Nutrients

19 pages, 3590 KB

Open AccessArticle

Synergistic Effects of a Pro-Inflammatory–High-Fat Composite Dietary Pattern on Gut–Liver Injury and the Therapeutic Potential of Haematococcus pluvialis-Derived Astaxanthin

by Jing Feng, Chao Han, Jinpeng Zhao, Zhuo Yang, Chen Chen, Rongzi Li, Chaoqun Sun, Liyuan Wang, Junsheng Huo, Shi Shen and Qin Zhuo

Nutrients 2026, 18(7), 1048; https://doi.org/10.3390/nu18071048 - 25 Mar 2026

Abstract

Background and Objectives: Pro-inflammatory diet and high-fat diet (HFD) often coexist in real-world, but their combined impact on the gut–liver axis and potential nutritional countermeasures remain insufficiently studied. This study aimed to evaluate a pro-inflammatory–high-fat composite dietary pattern on the intestine and liver [...] Read more.

Background and Objectives: Pro-inflammatory diet and high-fat diet (HFD) often coexist in real-world, but their combined impact on the gut–liver axis and potential nutritional countermeasures remain insufficiently studied. This study aimed to evaluate a pro-inflammatory–high-fat composite dietary pattern on the intestine and liver in the population, and to further evaluate the protective potential of astaxanthin (ATX) in complementary experimental systems. Methods: Data from the NHANES 2005–2010 were used to construct four composite exposure groups based on the dietary inflammation index (DII) and energy from fat. Survey-weighted regression analyses were performed to examine associations with systemic inflammation and liver injury. Interaction and C-reactive protein (CRP)-mediated effect analyses were conducted. Fifty SD rats were randomly divided into control group, model group induced by HFD combined with inflammatory factors, and low-, medium-, and high-dose Haematococcus pluvialis (HP) intervention groups. Serum lipids, liver enzymes, liver and colon pathology, and inflammatory and oxidative markers were measured in rats. In an in vitro organ-on-chip barrier model, the effect of ATX was observed when colonic barrier damage was induced using palmitic acid and lipopolysaccharides. Results: The high DII combined with HFD showed the largest increases in CRP, liver enzymes, and fatty liver index. A synergistic interaction was observed between DII and HFD, with CRP mediating approximately 20% of the effect. In rat model, HP-derived ATX improved the lipid profile, attenuated hepatic steatosis and oxidative damage, and reduced colonic pro-inflammatory cytokines, while restoration of tight junction proteins was limited. In colon organoid model, ATX showed limited efficacy in improving inflammation and barrier function. Conclusions: The pro-inflammatory–high-fat dietary pattern synergistically exacerbates gut–liver dysfunction. HP-derived ATX alleviates metabolic and inflammation-induced enterohepatic comorbidity, but its effect on repairing barrier structure is limited. Full article

(This article belongs to the Section Nutrition and Public Health)

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15 pages, 794 KB

Open AccessArticle

Effectiveness of a Bariatric-Specific Multivitamin Versus Conventional Targeted Supplementation for Preoperative Micronutrient Deficiency Correction in Bariatric Surgery Candidates: A Multicenter Retrospective Cohort Study

by Luigi Schiavo, Monica Mingo, Gianluca Rossetti, Farnaz Rahimi, Simona Bo, Luigi Cobellis, Francesco Cobellis, Emmanuele Giglio, Lilia Bertolani and Vincenzo Pilone

Nutrients 2026, 18(7), 1047; https://doi.org/10.3390/nu18071047 (registering DOI) - 25 Mar 2026

Abstract

Background: Micronutrient deficiencies (MD) are highly prevalent among candidates for bariatric surgery (BS) and are associated with adverse perioperative and postoperative outcomes. Although guidelines recommend systematic preoperative screening and correction, conventional targeted supplementation (CTS) often requires multiple products, potentially limiting adherence and delaying [...] Read more.

Background: Micronutrient deficiencies (MD) are highly prevalent among candidates for bariatric surgery (BS) and are associated with adverse perioperative and postoperative outcomes. Although guidelines recommend systematic preoperative screening and correction, conventional targeted supplementation (CTS) often requires multiple products, potentially limiting adherence and delaying surgical readiness. Bariatric-specific multivitamins (BSM) may simplify nutritional management, but their real-world effectiveness for preoperative correction of multiple MD remains insufficiently investigated. Objective: To compare the effectiveness, efficiency, and adherence of a BSM versus CTS for preoperative correction of multiple MD in BS candidates. Methods: This retrospective multicenter cohort study included 1560 adults with obesity evaluated for BS between 2020 and 2024 across three Italian bariatric centers. The primary efficacy analysis was restricted to patients presenting with ≥3 laboratory-confirmed MD at baseline. Patients treated between 2020 and 2022 received individualized CTS using multiple products, whereas those treated between 2023 and 2024 received a single BSM. Biochemical follow-up was scheduled at 4 and 8 weeks. The primary outcome was the achievement of complete biochemical correction of all baseline deficiencies at the predefined 4-week follow-up assessment (composite endpoint). Secondary outcomes included supplementation burden and self-reported adherence. Early correction rates were compared using absolute risk differences and risk ratios; adjusted associations were evaluated using multivariable regression models including center and baseline deficiency burden. As a supplementary analysis, the patient-level proportion of baseline deficiencies corrected at 4 weeks was also evaluated. Results: Among patients with ≥3 baseline deficiencies (n = 216), complete biochemical correction at 4 weeks was achieved in 55/134 patients (41.0%) in the BSM group and in 13/82 patients (15.9%) in the CTS group, corresponding to an absolute risk difference of 25.2 percentage points (95% CI 7.8–40.0) and a risk ratio of 2.59 (95% CI 1.51–4.44). In adjusted analyses accounting for center and baseline deficiency pattern, BSM use remained independently associated with early complete correction (adjusted absolute risk difference 26.3 percentage points; adjusted risk ratio 2.69). Sensitivity analyses restricting follow-up timing and excluding early calendar periods yielded consistent results. The mean proportion of baseline deficiencies corrected per patient at 4 weeks was higher in the BSM group compared with CTS (0.74 ± 0.25 vs. 0.54 ± 0.30). Compared with CTS, BSM was associated with lower supplementation burden (1 vs. 3.5 supplements on average) and higher adherence (92% vs. 70%). Conclusions: In a real-world multicenter cohort of BS candidates with ≥3 baseline MD, a simplified preoperative supplementation strategy based on a BSM was associated with a significantly higher probability of complete biochemical correction at 4 weeks, lower supplementation burden, and higher reported adherence compared with CTS. Although complete correction was not universal at 4 weeks, BSM significantly increased the likelihood of achieving early multi-deficiency normalization. Given the non-concurrent observational design, these findings should be interpreted as hypothesis-generating and warrant confirmation in prospective studies with concurrent cohorts. Full article

(This article belongs to the Section Nutrition and Obesity)

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27 pages, 2181 KB

Open AccessArticle

Structural Characterization and Anti-Colitis Mechanisms of Polygonatum sibiricum Polysaccharides via Modulation of Neutrophil Extracellular Traps (NETs)—Macrophage Crosstalk

by Jiaman Xu, Junna Zheng, Wukang Ke, Yu Qiu, Lu Zhang, Chenxi Wu, Xiaoxi Zhang, Daozong Xia and Fenfen Li

Nutrients 2026, 18(7), 1046; https://doi.org/10.3390/nu18071046 - 25 Mar 2026

Abstract

Background: Polygonatum sibiricum (PS), a perennial herbaceous plant belonging to the Liliaceae family, is widely distributed in China and other East Asian countries. PS has been used as food and medicine for thousands of years, and its rhizomes are rich in Polygonatum sibiricum [...] Read more.

Background: Polygonatum sibiricum (PS), a perennial herbaceous plant belonging to the Liliaceae family, is widely distributed in China and other East Asian countries. PS has been used as food and medicine for thousands of years, and its rhizomes are rich in Polygonatum sibiricum polysaccharides (PSP), which exhibit various bioactivities, yet their structural features and therapeutic mechanisms against ulcerative colitis (UC) remain unclear. Methods: A homogeneous polysaccharide, PSP-1b (57.45 kDa), was isolated from the rhizomes of PS via ion-exchange and gel filtration chromatography and structurally characterized using chromatographic and spectroscopic methods. In vivo, its effects were evaluated in a dextran sulfate sodium (DSS)-induced mouse model of UC, while in vitro mechanisms were explored using macrophages stimulated with lipopolysaccharide (LPS) and neutrophil extracellular traps (NETs). Results: PSP-1b was identified as a neutral polysaccharide with minimal branching. Its primary structural backbone was largely composed of →4)-β-D-Galp-(1→ residues. A portion of these backbone residues was substituted at the O-6 position by side chains primarily composed of β-D-Galp-(1→ units. In vivo, PSP-1b significantly alleviated DSS-induced colitis by reducing inflammatory cytokine secretion, suppressing colonic macrophage infiltration, and reversing neutrophil extracellular traps (NETs) deposition. In vitro, PSP-1b directly interacted with TLR4, inhibited the MAPK/NF-κB signaling pathway, and attenuated LPS- and NET-induced macrophage polarization and inflammation. Conclusions: PSP-1b as a promising candidate for functional foods or therapeutic agents targeting inflammatory bowel disease. Full article

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

19 pages, 716 KB

Open AccessArticle

Trends in HDL Cholesterol and Their Association with Dietary Carbohydrate Reduction Among Korean Adults: A Serial Cross-Sectional Trend Analysis Using KNHANES 2014–2023

by Myung-Gwan Kim and Hyun Wook Han

Nutrients 2026, 18(7), 1045; https://doi.org/10.3390/nu18071045 - 25 Mar 2026

Abstract

Purpose: Low HDL cholesterol (HDL-C) is a common lipid abnormality among East Asian populations, including Koreans, and is closely associated with increased cardiovascular disease risk. This has traditionally been linked to high-carbohydrate dietary patterns. Therefore, it is essential to assess how recent changes [...] Read more.

Purpose: Low HDL cholesterol (HDL-C) is a common lipid abnormality among East Asian populations, including Koreans, and is closely associated with increased cardiovascular disease risk. This has traditionally been linked to high-carbohydrate dietary patterns. Therefore, it is essential to assess how recent changes in dietary and lifestyle habits in Korea have influenced HDL-C levels. Methods: This study utilized data from the Korea National Health and Nutrition Examination Survey (KNHANES), conducted from 2014 to 2023. Using a complex sampling method, we analyzed annual trends in carbohydrate intake and HDL-C levels in Korean adults (aged 20–59 years), stratified by gender (male and female) and age (20–39 and 40–59 years), and identified determinants such as demographic factors, health behaviors, and dietary intake. Results: The primary factor in the increase in HDL-C levels was a reduction in carbohydrate intake. When analyzed by age and gender, this significant upward trend in HDL-C levels was consistently observed across all four groups: young men, middle-aged men, young women, and middle-aged women. However, the increase in obesity, indicated by increased BMI and waist circumference, had a negative impact on the improvement in HDL-C levels. The recent improvement in HDL-C levels in Korean adults can be attributed to the successful national dietary policy (reducing carbohydrate intake and increasing healthy fat intake). Conclusions: Public health policies should thus continue emphasizing healthy dietary practices, strengthening smoking cessation initiatives, and managing obesity. These findings suggest similar dietary and lifestyle interventions could effectively reduce cardiovascular disease risk in other Asian populations undergoing comparable dietary transitions. Full article

(This article belongs to the Special Issue Diet and Nutrition: Metabolic Diseases (2nd Edition))

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16 pages, 1118 KB

Open AccessArticle

Structure and Preliminary Reliability of the Diet Quality Questionnaire (DQQ)-Based Form Adapted for Use in the Polish Population—Results from Initial Validation Stage

by Paweł Rzymski, Agnieszka Zawiejska, Katarzyna Tomczyk, Alicja Rzymska, Małgorzata Kampioni, Agnieszka Lipiak, Małgorzata Kędzia, Ewelina Chawłowska and Beata Pięta

Nutrients 2026, 18(7), 1044; https://doi.org/10.3390/nu18071044 - 25 Mar 2026

Abstract

Background/Objectives: The Diet Quality Questionnaire (DQQ) is a brief, food group–based instrument designed for globally comparable population surveillance of diet quality. We culturally adapted the DQQ for Poland and evaluated its internal structure and reliability in an adult cohort. Methods: Following forward–backward translation [...] Read more.

Background/Objectives: The Diet Quality Questionnaire (DQQ) is a brief, food group–based instrument designed for globally comparable population surveillance of diet quality. We culturally adapted the DQQ for Poland and evaluated its internal structure and reliability in an adult cohort. Methods: Following forward–backward translation and expert review, the Polish DQQ was administered online to adult females. Internal structure was explored and test–retest reliability was assessed for total DQQ scores. Diet quality indicators (Dietary Diversity Score [DDS], NCD-protect, NCD-risk, and Global Dietary Recommendations score [GDR]) were summarized descriptively. Results: The average age in the cohort was 29.4 ± 13.6 years. A total of 296 respondents completed the survey; 100 completed the retest. Item-level test–retest reliability was good to excellent (Cohen’s kappa 0.72–1.00). Agreement for total scores was high with minimal bias (Bland–Altman bias 0.2, >95% of observations within limits of agreement) and there was no heteroscedasticity; Passing–Bablok regression indicated equivalence between the test and retest. Median (IQR) diet quality indicators were: DDS 6.0 (5.0; 7.0), NCD-protect 2.5 (1.5; 4.0), NCD-risk 2.5 (1.0; 4.0), and GDR 9.0 (7.5; 10.5). Eighty percent met DDS ≥ 5, while one-third consumed all five recommended food groups. Conclusions: DQQ-PL demonstrates high item-level stability and strong agreement for total scores, with structural findings aligning with its design as a non-latent, food group checklist for population monitoring. The Polish adaptation is feasible and reliable in the studied population (young adult women), supporting its potential use for rapid dietary surveillance pending broader validation. Full article

(This article belongs to the Section Nutrition Methodology & Assessment)

17 pages, 1131 KB

Open AccessArticle

Circulating Lycopene and β-Carotene Levels Are Inversely Associated with Carotid Intima–Media Thickness: A Systematic Review and Meta-Analysis

by Iván Cavero-Redondo, Alicia Saz-Lara, Andrea Del Saz-Lara, Óscar Martínez-Cifuentes, Iris Otero-Luis, Ana González-Collado and Juan Pablo Rey-López

Nutrients 2026, 18(7), 1043; https://doi.org/10.3390/nu18071043 - 25 Mar 2026

Abstract

Background: Carotid intima-media thickness (IMT) is a well-established surrogate marker of subclinical atherosclerosis and a predictor of cardiovascular risk. Carotenoids, particularly lycopene and β-carotene, have been proposed as protective antioxidants against vascular damage, but evidence from population-based studies is inconsistent. Objective: [...] Read more.

Background: Carotid intima-media thickness (IMT) is a well-established surrogate marker of subclinical atherosclerosis and a predictor of cardiovascular risk. Carotenoids, particularly lycopene and β-carotene, have been proposed as protective antioxidants against vascular damage, but evidence from population-based studies is inconsistent. Objective: We aim to perform a systematic review and meta-analysis of the associations between circulating levels of lycopene and β-carotene and carotid IMT in the general adult population, including potential sex-specific effects. Methods: A systematic search was conducted in PubMed, Scopus, and Web of Science up to March 2025, following PRISMA guidelines (PROSPERO registration: CRD420251003810). Observational and experimental studies reporting cross-sectional associations between plasma carotenoids and IMT were included. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated via random effects models. Subgroup and meta-regression analyses explored potential modifiers, including sex and cardiovascular risk factors. Results: Thirteen studies (n = 9131; mean age 46.4–71.6 years) met the inclusion criteria, eight of which were eligible for meta-analysis. High circulating lycopene levels were significantly associated with low IMT (pooled OR = 0.70; 95% CI: 0.59–0.84; I² = 65.7%). The association was stronger in men (OR = 0.62; 95% CI: 0.45–0.84) than in women (OR = 0.74; 95% CI: 0.58–0.95). In contrast, β-carotene was only marginally associated with IMT (pooled OR = 0.96; 95% CI: 0.92–0.99; I² = 72.6%). Meta-regression suggested that systolic blood pressure modified the lycopene-IMT relationship, whereas body mass index and low-density lipoprotein cholesterol influenced the β-carotene-IMT association. No evidence of publication bias was found. Conclusions: Increased serum lycopene concentrations, and to a lesser extent β-carotene concentrations, are inversely associated with carotid IMT, suggesting a protective role of lycopene in vascular health. The effect appears more pronounced in men, highlighting potential sex-specific differences in carotenoid metabolism and cardiovascular risk modulation. Full article

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

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23 pages, 512 KB

Open AccessArticle

Public School Teachers’ Nutrition Knowledge and Perceptions of the School Food Environment in Kazakhstan

by Svetlana Rogova, Olzhas Zhamantayev, Olga Plotnikova, Denis Turchaninov, Zhanna Yesmagambetova, Nurbek Yerdessov and Marat Kalishev

Nutrients 2026, 18(7), 1042; https://doi.org/10.3390/nu18071042 - 25 Mar 2026

Abstract

Background/Objectives: Schools, as structured social environments, are important settings for shaping lifelong eating habits, and teachers play a mediating role in nutrition education. This study aimed to assess nutrition knowledge among public school teachers, examine their perceptions of the school food environment, [...] Read more.

Background/Objectives: Schools, as structured social environments, are important settings for shaping lifelong eating habits, and teachers play a mediating role in nutrition education. This study aimed to assess nutrition knowledge among public school teachers, examine their perceptions of the school food environment, and identify factors associated with knowledge scores. Methods: A stratified cross-sectional survey was conducted among 736 teachers from 12 public schools during the fall of 2025. A structured questionnaire based on the Knowledge–Attitudes–Practice model was used to evaluate nutrition knowledge, teaching practices, perceived school food environment, and teachers’ observations of student food-related behaviors. Group differences were examined using t-tests and ANOVA, and multivariable logistic regression was applied to identify factors associated with low nutrition knowledge. Results: The mean knowledge score was 6.26 ± 2.64 out of 12, with 23.6% of teachers classified as having low knowledge, 59.9% satisfactory, and 16.4% good. Primary school teachers scored significantly higher than subject teachers (7.27 vs. 5.64; p < 0.001). Regular conduct of nutrition classes was associated with lower odds of low knowledge (adjusted OR 0.10, 95% CI 0.05–0.23, p < 0.001). A sensitivity analysis using continuous knowledge scores confirmed this pattern, with the absence of nutrition teaching predicting a 1.40-point reduction in scores (95% CI −1.86 to −0.94, p < 0.001). Teachers rated school meal quality moderately high, and frequently observed student refusal of canteen food and purchase of sweets or fast food outside school. Conclusions: This study found that public school teachers in Karaganda, Kazakhstan showed satisfactory overall nutrition knowledge, with gaps in applied understanding and common dietary myths. Primary teachers and those actively teaching nutrition had higher knowledge scores, indicating an association between pedagogical engagement and content knowledge. To help optimize the school food environment, educational policies would benefit from the development of cross-curricular instructional materials fitted specifically for secondary school subject teachers. Full article

(This article belongs to the Special Issue Shaping Healthy Nutrition and Lifestyles in Youth: Evidence from Schools, Camps and Community Programs)

16 pages, 1719 KB

Open AccessArticle

Calcium Intake and Food Sources Among Children, Adolescents and Women in Madagascar: Results from a Nationally Representative Survey

by Lantonirina Ravaoarisoa, Valeria Galetti, Ravakamaharitra Rakotovao, James Peter Wirth, Carla El-Mallah, Fabian Rohner, Mathieu Joyeux, Niry Randrenarizo, Zeinab Annan, Malaza Armel Alex Razanatsila, John Syllie Noela Randriarivony, Zo Nantenaina Raveloson and Rita Wegmüller

Nutrients 2026, 18(7), 1041; https://doi.org/10.3390/nu18071041 - 25 Mar 2026

Abstract

Background: Many countries in sub-Saharan Africa are at risk of inadequate calcium intake, yet no data exist for vulnerable population groups in Madagascar. We aimed to assess daily calcium intake, the major contributing food sources, and the prevalence of inadequate intake in [...] Read more.

Background: Many countries in sub-Saharan Africa are at risk of inadequate calcium intake, yet no data exist for vulnerable population groups in Madagascar. We aimed to assess daily calcium intake, the major contributing food sources, and the prevalence of inadequate intake in young children, adolescents, and women of reproductive age. Methods: The 2024 National Micronutrient Survey used a two-stage probabilistic design across all 23 regions. The daily calcium intake was estimated using a food frequency questionnaire that focused on calcium-rich foods that are commonly consumed in Madagascar and the calcium concentration measured in drinking water. Results: Calcium intake was low across all population groups, averaging 200–300 mg/d in adolescents and women and below 180 mg/d in young children. The prevalence of inadequate intake exceeded 96% in every population group. While calcium intake increased with increasing household wealth in children, the opposite pattern was observed for adolescents and women, whose intake decreased with increasing wealth. The main contributors to calcium intake were cassava leaves, cassava roots, small fresh and dried fish eaten with bones, drinking water across all population groups, and breastmilk in young children. Conclusions: The calcium intake is low throughout Madagascar and across all demographic groups. Strategies to improve intake are urgently needed and should include promoting continued breastfeeding and the consumption of calcium-rich, locally available, affordable foods such as small fish eaten with bones and leafy green vegetables, alongside a consideration of wheat flour fortified with calcium. Full article

(This article belongs to the Section Nutrition and Public Health)

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16 pages, 552 KB

Open AccessReview

A Critical Narrative Review Appraisal of the 2025–2030 Dietary Guidelines: Scientific Strengths, Conceptual Gaps, and Overlooked Dimensions of Sustainability and Health Equity

by Dimitrios Papandreou, Azza Alsuwaidi, Zainab Taha, Constantinos Giaginis, Georgios K. Vasios and Eleni P. Andreou

Nutrients 2026, 18(7), 1040; https://doi.org/10.3390/nu18071040 (registering DOI) - 25 Mar 2026

Abstract

The 2025–2030 Dietary Guidelines introduce an important shift in public health nutrition, emphasizing minimally processed foods, higher protein intake, greater inclusion of full-fat dairy, and a food-based advice centered on “real food” consumption. While several of these recommendations align with accumulating evidence, particularly [...] Read more.

The 2025–2030 Dietary Guidelines introduce an important shift in public health nutrition, emphasizing minimally processed foods, higher protein intake, greater inclusion of full-fat dairy, and a food-based advice centered on “real food” consumption. While several of these recommendations align with accumulating evidence, particularly the discouragement of ultra-processed foods and added sugars, substantial concerns remain regarding their internal coherence, population-level applicability, risk of misinterpretation, as well as environmental footprint. This critical narrative review evaluates whether the scope, emphasis, and framing of the new guideline components are proportionate to the strength, consistency, and context of the underlying evidence. Using a novel framework that distinguishes between nutritional adequacy, optimization, and therapeutic application, we assess the scientific coherence of key recommendations. A structured literature search was conducted in PubMed, Scopus, and Web of Science focusing on systematic reviews and meta-analyses of randomized controlled trials and large prospective cohort studies relevant to the updated guidelines. Particular attention is given to protein and saturated fat intakes, carbohydrate restriction in chronic disease, and the balance between simplification and scientific precision. Overall, the new guidelines represent a positive shift toward food-based recommendations; however, clearer differentiation between population-level guidance and context-specific interventions is required to preserve scientific rigor, reduce misinterpretation, and enhance public health relevance. Full article

(This article belongs to the Special Issue Towards Healthy and Sustainable Diets: Environmental and Nutritional Perspectives—2nd Edition)

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21 pages, 872 KB

Open AccessReview

Ultra-Processed Foods and the Cardiovascular-Kidney-Metabolic Continuum: Integrating Epidemiological, Multi-Omics, and Translational Evidence

by Saiful Singar, Amirhossein Ataei Kachouei, Leandro Lantigua-Somoano, David Manley, Anthony Cardinale, Muhammad Zulfiqah Sadikan, Saurabh Kadyan, Donya Shahamati, Lorena Dias, Amber Wood, Cinthia Chavarria, Sara K. Rosenkranz and Neda S. Akhavan

Nutrients 2026, 18(7), 1039; https://doi.org/10.3390/nu18071039 (registering DOI) - 25 Mar 2026

Abstract

Cardiovascular-kidney-metabolic (CKM) syndrome integrates excess adiposity, metabolic dysfunction, kidney impairment, subclinical cardiovascular diseases, and clinical events along a staged continuum that invites unified prevention and treatment. Ultra-processed foods (UPFs) are a complex, high-prevalence exposure that may influence risk across CKM stages through nutrient [...] Read more.

Cardiovascular-kidney-metabolic (CKM) syndrome integrates excess adiposity, metabolic dysfunction, kidney impairment, subclinical cardiovascular diseases, and clinical events along a staged continuum that invites unified prevention and treatment. Ultra-processed foods (UPFs) are a complex, high-prevalence exposure that may influence risk across CKM stages through nutrient profiles, additives, processing-induced compounds, and packaging-related contaminants. This review synthesizes epidemiologic, mechanistic, and translational evidence with attention to exposure definition and analytic rigor. We summarize NOVA-based UPF operationalization across dietary assessment tools, highlighting misclassification of mixed dishes, brand heterogeneity, and energy under-reporting, and we propose further examination of energy-adjusted models, calibration, and harmonized metrics. Observational studies consistently associate higher UPF intake with adiposity, diabetes, chronic kidney disease, cardiovascular events, and mortality, with modest to moderate effect sizes that are heterogeneous across populations. Mechanistic data from metabolomics, lipidomics, proteomics, and the gut microbiome converge on pathways of inflammation, lipid metabolism, oxidative and metabolic stress, and intestinal barrier dysfunction; in selected cohorts, multi-omics modules account for a substantial minority of UPF-outcome associations. We outline quality-control pipelines, batch-effect prevention/correction, and multiple-testing control necessary for reproducible diet-omics. Translationally, targeted lipidomic and proteomic panels show promise for CKM risk stratification and monitoring but require validation, clinical thresholds, and guideline endorsement. Equity and global context, including differences in product mix, food systems, and care capacity, modify population impact. We conclude with a research agenda prioritizing harmonized exposure metrics, error-aware modeling, standardized multi-omics workflows, and adequately powered, stage-specific interventions capable of testing mediation and prognostic utility. Full article

(This article belongs to the Special Issue Nutritional Strategies for Obesity-Related Metabolic Diseases)

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17 pages, 265 KB

Open AccessArticle

Family Eating Habits and Dietary Quality of Spanish Children and Adolescents: The PASOS Study

by Marina Ródenas-Munar, Silvia García, Santiago F. Gómez, Marcela González-Gross, Julia Wärnberg, Narcis Gusi, Susana Aznar, Elena Marín-Cascales, Miguel Ángel González-Valeiro, Susana Pulgar, Inmaculada Bautista, Maddi Osés, Luis Cereijo, Adela Martín-Oliveros, Montse Fitó, Paula Berruezo, Augusto G. Zapico, Juan Carlos Benavente-Marín, Jesús Sánchez Gomez, Evelyn Martin-Moraleda, Pedro E. Alcaraz, Marta Sevilla-Sanchez, Estefanía Herrera-Ramos, Idoia Labayen, Luis Carmona-Rosado, Ana Mateos-Lardiés, Helmut Schröder, Cristina Bouzas and Josep A. Tur Show full author list Hide full author list

Nutrients 2026, 18(7), 1038; https://doi.org/10.3390/nu18071038 - 25 Mar 2026

Abstract

Background: Childhood nutrition is essential for development and disease prevention. Parental dietary practices and sociodemographic factors shape children’s eating habits. Objective: To assess the association between parental diet quality, children’s diet, and nutritional status, as well as the influence of caregiver [...] Read more.

Background: Childhood nutrition is essential for development and disease prevention. Parental dietary practices and sociodemographic factors shape children’s eating habits. Objective: To assess the association between parental diet quality, children’s diet, and nutritional status, as well as the influence of caregiver sociodemographic factors. Design: Cross-sectional analyses were conducted using data from two waves of the PASOS study (2019–2020 and 2022–2023), which are nationally representative multicentre observational surveys. The analyses were restricted to participants with complete information on parental diet quality, children’s diet quality, and relevant covariates. Methods: Participants aged 8–16 years from the PASOS 2019–2020 (n = 1028) and 2022–2023 (n = 572) studies were included. Caregivers provided sociodemographic information and completed the Short Diet Quality Screener (SDQS), a validated questionnaire to assess parental diet quality. Children’s diet quality was assessed using the validated KIDMED index. Based on parental SDQS scores, participants were classified into low (≤50th percentile) or adequate/high (>50th percentile) diet quality groups. Associations were analysed using logistic regression and Pearson correlation. Results: Higher parental diet quality was consistently associated with greater adherence to the Mediterranean diet and higher consumption of fruit, breakfast cereals, and fish among children in both study waves. Children whose caregivers had better diet quality also showed a lower prevalence of abdominal obesity. Parental diet quality was positively associated with children’s diet quality and inversely related to several adiposity indicators, although associations with anthropometric measures were generally weak. Conclusions: Family-based approaches are essential for improving diet quality and preventing childhood obesity. Full article

(This article belongs to the Special Issue Physical Activity and Food Choice in Early Childhood: Developmental Pathways and Integrated Behaviors)

17 pages, 654 KB

Open AccessSystematic Review

A Scoping Review to Identify Interventions That Support Healthier Food Choices for Pupils in Specialist Schools

by Suzanne Spence, Louise Tanner, João P. A. Greca, Lindsay Pennington, Jayne V. Woodside and Morag J. Andrew

Nutrients 2026, 18(7), 1037; https://doi.org/10.3390/nu18071037 - 25 Mar 2026

Abstract

Background/Objectives: Children and young people (CYP) with a learning disability are at higher risk of living with overweight and obesity and may consume fewer fruits and vegetables compared to the general paediatric population. They are more likely to experience eating and drinking difficulties, [...] Read more.

Background/Objectives: Children and young people (CYP) with a learning disability are at higher risk of living with overweight and obesity and may consume fewer fruits and vegetables compared to the general paediatric population. They are more likely to experience eating and drinking difficulties, restrictive eating, and mealtime behavioural challenges. The school environment is considered an ideal setting to improve CYP’s dietary intakes. The primary objective was to identify existing interventions to support healthier food choices for CYP attending specialist schools. Secondary objectives considered intervention development, fidelity and outcomes. Methods: A scoping review and narrative synthesis. Eligible studies were identified from bibliographic databases (e.g., Medline, Embase, PsychInfo) and grey literature (e.g., Clinicaltrials.gov, the Cochrane Library). A two-stage screening process was used. Intervention components were mapped according to the TIDieR-PHP and AACTT frameworks. Results: Seven studies, reported in ten records, were included. Interventions included modifications to the dining environment, sensory exploration, health promotion and social reinforcement. Interventions were implemented across the school day: lunchtime (n = 2), breaktime (n = 3) and other times (n = 2). Studies mainly focused on adolescents. There was some mixed evidence of increased consumption of fruits and vegetables, whole grains and water. Due to small sample sizes and heterogeneity, definitive conclusions are limited. A key finding is the lack of interventions to improve CYP’s food choices in specialist schools. Conclusions: This review highlights a crucial need for the development of multi-component interventions co-produced with stakeholders to promote healthy food choices and improve the dietary intakes of CYP attending specialist schools. Full article

(This article belongs to the Section Nutrition and Public Health)

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3 pages, 161 KB

Open AccessCorrection

Correction: Gvozdenović et al. Impact of Vitamin D Status and Nutrition on the Occurrence of Long Bone Fractures Due to Falls in Elderly Subjects in the Vojvodina Region of Serbia. Nutrients 2024, 16, 2702

by Nemanja Gvozdenović, Ivana Šarac, Andrijana Ćorić, Saša Karan, Stanislava Nikolić, Isidora Ždrale and Jelena Milešević

Nutrients 2026, 18(7), 1036; https://doi.org/10.3390/nu18071036 - 25 Mar 2026

Abstract

There was an error in the original publication [...] Full article

24 pages, 614 KB

Open AccessReview

Fasting-Based Dietary Interventions in Cancer Patients and Survivors: A Scoping Review

by Kuang-Yi Wen, Julianne Freedman, Abenezer Tafese, William Kelly and Nicole Simone

Nutrients 2026, 18(7), 1035; https://doi.org/10.3390/nu18071035 (registering DOI) - 25 Mar 2026

Abstract

Background: Fasting-based interventions are increasingly investigated as adjuncts to cancer treatment for the potential to reduce therapy-related toxicities, improve metabolic health, and enhance quality of life. However, clinical evidence regarding their efficacy, tolerability, and acceptability remains limited and fragmented. This scoping review [...] Read more.

Background: Fasting-based interventions are increasingly investigated as adjuncts to cancer treatment for the potential to reduce therapy-related toxicities, improve metabolic health, and enhance quality of life. However, clinical evidence regarding their efficacy, tolerability, and acceptability remains limited and fragmented. This scoping review aimed to systematically map the current evidence on fasting-based interventions in cancer patients and survivors. Methods: A literature search was conducted in PubMed, Scopus, Web of Science, and CINAHL up to 10 June 2025. Eligible interventional studies included cancer patients or survivors and evaluated fasting-based interventions, such as time-restricted eating, intermittent fasting, short-term fasting, or fasting-mimicking diets. Studies were categorized by fasting types and outcomes like fatigue, treatment toxicity, metabolic and hematologic parameters, weight, quality of life, adherence, acceptability, illness perception, and adverse events were assessed. Result: Twenty interventional studies of FMD, TRE, STF, IF, or fasting combined with altered dietary approaches conducted across 10 countries were included, comprising a total of 871 participants. Participant ages ranged from 28 to 75 years. Overall, 9 of 20 studies exclusively enrolled breast cancer patients or survivors, and chemotherapy was the most common treatment context in 11 studies. Five of six studies reported reductions in fatigue. Among the five studies assessing quality of life, one demonstrated improvement, three reported no change, and one yielded mixed results. Six of eight studies reported reductions in chemotherapy-related toxicity, and weight loss was observed in 10 of 12 studies. Reductions in IGF-1 and insulin levels were reported in six of seven and four of five studies, respectively. Hematologic changes were noted in six studies, and only one study assessed illness perceptions, reporting positive findings. Fasting-related adverse events, reported in nine studies, were generally mild and transient. High adherence and acceptability were observed across studies; however, findings were heterogeneous across intervention types and were largely derived from small or moderate-strength studies. A descriptive quality metric assessment indicated that most studies were of moderate methodological strength. More intensive fasting protocols, such as FMD and STF, appeared to demonstrate more consistent metabolic effects, whereas TRE showed higher adherence but more variable clinical outcomes. Conclusions: Fasting-based interventions have the potential to be feasible and well tolerated among cancer patients and survivors, with early evidence suggesting benefits in reducing fatigue, minimizing treatment-related toxicities, and favorable metabolic effects. Large, well-designed trials including diverse cancer populations are needed to confirm long-term outcomes and guide clinical integration. Full article

(This article belongs to the Special Issue Intermittent Fasting: Health Impacts and Therapeutic Potential)

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13 pages, 503 KB

Open AccessArticle

Policy vs. Practice: Nutritional Quality and Menu Structure in Polish Hospitals During the “Good Meal in Hospital” Pilot Program—A Multicenter Cross-Sectional Study

by Agnieszka Orkusz and Martyna Orkusz

Nutrients 2026, 18(7), 1034; https://doi.org/10.3390/nu18071034 - 25 Mar 2026

Abstract

Background: Hospital nutrition is an essential component of patient care; however, the nutritional quality of meals in Polish hospitals has raised concerns for many years. In response to these challenges, the Ministry of Health implemented a nationwide pilot program, “Good Meal in [...] Read more.

Background: Hospital nutrition is an essential component of patient care; however, the nutritional quality of meals in Polish hospitals has raised concerns for many years. In response to these challenges, the Ministry of Health implemented a nationwide pilot program, “Good Meal in the Hospital,” to improve nutritional quality by developing and implementing a model tailored to patients’ needs. This study aimed to assess the compliance of hospital-standard diets with the program’s assumptions. Methods: Ten-day menus from ten hospitals across different regions of Poland (a total of 100 menus) were analyzed. A quantitative assessment of energy and nutritional values was conducted by calculating the average daily intake of energy and selected nutrients (protein, carbohydrates including sugars (mono- and disaccharides), fat, saturated fatty acids, fiber, and salt) and comparing these with national recommendations for hospital diets for adults. In parallel, a qualitative assessment of ten menu structure criteria was performed using a binary scoring system (0/1). Results: None of the analyzed hospitals met all quantitative and qualitative criteria simultaneously. All hospitals complied with recommendations for protein and carbohydrate content, whereas the most frequent deviations concerned excessive intake of fat, saturated fatty acids, and salt. Qualitative scores ranged from 6 to 10 points, with the most significant shortcomings related to the frequency of legumes and fish. A particularly noteworthy finding was the discrepancy between qualitative and quantitative compliance of the menus. Conclusions: The fact that none of the analyzed hospitals met all program criteria simultaneously indicates the limited effectiveness of its implementation in its current form. Full article

(This article belongs to the Section Nutritional Epidemiology)

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21 pages, 1159 KB

Open AccessArticle

Digestive Vulnerability and Exercise Exposure as Correlates of Gastrointestinal Symptoms and Race Withdrawal in Endurance and Ultra-Endurance Athletes

by Benoit Mauvieux, Elizabeth Mahon, Adrian Markov, Aghilas Slamani, Morgane Fresneau, Anthony Berthou, Eglantine Le Chevert, Jamie Pugh and Ben J. Edwards

Nutrients 2026, 18(7), 1033; https://doi.org/10.3390/nu18071033 - 25 Mar 2026

Abstract

Background: Gastrointestinal (GI) symptoms are common in endurance and ultra-endurance sports and may impair performance or lead to race withdrawal. While nutritional strategies are frequently emphasized, the respective roles of baseline digestive susceptibility and cumulative exercise exposure remain insufficiently characterized. Methods: Two complementary [...] Read more.

Background: Gastrointestinal (GI) symptoms are common in endurance and ultra-endurance sports and may impair performance or lead to race withdrawal. While nutritional strategies are frequently emphasized, the respective roles of baseline digestive susceptibility and cumulative exercise exposure remain insufficiently characterized. Methods: Two complementary cross-sectional questionnaire-based studies were conducted in endurance athletes. Study 1 included 230 ultra-trail runners and examined determinants of systematic GI symptoms during competition using a composite digestive vulnerability (DV) score reflecting susceptibility indicators. Study 2 included 497 endurance and ultra-endurance athletes from multiple disciplines and investigated multivariable correlates of GI symptoms and GI-related race withdrawal, integrating training-related GI symptoms (proxy of digestive vulnerability), habitual competition duration (≥6 h), sport category and specific digestive symptoms. Logistic regression models were adjusted for age and sex. Results: In Study 1, the DV score was independently associated with systematic GI symptoms during competition (adjusted OR per point = 1.93, 95% CI 1.33–2.80). In Study 2, athletes reporting GI symptoms during training had markedly higher odds of experiencing GI symptoms during competition (adjusted OR = 3.96, 95% CI 2.67–5.87). Habitual exposure to events lasting ≥6 h was independently associated with increased odds of GI-related race withdrawal (adjusted OR = 2.25, 95% CI 1.35–3.78). GI symptoms during competition represented the strongest proximal correlate of withdrawal (adjusted OR = 7.04, 95% CI 4.00–12.30), indicating a sequential relationship between baseline digestive vulnerability, symptom expression during competition and race termination. After adjustment for digestive vulnerability and exercise exposure, no individual nutritional category remained independently associated with GI outcomes. Conclusions: Gastrointestinal symptoms and race withdrawal in endurance athletes were more consistently associated with digestive vulnerability expressed during training and cumulative exercise exposure than with isolated nutritional items. These findings support a vulnerability–exposure framework in which individual digestive susceptibility interacts with prolonged physiological stress during endurance exercise. Identifying athletes with elevated digestive vulnerability during training may represent a practical strategy to improve individualized nutritional preparation and reduce GI-related race interruption. Full article

(This article belongs to the Special Issue Physical Exercise and Nutrition on the Gastrointestinal Pathophysiology)

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21 pages, 436 KB

Open AccessReview

The Effects of Curcumin on Vascular Endothelial Function, Lipid Metabolism, Inflammation and Neuroprotection—A Review

by Mateusz Ozorowski, Michał Wiciński, Grzegorz Liczner, Jakub Wójcicki and Elżbieta Włodarczyk

Nutrients 2026, 18(7), 1032; https://doi.org/10.3390/nu18071032 - 25 Mar 2026

Abstract

Curcumin, a polyphenolic compound obtained from the rhizome of Curcuma longa, is the main bioactive component of turmeric and exhibits a wide range of biological properties. This naturally occurring polyphenolic compound is widely known for its protective properties on the vascular endothelium [...] Read more.

Curcumin, a polyphenolic compound obtained from the rhizome of Curcuma longa, is the main bioactive component of turmeric and exhibits a wide range of biological properties. This naturally occurring polyphenolic compound is widely known for its protective properties on the vascular endothelium and its anti-inflammatory effects. Curcumin has been recognized as a factor in improving antioxidant defenses and lipid metabolism and as a neuroprotective agent. Thanks to its broad spectrum of activity, curcumin is gaining popularity as an ingredient in dietary supplements and as part of a healthy diet that supports overall health. In this article, we will take a closer look at curcumin—based on a review of the current literature, we will learn what curcumin is and what health benefits it can provide. Full article

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

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23 pages, 1778 KB

Open AccessReview

Body Water During Pregnancy: Physiology, Clinical Significance and Assessment Methods: A Narrative Review

by María Eugenia Flores-Quijano, Reyna Samano-Samano, Edgar Barrientos-Galeana and Hector Borboa-Olivares

Nutrients 2026, 18(7), 1031; https://doi.org/10.3390/nu18071031 - 24 Mar 2026

Abstract

Total body water (TBW) undergoes substantial physiological expansion during pregnancy, reflecting coordinated cardiovascular, renal, and endocrine adaptations required to support maternal metabolism, uteroplacental perfusion, and fetal growth. These changes involve not only an overall increase in body water but also shifts in the [...] Read more.

Total body water (TBW) undergoes substantial physiological expansion during pregnancy, reflecting coordinated cardiovascular, renal, and endocrine adaptations required to support maternal metabolism, uteroplacental perfusion, and fetal growth. These changes involve not only an overall increase in body water but also shifts in the distribution of extracellular water (ECW) and intracellular water (ICW), which influence maternal body composition, the interpretation of biochemical biomarkers affected by hemodilution, and pregnancy-related clinical outcomes. Despite its physiological and clinical relevance, the regulation and assessment of body-water compartments during pregnancy remain insufficiently integrated within nutritional and clinical research. This narrative review synthesizes current knowledge on the physiological regulation of TBW and its compartments across gestation and provides a critical analysis of the methodological approaches used to assess body-water distribution in pregnant populations. We review the mechanisms underlying plasma volume expansion, interstitial fluid accumulation, and tissue hydration, and discuss their implications for fetal growth, hypertensive disorders of pregnancy, and gestational diabetes mellitus. We also examine the principles, strengths, and limitations of the main techniques used to assess TBW and body-water compartments during pregnancy. Isotope dilution using stable isotopes (²H₂O and H₂¹⁸O) remains the reference method for TBW assessment, whereas bioelectrical impedance-based approaches, including bioelectrical impedance analysis (BIA), bioelectrical impedance spectroscopy (BIS), and bioelectrical impedance vector analysis (BIVA), offer practical alternatives for longitudinal monitoring of fluid redistribution during gestation. By integrating physiological and methodological perspectives, this review provides a framework for understanding body-water dynamics during pregnancy and for selecting appropriate approaches to assess maternal body composition and hydration. Full article

(This article belongs to the Special Issue Nutritional and Metabolic Programming Across the Female Lifespan: Body Composition, Hormonal Changes, and Health Outcomes)

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27 pages, 623 KB

Open AccessArticle

Who Holds the Plate? Psychotherapists’ Perspectives on Dietary Behavior, Transdiagnostic Evaluation and Interdisciplinary Collaboration in Eating Disorders

by Panagiota Tragantzopoulou, Aikaterini Tragantzopoulou and Vaitsa Giannouli

Nutrients 2026, 18(7), 1030; https://doi.org/10.3390/nu18071030 (registering DOI) - 24 Mar 2026

Abstract

Background/Objectives: Dietary behavior in eating disorders (EDs) is often framed through either nutritional or psychological perspectives, yet emerging evidence suggests that eating may involve a transdiagnostic, emotionally embedded, and relationally negotiated process. While research highlights the role of emotion regulation difficulties, perfectionism, [...] Read more.

Background/Objectives: Dietary behavior in eating disorders (EDs) is often framed through either nutritional or psychological perspectives, yet emerging evidence suggests that eating may involve a transdiagnostic, emotionally embedded, and relationally negotiated process. While research highlights the role of emotion regulation difficulties, perfectionism, control, and overvaluation of weight and shape in ED maintenance, less is known about how these processes are interpreted and managed in clinical practice across different cultural contexts. This study explored psychotherapists’ perspectives on dietary behavior, nutritional assessment, and interdisciplinary collaboration in ED treatment in Greece and the United Kingdom. Methods: Eighteen psychotherapists (9 Greek and 9 British) with experience in treating individuals with EDs participated in in-depth semi-structured interviews. Data were analyzed using reflexive thematic analysis. Results: Three themes were developed. First, therapists conceptualized dietary behavior as reflecting broader transdiagnostic psychological processes, particularly perfectionism, control, emotion regulation difficulties, and body image concerns. Second, nutritional assessment and intervention (e.g., food diaries and meal plans) were experienced as emotionally significant practices that required negotiation of timing, meaning, and clients’ readiness for change. Third, interdisciplinary collaboration was described as involving ongoing negotiation of nutritional authority, with therapists balancing nutritional considerations and psychological safety, influenced by contextual differences between UK and Greek mental health systems. Conclusions: Findings suggest that dietary behavior in ED treatment may benefit from approaches that integrate psychological and nutritional perspectives. Clinicians may consider attending to clients’ emotional readiness, the symbolic meanings of food, and the dynamics of multidisciplinary collaboration, offering insights that can inform clinical practice and future research. Full article

(This article belongs to the Special Issue Common Transdiagnostic Factors in Eating Disorders, Disordered Eating, and Mental Health Symptoms)

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