percentage is common among IBD patients and healthy adults despite a normal body mass index. Body fat mass is a predictor of nutritional status and likely influences the course of the disease, as it correlated positively with BMD, T-score, and Z-score. The association between fat tissue and bone health appears to be stronger in women. Further studies are needed to investigate additional factors that may affect bone health in IBD. Full article

(This article belongs to the Special Issue Advances in Nutritional Status, Interventions, and Care in Gastroenterology)

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22 pages, 4916 KB

Open AccessArticle

Very-Low-Absorbable Geraniol for the Treatment of Irritable Bowel Syndrome: A “Real-World” Open-Label Study on 1585 Patients

by Chiara Ricci, Ilaria Maria Saracino, Maria Chiara Valerii, Renato Spigarelli, Irene Bellocchio and Enzo Spisni

Nutrients 2025, 17(2), 328; https://doi.org/10.3390/nu17020328 - 17 Jan 2025

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Abstract

Objective: The objective of this study was to evaluate the efficacy of a very-low-absorbable geraniol formulation, administered as a food supplement, in patients with irritable bowel syndrome (IBS) in a real-world setting in Italy. Methods: This open-label study was conducted in Italy on patients diagnosed with IBS and treated for 4 weeks with 240 mg/day of Palmarosa essential oil, absorbed on 960 mg of ginger root powder to obtain a very-low-absorbable geraniol formulation. Baseline characteristics, including demographic and symptoms were recorded using the IBS Severity Scoring System (IBS-SSS). After 28 ± 7 days, the patients were asked to complete the IBS-SSS questionnaire again. The primary objective was to confirm the effects of a very-low-absorbable geraniol formulation on self-reported symptoms of IBS and the quality of life of affected individuals. The secondary objective was to confirm the effect of the treatment on the different IBS subtypes. Results: A total of 1585 patients were included in the study, with a mean age of 44.8 years and 56.4% women. Following the 4-week supplementation period, significant decreases were observed in the patients’ IBS-SSS (−67.9%) and all the primary IBS symptoms, such as abdominal distention (−82.3%), unsatisfaction with bowel habits (−46.2%), and interference with quality of life (QoL) (−64.9%) (all p < 0.01). The patients’ stool type improved significantly. Treatment was effective in all IBS subtypes. Conclusions: Treatment with very-low-adsorbable geraniol food supplement was associated with improvements in symptoms and bowel habits in all IBS subtypes in a real-world setting in Italy. These findings support the use of geraniol as an effective option for patients with IBS regardless of the disease subtype. Full article

(This article belongs to the Special Issue Advances in Nutritional Status, Interventions, and Care in Gastroenterology)

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Review

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19 pages, 1339 KB

Open AccessReview

Reshaping the Gut: Symptoms, Nutrition and Microbiota After Bariatric and Endoscopic Procedures in Obesity

by Tommaso Mancuso, Claudia Di Rosa, Alessia Falcone, Laura Restaneo, Nicolò Citterio, Dario Biasutto, Simone Carotti, Mentore Ribolsi, Annamaria Altomare, Michele Cicala and Michele Pier Luca Guarino

Nutrients 2026, 18(1), 108; https://doi.org/10.3390/nu18010108 - 28 Dec 2025

Cited by 2 | Viewed by 1564

Abstract

Obesity is a multifactorial disease linked to chronic inflammation, metabolic disorders, and gut microbiota dysbiosis. Bariatric surgery (BS) and endoscopic sleeve gastroplasty (ESG) are effective for sustained weight loss and comorbidity improvement but may cause gastrointestinal and nutritional complications. This narrative review, informed by a structured literature search, synthesizes evidence on gastrointestinal side effects, gut microbiota alterations, and nutritional management after BS and ESG. Literature searches in PubMed and Scopus, without time limits, included English full-text articles on postoperative symptoms, microbiota changes, and nutritional outcomes. Bariatric procedures (e.g., Roux-en-Y gastric bypass, sleeve gastrectomy) and ESG are associated with adverse events such as dumping syndrome, GERD, nausea, and micronutrient deficiencies. Surgery induces profound shifts in gut microbiota composition and diversity, contributing to improved metabolic regulation. ESG, though less invasive, produces comparable microbial changes with a favorable safety profile. Nutritional management—progressive diet protocols and supplementation—is critical for preventing deficiencies and sustaining outcomes. Mediterranean-style diets appear more sustainable than high-protein regimens. Study heterogeneity, small cohorts, and limited long-term ESG follow-up reduce generalizability. Multidisciplinary care integrating surgical or endoscopic approaches with personalized nutrition and microbiota modulation is essential to optimize outcomes in obesity management. Full article

(This article belongs to the Special Issue Advances in Nutritional Status, Interventions, and Care in Gastroenterology)

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18 pages, 596 KB

Open AccessReview

Targeting Irritable Bowel Syndrome Through Diet and Mechanism-Based Therapies: A Pathophysiological Approach

by Ioanna Aggeletopoulou, Katerina Karaivazoglou, Maria Kalafateli and Christos Triantos

Nutrients 2025, 17(22), 3595; https://doi.org/10.3390/nu17223595 - 17 Nov 2025

Cited by 4 | Viewed by 4337

Abstract

Irritable Bowel Syndrome (IBS) is a prevalent and heterogeneous functional gastrointestinal disorder with a complex and multifactorial pathophysiology. Traditional treatment approaches have focused on symptom relief, often overlooking the underlying biological mechanisms driving the disease. Τhis review summarizes the current evidence linking core pathophysiological pathways of IBS with mechanism- and diet- based therapeutic strategies to guide personalized treatment. Serotonergic signaling, microbial dysbiosis, immune activation, epithelial barrier dysfunction, and bile acid malabsorption interact to shape the diverse phenotypes of IBS, contributing to altered motility, visceral hypersensitivity, and gut-brain axis dysregulation. Increasing evidence supports that targeted dietary and biological interventions including low-FODMAP and Mediterranean low-FODMAP diets, targeted use of probiotics and psychobiotics, and vitamin D supplementation can modulate microbial composition, reduce luminal irritants, support barrier integrity, and attenuate immune system activation. Similarly, pharmacologic therapies including serotonergic receptor modulators, bile acid sequestrants and neuroimmune agents act on specific mechanistic pathways, reflecting a shift from symptom-based to mechanism-driven management. Collectively, these findings highlight that integrating dietary, microbial, neuroimmune, and serotonergic modulation within a unified therapeutic framework can support a more rational and individualized approach to IBS management and long term symptom control. Full article

(This article belongs to the Special Issue Advances in Nutritional Status, Interventions, and Care in Gastroenterology)

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20 pages, 1170 KB

Open AccessReview

Dietary Management of Eosinophilic Esophagitis in the Era of Molecular Diagnostics: The Role and Limitations of Component-Resolved Diagnostics—A Narrative Review

by Adam Wawrzeńczyk, Katarzyna Napiórkowska-Baran, Maciej Szota, Paweł Treichel, Justyna Durślewicz and Zbigniew Bartuzi

Nutrients 2025, 17(22), 3588; https://doi.org/10.3390/nu17223588 - 17 Nov 2025

Viewed by 2119

Abstract

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disorder characterized by eosinophilic infiltration of the esophageal epithelium, primarily driven by exposure to food and aeroallergens. Although dietary elimination remains the cornerstone of therapy, the identification of specific food triggers still largely relies on empiric methods. This narrative review explores the diagnostic and therapeutic role of component-resolved diagnostics (CRD) and other molecular tools in the personalized management of EoE. Across observational and cohort studies, CRD has shown improved sensitivity in detecting clinically relevant allergen sensitizations compared with conventional tests, allowing for more precise dietary guidance and, in some cases, reducing unnecessary food exclusions. However, remission rates achieved through CRD-guided diets remain comparable or slightly lower than those obtained with empiric elimination, highlighting the need for validation in prospective, controlled studies. Recent advances in omics-based diagnostics, including gene expression profiling and proteomic biomarkers, further underscore the potential of integrating molecular and immunologic endotyping into clinical practice. Overall, current evidence supports CRD as a promising adjunctive tool that enhances the precision of allergen identification but is not yet ready to replace empiric dietary strategies. Future research should focus on validating standardized CRD-guided algorithms, integrating omics-derived biomarkers, and developing non-invasive diagnostic platforms. Incorporating dietitian-led nutritional assessment and biomarker monitoring into CRD- and omics-informed care pathways may help prevent nutrient deficiencies, improve adherence, and translate molecular precision into safer, patient-centered dietary management. Full article

(This article belongs to the Special Issue Advances in Nutritional Status, Interventions, and Care in Gastroenterology)

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Other

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21 pages, 2152 KB

Open AccessSystematic Review

Non-Digestible Oligosaccharides and Constipation: A Systematic Review and Meta-Analysis of Randomized Trials on Stool Frequency, Stool Consistency, and Fermentation Biomarkers

by Huiyu Chen, Jiale Ren, Langrun Wang, Wenyi Zhang, Sufang Duan, Jie Guo, Qingshan Chen, Ran Wang, Jian He, Jingjing He and Ruixin Zhu

Nutrients 2025, 17(20), 3246; https://doi.org/10.3390/nu17203246 - 16 Oct 2025

Viewed by 3535

Abstract

Background: Chronic constipation lacks effective long-term treatments. Non-digestible oligosaccharides (NDOs) are short-chain carbohydrates that resist digestion and may improve bowel function. This systematic review and meta-analysis examines the effect of NDOs on constipation-related outcomes in humans. Methods: We searched Ovid MEDLINE, Embase, and Web of Science (2010–May 2025) for randomized controlled trials (RCTs) comparing NDOs with placebo, reporting stool frequency, stool consistency, fecal pH, or short-chain fatty acids (SCFAs). Data were pooled using random-effects meta-analysis. All effect estimates are reported as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Subgroups were analyzed based on baseline constipation status and treatment duration. Results: We included 20 RCTs (1786 participants) evaluating seven NDO types. NDO supplementation significantly increased stool frequency overall, with larger effects in constipated individuals (SMD 0.99, 95% CI 0.58–1.28) than in non-constipated population (SMD 0.30, 95% CI 0.10–0.51). By duration, shorter interventions (≤3 weeks) yielded greater frequency gains (SMD 0.89, 95% CI 0.40–1.38) than longer ones (SMD 0.24, 95% CI 0.09–0.38). While the overall effect on stool consistency was non-significant, constipated patients (SMD 0.46, 95% CI 0.19–0.74) and short-term trials (SMD 0.20, 95% CI 0.03–0.37) showed modest improvements. NDOs also lowered fecal pH (SMD −1.02, 95% CI −1.25–−0.79). Data on SCFAs were inconclusive and based on very limited studies. Conclusions: NDOs modestly increase stool frequency and lower fecal pH, with greater effects in constipated individuals and short-term interventions. However, evidence certainty remains low due to heterogeneity and study limitations. Further studies are needed to establish clinical utility. Full article

(This article belongs to the Special Issue Advances in Nutritional Status, Interventions, and Care in Gastroenterology)

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