Nutrients

15 pages, 1236 KB

Open AccessArticle

Carbohydrate Knowledge in People with Type 1 and Type 2 Diabetes in the NutriNet-Santé Cohort Study

by Sopio Tatulashvili, Alice Bellicha, Chantal Julia, Laurent Bourhis, Nathalie Arnault, Hélène Bihan, Serge Hercberg, Mathilde Touvier, Michael Joubert and Emmanuel Cosson

Nutrients 2026, 18(9), 1415; https://doi.org/10.3390/nu18091415 (registering DOI) - 29 Apr 2026

Abstract

Background: Effective glycemic control in diabetes management relies heavily on dietary carbohydrate knowledge. This study aimed to assess carbohydrate knowledge in individuals with type 1 diabetes (T1D) and insulin-treated type 2 diabetes (itT2D) using the GluciQuizz tool. Methods: A total of 465 persons [...] Read more.

Background: Effective glycemic control in diabetes management relies heavily on dietary carbohydrate knowledge. This study aimed to assess carbohydrate knowledge in individuals with type 1 diabetes (T1D) and insulin-treated type 2 diabetes (itT2D) using the GluciQuizz tool. Methods: A total of 465 persons (96 with T1D, 153 with itT2D; 89 and 127 matched controls without diabetes, respectively) from the French NutriNet-Santé prospective cohort were included. Participants completed the GluciQuizz questionnaire, which evaluates carbohydrate knowledge across five domains: carbohydrate food recognition; carbohydrate food content; nutrition label reading; glycemic targets and hypoglycemia prevention and treatment; and carbohydrate content of meals. Results: The mean age ± standard deviation of participants with diabetes was 65.8 ± 11.2 years, 44.2% male, with a diabetes duration of 23.3 ± 12.9 years. T1D participants scored significantly higher on the GluciQuizz compared to those with itT2D (23.9 ± 5.0 vs. 17.5 ± 5.6, p < 0.001). In secondary analysis, T1D participants showed superior knowledge to their matched controls without diabetes, whereas itT2D participants showed similar knowledge to their matched controls without diabetes. Conclusions: T1D participants demonstrated the best carbohydrate knowledge compared to those with itT2D. Targeted educational interventions in itT2D populations may improve dietary management and clinical outcomes. Full article

(This article belongs to the Section Nutrition and Diabetes)

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27 pages, 3988 KB

Open AccessReview

Sustainable Insect-Based Diets in Sub-Saharan Africa: A Review of Prevalence, Acceptability and Impact on Nutritional Status

by Maria Rouco, Charity Chinonso Ugwu, Gabriel Reina and Silvia Carlos

Nutrients 2026, 18(9), 1414; https://doi.org/10.3390/nu18091414 - 29 Apr 2026

Abstract

Malnutrition—including undernutrition, micronutrient deficiencies and overweight—remains a major public health concern in sub-Saharan Africa, largely driven by food insecurity. Edible insects have been proposed as a sustainable, nutrient-dense dietary alternative with potential to improve food security and nutritional outcomes. This review analyses studies [...] Read more.

Malnutrition—including undernutrition, micronutrient deficiencies and overweight—remains a major public health concern in sub-Saharan Africa, largely driven by food insecurity. Edible insects have been proposed as a sustainable, nutrient-dense dietary alternative with potential to improve food security and nutritional outcomes. This review analyses studies published until January 2024 in PubMed and Google Scholar assessing the prevalence, acceptability and nutritional impact of insect-based diets in sub-Saharan Africa. Thirteen original studies, predominantly qualitative, conducted in 8 of 47 countries in the region, met inclusion criteria. Two reviews provided additional evidence. Most studies focused on acceptability, which was strongly influenced by cultural and religious norms. Higher acceptance was observed among older individuals and those with lower educational attainment, while younger and more urbanized populations showed greater reluctance. Reported motivations for consumption included tradition, taste and perceived nutritional value. Some studies highlighted potential health risks related to food safety and the need for improved regulatory frameworks. The available nutritional analyses showed that edible insects are rich in protein and essential micronutrients, particularly iron and zinc, suggesting their potential to address common deficiencies. Although evidence on long-term nutritional impact remains limited, current findings support the feasibility and potential public health relevance of promoting insect-based diets in low-income settings. Full article

(This article belongs to the Special Issue Sustainable Nutrition Intervention Programmes: Innovative Evidence-Based Strategies to Modulate Malnutrition)

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27 pages, 1296 KB

Open AccessReview

Beyond Antioxidants: The Microbial Metabolic Landscape of Anthocyanins and Their Downstream Health Implications

by Yan Zeng, Munir Ahmed and Hua Zhang

Nutrients 2026, 18(9), 1413; https://doi.org/10.3390/nu18091413 - 29 Apr 2026

Abstract

Background/Objectives: Anthocyanins are dietary pigments associated with reduced risk of chronic diseases, yet their low systemic bioavailability challenges the traditional direct antioxidant hypothesis. This review aims to reconceptualize anthocyanin bioactivity by proposing the gut microbiome as a key mediator that biotransforms these compounds [...] Read more.

Background/Objectives: Anthocyanins are dietary pigments associated with reduced risk of chronic diseases, yet their low systemic bioavailability challenges the traditional direct antioxidant hypothesis. This review aims to reconceptualize anthocyanin bioactivity by proposing the gut microbiome as a key mediator that biotransforms these compounds into bioactive metabolites responsible for systemic health effects. Methods: This review synthesizes evidence on the microbial metabolism of anthocyanins and includes a structured appraisal of the literature using an evidence evaluation framework analogous to GRADE, focusing on their transit to the colon, enzymatic biotransformation by gut microbiota, and resulting production of phenolic metabolites such as protocatechuic acid (PCA). It also examines the role of specific bacterial taxa (e.g., Bifidobacterium and Lactobacillus) in enhancing bioavailability and explores the downstream cellular pathways modulated by these metabolites. Results: Gut microbiota convert anthocyanins into smaller phenolic metabolites such as PCA, syringic acid, gallic acid, and other respective metabolites, which achieve plasma concentrations up to 100-fold higher than parent compounds and can cross the blood–brain barrier. These metabolites exert systemic effects by modulating key signaling pathways (NF-κB and Nrf2) and restoring redox homeostasis. Additionally, beneficial gut bacteria enhance anthocyanin bioavailability and support the production of short-chain fatty acids (SCFAs). Conclusions: Systemic health benefits of anthocyanins are largely mediated by gut microbiota through the generation of bioactive metabolites. This microbiota-driven process redefines the mechanistic understanding of anthocyanin action and highlights the microbiome as a critical determinant of their efficacy in preventing cardiometabolic and neurodegenerative diseases. Full article

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

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25 pages, 1414 KB

Open AccessReview

Diet–Microbiome–Brain Axis and Mental Health: Biological Mechanisms and Nutritional Implications

by Diana Uțu, Aniela-Roxana Nodiți-Cuc, Andreea-Mihaela Kiș, Ramona Amina Popovici, Dana Emanuela Pitic, Laria-Maria Trusculescu, Diana Marian, Andreea Georgiana Nan, Asad Salehi Matin, Dora Mihaela Cîmpian, Cristina Raluca Bodo, Alexandra Enache and Iustin Olariu

Nutrients 2026, 18(9), 1412; https://doi.org/10.3390/nu18091412 - 29 Apr 2026

Abstract

Background/Objectives: Diet is a primary and modifiable determinant of gut microbiota composition, diversity, and metabolic activity, thereby shaping microbial-derived metabolites, immune and inflammatory signalling, neuroendocrine regulation, and neural communication with the central nervous system. Western dietary patterns, characterised by high intake of ultra-processed [...] Read more.

Background/Objectives: Diet is a primary and modifiable determinant of gut microbiota composition, diversity, and metabolic activity, thereby shaping microbial-derived metabolites, immune and inflammatory signalling, neuroendocrine regulation, and neural communication with the central nervous system. Western dietary patterns, characterised by high intake of ultra-processed foods, saturated fats, and low dietary fibre, are consistently associated with gut dysbiosis, impaired intestinal barrier function, chronic low-grade inflammation, and increased risk of depression, anxiety, cognitive impairment, and neurodegenerative disorders. Methods: This narrative review synthesises evidence from human observational studies, randomised controlled trials, animal models, and mechanistic investigations examining interactions among diet, gut microbiota, and mental health or neurobiological outcomes. Literature searches were conducted in PubMed, Scopus, and Web of Science for articles published up to December 2025. Results: The study highlights the therapeutic potential and limitations of dietary interventions, prebiotics, probiotics, and psychobiotics, and critically evaluates them. Also facilitates an improved understanding of diet–microbiome–brain interactions, which may help the development of personalised, nutrition-based strategies integrated into mental health prevention and clinical care. Conclusions: These findings support diet-based, microbiome-informed strategies as scalable adjuncts in mental health prevention and care. Full article

(This article belongs to the Special Issue Dietary Factors and Emotion and Cognitive Health)

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15 pages, 615 KB

Open AccessArticle

Association Between Dietary Patterns, Weight Loss, and Handgrip Strength Among Qatari Adults with a History of Bariatric Surgery: Results from the Qatar Biobank Study

by Shada Almaket, Gana Hissain, Salma Mehrez, Joyce Moawad and Zumin Shi

Nutrients 2026, 18(9), 1411; https://doi.org/10.3390/nu18091411 - 29 Apr 2026

Abstract

Background/Objectives: This study examines cross-sectional associations between dietary patterns, weight loss, and handgrip strength (HGS) among adults with a history of bariatric surgery. Methods: We analyzed data of 1888 adults (62.3% women; mean age 38.8 years) who attended the Qatar Biobank study. Dietary [...] Read more.

Background/Objectives: This study examines cross-sectional associations between dietary patterns, weight loss, and handgrip strength (HGS) among adults with a history of bariatric surgery. Methods: We analyzed data of 1888 adults (62.3% women; mean age 38.8 years) who attended the Qatar Biobank study. Dietary patterns were identified using factor analysis of data from a food frequency questionnaire. HGS was measured using dynamometry, and relative HGS (RHGS) was calculated as HGS/BMI. Results: The mean weight loss after bariatric surgery was 27.6 kg (23.4%), and the mean HGS was 30.1 (SD 11.2) kg. The mean duration after bariatric surgery was 3.6 years. Greater weight loss was associated with lower HGS (Q4 vs. Q1: −1.29 (95%CI −2.26 to −0.33)) but higher RHGS (Q4 vs. Q1: 0.10 (0.06 to 0.13)). Higher adherence to a “prudent diet” with high intake of fruits and vegetables was associated with stronger HGS (Q4 vs Q1: 1.07 (0.18 to 1.96)). In contrast, a “traditional diet” (high intake of mixed dishes, e.g., biryani, croissants, zaatar fatayer, lasagna, white rice, and Arabic bread) was inversely associated with HGS (Q4 vs. Q1: −1.27 (−2.19 to −0.35)). Conclusions: In conclusion, greater weight loss was associated with improved relative muscle strength, while adherence to a traditional diet was linked to weaker HGS. These findings highlight the importance of diet quality in maintaining muscle function after bariatric surgery. Full article

(This article belongs to the Special Issue Nutrition Modulation in Cardiometabolic Outcomes)

16 pages, 317 KB

Open AccessArticle

Optimizing Public Health Screening: Population-Specific BMI Thresholds for Targeted Body Composition Assessment in Hungary

by Tamas Jarecsny, Nadim Al-Muhanna, Dora Rebeka Fabian, Roland Kosik, Richard Schwab, Gergo Jozsef Szollosi, Laszlo Schandl, Gyula Tomasics, Eszter Melinda Pazmandi, Andras Folyovich, Ferenc Fazekas and Monika Fekete

Nutrients 2026, 18(9), 1410; https://doi.org/10.3390/nu18091410 - 29 Apr 2026

Abstract

Background: Body mass index (BMI) is widely used as a proxy of nutritional status and related lifestyle risk patterns in public health, yet it does not capture body composition–related heterogeneity in cardiometabolic risk. Evidence on whether a more detailed body composition assessment improves [...] Read more.

Background: Body mass index (BMI) is widely used as a proxy of nutritional status and related lifestyle risk patterns in public health, yet it does not capture body composition–related heterogeneity in cardiometabolic risk. Evidence on whether a more detailed body composition assessment improves population-level screening efficiency remains inconsistent, particularly in Central European populations. Methods: We conducted a cross-sectional analysis of 868 Hungarian adults participating in a nationwide mobile screening program. Locally weighted regression identified sex-specific BMI inflection points for cardiometabolic risk. Stratified receiver operating characteristic (ROC) analyses compared BMI with bioelectrical impedance-derived parameters across five outcomes. Cost- and time-effectiveness of scalable screening strategies were modeled at the population level. Results: Cardiometabolic risk increased at BMI levels below current WHO thresholds (females: 21.8–22.3 kg/m²; males: 23.8–24.3 kg/m²). Overall, body composition parameters did not outperform BMI in the full population. Subgroup-specific differences were observed, particularly among men with BMI 24–36 kg/m² for atherosclerosis risk, suggesting limited and outcome-specific added value rather than broad superiority over BMI. Together, non-linear risk patterns, stratified performance, and population-level modeling converged on mid-range BMI intervals (females: 22–30 kg/m²; males: 24–30 kg/m²) as likely screening windows of phenotypic heterogeneity. Within these ranges, targeted InBody assessment may help refine risk assessment for selected individuals. A mixed screening strategy covering 52% of the population would cost 178.4% of BMI-only screening, while reducing throughput by 24.3%. Conclusions: Population-specific BMI thresholds may more accurately reflect early deviations in nutritional and cardiometabolic risk than current universal cutoffs. BMI remains a useful first-line marker, and body composition assessment may add complementary information in selected BMI ranges. Overall, these findings support a potentially useful, subgroup-specific screening approach, but the modeled cost and time trade-offs should be considered hypothesis-generating and require further validation. Full article

(This article belongs to the Special Issue Public Health, Nutritional Behavior and Nutritional Status—3rd Edition)

49 pages, 4662 KB

Open AccessSystematic Review

Explore the Optimal Treatment Regimen Across Combinations of Variate Protein Sources and Exercise Modalities and Its Associated Factors in Older Adults: A Network Meta-Analysis and Meta-Regression of Randomized Controlled Trials

by Che-Li Lin, Shih-Wei Huang, Hung-Chou Chen, Mao-Hua Huang, Tsan-Hon Liou and Chun-De Liao

Nutrients 2026, 18(9), 1409; https://doi.org/10.3390/nu18091409 - 29 Apr 2026

Abstract

Background/Objectives: Aging is closely associated with sarcopenia, which has a significant impact on muscle mass and its function. Protein supplementation (PS) brings benefits such as lean mass and strength gains during exercise training. This paper determined the optimal regimen among the composites of [...] Read more.

Background/Objectives: Aging is closely associated with sarcopenia, which has a significant impact on muscle mass and its function. Protein supplementation (PS) brings benefits such as lean mass and strength gains during exercise training. This paper determined the optimal regimen among the composites of variate protein sources and training modalities for older individuals. Methods: We comprehensively searched the electronic databases, namely MEDLINE Complete, PEDro, the Cochrane Library, Google Scholar, EMBASE, and the China National Knowledge Infrastructure, from its inception until December 2025. We included randomized controlled trials (RCTs) that examined the effectiveness of any type of PS combined with one of three exercise types—resistance, aerobic, or multicomponent training—in untrained older adults. The main outcomes used to identify sarcopenia were assessed, including lean mass, handgrip and leg strength, and physical mobility measures. Network meta-analysis (NMA) was performed by a frequentist method using random-effects models. The estimated treatment effect was expressed as the standard mean difference (SMD) with a 95% confidence interval (CI). Any potential factor moderating the treatment effect was determined by the meta-regression analyses, including participant characteristics and methodological factors. Certainty of evidence (CoE) was assessed by the GRADE framework. Results: In total, we included 235 RCTs (20,980 participants) for analyses. A total of 10 protein sources (whey, soy, casein, milk, and the others) were identified, corresponding to 24 monotherapy and combined regimens of PS and exercise. Among the treatment arms, whey plus resistance training was ranked as the most effective treatment for muscle mass (large SMD, 1.29; CoE, moderate) and leg strength (large SMD, 1.16; CoE, moderate); additionally, whey plus multicomponent exercise training achieved the most promising effects on such sarcopenia-related physical indicators such as chair rise (large effect, SMD = 1.09; CoE: high), timed up and go (medium SMD, 0.70; CoE, high), and global mobility score (large SMD, 1.02; CoE, high). Conclusions: The treatment efficacy appears to be moderated by the participant’s conditions, PS resource, and PS dose, particularly the outcome of muscle mass and strength. The present NMA results indicate that whey protein incorporated with resistance training is the optimal program to help combat sarcopenia in older adults. Full article

(This article belongs to the Special Issue Nutrition, Exercise, and Health: Nutritional Supplements, Exercise Training, Skeletal Muscle Health, and Performance)

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14 pages, 317 KB

Open AccessArticle

Vitamin D in Type 2 Diabetes Mellitus According to Diabetic Kidney Disease Stage: What Is the Target in Clinical Practice?

by João Soares Felício, Lícia Oliveira Ruivo, Inessa Silveira Bezerra, Maria Eduarda Nunes Avelar do Carmo, Isabel Jacob Fernandes, Beatriz Dias Lobo, Lilian de Souza D’Albuquerque Silva, Franciane Trindade Cunha de Melo, Ana Carolina Contente Braga de Souza, Natércia Neves Marques De Queiroz, Márcia Costa dos Santos, Lorena Vilhena De Moraes, Mayana Batista Barros, Alan Pinheiro Fernandes, Paula Gabriella Costa da Penha, Ana Clara Fleury da Fonseca Rodrigues, Pedro Paulo Freire Piani, Ana Regina Bastos Motta, Valéria Suênya Galvão Leal, Melissa de Sá Oliveira dos Reis, Alyne Maciel Lobato, Karem Mileo Felício and Priscila Boaventura Barbosa De Figueiredo Show full author list Hide full author list

Nutrients 2026, 18(9), 1408; https://doi.org/10.3390/nu18091408 - 29 Apr 2026

Abstract

Background/Objectives: Low vitamin D (VD) has been associated with diabetic kidney disease (DKD). Nevertheless, VD normality concentrations remain under discussion. Objectives: To evaluate VD concentrations in early and advanced DKD stages according to the Endocrine Society and Institute of Medicine standards in patients [...] Read more.

Background/Objectives: Low vitamin D (VD) has been associated with diabetic kidney disease (DKD). Nevertheless, VD normality concentrations remain under discussion. Objectives: To evaluate VD concentrations in early and advanced DKD stages according to the Endocrine Society and Institute of Medicine standards in patients with type 2 diabetes mellitus (T2DM). Methods: A cross-sectional study included 80 patients with T2DM and DKD in early (urine albumin–creatinine ratio (UACR) between 30 and 299 mg/g), group 1 (n = 29), and advanced stage (UACR ≥ 300 mg/g), group 2 (n = 51). Results: Compared to group 1, patients in group 2 showed lower 25(OH)D concentrations (26.7 ± 10.1 vs. 30.2 ± 8.0 ng/mL; p ≤ 0.05). In group 2, when the serum VD concentrations were stratified according to the Endocrine Society, VD concentrations ≥ 30 ng/mL were associated with a considerably reduction in UACR compared with VD < 20 ng/mL (365.9 ± 268.3 vs. 937.6 ± 634 mg/g; p < 0.05), but not when compared to the range of 20–29.9 ng/mL (739.8 ± 1138 vs. 937.6 ± 634 mg/g; p = NS). Additionally, in this group, our regression model showed that each unit increase in VD was associated with a UACR reduction of 26.1 mg/g (R² = 0.103; p < 0.05). Conclusions: Higher vitamin D concentrations were associated with improved UACR only in clinical DKD, particularly when VD was at least 30 ng/mL. Full article

(This article belongs to the Section Nutrition and Diabetes)

11 pages, 362 KB

Open AccessArticle

Cardiovascular Response to Exercise with and Without Alcohol Consumption: Evidence of an Interaction Between Distance Covered and Perceived Exertion

by Thiago Ferreira de Sousa, Aline de Jesus Santos, José Carlos Aragão-Santos and Sandra Celina Fernandes Fonseca

Nutrients 2026, 18(9), 1407; https://doi.org/10.3390/nu18091407 - 29 Apr 2026

Abstract

Background: Acute alcohol consumption may interfere with the dynamics between internal and external load during exercise, potentially attenuating cardiovascular responses. Objective: This study investigated the association between distance covered during a running test and mean heart rate, while examining the moderating role of [...] Read more.

Background: Acute alcohol consumption may interfere with the dynamics between internal and external load during exercise, potentially attenuating cardiovascular responses. Objective: This study investigated the association between distance covered during a running test and mean heart rate, while examining the moderating role of the rating of perceived exertion (RPE) under conditions with and without acute alcohol ingestion. Methods: This crossover experimental study included 12 physically active male university students (23.7 ± 3.7 years). Participants completed two intermittent running sessions (control and alcohol conditions), separated by ≥48 h. In the alcohol condition, participants consumed 0.4 g of ethanol/kg of body mass. Heart rate was continuously monitored using a Polar RCX5 monitor, and total distance covered and RPE (Borg 6–20 scale) were assessed immediately after test completion. Analyses included paired comparisons, Pearson correlations, and linear regression models with interaction terms. Results: No significant associations between variables were observed in the control condition. With alcohol consumption, distance covered was positively associated with mean heart rate, and RPE significantly moderated this relationship. Conclusions: Acute alcohol ingestion may modify the interaction between external load, perceived exertion, and cardiovascular response during running. These results highlight the importance of integrated monitoring of internal and external load, especially in contexts involving recent alcohol consumption. Full article

(This article belongs to the Section Nutritional Epidemiology)

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16 pages, 552 KB

Open AccessArticle

Safety of Lactiplantibacillus plantarum K014 in Healthy Adults: A Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Trial

by Kar Shin Goh, Chee Ping Chong, Joo Shun Tan, Rhu Yann Ho, Zhang Jin Ng, Ahmad Zaimi bin Abdul Latiff, Sulosanah Sinnasamy and Mohd Hisyamuddin Seberi

Nutrients 2026, 18(9), 1406; https://doi.org/10.3390/nu18091406 - 29 Apr 2026

Abstract

Background and aims: Lactiplantibacillus plantarum is a widely studied probiotic species with well-documented benefits for gastrointestinal function and immune modulation. However, probiotic effects are strain-specific, and the safety of newly identified strains must be clinically established. L. plantarum K014, isolated from traditionally fermented [...] Read more.

Background and aims: Lactiplantibacillus plantarum is a widely studied probiotic species with well-documented benefits for gastrointestinal function and immune modulation. However, probiotic effects are strain-specific, and the safety of newly identified strains must be clinically established. L. plantarum K014, isolated from traditionally fermented vegetables, has not previously been evaluated in human subjects. This study aimed to evaluate the safety and tolerability of L. plantarum K014 in healthy Malaysian adults by assessing its effects on anthropometric measures, hematological indices, liver and renal function, gastrointestinal health, and selected immune-related outcomes, including the incidence and severity of common cold symptoms. Methods: This single-center, randomized, double-blind, placebo-controlled trial was conducted over a 6-month period. Of 304 healthy adults screened, 152 were enrolled and randomized in a 1:1 ratio to receive either L. plantarum K014 (≥1 × 10⁹ CFU/day) or placebo (maltodextrin), administered daily in sachet form; 125 participants completed the study. Clinical assessments, including physical examination, anthropometric measurements, and blood analyses, were performed at baseline, Month 4, and Month 6. Gastrointestinal symptoms, stool characteristics, and immune-related outcomes were monitored weekly using structured online questionnaires. Results: L. plantarum K014 was well tolerated, with no probiotic-related adverse events reported. No clinically significant changes were observed in body weight, BMI, hematological indices, or renal function in either group. Exploratory analyses indicated that participants receiving L. plantarum K014 exhibited statistically significant differences in several liver function markers, as well as lower severity of diarrhea and abdominal pain compared with placebo, though these findings were not prespecified efficacy endpoints and should be interpreted cautiously. Similarly, lower weekly ratings of common cold symptoms interfering with work or study were observed in the probiotic group as an exploratory observation. Conclusions: Daily consumption of L. plantarum K014 at a dose of ≥1 × 10⁹ CFU for six months was safe and well tolerated in healthy adults. The absence of adverse effects, together with observed trends toward lower gastrointestinal discomfort and immune-related symptoms, supports the suitability of L. plantarum K014 for further investigation in efficacy-driven clinical studies. Full article

(This article belongs to the Section Prebiotics, Probiotics and Postbiotics)

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18 pages, 645 KB

Open AccessArticle

The Psychological Dimensions of Dieting: A Two-Phase Study on Body Appreciation, Nutritional Awareness and Mental Well-Being

by Paula Sophia Cozma, Lóránd Dénes and Zsuzsánna Simon-Szabó

Nutrients 2026, 18(9), 1405; https://doi.org/10.3390/nu18091405 - 29 Apr 2026

Abstract

Background/Objectives: Dieting is a widespread behavior that is associated with psychological distress, body dissatisfaction, and eating disorders. Recent research suggests that a body-positive attitude and mindful approach to eating may influence individuals’ experiences with dieting; however, their combined role has been insufficiently explored. [...] Read more.

Background/Objectives: Dieting is a widespread behavior that is associated with psychological distress, body dissatisfaction, and eating disorders. Recent research suggests that a body-positive attitude and mindful approach to eating may influence individuals’ experiences with dieting; however, their combined role has been insufficiently explored. Methods: A two-phase study was conducted among voluntary adults using online data collection. In Phase 1, a cross-sectional survey was completed by 180 participants (71.7% women), assessing dieting behavior, body appreciation, nutritional awareness, psychological distress, well-being, and eating disorders. Correlation analyses, group comparisons, and regression models were performed. In Phase 2, 90 participants entered the pilot and received a brief psychoeducational digital material promoting mindful eating and positive body image. The follow-up assessment was completed by 59, after one month of engagement. Results: Body appreciation and nutritional awareness were positively associated with mental well-being and inversely related to psychological distress (p < 0.001 for all) and to eating disorder screening scores (p < 0.001 and p = 0.046, respectively). More frequent dieting was associated with lower body appreciation (p < 0.001). According to the observed pattern of correlations, body appreciation may play a role in the relationship between dieting and psychological distress. In the intervention phase, greater engagement with the psychoeducational material was associated with higher reported levels of nutritional awareness (p = 0.003) and greater perceived body awareness (p = 0.026) at follow-up; however, due to the exploratory design, findings are preliminary. Conclusions: The results suggest that dieting, as a behavior, may be embedded in broader psychological processes that include body-related attitudes and nutritional awareness. Taking these factors into account may have potential implications for preventive measures aimed at promoting healthier dietary habits, a more positive relationship with one’s body, and mental well-being. Full article

(This article belongs to the Special Issue The Impact of Eating Disorders and Emotional Eating on Health)

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17 pages, 307 KB

Open AccessArticle

Perceptions of Artificial Nutrition and Hydration at the End of Life Among Healthcare Professionals, Medical Students, and Lay Respondents: A Cross-Sectional Comparative Survey

by Mircea Stoian, Dorin Bica, Horatiu Cioloboc, Nicolae Demenciuc, Andrei Manea, Sergio Rares Bandila, Adina Stoian and Leonard Azamfirei

Nutrients 2026, 18(9), 1404; https://doi.org/10.3390/nu18091404 - 29 Apr 2026

Abstract

Background/Objectives: Artificial Nutrition and Hydration (ANH) at the end of life remains a clinically and ethically complex intervention. Although international guidelines exist, data regarding the awareness of them and their perceived applicability across different population groups remain limited. This study aimed to [...] Read more.

Background/Objectives: Artificial Nutrition and Hydration (ANH) at the end of life remains a clinically and ethically complex intervention. Although international guidelines exist, data regarding the awareness of them and their perceived applicability across different population groups remain limited. This study aimed to evaluate and compare perceptions and attitudes regarding ANH among healthcare professionals, medical students, and lay respondents. Methods: A cross-sectional, questionnaire-based comparative survey was conducted between July 2025 and March 2026, including 470 respondents (338 healthcare professionals, 46 medical students, and 86 lay respondents). The survey assessed perceptions of ANH, factors influencing decision-making, and familiarity with clinical guidelines and legislation. Results: General perceptions regarding ANH were broadly similar across groups. Significant differences were observed for the importance assigned to estimated life expectancy (p < 0.001) and family opinion (p = 0.017). Associations were identified between study group and opinions on clinical guidelines (χ²(6) = 16.366, p = 0.012) and legislation (χ²(6) = 14.712, p = 0.023), with lack of knowledge more frequent among lay respondents and students. Within healthcare professionals, physicians and nurses showed significantly different responses regarding guidelines (p < 0.001). Conclusions: In this cross-sectional survey, perceptions of ANH at the end of life were largely shared, but differed in relation to prognostic factors, family involvement, and awareness of guidelines and legislation, suggesting the presence of relevant knowledge gaps in end-of-life decision-making. Full article

(This article belongs to the Special Issue Nutritional and Metabolic Support in Critical Illness: Mechanisms, Monitoring, and Clinical Outcomes)

21 pages, 580 KB

Open AccessArticle

Maternal Diet, Lifestyle Factors, and Gestational Weight Gain: A Single-Center Case–Control Study in Hungary

by Edit Paulik, Anita Sisák, Anna Szolnoki, Evelin Olteán-Polanek, Márió Gajdács, Regina Molnár, Andrea Szabó, Gábor Németh and Hajnalka Orvos

Nutrients 2026, 18(9), 1403; https://doi.org/10.3390/nu18091403 - 29 Apr 2026

Abstract

Background/Objectives: Preterm birth (PTB) is a major public health concern worldwide, which may lead to detrimental maternal and neonatal outcomes. Maternal nutritional status, gestational weight gain (GWG), and lifestyle factors are potentially modifiable determinants of adverse pregnancy outcomes. This study examined the association [...] Read more.

Background/Objectives: Preterm birth (PTB) is a major public health concern worldwide, which may lead to detrimental maternal and neonatal outcomes. Maternal nutritional status, gestational weight gain (GWG), and lifestyle factors are potentially modifiable determinants of adverse pregnancy outcomes. This study examined the association between PTB and maternal GWG and assessed whether maternal dietary habits and lifestyle factors were related to GWG in women delivering preterm versus at term. Methods: A retrospective case–control study was conducted at a tertiary center in Hungary (MANOR Study, 2019). The case group included n = 100 women with PTB, while n = 200 matched term deliveries served as controls (1:2 ratio). Data were collected using a self-administered questionnaire and medical records. Pre-pregnancy body mass index (BMI) was categorized using standard definitions, while GWG was classified as inadequate, recommended, or excessive according to the US 2009 Institute of Medicine guidelines. A 7-item dietary index score was calculated based on gestational dietary habits. Results: Pre-pregnancy BMI distribution did not considerably differ between groups (p > 0.05); over one-third of women in both groups were overweight or had obesity (38.7% vs. 36.7%). Previous PTB (p < 0.001) and gestational hypertension (GHT) (p = 0.003) were more common among current PTB cases, while smoking, alcohol consumption, and gestational diabetes mellitus (GDM) showed negligible differences (p > 0.05)—28.0% of cases, and 34.5% of controls were classified as having healthy dietary habits, based on the dietary index score calculated. Inadequate GWG was more prevalent among PTB cases (49.0% vs. 26.8%), whereas excessive GWG was less frequent among cases (21.9% vs. 38.4%). Being within the recommended GWG range and the manifestation of gestational hypertension were associated with lower (aOR: 0.39; 95% CI: 0.18–0.87; p = 0.020) and higher (aOR: 3.43; 95% CI: 1.44–8.19; p = 0.005) odds of PTB, respectively. Conclusions: Inadequate GWG was more common in PTB, while excessive GWG was more frequent in term pregnancies. Fast-food consumption was associated with excessive GWG among term births. Optimizing GWG and improving maternal diet quality should be included as key, cross-cutting interventions targeting the improvement of antenatal care. Full article

(This article belongs to the Special Issue Effects of Nutrition and BMI on Obstetric–Gynecological Pathologies)

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19 pages, 3212 KB

Open AccessFeature PaperArticle

Hesperidin Attenuates Experimental MASH by Modulating the Liver–Immune–Brain Axis: Integrated Evidence from Network Pharmacology and In Vivo Analysis

by Seung-Hoon Yoo, Ji-Han Kim, Yeon-Joo Yoo and Byung-Cheol Lee

Nutrients 2026, 18(9), 1402; https://doi.org/10.3390/nu18091402 - 29 Apr 2026

Abstract

Background/Objectives: Metabolic dysfunction-associated steatohepatitis (MASH) is characterized by severe hepatic steatosis, lobular inflammation, and fibrosis. Although hesperidin, a citrus-derived flavanone, has been reported to exert metabolic and anti-inflammatory effects, its role in severe inflammatory and fibrotic conditions such as MASH remains incompletely understood. [...] Read more.

Background/Objectives: Metabolic dysfunction-associated steatohepatitis (MASH) is characterized by severe hepatic steatosis, lobular inflammation, and fibrosis. Although hesperidin, a citrus-derived flavanone, has been reported to exert metabolic and anti-inflammatory effects, its role in severe inflammatory and fibrotic conditions such as MASH remains incompletely understood. This study aimed to evaluate the effects of hesperidin in MASH using integrated in silico and in vivo approaches. Methods: Potential targets of hesperidin were identified using network pharmacology and molecular docking. For in vivo validation, C57BL/6 mice were fed a methionine- and choline-deficient (MCD) diet for five weeks, with oral administration of hesperidin (150 or 300 mg/kg/day) starting from week two. The MCD model induces severe hepatic inflammation and fibrosis but does not fully reflect metabolic features such as obesity and insulin resistance. Hepatic histology, serum transaminases, immune cell populations, and hypothalamic neuroinflammatory markers were assessed. Results: In silico analyses suggested that hesperidin interacts with key regulators associated with MASH, including PPARG, TGFB1, and TNF. In the in vivo MCD-induced model, hesperidin treatment reduced hepatic lipid accumulation and collagen deposition, accompanied by significant decreases in serum ALT and AST levels (by approximately 30–34% and 42–53%, respectively, depending on dose). These effects were associated with downregulation of pro-inflammatory and pro-fibrogenic gene expression and increased expression of antioxidant markers. In addition, hesperidin decreased circulating Ly6C^high monocytes and hepatic Kupffer cells, along with reduced hypothalamic microglial and astrocyte activation. Conclusions: Hesperidin attenuated key pathological features of MASH, including steatosis, inflammation, and fibrosis, and was associated with modulation of peripheral immune responses and central neuroinflammatory markers. These findings suggest that hesperidin may influence the liver–immune–brain axis and warrant further investigation in models that more closely reflect human metabolic conditions. Full article

(This article belongs to the Special Issue The Role of Bioactive Compounds in Human Health and Diseases (3rd Edition))

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4 pages, 162 KB

Open AccessEditorial

Nutrients: 15th Anniversary

by Annalisa Noce, Jay R. Hoffman and Ines Gonzalez-Casanova

Nutrients 2026, 18(9), 1401; https://doi.org/10.3390/nu18091401 - 29 Apr 2026

Abstract

Proper nutrition is a fundamental determinant of human health and is structured through the intake of various nutritional components: (i) macronutrients, including carbohydrates, lipids, and proteins, which provide energy and essential structural materials for metabolic and physiological processes; (ii) micronutrients, such as vitamins [...] Read more.

Proper nutrition is a fundamental determinant of human health and is structured through the intake of various nutritional components: (i) macronutrients, including carbohydrates, lipids, and proteins, which provide energy and essential structural materials for metabolic and physiological processes; (ii) micronutrients, such as vitamins and minerals, although required in smaller quantities, play crucial roles as enzymatic cofactors and regulators of numerous biochemical pathways; (iii) natural bioactive compounds (NBCs), substances found in plant-based foods (including polyphenols, carotenoids, phytosterols, and sulfur compounds) that exert protective effects thanks to their antioxidant and anti-inflammatory properties, contributing to the prevention of numerous chronic non-communicable diseases (CNCDs) [...] Full article

(This article belongs to the Special Issue Nutrients: 15th Anniversary)

24 pages, 7214 KB

Open AccessReview

The Gut Microbiota in Hematologic Malignancies: Mechanisms, Clinical Associations, and Translational Opportunities

by Santino Caserta, Enrica Antonia Martino, Mamdouh Skafi, Ernesto Vigna, Antonella Bruzzese, Nicola Amodio, Marco Fiorillo, Eugenio Lucia, Graziella D’Arrigo, Virginia Olivito, Caterina Labanca, Francesco Mendicino, Maria Eugenia Alvaro, Giovanni Tripepi, Fortunato Morabito and Massimo Gentile

Nutrients 2026, 18(9), 1400; https://doi.org/10.3390/nu18091400 - 29 Apr 2026

Abstract

Hematologic malignancies arise and progress within a systemic ecosystem in which the gut microbiota is an increasingly recognized, partially modifiable component. Across acute leukemias, chronic lymphocytic leukemia, plasma cell disorders, lymphomas, and clonal myeloid neoplasms, human studies consistently report reduced microbial diversity, depletion [...] Read more.

Hematologic malignancies arise and progress within a systemic ecosystem in which the gut microbiota is an increasingly recognized, partially modifiable component. Across acute leukemias, chronic lymphocytic leukemia, plasma cell disorders, lymphomas, and clonal myeloid neoplasms, human studies consistently report reduced microbial diversity, depletion of barrier-supportive, short-chain fatty acid-producing commensals, and enrichment of Gram-negative, pro-inflammatory, or hospital-adapted taxa. These alterations are associated with pre-leukemic clonal expansion, adverse genetic and immunological features, progression from precursor conditions, and inferior outcomes after chemotherapy, immunochemotherapy, chimeric antigen receptor T-cell therapy, and allogeneic hematopoietic stem cell transplantation. Mechanistic work in animal models and ex vivo systems demonstrates that microbiota-derived signals and metabolites—including Th17/IL-17-skewing consortia and the lipopolysaccharide intermediate ADP heptose sensed by the cytosolic receptor ALPK1—can actively modulate hematopoietic stem and progenitor cell fitness, inflammatory circuits, and malignant cell survival, supporting a causal role in disease biology. At the same time, major knowledge gaps remain because most human cohorts are small, single-center, and cross-sectional, frequently rely on 16S rRNA profiling, and are vulnerable to dietary, geographic, and treatment-related confounding. Within this context, three translational domains appear particularly promising: pharmaco-microbiomics, microbiome-informed risk stratification, and rational microbiota-targeted interventions, particularly diet-based strategies and antimicrobial stewardship. Here, we provide an integrated, disease-spanning synthesis of these data, emphasizing clonal hematopoiesis and myeloid neoplasms as emerging examples of microbiota–marrow crosstalk and outlining practical priorities for embedding microbiome science into future hematologic trials. Routine microbiome profiling or empiric microbiota-directed therapies cannot yet be recommended in everyday hematology practice, but integrating microbiome science into prospective therapeutic and transplant trials offers a realistic path to improved disease modeling, biomarker development, and rational adjunctive strategies to enhance outcomes for patients with hematologic malignancies. Full article

(This article belongs to the Special Issue Microbiome, Immunity, and Cancer: Deciphering the Intricate Crosstalk and Regulatory Networks)

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10 pages, 994 KB

Open AccessBrief Report

Dose-Dependent Alterations of the Human Gut Microbiome During Oral Iron Supplementation: A Randomized Study in Iron-Deficient Non-Anaemic Women

by Morton G. Schubert, Anaëlle Dentand, Maximilian Karczewski, Yasser Morsy, Felix Beuschlein, Michael Scharl and Pierre-Alexandre Krayenbuehl

Nutrients 2026, 18(9), 1399; https://doi.org/10.3390/nu18091399 - 29 Apr 2026

Abstract

Background/Objectives: Oral iron supplementation is widely used to treat iron deficiency but frequently causes gastro-intestinal side effects that limit treatment adherence. Unabsorbed luminal iron has been proposed to influence intestinal microbial communities, yet the effects of different oral iron doses on the [...] Read more.

Background/Objectives: Oral iron supplementation is widely used to treat iron deficiency but frequently causes gastro-intestinal side effects that limit treatment adherence. Unabsorbed luminal iron has been proposed to influence intestinal microbial communities, yet the effects of different oral iron doses on the human gut microbiome remain insufficiently characterized. Methods: In this randomized open-label study, 30 healthy premenopausal women with iron deficiency without anaemia received either low-dose oral iron supplementation (6 mg twice daily) administered under fasting conditions or standard-dose iron supplementation (100 mg once daily) taken with a meal for four weeks. Stool samples were collected before and after treatment and analyzed using 16S rRNA sequencing to evaluate microbiome composition. Results: Baseline characteristics, including age, body mass index, hemoglobin concentration and serum ferritin, were comparable between groups. After four weeks of treatment, distinct alterations in gut microbiome composition were observed between the low-dose and standard-dose groups. The genera Colidextribacter and GCA-900066575 decreased in the low-dose group but increased in the standard-dose group, whereas Oscillospira showed the opposite pattern. Gastrointestinal adverse events were reported by 87% of participants receiving standard-dose iron supplementation compared with 7% receiving low-dose iron supplementation (p < 0.0001). Conclusions: Oral iron supplementation induces dose-dependent changes in the intestinal microbiome and higher doses are associated with substantially increased gastrointestinal intolerance. These findings suggest that lower iron doses may reduce microbiome disruption and improve treatment tolerability. Full article

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

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26 pages, 1654 KB

Open AccessArticle

Effectiveness of a Comprehensive Program Including a Novel Concentrated High-Protein, High-Calorie Oral Nutritional Supplement to Enhance Nutritional and Morphofunctional Recovery in Malnourished Patients with Cancer: The ONAVIDA Study

by José Manuel García-Almeida, Rocío Fernández-Jiménez, Ana Hernández-Moreno, Gabriel Olveira, Mercedes Vázquez-Gutiérrez, Carolina Dassen, Pedro Pablo García-Luna, Amalia González-Jiménez, Josefina Olivares, María García-Duque, Mª José Martínez-Ramírez, Juan Manuel Guardia-Baena, María I. Rebollo-Pérez, Miguel Civera, Visitación Álvarez-de Frutos, Vicente Faus, Lucía Díaz-Naya, José Joaquín Alfaro-Martínez and Alejandro Sanz-París

Nutrients 2026, 18(9), 1398; https://doi.org/10.3390/nu18091398 - 29 Apr 2026

Abstract

Background/Objectives: Malnutrition in cancer adversely affects treatment outcomes and survival. Early intervention through oral nutritional supplements (ONSs) and dietary counseling can improve outcomes. This study evaluated the evolution of nutritional and morphofunctional parameters over three months in malnourished patients with cancer undergoing a [...] Read more.

Background/Objectives: Malnutrition in cancer adversely affects treatment outcomes and survival. Early intervention through oral nutritional supplements (ONSs) and dietary counseling can improve outcomes. This study evaluated the evolution of nutritional and morphofunctional parameters over three months in malnourished patients with cancer undergoing a comprehensive nutritional support program comprising dietary counseling, physical activity, and a novel concentrated high-protein, high-calorie ONS (cHPHC-ONS) with a high intrinsic leucine content. Methods: A prospective, observational, multicenter cohort study was conducted across 18 public hospitals in Spain. Two hundred thirty malnourished patients with cancer were enrolled: 147 naïve (no ONS treatment in the last three months) and 83 non-naïve (who transitioned to cHPHC-ONS after inadequate response to initial ONSs). Nutritional status was assessed using Global Leadership Initiative on Malnutrition (GLIM) criteria and morphofunctional parameters via bioelectrical impedance analysis, nutritional ultrasound, handgrip strength, the Timed Up and Go (TUG) test, and analysis of biochemical parameters. Results: After three months, 23.8% achieved normal GLIM nutritional status (p < 0.0001), with a greater improvement seen in non-naïve patients (28.4%, p < 0.0001). Weight loss ceased in 42.6% (p < 0.0001). and inflammation resolved for 10.3% (p = 0.0015). Non-naïve patients experienced a significant increase in fat-free mass index (p = 0.0159), appendicular skeletal muscle index (p = 0.0248), and rectus femoris cross-sectional area (p = 0.0016). Muscle strength increased significantly by +1.7 kg (p = 0.0025), and TUG test time decreased by 1.13 s (p = 0.0003) overall. Conclusions: The comprehensive nutritional support program—including a novel cHPHC-ONS, along with dietary and physical activity guidance—significantly improved the nutritional and morphofunctional status of malnourished patients with cancer, with benefits particularly evident in non-naïve individuals. Limitations: Observational design, no control group, short follow-up, and unadjusted non-multivariable comparisons, limiting causal inference. Full article

(This article belongs to the Section Clinical Nutrition)

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15 pages, 1904 KB

Open AccessArticle

Impact of Cheese Micronutrient Fortification on Micronutrient Consumption in Children from Morocco: A Modelling Study

by Alba M. Santaliestra-Pasías, Isabel Rueda-De Torre, Mª Isabel Benedicto-Toboso, Luis Mariano Esteban, Sergio Sabroso-Lasa, Karima Sabounji, Larbi Rjimati and Luis A. Moreno

Nutrients 2026, 18(9), 1397; https://doi.org/10.3390/nu18091397 - 29 Apr 2026

Abstract

Background/Objectives: Micronutrient malnutrition, particularly deficiencies in calcium, vitamin D, iron, zinc, and iodine, remains a significant public health issue among school-aged children in Morocco. Processed cheese, such as “The Laughing Cow” (TLC), has potential as a vehicle for fortification due to its [...] Read more.

Background/Objectives: Micronutrient malnutrition, particularly deficiencies in calcium, vitamin D, iron, zinc, and iodine, remains a significant public health issue among school-aged children in Morocco. Processed cheese, such as “The Laughing Cow” (TLC), has potential as a vehicle for fortification due to its widespread consumption and accessibility. This study aimed to evaluate the impact of fortified TLC on micronutrient intake and adequacy relative to the Recommended Dietary Allowances (RDA), among Moroccan children aged 6–12 years, and to explore differences in effects by socioeconomic status (SES). Methods: Data from the Moroccan Household Budget Survey (2013–2014) included 9266 children (39.4% TLC consumers). Dietary intake was assessed using 24 h recalls, and nutrient composition was analyzed using Ciqual 2020 tables and specialized software. Fortification scenarios were modelled to estimate potential impacts on micronutrient intake and compliance with RDAs. Results: Under the modelling scenarios, consumption of one portion/day of fortified TLC significantly improved RDAs compliance for iron, iodine, and zinc (p < 0.05). There was also an increase in RDA compliance for calcium and vitamin D, but differences were not significant. The impact of fortification on micronutrient intake and RDA compliance increased with socioeconomic status. Consumers of more than one portion/day showed the highest compliance with RDAs (p < 0.001). Fortification effects were consistent across age subgroups. Conclusions: Fortifying processed cheese represents a feasible strategy to address micronutrient deficiencies among Moroccan schoolchildren. This study highlights the potential of targeted fortification programmes to improve public health outcomes, particularly in vulnerable populations. Further research is needed to optimize fortification approaches and ensure sustainability. Full article

(This article belongs to the Section Pediatric Nutrition)

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