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Search Results (1,022)

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19 pages, 397 KiB  
Review
Effects of Blood-Glucose Lowering Therapies on Body Composition and Muscle Outcomes in Type 2 Diabetes: A Narrative Review
by Ioana Bujdei-Tebeică, Doina Andrada Mihai, Anca Mihaela Pantea-Stoian, Simona Diana Ștefan, Claudiu Stoicescu and Cristian Serafinceanu
Medicina 2025, 61(8), 1399; https://doi.org/10.3390/medicina61081399 - 1 Aug 2025
Viewed by 170
Abstract
Background and Objectives: The management of type 2 diabetes (T2D) extends beyond glycemic control, requiring a more global strategy that includes optimization of body composition, even more so in the context of sarcopenia and visceral adiposity, as they contribute to poor outcomes. [...] Read more.
Background and Objectives: The management of type 2 diabetes (T2D) extends beyond glycemic control, requiring a more global strategy that includes optimization of body composition, even more so in the context of sarcopenia and visceral adiposity, as they contribute to poor outcomes. Past reviews have typically been focused on weight reduction or glycemic effectiveness, with limited inclusion of new therapies’ effects on muscle and fat distribution. In addition, the emergence of incretin-based therapies and dual agonists such as tirzepatide requires an updated synthesis of their impacts on body composition. This review attempts to bridge the gap by taking a systematic approach to how current blood-glucose lowering therapies affect lean body mass, fat mass, and the risk of sarcopenia in T2D patients. Materials and Methods: Between January 2015 and March 2025, we conducted a narrative review by searching the PubMed, Scopus, and Web of Science databases for English-language articles. The keywords were combinations of the following: “type 2 diabetes,” “lean body mass,” “fat mass,” “body composition,” “sarcopenia,” “GLP-1 receptor agonists,” “SGLT2 inhibitors,” “tirzepatide,” and “antidiabetic pharmacotherapy.” Reference lists were searched manually as well. The highest precedence was assigned to studies that aimed at adult type 2 diabetic subjects and reported body composition results. Inclusion criteria for studies were: (1) type 2 diabetic mellitus adult patients and (2) reporting measures of body composition (e.g., lean body mass, fat mass, or muscle function). We prioritized randomized controlled trials and large observational studies and excluded mixed diabetic populations, non-pharmacological interventions only, and poor reporting of body composition. Results: Metformin was widely found to be weight-neutral with minimal effects on muscle mass. Insulin therapy, being an anabolic hormone, often leads to fat mass accumulation and increases the risk of sarcopenic obesity. Incretin-based therapies induced substantial weight loss, mostly from fat mass. Notable results were observed in studies with tirzepatide, demonstrating superior reduction not only in fat mass, but also in visceral fat. Sodium-glucose cotransporter 2 inhibitors (SGLT2 inhibitors) promote fat loss but are associated with a small yet significant decrease in lean muscle mass. Conclusions: Blood-glucose lowering therapies demonstrated clinically relevant effects on body composition. Treatment should be personalized, balancing glycemic control, cardiovascular, and renal benefits, together with optimal impact on muscle mass along with glycemic, cardiovascular, and renal benefits. Full article
(This article belongs to the Section Endocrinology)
17 pages, 666 KiB  
Review
Three Major Deficiency Diseases Harming Mankind (Protein, Retinoid, Iron) Operate Under Tryptophan Dependency
by Yves Ingenbleek
Nutrients 2025, 17(15), 2505; https://doi.org/10.3390/nu17152505 - 30 Jul 2025
Viewed by 173
Abstract
This story began half a century ago with the discovery of an unusually high presence of tryptophan (Trp, W) in transthyretin (TTR), one of the three carrier proteins of thyroid hormones. With the Trp-rich retinol-binding protein (RBP), TTR forms a plasma complex implicated [...] Read more.
This story began half a century ago with the discovery of an unusually high presence of tryptophan (Trp, W) in transthyretin (TTR), one of the three carrier proteins of thyroid hormones. With the Trp-rich retinol-binding protein (RBP), TTR forms a plasma complex implicated in the delivery of retinoid compounds to body tissues. W has the lowest concentration among all AAs involved in the sequencing of human body proteins. The present review proposes molecular maps focusing on the ratio of W/AA residues found in the sequence of proteins involved in immune events, allowing us to ascribe the guidance of inflammatory processes as fully under the influence of W. Under the control of cytokine stimulation, plasma biomarkers of protein nutritional status work in concert with major acute-phase reactants (APRs) and with carrier proteins to release, in a free and active form, their W and hormonal ligands, interacting to generate hot spots affecting the course of acute stress disorders. The prognostic inflammatory and nutritional index (PINI) scoring formula contributes to identifying the respective roles played by each of the components prevailing during the progression of the disease. Glucagon demonstrates ambivalent properties, remaining passive under steady-state conditions while displaying stronger effects after cytokine activation. In developing countries, inappropriate weaning periods lead to toddlers eating W-deficient cereals as a staple, causing a dramatic reduction in the levels of W-rich biomarkers in plasma, constituting a novel nutritional deficiency at the global scale. Appropriate counseling should be set up using W implementations to cover the weaning period and extended until school age. In adult and elderly subjects, the helpful immune protections provided by W may be hindered by the surge in harmful catabolites with the occurrence of chronic complications, which can have a significant public health impact but lack the uncontrolled surges in PINI observed in young infants and teenagers. Biomarkers of neurodegenerative and neoplastic disorders measured in elderly patients indicate the slow-moving elevation of APRs due to rampant degradation processes. Full article
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11 pages, 1250 KiB  
Article
Height Velocity in Pediatric Cystic Fibrosis Under Triple CFTR Modulator Therapy: A Real-Life Monocentric Experience
by Alessandra Boni, Francesco d’Aniello, Grazia Ubertini, Marco Cappa, Fabiana Ciciriello, Fabio Majo, Luca Cristiani, Federico Alghisi, Enza Montemitro, Sergio Bella, Matteo De Marchis, Renato Cutrera and Alessandro G. Fiocchi
J. Clin. Med. 2025, 14(15), 5259; https://doi.org/10.3390/jcm14155259 - 25 Jul 2025
Viewed by 263
Abstract
Background/Objectives: Cystic fibrosis (CF) is a multi-system disorder characterized by chronic respiratory failure, malnutrition, and impaired growth. Achieving linear growth above the 50th percentile is associated with better pulmonary outcomes. Since October 2022, Elexacaftor/Tezacaftor/Ivacaftor (ETI) has been approved in Italy for children aged [...] Read more.
Background/Objectives: Cystic fibrosis (CF) is a multi-system disorder characterized by chronic respiratory failure, malnutrition, and impaired growth. Achieving linear growth above the 50th percentile is associated with better pulmonary outcomes. Since October 2022, Elexacaftor/Tezacaftor/Ivacaftor (ETI) has been approved in Italy for children aged ≥6 years. However, data on its impact on height velocity (HV) remain lacking. This study aims to evaluate growth patterns by HV and explore differences according to the CFTR variant genotype. Methods: We conducted a prospective single-center study at the CF Unit of Bambino Gesù Children’s Hospital involving 24 children aged 6–11 years eligible for ETI treatment. Baseline assessments included height, weight, body mass index (BMI), bone mineral density (BMD), body composition (via bioelectrical impedance analysis, BIA), and muscle strength (one-minute sit-to-stand test (1STST)). Height, weight, HV, and BMI standard deviation scores (SDS) were calculated for the 6 months before and after ETI initiation. Results: The mean age of the cohort was 8.7 ± 1.9 years (F/M: 12/12), with most patients naïve to CFTR modulators. A significant increase in HV was observed post-ETI: from 4.2 ± 2.0 cm/year (−1.96 ± 2.4 SDS) in the 6 months before treatment to 7.1 ± 3.0 cm/year (+1.5 ± 3.7 SDS) after treatment initiation (p < 0.0001). Patients with F508del/minimal function (F/MF) genotypes (n = 11) showed significantly greater HV compared to those with F508del/F508del (F/F, n = 5) and F508del/residual function (F/RF, n = 8) genotypes (p < 0.0001). No significant differences were observed among genetic groups in baseline BMD or lean mass. Conclusions: ETI treatment significantly and rapidly improves HV in children with CF, particularly in those with F/MF genotypes. These findings underscore the role of CFTR modulator therapy in promoting linear growth, a key indicator of health in pediatric CF populations. Full article
(This article belongs to the Special Issue Cystic Fibrosis: Diagnosis and Treatment)
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11 pages, 652 KiB  
Article
Circulating Beta-Defensin 2 Levels Correlate with Conventional Inflammatory Markers in Infection-Free Individuals with Overweight and Obesity: An Exploratory Study
by Theocharis Koufakis, Dimitrios Kouroupis, Georgios Dimakopoulos, Theofylaktos Georgiadis, Areti Kourti, Paraskevi Karalazou, Katerina Thisiadou, Panagiotis Doukelis, Ioanna Zografou, Dimitrios Patoulias, Djordje S. Popovic, Athina Pyrpasopoulou, Evangelos Fousteris, Georgia Argyrakopoulou, Alexander Kokkinos, Olga Giouleme, Kalliopi Kotsa, Michael Doumas and Kali Makedou
Biomedicines 2025, 13(8), 1800; https://doi.org/10.3390/biomedicines13081800 - 23 Jul 2025
Viewed by 314
Abstract
Background/Objectives: The role of intestinal dysbiosis as an important driver of inflammation in metabolic disorders is becoming increasingly evident. Beta-defensin 2 is an antimicrobial peptide that contributes to innate immunity, while recently it has been suggested as a novel biomarker of gut [...] Read more.
Background/Objectives: The role of intestinal dysbiosis as an important driver of inflammation in metabolic disorders is becoming increasingly evident. Beta-defensin 2 is an antimicrobial peptide that contributes to innate immunity, while recently it has been suggested as a novel biomarker of gut dysbiosis. However, its role in obesity remains unexplored. This study aimed to compare circulating beta-defensin 2 levels between individuals with overweight and obesity and lean controls. An additional objective was to explore potential correlations between beta-defensin 2 and other inflammatory markers in this population. Methods: The study population consisted of 81 participants (61.7% females) divided into obesity (n = 27), overweight (n = 34), and normal body mass index (n = 20) groups. All participants were free of infection and diabetes mellitus. Beta-defensin 2, interleukin-6, presepsin, high-sensitivity C-reactive protein (hs-CRP), and ferritin were evaluated in the study groups. Results: We did not find significant differences in beta-defensin 2 levels between the groups (p = 0.936). In contrast, hs-CRP levels were higher in people with obesity compared to the sum of participants in the overweight and control groups (p = 0.044), after adjusting for the effects of age, sex, smoking, and vitamin D status. Furthermore, a positive correlation was established between beta-defensin 2 and presepsin values (p = 0.012). Conclusions: The results of the present study demonstrate that obesity is characterized by an aggravation of inflammation, as expressed by elevated hs-CRP levels. Although the study design cannot prove causal relationships, our findings also suggest that beta-defensin 2 levels correlate with the magnitude of systemic inflammation in infection-free individuals living with obesity. The value of the combined evaluation of different biomarkers in obesity-related outcomes warrants further investigation by larger studies. Full article
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21 pages, 3132 KiB  
Article
Relating Anthropometric Profile to Countermovement Jump Performance and External Match Load in Mexican National Team Soccer Players: An Exploratory Study
by Israel Rios-Limas, Carlos Abraham Herrera-Amante, Wiliam Carvajal-Veitía, Rodrigo Yáñez-Sepúlveda, César Iván Ayala-Guzmán, Luis Ortiz-Hernández, Andrés López-Sagarra, Pol Lorente-Solá and José Francisco López-Gil
Sports 2025, 13(7), 236; https://doi.org/10.3390/sports13070236 - 18 Jul 2025
Viewed by 670
Abstract
Background/Objectives: The role of body composition in sports performance has been widely studied, particularly in soccer. Understanding how anthropometric characteristics impact movement efficiency and neuromuscular performance is crucial for optimizing player performance. This study examined the relationship between body composition and locomotor performance [...] Read more.
Background/Objectives: The role of body composition in sports performance has been widely studied, particularly in soccer. Understanding how anthropometric characteristics impact movement efficiency and neuromuscular performance is crucial for optimizing player performance. This study examined the relationship between body composition and locomotor performance in elite soccer players. Methods: Thirty-six male soccer players from the Mexican National Team participated in the study, where body composition was assessed using surface anthropometry. Players underwent tests to measure countermovement jump (CMJ) performance, sprinting speed, maximum acceleration, and distance covered during two games of the CONCACAF Nations League quarterfinals. Correlation matrices were created to identify the most significant associations, followed by generalized linear models (GLMs) to associate body composition variables with performance metrics. Results: Anthropometric profile tables were created by playing position. Higher body fat percentage (%BF) was associated with lower performance. Specifically, higher %BF was associated with slower sprint speed (B = −0.74 m/s, p < 0.001) and shorter distance covered (B = −4.86 m/min, p < 0.001). Conversely, greater muscularity, reflected by corrected girth values for the thigh and calf, was associated with improved CMJ performance. Thigh corrected girth was positively associated with concentric mean force (B = 48.85 N, p < 0.001), and calf corrected girth was positively associated with peak power (B = 240.50 W, p < 0.001). These findings underscore the importance of low body fat and high lean mass for efficient movement. Conclusions: The results highlight the critical role of body composition in enhancing soccer performance, particularly for explosive movements like jumps, sprints, and accelerations. This study suggests that monitoring and optimizing body composition should be a central focus of nutrition, training, and conditioning strategies, adapted to the specific positional demands of professional soccer. Full article
(This article belongs to the Special Issue Cutting-Edge Research on Physical Fitness Profile in Soccer Players)
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16 pages, 391 KiB  
Systematic Review
High-Protein Dietary Interventions in Heart Failure: A Systematic Review of Clinical and Functional Outcomes
by Lorraine S. Evangelista, Rebecca Meraz, Kelly L. Wierenga, Angelina P. Nguyen, Alona D. Angosta and Jennifer Kawi
Nutrients 2025, 17(14), 2361; https://doi.org/10.3390/nu17142361 - 18 Jul 2025
Viewed by 500
Abstract
Background: Heart failure (HF) is frequently associated with skeletal muscle wasting, reduced functional capacity, and malnutrition. High-protein diets offer a promising nutritional intervention to improve these outcomes in individuals with HF. Objective: This systematic review evaluated randomized controlled trials of high-protein dietary interventions [...] Read more.
Background: Heart failure (HF) is frequently associated with skeletal muscle wasting, reduced functional capacity, and malnutrition. High-protein diets offer a promising nutritional intervention to improve these outcomes in individuals with HF. Objective: This systematic review evaluated randomized controlled trials of high-protein dietary interventions in HF populations, with emphasis on intervention characteristics, quantitative benefits, and risk of bias. Methods: We conducted a comprehensive search in PubMed, MEDLINE, Embase, and Cochrane CENTRAL from inception to June 2025. Eligible studies enrolled adults (≥18 years) with HF, implemented high-protein regimens (≥1.1 g/kg/day or ~25–30% of energy), and reported on functional capacity, body composition, muscle strength, clinical outcomes, or biochemical markers. Two reviewers independently screened, extracted data, and assessed bias (Cochrane RoB 2). Heterogeneity in dosing, duration, and outcomes precluded meta-analysis; we therefore provide a narrative synthesis. Results: Ten trials (nine randomized controlled trials, one pilot) involving 1080 patients (median n = 38; range 21–652) were included. High-protein interventions yielded mean improvements in six-minute walk distance of +32 ± 14 m, lean body mass gain of +1.6 ± 0.9 kg, and 9 ± 4% enhancement in quality-of-life scores; muscle strength effects varied from −2% to +11%. Two studies reported an 18% reduction in HF readmissions (p < 0.05). The risk-of-bias assessment identified two low-risk, three moderate-risk, and one high-risk study. Key limitations include small sample sizes, varied protein dosing (1.1–1.5 g/kg/day), short follow-up (2–6 months), and outcome heterogeneity. Conclusions: High-protein dietary strategies appear to confer modest, clinically relevant gains in functional capacity, nutritional status, and HF readmission risk. Larger, well-powered trials with standardized dosing and longer follow-up are necessary to establish optimal protein targets, long-term efficacy, and safety. Full article
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16 pages, 624 KiB  
Article
Impact of a Four-Week NCAA-Compliant Pre-Season Strength and Conditioning Program on Body Composition in NCAA Division II Women’s Basketball
by Zacharias Papadakis
J. Funct. Morphol. Kinesiol. 2025, 10(3), 266; https://doi.org/10.3390/jfmk10030266 - 15 Jul 2025
Viewed by 769
Abstract
Background: Pre-season training is pivotal for optimizing athletic performance in collegiate basketball, yet the effectiveness of such programs in improving body composition (BC) under NCAA-mandated hourly restrictions remains underexplored. The aim of this study was to evaluate the impact of a four-week, NCAA [...] Read more.
Background: Pre-season training is pivotal for optimizing athletic performance in collegiate basketball, yet the effectiveness of such programs in improving body composition (BC) under NCAA-mandated hourly restrictions remains underexplored. The aim of this study was to evaluate the impact of a four-week, NCAA Division II-compliant strength and conditioning (SC) program on BC in women’s basketball. Methods: Sixteen student athletes (20.6 ± 1.8 y; 173.9 ± 6.5 cm; 76.2 ± 20.2 kg) completed an eight-hour-per-week micro-cycle incorporating functional conditioning, Olympic-lift-centric resistance, and on-court skill development. Lean body mass (LBM) and body-fat percentage (BF%) were assessed using multi-frequency bioelectrical impedance on Day 1 and Day 28. Linear mixed-effects models were used to evaluate the fixed effect of Time (Pre, Post), including random intercepts for each athlete and covariate adjustment for age and height (α = 0.05). Results The LBM significantly increased by 1.49 kg (β = +1.49 ± 0.23 kg, t = 6.52, p < 0.001; 95% CI [1.02, 1.96]; R2 semi-partial = 0.55), while BF% decreased by 1.27 percentage points (β = −1.27 ± 0.58%, t = −2.20, p = 0.044; 95% CI [−2.45, −0.08]; R2 = 0.24). Height positively predicted LBM (β = +1.02 kg/cm, p < 0.001), whereas age showed no association (p > 0.64). Conclusions: A time-constrained, NCAA-compliant SC program meaningfully enhances lean mass and moderately reduces adiposity in collegiate women’s basketball athletes. These findings advocate for structured, high-intensity, mixed-modality training to maximize physiological readiness within existing regulatory frameworks. Future research should validate these results in larger cohorts and integrate performance metrics to further elucidate functional outcomes. Full article
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19 pages, 2086 KiB  
Article
Cord Blood Exosomal miRNAs from Small-for-Gestational-Age Newborns: Association with Measures of Postnatal Catch-Up Growth and Insulin Resistance
by Marta Díaz, Tania Quesada-López, Francesc Villarroya, Abel López-Bermejo, Francis de Zegher, Lourdes Ibáñez and Paula Casano-Sancho
Int. J. Mol. Sci. 2025, 26(14), 6770; https://doi.org/10.3390/ijms26146770 - 15 Jul 2025
Viewed by 239
Abstract
Small-for-gestational-age (SGA) infants who experience a marked postnatal catch-up, mainly in weight, are at risk for developing metabolic disorders; however, the underlying mechanisms are imprecise. Exosomes and their cargo (including miRNAs) mediate intercellular communication and may contribute to altered crosstalk among tissues. [...] Read more.
Small-for-gestational-age (SGA) infants who experience a marked postnatal catch-up, mainly in weight, are at risk for developing metabolic disorders; however, the underlying mechanisms are imprecise. Exosomes and their cargo (including miRNAs) mediate intercellular communication and may contribute to altered crosstalk among tissues. We assessed the miRNA profile in cord blood-derived exosomes from 10 appropriate-for-gestational-age (AGA) and 10 SGA infants by small RNA sequencing; differentially expressed miRNAs with a fold change ≥2.4 were validated by RT-qPCR in 40 AGA and 35 SGA infants and correlated with anthropometric, body composition (DXA) and endocrine–metabolic parameters at 4 and 12 mo. miR-1-3p, miR-133a-3p and miR-206 were down-regulated, whereas miR-372-3p, miR-519d-3p and miR-1299 were up-regulated in SGA infants. The target genes of these miRNAs related to insulin, RAP1, TGF beta and neurotrophin signaling. Receiver operating characteristic analysis disclosed that these miRNAs predicted with accuracy the 0–12 mo changes in body mass index and in total and abdominal fat and lean mass. In conclusion, the exosomal miRNA profile at birth differs between AGA and SGA infants and associates with measures of catch-up growth, insulin resistance and body composition through late infancy. Further follow-up of this population will disclose whether these associations persist into childhood, puberty and adolescence. Full article
(This article belongs to the Section Molecular Endocrinology and Metabolism)
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17 pages, 951 KiB  
Article
Food Tolerance and Quality of Eating After Bariatric Surgery—An Observational Study of a German Obesity Center
by Alexandra Jungert, Alida Finze, Alexander Betzler, Christoph Reißfelder, Susanne Blank, Mirko Otto, Georgi Vassilev and Johanna Betzler
J. Clin. Med. 2025, 14(14), 4961; https://doi.org/10.3390/jcm14144961 - 13 Jul 2025
Viewed by 391
Abstract
Background: Bariatric surgeries, specifically laparoscopic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), are a common intervention for morbid obesity, significantly affecting food tolerance and quality of eating. Understanding these changes is crucial for improving postoperative care and long-term success. Methods: [...] Read more.
Background: Bariatric surgeries, specifically laparoscopic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), are a common intervention for morbid obesity, significantly affecting food tolerance and quality of eating. Understanding these changes is crucial for improving postoperative care and long-term success. Methods: This observational study at University Hospital Mannheim involved 91 patients, aged between 18 and 65 year, who underwent SG or RYGB between 2009 and 2019. Food tolerance was assessed between 25 days and 117 months after surgery using the validated score by Suter et al. (Food Tolerance Score, FTS) and an additional score evaluating tolerance to specific food groups and quality of life. Data on body composition were collected through Bioelectrical Impedance Analysis (BIA) at follow-up visits. Statistical analyses included linear mixed models to analyze the association of food tolerance with body composition changes. Results: The FTS indicated moderate or poor food tolerance in 62.6% of patients, with no significant differences between SG and RYGB. Considering the results of the additional score, food groups such as red meat, wheat products, raw vegetables, carbon dioxide, fatty foods, convenience food, and sweets were the most poorly tolerated food groups. A total of 57 of the participants had a baseline and follow-up BIA measurement. Postoperatively, a significant reduction in body weight and BMI as well as in BIA parameters (fat mass, lean mass, body cell mass, and phase angle) was found. Quality of life improved after bariatric surgery and 76.9% rated their nutritional status as good or excellent, despite possible food intolerances. Conclusions: Bariatric surgery significantly reduces weight and alters food tolerance. Despite moderate or poor food tolerance, patients reported high satisfaction with their nutritional status and quality of life. Detailed food tolerance assessments and personalized dietary follow-ups are essential for the early detection and management of postoperative malnutrition, ensuring sustained weight loss and improved health outcomes. Full article
(This article belongs to the Section Endocrinology & Metabolism)
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12 pages, 1773 KiB  
Article
Dietary, Body Composition, and Blood Leptin Variations in Fit-Model Female Athletes During the Pre-Competition Period
by Ramutis Kairaitis, Petras Minderis, Inga Lukonaitienė, Gediminas Mamkus, Tomas Venckūnas and Sigitas Kamandulis
Nutrients 2025, 17(14), 2299; https://doi.org/10.3390/nu17142299 - 12 Jul 2025
Viewed by 577
Abstract
Background: The Fit-Model in bodybuilding is a relatively new category designed for women seeking a balanced physique, avoiding excessive muscularity and extreme leanness. This study examined the dietary strategies, body composition changes, and plasma leptin fluctuations of Fit-Model athletes during a seven-week pre-competition [...] Read more.
Background: The Fit-Model in bodybuilding is a relatively new category designed for women seeking a balanced physique, avoiding excessive muscularity and extreme leanness. This study examined the dietary strategies, body composition changes, and plasma leptin fluctuations of Fit-Model athletes during a seven-week pre-competition phase. Methods: Twelve females (age: 27.6 ± 4.4 years, body mass: 60.0 ± 6.2 kg) preparing for a national championship were monitored for energy and macronutrient intakes, total, lean, and fat mass, plasma leptin levels, and menstrual cycle characteristics. The five highest-ranked athletes were selected to compete at the world championship, allowing for comparisons between national and international athletes. Results: Low carbohydrate intake was reported, and total energy intake decreased from 1700 to 1520 kcal/day approaching the contest day. Athletes experienced an average body mass loss of 4.2 kg, with no clear relationship between final weight or fat mass and competitive success. Plasma leptin levels were markedly low during all 7 weeks of preparation with a further decline before the contest, but did not correlate with either changes in body composition and weight or energy or macronutrient intakes. Menstrual cycle disturbances were prevalent, with only two athletes maintaining regular cycles by the end of the preparation. Conclusions: Fit-Model athletes undergo a considerable decline in body weight and fat mass during the final weeks before the contest, yet these changes do not appear to be decisive for performance outcomes. Persistently low leptin levels and menstrual irregularities call for strategies that balance physique optimization with endocrine health to support both the performance and well-being of athletes. Full article
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20 pages, 1370 KiB  
Article
Interpretable Machine Learning for Osteopenia Detection: A Proof-of-Concept Study Using Bioelectrical Impedance in Perimenopausal Women
by Dimitrios Balampanos, Christos Kokkotis, Theodoros Stampoulis, Alexandra Avloniti, Dimitrios Pantazis, Maria Protopapa, Nikolaos-Orestis Retzepis, Maria Emmanouilidou, Panagiotis Aggelakis, Nikolaos Zaras, Maria Michalopoulou and Athanasios Chatzinikolaou
J. Funct. Morphol. Kinesiol. 2025, 10(3), 262; https://doi.org/10.3390/jfmk10030262 - 11 Jul 2025
Viewed by 388
Abstract
Objectives: The early detection of low bone mineral density (BMD) is essential for preventing osteoporosis and related complications. While dual-energy X-ray absorptiometry (DXA) remains the gold standard for diagnosis, its cost and limited availability restrict its use in large-scale screening. This study investigated [...] Read more.
Objectives: The early detection of low bone mineral density (BMD) is essential for preventing osteoporosis and related complications. While dual-energy X-ray absorptiometry (DXA) remains the gold standard for diagnosis, its cost and limited availability restrict its use in large-scale screening. This study investigated whether raw bioelectrical impedance analysis (BIA) data combined with explainable machine learning (ML) models could accurately classify osteopenia in women aged 40 to 55. Methods: In a cross-sectional design, 138 women underwent same-day BIA and DXA assessments. Participants were categorized as osteopenic (T-score between −1.0 and −2.5; n = 33) or normal (T-score ≥ −1.0) based on DXA results. Overall, 24.1% of the sample were classified as osteopenic, and 32.85% were postmenopausal. Raw BIA outputs were used as input features, including impedance values, phase angles, and segmental tissue parameters. A sequential forward feature selection (SFFS) algorithm was employed to optimize input dimensionality. Four ML classifiers were trained using stratified five-fold cross-validation, and SHapley Additive exPlanations (SHAP) were applied to interpret feature contributions. Results: The neural network (NN) model achieved the highest classification accuracy (92.12%) using 34 selected features, including raw impedance measurements, derived body composition indices such as regional lean mass estimates and the edema index, as well as a limited number of categorical variables, including self-reported physical activity status. SHAP analysis identified muscle mass indices and fluid distribution metrics, features previously associated with bone health, as the most influential predictors in the current model. Other classifiers performed comparably but with lower precision or interpretability. Conclusions: ML models based on raw BIA data can classify osteopenia with high accuracy and clinical transparency. This approach provides a cost-effective and interpretable alternative for the early identification of individuals at risk for low BMD in resource-limited or primary care settings. Full article
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17 pages, 586 KiB  
Article
What Cachexia-Related Outcomes Are Measured in Lung Cancer Chemotherapy Clinical Trials?
by Valentina Razmovski-Naumovski, Anthony Tanous and Ross Valaire
Cancers 2025, 17(14), 2309; https://doi.org/10.3390/cancers17142309 - 11 Jul 2025
Viewed by 378
Abstract
Background: Cachexia worsens prognosis, quality of life and chemotherapy treatment compliance of patients with lung cancer. Chemotherapy-induced cachexia has also been implicated in lowered mortality. This study aimed to evaluate the frequency of cachexia-related measures and symptoms as outcomes in lung cancer chemotherapy [...] Read more.
Background: Cachexia worsens prognosis, quality of life and chemotherapy treatment compliance of patients with lung cancer. Chemotherapy-induced cachexia has also been implicated in lowered mortality. This study aimed to evaluate the frequency of cachexia-related measures and symptoms as outcomes in lung cancer chemotherapy trial protocols and to examine how key trial characteristics influence them. Method: We conducted a cross-sectional data analysis of randomised controlled chemotherapy trials of lung cancer registered in four public trial registries between 2012 and 2023. Trial outcome measures included overall survival, treatment toxicity/side effects and cachexia-related indicators such as physical activity, weight/body mass index (BMI), dietary limitations, caloric intake and lean muscle mass. Symptom-related outcomes, including appetite loss, diarrhoea, pain, fatigue/insomnia, constipation, nausea, vomiting, dysphagia, dyspnoea and oral mucositis, were also extracted. Additionally, the number and type of performance status and assessment tool were recorded. Data were summarised descriptively. Chi-square tests were used to examine associations between trial outcomes and characteristics including cancer type, trial location, lead investigator/funding source, assessment tools and trial commencement year. A p < 0.05 was considered statistically significance. Results: Of the 335 trial protocols (non-small cell (87.2%) and small cell (12.8%)), most were from Europe (50.4%). The trial lead investigator was from industry (56.7%) followed by academia (25.1%). Allied health professional involvement was minimal (0.6%). Trial protocols mostly recorded overall survival (96.4%) and toxicity (83.9%). However, physical activity, weight/BMI, dysphagia, dyspnoea and oral mucositis were recorded in <30%, with dietary limitations, caloric intake and lean muscle mass recorded in <3% of the trials. Measures and symptoms were not associated with cancer type. Trial location was associated with the measures toxicity, physical activity and caloric intake and all symptoms. Lead investigator was associated with the measures toxicity and weight/BMI and all symptoms except for dyspnoea. Performance status and assessment tools were mentioned in 93.4% and 41.8% of the trials, respectively, with significant associations between assessment tools and outcomes, except for weight/BMI, dietary limitations, lean muscle mass, dysphagia and oral mucositis. There was a significant trend with trial commencement year for the measures physical activity (p = 0.002) and weight/BMI (p = 0.000) and all symptoms, except for appetite loss (p = 0.115) and pain (p = 0.433). Conclusions: While the reporting of measures and outcomes was generally higher compared to gastrointestinal chemotherapy cancer trials, it still faced significant under-reporting. Assessment tools should include cachexia-specific symptoms to accurately assess the quality of life in patients with lung cancer undergoing chemotherapy clinical trials. Full article
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14 pages, 276 KiB  
Article
Exploratory Assessment of Health-Related Parameters in World-Class Boccia Players Using DXA
by Bárbara Vasconcelos, José Irineu Gorla, Karina Santos Guedes de Sá, Rui Corredeira and Tânia Bastos
Healthcare 2025, 13(14), 1658; https://doi.org/10.3390/healthcare13141658 - 9 Jul 2025
Viewed by 314
Abstract
Background: Sport plays an important role in the health promotion of people with cerebral palsy (CP). However, risk factors may impair sport performance and health in non-ambulatory athletes. Therefore, the aim of the present study was to explore body composition and bone [...] Read more.
Background: Sport plays an important role in the health promotion of people with cerebral palsy (CP). However, risk factors may impair sport performance and health in non-ambulatory athletes. Therefore, the aim of the present study was to explore body composition and bone health in a group of world-class Boccia players with CP. Methods: Five BC2-class players with CP, aged 15–42 years old, were assessed using Dual-Energy X-Ray Absorptiometry (DXA) for body composition and bone mineral density (BMD) and content (BMC). The fat mass index (kg/m2) was used to define obesity, and the BMD Z-score used to analyze bone health. A preliminary indicator of sarcopenia was considered using the appendicular lean mass index. Results: Players 1 and 3 exhibited similar body compositions (obesity class 1 and BMD Z-score are below the expected range for age). Player 5 exhibited multiple health-related risk factors. The results regarding youth players (Player 2 and Player 4) should be analyzed with caution. Conclusions: Overall, due to Boccia’s specific characteristics, players may benefit from close monitoring by multidisciplinary teams and supplementary strategies (e.g., strength training, individualized diet plans) to promote quality of life and performance. However, further research is needed to confirm the data, since these preliminary findings do not allow for broader generalizations. Full article
25 pages, 1099 KiB  
Review
Nutritional Management of Liver Failure in the Intensive Care Unit
by Zsófia Verzár, Rudolf Kiss, Csaba Pál Bálint, Annamária Pakai and Tímea Csákvári
Medicina 2025, 61(7), 1210; https://doi.org/10.3390/medicina61071210 - 3 Jul 2025
Viewed by 601
Abstract
Liver failure, both acute and chronic, represents a complex, life-threatening condition frequently requiring intensive care unit (ICU) admission. Nutritional management is a crucial component of supportive therapy, aiming to mitigate catabolism, preserve lean body mass, and support immune and organ function. In acute [...] Read more.
Liver failure, both acute and chronic, represents a complex, life-threatening condition frequently requiring intensive care unit (ICU) admission. Nutritional management is a crucial component of supportive therapy, aiming to mitigate catabolism, preserve lean body mass, and support immune and organ function. In acute liver failure (ALF), early nutritional intervention within 24–48 h and individualized energy–protein prescriptions are essential, even in the presence of hepatic encephalopathy. Chronic liver failure (CLF) and acute-on-chronic liver failure (ACLF) are often associated with severe malnutrition, sarcopenia, and systemic inflammation, necessitating tailored nutritional strategies. Subjective Global Assessment (SGA) and Royal Free Hospital Global Assessment (RFH-GA) tools are instrumental in identifying nutritional risk. Enteral nutrition (EN) is preferred across all stages, with parenteral nutrition (PN) reserved for contraindications. Special considerations include micronutrient repletion, prevention of refeeding syndrome, and perioperative nutritional support in transplant candidates and recipients. This clinical overview summarizes current evidence and guidelines on ICU nutrition in liver failure, emphasizing a multidisciplinary approach to improve outcomes. Full article
(This article belongs to the Section Gastroenterology & Hepatology)
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23 pages, 2746 KiB  
Article
Hydration Status and Acute Kidney Injury Biomarkers in NCAA Female Soccer Athletes During Preseason Conditioning
by Daniel E. Newmire, Erica M. Filep, Jordan B. Wainwright, Heather E. Webb and Darryn S. Willoughby
Nutrients 2025, 17(13), 2185; https://doi.org/10.3390/nu17132185 - 30 Jun 2025
Viewed by 435
Abstract
Exercise training in extreme temperatures concurrent with hypohydration status may potentiate the development of acute kidney injury (AKI) in young, healthy persons. Background/Objectives: It is unknown how repeated training bouts in ambient higher temperatures and humidity may influence measures of AKI. The [...] Read more.
Exercise training in extreme temperatures concurrent with hypohydration status may potentiate the development of acute kidney injury (AKI) in young, healthy persons. Background/Objectives: It is unknown how repeated training bouts in ambient higher temperatures and humidity may influence measures of AKI. The purpose of this study was to investigate hydration status and renal biomarkers related to AKI in NCAA Division I female soccer athletes during preseason conditioning. Methods: A convenience sample of n = 21 athletes were recruited (mean ± SEM; age: 19.3 ± 0.25 y; height: 169.6 ± 1.36 cm; mass: 68.43 ± 2.46 kg; lean body mass: 45.91 ± 1.13 kg; fat mass: 22.51 ± 1.69 kg; body fat %: 32.22 ± 1.32%). The average temperature was 27.43 ± 0.19 °C, and the humidity was 71.69 ± 1.82%. Body composition, anthropometric, workload, and 14 urine samples were collected throughout the preseason training period for urine specific gravity (USG), creatinine (uCr), cystatin C (uCyst-C), and neutrophil gelatinase-associated lipocalin (uNGAL) analyses. Results: Our investigation showed that, when compared to baseline (D0), the athletes maintained a USG-average euhydrated status (1.019 ± 0.001) and were euhydrated prior to each exhibition game (D5-Pre: p = 0.03; 1.011 ± 0.001; D10-Pre: p = 0.0009; 1.009 ± 0.001); uCr was elevated on D8 (p = 0.001; 6.29 ± 0.44 mg·dL−1·LBM−1) and D10-Post (p = 0.02; 6.61 ± 0.44 mg·dL−1·LBM−1); uCyst-C was elevated on D6 through D10 (p = 0.001; ~0.42 ± 0.01 mg·dL−1); no differences were found in uNGAL concentration. The highest distance (m) displaced was found during exhibition games (D5: p = <0.0001; ~8.6 km and D10: p = <0.0001; ~9.6 km). During the preseason conditioning, the athletes maintained a euhydrated status (~1.019) via USG, an increase in uCr that averaged within a normal range (208 mg·dL−1), and an increase in uCyst-C to near AKI threshold levels (0.42 mg·L−1) for several practice sessions, followed by an adaptive decline. No differences were found in uNGAL, which may be explained by athlete variation, chosen time sample collection, and variation in training and hydration status. Conclusions: The athletes maintained a euhydrated status, and this may help explain why urinary markers did not change or meet the reference threshold for AKI. Full article
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