Search Results (1,864)

Background: Purines and pyrimidines are essential for the synthesis of nucleotides for DNA/RNA synthesis and for intermediate lipids, carbohydrates, and one-carbon metabolism. They are defined as nonessential as they can be synthesized de novo in vivo. However, the rate of de novo synthesis may be below requirements during rapid growth. Accordingly, nucleotide supplementation has been associated with potential benefits for growth in newborn infants. Therefore, nucleotides have been considered conditionally essential, and adequate availability may be relevant during periods of growth and development, particularly in preterm infants. Aims: To investigate plasma concentrations of purines and pyrimidines in cord blood in relation to (1) gestational age, (2) the blood of the corresponding mother, and (3) postnatal preterm infants’ blood. Methods: 155 infant–mother pairs (23 6/7–41 5/7 weeks postmenstrual age) from 10/2020–11/2022 were included. Purines and pyrimidines were analyzed with tandem mass spectrometry. Data are expressed as the median and interquartile range. Results: Cytidine, uridine, inosine, xanthine, hypoxanthine, adenosine, adenosine monophosphate, and guanosine monophosphate concentrations were above the lower limits of detection. Fetal plasma concentrations were significantly higher than those in corresponding mothers. The more immature the fetuses, the higher were the concentrations in umbilical cord plasma. Cytidine, inosine, xanthine, and hypoxanthine plasma concentrations significantly decreased within 14 days after birth. Conclusions: Fetal plasma concentrations of several purines and pyrimidines were higher than corresponding maternal concentrations, and concentrations of several metabolites decreased markedly after birth, demonstrating substantial changes in purine and pyrimidine concentrations across the fetal-to-postnatal transition. The underlying mechanisms (including potential contributions of placental transport, endogenous metabolism, tissue uptake, elimination, and nutritional intake) require further investigation. Full article

Background/Objectives: Vitamin A (VA), which is fat-soluble, belongs to the group of carotenoids, a class of highly effective antioxidant and genoprotective compounds (including astaxanthine, zeaxanthine, luteine). It plays a critical role in cellular growth, differentiation, and oxidative stress regulation, but prospective evidence linking childhood VA to subsequent genomic stability is scarce. This study investigated whether baseline VA levels were associated with later measurements of relative telomere length (RTL), four ribosomal DNA copy numbers (rDNA-CN: 5S, 18S, 28S, and 45S), and mitochondrial DNA copy number (mtDNA-CN) in children over a 4-year follow-up. Methods: Baseline VA levels were measured in 2021. In 2025, peripheral blood genomic DNA was extracted, and RTL, rDNA-CNs, and mtDNA-CN were quantified using qPCR. Multivariable linear regression and restricted cubic spline regression (RCS) were employed to examine the associations and dose–response shapes. Sex-stratified analyses with interaction tests were performed to evaluate effect modification by sex. Results: Among 215 children, baseline VA was positively associated with RTL, 5S rDNA-CN, 18S rDNA-CN, and 45S rDNA-CN after covariate adjustment. RCS analyses revealed strictly monotonic positive dose–response curves between VA and RTL, 5S rDNA-CN, and 18S rDNA-CN, with no statistically significant sex interaction (all p for interaction > 0.05). Conclusions: Higher childhood VA levels are positively associated with longer telomeres and higher rDNA-CN in later childhood, suggesting that adequate early-life VA may confer long-term benefits for ribosomal genomic stability and cellular aging. These observations expand our understanding of nutrition-related modulators of child genomic homeostasis and support further investigation into nutritional interventions targeting genomic protection in early life. Full article

Maternal nutrition during pregnancy and lactation plays an important role in the neurodevelopment of offspring. One-carbon (1C) metabolism includes B-vitamins such as folic acid (vitamin B9) and vitamin B12, and the nutrient choline. Adequate dietary intake of B-vitamins and choline by women prior to getting pregnant and during pregnancy is essential for the neurodevelopment of the infant. The aim of this narrative review is to summarize the current findings on maternal diet intake of B-vitamins and choline and how their intake impacts DNA methylation levels in offspring. From our analysis of clinical and preclinical research, the evidence indicates that maternal intake of 1C nutrients during pregnancy is associated with DNA methylation in offspring during early life; however, it remains unknown whether these changes last past early life. Additionally, the impact on health outcomes requires further investigation. The studies included in our narrative review were heterogeneous and small, and future studies are needed to draw more definitive conclusions. To conclude the review, we discuss opportunities to enhance the scientific rigor of future studies in this field. One point to consider is the inclusion of both female and male offspring in all outcome assessments to facilitate a comprehensive understanding of potential sex-specific effects and to determine how each sex may be differentially impacted by maternal B-vitamin and choline intake during pregnancy and lactation. Additionally, increasing sample size appropriately and initiating multi-center preclinical randomized controlled trials (mpRCTs) could enhance scientific rigor. Full article

Children with Down syndrome (DS) may experience feeding difficulties arising from interactions among hypotonia, cardiorespiratory and gastrointestinal conditions, swallowing dysfunction, oral-motor and sensory differences, delayed feeding skill development, and psychosocial or environmental factors. These difficulties may compromise feeding safety and efficiency, restrict dietary diversity, and contribute to inadequate fluid or nutrient intake, faltering growth, micronutrient deficiencies, or excess adiposity. This narrative review synthesized the literature selected for its relevance to feeding development and nutritional risk in children and adolescents with DS. Sources were identified through PubMed/MEDLINE, Scopus, and the Web of Science Core Collection, supplemented by reference-list review and citation tracking; cited sources were last verified on 26 August 2026. Evidence was organized according to developmental stage and clinical domain, with attention to study design, sampling, assessment methods, and applicability to the pediatric DS population. The findings indicate that breastfeeding is possible but may require early assessment of milk transfer and nutritional adequacy. Oropharyngeal dysphagia and silent aspiration are important clinical concerns, although much of the evidence comes from selected clinical and referral-based cohorts. Impaired chewing, delayed texture progression, and food selectivity may restrict the consumption of meat, vegetables, whole grains, and other nutrient-dense foods, potentially reducing dietary variety and the intake of protein, fiber, and specific micronutrients. Reliance on a narrow range of accepted soft or energy-dense foods may nevertheless provide adequate or excessive energy, allowing poor dietary quality to coexist with excess body weight. Nutritional assessment should therefore consider food choices, texture adaptations, and actual nutrient intake alongside growth and body mass index. The strongest support is for systematic, individualized, and multidisciplinary care integrating swallowing safety, feeding skills, actual dietary and fluid intake, growth, biochemical status, associated medical conditions, and family circumstances. Evidence for specific feeding therapies, supplements, and nutrition-related interventions remains limited by small samples, heterogeneous methods, and short follow-up. More representative longitudinal and intervention studies using standardized, age-appropriate outcomes are needed. Full article

Background/Objectives: Peritoneal dialysis (PD) requires patients to manage dialysis procedures, medications, fluid intake, and nutrition at home. Existing assessment approaches do not adequately distinguish patients’ treatment-related knowledge and awareness from their self-reported adherence practices across these domains. This study aimed to develop and psychometrically evaluate the Peritoneal Dialysis Treatment Adherence Scale, a patient-reported instrument designed to assess treatment-related knowledge/awareness and self-reported adherence practices in peritoneal dialysis. Methods: This multicenter methodological study included 600 adults receiving PD at eight hospitals in Türkiye. An initial 64-item pool was evaluated by 12 experts and pilot-tested with 30 patients. The main sample was randomly divided into two independent subsamples of 300 participants for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). EFA was conducted using principal axis factoring with direct oblimin rotation, and Horn’s parallel analysis was used to determine factor retention. CFA was conducted in the independent confirmatory subsample. Internal consistency was evaluated using Cronbach’s alpha and McDonald’s omega, and three-week test–retest reliability was assessed in 30 participants using intraclass correlation coefficients. Results: The final instrument comprised a 32-item Knowledge Dimension, assessing self-reported treatment knowledge and awareness, and a 25-item Adherence Practices Dimension, assessing the frequency and consistency of self-reported adherence practices. Primary factor loadings ranged from 0.694 to 0.971 for Knowledge and from 0.508 to 0.951 for Adherence Practices, with no items meeting the prespecified criterion for problematic cross-loading. Separate four-factor CFA models demonstrated acceptable within-dimension fit; however, the additional integrated eight-factor CFA including all 57 items did not meet all conventional global-fit criteria, indicating that the overall measurement structure requires further independent validation. Internal consistency in the independent confirmatory subsample was high for both dimensions: Knowledge, α = 0.950 and ω = 0.984; Adherence Practices, α = 0.952 and ω = 0.986. Test–retest reliability was strong for Knowledge (ICC = 0.946) and Adherence Practices (ICC = 0.940). Conclusions: The Peritoneal Dialysis Treatment Adherence Scale demonstrated promising but provisional structural evidence, high internal consistency, and strong temporal stability. Its separately scored Knowledge and Adherence Practices dimensions may support domain-specific assessment in PD; however, the overall eight-factor measurement structure requires further independent validation before widespread clinical use. Full article

Bovine respiratory disease (BRD) causes economic loss and antimicrobial use in North American beef production. This rapid scoping review examined whether nutritional management of beef cows and pre-weaning calves affects BRD morbidity or mortality before or after weaning. Eligible sources were English- or French-language North American studies published from 2000 onward that evaluated nutrition or colostrum management in beef cows or calves and reported BRD-specific, secondary, or tertiary outcomes. Six bibliographic databases and grey-literature sources were searched. One reviewer charted and verified data using a pre-tested form. Findings were synthesized narratively without formal critical appraisal. Forty-seven studies were included: 22 reported BRD-specific morbidity or mortality, 20 reported only secondary outcomes (e.g., crude mortality), and five reported only tertiary outcomes (e.g., vaccine antibody titres). Three of five controlled trials of maternal protein supplementation reported favourable offspring BRD outcomes, although incomplete comparisons, absent treatment effect estimates, and the absence of formal critical appraisal limited interpretation. Selected maternal trace mineral trials reported reduced post-weaning BRD morbidity or fewer aggregated sick incidents. Direct evidence for colostrum-management strategies was sparse; other findings were inconsistent or based on few or no BRD events. Evidence remains insufficient for specific recommendations. Adequately powered commercial trials should report prespecified BRD outcomes, effect sizes, and confidence intervals. Full article

Background: Antisperm antibodies (ASA) are recognized as a potential immunological factor in male infertility; however, their prevalence and clinical correlates remain incompletely characterized in Middle Eastern populations. This study aimed to estimate the prevalence of clinically significant ASA positivity and investigate its associations with demographic, clinical, and semen characteristics among infertile men in Erbil, Kurdistan Region of Iraq. Methods: A multicenter retrospective cross-sectional study was conducted between July 2025 and March 2026 at urology and fertility centers in Erbil. A total of 465 infertile men were included after predefined data cleaning and MAR-test reclassification procedures. Demographic, clinical, and semen parameters were collected, and ASA status was assessed using the direct mixed antiglobulin reaction (MAR) test. Clinically significant positivity was defined as antibodies bound to ≥50% of motile spermatozoa. Associations between ASA status and participant characteristics were examined using bivariate and multivariable analyses. Additional exploratory analyses included k-means clustering of semen profiles and Random Forest machine-learning modelling to evaluate predictors of ASA positivity. Results: ASA positivity was identified in 53 of 465 participants, yielding a prevalence of 11.4% (95% CI: 8.7–14.7%). No significant associations were observed between ASA positivity and residence, smoking status, varicocele, infertility type, nutritional supplement use, sperm concentration, progressive motility, non-progressive motility, or sperm morphology (all p > 0.05). Men with secondary infertility demonstrated a modestly higher median ASA percentage than those with primary infertility; however, binary ASA positivity did not differ significantly between groups. Multivariable logistic regression showed limited explanatory capacity (AUC = 0.607), while a Random Forest classifier achieved only marginal discrimination on the test dataset (AUC = 0.567). Clustering analysis identified two distinct semen-quality phenotypes, but ASA prevalence did not differ significantly between clusters. Conclusions: Clinically significant ASA positivity was present in approximately one in nine infertile men attending participating centers in Erbil. Routine demographic, clinical, and semen characteristics were poor predictors of ASA status, and neither conventional statistical modelling nor machine-learning approaches reliably identified ASA-positive individuals. These findings suggest that ASA-associated infertility may not be adequately captured by standard infertility assessments alone and support the selective use of direct ASA testing within comprehensive male infertility evaluation. Larger prospective studies incorporating fertile controls, detailed reproductive histories, complementary antibody assays, and immunological biomarkers are warranted. Full article

Greenhouse tomato production in closed and semi-closed soilless systems can reduce water and fertilizer losses, but drainage reuse requires coordinated chemical, sanitary, and nutritional control. This review critically synthesizes evidence on drainage characterization, disinfection, nutrient reconditioning, and digital monitoring, with emphasis on coir-based systems. Structured searches of Scopus, Web of Science Core Collection, and PubMed were complemented by Google Scholar and reference-list screening. Evidence was classified as direct, related, transferable, or contextual according to its relevance to coir-grown tomato. Electrical conductivity and pH are necessary but insufficient because crop uptake, source-water quality, and substrate exchange processes alter individual ions. UV-based treatments can provide effective disinfection when dose, turbidity, flow, and target organism are controlled, whereas hydrogen peroxide is better supported as a complementary treatment. ToBRFV persistence in water requires virus-specific validation, and potential substrate- or biofilm-associated reservoirs remain insufficiently quantified. Only one study in the key-evidence matrix met the strict definition of direct evidence for coir-grown tomato with drainage recovery or recirculation; most sodium-management, disinfection, and monitoring evidence was therefore related or transferable. Safe reuse depends on a monitored, multi-barrier management chain with managed partial renewal when chemical or sanitary risks cannot be adequately controlled. Full article

Obesity is an important public health concern among children and adolescents. Effective weight management generally requires dietary modification, nutrition education, physical activity, and continued behavioral support. This study developed and evaluated Korat crispy chicken sticks (K) as a dietary component of a multicomponent weight management program for adolescents with obesity, with commercial chicken sticks (C) as the comparator. A mixture design was used to optimize the product formulation, and a reduced-sugar formulation was selected. The selected product had a hardness of 1548.52 ± 321.25 g, crispness of 54.00 ± 13.23 fracture peaks, water activity of 0.407 ± 0.001, and protein content of 56.90 ± 0.75% on a dry weight basis. Sensory evaluation showed significant differences between the tested products regarding color, aroma, texture, and overall liking (all p < 0.05), but no significant difference in flavor. A preliminary randomized controlled trial was conducted among 38 adolescents with obesity. Participants were randomly allocated to the K group (n = 20) or C group (n = 18) for at least two months. Both groups received the same nutrition education, dietary energy restriction, physical activity recommendations, and telemedicine follow-up. No formal a priori sample size calculation was performed; therefore, the clinical findings were considered exploratory. Both groups showed small reductions in body weight and BMI. BMI decreased by 0.90% in the K group and 1.05% in the C group; neither within-group change was statistically significant. LDL cholesterol decreased from 104.35 ± 17.06 to 101.78 ± 20.70 mg/dL in the K group, but the within-group change was not statistically significant (p = 0.894). In contrast, LDL cholesterol increased from 112.71 ± 24.40 to 123.81 ± 28.34 mg/dL in the C group (p = 0.046). The unadjusted comparison of post-intervention LDL values differed between the groups (p = 0.009), but this finding does not demonstrate a statistically significant LDL reduction within the K group. MDA levels decreased in both groups, but the changes were not statistically significant. These preliminary findings indicate that Korat crispy chicken sticks may be feasible as a dietary component of a multicomponent weight management program. However, the study did not establish an independent effect of the Korat product on BMI, LDL cholesterol, or oxidative stress. Larger adequately powered randomized controlled trials using prespecified outcomes and baseline-adjusted between-group analyses are required. Full article

Human exposure to foodborne xenobiotics, including environmental contaminants that enter the food chain, is no longer adequately represented by isolated chemicals. Individuals encounter complex and dynamic mixtures of food additives, pesticide residues, veterinary drugs, mycotoxins, processing contaminants, packaging migrants, environmental pollutants, and other dietary chemicals that interact with genetics, metabolism, the gut microbiome, nutritional status, and lifestyle throughout life. The dietary exposome therefore represents a critical interface linking food contaminants, internal chemical exposure, molecular perturbation, and long-term human health. Conventional toxicology provides an indispensable foundation for food safety regulation through hazard characterization and population-based health guidance values but is less equipped to explain interindividual variability in biological response and chronic disease susceptibility. Precision toxicology provides an integrative and mechanism-informed framework that combines high-resolution analytical chemistry, human biomonitoring, exposomics, multiomics, new approach methodologies, and artificial intelligence. This integration enables the characterization of biologically effective exposure, the elucidation of exposure–response relationships, and the identification of interindividual variability in toxicological susceptibility. This perspective proposes a translational framework connecting external exposure → internal dose → biological response → individual susceptibility → health outcome. We position this framework relative to existing exposome, exposure-pathway, and adverse-outcome-pathway frameworks; specify the evidence required at each transition; make its life-course dimension explicit; illustrate it with a worked per- and polyfluoroalkyl substance (PFAS) example; and outline a stepwise route into food risk assessment together with its principal limitations. Such integration could advance food safety science beyond residue detection toward biologically informed exposure assessment, ultimately supporting more evidence-based regulatory decision-making, preventive strategies, and public health protection. Full article

Background/Objectives: This secondary analysis evaluated the discordance between dietary adequacy and serum zinc levels in children and adolescents with chronic diseases, exploring the nutritional and biochemical traits of patients within an intermediate serum zinc range. Methods: Serum zinc was measured via atomic absorption spectrophotometry, and dietary tracking was conducted using a prospective 72 h food record. Subgroups were classified using Japanese Society of Clinical Nutrition thresholds (<60, 60–<80, and ≥80 μg/dL), treating the 60–<80 μg/dL band strictly as an operational, exploratory classification rather than a validated pediatric diagnostic standard. Results: Among the 90 participants, 31% fell into the 60–<80 μg/dL intermediate serum range and 61% exhibited inadequate dietary intake. Status discordance was frequent: 41% presented with inadequate dietary intake despite maintaining normal serum levels (≥80 μg/dL), whereas 11% had intermediate serum levels despite achieving adequate dietary intake. There was no significant association between serum zinc concentration and dietary zinc intake. Operationally classified intermediate-range participants demonstrated several nutritional and biochemical differences, notably showing higher intakes of vitamins B6, D, and E, elevated triglycerides, ESR, and IgG3, alongside lower hemoglobin. Conclusions: Dietary adequacy and serum zinc levels are frequently discordant, reinforcing that these metrics serve as complementary rather than interchangeable indicators of zinc status. The distinct profiles observed within the operational 60–<80 μg/dL category provide candidate relationships that warrant future targeted investigation. Full article

Background and Objectives: Exercise combined with a hypocaloric high-protein diet is recommended for sarcopenic obesity (SO), yet accessible dietary support remains limited. EatWelLog^®, a mobile health (mHealth) nutrition application, was developed to facilitate dietary self-management. This study evaluated the feasibility, acceptability, and preliminary effects of an EatWelLog^®-supported lifestyle intervention for community-dwelling older adults with SO. Methods: In this two-arm randomized controlled trial (RCT), 40 adults aged ≥65 years at risk of SO were randomized to Conventional Supervised (CS) or mHealth-supported (MH) groups. Both groups received an 8-week intervention that included three individualized dietitian consultations, five group nutrition classes, and eight weekly 60 min multicomponent exercise sessions. The MH group also used EatWelLog^® during the intervention and the 6-month follow-up. Outcomes were assessed at baseline (T0), immediately post-intervention (T1), and at the 3-month (T2) and 6-month (T3) follow-ups. Results: Recruitment (48.8%) and attendance (83.3%) rates supported feasibility. Four participants in the MH group dropped out after the beginning of the intervention. The App demonstrated moderate-to-high acceptability. Between-group differences and group × time interactions were not detected for primary outcomes. Muscle strength improved from baseline to post-intervention in both groups, and physical performance showed improvements in MH across all follow-up assessments. Focus group participants valued the App’s dietary tracking, feedback, and reminders, though they identified limitations in food-recording functions. Conclusions: Findings support feasibility and acceptability, but strategies are needed to reduce attrition and improve compliance with recording diets. As this pilot was not powered for effectiveness, the App’s added benefit remains uncertain. A larger, adequately powered RCT is warranted. Full article

Body composition (BC) analysis may integrate assessment of nutritional risk in patients with gastrointestinal cancers. Applying unsupervised machine learning techniques, we derived BC profiles (BCPs) and investigated their association with malnutrition risk and quality of life. This cross-sectional analysis includes gastrointestinal cancer patients enrolled in the NUTRItional and sarcopenia SCREENing project, part of the ONCOCAMP study (ClinicalTrials.gov ID: NCT06270602). Malnutrition assessment was performed using the NRS-2002, anthropometry and BC analysis; HRQoL was evaluated with the EORTC QLQ-C30 questionnaire. Principal component analysis and k-means clustering identified BCPs. Data from 189 patients (mean age: 66.3 ± 11.2 years) with gastric (37%), pancreatic (26.5%), rectal (24.3%) and hepatocellular carcinoma (12.2%) were analyzed. Overall, 36.5% of patients were at nutritional risk (NRS-2002 ≥ 3). Two BC clusters, High Muscle Profile (HMP) and Low Muscle Profile (LMP), were derived. Although no statistically significant association was observed in the overall cohort, multivariable analysis stratified by gender identified an association between LMP and nutritional risk among male patients (OR = 3.77, 95% CI: 1.08–14.3, p = 0.042); however, this finding should be considered exploratory. Nutritional risk, but not BC profiles, was associated with poorer Summary Score (β = 8.0, 95% CI: −14 to −2.3, p = 0.007) and higher Symptom Score (β = 9.8, 95% CI:4.5 to 15, p < 0.001). These preliminary results warrant further confirmation in larger, adequately powered longitudinal cohorts. Future studies should determine whether BCPs provide additional value beyond established nutritional screening and individual BC parameters in clinical practice. Full article

Background/Objectives: Modifiable lifestyle factors are established determinants of venous thromboembolism risk, but their relationship with the severity and early course of acute pulmonary embolism (PE) is poorly characterized, and no validated Romanian-language instrument captures these domains in the acute PE setting. This protocol describes a prospective observational study with two distinct components: (i) a measurement component that develops and validates the Pulmonary Embolism Lifestyle and Nutrition Questionnaire (PE-LNQ), a composite patient-completed instrument, and (ii) a clinical component that analyzes the associations between lifestyle factors, routine clinical and laboratory data, and the severity and early outcomes of acute PE. Methods: Phase 1 comprises cross-cultural adaptation, content validation, piloting, and COSMIN-based psychometric evaluation. Its primary endpoints are test–retest reliability (ICC ≥ 0.70) and confirmation of ≥75% of a priori construct-validity hypotheses, including convergent validity against measured anthropometry and routine biomarkers. Phase 2 enrolls consecutive adults with CTPA-confirmed acute PE in a staged design (minimum 220 patients single-center; approximately 400 with a planned multicenter extension). The primary clinical endpoint is intermediate-/high-risk PE (vs. low risk) by sPESI/PESI, with the ordinal PESI class (I–V) as the key secondary endpoint. Severity data and a pre-specified panel of routine admission laboratory parameters are extracted from the medical record without study-specific sampling; patients are followed for in-hospital, 3-, and 6-month adverse events. The confirmatory analysis is multivariable logistic regression; ordinal, survival, incremental-value, and biomarker analyses are pre-specified as secondary or exploratory. Expected Results: The PE-LNQ is expected to show adequate reliability and validity, and less favorable lifestyle profiles to be associated with higher severity class and more early adverse events. Conclusions: This study will deliver a validated, freely reusable instrument and clarify the prognostic relevance of modifiable lifestyle factors, supporting their integration into risk assessment and secondary prevention. Full article

Polyendocrine metabolic ovarian syndrome (PMOS), formerly known as polycystic ovary syndrome (PCOS), is a heterogeneous endocrine and metabolic disorder associated with reproductive dysfunction, hyperandrogenism, insulin resistance, chronic low-grade inflammation and an increased risk of long-term cardiometabolic disease. Lifestyle intervention remains the cornerstone of management; however, the optimal nutritional strategy continues to be debated. This narrative review summarizes current evidence on nutritional management of PMOS, including dietary approaches, the role of the gut microbiota, dietary supplementation and complementary lifestyle interventions. Current evidence indicates that no single dietary model is universally superior for all women with PMOS. Instead, different dietary approaches may improve selected anthropometric, metabolic, endocrine, and reproductive outcomes, although the consistency of these effects varies across interventions and outcomes. The most consistent benefits are observed for body weight, insulin resistance, glycolipid metabolism and cardiometabolic risk, whereas improvements in reproductive and hyperandrogenic outcomes are generally more variable. Gut microbiota modulation represents a biologically plausible mechanism linking diet with metabolic and reproductive function, although its role as a mediator of dietary effects remains insufficiently established. Adjunctive supplementation, particularly with inositols, vitamin D, omega-3 fatty acids, and selected probiotics or synbiotics, may improve selected metabolic and reproductive outcomes, although the certainty and consistency of these effects vary across supplements. Such approaches should be considered complementary to, rather than a replacement for, lifestyle management. Physical activity, behavioural support, adequate sleep and stress management further contribute to comprehensive care, although evidence is strongest for structured exercise interventions. Lifestyle approaches may also have a role in early risk modification, particularly through the prevention of excess weight gain and promotion of physical activity, although direct evidence for primary prevention of PMOS remains limited. Overall the findings support individualized and sustainable nutritional and lifestyle strategies rather than a universal therapeutic approach. Future research should focus on well-designed long-term randomized trials and the development of personalized approaches that account for clinical and metabolic heterogeneity in PMOS. Full article