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32 pages, 1468 KB  
Article
Time-Updated Prognostic Modeling in ICU Patients with Documented Coma or Unresponsiveness Using Routine Arterial Blood Gas Trajectories: An Exploratory Explainable Machine-Learning Study
by Pompiliu Mircea Bogdan, Camer Salim, Roxana Elena Bogdan-Goroftei, Alina Pleșea-Condratovici, Cristian Guțu, Călin Gheorghe Buzea, Bogdan Costăchescu, Letiția Doina Duceac, Manuela Arbune, Constantin-Marinel Vlase, Irina Luciana Gurzu and Alina Mihaela Călin
J. Clin. Med. 2026, 15(13), 5056; https://doi.org/10.3390/jcm15135056 - 29 Jun 2026
Viewed by 138
Abstract
Background/Objectives: Prognostication in ICU patients with documented coma or unresponsiveness is a high-stakes task that informs escalation of care, goals-of-care discussions, and family counselling. Conventional scores are often based on static snapshots and may not reflect early physiological evolution in heterogeneous real-world ICU [...] Read more.
Background/Objectives: Prognostication in ICU patients with documented coma or unresponsiveness is a high-stakes task that informs escalation of care, goals-of-care discussions, and family counselling. Conventional scores are often based on static snapshots and may not reflect early physiological evolution in heterogeneous real-world ICU populations. Routine arterial blood gases (ABG) and SpO2 are repeatedly measured during early ICU care and may capture clinically meaningful trajectories that can be leveraged by explainable machine learning. To develop and internally validate exploratory, time-updated explainable machine-learning models for ICU outcome in ICU patients with clinically documented coma or unresponsiveness using routine ABG/SpO2 measurements and physiological trajectories available at admission, 24 h, and 72 h, and to evaluate whether trajectory information adds prognostic information within a staged internal-validation framework. Methods: We conducted a retrospective single-centre study of 108 adult ICU patients with clinically documented coma or unresponsiveness. Predictors included demographics, comorbidity burden, COVID-19 status, baseline ABG/SpO2 at ICU admission, inflammatory and coagulation biomarkers, and derived ABG/SpO2 trajectory variables at 24 h and 72 h. Trajectory variables were defined as changes from admission to 24 h and to 72 h and were retained as missing when follow-up measurements were unavailable. The primary ICU-course outcome was ICU death versus transfer to ward. Three staged models were evaluated: Model A using baseline variables, Model B adding 24 h trajectory features, and Model C adding 72 h trajectory features. For each stage, models were analyzed with and without the derived respiratory_support index; models excluding respiratory_support were treated as the main interpretive analyses. Logistic regression, random forest, and gradient boosting (XGBoost) classifiers were assessed using repeated stratified 5-fold cross-validation with 20 repeats and aligned out-of-fold predictions. Performance was reported using AUC-ROC, precision–recall AUC, Brier score, and operating-point metrics; clinical utility was examined with decision-curve analysis. Model interpretation used SHAP and partial dependence plots. Robustness analyses included feature-exclusion sensitivity analysis for respiratory_support and a label-permutation sanity check. Results: ICU mortality was 65.7% (71/108). Follow-up ABG completeness was 75.9% at 24 h and 61.1% at 72 h. Because respiratory_support summarized the highest support level during the first 72 h and strongly separated outcome groups, models excluding respiratory_support were treated as the primary interpretive analyses. In the primary NoRS logistic-regression models, discrimination was moderate-to-strong, with AUC-ROC 0.822 for Model A_noRS, 0.848 for Model B_noRS, and 0.895 for Model C_noRS; bootstrap 95% confidence intervals were 0.739–0.897, 0.766–0.919, and 0.830–0.951, respectively. Measurement-availability sensitivity analyses and simple benchmark models were added to contextualize trajectory-related performance. Respiratory_support-enriched models were retained only as secondary severity-aware analyses, not as admission-only prediction models. Label permutation reduced discrimination toward chance (AUC ≈ 0.55). SHAP and partial-dependence analyses identified oxygenation variables, inflammatory burden, acid–base status, and ΔPaO2 at 72 h as clinically coherent contributors to predicted risk; when included, respiratory_support dominated feature attribution, consistent with its role as an organ-support intensity marker. Conclusions: In ICU patients with clinically documented coma or unresponsiveness, explainable machine-learning models using routine ABG/SpO2 trajectories within the first 72 h are feasible and may provide time-updated prognostic information, but the incremental value of trajectory-enriched models over simpler admission-only benchmarks remains unproven. Trajectory-enriched NoRS models retained meaningful discrimination after removing organ-support severity, suggesting a possible physiologically meaningful signal beyond support intensity alone, although definitive incremental value over parsimonious admission-only benchmarks was not established. These findings should be interpreted as exploratory and internally validated only; they do not establish a deployable ICU mortality score, do not demonstrate superiority over established ICU severity scores, and require external validation in larger multicentre cohorts before clinical deployment. Full article
(This article belongs to the Section Emergency Medicine)
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15 pages, 1295 KB  
Article
Effects of Caffeine Supplementation on Blood Glucose and Electromyographic Activity During Resistance Exercise: A Randomized, Double-Blind, Placebo-Controlled Crossover Study
by Guilherme Pereira Saborosa, Luciano Bernardes Leite, Pedro Forte, Bruno de Casio Coelho, Rafael Peixoto, Alexandra Malheiro, Pedro Afonso, Ana Claudia Pelissari Kravchychyn, Cintia Campolina Duarte Rocha da Silva, Christiano Eduardo Veneroso, Nuno Pimenta, Tiago Rafael Moreira, Helton de Sá Souza and Sandro Fernandes da Silva
Physiologia 2026, 6(2), 44; https://doi.org/10.3390/physiologia6020044 - 22 Jun 2026
Viewed by 207
Abstract
Background/Objectives: Caffeine is a widely used ergogenic aid; however, evidence regarding its effects on neuromuscular and metabolic responses during resistance training remains limited. Therefore, this study aimed to analyze the effects of caffeine supplementation on blood glucose concentration and neuromuscular activation, assessed through [...] Read more.
Background/Objectives: Caffeine is a widely used ergogenic aid; however, evidence regarding its effects on neuromuscular and metabolic responses during resistance training remains limited. Therefore, this study aimed to analyze the effects of caffeine supplementation on blood glucose concentration and neuromuscular activation, assessed through electromyographic activity, during a muscular endurance test. Methods: Eleven resistance-trained men (25.7 ± 5.9 years) participated in this randomized, double-blind, crossover trial. Six laboratory visits were conducted, including one-repetition maximum (1RM) and maximal voluntary isometric contraction (MVIC) testing in the bench press exercise. From the second visit onward (baseline; BL), participants completed a 24 h dietary recall (24hDR), pre- and post-exercise blood glucose assessments, and a muscular endurance test performed at 80% of 1RM until concentric failure, while electromyographic activity was recorded from the clavicular and sternal portions of the pectoralis major, triceps brachii, and anterior deltoid. From the third visit onward, participants received one of the following randomized interventions 60 min before testing: low-dose caffeine (LC = 3 mg·kg−1), high-dose caffeine (HC = 6 mg·kg−1), low-dose placebo (LP = 230 mg), or high-dose placebo (HP = 460 mg). Results: There was an increase in the number of repetitions in all conditions vs. BL, with no significant differences (p > 0.05). Electromyographic activity did not differ between conditions (p > 0.05). Blood glucose decreased post-test in BL and placebo conditions (p < 0.05) but remained stable with caffeine (p > 0.05). Conclusions: Low and high doses of caffeine did not significantly affect muscular endurance performance or neuromuscular activation. However, caffeine supplementation appeared to attenuate the post-exercise decline in blood glucose concentration following exercise performed to concentric failure. Full article
(This article belongs to the Special Issue Resistance Training Is Medicine: 2nd Edition)
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13 pages, 724 KB  
Article
Meal-Specific and Qualitative Patterns of Ultra-Processed Food Consumption in Adults with Food Addiction and Excess Weight: A Secondary Cross-Sectional Analysis of a Randomized Controlled Trial
by Débora C. Ferro, Marianna V. C. Rocha, Thayná X. R. de Oliveira, Mariana K. de B. Lima, Cellyne V. da Silva and Nassib B. Bueno
Obesities 2026, 6(3), 43; https://doi.org/10.3390/obesities6030043 - 20 Jun 2026
Viewed by 248
Abstract
Evidence suggests that individuals with food addiction (FA) consume more ultra-processed foods (UPFs), but gaps remain regarding which types and at which meals. This study compared the types of UPFs consumed and the meals with the highest UPF density between individuals with and [...] Read more.
Evidence suggests that individuals with food addiction (FA) consume more ultra-processed foods (UPFs), but gaps remain regarding which types and at which meals. This study compared the types of UPFs consumed and the meals with the highest UPF density between individuals with and without FA. Food intake was assessed via 24 h dietary recalls, and foods were classified via the NOVA system and disaggregated into subgroups. FA was identified using the modified Yale Food Addiction Scale 2.0. Linear regression compared UPF consumption between groups, adjusted for confounders. A total of 144 participants were analyzed, and 26 (18%) met the criteria for FA. In multivariable analysis, the FA group had a higher UPF energy contribution (in %kcal) than those without FA (28.30% vs. 22.30%; p = 0.02), and a lower consumption of unprocessed and minimally processed foods (47.40% vs. 54.40%; p = 0.03). Higher consumption of ultra-processed sweets and confectionery (10.39% vs. 4.18%; p = 0.001) and greater UPF intake as part of the afternoon snack (8.34% vs. 4.67%; p = 0.005) were also observed in the FA group. UPF consumption differed between groups. Individuals with FA showed a sweets-dominant, meal-specific pattern with a higher intake of ultra-processed sweets and confectionery, concentrated during the afternoon snack. Full article
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26 pages, 4286 KB  
Article
National Food Consumption Survey (NIPNOD 2018–2023): Results of Dietary Habits and Diet Quality Among Adolescents in Croatia
by Ana Ilić, Ivana Rumbak, Martina Pavlić, Lidija Šoher, Daniela Čačić Kenjerić, Jasna Pucarin-Cvetković and Darja Sokolić
Children 2026, 13(6), 799; https://doi.org/10.3390/children13060799 - 10 Jun 2026
Viewed by 287
Abstract
Background/Objectives: In Croatia, national data on adolescents’ dietary habits are limited, resulting in a lack of evidence-based food-based dietary guidelines and public health interventions. This study aims to conduct an in-depth evaluation of dietary habits in a national sample of Croatian adolescents [...] Read more.
Background/Objectives: In Croatia, national data on adolescents’ dietary habits are limited, resulting in a lack of evidence-based food-based dietary guidelines and public health interventions. This study aims to conduct an in-depth evaluation of dietary habits in a national sample of Croatian adolescents stratified by region, sex and age, from the National food consumption survey on adolescents and adults (NIPNOD 2018–2023). Methods: This cross-sectional study included 258 adolescents (50.4% boys; aged 10 to < 18) from the NIPNOD 2018–2023 survey (OC/EFSA/DATA/2017/01), conducted according to the EU Menu methodology. For analysis, the sample was divided into two age groups (10–13 and 14–17 years). To assess dietary intake, two 24 h recalls were analyzed using NutriCro® v. 3.0 software. Dietary intake was compared with European Food Safety Authority dietary reference values (DRV). The contribution of 14 food groups to daily energy intake was analyzed. Diet quality was assessed using the Diet Quality Index for Adolescents (DQI-A). Results: The mean daily energy intake was 1820 ± 529 kcal, consisting of 45.5 ± 7.0% carbohydrates, 37.8 ± 6.3% fats, and 15.1 ± 3.1% protein. The observed two-day mean intake suggested that 51.6% of adolescents had carbohydrate intake within the EFSA DRV range, while 5.4% and 32.2% had protein and fat intake within the EFSA DRVs, respectively. The main contributors to daily energy intake were grains and grain products (31.5%), meat, poultry, fish, and eggs (18.1%), and cakes, confectionery, sweets, and sugar (14.9%). Frequent breakfast skipping and snack consumption were common, particularly among older adolescents. Adolescents had moderate overall diet quality (57.4 ± 11.6% DQI-A), with no differences between age groups. Conclusions: Analysis of the dietary habits of adolescents in Croatia indicates that most have inadequate macronutrient intake, irregular meal frequency, and moderate overall diet quality. These results highlight the need to develop public health strategies and interventions to improve dietary habits among adolescents in Croatia. Full article
(This article belongs to the Section Pediatric Gastroenterology and Nutrition)
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23 pages, 1596 KB  
Article
Comparative Effects of Donepezil and Tacrine on Recall-Related Exploratory Behavior in a Subacute Lipopolysaccharide-Induced Neuroinflammatory Model of Cognitive Impairment
by Adrian-Florentin Dragomir, Aurelia Cristiana Barbu, Smaranda Stoleru, Aurelian Zugravu, Maria Carina Dumitrescu, George Bazar, Cristina Isabel Viorica Ghita, Silvia Fratea, Clara Maria Stoleru, Oana Andreia Coman and Ion Fulga
Biomedicines 2026, 14(6), 1306; https://doi.org/10.3390/biomedicines14061306 - 9 Jun 2026
Viewed by 286
Abstract
Background/Objectives: Neuroinflammation is increasingly recognized as an important contributor to Alzheimer-like cognitive impairment. Lipopolysaccharide (LPS) is commonly used in experimental models to trigger systemic immune activation and behavioral alterations associated with neuroinflammation. This study aimed to validate a subacute LPS-induced model of recall-phase [...] Read more.
Background/Objectives: Neuroinflammation is increasingly recognized as an important contributor to Alzheimer-like cognitive impairment. Lipopolysaccharide (LPS) is commonly used in experimental models to trigger systemic immune activation and behavioral alterations associated with neuroinflammation. This study aimed to validate a subacute LPS-induced model of recall-phase impairment and to compare the effects of donepezil and tacrine on recall-related exploratory behavior in rats. Methods: Male Wistar rats were tested in a two-trial Y-maze paradigm consisting of an acquisition trial followed by a recall trial 24 h later. In the validation experiment, rats received saline or LPS 1 mg/kg intraperitoneally for four consecutive days. In the intervention experiment, rats received saline, LPS, or LPS combined with donepezil 1 or 3 mg/kg or tacrine 3 or 5 mg/kg. The primary recall-phase outcome was the unknown/known arm time ratio (U/K time ratio). Additional outcomes included arm times, arm entries, U/K entry ratios, discrimination indices, and mean time per entry. Results: Repeated LPS administration significantly reduced the U/K time ratio, decreased time- and entry-based discrimination indices, reduced time spent in the unknown arm, and decreased unknown-arm entries, without significantly altering acquisition-phase behavior, total entries, or mean time per entry. In the intervention experiment, donepezil 1 mg/kg and tacrine 5 mg/kg significantly increased the U/K time ratio compared with LPS. Discrimination indices and entry-based measures further supported a treatment-related shift toward novelty-directed exploration, while total arm entries and mean time per entry were not significantly changed. Conclusions: Subacute LPS administration produced a measurable recall-phase exploratory impairment in the Y-maze. Donepezil and tacrine attenuated several components of this impairment, with partially distinct dose-related behavioral profiles. Full article
(This article belongs to the Special Issue Animal Models for Neurological Disease Research)
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18 pages, 303 KB  
Article
Dairy Products Are Not Adversely Associated with Depressive Symptoms over 6 Years in the Hispanic Community Health Study/Study of Latinos
by Anne Bodenrader, Daniela Sotres-Alvarez, Maria Carlota Dao, Tammy M. Scott, Semra A. Aytur, Sabrina E. Noel, Qibin Qi, Linda C. Gallo, Martha Daviglus, Wassim Tarraf, Robert Kaplan and Sherman J. Bigornia
Nutrients 2026, 18(11), 1805; https://doi.org/10.3390/nu18111805 - 3 Jun 2026
Viewed by 467
Abstract
Background/Objectives: Current evidence suggests that Hispanic/Latino adults experience a disproportionate burden of depression. Dairy consumption has been associated with fewer depressive symptoms, but examinations in Hispanic/Latino cohorts are unavailable. Our objective was to measure the 6-year prospective associations between dairy consumption and [...] Read more.
Background/Objectives: Current evidence suggests that Hispanic/Latino adults experience a disproportionate burden of depression. Dairy consumption has been associated with fewer depressive symptoms, but examinations in Hispanic/Latino cohorts are unavailable. Our objective was to measure the 6-year prospective associations between dairy consumption and depressive symptoms among Hispanic/Latino adults. Methods: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a prospective population-based cohort study of 16,415 Hispanic/Latino adults residing in the US. We estimated daily dairy product consumption from two 24 h baseline dietary recalls using the National Cancer Institute method. The 10-item Center for Epidemiological Studies Depression Scale (CESD10) administered at baseline and follow-up assessed depressive symptoms. Survey multiple linear regression models adjusted for baseline CESD10 and other covariates, including sociodemographic, dietary and health factors. Standardized β coefficients represent the standard deviation difference in 6-year CESD10 score per one standard deviation increase in daily dairy intake at baseline. Complete data were available among 10,618 participants. Results: Neither baseline total dairy consumption (standardized β (95% CI); −0.019 (−0.048, 0.011)), nor milk (−0.006 (−0.029, 0.018)), cheese (0.038 (−0.006, 0.081)), or cream (−0.005 (−0.037, 0.028), p > 0.05 for all) consumption was significantly associated with the follow-up CESD10 score. Conversely, we observed a significant and inverse association between yogurt (−0.036 (−0.058, −0.013), p = 0.002) and butter (−0.049 (−0.092, −0.006), p = 0.027) with the CESD10 score. Conclusions: Total dairy, fat-based dairy groupings, milk, cheese, and cream were not associated with CESD10 score at 6-year follow-up; yogurt and butter showed inverse associations that require cautious interpretation due to very small effect sizes. Although additional prospective analyses in other diverse cohorts are needed to confirm these results, our findings suggest that dairy consumption is not adversely associated with depressive symptoms in Hispanic/Latino adults. Full article
(This article belongs to the Section Nutritional Epidemiology)
15 pages, 284 KB  
Article
Nutritional Status and Physical Activity Levels in Adult Patients with Phenylketonuria
by Damla Kalkan, Yılmaz Yıldız, Yiğitcan Karanfil, Feza Korkusuz, Ali Dursun, Serap Sivri and Hülya Gökmen Özel
Nutrients 2026, 18(11), 1804; https://doi.org/10.3390/nu18111804 - 3 Jun 2026
Viewed by 390
Abstract
Background/Objectives: Phenylketonuria (PKU) is a rare autosomal recessive disorder caused by phenylalanine hydroxylase (PAH) deficiency, impairing the conversion of phenylalanine (Phe) to tyrosine. Although early diagnosis and intervention yield excellent outcomes, dietary adherence often declines in adulthood, potentially leading to poor metabolic control [...] Read more.
Background/Objectives: Phenylketonuria (PKU) is a rare autosomal recessive disorder caused by phenylalanine hydroxylase (PAH) deficiency, impairing the conversion of phenylalanine (Phe) to tyrosine. Although early diagnosis and intervention yield excellent outcomes, dietary adherence often declines in adulthood, potentially leading to poor metabolic control and adverse nutritional consequences. This study aimed to evaluate physical activity levels, nutritional status, metabolic control, and anthropometric outcomes in adults with classic PKU, which have not been sufficiently researched in the current literature. Methods: This cross-sectional study included 100 adults with classical PKU (cPKU; baseline phenylalanine levels ≥ 1200 µmol/L) under regular follow-up at the Division of Metabolism, Hacettepe İhsan Doğramacı Childrens’ Hospital. Sociodemographic traits and dietary behaviors were evaluated through structured interviews carried out by a dietitian. Dietary intake was assessed by using a 24 h dietary recall method, and nutrient analyses were performed with the Bebis 7.2 software program. Using the short version of the International Physical Activity Questionnaire (IPAQ), physical activity levels were specified, and participants were categorized according to established scoring criteria. Results: A hundred adults with classical PKU took part in the study, including 47 males and 53 females, with a mean age of 23.84 ± 5.41 years; 5% of participants were underweight, 40% had normal weight, 39% were overweight, and 16% were listed as obese. The intake of mean daily energy is 2443.8 ± 384.6 kcal for men and 1822.5 ± 312.7 kcal for women. Carbohydrates contributed approximately 61% of total daily energy intake in both genders, whereas protein accounted for 12–13% and fat for approximately 26–27% of total energy intake; 17% of participants were physically inactive, 40% were minimally active, and 43% met criteria for sufficient physical activity according to IPAQ-based classification. Energy intake, the use of Phe-free protein substitutes, and BMI were significantly higher in the sufficiently active group compared to the low-active group in men, while no significant differences were observed between physical activity groups among women. Conclusions: Adults with classical PKU showed a high prevalence of overweight and obesity, together with differences in dietary intake and physical activity patterns. Physical activity levels were associated with several nutritional and metabolic characteristics; however, further long-term research is required to fully understand these connections. Full article
(This article belongs to the Special Issue Dietary Amino Acid Metabolism in Human Health and Disease)
16 pages, 1187 KB  
Article
Association of Sleep Quality, Nutritional Factors, and Salivary Melatonin and Cortisol Levels with Oral Lichen Planus: A Case–Control Study
by Éverton Adriano Wegner, Julia de Salles Teixeira, Gabriel Rübensam, Catieli Gobetti Lindholz, Fernanda Gonçalves Salum and Karen Cherubini
Biomedicines 2026, 14(6), 1275; https://doi.org/10.3390/biomedicines14061275 - 3 Jun 2026
Viewed by 400
Abstract
Background/Objectives: The etiology of oral lichen planus (OLP) is unknown, and the treatment is palliative. Considering the possible influence of factors related to lifestyle on the etiopathogenesis and behavior of OLP, the aim of the present study was to investigate the association [...] Read more.
Background/Objectives: The etiology of oral lichen planus (OLP) is unknown, and the treatment is palliative. Considering the possible influence of factors related to lifestyle on the etiopathogenesis and behavior of OLP, the aim of the present study was to investigate the association of sleep quality, nutritional profile, and salivary melatonin and cortisol levels with OLP. Methods: Thirty-two OLP patients and 31 controls completed the Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale, and 24 h dietary recall survey. Saliva was collected to determine melatonin and cortisol levels by liquid chromatography coupled to mass spectrometry. Results: The OLP patients showed higher scores in the sleep disturbances component of PSQI (p = 0.021) and lower salivary melatonin levels (p = 0.015), whereas salivary cortisol did not differ between the groups (p = 0.402). The Control group had higher prevalence of coffee drinkers (p = 0.045), whereas the OLP group had higher consumption of protein (p = 0.011), lipids (p = 0.043), calories (p = 0.022), monounsaturated fat (p = 0.030), polyunsaturated fat (p = 0.007), saturated fat (p = 0.027), cholesterol (p = 0.041), iron (p = 0.014), zinc (p = 0.048), magnesium (p = 0.025), sodium (p = 0.008), and vitamin E (p = 0.016) compared to controls. Conclusions: The results suggest that OLP is associated with lifestyle factors related to sleep and diet, as well as with lower levels of salivary melatonin. Given the exploratory nature of the study, further research is needed to better understand these findings. Full article
(This article belongs to the Special Issue Oral Oncology and Potentially Malignant Disorders)
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19 pages, 524 KB  
Article
Impact of Nutrition Education on Nutrition Knowledge, Attitudes, Practices, and Immune-Related Nutrient Intake in People Living with HIV: A Randomized Controlled Trial
by Souheir M. Alia, Taoufik L. Zoubeidi and Habiba I. Ali
Nutrients 2026, 18(11), 1709; https://doi.org/10.3390/nu18111709 - 27 May 2026
Viewed by 501
Abstract
Objective: Nutrition is critical for people living with human immunodeficiency virus (PLHIV); nonetheless, nutritional interventions have not been conducted among PLHIV in the Middle East and North Africa region. This study evaluated the effects of a nutrition-related education intervention on total knowledge, [...] Read more.
Objective: Nutrition is critical for people living with human immunodeficiency virus (PLHIV); nonetheless, nutritional interventions have not been conducted among PLHIV in the Middle East and North Africa region. This study evaluated the effects of a nutrition-related education intervention on total knowledge, attitude, and practice (KAP) scores and on the intake of immune-enhancing foods and nutrients among PLHIV. Methods: Sixty-three PLHIV were recruited from an outpatient HIV clinic in Dubai, United Arab Emirates, between August and November 2023 and randomly assigned to an intervention (n = 31) or control group (n = 32). The intervention group participated in an individualized, six-session nutrition education program based on the Health Belief Model, whereas the control group received usual care plus a nutrition education brochure on HIV nutrition and health. Data were collected at baseline and after the five-month intervention period using validated instruments assessing HIV-related nutrition knowledge, attitudes, and practices. A food frequency questionnaire and two non-consecutive 24 h dietary recalls were used to assess the intake of immune-enhancing nutrients. Results: Post-intervention KAP score distributions differed significantly between the control and intervention groups for knowledge, attitude, and practices (p < 0.001, 0.003, and 0.001, respectively). Immune-enhancing vitamin intake did not differ significantly between groups, except vitamin E, which increased in the intervention group (p = 0.042). Conclusions: The intervention improved participants’ nutrition-related KAP scores but did not increase the intake of immune-enhancing nutrients, except for vitamin E. Further studies are warranted to develop interventions that improve the intake of immune-enhancing nutrients. Full article
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22 pages, 31225 KB  
Article
SAR-Based Flood Extent Mapping with a Lightweight Siamese U-Net and Differential Attention Mechanism
by Ahmet Kaçmaz and Ugur Alganci
Earth 2026, 7(3), 87; https://doi.org/10.3390/earth7030087 - 25 May 2026
Viewed by 509
Abstract
Floods are among the most catastrophic natural disasters globally, causing significant damage to both life and infrastructure. Consequently, immediate and accurate assessment of inundated areas is critical for effective emergency response. While optical remote sensing is typically used for flood assessment, it is [...] Read more.
Floods are among the most catastrophic natural disasters globally, causing significant damage to both life and infrastructure. Consequently, immediate and accurate assessment of inundated areas is critical for effective emergency response. While optical remote sensing is typically used for flood assessment, it is often ineffective during active flood events due to persistent cloud cover and precipitation. To address this, this research develops a deep learning method utilizing Synthetic Aperture Radar (SAR), which offers all-weather, 24 h imaging capabilities. Specifically, an attention-based differential Siamese U-Net was developed to detect temporal changes in bi-temporal SAR imagery (e.g., Sentinel-1) acquired before and after flood events. The method was evaluated on the S1GFloods dataset, comprising 5360 bi-temporal Sentinel-1 SAR image pairs across 46 flood incidents on six continents. Experimental results demonstrate a flood Intersection over Union (IoU) of 92.43%, an F1 score of 96.07%, and a recall of 97.64%. These metrics rank the proposed approach third overall among top-performing methods on this dataset. Notably, the high recall rate indicates the model is particularly beneficial for emergency response, as it minimizes the number of undetected flooded areas. Despite utilizing a CNN-based architecture that is less complex than Vision Transformer models, this method achieves results comparable to the state-of-the-art DAM-Net, with a performance difference of only 0.77%. Full article
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16 pages, 2622 KB  
Article
Marbling Matters: Lean and Fatty Red Meat Show Opposing Associations with Brain Structural Indices
by Brandon S. Klinedinst, Alice L. Dawson, Michael DelCasale, Arjun Venkateswaran and Auriel A. Willette
Nutrients 2026, 18(10), 1635; https://doi.org/10.3390/nu18101635 - 21 May 2026
Viewed by 789
Abstract
Background/Objectives: Red meat is often treated as a single dietary category in nutritional epidemiology, despite substantial heterogeneity in fat content, quality parameters, and preparation methods. This may obscure meaningful associations with brain aging. We tested whether global brain structural associations differed across lean [...] Read more.
Background/Objectives: Red meat is often treated as a single dietary category in nutritional epidemiology, despite substantial heterogeneity in fat content, quality parameters, and preparation methods. This may obscure meaningful associations with brain aging. We tested whether global brain structural associations differed across lean red meat, fatty red meat, pork, processed pork, and organ meat in a large community-based neuroimaging cohort. Methods: Participants were 45,811 UK Biobank adults aged 50 to 80 years with structural MRI, dietary recall, and covariate data. Dietary intake was assessed using up to five administrations of the Oxford WebQ 24 h recall and averaged across available timepoints. Global cortical thickness, total gray matter volume, and total white matter volume were derived from T1-weighted MRI. Continuous predictors were screened for linear quadratic, or spline form prior to grouped penalized variable selection. Final multivariable models incorporated sensitivity analyses stratified by socioeconomic status (SES) and sex. Results: Associations with global brain structure differed by meat type and fat content. Lean red meat showed the most favorable overall pattern, including modest nonlinear favorable association with global cortical thickness and a positive association with white matter volume among higher-SES participants. Fatty red meat showed unfavorable associations with cortical thickness and gray matter volume. Pork showed an unfavorable association with cortical thickness. Organ meat showed an unfavorable association with gray matter volume and with white matter volume among lower-SES participants. Overall, findings suggested that lean red meat tracked with neutral-to-favorable brain structural correlates, whereas fattier red meat and organ meat generally tracked with less favorable structural outcomes. Conclusions: Meat did not relate to global brain structure as a single uniform exposure. Instead, associations differed meaningfully by meat type, fat content, and socioeconomic context. Treating red meat as a single undifferentiated exposure may flatten biologically relevant heterogeneity and contribute to mixed prior findings. These results support more precise dietary phenotyping in brain-health research and suggest that distinctions in meat quality may matter when evaluating long-term brain aging. Findings should not be interpreted to suggest that unlimited meat intake is broadly health-promoting, even if lean, given the established cardiometabolic and vascular risks associated with excess intake of high-fat or processed meats. Full article
(This article belongs to the Section Nutrition and Neuro Sciences)
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27 pages, 1229 KB  
Article
From Access to Adaptation: Household Food Dynamics Under COVID-19 Lockdowns in Tygerberg, Western Cape, South Africa
by Xikombiso Mbhenyane, Rushaan Ruiters and Mthokozisi Zuma
Sustainability 2026, 18(10), 5126; https://doi.org/10.3390/su18105126 - 19 May 2026
Viewed by 326
Abstract
The COVID-19 pandemic prompted governments to implement lockdowns and social distancing measures to curb transmission, which, in South Africa, disrupted economic activity, reduced household income, and challenged the sustainability of household food access. This study assessed food accessibility, availability, dietary diversity, food security [...] Read more.
The COVID-19 pandemic prompted governments to implement lockdowns and social distancing measures to curb transmission, which, in South Africa, disrupted economic activity, reduced household income, and challenged the sustainability of household food access. This study assessed food accessibility, availability, dietary diversity, food security status, and coping strategies among households in the Tygerberg region during lockdowns. A cross-sectional design was employed using a researcher-administered questionnaire to collect sociodemographic and household data. Food security was assessed using the Household Food Insecurity Access Scale and the Household Food Security Survey Module, dietary diversity using a 24 h recall, and coping strategies through a standardized tool. Among the 432 households surveyed, 62% reported reduced income during lockdowns, while approximately 80% experienced food insecurity in the preceding 30 days and 72% over the past year. Dietary diversity was low in 47.3% of households, consuming fewer than seven food groups, and medium in 46.4%, consuming eight to eleven food groups. Common coping strategies included purchasing cheaper, less preferred foods, skipping meals, and reliance on social relief measures such as food parcels and the Social Relief of Distress grant. Overall, while food availability remained relatively stable, economic access emerged as the principal constraint, undermining dietary quality and household resilience and highlighting the need for income-responsive and socially sustainable food security interventions to strengthen urban food system resilience during prolonged socio-economic shocks. Full article
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41 pages, 47516 KB  
Article
Clinicopathological Characteristics and Prediction of Overall Survival and Death Within 2 Years in Diffuse Large B-Cell Lymphoma Based on Histological Images and Deep Learning
by Joaquim Carreras
Biomedicines 2026, 14(5), 1134; https://doi.org/10.3390/biomedicines14051134 - 17 May 2026
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Abstract
Background: Diffuse large B-cell lymphoma (DLBCL) is one of the most frequent lymphomas. To date, it is not possible to identify which DLBCL patients will have an aggressive clinical evolution only by using hematoxylin and eosin (H&E) histological images. Methods: This [...] Read more.
Background: Diffuse large B-cell lymphoma (DLBCL) is one of the most frequent lymphomas. To date, it is not possible to identify which DLBCL patients will have an aggressive clinical evolution only by using hematoxylin and eosin (H&E) histological images. Methods: This study predicted the prognosis of DLBCL using H&E images, computer vision and deep learning. The series included 114 DLBCL cases, split into 2 prognostic groups according to overall survival, and 44 cases of reactive lymphoid tissue. Results: The curve fitting and slope analysis showed a point of inflection at 2 years (24 months), which differentiated patients with aggressive clinical evolution (“Dead < 2 years”, b1 = −0.024) from the rest with moderate clinical evolution (“Others”, b1 = −0.003). Twenty different convolutional neural networks (CNNs) were used, and explainable artificial intelligence (XAI) was also applied. The final model based on DarkNet-19 predicted prognosis groups with high performance (test set accuracy = 96.3%). The other performance parameters were precision (94.5%), recall (95.0%), false positive rate (3.1%), specificity (96.9%), and F1 score (94.7%). XAI, including grad-CAM, occlusion sensitivity, and image-LIME, confirmed that the CNN focused on the correct areas. Hybrid partitioning to prevent information leakage with patient-based analysis, image classification between DLBCL and 44 cases of reactive lymphoid tissue, and hyperparameter tuning were also successfully performed. Correlation with the clinicopathological characteristics found that the Dead < 2 years group was correlated with stage III–IV, International Prognostic Index (IPI) High + High/intermediate, progressive disease, non-GCB cell-of-origin, CD10−, BCL2+, and Epstein–Barr virus (EBER)+. Analysis of the microenvironment, immune checkpoint, cell cycle, and germinal center markers showed that Dead < 2 years had higher IL10, PD-L1, and CD163 levels and lower E2F1 protein expression. No differences were found for Ki67, CSF1R, CASP8, TNFAIP8, LMO2, MYC, MDM2, CDK6, and TP53 markers at a quantitative level. Conclusions: The DLBCL overall survival can be predicted using H&E histological images and deep learning using the 2-year (24 months) point (similar to POD24). This trained CNN can be used as a pretrained model for transfer learning in the future. Full article
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16 pages, 826 KB  
Article
Designing a Food Frequency Questionnaire for a Vegetarian Population in Germany by Means of Mixed-Integer Linear Programming
by Julia Blaurock, Thorsten Heuer and Kurt Gedrich
Nutrients 2026, 18(10), 1587; https://doi.org/10.3390/nu18101587 - 16 May 2026
Viewed by 296
Abstract
Background: Food frequency questionnaires (FFQs) are important tools for dietary assessment in large epidemiological studies, playing a crucial role in evaluating the relationship between diet and health. However, adapting the food lists in FFQs to align with specific study objectives or target populations [...] Read more.
Background: Food frequency questionnaires (FFQs) are important tools for dietary assessment in large epidemiological studies, playing a crucial role in evaluating the relationship between diet and health. However, adapting the food lists in FFQs to align with specific study objectives or target populations presents a considerable challenge. Methods: The present study develops a framework using mixed-integer linear programming (MILP) to minimize the food list of an FFQ using a vegetarian population in Germany as a proof of concept. Constraints of the optimization ensured that the selected food items have a certain nutrient coverage and variance coverage, as well as an appropriate aggregation level. Nutrient intake for three scenarios for FFQs was compared with 24 h recalls (24HR) using R2, calculated through linear regression. The three scenarios were: 1. FFQ reflecting the effect of categorizing portion sizes, 2. FFQ reflecting the effect of selecting food items, 3. FFQ reflecting the effect of categorizing portion sizes and selecting food items. Results: Length of minimized FFQs increased with a higher proportion of nutrient coverage and variance coverage. Including aggregation of food items produced shorter FFQs than FFQs that only contain food items at a lower aggregation level. R2 values across the three scenarios showed that the FFQ captured most of the between-person variation in nutrient intake that was observed in the 24HR. Conclusions: MILP offers a reliable and data-driven framework for compiling optimized FFQs. Full article
(This article belongs to the Section Nutrition Methodology & Assessment)
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13 pages, 263 KB  
Article
An Examination of the Effect of Yogurt Consumption on Nutrient Quality of the Diets of Canadians Across the Ages
by Hrvoje Fabek, Mavra Ahmed, Sylvie S. L. Leung Yinko, Peggy Drouillet-Pinard and G. Harvey Anderson
Nutrients 2026, 18(10), 1581; https://doi.org/10.3390/nu18101581 - 15 May 2026
Viewed by 685
Abstract
Background/Objectives: Dairy yogurts are a source of protein and micronutrients in the Canadian diet. However, Canada’s Food Guide emphasizes the consumption of plant-based foods, which is facilitated by a greater availability of dairy alternatives on the market. The nutritional composition of these products [...] Read more.
Background/Objectives: Dairy yogurts are a source of protein and micronutrients in the Canadian diet. However, Canada’s Food Guide emphasizes the consumption of plant-based foods, which is facilitated by a greater availability of dairy alternatives on the market. The nutritional composition of these products varies and can differ from dairy foods such as yogurt, which contain high-quality protein and micronutrients. The objective of this study was to examine the effect of dairy yogurt consumption as part of a diet on any given day on nutrient intakes in Canadians across ages. Methods: The 2015 Canadian Community Health Survey (CCHS)—Nutrition first day 24 h recalls of males and females > 1 years of age (n = 17,308) and of yogurt consumers (n = 3788) were examined to estimate nutrient intakes arising from yogurt consumption. Respondents were allocated into four groups defined by their daily yogurt intake in grams (i.e., Group I/non-yogurt consumers: <1 g; Group II: 1–90 g; Group III: 90–115 g; Group IV: >115 g). Results/Conclusions: The results of this study provide timely data on Canadian yogurt consumption across the ages and show that those consuming yogurt have higher intakes of essential nutrients, such as protein, calcium, potassium, vitamin D, and dietary fibre. The data from this study emphasize the importance of yogurt in the context of a healthy eating pattern and emphasize the need to encourage consumption of yogurt within Canada’s Healthy Eating Strategy. Full article
(This article belongs to the Section Nutrition and Public Health)
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