Nutrients

16 pages, 1222 KiB

Open AccessArticle

The Effects of Higher Protein Intake on Muscle Mass and Clinical Outcomes in Critically Ill Cancer Patients: A Prespecified Per-Protocol Analysis

by Jerusa Marcia Toloi, Ana Carolina Gallo Laranja, Diogo Oliveira Toledo, Ricardo Esper Treml, Luiz Marcelo S. Malbouisson, William Manzanares and João Manoel Silva-Jr

Nutrients 2025, 17(17), 2742; https://doi.org/10.3390/nu17172742 - 24 Aug 2025

Abstract

Background/Objectives: The optimal protein dose for critically ill cancer patients, especially for muscle mass preservation and survival, remains unclear. This study evaluated whether a higher protein intake, compared to usual intake, was associated with improved clinical outcomes in this population. Methods: This was [...] Read more.

Background/Objectives: The optimal protein dose for critically ill cancer patients, especially for muscle mass preservation and survival, remains unclear. This study evaluated whether a higher protein intake, compared to usual intake, was associated with improved clinical outcomes in this population. Methods: This was a prospective analysis of critically ill adult cancer patients admitted to an oncological intensive care unit (ICU). Patients were initially assigned to receive protein prescriptions of either 1.5 or 2.0 g per kilogram per day (g/kg/day), but due to common limitations in achieving prescribed targets in this setting, a prespecified per-protocol analysis was conducted. After three days of exclusive nutritional therapy, patients were reclassified into two groups based on actual protein intake: >1.5 g/kg/day (higher intake group, IG) and ≤1.5 g/kg/day (usual intake group, CG). The primary outcome was muscle mass preservation, measured by quadriceps muscle thickness (QMT) via ultrasound on days 1, 7, and 14. Secondary outcomes included ICU survival, hospital and ICU length of stay, mechanical ventilation duration, dialysis requirement, and 60-day survival. Results: From June 2019 to September 2023, 117 patients were included. Following the planned interim analysis, the study was stopped after meeting the Pocock criterion for ICU survival (p = 0.0013). After reclassification, 68.4% (n = 80) were in the IG and 31.6% (n = 37) in the CG. ICU stay was similar (both medians 13 days), but the IG had shorter hospital stays [21.0 vs. 27.5 days, p = 0.020], less QMT loss, and improved ICU (HR = 0.31, 95% CI 0.15–0.64), hospital (HR = 0.43, CI 0.23–0.80), and 60-day survival (HR = 0.43, CI 0.23–0.80), along with shorter ventilation duration (HR = 0.54, CI 0.30–0.99). Conclusions: Higher protein intake (>1.5 g/kg/day) was associated with better muscle mass preservation and improved clinical outcomes in critically ill cancer patients. Full article

(This article belongs to the Section Proteins and Amino Acids)

► Show Figures

Figure 1

19 pages, 2301 KiB

Open AccessArticle

Lactase Persistence-Associated rs4988235 Polymorphism: A Novel Genetic Link to Cardiovascular Risk via Modulation of ApoB100 and ApoAI

by Nihad Kharrat Helu, Habib Al Ashkar, Nora Kovacs, Roza Adany and Peter Piko

Nutrients 2025, 17(17), 2741; https://doi.org/10.3390/nu17172741 - 24 Aug 2025

Abstract

Background/Objectives: As part of the human adaptation to dairy consumption, the presence of the rs4988235-T variant in the MCM6 gene primarily determines lactase persistence in adult European populations, increasing the expression of the lactase-encoding LCT gene. Carriers of the C/C variant are [...] Read more.

Background/Objectives: As part of the human adaptation to dairy consumption, the presence of the rs4988235-T variant in the MCM6 gene primarily determines lactase persistence in adult European populations, increasing the expression of the lactase-encoding LCT gene. Carriers of the C/C variant are lactose intolerant, while carriers of the T/T or T/C variant have persistent lactase enzyme activity and are able to digest lactose in adulthood. While the association between lactose intolerance and increased cardiovascular risk (CVR) is well-known, the underlying causes have only been partly explored. The present study aimed to investigate the association of rs4988235 polymorphism with significant lipids affecting cardiovascular health and estimated CVR. Methods: The rs4988235 polymorphism was genotyped in 397 subjects from the general Hungarian population and 368 individuals from the Roma population. To characterize the overall lipid profile, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), high density lipoprotein cholesterol (HDL-C), apolipoprotein AI (ApoAI), and apolipoprotein B100 (ApoB100) levels were measured, and their ratios (TG/HDL-C, LDL-C/HDL-C, and ApoB100/ApoAI) were calculated. Cardiovascular risk was estimated using the Framingham Risk Score (FRS), Pooled Cohort Equations (PCE), Revised Pooled Cohort Equations (RPCE), and the Systematic Coronary Risk Evaluations (SCORE and SCORE2) algorithms. Adjusted linear and logistic regression analyses were performed, with p < 0.05 considered significant. Results: The Roma population had a significantly higher prevalence of the C/C genotype than the general population (65.5% vs. 40.3%, respectively). The results of the adjusted linear regression analysis showed a significant association between the C/C genotype and higher LDL-C level (B = 0.126, p = 0.047) and ApoB100 level (B = 0.046, p = 0.013), as well as a higher LDL-C/HDL-C ratio (B = 0.174, p = 0.021) and a higher ApoB100/ApoAI ratio (B = 0.045, p = 0.002), as well as a lower HDL-C level (B = −0.041, p = 0.049). The C/C genotype was also significantly associated with an increased cardiovascular risk (CVR) as estimated by the SCORE (B = 0.235, p = 0.034), SCORE2 (B = 0.414, p = 0.009), PCE (B = 0.536, p = 0.008), and RPCE (B = 0.289, p = 0.045) but not the FRS. After adjusting the statistical model further for ApoAI and ApoB100 levels, the significant correlation with the risk estimation algorithms disappeared (SCORE: p = 0.099; SCORE2: p = 0.283; PCE: p = 0.255; and RPCE: p = 0.370). Conclusions: Our results suggest that the C/C genotype of rs4988235 is associated with significantly higher ApoB100 and lower ApoAI levels and consequently higher ApoB100/ApoAI ratios, potentially contributing to an increased risk of cardiovascular disease. The results of the statistical analyses suggest that the association between lactose intolerant genotype and cardiovascular risk may be mediated indirectly via modification of the apolipoprotein profile. Full article

(This article belongs to the Special Issue Lipids and Lipoproteins in Cardiovascular Diseases)

► Show Figures

Figure 1

15 pages, 364 KiB

Open AccessReview

Nutrition Facts in the Over-Eighty Population: A Narrative Review

by Paolo Riccio and Emilio Jirillo

Nutrients 2025, 17(17), 2740; https://doi.org/10.3390/nu17172740 - 24 Aug 2025

Abstract

Background: For the first time, humanity is facing the worldwide challenge of global population aging over 80 years. As individuals age, energy acquisition and metabolism undergo significant changes, leading to a progressive decline in energy intake, absorption, and utilization. These changes contribute [...] Read more.

Background: For the first time, humanity is facing the worldwide challenge of global population aging over 80 years. As individuals age, energy acquisition and metabolism undergo significant changes, leading to a progressive decline in energy intake, absorption, and utilization. These changes contribute to malnutrition, loss of muscle mass, frailty, hormonal decline, mineral depletion, and impaired hydration, all of which increase the risk of morbidity and decrease quality of life. In addition, as life expectancy increases, advanced age often brings a gradual loss of autonomy, mirroring early-life dependency. Objectives: Addressing this age shift requires targeted interventions to support the wellness of the growing very elderly population. This review provides an overview of healthy aging through an integrated approach that includes nutritional intervention, lifestyle modifications, and targeted supplementation to support functional independence and overall well-being in older adults. The guiding principle is that longevity matters less than aging well. Full article

(This article belongs to the Special Issue Mineral Nutrition on Human Health and Disease)

25 pages, 1944 KiB

Open AccessArticle

Cachexia Phenotyping Through Morphofunctional Assessment and Mitocondrial Biomarkers (GDF-15 and PGC-1α) in Idiopathic Pulmonary Fibrosis

by Alicia Sanmartín-Sánchez, Rocío Fernández-Jiménez, Josefina Olivares-Alcolea, Eva Cabrera-César, Francisco Espíldora-Hernández, Isabel Vegas-Aguilar, María del Mar Amaya-Campos, Víctor José Simón-Frapolli, María Villaplana-García, Isabel Cornejo-Pareja, Ana Sánchez-García, Mora Murri, Patricia Guirado-Peláez, Álvaro Vidal-Suárez, Lourdes Garrido-Sánchez, Francisco J. Tinahones, Jose Luis Velasco-Garrido and Jose Manuel García-Almeida

Nutrients 2025, 17(17), 2739; https://doi.org/10.3390/nu17172739 - 24 Aug 2025

Abstract

Background/Objetives: Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease with poor prognosis. Nutritional disorders, particularly cachexia, significantly impact morbidity and mortality in IPF but remain under-investigated. This study aimed to characterize cachexia phenotypes in IPF through morphofunctional assessment (MFA) and [...] Read more.

Background/Objetives: Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease with poor prognosis. Nutritional disorders, particularly cachexia, significantly impact morbidity and mortality in IPF but remain under-investigated. This study aimed to characterize cachexia phenotypes in IPF through morphofunctional assessment (MFA) and to evaluate their prognostic relevance, including the role of mitochondrial biomarkers. Methods: In this prospective bicenter study, 85 IPF patients underwent MFA including bioelectrical impedance vector analysis (BIVA), nutritional ultrasound (NU), and T12-level computed tomography (T12-CT) for body composition. Functional and strength assessments included timed up and go test (TUG) and handgrip strength (HGS), respectively. Cachexia was defined by Evans’ criteria, Martin’s CT-based criteria, and our IPF-specific proposed definition. Serum GDF-15 and PGC-1α levels were also measured. Results: Cachexia prevalence varied by definition: 24.71% (Evans), 29.5% (Martin) and 42.4% (IPF Cachexia Syndrome). Cachectic patients showed significantly lower muscle mass, function, and quality (measured by reduced muscle attenuation at T12-CT), along with higher GDF-15 and lower PGC-1α levels. The presence of IPF Cachexia syndrome (HR 2.56; 95% CI, 1.08–6.07; p = 0.033), GDF-15 > 4412.0 pg/mL (HR 3.21; 95% CI, 1.04–9.90; p = 0.042) and impaired TUG (>8 s) (HR 3.77; 95% CI, 1.63–8.71; 0.002) were all independently associated with increased 24-month mortality. Conclusions: Cachexia is prevalent in IPF and showed strong concordance between the three diagnostic criteria. The IPF Cachexia syndrome, based on comprehensive morphofunctional phenotyping, demonstrated superior discriminatory capacity. The addition of mitochondrial biomarkers may improve early detection and support personalized interventions to improve patient outcomes. Full article

(This article belongs to the Section Clinical Nutrition)

► Show Figures

Graphical abstract

11 pages, 480 KiB

Open AccessArticle

Occurrence and Correlates of Vitamin D and Iron Deficiency in Children with Autism Spectrum Disorder

by Magdalena Yvonne Koh, Audrey J. W. Lee, Hung Chew Wong and Ramkumar Aishworiya

Nutrients 2025, 17(17), 2738; https://doi.org/10.3390/nu17172738 - 23 Aug 2025

Abstract

Background/Objectives: This study aimed to determine the occurrence of vitamin D and iron deficiency in children with autism spectrum disorder (ASD) in Singapore and identify correlates of the presence of these deficiencies, if any. Methods: This is an observational, cross-sectional, retrospective [...] Read more.

Background/Objectives: This study aimed to determine the occurrence of vitamin D and iron deficiency in children with autism spectrum disorder (ASD) in Singapore and identify correlates of the presence of these deficiencies, if any. Methods: This is an observational, cross-sectional, retrospective review of children with a diagnosis of autism, aged 1 to 10 years old, seen at a tertiary developmental paediatric centre from January 2018 to December 2022, with blood investigations completed. Autism diagnosis was determined either clinically by a developmental paediatrician using DSM-5 criteria or using the Autism Diagnostic Observation Schedule (ADOS-2). Children with genetic disorders and chronic medical conditions were excluded. Logistic regression was used to evaluate associations with the deficiencies, and the Bonferroni method was applied on post hoc comparisons. Results: The overall sample comprised 241 children (79% males, mean age 4.2 years [SD 2.25]. There were 222 and 236 children who had blood investigations for vitamin D and iron levels performed, respectively. Out of the 222 children whose vitamin D tests were performed, 36.5% had vitamin D insufficiency/deficiency. Iron deficiency occurred in 37.7% for children who had their iron levels tested. There were 122 observations for both iron levels and complete blood count. Out of these, 19 (15.6%) had iron deficiency anaemia. There were no significant correlates for iron deficiency, with picky eating included. Conclusions: Vitamin D and iron deficiencies were common in this sample. Clinicians should consider testing for vitamin D and iron for children with ASD, especially for vitamin D in children of Indian ethnicity and older age. Full article

(This article belongs to the Special Issue Nutrition in the Early Years: Feeding Challenges and Their Health Implications)

17 pages, 300 KiB

Open AccessArticle

Low Maternal Care and Protection and Body Image Dissatisfaction as Psychopathological Predictors of Binge Eating Disorder in Transitional-Age Youth

by Emanuela Bianciardi, Rossella Mattea Quinto, Ester Longo, Valentina Santelli, Lorenzo Contini, Alberto Siracusano, Cinzia Niolu and Giorgio Di Lorenzo

Nutrients 2025, 17(17), 2737; https://doi.org/10.3390/nu17172737 - 23 Aug 2025

Abstract

Background: Binge eating disorder (BED) frequently arises during the transitional age (18–25 years), a critical developmental period characterized by challenges in autonomy, identity formation, and interpersonal functioning. This study investigated psychopathological predictors of BED risk in this age group, with particular focus [...] Read more.

Background: Binge eating disorder (BED) frequently arises during the transitional age (18–25 years), a critical developmental period characterized by challenges in autonomy, identity formation, and interpersonal functioning. This study investigated psychopathological predictors of BED risk in this age group, with particular focus on parental bonding, attachment style, body dissatisfaction, alexithymia, and depressive symptoms. Methods: A total of 287 participants aged 18–25 years completed the Binge Eating Scale (BES), Beck Depression Inventory-II (BDI-II), Body Shape Questionnaire (BSQ), Toronto Alexithymia Scale (TAS-20), Attachment Style Questionnaire (ASQ), and Parental Bonding Instrument (PBI). Sociodemographic information and body mass index (BMI) were also collected. Results: Compared with non-BED risk groups, individuals at risk of BED exhibited significantly higher BMI, greater alexithymia, higher body dissatisfaction, more insecure attachment patterns, and lower recalled paternal and maternal care. Hierarchical binary logistic regression revealed that the final model explained 56.1% of the variance (Nagelkerke R²) and correctly classified 92.1% of cases. Significant predictors of BED included body dissatisfaction, elevated BMI, low maternal care, and low maternal protection. Conclusions: This study is the first to examine BED risk factors specifically during the transitional age. Findings indicate that body image dissatisfaction, higher BMI, and inadequate maternal emotional care and protection are salient predictors at this life stage. Preventive interventions should integrate parental psychoeducation, nutritional guidance, and therapeutic strategies addressing both eating disorder symptoms and attachment-related difficulties to reduce BED onset and improve psychosocial outcomes in emerging adults. Full article

(This article belongs to the Special Issue Eating Behaviors and Eating Disorders: Prevention, Clinical Characterization, and Treatment)

16 pages, 518 KiB

Open AccessArticle

Dietitians’ Adherence and Perspectives on the European Association for the Study of Obesity (EASO) and the European Federation of the Associations of Dietitians (EFAD) Recommendations for Overweight and Obesity Management: A Mixed-Methods Study

by Odysseas Androutsos, Hilda Mulrooney, Vaios Svolos, Antonis Vlassopoulos, Elisabeth Govers and Maria Hasssapidou

Nutrients 2025, 17(17), 2736; https://doi.org/10.3390/nu17172736 - 23 Aug 2025

Abstract

Introduction: Recent guidelines developed by the European Association for the Study of Obesity (EASO) and the European Federation of the Associations of Dietitians (EFAD) focused on the dietetic management of obesity in adults. The present study aimed to explore the perspectives of healthcare [...] Read more.

Introduction: Recent guidelines developed by the European Association for the Study of Obesity (EASO) and the European Federation of the Associations of Dietitians (EFAD) focused on the dietetic management of obesity in adults. The present study aimed to explore the perspectives of healthcare professionals regarding these guidelines. Methods: In total, 85 registered dietitians/nutritionists from Greece, the Netherlands, the Republic of Ireland, and the United Kingdom completed an online survey, and 10 were interviewed, in February–March 2023. Demographic data were also collected. Results: Awareness of the EASO-EFAD guidelines among registered dietitians/nutritionists was moderate (57.6%), but only 20% had read them in full. Dietitians with higher education and relevant experience were more likely to have read the guidelines. Less than half reported that key evidence-based recommendations, such as individualized medical nutrition therapy and intensive behavioral interventions, are already included in national guidance. Recommendations like portfolio or DASH diets, partial meal replacements, and calorie restriction were less commonly part of national guidance/usual practice. A small percentage of participants described their adoption of several nutritional approaches novel to them. These included the portfolio dietary pattern, partial meal replacements, and intermittent fasting or continuous calorie restriction. For some Irish dietitians, prioritizing weight as the main outcome conflicted with their emphasis on overall health and individualized nutrition therapy. Other barriers of recommendation implementation included exclusive availability in English, rapid changes in obesity management, staffing shortages, limited multidisciplinary collaboration, and inconsistent knowledge among healthcare providers. Conclusions: The present study identified gaps in the adoption of the EASO-EFAD guidelines into dietetic/clinical practice. EFAD will develop strategies to disseminate these guidelines at different levels of stakeholders (national/local authorities, dietitians/nutritionists, and patients). Full article

(This article belongs to the Special Issue Nutritional Assessment in Preventing and Managing Obesity)

17 pages, 897 KiB

Open AccessArticle

Combined Effects of Exercise and Broccoli Supplementation on Metabolic and Lipoprotein Biomarkers in Adults with Type 2 Diabetes: A Randomized Controlled Trial

by Maryam Delfan, Masoumeh Gharedaghi, Farzaneh Zeynali, Rawad El Hage, Anthony C. Hackney, Halil İbrahim Ceylan, Ayoub Saeidi, Ismail Laher, Nicola Luigi Bragazzi and Hassane Zouhal

Nutrients 2025, 17(17), 2735; https://doi.org/10.3390/nu17172735 - 23 Aug 2025

Abstract

Aim: To investigate the synergistic effects of exercise training and Brassica oleracea var. italica (broccoli sprout) supplementation on Apolipoprotein A-I, B-100, and J levels in men with Type 2 diabetes mellitus (T2DM). Methods: Forty-four males with T2DM were randomly assigned to four [...] Read more.

Aim: To investigate the synergistic effects of exercise training and Brassica oleracea var. italica (broccoli sprout) supplementation on Apolipoprotein A-I, B-100, and J levels in men with Type 2 diabetes mellitus (T2DM). Methods: Forty-four males with T2DM were randomly assigned to four groups: Control (CG), Supplement (SG), Training (TG), and Training + Supplement (TSG) groups. Participants in the supplement groups (SG and TSG) received 10 g of broccoli supplement after meals for 12 weeks, while those in the training groups (TG and TSG) participated in a structured exercise program (resistance and aerobic), performed three times per week for 12 weeks, at intensities of 60–70% one-repetition maximum (1RM) for resistance training and 60–70% peak oxygen uptake (VO_2peak) for aerobic training. Results: Circulating levels of apolipoproteins improved after 12 weeks in the TSG, TG, and SG groups. However, the TSG group exhibited the most pronounced improvements across metabolic and lipoprotein markers, reflecting an additive effect of both interventions. Specifically, the TSG group demonstrated absolute reductions in ApoB-100 (−48.30 ± 7.20 mg/dL) and ApoJ (−44.05 ± 5.76 mg/dL), along with an increase in ApoA-I (+44.92 ± 6.05 mg/dL). Main effect analysis revealed that exercise training elicited the most substantial improvements across metabolic and lipoprotein markers, with large effect sizes for glucose (η²p = 0.787), insulin (η²p = 0.640), HOMA-IR (η²p = 0.856), ApoA-I (η²p = 0.685), ApoB-100 (η²p = 0.774), ApoJ (η²p = 0.848), and HDL-C (η²p = 0.535). Supplementation showed moderate effects, particularly on HOMA-IR (η²p = 0.370), ApoA-I (η²p = 0.383), and ApoB-100 (η²p = 0.334), supporting an additive but exercise-dominant benefit. The combined intervention group (TSG) showed the most pronounced improvements across all measured outcomes, with large effect sizes for ApoA-I (η²p = 0.883), glucose (η²p = 0.946), insulin (η²p = 0.881), HOMA-IR (η²p = 0.904), and ApoJ (η²p = 0.852). Conclusions: The effects of combining training and broccoli sprout supplementation on apolipoprotein levels are likely to result from the activation of two separate pathways, one from training and the other from supplementation. This dual-modality intervention could serve as an effective complementary strategy in managing metabolic and cardiovascular risk factors for individuals with T2DM. However, the magnitude of change induced by the combination of exercise training and broccoli supplementation was largely driven by the training component, with supplementation providing complementary but less consistent benefits. Full article

(This article belongs to the Special Issue The Role of Foods and Nutritional and Botanical Supplements for the Enhancement of Human Health and Performance)

20 pages, 1370 KiB

Open AccessArticle

Multi-Species Synbiotic Supplementation Enhances Gut Microbial Diversity, Increases Urolithin A and Butyrate Production, and Reduces Inflammation in Healthy Adults: A Randomized, Placebo-Controlled Trial

by Brooke A. Napier, Jessica R. Allegretti, Paul Feuerstadt, Colleen R. Kelly, Nicholas W. Van Hise, Ralf Jäger, Zain Kassam and Gregor Reid

Nutrients 2025, 17(17), 2734; https://doi.org/10.3390/nu17172734 - 23 Aug 2025

Abstract

Background: In healthy adults, probiotic supplementation alone does not increase Urolithin A (UroA) and rarely increases butyrate, both microbiome-derived metabolites that influence key biological functions involved in regulating gastrointestinal symptoms. Accordingly, this clinical trial evaluated key biological functions of a multi-species synbiotic [...] Read more.

Background: In healthy adults, probiotic supplementation alone does not increase Urolithin A (UroA) and rarely increases butyrate, both microbiome-derived metabolites that influence key biological functions involved in regulating gastrointestinal symptoms. Accordingly, this clinical trial evaluated key biological functions of a multi-species synbiotic with 24 probiotic strains and a polyphenol-based prebiotic using capsule-in-capsule delivery technology. Methods: We conducted a randomized, placebo-controlled trial among healthy participants (n = 32). Participants were administered a daily synbiotic (53.6 billion AFU multi-species probiotic and 400 mg Indian pomegranate extract; DS-01) or matching placebo for 91 days. Samples were obtained at baseline Day 0, and Days 7, 14, 49, and 91. Endpoints included changes in fecal microbiome composition, urinary UroA, fecal butyrate, serum CRP, and safety. Results: The synbiotic significantly increased alpha-diversity of Bifidobacterium and Lactobacillus spp. at all timepoints, including at end-of-study (Day 91, p < 0.0001) and increased native beneficial microbes. UroA production was significantly increased in the synbiotic arm at short-term (Day 7, 12-fold, p < 0.02) and long-term (Day 91, 49-fold, p < 0.001) timepoints. A higher proportion of synbiotic participants were capable of converting polyphenols into UroA (Day 91, 100% vs. 44.4%; p < 0.01). Mechanistically, synbiotic participants showed an increased abundance of Lactobacillus species involved in UroA precursor metabolism and UroA-producing Gordonibacter species. The synbiotic also significantly increased fecal butyrate levels (p < 0.03), and butyrate-producing species, in low-baseline butyrate producers, through Day 91, and was associated with reduced systemic inflammation. Conclusions: This multi-species synbiotic significantly increases diversity and abundance of key beneficial bacteria, enhances UroA production and butyrate levels, and is associated with lowered systemic inflammation. This is the first synbiotic to increase both UroA and butyrate. Full article

(This article belongs to the Section Prebiotics and Probiotics)

► Show Figures

Figure 1

20 pages, 2210 KiB

Open AccessArticle

Menaquinone-7 Supplementation Increases Multiple Advanced Glycation End-Products and Oxidation Markers in Zucker Diabetic Fatty Rats

by Ingo Mrosewski, Thomas Fleming, Gundula Schulze-Tanzil, Christian Werner, Clemens Gögele, Valeriya Mantel, Maria Kokozidou and Thomas Bertsch

Nutrients 2025, 17(17), 2733; https://doi.org/10.3390/nu17172733 - 23 Aug 2025

Abstract

Background: Dicarbonyls and advanced glycation end-products (AGEs) contribute to oxidative stress, inflammation, and complications in type 2 diabetes mellitus (T2DM). Menaquinone-7 (MK-7), a vitamin K2 subtype, has shown benefits for glucose tolerance and vascular health in some studies. We evaluated the impact of [...] Read more.

Background: Dicarbonyls and advanced glycation end-products (AGEs) contribute to oxidative stress, inflammation, and complications in type 2 diabetes mellitus (T2DM). Menaquinone-7 (MK-7), a vitamin K2 subtype, has shown benefits for glucose tolerance and vascular health in some studies. We evaluated the impact of MK-7 on dicarbonyls, free AGEs, and protein nitration/oxidation adducts in a rat model of T2DM. Methods: Male heterozygous (fa/+, control) and homozygous (fa/fa, diabetic) Zucker Diabetic Fatty rats were fed a diabetogenic diet without or with MK-7 for 12 weeks. After sacrifice, plasma dicarbonyls as well as plasma and urinary levels of free AGEs and protein nitration/oxidation adducts were quantified by isotope dilution tandem mass spectrometry. Results: Diabetic rats showed significantly increased plasma glyoxal, 3-deoxyglucosone, and fructosyl-lysine with non-significant trends toward increased methylglyoxal-derived hydroimidazolone and methionine sulfoxide, as well as reductions in methylglyoxal and dityrosine. Urinary carboxyethyl-lysine, carboxymethyl-lysine, fructosyl-lysine (all significant), and dityrosine (non-significant) were elevated in diabetic rats; glucosepane (non-significant) was reduced. MK-7 supplementation reduced no measured parameter but was associated with non-significant further increases in plasma glyoxal-derived hydroimidazolone, carboxyethyl-lysine, carboxymethyl-lysine, fructosyl-lysine, 3-nitrotyrosine, and methionine sulfoxide, as well as in urinary glyoxal-derived hydroimidazolone, carboxyethyl-lysine, fructosyl-lysine, and 3-nitrotyrosine, in diabetic rats. Correlation analysis revealed significant associations between glucose, dicarbonyls, AGEs, and oxidative markers. Conclusions: High-dose MK-7 supplementation did not improve dicarbonyl stress, AGE burden, or protein nitration/oxidation. With respect to available scientific evidence and our observations, the combination of glycemia-driven amplification of glycation and oxidative stress, as well as MK-7-induced glutathione depletion, were likely causative. Full article

(This article belongs to the Section Nutrition and Diabetes)

► Show Figures

Figure 1

27 pages, 553 KiB

Open AccessArticle

Beyond the Pill: Unveiling the Characteristics of Prenatal Micronutrient Consumption Among Hungarian Pregnant Women According to Different Levels of Adherence

by Evelin Polanek, Ferenc Rárosi, Csenge Fruzsina Béky, Regina Molnár, Gábor Németh, Hajnalka Orvos, Edit Paulik and Andrea Szabó

Nutrients 2025, 17(17), 2732; https://doi.org/10.3390/nu17172732 - 23 Aug 2025

Abstract

Background/Objectives: There is clear evidence that maternal micronutrient deficiencies result in adverse maternal and fetal health outcomes. Therefore, corrective supplementation should be considered when dietary intake is insufficient, particularly for vitamin D (VD), omega-3 fatty acids (O3), folic acid (FA), or prenatal [...] Read more.

Background/Objectives: There is clear evidence that maternal micronutrient deficiencies result in adverse maternal and fetal health outcomes. Therefore, corrective supplementation should be considered when dietary intake is insufficient, particularly for vitamin D (VD), omega-3 fatty acids (O3), folic acid (FA), or prenatal multiple micronutrient products (PMM). Despite its significance, intake patterns in Hungary remain largely unexplored, and evaluating adherence to recommended intake levels would be of even greater importance. This is the first Hungarian study to provide a comprehensive overview of the frequency and adherence patterns of micronutrient supplementation among pregnant women, while also analyzing their association with predictors and outcomes. Methods: This cross-sectional study involved 300 pregnant women who delivered in a university hospital. Data were collected using a self-reported questionnaire and clinical maternal and neonatal records. Results: The prevalence of FA, VD, O3, and PMM intake among the participants was 89.0%, 76.4%, 58.7%, and 67.6%, respectively. However, adherence to recommendations was notably lower: 41.1% for VD, 37.5% for O3, 36% for PMM, and 31% for FA. Higher adherence was associated with older maternal age, higher educational level, county town residence, planned pregnancy, primiparity, previous spontaneous abortion, and early initiation of antenatal care. Our findings refute concerns about the obesogenic effect of supplementation for both mothers and newborns. FA intake correlated with a lower likelihood of cesarean section, while O3 use was associated with improved uterine contractility and reduced risk of gestational diabetes mellitus. Conclusions: Our study underscores the need for individualized counselling on micronutrient supplementation, with particular emphasis on appropriate timing, dosage, and potential benefits. Full article

(This article belongs to the Section Nutrition in Women)

► Show Figures

Figure 1

16 pages, 258 KiB

Open AccessArticle

Enhanced Cognitive Behavioral Therapy for Young Adolescents with Anorexia Nervosa: Identifying Predictors of Treatment Response

by Simona Calugi, Mirko Chimini, Anna Dalle Grave, Gianmatteo Cattaneo, Maddalena Conti and Riccardo Dalle Grave

Nutrients 2025, 17(17), 2731; https://doi.org/10.3390/nu17172731 - 23 Aug 2025

Abstract

(1) Background: This study aimed to identify baseline demographic, clinical, and psychosocial predictors of treatment response in adolescents with anorexia nervosa (AN) undergoing an intensive 20-week enhanced cognitive behavioral therapy (CBT-E) program, which included inpatient and day patient phases. Treatment outcomes were assessed [...] Read more.

(1) Background: This study aimed to identify baseline demographic, clinical, and psychosocial predictors of treatment response in adolescents with anorexia nervosa (AN) undergoing an intensive 20-week enhanced cognitive behavioral therapy (CBT-E) program, which included inpatient and day patient phases. Treatment outcomes were assessed at the end of intensive treatment (EOIT) and at a 20-week follow-up. (2) Methods: A prospective cohort of 68 adolescents under the age of 16 consecutively admitted to intensive CBT-E was evaluated. Baseline measures included body mass index (BMI)-for-age percentiles, percentage of expected body weight (%EBW), eating disorder psychopathology (EDE-Q), general psychopathology, and functional impairment. (3) Results: Of those who began treatment, 83.4% completed the program and 70.2% were available for follow-up assessment. Based on intent-to-treat analysis, 94.1% achieved a “good BMI outcome” and 73.5% met criteria for “full response” at EOIT. At follow-up, 64.7% maintained a good BMI and 55.9% sustained a full response. Completers’ analysis indicated that baseline body weight, clinical impairment, general psychopathology, and weight regain influenced treatment outcomes. However, no baseline demographic or clinical variables predicted treatment completion or outcome at either time point at intention-to-treat analysis, except that younger age at admission was linked to higher eating disorder psychopathology at follow-up. (4) Conclusions: In treatment completers, certain baseline clinical factors and weight regain influenced outcomes, while in the full sample, younger age predicted greater residual psychopathology at follow-up. These findings, if confirmed, emphasize the need for early intervention, focused support for weight regain, and potential adaptations of CBT-E for early adolescents. Full article

(This article belongs to the Special Issue Integration of Nutritional and Psychological Interventions in the Management of Anorexia Nervosa, Bulimia Nervosa and Other Eating Disorders)

13 pages, 1149 KiB

Open AccessArticle

Food Insecurity, Diet and Health Outcomes in Pediatric Inflammatory Bowel Disease: A Pilot Study

by Nicole Zeky, Alysse Baudier, Colleen Leblanc, Elizabeth McDonough, Sarah A. Dumas and Dedrick Moulton

Nutrients 2025, 17(17), 2730; https://doi.org/10.3390/nu17172730 - 23 Aug 2025

Abstract

Background/Objectives: Food insecurity (FI) is a well-defined factor in pediatric health outcomes and has been associated with lower diet quality. While poor diet quality has been linked to the rising prevalence of inflammatory bowel disease (IBD), little is known about the impact of [...] Read more.

Background/Objectives: Food insecurity (FI) is a well-defined factor in pediatric health outcomes and has been associated with lower diet quality. While poor diet quality has been linked to the rising prevalence of inflammatory bowel disease (IBD), little is known about the impact of FI on pediatric IBD. This pilot study explores the feasibility and potential impact of FI on dietary intake and clinical outcomes in children with newly diagnosed IBD. Methods: This pilot study included newly diagnosed IBD patients aged 5 to 18. FI screening was completed using the USDA 6-item and AAP 2-item screeners at diagnosis and 6 months. Dietary intake was classified according to their degree of processing (NOVA classification). Clinical data, anthropometrics, and healthcare utilization were collected over 6 months. Results: Among 20 patients, FI was identified in 40% of families. Food-insecure patients had significantly lower weight and BMI z-scores at diagnosis compared to food-secure peers (p = 0.002 and p = 0.0013, respectively). Food-insecure patients consumed more ultra-processed foods (UPFs, 70.6% vs. 66.7%, p = 0.473). However, most patients consumed diets high in ultra-processed foods. FI status was dynamic over the study period. Hospitalizations were more frequent among food-insecure patients. Conclusions: FI is common in pediatric IBD and associated with poorer nutritional status. FI was associated with higher consumption of UPFs, although diet quality was poor among most patients. Future studies should validate these findings in large cohorts and evaluate longitudinal interventions. Full article

(This article belongs to the Section Pediatric Nutrition)

► Show Figures

Figure 1

25 pages, 7531 KiB

Open AccessArticle

Targeted Microbial Shifts and Metabolite Profiles Were Associated with Clinical Response to an Anti-Inflammatory Diet in Osteoarthritis

by Marta Sala-Climent, Kevin Bu, Roxana Coras, Martha Cedeno, Simone Zuffa, Jessica Murillo-Saich, Helena Mannochio-Russo, Celeste Allaband, Michal K. Hose, Anna Quan, Soo-In Choi, Katherine Nguyen, Shahrokh Golshan, Rebecca B. Blank, Tiffany Holt, Nancy E. Lane, Rob Knight, Jose Scher, Pieter Dorrestein, Jose Clemente and Monica Guma Show full author list Hide full author list

Nutrients 2025, 17(17), 2729; https://doi.org/10.3390/nu17172729 - 22 Aug 2025

Abstract

Introduction: Osteoarthritis (OA) is a chronic degenerative joint disease with limited treatment options focused primarily on symptom management. Emerging evidence suggests that dietary interventions may influence inflammation and pain through modulation of the gut microbiome and metabolome. Methods: We conducted a 4-week open-label [...] Read more.

Introduction: Osteoarthritis (OA) is a chronic degenerative joint disease with limited treatment options focused primarily on symptom management. Emerging evidence suggests that dietary interventions may influence inflammation and pain through modulation of the gut microbiome and metabolome. Methods: We conducted a 4-week open-label pilot trial evaluating the effects of an anti-inflammatory dietary intervention (ITIS diet) in 20 patients with knee OA (ClinicalTrials.gov ID: NCT05559463, registered prior to enrollment; sponsor: University of California, San Diego; responsible party: Monica Guma; study start date: 1 October 2021). The following were assessed before and after the intervention: (1) clinical outcomes; (2) gut and salivary microbiomes; and (3) salivary, stool, and plasma metabolomes. Responders were defined as patients achieving ≥30% reduction in Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain scores. Results: The ITIS diet was well-tolerated, with good adherence (66.2%) and a significant improvement in clinical outcomes, including reduced pain and improved overall health measured with the visual analog scale (VAS). Responders (n = 8) showed distinct gut microbiome and metabolome profiles compared to non-responders (n = 12). Notably, taxa within the Lachnospiraceae family exhibited dynamic, bidirectional shifts post-intervention: Anaerostipes and Limivivens were enriched among responders and negatively correlated with pain scores, while Oliverpabstia and Fusicatenibacter were depleted following dietary intervention. These taxa also showed strong correlations with anti-inflammatory metabolites, including hydroxydecanoic acid derivatives and pyridoxine. Furthermore, subsequent network analysis revealed more structured and selective microbiome–metabolome interactions in responders, specifically post-intervention. Conclusions: This pilot study shows that a short-term anti-inflammatory dietary intervention was associated with meaningful changes in the gut microbiome and metabolome. Members of the Lachnospiraceae family emerged as key taxa associated with pain reduction and anti-inflammatory metabolite production. Our findings suggest that specific microbial responses—rather than global diversity changes—may underlie dietary responsiveness in OA. Although exploratory and limited by sample size, our results support further investigation into personalized, microbiome-informed nutritional strategies for OA management. Full article

(This article belongs to the Section Nutritional Immunology)

28 pages, 1133 KiB

Open AccessArticle

Mapping the Cognitive Architecture of Health Beliefs: A Multivariate Conditional Network of Perceived Salt-Related Disease Risks

by Stanisław Surma, Łukasz Lewandowski, Karol Momot, Tomasz Sobierajski, Joanna Lewek, Bogusław Okopień and Maciej Banach

Nutrients 2025, 17(17), 2728; https://doi.org/10.3390/nu17172728 - 22 Aug 2025

Abstract

Background: Public beliefs about dietary risks, such as excessive salt intake, are often not isolated misconceptions but part of structured cognitive systems. This study aimed to explore how individuals organize their beliefs and misperceptions regarding salt-related health consequences. Material and Methods: Using data [...] Read more.

Background: Public beliefs about dietary risks, such as excessive salt intake, are often not isolated misconceptions but part of structured cognitive systems. This study aimed to explore how individuals organize their beliefs and misperceptions regarding salt-related health consequences. Material and Methods: Using data from an international online survey, we applied a system of multivariate proportional odds logistic regression (POLR) models to estimate conditional associations among beliefs about salt’s links to various diseases—including cardiovascular, metabolic, renal, neuropsychiatric, and mortality outcomes. In addition, exploratory and confirmatory factor analyses (EFA and CFA) were conducted to identify and validate latent constructs underlying the belief items. Beliefs were modeled as interdependent, controlling for latent constructs, sociodemographics, and self-reported health awareness. Statistically significant associations (p < 0.05) were visualized via a heatmap of beta coefficients. Results: Physicians showed almost universal agreement that salt contributes to hypertension (µ = 0.97), compared to non-medical respondents (µ = 0.85; p < 0.0001). Beliefs about mortality (µ = 1.55 for MDs vs. 0.99 for non-medical; p < 0.0001) emerged as central hubs in the belief network. Strong inter-item associations were observed, such as between hypertension and heart failure (β = −0.39), and between obesity and type 2 diabetes (β = −0.94). Notably, cognitive gaps were found, including a lack of association between atrial fibrillation and stroke, and non-reciprocal links between hypertension and heart failure. Conclusions: Beliefs about the health effects of salt are structured and sometimes asymmetrical, reflecting underlying reasoning patterns rather than isolated ignorance. Understanding these structures provides a systems-level view of health literacy and may inform more effective public health communication and education strategies. Full article

(This article belongs to the Special Issue Nutritional Aspects of Cardiovascular Disease Risk Factors)

12 pages, 424 KiB

Open AccessArticle

Association Between Adherence to the Mediterranean Diet and Metabolic Syndrome and Its Components Among Polish Postmenopausal Women: A Cross-Sectional Study

by Joanna Bajerska, Aleksandra Skoczek-Rubińska, Magdalena Dębińska-Kubiak, Wiktoria Stanisławska and Jarosław Walkowiak

Nutrients 2025, 17(17), 2727; https://doi.org/10.3390/nu17172727 - 22 Aug 2025

Abstract

Background/Objectives: The decrease in estrogen levels during menopause is associated with an increase in visceral fat accumulation, which can contribute to the development of metabolic syndrome (MetS). While some studies have suggested a link between the Mediterranean diet (MedDiet) and the reduced [...] Read more.

Background/Objectives: The decrease in estrogen levels during menopause is associated with an increase in visceral fat accumulation, which can contribute to the development of metabolic syndrome (MetS). While some studies have suggested a link between the Mediterranean diet (MedDiet) and the reduced incidence of MetS and its components in the general population, these findings have not been confirmed among postmenopausal women. Therefore, this study investigated the association between the adherence to the MedDiet and the odds of having MetS, and established the food groups responsible for this effect in postmenopausal women. Methods: This cross-sectional study involved 312 postmenopausal women who underwent anthropometric measurements and blood parameter assessment. Adherence to the MedDiet was assessed using the Alternate Mediterranean Diet score (the aMED score), and MetS was defined based on the updated 2022 criteria. Results: After adjusting for potential confounders, adherence to the MedDiet was inversely associated with central obesity and hypertension. For each one-point increase in the aMED score (indicating a better adherence to the MedDet), the odds of central obesity and hypertension were significantly reduced by 33% (OR = 0.669, 95% CI: 0.518; 0.866, p = 0.002) and by 18% (OR = 0.817, 95% CI: 0.689; 0.969, p = 0.020), respectively. A greater consumption of nuts and fish was associated with lower odds of central obesity (OR = 0.972, 95% CI: 0.950; 0.995; p = 0.016) and (OR = 0.989, 95%CI: 0.979; 1.000; p = 0.043), respectively, whereas high processed red meat consumption was associated with hypertension (OR = 1.004, 95% CI: 1.000; 1.008, p = 0.048). Conclusions: A greater adherence to the MedDiet was associated with lower odds of central obesity and hypertension among postmenopausal women; however, it did not translate to a reduced likelihood of having MetS. A higher consumption of nuts and fish was associated with lower odds of central obesity, whereas a higher consumption of red, processed meats was associated with higher odds of hypertension. Longitudinal studies are needed to determine the causality of these relationships. Full article

(This article belongs to the Section Nutrition in Women)

► Show Figures

Figure 1

21 pages, 929 KiB

Open AccessReview

Potential Effects of Low-Calorie Sweeteners on Human Health

by Huang-Pin Chen, Yuan Kao, Meng-Wei Lin, Chun-Te Lee, Hung-Tsung Wu and Hsin-Yu Kuo

Nutrients 2025, 17(17), 2726; https://doi.org/10.3390/nu17172726 - 22 Aug 2025

Abstract

Low-calorie sweeteners (LCS) are widely utilized as sugar substitutes due to their intense sweetness, thermal stability, and applicability in weight management and diabetic-friendly products. However, increasing evidence has raised concerns about their potential long-term effects on metabolic health, glucose regulation, cardiovascular function, carcinogenicity, [...] Read more.

Low-calorie sweeteners (LCS) are widely utilized as sugar substitutes due to their intense sweetness, thermal stability, and applicability in weight management and diabetic-friendly products. However, increasing evidence has raised concerns about their potential long-term effects on metabolic health, glucose regulation, cardiovascular function, carcinogenicity, and gut microbiota composition. This review systematically evaluates the pharmacokinetics, metabolic effects, and associated health outcomes of major LCS. Mechanistically, LCS exert effects via sweet taste receptor-mediated pathways, altering glucose absorption, insulin secretion, and intracellular signaling cascades. Additionally, LCS influence gut microbiota composition, with certain agents promoting dysbiosis and glucose intolerance. While some findings support the metabolic benefits of selected LCS, others underscore potential risks, necessitating cautious interpretation. In conclusion, while LCS offer viable alternatives to sugar, their health effects are context-dependent and may vary across different sweeteners and populations. Long-term, high-quality clinical trials are essential to elucidate their safety and efficacy. Full article

(This article belongs to the Special Issue Consumption of Ultra-Processed Foods and Risk of Non-Communicable Diseases)

12 pages, 562 KiB

Open AccessArticle

Metabolizable Energy Value of Chickpeas and Lentils in the Human Diet: A Randomized Controlled Trial

by Janet A. Novotny, Theresa Henderson and David J. Baer

Nutrients 2025, 17(17), 2725; https://doi.org/10.3390/nu17172725 - 22 Aug 2025

Abstract

Background/Objectives: Accurate knowledge of the energy (calorie) value of foods is important for food labeling, food policy, and diet planning to support health. Virtually no data are available on the energy values of chickpeas and lentils,—two pulses that help control blood glucose and [...] Read more.

Background/Objectives: Accurate knowledge of the energy (calorie) value of foods is important for food labeling, food policy, and diet planning to support health. Virtually no data are available on the energy values of chickpeas and lentils,—two pulses that help control blood glucose and body weight. The objective of this study was to measure the metabolizable energy value of chickpeas and lentils when fed as part of a diet and compare those values to Atwater values. Methods: A randomized controlled crossover intervention was conducted to measure the energy value of chickpeas and lentils in humans (n = 18). Total 7-day fecal and urine collections were conducted after a 10-day adaptation to the controlled diet. Results: The metabolizable energy (ME) of the chickpeas is 515 ± 17 kJ/serving (123 ± 4 kcal/serving) (serving mass = 85.5 g), which is 10.4% lower (p = 0.002) and 8.0% lower (p = 0.02) than the ME calculated using Atwater General or Specific Factors, respectively. The metabolizable energy of the lentils is 498 ± 17 kJ/serving (119 ± 4 kcal/serving) (serving mass = 98.5 g), which is 16.0% lower (p < 0.0001) and 13.6% lower (p = 0.003) than the ME calculated using Atwater General or Specific Factors, respectively. Conclusions: Using Atwater Factors to calculate the metabolizable energy value of chickpeas and lentils overestimates their available calories. Full article

(This article belongs to the Section Carbohydrates)

► Show Figures

Figure 1

11 pages, 668 KiB

Open AccessFeature PaperArticle

Influence of Gestational Age on the Level of Functional Peptides (Peptidome) in Breast Milk

by Anna-Lena Abels, Johanna Ruhnau, Till Ittermann, Manuela Gesell Salazar, Anja Lange, Antje Vogelgesang, Hans Jörgen Grabe, Uwe Völker, Matthias Heckmann and Elke Hammer

Nutrients 2025, 17(17), 2724; https://doi.org/10.3390/nu17172724 - 22 Aug 2025

Abstract

Background/Objectives: Human milk provides essential nutrients and immune factors with beneficial impact on term, but especially preterm infants’ development. Therefore, this study focuses on the quantification of differences in the peptidome composition of breast milk from mothers of preterm and term infants, keeping [...] Read more.

Background/Objectives: Human milk provides essential nutrients and immune factors with beneficial impact on term, but especially preterm infants’ development. Therefore, this study focuses on the quantification of differences in the peptidome composition of breast milk from mothers of preterm and term infants, keeping in mind that this could reflect different biological needs of these infants or indicate nutritional gaps for healthy development. Methods: In a prospective observational study, breast milk samples were collected from 10 mothers of preterm infants (29–36 weeks gestational age,) and 13 mothers of term infants (37–41 weeks) at day 4 to 6 postnatally. A non-targeted tandem mass spectrometry approach was employed to analyze the milk peptidome. Results: In total, 4570 peptides were quantified. Adjusting the results for maternal age, weight, and height revealed a significant difference for 130 peptides derived from 19 different proteins between preterm and term milk. Proteins comprised high abundant proteins (e.g., α_S1-casein, κ- casein, or ß-casein), but also proteins that are less prominent in milk but of high functional importance (e.g., Hypoxia-inducible factor 1-alpha, Olfactory receptor 4M1). The differentially abundant peptides included peptides derived from ß-casein, which have already been described as being involved in antimicrobial functions as well as proliferation stimulating. For another 32 peptides, bioactivity was predicted. Conclusions: The current study provides a comprehensive overview on the differences in the milk peptidome at different gestational ages independent from common maternal phenotypes and improved the database for future peptide functionality studies. Full article

(This article belongs to the Special Issue Bioactive Milk Proteins and Human Health—2nd Edition)

► Show Figures

Graphical abstract

Journal Description

Nutrients

Latest Articles

Journal Menu

Journal Browser

Highly Accessed Articles

Latest Books

E-Mail Alert

News

Topics

Conferences

Special Issues

Topical Collections

Conference Reports

Further Information

Guidelines

MDPI Initiatives

Follow MDPI