Search Results (373)

Introduction: Restrictive diets are increasingly encountered in pediatric practice and may be adopted voluntarily or prescribed for medical conditions. Although they can support normal growth when appropriately planned, exclusion of nutritionally important foods may increase the risk of nutrient inadequacy. This narrative review examined nutritional deficiencies and laboratory monitoring in children following plant-based, food-allergy elimination, gluten-free, ketogenic, and protein-restricted diets for inherited metabolic disorders. Methods: Targeted searches of PubMed, Scopus, and Web of Science were conducted through 30 June 2026 using pediatric, diet-specific, nutritional-status, and biomarker terms. Because this was a narrative review, the literature was selected and synthesized qualitatively rather than through a formal systematic-screening process; no fixed study count, duplicate independent screening, or formal risk-of-bias assessment was performed. Professional guidelines and position papers were prioritized when discussing monitoring considerations, while pediatric studies were used to describe dietary intake, biochemical findings, clinically manifest deficiency, and growth outcomes. Results: Nutritional risks differed according to the foods or nutrients restricted. Vitamin B12 and iron were major concerns in plant-based diets, whereas cow’s milk and multiple-food elimination increased the risk of inadequate calcium, vitamin D, iodine, protein, and energy intake. Gluten-free diets were commonly associated with low fiber, iron, folate, and B-vitamin intake, particularly when refined, non-fortified products predominated. Ketogenic dietary therapy required attention to selenium, vitamin D, bone-related minerals, carnitine in selected patients, and linear growth. In phenylketonuria and related disorders, nutritional adequacy depended strongly on protein-substitute adherence and appropriate provision of essential amino acids and micronutrients. Across all dietary patterns, laboratory results required interpretation in relation to dietary intake, growth, supplementation, inflammation, medication, and the underlying condition. Across dietary patterns, inadequate intake, biochemical abnormalities, clinically manifest deficiency, and impaired growth were considered related but distinct outcomes. Conclusions: Nutritional monitoring should be individualized and based on the actual dietary restriction and clinical risk. The principal contribution of this review is a practical, risk-based framework that links the specific dietary restriction and adequacy of replacement foods with growth, symptoms, supplementation, and targeted laboratory biomarkers. Full article

Background/Objectives: The semi-solid enteral nutrition method, in which semi-solid nutrients are administered through a gastrostoma rather than liquid nutrients, is a medical technology for nutritional management developed in Japan. This nutritional method has spread rapidly, and in 2018, the Home Semi-solid Enteral Nutrition Guidance and Management fee was newly established in the payment system for medical services. However, there are few studies evaluating this nutrition method in actual clinical practice. Methods: Using the DeSC medical claims database, we investigated patient characteristics, the number of fee calculations, and the length of hospital stay for all hospitalizations and for pneumonia during and after fee calculation. Results: Home semi-solid enteral nutrition guidance and management was received at least once by 3105 patients (mean age: 79.4 years). Cerebrovascular disease, nervous system disease, dementia, and pneumonia were the most common diseases at the start of guidance and management, and the mean number of sessions received was 7.7. The mean length of stay for any hospitalization was significantly shorter during the guidance and management period than after the last guidance and management session (8.2 vs. 29.1 days). Notably, the mean length of hospital stay for pneumonia was also significantly shorter during the guidance and management period than after the last guidance and management session (3.1 vs. 10.2 days). Conclusions: This study clarified the calculation status of the Home Semi-solid Enteral Nutrition Guidance and Management fee and outcomes of patients who received this guidance and management. These findings suggest that the provision of this guidance and management may be associated with the shorter length of hospital stay. However, because residual confounding cannot be ruled out, a causal relationship cannot be established. Overall, the provision of this guidance and management may be associated with maintaining stable home care. Full article

Background/Objectives: Financial monitoring of public health programmes frequently relies on budget execution indicators, which may not fully reflect operational performance. This study evaluated the financial and operational performance of Romania’s National Programme for Women’s and Children’s Health at the county level and examined how resource utilisation coexisted with programme activity, coverage of the eligible population, and local implementation profiles during 2021–2024. Methods: A longitudinal descriptive observational study was conducted using aggregated administrative data from Bacău County, Romania. Financial indicators included annual budget allocations, actual expenditures, budget execution rates, and mean cost per beneficiary. Operational indicators included activity volume, reported coverage of eligible populations, and continuity of implementation. Monetary values were converted into constant 2024 prices. Descriptive and comparative trend analyses were performed. Results: The mean budget execution rate was 84.08%, ranging from 68.70% to 94.93%. Screening interventions generated the highest activity volumes and lowest unit costs, whereas prophylactic and nutritional interventions accounted for most programme expenditure. Reported coverage varied substantially across interventions, particularly for neonatal hearing screening. Similar budget execution rates were associated with distinct operational profiles. Conclusions: Budget execution alone did not adequately reflect programme performance. Integrated monitoring of financial and operational indicators may support more effective programme management and resource allocation. Full article

Background: Sarcopenia and malnutrition may contribute to persistent functional vulnerability after lung transplantation, yet their prevalence using actual criteria, relationship and clinical correlates remain incompletely defined. Methods: Ninety-nine adult lung transplant recipients (Ltx) were included in the study during their routine follow-up. Sarcopenia was defined using EWGSOP2 criteria, integrating muscle strength, dual-energy X-ray absorptiometry-derived appendicular lean mass, and physical performance. Malnutrition was assessed using GLIM criteria before transplantation and at follow-up. Clinical, nutritional, biological, body-composition, and pulmonary-function variables were compared according to sarcopenia status. Results: Sarcopenia was identified in 17 recipients (17.2%), including 12 (12.1%) with severe sarcopenia. Malnutrition was frequent before transplantation and persisted at follow-up, affecting 52 of 98 recipients (53.1%) before transplantation and 23 of 99 recipients (23.2%) after transplantation. Sarcopenia was related to underlying diseases leading to transplantation (mainly COPD and ILD) and sarcopenic Ltx were older (66.1 ± 6.7 vs. 57.7 ± 12.6 years; p = 0.05), had greater smoking exposure (38.2 ± 25.6 vs. 22.2 ± 20.2 pack-years; p = 0.02) and prednisone dose (13.5 ± 8.1 vs. 8.9 ± 2.7 mg/day; p = 0.001). Despite a trend towards lower albuminemia (40.5 ± 4.7 vs. 42.1 ± 4.3 g/L; p = 0.07), malnutrition was not associated with sarcopenia status. Lung function improved substantially after transplantation, with mean FEV₁ increasing from 25.7 ± 16.6% to 82.0 ± 25.4% predicted at assessment (p < 0.001); however, FEV₁ at assessment did not differ considering sarcopenia status. Conclusions: In lung transplant recipients, EWGSOP2-defined sarcopenia was common and largely uncaptured by BMI, malnutrition status, routine biomarkers, adiposity indices, or spirometry recovery. Malnutrition was reduced by personalized nutritional support but persisted in many patients, supporting more systematic muscle-health and nutritional assessment to allow reduced post-transplant morbidity. Full article

Higher Education Institutions (HEIs) are vital leverage points for climate action, yet the role of campus food environments in supporting these commitments is rarely assessed. This mixed-methods diagnostic study examined the food environment, sustainability literacy, behavioural barriers, and reported preferences regarding plant-based eating at a major European university. Across 29 campus canteens, plant-based meals accounted for only 17.2% of menu options and less than 1% of actual meal volume, with substantial inconsistency in availability and labelling across weekdays and canteens. Student survey findings (n = 198) revealed low food sustainability literacy: 64.7% of participants failed the assessment, particularly males (78.1%) and omnivores (75.7%). Among omnivore respondents, the most frequent barriers to adopting plant-based diets were ideological resistance, nutrition concerns, palatability, convenience, and cost. Students most strongly endorsed improved taste, more options (70.2%), and lower prices (62.1%) as strategies to encourage plant-based choices. Taken together, these findings highlight a structural implementation gap between institutional sustainability commitments and the campus food environment. They underscore the need for targeted interventions to improve food sustainability literacy and to increase the availability and attractiveness of plant-based options required for climate mitigation. To address this systemic challenge, this paper proposes a scalable HEI Food Transition Framework, informed by the results, that integrates choice architecture, curricular reform, inclusive provisioning, and data-driven accountability, offering a strategic pathway to align campus food environments with the United Nations Sustainable Development Goals. Full article

Background/Objectives: The obesity epidemic coexists with the phenomenon of “hidden hunger” (Type B malnutrition)—a micronutrient deficiency amidst a caloric excess. Traditional dietary assessment methods often distort the actual picture by ignoring technological losses during cooking, which necessitates the use of digital tools. Methods: A cross-sectional study (N = 3267) was conducted using the digital platform “NIAP”. The analysis was based on valid 3–7-day dietary records with algorithmic accounting for nutrient retention factors during thermal processing. The nutrient profiles of individuals with a normal body mass index (BMI) and obesity (BMI ≥ 30 kg/m²) were compared. Results: The epidemiology of intake shortfalls was highly prevalent and pronounced: 99.9% of the cohort had ≥1 inadequacy (with a mean negative deviation of −77.3% for vitamin D and −59.2% for Omega-3), and 61.5% exhibited ≥10 simultaneous multiple intake shortfalls. These inadequacy rates remained robust in a sensitivity analysis excluding under-reporters. The obesity group consumed significantly more energy, saturated fatty acids, added sugars, cholesterol, and sodium, but demonstrated a lower relative macronutrient intake (g/kg of body weight). Absolute fiber intake did not differ between the groups, indicating a decrease in its density per 1000 kcal in the diet of individuals with obesity; the intake of Omega-3 polyunsaturated fatty acids (PUFAs) showed a downward trend. The Na:K ratio was significantly higher in the obesity group (1.19 vs. 1.04, p < 0.001). Correlation analysis confirmed an inverse relationship between BMI and the overall nutrient density of the diet. Conclusions: A high-energy diet does not compensate for systemic micronutrient inadequacy among the evaluated cohort. Obesity is associated with a dietary imbalance favoring “empty calories” and pro-inflammatory components against a background of severe multiple dietary inadequacies. The integration of algorithmic dietary assessment that accounts for cooking losses is critical for objective diagnosis and personalized nutritional intervention. Full article

This study evaluated the effects of replacing alfalfa hay with sulla [Sulla coronaria (L.) B.H. Choi & H. Ohashi] hay or sulla haylage in pasture-based diets for lactating Sarda ewes on milk production, milk composition, and nutrient utilization efficiency. Seventy-two mid-lactation ewes were assigned to three dietary treatments for 56 days—alfalfa hay (AH), sulla hay (SH), or sulla haylage (SHL)—all combined with 3 h/day grazing and a fixed amount of supplemental concentrate. The diets were formulated to be theoretically isoenergetic and isoproteic. Pasture nutritive value was generally comparable among the groups throughout the experimental period. Milk yield did not differ among treatments; however, fat- and protein-corrected milk (FPCM) and milk fat and protein concentrations were higher in AH compared with the sulla-based diets. Actual nutrient intake differed among treatments, with nitrogen intake (NI) being greatest in AH, consistent with the higher milk urea concentration observed in this group. Estimated apparent energy utilization efficiency (FPCM/UFL intake) showed treatment-associated differences in exploratory analyses, with lower values observed in SH compared with AH and SHL. Similarly, exploratory estimates of apparent nitrogen utilization efficiency (Milk N/NI) were highest in SHL, intermediate in SH, and lowest in AH (p < 0.001). Condensed tannins were not detected in the conserved sulla forages under the analytical conditions adopted in this study. Therefore, the observed responses were unlikely to be directly associated with detectable condensed tannin activity. Overall, the results suggest that forage conservation method may influence milk composition and estimated apparent nutrient utilization indices, with sulla haylage showing higher exploratory estimates of apparent nitrogen utilization efficiency without negative effects on milk yield under the conditions of the present study. Full article

Background/Objectives: Given the limited evidence internationally, this qualitative study employed discovery interviews to explore the lived experience of patients who developed Hospital-Acquired Malnutrition (HAM) and that of their carers. Methods: Seven (two patients [(n = 1 female] and five carers [n = 3 female]) completed discovery interviews with an experienced independent interviewer. Carers were either spouses or parents. Responses were thematically analyzed using a constant comparative approach. Results: A key theme was ‘It’s not about the food, it’s the hospital system’ with the needs of the system dominating, including when patients were feeling at their worst. Subthemes were ‘integration of care’ and ‘patient acuity’, including symptoms that impacted food intake. Another theme was ‘Who is looking out for the patient?’, exploring ‘reliance on carer advocacy’, and ‘variation in staff involvement’. One carer said, “… the girl that delivered the meal tray was the only one in our hospital stay who actually said to [the patient], ‘I’m so glad you’re sitting up. I was worried about you because you hadn’t eaten for so long?” A persistent but comparatively less strong theme was ‘When it is about the food’ which explored ‘the quality of the food’ and ‘receiving information on eating and drinking’. Conclusions: The three key themes identified from carers and patients were hospital system impacts, care co-ordination and, less strongly, experiences with food quality and information. The key opportunities to prevent, or better support the nutritional care of patients with, HAM may be through improving systems and care co-ordination. Full article

Developing functional foods that address both oxidative stress and physiological challenges like dysphagia is a critical frontier in personalized nutrition. This study investigates the multi-component synergy of Fu Ling Yin Zi (FLYZ), a traditional dietary therapy, and translates its functional properties into a 3D-printed dysphagia-friendly food. Using response surface methodology, the optimal FLYZ formulation was established at a 5:1:5 ratio of Poria cocos (Schw.) Wolf., Amygdalus communis Vas, and Citrus reticulata. Network pharmacology and molecular docking suggested that FLYZ’s active compounds (e.g., nobiletin, stigmasterol, tangeretin, l-SPD, glabridin, estrone) may mitigate oxidative stress via multiple targets (PTGS2, AKT1, TNF, ESR1, MMP9, and MAOA), with pathway analysis pointing to a potential role of the AKT1/GSK3β/HIF-1α axis. Subsequent in vitro cellular assays demonstrated that FLYZ enhanced antioxidant enzyme activities, reduced intracellular ROS, and modulated the expression of associated genes, supporting a potential link to this pathway. To actualize these functional benefits for patients with swallowing difficulties, a novel 3D-printing ink incorporating FLYZ and walnut oil within a hydrogel matrix (3% xanthan gum, 3% pectin, 1.5% carrageenan) was developed. The printed constructs exhibited excellent shape fidelity and, based on standardized IDDSI fork and spoon tests, were categorized as level 4 (pureed/extremely thick). Furthermore, a simulated in vitro digestion model showed that the colloidal network significantly protected FLYZ’s polyphenols and flavonoids, markedly improving their bioaccessibility and post-digestion antioxidant capacity. Collectively, this work establishes an integrated approach that combines predictive molecular profiling with advanced 3D food printing, thereby supporting the development of future foods tailored for personalized nutrition. Full article

A stable gut microbial community (SGMC) created by the culture of fecal samples in a chemostat-based gut model is a physiologically relevant, reproducible tool for ecological research on the gut microbiome. It is also a subject of continuous improvement for the model to better mimic the in vivo system. In this research, compositions of fecal homogenates and the derived SGMC were analyzed based on shotgun metagenomic sequencing. It was found that taxa in the fecal inocula could be divided into resilient or sensitive types according to their response to environmental factors; taxa were sorted into three subsets—shared, emerged, and lost—by how they were represented in the established communities. The first two subsets consisted of resilient species, constituting an SGMC, which was suitable for long-term, ecological research. In contrast, species of the lost subset were sensitive to the new environmental conditions and were missing from the SGMC. However, these lost species may carry host-dependent information that is useful or even critical for drug and functional foods development or nutrition research. The differentiation between the three subsets reveal the community shift and metabolic profile along with SGMC formation and could serve as a diagnosis for understanding the extent to which the SGMC mimics, or differs from, the actual ecosystem in vivo or the donor’s fecal samples, which may be useful in work to upgrade in vitro models. Full article

Food allergies impose strict constraints on dietary decision-making, necessitating recommender systems that guarantee safety without compromising nutritional quality or user satisfaction. Existing systems often treat safety as a preference, failing to meet rigorous safety-critical standards or account for complex interactions between allergens, nutrition, and visual appeal. To address this issue, we propose a structured, multi-objective recipe recommendation framework. In this framework, rather than being modeled as an additive objective, allergen safety is prioritized through a safety-aware penalty-based ranking mechanism. The framework integrates three core modules: an allergen safety score accounting for cross-reactivity and cooking conditions; a nutritional balance score aligned with Dietary Reference Intakes (DRIs); and a neural-derived visual appeal score. In evaluation, we conducted a controlled user study ($N=20$) to evaluate the framework against single-factor baselines. Our integrated strategy consistently outperforms all single-factor baselines across evaluated metrics. Sensitivity analysis further confirms that safety-aware ranking ensures stable recommendation behavior across diverse preference profiles. Notably, behavioral analysis revealed a decision–action discrepancy, wherein users exhibited more risk-averse behavior during actual interactions than their explicitly stated preferences suggested. These findings suggest that prioritizing safety through safety-aware ranking mechanisms, together with multi-objective optimization, provides a robust foundation for personalized health-aware dietary support. Full article

Background: While recent literature emphasizes the predictive value of composite inflammatory and nutritional indices for vascular outcomes, this study evaluates the actual predictive capacity of preoperative indices (PNI, GNRI, SII, NLR, PLR) for de novo arteriovenous fistula (AVF) maturation and 1-year primary patency. Methods: We retrospectively analyzed 945 end-stage renal disease patients who underwent strictly radio-cephalic autologous AVF creation. Preoperative indices were calculated from routine parameters. Diagnostic accuracy for predicting 1-year patency loss was assessed using receiver operating characteristic (ROC) curves, and a multivariate logistic regression model was constructed to adjust for baseline anatomical and clinical variables. Targeted subgroup analyses evaluated high-risk populations, including those with diabetes, coronary, and peripheral artery disease. Results: The 1-year primary and secondary patency rates were 73.3% and 93.1%, respectively. In contrast to prevalent reports, no significant differences in preoperative PNI, GNRI, NLR, PLR, or SII scores existed between patients with patent and thrombosed fistulas (p > 0.05). ROC analyses showed no predictive utility (AUC: 0.476–0.518). Crucially, multivariate logistic regression revealed that preoperative arterial (OR: 0.58, p < 0.001) and venous diameters (OR: 0.51, p < 0.001) were the strongest independent predictors of AVF failure, whereas all systemic biomarkers lacked independent predictive significance. Subgroup analyses confirmed these indices failed to predict AVF outcomes even in high-risk settings with severe endothelial dysfunction. Conclusions: Preoperative composite nutritional and inflammatory indices do not independently predict AVF maturation or long-term patency when adjusted for local anatomy. Local anatomical features and hemodynamics heavily dominate vascular outcomes, indicating that systemic biomarkers have limited standalone clinical utility for guiding preoperative vascular access planning. Full article

Background: Dining out has become increasingly prevalent in China, which is associated with higher intakes of energy, fat and sodium, elevating the risk of diet-related non-communicable diseases. However, evidence on color-coded nutrition labels for onsite prepared meals remains scarce. This study aimed to examine consumers’ perceptions of Dish-Choice, a three-color-coded onsite label, in comparison with the standard Nutrition Facts Label (NFL), to evaluate subjective perceptions of this novel label. Methods: A self-controlled trial was conducted among 3008 diners from canteens in Shanghai, with completing questionnaires twice: first on NFL perceptions, then three months later on Dish-Choice. Logistic regression and paired-sample comparison were used for analysis. Results: Compared with the NFL, Dish-Choice was associated with higher perceptual scores, with greater changes in overweight/obese, males, lower socio-economic status (SES) groups and those with poor dietary quality. Conclusions: The Dish-Choice label elicits more positive perceptual responses across multiple perceptual constructs. It is particularly well-received among vulnerable populations with lower health literacy, including men, lower-SES groups, and individuals with poor dietary habits. This supports its potential as a public health tool for on-site dining settings, though further research is needed to confirm its impact on actual food choices. Full article

Fish-derived products are extensively acknowledged for their substantial role in fostering balanced diets and supporting a healthy way of life. This research is aimed at formulating, analyzing and evaluating a fish-based food product. The methodology adopted in this study adheres to contemporary food safety standards, prioritizing the utilization of minimal technological processes and natural ingredients, a focus that is gaining prominence within contemporary industrial practices. Thus, the proposal for a formulation obtained by integrating powders and extracts from plant byproducts (Citrus) represents a concrete application direction with real potential for commercialization. The product has been enriched with biocomponents derived from orange peel, namely orange extract (OE) and orange peel powder (PPO). The research focused on product development and the in situ evaluation of the effects of OE and PPO. The physicochemical composition, bioactive compound content, and antioxidant activity were evaluated, along with the microbiological status under post-opening refrigeration conditions, in order to simulate actual consumer use. In addition, the product’s color parameters and sensory attributes were analyzed. The results highlight significant potential for the development of a clean-label fish-based product, characterized by a simplified and easily implementable formulation, aligned with current production and consumption requirements. Compared to the control sample, both OE and PPO significantly influenced the analyzed parameters. Differences in physicochemical composition were observed in the experimental samples. In addition, PPO increased the antioxidant activity of the samples and the profile of bioactive compounds. Microbiological analysis, performed on day 0 and after 3 and 7 days of storage at 4 °C showed opening, confirmed the absence of Escherichia coli and Staphylococcus aureus in all samples and had an influence on the growth of fungi. The acceptability of fish-based products is often limited by odor perception, which is one of the main factors leading to consumer rejection. Sensory evaluation demonstrated that citrus-enriched samples were distinguished by the perception of particular sensory attributes. This formulation presents a practical solution to address this constraint, thereby enhancing the product’s sensory acceptability. The integration of OE and PPO yielded a more harmonized sensory profile, as evidenced by elevated hedonic scores and an intermediate placement in both principal component analysis (PCA) and external preference mapping. This research furnishes a thorough characterization of a fish-based food product, underscoring its potential as a viable option for balanced dietary regimens. Simultaneously, the findings support the product’s adherence to sustainability principles through the utilization of bioactive compounds sourced from plant byproducts, thus satisfying contemporary requirements for foods that possess an optimal nutritional profile and a diminished environmental footprint. Full article

Nutritional supplement use has emerged as an important health-related consumption behavior in digitalized environments, with implications for both public health and individual well-being. While prior research has largely focused on general populations, limited attention has been paid to how occupational pressures and digital information contexts jointly shape supplement-related decision-making among highly educated professionals. Addressing this gap, this study examines the behavioral determinants of nutritional supplement use among academics within an intention–behavior framework. Using survey data collected from academic professionals, the proposed model was tested through confirmatory factor analysis and structural equation modeling. The findings reveal that health motivation and academic work stress significantly predict supplement use intention, which, in turn, strongly influences actual consumption behavior. In contrast, digital health literacy and digital marketing exposure do not exert significant direct effects on usage intention. These results provide theoretical insight into the boundary conditions of informational determinants in consumer behavior models, suggesting that intrinsic motivation and contextual stressors may play a more dominant role than digital influences among highly educated consumers. From a practical perspective, the findings highlight the importance of addressing stress-related health coping mechanisms and motivation-driven behaviors in promoting informed supplement use. Full article