Search Results (479)

Background: Sedentary behavior is a major modifiable risk factor for chronic metabolic disorders, particularly type 2 diabetes mellitus (T2DM). Despite recommendations promoting regular physical activity (PA), adherence remains low. DIA/01 is a multidisciplinary study designed to promote healthy lifestyles for the prevention and management of T2DM, supporting healthcare systems. Methods: A total of 123 adults with T2DM diagnosed will be enrolled at the Diabetes Center of the University Hospital of Perugia throughout 2025. Inclusion criteria are age 25–80 years, ability to walk independently, being inactive, and BMI 18.5–40 kg/m². Exclusion criteria include severe cardiovascular, central nervous system, or musculoskeletal diseases contraindicating PA. Participants will be randomized into three groups: (1) standard care (SC); (2) SC plus theoretical PA counseling (TCPA); and (3) SC plus TCPA plus a 3-month supervised mixed exercise program. The assessment, conducted at baseline and at 6 and 12 months, includes total weekly PA (WPA) time, using IPAQ-SF and actigraphy. Moreover, glycated hemoglobin, sedentary time (ST), functional capacity, body composition, cardiometabolic risk factors, dietary adherence, perceived barriers and willingness to initiate PA, readiness to change, health-related quality of life, and sleep quality will be studied. This study is registered in the Clinical Trials Registry on 13 May 2026, with the identifier NCT07583355. Conclusions: Participants in groups (2) and (3) are expected to show greater improvements in WPA, reductions in ST, and favorable changes in metabolic and functional outcomes compared with SC. This approach may support long-term engagement in regular PA and contribute to improving the clinical management of T2DM. Full article

Background: The increasing prevalence of overweight and obesity highlights the need for practical and sustainable dietary strategies for weight management. Although dietary fibre intake is associated with improved satiety and metabolic health, achieving recommended intake levels through whole foods alone remains challenging. Evidence supporting convenient, ready-to-consume fibre beverages in free-living overweight adults is also limited. Therefore, this study evaluated the effects of a soya-based dietary fibre beverage (SBB) on body composition and metabolic parameters in overweight adults. Methods: A 12-week parallel, cluster-randomized controlled trial was conducted on overweight university students and staff. An intervention group (IG) (n = 21) consumed the soya-based dietary fibre twice daily for 12 weeks, while the control group (CG) (n = 21) continued their habitual diet. Results: Significant group × time interactions were observed for body weight (p < 0.001), BMI (p = 0.021), waist circumference (p = 0.046), waist-to-hip ratio (p = 0.042), and body fat percentage (p = 0.004). The IG showed reductions in body weight (−1.12 kg), waist circumference (−4.29 cm), and body fat percentage (−0.73%), whereas the CG demonstrated minimal changes. No significant changes were observed in fasting glucose, lipid profile, CRP, or IL-6, suggesting no clinically significant adverse biochemical changes during the intervention period and supporting its short-term tolerability. Dietary analysis confirmed a marked increase in fibre intake in the IG (~50 g/day), indicating good adherence to the intervention. Conclusions: SBB supplementation improved body composition and central adiposity without affecting systemic inflammatory biomarkers and may represent a practical dietary approach for weight management in free-living overweight adults. Further studies are needed to confirm its long-term efficacy and safety. Full article

Dietary fibre (DF) and bioactive compounds (BCs) are essential components of a healthy diet and are abundant in plant-rich dietary patterns. Increasing evidence demonstrates that their combined and synergistic actions significantly influence human health, largely through their effects on the gut microbiota. This review highlights the need for more precise terminology regarding DF and BCs, as inconsistent use of these terms can create confusion among both consumers and researchers. The DF complex encompasses all non-digestible food components that have a positive effect on human health, together with the BCs associated with them, recognising that DF often serves as a carrier for these compounds throughout the digestive tract. Although recommended intakes for BCs have not been established, intake levels observed in populations adhering to healthy dietary patterns may serve as useful reference points. Updated data on the intake and estimated intestinal bioaccessibility of polyphenolic compounds in the contemporary Spanish diet are presented. Full article

Background/Objectives: Childhood obesity is a complex, multifactorial condition that requires comprehensive and sustained interventions. Despite the central role of dietary modification in obesity management, current approaches to dietary counselling remain heterogeneous and often fail to account for the broader environmental and social determinants of eating behavior. In pediatric populations, dietary habits are strongly influenced by family dynamics, home food environments, school settings, and peer interactions, highlighting the need for system-oriented intervention models. Methods: This structured narrative review with conceptual framework development presents an integrative framework for dietary counselling in pediatric obesity, combining evidence-based nutritional strategies with behavioral and environmental approaches. The paper synthesizes current literature on early-life habit formation, family-based behavioral treatment, feeding practices, and environmental determinants of dietary behavior. Results: The proposed framework emphasizes the role of the family as the primary therapeutic unit and highlights the importance of modifying the home food environment and implementing gradual, achievable changes through the “small steps” approach. A structured, visit-based model of dietary counselling is introduced, integrating dietary assessment, patient education, and behavioral strategies. Additionally, the influence of external environments—including schools, peer groups, and public health systems—is considered to provide a comprehensive understanding of factors shaping dietary behaviors in children. Conclusions: The proposed system-oriented framework offers practical guidance for clinicians and public health practitioners and supports the development of more effective and sustainable interventions. Integrating individual, family, and environmental perspectives may improve adherence to dietary recommendations and enhance long-term outcomes in pediatric obesity management. Full article

Background: Nutritional therapy is central in the management of chronic kidney disease (CKD) and cancer, yet these conditions impose partially conflicting requirements. The 2024 KDIGO guideline recommends a controlled protein intake (~0.8 g/kg/day) to reduce metabolic burden in non-dialysis CKD patients, whereas the ESPEN (European Society for Clinical Nutrition and Metabolism) guidelines support higher protein intake (≥1.0–1.5 g/kg/day) to prevent cancer-related malnutrition. Evidence guiding patients affected by both conditions is limited. We evaluated the effects of a Mediterranean-like controlled protein diet in onconephrological patients compared with CKD controls. Methods: In this retrospective study, 358 CKD patients (183 onconephrological, 175 controls) were followed at a tertiary center (2017–2024). Patients received a protein-controlled diet (0.6–1.0 g/kg/day) tailored to comorbidities and nutritional status. Nutritional assessment included bioelectrical impedance analysis and anthropometry. Renal function was evaluated using creatinine and cystatin C, and measured GFR by iohexol clearance at baseline and 12 months. Results: Baseline body composition was comparable between groups. After intervention, serum urea significantly decreased in both groups, without a decline in measured or estimated GFR. Fat mass and central adiposity indices were reduced, while lean mass and phase angle remained stable. No evidence of protein–energy wasting or catabolic activation emerged. Longitudinal analyses showed no significant time × cancer interaction for renal function or most bioimpedance-derived body composition parameters. However, at extended follow-up, arm circumference and tricipital skinfold thickness showed significant time × cancer interactions, suggesting different longer-term peripheral anthropometric trajectories according to cancer status. Conclusions: In this retrospective real-world cohort, structured nephro-nutritional management with an individualized Mediterranean-like controlled protein prescription was associated with preserved renal function and no evidence of overt nutritional deterioration in onconephrological patients. These findings support the feasibility and apparent safety of this approach in selected patients, while highlighting the need for prospective studies with objective dietary adherence assessment and longer-term evaluation of cancer-related anthropometric trajectories. Full article

Background/Objectives: Adolescence is a critical period for the adoption of health-risk behaviors and the development of non-communicable diseases (NCDs). Schools represent a strategic setting for health promotion interventions; however, Italian studies simultaneously assessing NCD-prevention knowledge and lifestyle behaviors in the same adolescent population remain scarce. The study aimed to evaluate improvements in knowledge regarding nutrition and other lifestyle-related behaviors among Italian adolescents following a school-based educational intervention. Secondary objectives included describing lifestyle behaviors within the study population and exploring participants’ evaluation of the intervention. Methods: A quasi-experimental pre-post study was conducted between March and May 2025 in five lower secondary schools. A total of 410 adolescents aged 11–16 years were enrolled through a two-stage cluster sampling procedure. The intervention, lasting approximately two hours, was delivered by a trained nurse-researcher and addressed four health domains: nutrition, physical activity, screen exposure, and substance use. Results: Following the intervention, a measurable increase in overall knowledge scores (mean increase: +3.9 points) was observed, with 88.9% of participants showing improvement. The largest improvements were observed in nutrition-related knowledge and awareness of passive smoking harms. Despite these gains, unhealthy behaviors remained prevalent, including low adherence to physical activity recommendations (36.1%), suboptimal dietary quality (39.9%), and high screen exposure. A linear regression model identified five independent determinants of higher knowledge improvement: older age, female gender, higher screen exposure, having at least one employed parent, and lower pre-intervention test scores. The intervention was positively evaluated, with high levels of satisfaction, clarity, and perceived usefulness. Conclusions: Nevertheless, the persistent gap between knowledge and behavior underscores the need to integrate motivational and environmental components, gender-sensitive approaches, and longitudinal evaluations to foster sustainable, healthy choices and contribute to NCD prevention. Full article

Inadequate fruit and vegetable consumption is associated with increased risk of chronic disease. Yet, many individuals consume below the recommended intake according to the Dietary Guidelines for Americans (DGA). This study aimed to examine the association of adherence to the DGA (2020–2025) recommendations for fruit and vegetable (FV) intake of 1.5–2 cups of fruits and 2–3 cups of vegetables daily for adults among caretakers with a child(ren) living in households eligible for a Supplemental Nutrition Assistance Program (SNAP). We conducted a cross-sectional analysis of 85 caretakers with children in an urban neighborhood of low-income in the Bronx, New York (NY). Log-binomial regressions demonstrated that having more children (RR 1.36; 95% CI 1.15–1.59), younger children (RR 1.22; 95% CI 1.07–1.39), or children participating in a school lunch program (RR 1.47; 95% CI 1.16–1.85) was positively associated with caretakers’ probability of adhering to the DGA recommendations for FV intake. Our study highlights the eating behaviors of families living with children ≤ 10 years of age, many of whom were participating in a school lunch program, and underscores the dietary benefits associated with these characteristics. Full article

Hypertension frequently remains uncontrolled despite pharmacological therapy, supporting interest in complementary nutritional strategies. This narrative review evaluates human clinical evidence and mechanistic pathways for minerals, polyphenols, omega-3 fatty acids, probiotics, coenzyme Q10, and L-arginine in blood pressure regulation. Across these categories, antihypertensive effects appear to depend largely on post-ingestion metabolic biotransformation into bioactive metabolites that influence endothelial nitric oxide availability, vascular inflammation, renal sodium handling, and renin–angiotensin system activity. Randomized controlled trials and meta-analyses consistently demonstrate modest reductions in systolic blood pressure of approximately 2–8 mmHg, although most studies are short-term and frequently use supplementation models. The overall certainty of evidence is moderate due to consistent but heterogeneous randomized trials. Variability in response is partly explained by metabolic phenotype and gut microbiota composition, and combined dietary patterns targeting multiple mechanisms may produce additive effects. Overall, nutraceuticals function as adjunct physiological modulators that may contribute to cardiovascular risk reduction but are not intended to replace pharmacological therapy. The present review integrates post-ingestion metabolism, microbiota-derived mediators, and clinical trial evidence into a unified physiological framework explaining why consistent but modest blood pressure reductions occur across heterogeneous interventions. Nutritional strategies remain underutilized in routine clinical practice despite reproducible physiological effects. Incorporating evidence-based nutraceutical approaches alongside pharmacological management may facilitate patient engagement with lifestyle modification, as dietary interventions are often perceived as more achievable than isolated behavioral recommendations. A holistic management model integrating medical therapy, nutrition, and patient education may therefore enhance long-term adherence to cardiovascular prevention strategies and support sustained risk reduction. Full article

Background/Objective: Rapid, validated dietary screening tools are lacking for individuals with spinal cord injury (SCI), where routine clinical check-ups do not allow sufficient time for extensive dietary assessments typically required to evaluate adherence to dietary recommendations. We developed a 15-item dietary screener (SCI NutriTool) and evaluated its accuracy in classifying non-adherence to a healthy food pyramid compared with a validated food frequency questionnaire (FFQ). Methods: The SCI NutriTool was developed through literature review and expert consensus. In a validation study, 51 adults with SCI (mean age 57.0 years; 76.5% men; 68.8% traumatic injury) completed the SCI NutriTool twice and a validated 97-item FFQ, which served as the reference method. Results: The SCI NutriTool demonstrated substantial variability in performance across food groups, reflecting its domain-specific screening properties. Sensitivity was high for fruits and vegetables (91.7%), protein-rich foods (90.5%), and sweetened/alcoholic beverages and snacks (82.4%), with relatively high positive predictive values (PPV: 73.7–90.5%), supporting the tool’s ability to identify individuals who are likely non-adherent and may benefit from further nutritional assessment or counselling. In contrast, for starchy foods and nuts, oils, and fatty spreads/sauces, sensitivity was low (20.0% and 50.0%), while specificity was modest. This indicates that the tool performs better in correctly identifying adherent individuals in these domains, which is reflected in higher negative predictive values (NPV: up to 94.1%). However, the low sensitivity suggests that individuals with non-adherence may be missed, limiting the tool’s usefulness as an early screening trigger for these food groups. Conclusions: The SCI NutriTool’s performance varies across food groups, demonstrating a stronger ability to identify non-adherence in protein-rich foods, fruit and vegetables, sweetened and alcoholic beverages, and snacks, but limited discriminatory capacity for others. In particular, it is not suitable for screening non-adherence to starchy foods and fats. Accordingly, it is best used as a triage tool to guide further dietary assessment and targeted nutritional interventions rather than as a standalone diagnostic instrument. Full article

Background/Objectives: Celiac disease is a chronic autoimmune disorder triggered by gluten ingestion in genetically predisposed individuals. In children and adolescents, it presents heterogeneously and may negatively affect physical, psychological, and social well-being. Although a strict gluten-free diet is the only effective treatment, it may also impose important dietary, social, and economic burdens. This systematic review aimed to evaluate the impact of celiac disease on the quality of life of affected children and adolescents and their families. Methods: This systematic review was conducted according to PRISMA, AMSTAR 2, and Cochrane Handbook recommendations. Searches were performed in PubMed, Scopus, CINAHL, Web of Science, and PsycINFO for studies published between 2019 and 2026 in English or Spanish. Quantitative, qualitative, and mixed-methods studies on pediatric celiac disease and quality of life were included. Two reviewers independently conducted study selection, data extraction, and risk-of-bias assessment. Due to study heterogeneity, a narrative synthesis was performed. Results: Thirteen studies were included. Children and adolescents with celiac disease generally reported lower quality of life, particularly in emotional, social, and school-related domains. Adherence to a gluten-free diet was an important factor associated with quality of life. Although it improved symptoms, it was also linked to social restrictions, nutritional imbalances, and financial burden. Families also reported stress, lifestyle changes, and reduced well-being. Findings should be interpreted cautiously due to heterogeneity and variability in methodological quality across studies. Conclusions: Current evidence suggests that celiac disease may have a multidimensional impact on the quality of life of pediatric patients and their families. These findings support the need for a comprehensive multidisciplinary approach addressing dietary, psychosocial, and family-related factors. Full article

Background: Obesity is a major public health concern associated with adverse physical and psychological outcomes, including body shame (BS) and reduced self-esteem (SE). Lifestyle interventions incorporating dietary and exercise components, such as time-restricted eating (TRE), mindful eating, and structured physical activity, have shown promise; however, evidence on their combined effects within scalable, web-based formats remains limited. Objective: This study aimed to evaluate the effectiveness of a multi-component, web-based lifestyle intervention integrating TRE, mindful eating, and structured online exercise on body composition and psychological outcomes in young adults. Methods: In this pilot randomized controlled trial, 42 healthy young adults (age: 20.4 ± 1.6 years) were allocated to either an intervention group (n = 28) or a control group (n = 14). The intervention group followed an integrated program combining TRE, mindful eating principles, and guided online exercise sessions, while the control group received standard dietary and physical activity recommendations. Outcomes included body composition, anthropometric measures, BS (Weight- and Body-Related Shame and Guilt Scale), SE (Rosenberg Self-Esteem Scale), and eating behavior (Three-Factor Eating Questionnaire). Results: Significant group × time interactions were observed for body fat percentage (p < 0.001), fat mass (p = 0.001), and body mass (p = 0.025), with the intervention group demonstrating greater reductions compared with controls. BS scores significantly decreased in the intervention group, whereas no significant between-group differences were observed for SE (p > 0.05). Dietary adherence appeared higher than exercise adherence over the intervention period. Conclusions: A multi-component, web-based lifestyle intervention integrating TRE, mindful eating, and structured exercise may improve body composition and reduce BS in young adults. However, changes in SE were not observed over the short term. These findings support the feasibility of scalable digital lifestyle interventions, while highlighting the need for longer-term studies to clarify psychological outcomes. Full article

Background/Objectives: Multiple sclerosis (MS) is a chronic, demyelinating and neurodegenerative disease frequently associated with dysphagia, nutritional imbalances, and alterations in body composition. This study aims to describe the anthropometric profile and body composition in people with MS, estimate the risk and type of dysphagia, analyse dietary intake and habits, and evaluate the evolution of these parameters over six months. Methods: This descriptive analytical longitudinal study included 30 patients with MS (20 women, 10 men), with a median age of 53.3 years at baseline and 54.0 years at final assessment. The prevalence of dysphagia risk was determined, dietary patterns and body composition were characterised, and their interactions were explored through two assessments conducted six months apart. Results: Overall, 90% of the sample had relapsing–remitting MS (RRMS). At both the initial and final assessments, the median BMI was above 25 kg/m² and a high prevalence of dysphagia risk (63.3% and 76.7%), particularly for liquids. Frequent inadequacies were observed in the intake of certain macronutrients and micronutrients, including energy, fibre, potassium and magnesium. Likewise, the analysis by food groups revealed low adherence to recommendations, particularly for fruits, cereals, legumes, fish and lean meats. No significant differences were detected between the two time points. Conclusions: Dysphagia, dietary intake, habits, and body composition are interconnected dimensions in MS; systematically integrating nutritional assessment and dysphagia screening into clinical practice would contribute to a more comprehensive management and to improvements in swallowing disorders and nutritional status in people with MS. Full article

Background: Risk of malnutrition among patients with Parkinson’s disease (PD) can reach up to 60%, with prevalence rates as high as 24%. Dietary management for PD patients is a promising adjuvant therapy that may improve some motor and non-motor symptoms. However, there is limited information regarding nutrient intake and adherence to recommended dietary requirements in this population in Lithuania. Methods: In this case–control study conducted at Vilnius University Hospital Santaros Klinikos (2023–2025), usual dietary intake was assessed using two non-consecutive 24 h recalls. Intake was compared with Lithuanian Recommended Daily Intake (RDI) values. Associations between nutrient intake and selected non-motor symptoms were analyzed. Results: Fifty-nine patients with PD and 54 controls were included and compared with RDI; patients with PD had lower intakes of dietary fiber (20.63 g/day), vitamin A (627.15 μgRE/day), and vitamin D (3.18 μg/day), alongside a higher energy contribution from total sugars (11.31 E%). Less than half met RDI for protein, fat, polyunsaturated fatty acids (PUFA), and monounsaturated fatty acids (MUFA) energy contribution, vitamins E and C, calcium, and zinc. Compared with controls, PD patients consumed more dietary fiber, plant protein, and total carbohydrate and had a higher carbohydrate-derived energy contribution. PD patients with depressive mood consumed fewer carbohydrate, dietary fiber, plant protein, and some vitamins and minerals compared to those without. Conclusions: Patients with PD had higher total sugar-derived energy consumption and lower dietary fiber and vitamin D intake than the RDI. There were differences in dietary intake among PD patients with and without specific non-motor functions. Full article

Background: Exclusive enteral nutrition (EEN) is the recommended first-line therapy for induction of remission in pediatric mild-to-moderate Crohn’s disease (CD), but its restrictive nature often limits adherence and long-term sustainability. A modified version of the Crohn’s Disease Exclusion Diet (CDED), integrating Mediterranean dietary principles, was developed to offer a more acceptable alternative while preserving therapeutic efficacy. Methods: We conducted a retrospective, single-center study comparing short- and long-term outcomes of a Mediterranean-adapted CDED (M-CDED) with partial enteral nutrition (PEN) versus standard EEN in children with mild-to-moderate CD. Clinical remission was assessed after 8 and 16 weeks, while long-term outcomes were assessed after 1 and 2 years. Results: Data collected from thirty-two patients were analyzed (EEN, 14; M-CDED, 18). Clinical remission rates were comparable after 8 weeks (92.8% EEN vs. 94.4% M-CDED) and 16 weeks (100% in both groups). However, at 12 and 24 months, M-CDED was associated with significantly higher rates of clinical and biochemical remission and a markedly lower need for biologic drugs (12-month biologic initiation: 50% EEN vs. 11.1% M-CDED; p = 0.01). Adherence to M-CDED was excellent throughout follow-up. Conclusions: M-CDED with PEN appears to be as effective as EEN for remission induction, with improved long-term disease control and reduced therapeutic escalation. These findings support the feasibility of M-CDED as a sustainable option for long-term management of pediatric CD. Prospective studies are needed to confirm these results. Full article

Background/Objectives: Dietary sweetener use is common among individuals with diabetes, yet little is known about the socioeconomic and dietary factors that influence the choice between caloric and artificial sweeteners in Central and Eastern Europe. This study examined the determinants of caloric and artificial sweetener use among adults with diabetes mellitus (DM) in Hungary. Methods: We conducted a cross-sectional analysis using frequency-based self-reported dietary measures of 542 adults with self-reported DM from the 2019 European Health Interview Survey (EHIS). Weighted descriptive statistics and multivariable logistic regression models were used to evaluate associations between sweetener use and sociodemographic, lifestyle, and dietary characteristics. Results: Overall, 28.0% of participants reported daily use of caloric sweeteners, and 45.2% reported daily use of artificial sweeteners. Higher educational attainment and healthier dietary patterns, including greater fruit and vegetable consumption, were associated with lower odds of caloric sweetener use. Individuals with lower fruit and vegetable intake, less frequent fruit juice consumption, and poor adherence to diabetic diet recommendations were more likely to use caloric sweeteners. In contrast, artificial sweetener use was strongly associated with daily fruit consumption, lower intake of fruit juice, and adherence to a diabetic diet. Vegetable intake showed a positive association with artificial sweetener use, which may reflect compensatory patterns in dietary self-management. Conclusions: Caloric and artificial sweetener use were associated with distinct socioeconomic and dietary profiles. Caloric sweetener use was linked to less healthy dietary behaviors, whereas artificial sweetener use appeared to be consistent with sugar-reduction strategies. These findings highlight the need for tailored dietary counseling that addresses both sweetener use and broader dietary patterns among individuals with diabetes in Hungary. Full article