Nutrients

14 pages, 8289 KB

Open AccessArticle

Betulin Alleviates 5-Fluorouracil-Induced Intestinal Mucositis in Mice

by Shiyi Sun, Ziming Wang, Haoyue Xu, Chengheng Dai, Wenhannian Li, Mengcheng Ying, Ayimnisa Ayitniyaz, Changmin Shao and Zhiwei Hu

Nutrients 2026, 18(15), 2487; https://doi.org/10.3390/nu18152487 (registering DOI) - 1 Aug 2026

Abstract

Background: Chemotherapy-induced intestinal mucositis (CIM) is a common gastrointestinal complication of anticancer therapy, and 5-fluorouracil (5-FU) is among the agents most frequently implicated. Betulin (BE), a lupane-type pentacyclic triterpenoid with anti-inflammatory and cytoprotective activities, has not been systematically evaluated in 5-FU-induced CIM. Purpose: [...] Read more.

Background: Chemotherapy-induced intestinal mucositis (CIM) is a common gastrointestinal complication of anticancer therapy, and 5-fluorouracil (5-FU) is among the agents most frequently implicated. Betulin (BE), a lupane-type pentacyclic triterpenoid with anti-inflammatory and cytoprotective activities, has not been systematically evaluated in 5-FU-induced CIM. Purpose: This study evaluated the therapeutic effects of BE in a mouse model of 5-FU-induced CIM and examined associated histopathological, apoptotic, inflammatory, and gut microbiota changes. Methods: BALB/c mice received intraperitoneal 5-FU (30 mg/kg/day) for four consecutive days, followed by oral BE at 0, 50, 100, 200, or 400 mg/kg/day for another four days. Clinical manifestations, colon morphometry, blinded descriptive histopathological assessment, apoptosis- and inflammation-related markers, and gut microbiota were assessed. Results: BE treatment alleviated body weight loss, diarrhea, and reduced food intake and was associated with improved colon morphometry and less severe histological injury. At 200 mg/kg, BE treatment was associated with lower Tnf and Nos2 mRNA expression, lower Bax and total caspase-3 protein abundance, higher Bcl-2 protein abundance, and lower iNOS protein abundance. Microbiota analysis of the 200 mg/kg group showed treatment-associated differences in microbial diversity and community composition; these findings were considered exploratory because of the small sample size. Conclusions: BE showed therapeutic potential in 5-FU-induced intestinal mucositis. The molecular and microbiota findings obtained at 200 mg/kg support associations with apoptosis-, inflammation-, and microbiota-related changes but do not establish a definitive mechanism. Full article

(This article belongs to the Special Issue Anti-Inflammatory, Antioxidant, and Antimicrobial Potential of Natural Products)

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22 pages, 338 KB

Open AccessArticle

Nutritional Evaluation of Traditional Portuguese Recipes from Three Different Regions: A Contribution to Food Composition Databases

by Mariana Lourenço, Paula Pereira, Marta Neves, Manuel Bicho and Ana Valente

Nutrients 2026, 18(15), 2486; https://doi.org/10.3390/nu18152486 (registering DOI) - 1 Aug 2026

Abstract

Background/Aim: Traditional Portuguese cuisine is a key component of the country’s cultural identity. Understanding how traditional Portuguese dishes align with, or diverge from, the principles of a balanced and sustainable diet is essential for promoting healthy eating habits while preserving cultural heritage. The [...] Read more.

Background/Aim: Traditional Portuguese cuisine is a key component of the country’s cultural identity. Understanding how traditional Portuguese dishes align with, or diverge from, the principles of a balanced and sustainable diet is essential for promoting healthy eating habits while preserving cultural heritage. The aims of this study were: (a) to evaluate and compare the nutritional composition of traditional Portuguese recipes from different regions; and (b) to assess the adequacy of complete regional menus in relation to recommendations for a balanced and healthy meal. Methodology: A pilot study was conducted analysing 60 traditional Portuguese recipes from three regions of mainland Portugal (North, Centre, and South). Twenty recipes per region were evaluated, including six first courses, eight main courses, and six desserts. Nutritional composition was determined per 100 g, and regional differences were analysed using one-way ANOVA with Tukey’s post hoc test (p < 0.05). Six complete menus were also constructed and assessed against reference values for energy and nutrient intake. Results: Significant differences were observed in the energy (p = 0.02) and sodium (p = 0.03) content of first-course dishes, particularly between the Northern region and the other regions. The Central region showed higher mean dietary fibre values. No statistically significant regional differences were identified for main courses or desserts. Menu analysis revealed that most traditional menu combinations exceeded recommended energy values and showed imbalances in macronutrient distribution, notably excessive saturated fat and insufficient dietary fiber. Conclusions: Traditional Portuguese first-course dishes display relevant regional nutritional differences. Overall, complete traditional menus frequently fall short of current nutritional recommendations, emphasizing the need for culturally sensitive adaptations that maintain culinary heritage while supporting public health goals, namely by lowering saturated fat and sodium content and enhancing dietary fibre levels. Full article

(This article belongs to the Special Issue Dietary Patterns and Data Analysis Methods)

4 pages, 160 KB

Open AccessEditorial

Metabolic Features and Nutritional Interventions in Chronic Diseases—2nd Edition

by Junjie Luo, Peng An and Yongting Luo

Nutrients 2026, 18(15), 2485; https://doi.org/10.3390/nu18152485 (registering DOI) - 1 Aug 2026

Abstract

Metabolic dysfunction is increasingly recognized as a central driver in the pathogenesis and progression of a wide spectrum of chronic diseases, ranging from age-related disorders and metabolic syndrome to cardiovascular diseases, cancer, and gastrointestinal pathologies [...] Full article

(This article belongs to the Special Issue Metabolic Features and Nutritional Interventions in Chronic Diseases—2nd Edition)

18 pages, 1967 KB

Open AccessArticle

Multistrain Probiotic Supplementation Combined with a Standardized Diet Did Not Significantly Affect Exercise Performance or Inflammatory Responses in Male Endurance Runners: A Randomized Controlled Trial

by Katarzyna Jagłowska, Marcin Folwarski, Maciej Chroboczek, Marta Potrykus, Mariusz Kaczmarczyk, Karolina Skonieczna-Żydecka and Jan Jacek Kaczor

Nutrients 2026, 18(15), 2484; https://doi.org/10.3390/nu18152484 (registering DOI) - 1 Aug 2026

Abstract

Background: Gut microbiota may influence metabolic and inflammatory responses to exercise through the gut–muscle axis, and probiotic supplementation has been proposed to support adaptation and recovery in endurance athletes. However, evidence in trained populations is inconsistent and is confounded by variability in diet, [...] Read more.

Background: Gut microbiota may influence metabolic and inflammatory responses to exercise through the gut–muscle axis, and probiotic supplementation has been proposed to support adaptation and recovery in endurance athletes. However, evidence in trained populations is inconsistent and is confounded by variability in diet, probiotic strains, dose, and intervention duration. We tested whether a multistrain probiotic, administered against a fully standardized diet, would affect exercise performance and inflammatory, metabolic, and muscle-damage responses. Methods: In this randomized, double-blind, placebo-controlled trial, 30 trained male long-distance runners were randomized and 27 completed the study (probiotic [PRO], n = 13; placebo [PLA], n = 14). All participants followed a standardized, normocaloric meal-box diet for four weeks. Aerobic capacity (peak oxygen uptake, VO₂peak; primary outcome) was assessed by an incremental treadmill test and anaerobic performance by a 30 s Wingate test, before (PRE) and after (POST) supplementation. Interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), creatine kinase (CK), and lactate (LA) were measured around exercise. Outcomes were analyzed with linear mixed-effects models; the primary estimand was the group × phase interaction. Results: VO₂peak did not differ between groups over time (PLA 55.00 ± 7.60 → 57.33 ± 8.41; PRO 55.40 ± 7.85 → 53.14 ± 5.95 mL·kg⁻¹·min⁻¹; group × phase −3.5 mL·kg⁻¹·min⁻¹, 95% CI −7.0 to −0.1; nominal p = 0.044, not significant after FDR correction, adjusted p = 0.707). No group × phase or group × phase × sampling-time interaction was significant for IL-6, TNF-α, LA, or CK (all interaction p > 0.15), indicating that supplementation did not modify the exercise-induced response of any biomarker; exercise itself robustly increased IL-6, TNF-α, and LA in both groups (p < 0.001). Conclusions: In trained male endurance runners consuming a standardized diet, four weeks of multistrain probiotic supplementation did not significantly affect aerobic or anaerobic performance, LA response, muscle-damage markers, or circulating inflammatory cytokines compared with placebo. Adequately powered trials with prespecified primary endpoints and direct microbiome assessment are needed. Full article

(This article belongs to the Section Sports Nutrition)

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14 pages, 536 KB

Open AccessSystematic Review

DHA Alone, EPA + DHA, EPA + DHA + GLA, and EPA + DHA with or Without Vitamin D During Chemotherapy in Women with Breast Cancer: An Intervention- and Outcome-Stratified Systematic Review

by Kinga Fronk, Mariusz Wysokiński, Rafał Podgórski and Edyta Łuszczki

Nutrients 2026, 18(15), 2483; https://doi.org/10.3390/nu18152483 (registering DOI) - 1 Aug 2026

Abstract

Background/Objectives: Prospective studies of omega-3 supplementation during breast cancer chemotherapy differ in intervention composition, co-supplementation, dose, treatment setting, and outcomes. We summarized and critically appraised interventions comprising DHA alone, EPA + DHA, EPA + DHA + GLA, or EPA + DHA with [...] Read more.

Background/Objectives: Prospective studies of omega-3 supplementation during breast cancer chemotherapy differ in intervention composition, co-supplementation, dose, treatment setting, and outcomes. We summarized and critically appraised interventions comprising DHA alone, EPA + DHA, EPA + DHA + GLA, or EPA + DHA with or without vitamin D, stratified by intervention composition and outcome domain. Methods: PubMed/MEDLINE, the Cochrane Library/CENTRAL, ClinicalTrials.gov, Scopus, Web of Science Core Collection, and Embase were last searched on 8 July 2026, supplemented by citation searching. Eligible studies prospectively administered EPA and/or DHA during chemotherapy and reported inflammatory/biological, nutritional/functional, quality-of-life, treatment-related, anticancer-response, or safety outcomes. Active co-supplementation was analyzed separately. Owing to clinical and methodological heterogeneity, findings were synthesized narratively; risk of bias and outcome-specific certainty were assessed using RoB 2-informed and GRADE approaches. Results: Fourteen reports representing ten prospective interventional trials were included. No eligible EPA-only trial was found. Interventions comprised EPA + DHA/fish oil without another active nutrient, DHA alone, EPA + DHA plus gamma-linolenic acid, and a factorial trial of EPA + DHA with or without vitamin D. One trial reported lower paclitaxel-induced neuropathy, whereas another found no benefit for paclitaxel-associated acute pain or neuropathic symptoms. Biomarker, nutritional, functional, and quality-of-life findings were inconsistent and often derived from small trials, exploratory or compliance-restricted analyses, companion reports, or co-supplementation designs. No consistent improvement in treatment response or survival was demonstrated. Serious supplementation-related adverse events were not reported, although adverse-event reporting varied. Certainty was low for safety and very low for efficacy-related domains. Conclusions: Current evidence is preliminary. The evaluated interventions appeared generally tolerated, but independent clinical efficacy of DHA alone, EPA + DHA without another active nutrient, EPA + DHA + GLA, or EPA + DHA with or without vitamin D during breast cancer chemotherapy remains unproven. Full article

(This article belongs to the Special Issue Nutritional Management and Intervention for Breast Cancer)

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22 pages, 1490 KB

Open AccessArticle

Rethinking Mediterranean Diet Adherence and Body Composition: A 3-Year Prospective Observational Study in Patients with Type 2 Diabetes and Arterial Hypertension

by Dora Bučan Nenadić, Josipa Radić, Ela Kolak Gaurina, Marija Selak and Mislav Radić

Nutrients 2026, 18(15), 2482; https://doi.org/10.3390/nu18152482 (registering DOI) - 1 Aug 2026

Abstract

Background/Objectives: Type 2 diabetes mellitus (T2DM) and arterial hypertension (AH) frequently coexist and are major risk factors for cardiovascular disease (CVD) and chronic kidney disease. Although the Mediterranean diet (MeDi) is widely recommended in cardiometabolic management, longitudinal real-world evidence regarding dietary adherence, [...] Read more.

Background/Objectives: Type 2 diabetes mellitus (T2DM) and arterial hypertension (AH) frequently coexist and are major risk factors for cardiovascular disease (CVD) and chronic kidney disease. Although the Mediterranean diet (MeDi) is widely recommended in cardiometabolic management, longitudinal real-world evidence regarding dietary adherence, body composition, and the role of continuous dietitian-led follow-up remains limited. Methods: This three-year prospective observational study included 158 adults with T2DM and AH treated at the Outpatient Clinic for Clinical Nutrition, University Hospital Centre Split, Croatia. Body composition was assessed using multi-frequency bioelectrical impedance analysis, dietary adherence using the Mediterranean Diet Serving Score (MDSS), and renal and metabolic parameters using standard laboratory methods. Participants were stratified according to attendance at scheduled dietitian-led follow-up visits. Results: Significant reductions were observed in body weight, body mass index (BMI), waist circumference, muscle mass, skeletal muscle index, and phase angle (PhA) during follow-up (all p < 0.001). Lipid profile improved, with reductions in total cholesterol and low-density lipoprotein levels and an increase in high-density lipoprotein concentrations. In contrast, renal function declined, as evidenced by increased creatinine and urea levels and decreased estimated glomerular filtration rate (eGFR). CVD incidence increased significantly during follow-up (p < 0.001). Although overall adherence to the MeDi improved, only 17.8% of participants achieved high adherence. Participants attending regular dietitian-led follow-up demonstrated significantly higher MDSS scores, greater adherence to the MeDi, and higher phase angle values compared with participants without regular follow-up. Conclusions: Adults with T2DM and AH demonstrated partial enhancement of MeDi adherence over three years; although the lipid profile also improved, this could not be attributed to diet and may largely reflect pharmacological treatment. These changes were accompanied by progressive muscle mass loss, declining renal function, and increased cardiovascular burden. Continuous dietitian-led follow-up was associated with superior dietary quality and better nutritional status, supporting the importance of individualized, multidisciplinary approaches integrating sustained nutritional counselling, lean mass preservation, and structured physical activity in long-term cardiometabolic care. Full article

(This article belongs to the Special Issue Nutritional Interventions in Type 2 Diabetes: Impact on Metabolic Health and Complications)

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18 pages, 4084 KB

Open AccessArticle

Dietary Vitamin D Insufficiency Aggravates High-Fat Diet-Induced Hepatic Steatosis Associated with Reduced Hepatic SIRT1 Activity and Nrf2-Related Antioxidant Gene Expression in Male C57BL/6J Mice

by Amanzholova Kamila and Eugene Chang

Nutrients 2026, 18(15), 2481; https://doi.org/10.3390/nu18152481 - 31 Jul 2026

Abstract

Background/Objectives: As obesity continues to increase globally, it has become a major contributor to the growing burden of metabolic diseases, including type 2 diabetes mellitus, cardiovascular disease, and nonalcoholic fatty liver disease (NAFLD). Hepatic lipid accumulation during obesity contributes to oxidative stress [...] Read more.

Background/Objectives: As obesity continues to increase globally, it has become a major contributor to the growing burden of metabolic diseases, including type 2 diabetes mellitus, cardiovascular disease, and nonalcoholic fatty liver disease (NAFLD). Hepatic lipid accumulation during obesity contributes to oxidative stress and alterations in mitochondrial homeostasis, key features of NAFLD progression. This study investigated whether vitamin D insufficiency aggravates obesity-related hepatic steatosis in association with changes in hepatic sirtuin 1 (SIRT1) activity and nuclear factor erythroid 2–related factor 2 (Nrf2)-related antioxidant gene expression. Methods: Male C57BL/6J mice were maintained on one of three dietary regimens for 16 weeks: a normal diet (NOR; 10% fat containing 1000 IU vitamin D/kg), a high-fat diet (HF; 60% fat containing 1000 IU vitamin D/kg), or a vitamin D-deficient high-fat diet (HF + NVD; 60% fat with no added vitamin D). Results: Vitamin D insufficiency in HF-fed mice (HF + NVD) was associated with significantly higher hepatic triglyceride accumulation and lipid peroxidation than those observed in the HF group. A concomitant reduction in the expression of Nrf2-dependent antioxidant genes was observed in the HF + NVD group. Furthermore, hepatic mitochondrial DNA content as well as hepatic SIRT1 mRNA level and activity, the NAD⁺/NADH ratio, and CPT1α mRNA expression were significantly decreased in the HF + NVD group. Conclusions: An inadequate vitamin D status was associated with greater hepatic lipid deposition, enhanced oxidative stress, and reduced hepatic SIRT1 activity, and lower expression of Nrf2-related antioxidant genes. These findings support that maintaining adequate vitamin D status might help preserve hepatic metabolic homeostasis during obesity. Full article

(This article belongs to the Special Issue The Role of Vitamin D in Endocrine Diseases: Pathophysiology and Treatment)

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23 pages, 387 KB

Open AccessReview

MASLD and Pancreatic Diseases: From Shared Mechanisms to Clinical Implications and Future Directions

by Jesús Rivera-Esteban, Belén Agudo, Beatrice Patrizi, Alejandra Manzur, Daniel de la Iglesia, Víctor Valverde, Neus García Ferris, Carlos Esteban, Elena Santos, Fernando Pons, Marta Hernández-Conde, Javier Abad, Mariano González-Haba and José Luis Calleja

Nutrients 2026, 18(15), 2480; https://doi.org/10.3390/nu18152480 - 31 Jul 2026

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognised as a systemic disorder with clinically relevant extrahepatic manifestations. Pancreatic diseases have gained particular attention in this context, as they share key metabolic and inflammatory mechanisms with MASLD and may influence each other’s natural [...] Read more.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognised as a systemic disorder with clinically relevant extrahepatic manifestations. Pancreatic diseases have gained particular attention in this context, as they share key metabolic and inflammatory mechanisms with MASLD and may influence each other’s natural history and clinical outcomes. Beyond shared cardiometabolic risk factors, emerging evidence suggests that MASLD may actively contribute to pancreatic dysfunction and disease progression, supporting a bidirectional liver–pancreas relationship. Recognition of this association is essential to improve risk stratification, diagnostic assessment, and clinical management. This review summarises the current evidence linking MASLD with pancreatic disorders, focusing on acute and chronic pancreatitis, pancreatic cancer, and fatty pancreas. We examine shared pathophysiological pathways and discuss how these interactions may affect disease progression, nutritional status, diagnostic strategies, and therapeutic decision-making. We also address key clinical challenges, including alcohol assessment and MASLD–MetALD misclassification, highlight current knowledge gaps, and provide scenario-specific recommendations. Full article

(This article belongs to the Special Issue Navigating MASLD: From Nutrition and Metabolic Roots to Clinical Decision-Making)

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22 pages, 1142 KB

Open AccessReview

Refractory Celiac Disease: Nutritional Failure, Immune Dysregulation, and Lymphomagenesis

by Ioanna Aggeletopoulou, Ploutarchos Pastras, Maria Kalafateli and Christos Triantos

Nutrients 2026, 18(15), 2479; https://doi.org/10.3390/nu18152479 - 31 Jul 2026

Abstract

Refractory celiac disease (RCeD) is a rare but severe complication of celiac disease characterized by persistent or recurrent malabsorptive symptoms and villous atrophy despite a strict gluten-free diet, after exclusion of ongoing gluten exposure, alternative enteropathies, and overt lymphoma. RCeD comprises two biologically [...] Read more.

Refractory celiac disease (RCeD) is a rare but severe complication of celiac disease characterized by persistent or recurrent malabsorptive symptoms and villous atrophy despite a strict gluten-free diet, after exclusion of ongoing gluten exposure, alternative enteropathies, and overt lymphoma. RCeD comprises two biologically distinct entities. RCeD-I is associated with phenotypically normal, polyclonal intraepithelial lymphocytes and generally reflects persistent gluten-independent mucosal inflammation with a relatively favorable prognosis. RCeD-II is defined by expansion of aberrant clonal intraepithelial lymphocytes lacking normal surface T-cell markers and is increasingly regarded as a low-grade intraepithelial lymphoma or in situ lymphomatous disorder, with substantial risk of progression to enteropathy-associated T-cell lymphoma (EATL). Mechanistic studies identify epithelial stress, IL-15-driven IEL survival, stromal and innate immune amplification, and cytotoxic epithelial injury as central drivers of refractory mucosal damage. In RCeD-II, aberrant IELs acquire a hybrid T/NK-like phenotype, persist through anti-apoptotic IL-15/JAK–STAT signaling, and induce enterocyte killing, while molecular alterations involving JAK1, STAT3, JAK/STAT regulators, NF-κB signaling, epigenetic regulators, and chromosomal abnormalities support stepwise lymphomagenesis. Recent single-cell multiomic studies further reveal genetically altered intestinal lymphocyte clones and intratumoral heterogeneity across the RCeD-II–EATL continuum. From a nutritional immunology perspective, RCeD illustrates a setting in which removal of the initiating dietary antigen is insufficient to restore mucosal immune homeostasis. This review summarizes the pathogenic processes that distinguish RCeD-I from RCeD-II and link failed mucosal recovery after gluten withdrawal to persistent immune-mediated epithelial injury, aberrant IEL expansion, clonal evolution, and lymphoma progression. Full article

(This article belongs to the Special Issue Nutrition and Immune Modulation in Autoimmune Diseases)

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34 pages, 3935 KB

Open AccessReview

Gut Microbiota-Targeted Nutrition for Healthy Aging: Mechanistic Roles of Polyphenols and Dietary Fiber in Geroscience

by Agata Kryczyk-Poprawa, Elżbieta Rząsa-Duran, János Tamás Varga, Andrea Lehoczki, Virág Zábó, Vince Fazekas-Pongor, Dávid Major, Tamás Csípő, Ágnes Szappanos, Ágnes Lipécz and Mónika Fekete

Nutrients 2026, 18(15), 2478; https://doi.org/10.3390/nu18152478 - 31 Jul 2026

Abstract

Age-related alterations in the gut microbiota contribute to chronic low-grade inflammation, immune dysregulation, metabolic dysfunction, frailty, sarcopenia, and cognitive decline. Dietary polyphenols and fermentable fiber modulate microbial composition and metabolism, promoting the production of bioactive metabolites, including short-chain fatty acids, secondary bile acids, [...] Read more.

Age-related alterations in the gut microbiota contribute to chronic low-grade inflammation, immune dysregulation, metabolic dysfunction, frailty, sarcopenia, and cognitive decline. Dietary polyphenols and fermentable fiber modulate microbial composition and metabolism, promoting the production of bioactive metabolites, including short-chain fatty acids, secondary bile acids, indole derivatives, and urolithins, which regulate intestinal barrier integrity, immune homeostasis, mitochondrial function, and gut–organ communication. This narrative review critically synthesizes evidence from experimental studies, observational cohorts, randomized controlled trials, systematic reviews, and meta-analyses to examine microbiota-mediated mechanisms linking these dietary components to healthy aging within the geroscience framework. Although mechanistic evidence is compelling, translation into clinically meaningful aging outcomes remains limited because most intervention studies are small and heterogeneous and primarily rely on surrogate biomarkers. Current evidence supports polyphenol- and fiber-rich dietary patterns as biologically plausible strategies for promoting healthy aging through modulation of the gut microbiota; however, establishing causal relationships will require standardized microbiome methodologies, validated microbiome-derived biomarkers, integrated multi-omics approaches, and adequately powered longitudinal studies and randomized controlled trials. Full article

(This article belongs to the Special Issue The Role of Food Supplements in Human Health)

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19 pages, 1344 KB

Open AccessArticle

Vitamin D Supplementation and 12-Month Changes in Muscle Function and Physical Performance in Older Adults with Vitamin D Deficiency: A Prospective Observational Cohort Study

by Christina Angelaki, Vasiliki Mamakou, Ioanna A. Anastasiou, Dimitrios Mourkogiannis, Aristotelis Vathis, Michael Angelakis, Georgia Markou, Stavroula-Panagiota Lontou, Konstantinos Makrilakis, Alexander Kokkinos and Nikolaos Tentolouris

Nutrients 2026, 18(15), 2477; https://doi.org/10.3390/nu18152477 - 31 Jul 2026

Abstract

Background: Vitamin D deficiency in older adults may impair muscle function and physical performance. This prospective observational cohort study examined the 12-month outcomes of vitamin D supplementation, delivered as part of routine clinical care, in older adults with vitamin D deficiency compared with [...] Read more.

Background: Vitamin D deficiency in older adults may impair muscle function and physical performance. This prospective observational cohort study examined the 12-month outcomes of vitamin D supplementation, delivered as part of routine clinical care, in older adults with vitamin D deficiency compared with an insufficiency comparison group. Methods: A total of 194 participants aged ≥60 years were enrolled: 164 with vitamin D deficiency (25(OH)D <20 ng/mL; supplementation group) and 30 with insufficiency (20–29 ng/mL; comparison group). The supplementation group received supplementation targeting 25(OH)D >30 ng/mL; the comparison group received no supplementation. The Handgrip Strength Test (HGS), the Gait Speed Test (GST), the Short Physical Performance Battery Test (SPPB), and the Timed Up and Go Test (TUG) were assessed at baseline and 12 months. Results: Supplementation raised 25(OH)D by 142.9% versus 5.4% in the comparison group (p < 0.001). For the primary outcome, the supplementation group showed a 16.2% increase in the HGS versus no change in the comparison group (p < 0.001; ANCOVA partial η² = 0.284). For the secondary outcomes, the comparison group was associated with a significant functional decline relative to the supplementation group: the median change on the SPPB in the comparison group was 0.0% (IQR: −8.7, 0.0; between-group p < 0.001) and the TUG worsened by +3.2% (between-group p < 0.001), while the supplementation group remained stable. The ANCOVA indicated between-group differences on the SPPB (p < 0.001) and TUG (p = 0.002). Gait speed showed no significant difference. Conclusions: Vitamin D supplementation was associated with more favourable functional outcomes across multiple musculoskeletal domains in vitamin D-deficient older adults. The comparison group’s deterioration on the SPPB and TUG is consistent with an association between correcting deficiency and preserved function. Full article

(This article belongs to the Special Issue Vitamin D Status and Immune Health: Determinants, Mechanisms, and Clinical Implications)

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14 pages, 700 KB

Open AccessArticle

Effect of Tomato Consumption on Liver Steatosis in MASLD: A Randomized Controlled Trial (POMOSANO Study)

by Rossella Tatoli, Rossella Donghia, Nicola Carella, Nicole Cerabino, Martina Di Chito, Marianna Zappimbulso, Pasqua Letizia Pesole, Dolores Stabile, Annalisa Ferro, Giovanni Pascale, Endrit Shahini, Francesca Pavone, Luigi Fontana and Gianluigi Giannelli

Nutrients 2026, 18(15), 2476; https://doi.org/10.3390/nu18152476 - 30 Jul 2026

Abstract

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common chronic liver disease for which lifestyle modification remains the main treatment. However, the role of specific dietary components is not fully understood. We investigated whether daily tomato consumption, a source of Mediterranean [...] Read more.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common chronic liver disease for which lifestyle modification remains the main treatment. However, the role of specific dietary components is not fully understood. We investigated whether daily tomato consumption, a source of Mediterranean diet bioactive compounds, improves hepatic steatosis in adults with MASLD. Methods: In the randomized controlled POMOSANO trial, 79 adults with MASLD (BMI ≤ 30 kg/m²) were assigned to a tomato intervention group (n = 42), consuming 200 g/day of raw tomatoes and 50 g/day of tomato sauce, or to a control group (n = 37) following a tomato-free diet. The intervention lasted 6 weeks. Hepatic steatosis was assessed by the FibroScan^® controlled attenuation parameter (CAP). Secondary outcomes included anthropometric measures, body composition, liver stiffness, and metabolic and biochemical markers. Linear mixed-effects models were used to evaluate changes over time. Results: CAP decreased in both groups, with a greater reduction in the intervention group (median change: −35.00 vs. −18.00 dB/m). The adjusted linear mixed-effects model confirmed that the change in CAP in the control group was β = −12.81 (95% CI −25.55 to −0.08; p = 0.0490). Crucially, the treatment-by-time interaction was significant (β = −26.63, 95% CI −44.00 to −9.25; p = 0.0030), demonstrating a significantly greater reduction in hepatic steatosis in the tomato intervention group compared to the control group. CAP values were also significantly lower in the intervention group at follow-up (p = 0.0433). The adjusted linear mixed-effects model confirmed a significant reduction in CAP over time (β = −12.81, 95% CI −25.55 to −0.08; p = 0.0490) and a significant treatment-by-time interaction (β = −26.63, 95% CI −44.00 to −9.25; p = 0.0030), indicating a greater reduction in hepatic steatosis in the intervention group. No significant between-group differences were observed for liver stiffness, FIB-4 index, body weight, body composition, or most metabolic and biochemical markers. Conclusions: Daily consumption of raw tomatoes and tomato sauce reduced hepatic steatosis in adults with MASLD, supporting tomato-rich dietary strategies as a potential nutritional approach for MASLD management. Full article

(This article belongs to the Special Issue Nutrition and Diet for MASLD/NAFLD Management)

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16 pages, 307 KB

Open AccessArticle

Effects of Three Consecutive Days of Diurnal Intermittent Fasting on Cognitive Function, Psychomotor Vigilance, and Sleep Quality in Adolescent Male Soccer Players: A Quasi-Experimental Parallel-Group Study

by Hamza Baati, Sabra Ouni, Fida Ayachi, Feriel Amor, Mevlüt Yıldız, Halil İbrahim Ceylan, Raul Ioan Muntean, Omaima Chrif, MoezAlIslam E. Faris and Wissem Dhahbi

Nutrients 2026, 18(15), 2475; https://doi.org/10.3390/nu18152475 - 30 Jul 2026

Abstract

Aim: While voluntary Islamic intermittent fasting (IF) of three consecutive days (mimicking practices such as Ayyam al-Bid) may be observed by Muslim athletes, its short-term effects on cognitive function and sleep quality in adolescent team-sport athletes remain unexamined. This study investigated the impact [...] Read more.

Aim: While voluntary Islamic intermittent fasting (IF) of three consecutive days (mimicking practices such as Ayyam al-Bid) may be observed by Muslim athletes, its short-term effects on cognitive function and sleep quality in adolescent team-sport athletes remain unexamined. This study investigated the impact of three successive days of dawn-to-sunset IF on memory, attention, psychomotor vigilance, and subjective sleep quality in young male soccer players. Methods: A quasi-experimental, parallel-group design was employed. Thirty-five male soccer players (age: 15.6 ± 0.8 years; body mass: 55.07 ± 6.53 kg) were allocated to an IF group (n = 17) or a non-fasting control group (n = 18). The fasting protocol comprised approximately 14 consecutive hours of complete food and fluid abstinence per day (from 04:40 to 18:36, with daily variations of −3 min for the dawn and +2 min for the sunset, local time). Cognitive function was assessed using the CogniFit Cognitive Assessment Battery (CAB) and the Psychomotor Vigilance Test (PVT), and subjective well-being was quantified via the Hooper Index. Both assessment sessions were conducted between 14:00 and 17:00 to control for diurnal variation. Results: The Group × Time interaction for single-item subjective sleep quality reached nominal significance at the unadjusted threshold (Z = 2.18, p = 0.029, r = 0.37) but did not survive Bonferroni correction for the four Hooper Index comparisons (α = 0.0125); this result is therefore interpreted as hypothesis-generating only, reflecting a within-group deterioration in the control group (p < 0.05) alongside a non-significant marginal improvement in the fasting group. No statistically significant Group × Time interaction was detected for any memory subdomain (all p ≥ 0.419, r ≤ 0.14), attention component (all p > 0.176, r ≤ 0.23), or PVT parameter (all p > 0.192, η²p/r ≤ 0.22) under the present study conditions. Within-group improvements in memory and attention observed in both groups were consistent with test–retest learning effects. Conclusions: No statistically significant Group × Time interaction was detected for memory, attention-related executive functions, or psychomotor vigilance in young male soccer players under the present study conditions; the study was not designed as an equivalence or non-inferiority trial and cannot exclude effects smaller than the targeted medium magnitude, alongside a nominally divergent but statistically uncorrected sleep quality trajectory relative to non-fasting controls, which should be interpreted as hypothesis-generating pending replication. These findings provide preliminary, hypothesis-generating evidence that no statistically significant cognitive or psychomotor impairment was detected under the present study conditions; because the study was not designed as an equivalence or non-inferiority trial, compatibility between short-term voluntary IF and adolescent athletic training cannot be inferred from the absence of a significant interaction alone. Full article

(This article belongs to the Special Issue Nutrition, Physical Activity and Lifestyle Behaviors in Mental Health and Psychological Well-Being Across the Lifespan)

14 pages, 1582 KB

Open AccessArticle

Nutritional Epigenetics of Vitamin Intake (A, B₁, B₂, B₃, B₆, B₁₂, and E): Associations with Genome-Wide DNA Methylation

by Sadiye Aras, Jiajun Shi, Shuai Xu, Jie Wu, Wanqing Wen, Regina Courtney, Hui Cai, Xiao-Ou Shu, Wei Zheng, Jirong Long, Qiuyin Cai and Xiaofei Wang

Nutrients 2026, 18(15), 2474; https://doi.org/10.3390/nu18152474 - 30 Jul 2026

Abstract

Background/Objectives: DNA methylation is a key epigenetic mechanism involved in gene regulation and chromatin stability and may be influenced by nutritional exposures. However, population-level evidence regarding associations between dietary vitamin intake and genome-wide DNA methylation remains limited. Methods: We investigated associations between dietary [...] Read more.

Background/Objectives: DNA methylation is a key epigenetic mechanism involved in gene regulation and chromatin stability and may be influenced by nutritional exposures. However, population-level evidence regarding associations between dietary vitamin intake and genome-wide DNA methylation remains limited. Methods: We investigated associations between dietary intake of vitamins A, B₁, B₂, B₃, B_6, B₁₂, and E and blood DNA methylation in 2030 participants from the Southern Community Cohort Study (SCCS). Dietary intake was assessed using a validated Food Frequency Questionnaire, and genome-wide DNA methylation was profiled using the Illumina Infinium MethylationEPIC v2.0 BeadChip. Epigenome-wide association analyses were conducted using robust linear regression models adjusted for demographic, lifestyle, and estimated cellular composition variables. Results: We identified 34 CpG sites associated with dietary intake of vitamins B₁, B₂, B₃, B₆, and E, at a false discovery rate-adjusted p-value (FDR_p) threshold of <0.1. The strongest association was observed between vitamin B₆ intake and cg19831775 (Beta = −0.111, FDR_p = 0.015). No statistically significant associations were identified for vitamins A and B₁₂. Most observed effects were modest, and associations were locus-specific rather than global. Race- and sex-stratified analyses demonstrated generally consistent directions of association, although statistical significance was attenuated in subgroup analyses. Conclusions: These findings provide suggestive evidence that dietary intake of vitamins B_1, B₂, B₃, B₆ and E may be associated with subtle variation in DNA methylation at specific genomic loci. Full article

(This article belongs to the Section Nutrigenetics and Nutrigenomics)

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15 pages, 2278 KB

Open AccessArticle

Nutrition Behaviour During Pregnancy: Eating Twice as Healthy? A Secondary Analysis of the Nutrition Component of the NELIP Randomized Controlled Trial

by Karishma Hosein, Taniya S. Nagpal, Roberta Bgeginski, Isabelle Giroux, Harry Prapavessis and Michelle F. Mottola

Nutrients 2026, 18(15), 2473; https://doi.org/10.3390/nu18152473 - 30 Jul 2026

Abstract

Background/Objectives: To examine adherence to the specific goals of the nutrition component of a healthy lifestyle intervention program during pregnancy (the Nutrition and Exercise Lifestyle Intervention Program; NELIP) from baseline at 12–18 weeks gestation to trial midpoint (24–25 weeks gestation) and endpoint (34–36 [...] Read more.

Background/Objectives: To examine adherence to the specific goals of the nutrition component of a healthy lifestyle intervention program during pregnancy (the Nutrition and Exercise Lifestyle Intervention Program; NELIP) from baseline at 12–18 weeks gestation to trial midpoint (24–25 weeks gestation) and endpoint (34–36 weeks gestation). Methods: A convenience sample of 90 individuals were included in the secondary analysis. Participants completed the pregnancy intervention in one of three groups: NE, nutrition and exercise introduced simultaneously; N+E, nutrition introduced first followed by exercise introduced at midpoint; or E+N, exercise introduced first followed by nutrition introduced at midpoint. A meal plan with guidelines for carbohydrate and protein consumption was included in the nutrition component, and adherence to the specific meal plan goals was tracked using a novel rubric developed especially for the meal plan in the NELIP intervention. Results: All groups had improvements in nutrition adherence from baseline to midpoint, with the NE group scoring highest in adherence (12.9 ± 2.0 points) at midpoint compared to the N+E (11.2 ± 1.8 points) and E+N (11.8 ± 2.0 points) groups (F_{(2, 85)} = 6.08, p = 0.00, η² = 0.13). From midpoint to endpoint, N+E was the only group with no decline in adherence. Conclusions: The N+E group had the most stable improvements in adherence over the course of the intervention, despite better improvements in adherence from baseline to midpoint in groups NE and E+N. Time of intervention component introduction may have a differential impact on adherence score fluctuation, with baseline nutrition scores potentially influencing nutrition habits over time. Full article

(This article belongs to the Special Issue Effects of Nutrition and Exercise During Pregnancy on Maternal and Infant Health)

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42 pages, 5624 KB

Open AccessReview

Potential Relevance of Amazonian Diet Components in Parkinson’s Disease: An Integrative Review with Multivariate Analysis

by Maria Fernanda Manica-Cattani, Ivana Beatrice Mânica da Cruz, Euler Esteves Ribeiro, Raquel de Souza Praia, Cristina Maranghello, Ivo Emilio Jung, Vitória Farina Azzolin, Railla da Silva Maia, Marco Aurélio Echart Montano, Vanusa Nascimento, Eduardo Vélez Martin and Verônica Farina Azzolin

Nutrients 2026, 18(15), 2472; https://doi.org/10.3390/nu18152472 - 30 Jul 2026

Abstract

Dietary patterns increasingly influence research on neurodegenerative diseases, with attention shifting from isolated nutrients to integrative nutritional models. The Amazonian Diet, a biodiversity-based dietary pattern rich in native fruits, seeds, freshwater fish, and cassava-derived foods, is naturally enriched in bioactive compounds including polyphenols, [...] Read more.

Dietary patterns increasingly influence research on neurodegenerative diseases, with attention shifting from isolated nutrients to integrative nutritional models. The Amazonian Diet, a biodiversity-based dietary pattern rich in native fruits, seeds, freshwater fish, and cassava-derived foods, is naturally enriched in bioactive compounds including polyphenols, anthocyanins, carotenoids, methylxanthines, selenium, vitamins, and unsaturated fatty acids. This review aimed to investigate the potential relevance of key foods derived from the Amazonian Diet to Parkinson’s disease (PD) by integrating compositional nutritional analysis, multivariate analytical approaches, and mechanistic evidence synthesis. In Stage 1, the composition of 36 Amazonian foods was analyzed using TBCA and FAO data, followed by hierarchical clustering analysis (Ward’s linkage, Euclidean distance). Distinct compositional patterns were identified, highlighting foods with high bioactive diversity, relevant lipid composition, and dietary fiber. In Stage 2, an integrative literature review (PubMed/MEDLINE, SciELO) of in vitro, in vivo, observational, and clinical studies suggested that açaí berry, guaraná, cocoa/cacao, camu-camu, and Brazil nuts contain nutrients and bioactive compounds that intersect with biological pathways implicated in PD, including oxidative stress, mitochondrial dysfunction, and neuroinflammation. However, this review does not evaluate the effects of the Amazonian Diet on PD incidence, progression, symptoms, levodopa response, or biomarkers. Full article

(This article belongs to the Special Issue Therapeutic Opportunities for Food Supplements in Neurodegenerative Disease (2nd Edition))

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23 pages, 21228 KB

Open AccessArticle

Obesogenic Diets Composition Differentially Alters the Clostridium/Bacteroides Ratio and Drives Colonic Inflammation

by Mayra Montecillo-Aguado, Esmeralda Rodríguez-Miranda, Guillermina Baay-Gúzman, Juana Rosalba Garcia-Ramirez, Daniel Hernández-Cueto, Sergio López-Briones and Marco Antonio Hernández-Luna

Nutrients 2026, 18(15), 2471; https://doi.org/10.3390/nu18152471 - 30 Jul 2026

Abstract

Background: Diets high in fat and carbohydrates, like fructose, trigger colon inflammation, increase intestinal permeability, and drive dysbiosis. However, the effects of obesogenic diets on gut microbiota, including Clostridium and Bacteroides, remain unknown. Understanding how these diets damage the colon is critical. [...] Read more.

Background: Diets high in fat and carbohydrates, like fructose, trigger colon inflammation, increase intestinal permeability, and drive dysbiosis. However, the effects of obesogenic diets on gut microbiota, including Clostridium and Bacteroides, remain unknown. Understanding how these diets damage the colon is critical. Methods: Using a controlled preclinical obesity model, we compared the effects over time of High-Fat Diet (HFD), High-Fructose Diet (HFrD), and their combination (HFHFrD). Diet-induced dysbiosis was assessed at 4 and 8 weeks via qPCR using primers specific to bacterial phyla and species. In addition, intestinal inflammation, atrophy, and mucin production were evaluated by digital pathology after 8 weeks of diet exposure. Results: both HFrD and HFHFrD mice exhibited marked intestinal inflammation, atrophy, and damage, alongside altered production of neutral and mixed mucins. HFD-fed mice displayed a 15-fold surge in Clostridium/Bacteroides ratio at 4 weeks. At 8 weeks, HFrD-fed mice showed a striking 10-fold rise in microbial relative abundance compared to the other diets. Both HFrD and HFHFrD triggered an early increase in Bacteroides species, but significance emerged only at 8 weeks. Conclusions: Although all obesogenic diets induced inflammation, atrophy, epithelial damage, and altered mucin patterns, HFrD and HFHFrD caused pronounced disruptions to barrier function and dysbiosis. Critically, HFD consistently raised the Firmicutes/Bacteroidetes ratio at 4 and 8 weeks, while the Clostridium/Bacteroides ratio spiked only at 4 weeks. Obesogenic diets fundamentally shifted microbial load and diversity. Therefore, bacterial ratios, such as Clostridium/Bacteroides, may signal dysbiosis and tissue damage from obesogenic diets, but further research is required for confirmation. Full article

(This article belongs to the Special Issue Specialized Diets, Gut Microbiota, and Obesity)

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19 pages, 749 KB

Open AccessArticle

Effects of Nordic Walking Combined with High-Protein Intake and Time-Restricted Eating on Muscle-Related Outcomes in Postmenopausal Women: A Three-Arm Randomized Controlled Trial

by Yong Yang, Ya Zhu and Zbigniew Ossowski

Nutrients 2026, 18(15), 2470; https://doi.org/10.3390/nu18152470 - 29 Jul 2026

Abstract

Background: Muscle health decline is a major concern in postmenopausal women; however, most interventions have focused on exercise as an isolated component. It remains unclear whether embedding exercise within a broader lifestyle framework enhances muscle-related outcomes. Methods: A total of 100 postmenopausal women [...] Read more.

Background: Muscle health decline is a major concern in postmenopausal women; however, most interventions have focused on exercise as an isolated component. It remains unclear whether embedding exercise within a broader lifestyle framework enhances muscle-related outcomes. Methods: A total of 100 postmenopausal women took part in this randomized controlled trial and were randomly assigned to three groups: Nordic walking combined with high-protein intake and time-restricted eating (NW+HP+TRE, n = 36), Nordic walking combined with time-restricted eating (NW+TRE, n = 33), and a control group (n = 31). The intervention lasted 12 weeks. The primary outcome was handgrip strength, and the secondary outcomes included physical performance (6 m gait speed and five times chair-stand time) and lean mass-related measures. Adherence to all intervention components was monitored throughout the study. Results: During the intervention, four participants did not complete the post-intervention assessment, resulting in 96 participants being included in the final analysis. Handgrip strength improved in both intervention groups, with the largest increase observed in the NW+HP+TRE group. Physical performance outcomes showed a similar pattern. In contrast, the NW+TRE group showed less favorable changes in lean mass-related measures, whereas the control group showed minimal overall changes. Adherence to Nordic walking, time-restricted eating, and protein intake was high in the intervention groups. Conclusions: A Nordic walking-based integrated lifestyle intervention was associated with a more favorable overall pattern of change in muscle strength, physical performance, and lean mass-related outcomes in postmenopausal women. These findings should be interpreted as differences between intervention packages rather than as evidence for the isolated effect of any single lifestyle component. Further research is needed to examine the long-term sustainability of such interventions and to clarify the contribution of individual components. Full article

(This article belongs to the Section Nutrition in Women)

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25 pages, 1064 KB

Open AccessReview

Gut Microbiome Changes in Preclinical Alzheimer’s Disease

by D. M. Sithara Dissanayaka, Stephanie R. Rainey-Smith, Hamid R. Sohrabi, Thilini N. Jayasinghe, Vincent Ho, Vijay Jayasena, Kevin Taddei, Colin L. Masters, Ralph N. Martins and W. M. A. D. Binosha Fernando

Nutrients 2026, 18(15), 2469; https://doi.org/10.3390/nu18152469 - 29 Jul 2026

Abstract

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder that develops many years before clinical symptoms appear. The biological changes involved in the earliest stages remain poorly understood, particularly during the preclinical stage. Our previous work has identified gradual gut microbial and metabolic changes [...] Read more.

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder that develops many years before clinical symptoms appear. The biological changes involved in the earliest stages remain poorly understood, particularly during the preclinical stage. Our previous work has identified gradual gut microbial and metabolic changes during this stage, suggesting these may represent early biological shifts that precede disease progression. Recent studies suggest that the gut microbiome may contribute to early AD processes through its effects on immune regulation, metabolism, and gut–brain communication. Changes in gut microbial composition, including reduced levels of short-chain fatty acid (SCFA)-producing bacteria, such as Faecalibacterium, Roseburia, and Eubacterium, have been reported in individuals with AD and mild cognitive impairment. These microbial alterations have also been linked to disrupted metabolic activity, impaired gut barrier function, and increased neuroinflammatory responses. Diet is an important factor influencing gut microbial composition and metabolic activity. Mediterranean, DASH, and prudent dietary patterns are generally associated with beneficial microbial profiles and increased SCFA production, whereas Western dietary patterns are linked to lower microbial diversity and increased pro-inflammatory taxa. This review summarises the current evidence linking gut microbiota, SCFAs, microbial metabolism, and dietary patterns with early AD pathology, while highlighting important gaps in the existing literature. Full article

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

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