Nutrients

10 pages, 503 KB

Open AccessArticle

Nutritional Risk in Patients with IBD: Results from a National Survey

by Camilla Fiorindi, Giulia Cei, Salvatore Leone, Enrica Previtali, Giorgia Burbui, Chiara Celli and Francesco Giudici

Nutrients 2026, 18(8), 1261; https://doi.org/10.3390/nu18081261 (registering DOI) - 16 Apr 2026

Abstract

Background: Malnutrition is a clinically relevant yet often under-recognized complication of inflammatory bowel diseases (IBD). Evidence from non-hospitalized patients remains limited. This study provides a descriptive analysis of indicators of nutritional risk among members of the Italian IBD patients’ association and explores [...] Read more.

Background: Malnutrition is a clinically relevant yet often under-recognized complication of inflammatory bowel diseases (IBD). Evidence from non-hospitalized patients remains limited. This study provides a descriptive analysis of indicators of nutritional risk among members of the Italian IBD patients’ association and explores the association with symptoms, clinical characteristics, and access to nutritional care. Methods: A cross-sectional survey was conducted on 705 IBD patients. The questionnaire incorporated all the items required to assess nutritional risk included in the Malnutrition Universal Screening Tool (MUST) and its association with other clinical parameters. Results: Overall, 43.0% of respondents were found to be at moderate or high risk of malnutrition based on the MUST. A low BMI was observed in 25.6% of patients with CD and 22.1% of those with UC. Additionally, unintentional weight loss (UWL) occurred in 24.5% and 23.7% of CD and UC patients, respectively. In total, 30% of patients reported restricting their diet because they were afraid certain foods would worsen their symptoms. Gastrointestinal symptoms were significantly associated with MUST ≥ 2. Only 21.7% of participants reported receiving nutritional counselling. A total of 67.3% of subjects already at high nutritional risk (MUST ≥ 2) have never received any dietary recommendations. Conclusions: In this community sample of IBD patients, a considerable proportion reported indicators compatible with nutritional risk. These findings are not generalized to the general IBD population due to the dissemination through a patient association, but highlight gaps in outpatient nutritional assessment and patient education. Structured, accessible nutritional support may help address these unmet needs. Full article

(This article belongs to the Special Issue Nutritional Care in Patients with Inflammatory Bowel Disease)

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33 pages, 2016 KB

Open AccessArticle

Fermentation Enhances Antioxidant, Antiplatelet, and Anti-Inflammatory Properties of Oat- and Soy-Derived Dairy Alternatives

by Nikolaos Koutis, Georgios Liepouris, Ilianna Moysidou, Lydia Vogiatzaki, Katie Shiels, Sushanta Kumar Saha, Anna Ofrydopoulou and Alexandros Tsoupras

Nutrients 2026, 18(8), 1260; https://doi.org/10.3390/nu18081260 (registering DOI) - 16 Apr 2026

Abstract

Background: The increasing demand for plant-based dairy alternatives has stimulated interest in their potential health-promoting properties, particularly when combined with fermentation processes that may enhance the bio-efficacy and bioavailability of bioactive compounds. Methods: The present study investigated the impact of fermentation on the [...] Read more.

Background: The increasing demand for plant-based dairy alternatives has stimulated interest in their potential health-promoting properties, particularly when combined with fermentation processes that may enhance the bio-efficacy and bioavailability of bioactive compounds. Methods: The present study investigated the impact of fermentation on the antioxidant, antiplatelet, and anti-inflammatory activities of oat- and soy-based dairy alternatives. Total lipids were extracted and fractionated into lipophilic and amphiphilic lipid fractions, which were subsequently evaluated for antioxidant capacity using 2,2′-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS), 2,2-diphenyl-1-picrylhydrazyl (DPPH), and ferric reducing antioxidant power (FRAP) assays, as well as for their inhibitory activity against platelet aggregation induced by platelet-activating factor (PAF) or by ADP. Results: Fermentation significantly enhanced the biological activity of the tested products, with fermented samples exhibiting lower IC₅₀ values and thus more potent anti-inflammatory and antiplatelet efficacy and improved antioxidant performance compared with the non-fermented plant-based dairy alternative products. The amphiphilic lipid fractions demonstrated the strongest bioactivity, suggesting that fermentation promotes structural modifications in polar lipids that contribute to enhanced functional properties. Overall, fermented soy products exhibited stronger antiplatelet (anti-ADP) and anti-inflammatory (anti-PAF) activities, with lower IC₅₀ values (indicating higher inhibitory potency), whereas fermented oat products demonstrated particularly enhanced antioxidant capacity, especially in TAC fractions, as evidenced by higher FRAP values and carotenoid content (e.g., oat yogurt TAC: 19.14 ± 9.97 mg CE/g extract). In DPPH assays, TAC fractions of both soy and oat showed comparable radical scavenging activity (TEAC ≈ 0.019 for soy yogurt TAC), while ABTS and FRAP assays highlighted matrix-dependent differences between lipid fractions. Fatty acid analysis further indicated favorable compositional changes associated with fermentation, including favorable alterations in the n-6/n-3 fatty acid ratio of the fatty acid content of the bioactive polar lipid species, while OMICs analysis indicated the specific molecular species of phospho-/glyco-based polar lipids present in these products. Conclusions: These findings suggest that fermentation can substantially improve the biofunctional profile of plant-based dairy alternatives and highlight fermented oat- and soy-based products as promising dietary sources of bioactive polar lipids with potential cardioprotective properties. Full article

(This article belongs to the Special Issue Nutraceuticals, Bioactive Compounds and Functional Foods: Their Role in Chronic Diseases (2nd Edition))

17 pages, 289 KB

Open AccessArticle

Do Financial Constraints, Perceived Food Insecurity, and Pro-Environmental Behavior Explain Intentions to Reduce Meat and Fat Consumption in Older Adults? A Preliminary Study

by Marzena Jeżewska-Zychowicz, Robert Gajda and Rafał Kubacki

Nutrients 2026, 18(8), 1259; https://doi.org/10.3390/nu18081259 (registering DOI) - 16 Apr 2026

Abstract

Background: The consumption of meat and high-fat foods is constantly discussed, with attention to their health and environmental consequences, as well as the barriers to changing current behaviors. Objective: The study aimed to examine how pro-environmental behavior, perceived food insecurity, and financial constraints [...] Read more.

Background: The consumption of meat and high-fat foods is constantly discussed, with attention to their health and environmental consequences, as well as the barriers to changing current behaviors. Objective: The study aimed to examine how pro-environmental behavior, perceived food insecurity, and financial constraints correlate with intentions to limit meat and fat consumption among older adults. Methods: A cross-sectional study was conducted in 2025 among 475 individuals aged 60 to 92 years. The questionnaire includes scales that enable the calculation of four scores: Meat Reduction, Low Fat, Perceived Food Insecurity, and Lack of Financial Support. Additionally, questions about involvement in pro-ecological behaviors and sociodemographic characteristics were included. Logistic regression analysis was used to examine associations between perceived food insecurity, lack of financial support, and pro-environmental behaviors (independent variables) and intentions to reduce meat (Model 1) and fat (Model 2) (dependent variables). Results: Intentions to limit meat correlated positively with buying food produced in an environmentally friendly way (adjusted OR = 2.05; 95% CI: 1.56, 2.69), not wasting food (adjusted OR = 1.26; 95% CI: 1.05, 1.51), and buying local food (adjusted OR = 1.48; 95% CI: 1.21, 1.82). Intentions to limit fat correlated positively with buying food produced in an environmentally friendly way (adjusted OR = 1.66; 95% CI: 1.27, 2.18) and not wasting food (adjusted OR = 1.45; 95% CI: 1.20, 1.76). No relationships were found between the lack of financial support and intentions to limit meat (p = 0.069) and fat (p = 0.600). The perceived food insecurity decreased the likelihood of intentions to restrict fat (adjusted OR = 0.45; 95% CI: 0.24, 0.83), but not meat (p = 0.387). Conclusions: To better understand why experienced financial constraints did not influence the intention to reduce consumption of meat and high-fat products, further research is needed that focuses on motivation to change and the ability to change behavior among older people. Nevertheless, the results suggest that enhancing pro-environmental behaviors beyond those directly related to meat and fat consumption may facilitate reductions in meat and fat consumption through pro-environmental behavioral spillover. Full article

(This article belongs to the Special Issue Food Insecurity and Nutritional Health Among Older Adults)

32 pages, 1797 KB

Open AccessReview

Consequences of Western and Mediterranean Diets’ Nutrients on the Microbiota–Gut–Brain Axis

by Arnaud Michel, Grégory Pourié and Tunay Kökten

Nutrients 2026, 18(8), 1258; https://doi.org/10.3390/nu18081258 - 16 Apr 2026

Abstract

Background: The prevalence of neurodegenerative diseases like Alzheimer’s and mental disorders like depression or anxiety appears higher in patients with gastrointestinal tract diseases like inflammatory bowel disease (IBD). Conversely, depressed patients have higher rates of gastrointestinal disorders. These observations suggest bidirectional communication between [...] Read more.

Background: The prevalence of neurodegenerative diseases like Alzheimer’s and mental disorders like depression or anxiety appears higher in patients with gastrointestinal tract diseases like inflammatory bowel disease (IBD). Conversely, depressed patients have higher rates of gastrointestinal disorders. These observations suggest bidirectional communication between the brain and the gastrointestinal tract, the so-called “gut–brain axis”. Moreover, an altered microbiota, called “dysbiosis”, has been reported in these diseases, highlighting the network between gut microbes and their host. The emergence of the microbiota as a key regulator of the gut–brain dialog has led to the establishment of the concept of the “microbiota–gut–brain axis”. Objectives: In this narrative review, we outline the main interaction channels between the gastrointestinal tract and the brain. Then, we summarize current knowledge of two major diets (i.e., Western and Mediterranean diets) and the principal dietary components that modulate the microbiota–gut–brain axis to discuss the mechanisms putatively involved in intestinal, psychiatric, and neurological disorders. Conclusions: Diet is a major factor influencing the gut microbiota, and consequently, also putatively systemic mechanisms through the microbiota–gut–brain axis. Indeed, the composition of the diet is crucial for health and disease. Despite the main role of diet, the physiological, cellular, or molecular mechanisms involved in the complex communication between the microbiome, gut, and brain are still poorly understood. Full article

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

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10 pages, 516 KB

Open AccessArticle

Nutrition Education in Greek Secondary School Textbooks: A Content Analysis of Coverage and Thematic Orientation

by Antonios Emmanouil Chronakis, Emilia Vassilopoulou, Elisabeth Vardaka and Athanasios Papadopoulos

Nutrients 2026, 18(8), 1257; https://doi.org/10.3390/nu18081257 - 16 Apr 2026

Abstract

Background: In Greece, nutrition education is not taught as an independent subject but is incorporated across multiple disciplines. Objective: To evaluate the extent, distribution, and thematic orientation of nutrition-related content in Greek secondary school textbooks. Methods: A systematic content analysis was [...] Read more.

Background: In Greece, nutrition education is not taught as an independent subject but is incorporated across multiple disciplines. Objective: To evaluate the extent, distribution, and thematic orientation of nutrition-related content in Greek secondary school textbooks. Methods: A systematic content analysis was conducted on all officially approved textbooks used in Greek secondary education during the academic year 2022–2023. A total of 164 textbooks (26,914 pages) were analyzed. Nutrition-related references were systematically identified using predefined keywords and categorized into thematic domains. Coding was performed independently by two researchers (Cohen’s κ = 0.84). Results: A total of 1426 nutrition-related references were identified. Nutrition-related content was unevenly distributed, with 57.1% in Gymnasium textbooks and 42.9% in Lyceum textbooks. When normalized, Gymnasium textbooks contained 7.47 references per 100 pages compared with 3.82 in Lyceum. Content was primarily focused on biological concepts (27.1%) and health/disease prevention (20.3%), while behavioral (16.5%), psychosocial (16.2%), and sustainability-related (19.8%) dimensions were less represented. No references addressed skills-based nutrition education. Conclusions: Nutrition education in Greek textbooks is present but fragmented and predominantly biologically oriented. The lack of behavioral and skills-based content suggests the need for more comprehensive and interdisciplinary educational approaches. Full article

(This article belongs to the Section Nutritional Policies and Education for Health Promotion)

15 pages, 1028 KB

Open AccessSystematic Review

by Felicia Gabriela Beresescu, Razvan Marius Ion, Adriana Monea, Alina Ormenisan, Despina Luciana Bereczki-Temistocle, Liana Beresescu and Andrea Bors

Nutrients 2026, 18(8), 1256; https://doi.org/10.3390/nu18081256 - 16 Apr 2026

Abstract

Background: Obesity and periodontitis are linked through inflammatory and metabolic pathways, and the oral microbiota may mediate this interaction. Age-related changes in immunity, salivary function, and cumulative exposure may modify obesity-associated periodontal dysbiosis. Objective: We sought to synthesize the potential for age-related differences [...] Read more.

Background: Obesity and periodontitis are linked through inflammatory and metabolic pathways, and the oral microbiota may mediate this interaction. Age-related changes in immunity, salivary function, and cumulative exposure may modify obesity-associated periodontal dysbiosis. Objective: We sought to synthesize the potential for age-related differences in the oral microbiota of adult obese patients with periodontitis and assess the strength of current literature in supporting age-specific interpretations. Methods: A systematic search of PubMed/MEDLINE, Scopus, and Embase identified 1088 records. After screening and full-text assessment, 50 studies that met the criteria for focused qualitative synthesis remained. Within that review corpus, 10 representative adult human studies provided the most direct evidence linking obesity or overweight, periodontal phenotype, oral microbiota, and age-relevant interpretation. Risk of bias was appraised with the Newcastle–Ottawa Scale. Results: Direct head-to-head microbiome comparisons between younger and older obese adults with periodontitis are rare. Direct evidence links obesity to greater periodontal inflammatory burden, enrichment of classical periopathogens and bridging taxa, and shifts in community structure. Contextual aging studies have suggested that older adults may more often harbor lower-diversity, persistence-oriented communities enriched in stress-tolerant, proteolytic, or opportunistic taxa, whereas younger obese adults more often show inflammation-amplifying consortia enriched in classical periopathogens and bridging taxa. However, these patterns remain largely hypothesis-generating because the evidence base is heterogeneous and predominantly cross-sectional. Conclusions: Age likely modifies the obesity–periodontitis–microbiota axis, but direct comparative evidence on adults remains limited. The current literature supports cautious age-aware interpretation within a systematic review framework rather than definitive age-specific microbial signatures or treatment algorithms. Full article

(This article belongs to the Special Issue Micronutrients and Bioactive Molecules: Their Development, Interaction, and Impact on Human Health—2nd Edition)

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16 pages, 1283 KB

Open AccessArticle

Making Sense of Developmental Kinetics Under High-Sugar Stress: Mathematical Modeling of Phenotypic Plasticity in Drosophila melanogaster

by Bence Pecsenye, Maha Rockaya, Tünde Pacza, Zibuyile Mposula and Endre Máthé

Nutrients 2026, 18(8), 1255; https://doi.org/10.3390/nu18081255 - 16 Apr 2026

Abstract

Background/Objectives: Although Drosophila melanogaster is widely used in genetics and nutrition research, developmental kinetics are rarely analyzed using formal mathematical modeling. Most dietary studies present developmental curves without rigorous fitting, limiting quantitative interpretation. This study applies and compares three primary models, as well [...] Read more.

Background/Objectives: Although Drosophila melanogaster is widely used in genetics and nutrition research, developmental kinetics are rarely analyzed using formal mathematical modeling. Most dietary studies present developmental curves without rigorous fitting, limiting quantitative interpretation. This study applies and compares three primary models, as well as develops secondary models, to characterize the effects of high-sugar diets on egg-to-adult (life cycle) development. Methods: Standardized husbandry and an embryo-to-pupa feeding assay were performed across 11 sucrose concentrations. Synchronized embryo collection and high-resolution monitoring were used for this assay. Three primary models—dose–response, Gompertz, and logit-based linearization—were fitted to developmental curves to extract timing (t_mid) and synchrony (s_dvp) parameters. Secondary modeling was used to evaluate how these parameters change with respect to sucrose concentration. Results: Increasing sucrose concentration markedly delayed pupariation and reduced viability at the highest levels. All models showed increasing t_mid and decreasing s_dvp with rising sugar concentration, with the Gompertz model providing the best overall performance. Secondary modeling revealed a consistent bilinear response with a breakpoint at 0.52–0.62 M, separating low-, medium-, and high-sucrose conditions. Reduced sampling frequency decreased model robustness, while twice-daily observations remained sufficient. Conclusions: Mathematical modeling provides a robust, practical framework for quantifying the effects of diet on D. melanogaster development. The Gompertz model provided the best fit and yielded biologically interpretable parameters. The bilinear secondary model effectively captured sucrose-dependent stress responses and quantified plasticity through environment-dependent changes in developmental timing and synchrony. Overall, this work establishes a quantitative practical framework for modeling developmental kinetics under nutritional perturbations, and the approach can be extended with additional secondary environmental factors to improve predictive analyses of nutritional effects. Full article

(This article belongs to the Topic The Link Between Dietary Patterns and Health Outcomes)

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20 pages, 2298 KB

Open AccessArticle

Effect of 4-Week Consumption of “Navelina” Oranges on Serum Lipid Profile in Patients with MASLD: Evidence from a Randomized Clinical Trial

by Valentina De Nunzio, Giuliano Pinto, Davide Guido, Emanuela Aloisio Caruso, Miriam Cofano, Ilenia Saponara, Matteo Centonze, Maria Grazia Refolo and Maria Notarnicola

Nutrients 2026, 18(8), 1254; https://doi.org/10.3390/nu18081254 - 16 Apr 2026

Abstract

Background: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) refers to fatty liver disease associated with metabolic syndrome. MASLD causes alterations in lipid metabolism, which can be regulated with a diet rich in polyphenols. The present study aims to evaluate the effects of daily consumption [...] Read more.

Background: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) refers to fatty liver disease associated with metabolic syndrome. MASLD causes alterations in lipid metabolism, which can be regulated with a diet rich in polyphenols. The present study aims to evaluate the effects of daily consumption of 400 g of “Navelina” oranges for 4 weeks on serum lipid profiles in a group of 60 patients with MASLD, to identify specific lipid species associated with improvements in hepatic steatosis. Methods: Blood samples were collected from all participants, and biochemical measurements and a serum lipidomic profile were performed. Finally, a Spearman correlation analysis was used to assess the relationships between serum lipidomic fatty acids and biochemical lipid markers. Results: In the experimental treatment arm, serum lipidomic analysis showed a slight decrease in Arachidonic acid (AA) and the Arachidonic acid/Eicosapentaenoic acid ratio (AA/EPA ratio) but no significant interaction between time and treatment was detected. In the same group, Oleic acid, MUFAs and the AA/EPA ratio were significantly and negatively correlated with HDL (r = −0.368, p = 0.046), (r = −0.384, p = 0.036), and (r = −0.522, p = 0.003), respectively. Conversely, EPA and n-3 PUFAs were positively and significantly correlated with HDL (r = 0.447, p = 0.013) and (r = 0.403, p = 0.027) respectively. Conclusions: Furthermore, this study represents one of the first clinical trials to shed a light on the potential association of “Navelina” orange polyphenols on serum fatty acid profiles in patients with MASLD, supporting studies on the nutraceutical effect of oranges on lipid metabolism. Full article

(This article belongs to the Special Issue Nutritional Bioactive Components and Lipid Metabolic Diseases: A Comprehensive Exploration)

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17 pages, 1208 KB

Open AccessArticle

A Retrospective Interventional Study Examining Whether Successful Replacement Therapy After a Confirmed Vitamin D Deficiency Correlates with Improved Disease-Free Survival in the Curative Intent Treatment of HER2+ Breast Cancer

by Eugene R. Ahn, Nandhini Iyer and Samuel B. Cothran

Nutrients 2026, 18(8), 1253; https://doi.org/10.3390/nu18081253 - 16 Apr 2026

Abstract

Background: Vitamin D is a secosteroid that exerts immunomodulatory and anti-proliferative effects through the vitamin D receptor (VDR). Because HER2-targeted therapies substantially improve prognosis in HER2-positive breast cancer and introduces a new mechanism of immunotherapy, we hypothesized that successful correction of vitamin D [...] Read more.

Background: Vitamin D is a secosteroid that exerts immunomodulatory and anti-proliferative effects through the vitamin D receptor (VDR). Because HER2-targeted therapies substantially improve prognosis in HER2-positive breast cancer and introduces a new mechanism of immunotherapy, we hypothesized that successful correction of vitamin D deficiency would be associated with improved disease-free survival (DFS) in patients treated with curative intent. Methods: We performed a retrospective interventional cohort study of patients with early-stage HER2-positive breast cancer treated at Cancer Treatment Centers of America Midwestern Regional Medical Center from 2008 to 2014. Eligible patients had baseline vitamin D deficiency (25-hydroxyvitamin D or D25 < 30 ng/mL), received trastuzumab-based therapy, and had ≥12 months follow-up. Patients received vitamin D3 supplementation (typically 2000–10,000 IU/day) with doses adjusted based on D25 level follow-up. Responders were defined as having achieved a mean D25 ≥ 30 ng/mL during the first year; non-responders remained <30 ng/mL DFS was analyzed using Kaplan–Meier and Cox models. Results: Of 196 patients, 129 (65.8%) were vitamin D-deficient at baseline. Among these, 76 (60.3%) achieved repletion while 50 (39.7%) remained deficient. Three did not have D25 follow-up obtained. Thirty-one DFS events occurred but no deaths. Responders demonstrated numerically improved outcomes (3-year DFS 90% vs. 85%). Non-responders had a 1.7-fold higher hazard of recurrence, and those who achieved the highest D25 levels (>50 ng/mL) had the most favorable DFS trends, suggesting a dose response. Conclusions: Failure to correct a vitamin D deficiency was associated with a 1.7-fold higher recurrence risk, although the relationship did not achieve statistical significance. A similar effect size was reported in another retrospective cohort of HER2-positive breast cancer that did achieve statistical significance, and a doubling of pCR rates was seen in two recently completed RCTs in 2025, with benefits particularly seen in the triple-negative and HER2-positive subtypes. Prospective trials evaluating optimized vitamin D repletion in HER2-positive breast cancer are warranted. Full article

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

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14 pages, 752 KB

Open AccessArticle

Peanut Oral Immunotherapy in Children: An Italian Single-Center Retrospective Cohort Study

by Benedetta Pessina, Camilla Sertori, Simona Barni, Francesco Catamerò, Giulia Liccioli, Erika Paladini, Lucrezia Sarti, Leonardo Tomei, Julia Upton, Claudia Valleriani, Francesca Mori and Mattia Giovannini

Nutrients 2026, 18(8), 1252; https://doi.org/10.3390/nu18081252 - 16 Apr 2026

Abstract

Introduction: Peanut oral immunotherapy (P-OIT) is an emerging treatment strategy for peanut allergy (PA). Although a standardized pharmaceutical product, Peanut (Arachis hypogaea) Allergen Powder-dnfp, has been approved in several countries, it is not universally available. In such contexts, real-world protocols using [...] Read more.

Introduction: Peanut oral immunotherapy (P-OIT) is an emerging treatment strategy for peanut allergy (PA). Although a standardized pharmaceutical product, Peanut (Arachis hypogaea) Allergen Powder-dnfp, has been approved in several countries, it is not universally available. In such contexts, real-world protocols using readily utilizable peanut products may represent an alternative approach. This study aimed to describe the feasibility, safety, and clinical outcomes of P-OIT using toasted peanuts in a real-world effort in a pediatric population. Methods: This single-center retrospective cohort study enrolled children who initiated P-OIT at our tertiary pediatric hospital Allergy Unit between April 2015 and December 2024. Demographic and clinical features, allergy test results, and information about P-OIT were recorded. Desensitization was defined as tolerance of 630 mg of peanut protein (PP). Results: Sixty patients (51.7% male; median age 8.2 years) were included. 22/60 (36.7%) achieved desensitization within a median time of 22.7 months. 21/60 (35%) were still undergoing P-OIT at a median tolerated dose of 100 mg of PP, and 17/60 (28.3%) discontinued treatment, most commonly due to loss to follow-up (44%). At least one adverse reaction occurred in 43/60 (71.7%) patients, predominantly mild and self-limiting (68.3% resolved spontaneously, 39.5% occurred at home). However, 11/60 (18.3%) showed anaphylaxis, and 3/60 (5%) received adrenaline. A reduction in Ara h 2 serum-specific IgE levels compared to the baseline was observed in patients completing escalation (p = 0.03). Conclusions: In this real-world single-center cohort, P-OIT using toasted peanuts was feasible in a subset of patients and was associated predominantly with mild adverse reactions, although systemic reactions were also recorded. Treatment discontinuation and adherence remain relevant challenges. These findings highlight the need for prospective, controlled studies to better define the role, safety profile, and patient selection criteria for food-based P-OIT protocols in settings where standardized products are not available. Full article

(This article belongs to the Special Issue Nutritional Intervention for Pediatric Allergy and Asthma)

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8 pages, 221 KB

Open AccessEditorial

New Perspectives in Nutritional Management for Neonatal Health

by Silvia Salvatore, Mariella Baldassarre, Maria Lorella Giannì and Massimo Agosti

Nutrients 2026, 18(8), 1251; https://doi.org/10.3390/nu18081251 - 16 Apr 2026

Abstract

The neonatal period and early childhood events are increasingly emerging as key determinants of human health [...] Full article

(This article belongs to the Special Issue Nutrition Management in Neonatal Health)

16 pages, 676 KB

Open AccessReview

Chlorella Growth Factor: Biochemical Identity, Redox-Active Mechanisms, Nutritional Relevance, and Translational Implications

by Wojciech Rzeski and Weronika Rzeska

Nutrients 2026, 18(8), 1250; https://doi.org/10.3390/nu18081250 - 15 Apr 2026

Abstract

Chlorella Growth Factor (CGF) is a nucleotide-rich, water-soluble intracellular fraction derived from disrupted Chlorella biomass that has historically been described as a “growth-promoting” extract but remains poorly defined at the molecular level. In this review, we propose that CGF should not be interpreted [...] Read more.

Chlorella Growth Factor (CGF) is a nucleotide-rich, water-soluble intracellular fraction derived from disrupted Chlorella biomass that has historically been described as a “growth-promoting” extract but remains poorly defined at the molecular level. In this review, we propose that CGF should not be interpreted as a classical receptor-binding growth factor, but rather as a heterogeneous, nucleotide-dominant metabolic fraction that may modulate cellular redox balance and biosynthetic capacity. We integrate available evidence on CGF characterization, including A260-based analytical indices, mineral-dependent biosynthesis, and extraction methodologies, with mechanistic observations from in vitro, animal, and applied biological systems. Across these contexts, CGF-associated fractions have been reported to influence redox-sensitive pathways, including NAD(H)/NADP(H)-linked processes, MAPK/AP-1 signaling, extracellular matrix regulation, and humoral immune responses. However, most mechanistic evidence remains indirect, and compositional heterogeneity limits direct comparability across studies. From a nutritional perspective, CGF contributes minimal macronutrient value but may provide conditionally relevant dietary nucleotides, amino acids, and redox-active metabolites that support metabolic processes under stress conditions. Observed biological effects are consistent with a model of metabolic permissiveness, in which CGF-associated fractions may support endogenous cellular functions rather than directly initiating signaling cascades. Key translational challenges include the lack of compositional standardization, limited nucleotide speciation, variability in extraction protocols, and the absence of pharmacokinetic and controlled human studies using well-characterized CGF preparations. Overall, CGF may be conceptualized as a candidate dietary bioactive with redox-centered and metabolically permissive properties. Further work integrating standardized analytical frameworks with mechanistic and clinical validation will be required to establish its role in human nutrition and functional food applications. Full article

(This article belongs to the Section Nutrition and Metabolism)

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19 pages, 1341 KB

Open AccessArticle

Incremental Prognostic Value of the CONUT Score for In-Hospital Mortality and Length of Stay in Hospitalized Patients

by Jose M. Romero-Márquez, Cristina Novo-Rodríguez, María Hayón-Ponce, María Novo-Rodríguez, Araceli Muñoz-Garach, Victoria Luna-López and Carmen Tenorio-Jiménez

Nutrients 2026, 18(8), 1249; https://doi.org/10.3390/nu18081249 - 15 Apr 2026

Abstract

Background: Disease-related malnutrition is highly prevalent among hospitalized patients and is associated with increased mortality, complications, and prolonged hospital stays. Early identification of patients at nutritional risk is therefore essential to improve clinical outcomes. The Controlling Nutritional Status (CONUT) score is an objective [...] Read more.

Background: Disease-related malnutrition is highly prevalent among hospitalized patients and is associated with increased mortality, complications, and prolonged hospital stays. Early identification of patients at nutritional risk is therefore essential to improve clinical outcomes. The Controlling Nutritional Status (CONUT) score is an objective prognostic immunometabolic marker derived from serum albumin, total cholesterol, and lymphocyte count. This study aimed to evaluate the prognostic value of the CONUT score for in-hospital mortality and length of hospital stay (LOS) in hospitalized patients with moderate-to-severe nutritional risk and to determine whether incorporating CONUT improves the predictive performance of a clinical model based on routine admission variables. Methods: A retrospective observational cohort study was conducted, including 671 adult patients admitted to a tertiary university hospital with CONUT ≥ 6. Multivariable logistic regression was used to assess predictors of in-hospital mortality, while LOS was analyzed using multivariable linear regression. Model discrimination was evaluated using receiver operating characteristic (ROC) curve analysis and comparison of the area under the curve (AUC). Results: Higher CONUT scores were independently associated with increased in-hospital mortality. Each one-point increase in CONUT was associated with 28% higher odds of death (OR 1.28; 95% CI 1.13–1.46; p < 0.001). Patients with a severe CONUT score had significantly higher mortality compared with those with a moderate CONUT score (OR 1.77; 95% CI 1.12–2.81; p = 0.004). Incorporating CONUT into the clinical prediction model significantly improved discrimination, increasing the AUC from 0.728 to 0.753 (DeLong p = 0.035). Higher CONUT values were also associated with longer hospital stays: each additional point corresponded to a 5.4% increase in LOS (p = 0.009), and a severe CONUT score was associated with a 17.6% longer stay (p = 0.027). Conclusions: the CONUT score is independently associated with in-hospital mortality and prolonged hospitalization. While its incremental discriminative improvement is modest, its automated calculation from routine laboratory data makes it a practical and scalable tool for early risk stratification. Full article

(This article belongs to the Section Clinical Nutrition)

14 pages, 513 KB

Open AccessArticle

Does Functionality Appreciation Mediate the Relationship Between Breastfeeding Attitudes and Breastfeeding Intentions?

by Cristian Di Gesto, Marta Spinoni and Caterina Grano

Nutrients 2026, 18(8), 1248; https://doi.org/10.3390/nu18081248 - 15 Apr 2026

Abstract

Background: This study aimed to contribute to the growing empirical interest in the role of positive body image in the context of breastfeeding. Research Aim: We examined the association between positive attitudes toward breastfeeding and breastfeeding intentions among postpartum women and investigated the [...] Read more.

Background: This study aimed to contribute to the growing empirical interest in the role of positive body image in the context of breastfeeding. Research Aim: We examined the association between positive attitudes toward breastfeeding and breastfeeding intentions among postpartum women and investigated the mediation of functionality appreciation. Method: A total of 305 women who had given birth within the past 1 to 3 months (M = 34.11 years) participated in the study. Women completed a questionnaire assessing breastfeeding attitudes, appreciation of breastfeeding functionality, breastfeeding intentions, previous breastfeeding experience, as well as Body Mass Index and sociodemographic and obstetric characteristics. A mediation model was used to examine direct and indirect associations between attitudes toward breastfeeding, breastfeeding intentions, and functionality appreciation. Results: Results showed significant associations between positive attitudes towards breastfeeding, breastfeeding intentions, and functionality appreciation. Positive attitudes toward breastfeeding were positively associated with breastfeeding intentions (β = 0.63, p < 0.001) and with functionality appreciation (β = 0.51, p < 0.001), with functionality appreciation accounting for a significant indirect association (β = 0.21, 95% CI [0.14, 0.29]). Finally, previous breastfeeding experience was positively associated with breastfeeding intentions (β = 0.15, p < 0.001). Conclusions: This study marks the initial attempt to examine the significance of functionality appreciation in postpartum women, highlighting potential associations between breastfeeding attitudes and breastfeeding intentions. These findings may offer preliminary insights for future research and for informing the development of targeted interventions, although further evidence from more diverse populations is needed. Full article

(This article belongs to the Special Issue Early Nutrition and Neurodevelopment)

11 pages, 269 KB

Open AccessReview

Beyond “It’s Just a Phase”: A Review of Picky Eating in Children

by Pedro Alarcon and Yvan Vandenplas

Nutrients 2026, 18(8), 1247; https://doi.org/10.3390/nu18081247 - 15 Apr 2026

Abstract

Picky eating is one of the most frequent feeding problems in childhood and is often dismissed as a normal developmental phase. Despite a steadily expanding body of research, uncertainty persists regarding its clinical relevance, assessment, and management. This review synthesizes recent evidence on [...] Read more.

Picky eating is one of the most frequent feeding problems in childhood and is often dismissed as a normal developmental phase. Despite a steadily expanding body of research, uncertainty persists regarding its clinical relevance, assessment, and management. This review synthesizes recent evidence on picky eating in children, with a specific focus on definitions, epidemiology, developmental trajectories, underlying mechanisms, clinical impact, and interventions. Reliance on broad definitions and prevalence estimates has obscured clinically meaningful distinctions between transient, developmentally typical food selectivity and persistent patterns associated with nutritional risk, functional impairment, and family stress. Drawing on contemporary data, we propose a continuum-based, phenotype-oriented framework that emphasizes persistence, severity, and functional impact rather than food refusal alone. Advances in understanding picky eating have not consistently translated into improved clinical care, highlighting persistent gaps in implementation, access, and dissemination of evidence-based feeding guidance. Finally, we outline priorities for future research and practice aimed at improving outcomes for children with clinically relevant picky eating. Full article

(This article belongs to the Special Issue Infant and Toddler Feeding and Development)

17 pages, 923 KB

Open AccessArticle

Fifteen Years of Patient Experience with Hospital Food in a Spanish Long-Term Care Hospital

by M.ª Isabel Ferrero-López, Clara Pérez-Esteve, Mercedes Guilabert Mora, Cristina M.ª Nebot-Marzal and José Mira

Nutrients 2026, 18(8), 1246; https://doi.org/10.3390/nu18081246 - 15 Apr 2026

Abstract

Background/Objectives: Adequate nutrition in older adults is essential to maintaining health, functionality, and quality of life, particularly in long-term care hospitals (HACLEs). Previous studies suggest that dissatisfaction with hospital food is linked to longer stays, more complications, and negative perceptions of care. [...] Read more.

Background/Objectives: Adequate nutrition in older adults is essential to maintaining health, functionality, and quality of life, particularly in long-term care hospitals (HACLEs). Previous studies suggest that dissatisfaction with hospital food is linked to longer stays, more complications, and negative perceptions of care. Given these concerns, this study aimed to assess patients’ experiences with hospital food over a 15-year period in a HACLE in Spain, identify key influencing factors, and validate an updated PREM (Patient Reported Experience Measure) tool for food services. Methods: A retrospective, observational, repeated cross-sectional study was conducted using annual PREM surveys administered between 2011 and 2025 to patients on oral diets. Psychometric validation of the updated 8-item version (2024) was conducted. Results: Out of 1618 surveys, 1540 were included in the final analysis. The updated PREM showed strong internal consistency (α = 0.85, ω = 0.87), a two-factor structure (food quality and service conditions), and adequate model fit. Perceptions worsened after a catering company change in 2022 but improved following the implementation of new food distribution carts in 2025. The PREM total score showed a strong positive association with the global satisfaction item, providing supportive evidence based on a closely related anchor measure (Spearman’s rho = 0.80, 95% CI 0.77–0.82; p < 0.001). Scores differed significantly by diet type: patients receiving a pureed diet reported the highest average satisfaction score, followed by those on a soft diet and a regular diet. The group on a soft diet excluding foods that pose a choking hazard had the lowest mean score. Conclusions: The validated PREM scale is a reliable tool to monitor patient experience with hospital food. It enables early detection of quality issues and supports targeted improvements. Routine use in long-term care settings may foster personalized, patient-centered nutrition strategies and enhance care quality. Full article

(This article belongs to the Special Issue Nutritional Nursing and Rehabilitation in Hospital and Long-Term Care Settings)

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13 pages, 1056 KB

Open AccessArticle

Predominant Dietary Pattern Characteristics and Their Association with Obesity-Related Metabolic Phenotypes in Middle-Aged and Older Chinese Adults: Findings from a Nationwide Cross-Sectional Study

by Wenjing Yan, Weihua Dong, Xiaona Zhang, Qingqing Man, Rongzhen Li, Yun Luo, Panpan Huang, Xiangjie Yao, Lianlong Yu, Lili Chen, Jian Zhang, Pengkun Song and Gangqiang Ding

Nutrients 2026, 18(8), 1245; https://doi.org/10.3390/nu18081245 - 15 Apr 2026

Abstract

Background/Objectives: To identify major dietary patterns among adults aged ≥45 years and examine their associations with metabolic health–obesity phenotypes. Materials and Methods: We analyzed 32,091 adults aged ≥45 years from the 2015 China Adults National Chronic Disease and Nutrition Surveillance. Diet was assessed [...] Read more.

Background/Objectives: To identify major dietary patterns among adults aged ≥45 years and examine their associations with metabolic health–obesity phenotypes. Materials and Methods: We analyzed 32,091 adults aged ≥45 years from the 2015 China Adults National Chronic Disease and Nutrition Surveillance. Diet was assessed using three consecutive 24 h dietary recalls, with household condiment weighing used to improve estimation of cooking oil and salt intake. Dietary patterns were derived using principal component analysis and categorized into quartiles. Multinomial logistic regression adjusted for energy intake and key sociodemographic/lifestyle factors to estimate odds of metabolically unhealthy non-obesity (MUNO), metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO) versus metabolically healthy non-obesity (MHNO). Results: Four patterns with geographic variation were identified: (1) the Rice–Vegetable–Pork pattern; (2) the Fruit–Egg–Dairy pattern; (3) the Red Meat–Offal–Snack pattern; and (4) the Soybeans–Tubers–Grains pattern. Compared with Q1, Q4 of Pattern 1 was associated with lower odds of MHO (OR = 0.42, 95% CI: 0.38–0.46) and MUO (OR = 0.40, 95% CI: 0.36–0.44). Pattern 2 and Pattern 3 were associated with higher odds of MHO (Q4 vs. Q1: OR = 1.42 and 1.21) and MUO (OR = 1.36 and 1.14, all p < 0.001). Pattern 4 was inversely associated with MHO (OR = 0.85, 95% CI: 0.79–0.92) but positively associated with MUNO (OR = 1.16, 95% CI: 1.08–1.24). Conclusions: The Rice–Vegetable–Pork pattern was associated with more favorable obesity-related metabolic phenotypes, whereas energy-dense, animal-derived patterns were associated with higher odds of obesity phenotypes; the Soybeans–Tubers–Grains pattern showed mixed associations. Full article

(This article belongs to the Special Issue Global Nutrition Transition and Chronic Disease Prevention: Perspectives on the Chinese Diet and Beyond)

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26 pages, 584 KB

Open AccessReview

Ketogenic Diet in Children with Type 1 Diabetes: Parental Motivations and Potential Risks for Metabolic Health and Development

by Rujith Kovinthapillai, Yung-Yi Lan, Andrzej Kędzia and Elżbieta Niechciał

Nutrients 2026, 18(8), 1244; https://doi.org/10.3390/nu18081244 - 15 Apr 2026

Abstract

Background: The ketogenic diet has gained substantial popularity in recent years, and an increasing number of caregivers of children with type 1 diabetes are considering it as a nutritional strategy to improve glycemic control. Reported benefits include fewer postprandial glucose fluctuations, lower insulin [...] Read more.

Background: The ketogenic diet has gained substantial popularity in recent years, and an increasing number of caregivers of children with type 1 diabetes are considering it as a nutritional strategy to improve glycemic control. Reported benefits include fewer postprandial glucose fluctuations, lower insulin requirements, and reduced insulin-associated weight gain. However, the use of this diet in children with type 1 diabetes remains highly debated, and scientific evidence regarding its safety and long-term effects in the pediatric population is limited. This narrative review aims to explore the motivations that lead parents to initiate a ketogenic diet in their children with type 1 diabetes and to summarize current knowledge on its potential metabolic and developmental consequences. Methods: A narrative review of the literature was conducted, including original research articles, case reports, and existing reviews addressing the use of ketogenic diets in children with type 1 diabetes. Clinical observations and published accounts of family experiences were also examined to contextualize emerging concerns and motivations. Results: Parents most commonly adopt a ketogenic diet for their children due to the desire for tighter glucose control, concerns about insulin-related weight gain, and the influence of information shared on social media. Some observational data suggest improvements in glycemic stability and reduced insulin requirements under ketogenic dietary regimens, while available evidence also highlights several potential risks, including dyslipidemia, increased susceptibility to hypoglycemia, slowed linear growth, and possible neurocognitive and psychosocial effects. Long-term safety data remain scarce, and current findings are insufficient to establish clear clinical recommendations. Conclusions: Interest in ketogenic diets among families of children with type 1 diabetes is growing, yet existing evidence suggests that the diet may pose significant metabolic and developmental risks in this population. Further well-designed studies are needed to evaluate its safety and efficacy. This review may assist clinicians in counseling families and underscores the need for evidence-based guidelines regarding restrictive dietary patterns in youth with type 1 diabetes. Full article

(This article belongs to the Special Issue Nutrition and Behavioral Interventions for Diabetes)

11 pages, 454 KB

Open AccessArticle

Beyond 25(OH)D: Carboxylated Osteocalcin and the Undercarboxylated/Carboxylated Osteocalcin Ratio as Superior Biomarkers for Vitamin D Recovery in Offspring Affected by Maternal Deficiency

by Wai-Tao Chan, Hung-Chang Lee, Chun-Yan Yeung, Jen-Shiu Chiang Chiau, Mei-Lein Cheng, Szu-Wen Chang, Shu-Chao Weng and Chuen-Bin Jiang

Nutrients 2026, 18(8), 1243; https://doi.org/10.3390/nu18081243 - 15 Apr 2026

Abstract

Background: Maternal vitamin D deficiency (VDD) compromises fetal skeletal development. The impact of postnatal vitamin D supplementation on osteocalcin (OC) carboxylation, converting undercarboxylated (ucOC) to carboxylated osteocalcin (cOC), in offspring remains unclear, given conflicting reports on the correlation between serum 25-hydroxyvitamin D [...] Read more.

Background: Maternal vitamin D deficiency (VDD) compromises fetal skeletal development. The impact of postnatal vitamin D supplementation on osteocalcin (OC) carboxylation, converting undercarboxylated (ucOC) to carboxylated osteocalcin (cOC), in offspring remains unclear, given conflicting reports on the correlation between serum 25-hydroxyvitamin D (25(OH)D) and specific OC forms. This study investigated OC profile recovery in a mouse model of maternal VDD. Methods: Female C57BL/6J mice were fed a VDD diet from four weeks pre-conception through lactation. Weaned offspring were maintained on the VDD diet and randomized to three groups: control (saline), standard-dose (1500 IU/kg), or high-dose (4500 IU/kg) vitamin D supplementation. Serum 25(OH)D, cOC, and ucOC were quantified via ELISA at 1, 2, and 4 weeks post-intervention. Results: Controls remained vitamin D-deficient (<13 ng/mL). Supplementation dose-dependently increased serum 25(OH)D (p < 0.05). Crucially, while absolute ucOC levels remained stable across all groups, supplementation significantly upregulated cOC and total osteocalcin at all time points (p < 0.05). Consequently, the ucOC/cOC ratio significantly decreased in supplemented groups. Partial correlation analysis revealed a strong positive correlation between 25(OH)D and cOC (r_partial = 0.718) and a negative correlation with the ucOC/cOC ratio (r_partial = −0.433), but no correlation with ucOC (r_partial = −0.102). Conclusions: In offspring affected by maternal VDD, vitamin D supplementation improves the osteocalcin carboxylation profile primarily by driving carboxylated osteocalcin synthesis rather than reducing the undercarboxylated pool. Serum cOC and the ucOC/cOC ratio serve as superior functional biomarkers to ucOC for monitoring therapeutic efficacy in this early-life developmental model. Full article

(This article belongs to the Section Pediatric Nutrition)

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