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Nutritional Support of GLP-1 Therapy: From Diabetes and Obesity Management...
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Nutritional Support of GLP-1 Therapy: From Diabetes and Obesity Management to Cardiovascular Prevention

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

Deadline for manuscript submissions: 15 August 2026 | Viewed by 8593

Special Issue Editors

Dr. Magdalena Makarewicz-Wujec

E-Mail Website
Guest Editor
Institute of Pharmaceutical Care, University of Economics and Human Sciences, 01-043 Warsaw, Poland
Interests: clinical nutrition; pharmacy; cardiovascular prevention
Dr. Alicja Kucharska

E-Mail Website
Guest Editor
Department of Human Nutrition, Medical University of Warsaw, Warsaw, Poland
Interests: clinical nutrition; dietary prevention and therapy for type 2 diabetes; obesity and cardiovascular diseases; nutrition-related cardiometabolic risk; public health nutrition; dietary patterns; compliance with nutritional guidelines
Dr. Edyta Czepielewska

E-Mail Website
Guest Editor
School of Health and Medical Sciences, Vizja University, Okopowa 59, 01-043 Warsaw, Poland
Interests: pharmaceutical care and the safety of medicinal products and dietary supplements, especially for elderly patients

Special Issue Information

Dear Colleagues,

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have rapidly evolved from glucose-lowering agents into pleiotropic drugs with benefits that extend far beyond glycaemic control. Current evidence shows that GLP-1 RAs can significantly reduce body weight, lower blood pressure, improve lipid profiles, reduce insulin resistance and provide direct cardioprotective and vasculoprotective effects. Consequently, these agents are increasingly recommended not only for the treatment of type 2 diabetes and obesity but also for the primary prevention of cardiovascular disease. The weight loss achieved through the pharmacological action of GLP-1 RAs, especially when combined with other agents, is comparable to the outcomes previously only attainable through bariatric surgery. However, these unprecedented weight-loss responses raise new concerns, including potential decreases in skeletal muscle quantity, quality and function, gastrointestinal adverse effects, risk of inadequate nutrient intake,  possible reductions in bone mineral density, and relatively high discontinuation rates of treatment. Therefore, structured nutritional monitoring and personalised dietary support are crucial components of effective GLP-1 RA therapy management.

This Special Issue of Nutrients, "Nutritional Support of GLP-1 Therapy: From Diabetes and Obesity Management to Cardiovascular Prevention”, invites original research and state-of-the-art reviews that address the efficacy and safety of GLP-1-based regimens in the context of nutritional and musculoskeletal risks and propose evidence-based strategies for optimal dietary, nutritional supplementation, and lifestyle support. 

Dr. Magdalena Makarewicz-Wujec
Dr. Alicja Kucharska
Dr. Edyta Czepielewska
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • GLP-1 receptor agonists
  • nutritional support
  • obesity treatment
  • type 2 diabetes
  • cardiovascular prevention
  • muscle mass preservation
  • bone health
  • adverse effects
  • weight management
  • micronutrient intake

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Published Papers (4 papers)

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Research

Jump to: Review

10 pages, 499 KB  
Communication
Short-Term Associations Between Fat-Free Mass Preservation and Glycaemic Markers During Tirzepatide Therapy: A Secondary Exploratory Analysis
by Luigi Schiavo, Biagio Santella, Monica Mingo, Gianluca Rossetti, Marcello Orio, Luigi Cobellis, Francesco Cobellis and Vincenzo Pilone
Nutrients 2026, 18(7), 1092; https://doi.org/10.3390/nu18071092 - 29 Mar 2026
Viewed by 775
Abstract
Background/Objectives: Tirzepatide (TZP), a dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist, induces substantial weight loss in patients with obesity; however, pharmacologically induced weight reduction may be accompanied by losses in fat-free mass (FFM), muscle strength (MS), and resting metabolic rate (RMR), [...] Read more.
Background/Objectives: Tirzepatide (TZP), a dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist, induces substantial weight loss in patients with obesity; however, pharmacologically induced weight reduction may be accompanied by losses in fat-free mass (FFM), muscle strength (MS), and resting metabolic rate (RMR), potentially influencing metabolic health. The metabolic implications of short-term preservation of metabolically active tissue during TZP therapy remain incompletely characterized. Methods: We performed a secondary, exploratory analysis of a previously published 12-week prospective, non-randomized comparative study including 60 patients with obesity treated with TZP (n = 30 TZP+Low Energy Ketogenic Therapy [LEKT]; n = 30 TZP+Low Calorie Diet [LCD]). Body weight (BW), fat mass (FM), FFM, MS, and RMR were assessed at baseline and week 12. Glycaemic parameters included fasting glucose, insulin, hemoglobin A1c (HbA1c), and HOMA-IR. All analyses were exploratory and hypothesis-generating. Results: Both groups achieved comparable reductions in BW after 12 weeks. FM decreased in both groups, while relative preservation of FFM, MS, and RMR was observed in one dietary context. Short-term changes in HbA1c, insulin, and HOMA-IR were statistically associated with concurrent changes in FFM, MS, and RMR, whereas no consistent associations were observed with changes in total BW or FM. Baseline glycaemic values were largely within the normoglycemic range. Conclusions: In this short-term secondary exploratory analysis, preservation of metabolically active tissue during TZP therapy was associated with concurrent glycaemic profiles, whereas no consistent associations were observed with total weight loss magnitude. These findings do not imply causality and should be interpreted as hypothesis-generating, warranting confirmation in larger, randomized, long-term studies. Full article
(This article belongs to the Special Issue Nutritional Support of GLP-1 Therapy: From Diabetes and Obesity Management to Cardiovascular Prevention)
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16 pages, 240 KB  
Article
Nutritional Counseling Is Independently Associated with Greater Knowledge of Drug–Food Interactions in Patients with Type 2 Diabetes
by Joanna Korbela and Agnieszka Białek
Nutrients 2026, 18(5), 742; https://doi.org/10.3390/nu18050742 - 26 Feb 2026
Viewed by 701
Abstract
Background: Type 2 diabetes mellitus (T2DM) is commonly managed with complex pharmacotherapy combined with dietary modification, which increases the risk of clinically relevant drug–food interactions (DFIs). Despite their potential impact on treatment efficacy and safety, patient knowledge of DFIs—particularly in the context of [...] Read more.
Background: Type 2 diabetes mellitus (T2DM) is commonly managed with complex pharmacotherapy combined with dietary modification, which increases the risk of clinically relevant drug–food interactions (DFIs). Despite their potential impact on treatment efficacy and safety, patient knowledge of DFIs—particularly in the context of modern therapies such as glucagon-like peptide-1 receptor agonists (GLP-1 RAs)—remains insufficiently explored. Methods: This cross-sectional study assessed knowledge of DFIs among 103 adults with T2DM using a self-administered, expert-validated questionnaire. Data on sociodemographic characteristics, clinical variables, anti-diabetic therapy (including GLP-1 RAs), sources of education, and attendance at dietary consultations were collected. Knowledge scores were calculated based on correct responses and categorized into tertiles (low, moderate, high). Associations were analyzed using non-parametric tests. Multivariable logistic regression was performed to identify independent predictors of moderate-to-high DFI knowledge. Results: Substantial gaps in DFI knowledge were identified, particularly regarding interactions involving dietary fiber, dairy products, grapefruit juice, and nutrient deficiencies associated with long-term pharmacotherapy. Knowledge level was not significantly associated with age, educational attainment, diabetes duration, or GLP-1 RA use. Female sex was associated with higher knowledge in univariate analysis (p = 0.026); however, this association did not remain significant in the multivariable regression model. Attendance at at least one dietary consultation in the previous year was significantly associated with higher knowledge levels (p = 0.041) and remained an independent predictor in multivariable analysis (OR = 2.31; 95% CI: 1.04–5.15; p = 0.039). Most participants reported not receiving prior education on DFIs, while expressing a strong need for more frequent counseling. Conclusions: Patients with T2DM demonstrate insufficient knowledge of clinically relevant DFIs, including selected issues related to GLP-1 RA therapy. Attendance at structured dietary consultations was independently associated with higher levels of DFI knowledge; however, the directionality and causality of this relationship cannot be established. Given the cross-sectional design and the assessment of knowledge rather than behavioral or clinical outcomes, these findings should be interpreted as hypothesis-generating. Further longitudinal and interventional studies are required to determine whether improved DFI knowledge translates into meaningful changes in dietary behavior, treatment adherence, or metabolic outcomes. Full article
(This article belongs to the Special Issue Nutritional Support of GLP-1 Therapy: From Diabetes and Obesity Management to Cardiovascular Prevention)

Review

Jump to: Research

25 pages, 5766 KB  
Review
Adherence and Persistence with GLP-1-Based Therapies: International Real-World Evidence and the Role of Nutritional and Lifestyle Support—A Narrative Review
by Artur Dziewierz and Zbigniew Siudak
Nutrients 2026, 18(11), 1761; https://doi.org/10.3390/nu18111761 - 30 May 2026
Viewed by 438
Abstract
Background/Objectives: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have transformed type 2 diabetes mellitus (T2DM) and obesity care, with clinical trials demonstrating weight loss exceeding 15%. However, real-world effectiveness lags trial efficacy, largely owing to high discontinuation rates. We characterize the global persistence gap [...] Read more.
Background/Objectives: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have transformed type 2 diabetes mellitus (T2DM) and obesity care, with clinical trials demonstrating weight loss exceeding 15%. However, real-world effectiveness lags trial efficacy, largely owing to high discontinuation rates. We characterize the global persistence gap and propose a framework integrating Medical Nutrition Therapy (MNT) to improve adherence. Methods: We conducted a narrative review of real-world evidence from North America, Europe, Asia, and Latin America, synthesized with physiological, nutritional, and behavioral data to distinguish established contributors to discontinuation from strategies that remain partly extrapolated from related populations. Results: Global persistence varies widely: from approximately 75–80% at 12 months in reimbursed T2DM cohorts (Sweden, Denmark) to below 10% in obesity-focused or high out-of-pocket-cost settings (Poland, Colombia), with intermediate rates in the United States and United Kingdom; in several cohorts, persistence falls below 15% by 24 months. The primary drivers are gastrointestinal intolerance and economic barriers. Meal size, dietary composition, and gastric-emptying effects influence gastrointestinal tolerability; inadequate protein intake during rapid weight loss raises concern for lean mass loss. Conclusions: Pharmacotherapy alone is unlikely to sustain long-term obesity management. Narrowing the persistence gap will require an integrated care model in which structured nutritional support—targeting protein intake, micronutrient density, and gastric-sparing feeding—is systematically offered rather than treated as an optional adjunct, while recognizing that most supporting evidence is extrapolated from primary trials in obesity and cardiometabolic disease rather than derived from GLP-1–specific randomized trials. Full article
(This article belongs to the Special Issue Nutritional Support of GLP-1 Therapy: From Diabetes and Obesity Management to Cardiovascular Prevention)
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28 pages, 690 KB  
Review
Nutrition and Physical Activity in Optimizing Weight Loss and Lean Mass Preservation in the Incretin-Based Medications Era: A Narrative Review
by Luisa Barana, Michelantonio De Fano, Massimiliano Cavallo, Marcello Manco, Deborah Prete, Carmine Giuseppe Fanelli, Francesca Porcellati and Roberto Pippi
Nutrients 2026, 18(1), 131; https://doi.org/10.3390/nu18010131 - 31 Dec 2025
Cited by 4 | Viewed by 5080
Abstract
Background/Objectives: Incretin-based medications have transformed obesity management by enabling substantial body weight reduction. However, the rapid and pronounced loss of body mass necessitates a comprehensive, multidisciplinary approach incorporating nutritional and physical activity strategies to preserve lean mass, optimize functional outcomes, and prevent long-term [...] Read more.
Background/Objectives: Incretin-based medications have transformed obesity management by enabling substantial body weight reduction. However, the rapid and pronounced loss of body mass necessitates a comprehensive, multidisciplinary approach incorporating nutritional and physical activity strategies to preserve lean mass, optimize functional outcomes, and prevent long-term complications. This narrative review provides a critical overview of this emerging clinical concern, which is expected to gain increasing relevance in the coming years. Methods: A literature review was conducted up to 31 October 2025, focusing on studies addressing nutritional, physical activity, and adjunctive interventions in adults with obesity treated with incretin-based medications. Results: Incretin-based agents induce significant weight loss, comparable to bariatric surgery, predominantly targeting adipose tissue. Nevertheless, these medications also cause rapid reductions in muscle and bone mass, often accompanied by nutrient deficiencies, which may compromise metabolic health and physical function. Tailored nutritional strategies—including hypocaloric diets enriched in protein and fiber, as well as amino acid, vitamin, and mineral supplementation—are critical to preserve lean mass and support sustained weight maintenance. Concurrently, structured, supervised physical activity, encompassing aerobics, resistance, and strength training, mitigates muscle loss and enhances functional capacity. Emerging pharmacological agents designed to promote adipose tissue reduction while preserving lean mass, as well as interventions targeting gut microbiota modulation, may represent promising adjunctive strategies to optimize long-term outcomes further. Conclusions: While incretin-based medications produce substantial weight loss, their impact on lean mass underscores the necessity of integrating personalized nutrition, supplementation, and structured exercise to preserve muscle, prevent malnutrition, and optimize long-term health and obesity outcomes. Full article
(This article belongs to the Special Issue Nutritional Support of GLP-1 Therapy: From Diabetes and Obesity Management to Cardiovascular Prevention)
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