Search Results (47)

Background/Objectives: Daily caloric restriction (DCR) is a common dietary weight loss strategy, but leads to metabolic and behavioral adaptations, including maladaptive eating behaviors and dysregulated appetite. Intermittent fasting (IMF) may mitigate these effects by offering diet flexibility during energy restriction. This secondary analysis compared changes in eating behaviors and appetite-related hormones between 4:3 intermittent fasting (4:3 IMF) and DCR and examined their association with weight loss over 12 months. Methods: Adults with overweight or obesity were randomized to 4:3 IMF or DCR for 12 months. Both randomized groups received a matched targeted weekly dietary energy deficit (34%), comprehensive group-based behavioral support, and a prescription to increase moderate-intensity aerobic activity to 300 min/week. Eating behaviors were assessed using validated questionnaires at baseline and months 3, 6, and 12. Fasting levels of leptin, ghrelin, peptide YY, brain-derived neurotrophic factor, and adiponectin were measured at baseline and months 6 and 12. Linear mixed models and Pearson correlations were used to evaluate outcomes. Results: Included in this analysis were 165 adults (mean ± SD; age 42 ± 9 years, BMI 34.2 ± 4.3 kg/m², 74% female) randomized to 4:3 IMF (n = 84) or DCR (n = 81). At 12 months, binge eating and uncontrolled eating scores decreased in 4:3 IMF but increased in DCR (p < 0.01 for between-group differences). Among 4:3 IMF, greater weight loss was associated with decreased uncontrolled eating (r = −0.27, p = 0.03), emotional eating (r = −0.37, p < 0.01), and increased cognitive restraint (r = 0.35, p < 0.01) at 12 months. There were no between-group differences in changes in fasting appetite-related hormones at any time point. Conclusions: Compared to DCR, 4:3 IMF exhibited improved binge eating and uncontrolled eating behaviors at 12 months. This may, in part, explain the greater weight loss achieved by 4:3 IMF versus DCR. Future studies should examine mechanisms underlying eating behavior changes with 4:3 IMF and their long-term sustainability. Full article

Background/Objectives: To evaluate the clinical characteristics and diagnostic significance of dissociation between bithermal caloric test and video head impulse test (vHIT) in patients presenting with dizziness. Methods: We retrospectively reviewed 644 patients who underwent bithermal caloric testing and vHIT at a university-affiliated general hospital. Patients were classified into concordant and discordant groups based on test results. The discordant group was further subdivided into those with abnormal caloric test and normal vHIT, and those with normal caloric test and abnormal vHIT. Demographic data, vestibular function test outcomes, and clinical diagnoses were analyzed. Results: Discordant results were observed in 36.5% of patients. Among these, 31.8% had abnormal caloric responses with normal vHIT, and 4.7% had normal caloric responses with abnormal vHIT. Most patients in both discordant subgroups were diagnosed with peripheral vestibular disorders, such as Ménière’s disease and unilateral vestibulopathy. The abnormal caloric/normal vHIT pattern was more common and associated with low-frequency dysfunction. The normal caloric/abnormal vHIT pattern, though less frequent, also involved predominantly peripheral etiologies. Conclusions: Dissociation between caloric and vHIT results is not uncommon and provides important diagnostic insights. Employing both tests in a complementary manner enhances the identification of frequency-specific vestibular deficits and supports more accurate diagnosis and management of vestibular disorders. Full article

Background/Objectives: Obesity pharmacotherapy vastly improved the treatment of the disease of obesity. However, GLP-1 receptor agonists and GIP/GLP-1 dual agonists may lead to nutritional complications, including severe caloric restriction, micronutrient deficiencies, lean body mass loss, dehydration, and ketosis. We examine these risks and outlines dietitian-led strategies to support improved safety and effectiveness. Methods: This narrative review was conducted in three stages: literature search, screening of abstracts and full texts, and synthesis of findings. Searches were carried out in April and May 2025 across PubMed, Embase, Scopus, ScienceDirect, Web of Science, and Google Scholar using keywords related to obesity pharmacotherapy and nutrition. Results: Clinical observations and trial data suggest that some individuals may consume fewer than 800 kcal/day during the initial stages of treatment. Prolonged energy and protein deficits can increase the risk of sarcopenia, metabolic dysfunction, and reduce treatment adherence. Additional risks include inadequate micronutrient intake due to reduced dietary variety, dehydration linked to gastrointestinal symptoms and hypodipsia, and rare but serious cases of ketoacidosis. Patients at heightened risk include older adults, those with low baseline muscle mass, and individuals with restrictive eating patterns. Conclusions: Obesity medications introduce unique nutritional risks that are not yet addressed by standardised clinical protocols. Registered dietitians play a critical role in assessing intake patterns, monitoring for red flags, and delivering targeted nutritional support. Integrating structured dietary assessment tools, checklists, and risk-specific guidance into pharmacotherapy pathways can enhance safety, promote adherence, and improve long-term outcomes. Full article

Background: Vestibular hypofunction occurs in 29.5% of older adults with benign paroxysmal positional vertigo (BPPV), but its impact on postural control, well-being and frailty was not studied before. This study compared the well-being, frailty and postural control between older adults with BPPV and vestibular hypofunction (oaBPPV+), and older adults with only BPPV (oaBPPV). Methods: Thirty-one older adults (≥65 years old) diagnosed with BPPV were recruited. Unilateral vestibular hypofunction was defined as a >25% caloric asymmetry, and bilateral vestibular hypofunction as a total response <6°/s per ear, using bithermal caloric irrigations. The oaBPPV+ group was compared to the oaBPPV group using the measures of well-being (Dizziness Handicap Inventory, Falls Efficacy Scale and 15-item Geriatric Depression Scale), frailty (Modified Fried Criteria), and postural control (timed chair stand test, mini-Balance Evaluation Systems test and Clinical Test of Sensory Interaction on Balance (CTSIB)). Falls and the number of repositioning maneuvers were documented. Significance level was set at α = 0.05. Results: Unilateral vestibular hypofunction was present in 32% of participants, mainly in females (p = 0.04). Bilateral vestibular hypofunction was not found. The oaBPPV+ group (n = 10, mean age 72.5 (4.5)) experienced more comorbidities (p = 0.02) than the oaBPPV group (n = 21, mean age 72.6 (4.9)). Groups did not differ regarding dizziness symptoms (p = 0.46), fear of falling (p = 0.44), depression (p = 0.48), falls (p = 0.08) or frailty (p = 0.36). However, the oaBPPV+ group showed significantly worse postural control under vestibular-dependent conditions (p < 0.001). Conclusions: Despite equally impaired well-being and frailty, the oaBPPV+ group showed greater sensory orientation deficits. Clinicians and researchers should be alert for co-existing vestibular hypofunction in older adults with BPPV, since this may exacerbate their already impaired postural control more than only BPPV. Full article

Background/Objectives: In primary care, tailored physical activity and nutritional counselling are scarce for older adults. Several challenges contribute to this issue, the primary obstacle being limited access to expert healthcare providers. The purpose of this study was to propose a quick, easy-to-implement case-finding tool offering straightforward nutritional and physical activity counselling to overcome these barriers. Methods: Cross-sectional, baseline analysis was performed on 277 participants of the Cognitive Function and Amyloid Marker in Frail Older Adults (COGFRAIL) study, aged 70 years and older with mild cognitive impairment (mini-mental state examination score ≥ 20) and autonomy in daily living activities (ADL ≥ 4). Body composition was assessed using dual-energy X-ray absorptiometry, physical function was assessed using the short physical performance battery (SPPB), and nutrition was assessed using the mini nutritional assessment (MNA). A structured dietary interview was conducted to collect data on a typical daily intake pattern. A second database of 725 autonomous frail older adults from the Frailty clinic was used to test the robustness of the findings. Results: Participants with MNA scores < 24/30 and SPPB scores < 6/12 presented a high percentage of protein (74.1%) and caloric (66.7%) deficiency compared to the other categories. Based on standard daily protein and caloric recommendations, age, and weight, this category had a daily protein-caloric deficit of −19.4 ± 22.7 g and −225.5 ± 430.1 Kcal. Conclusions: Based on the data, an easy-to-use algorithm using MNA and SPPB scores is suggested. This algorithm could serve as an effective tool for guiding nutritional and physical activity counselling for community-dwelling older adults. Full article

Purpose: Accurate and precise navigation in space and postural stability rely on the central integration of multisensory input (vestibular, proprioceptive, visual), weighted according to its reliability, to continuously update the internal estimate of the direction of gravity. In this study, we examined both peripheral and central vestibular functions in a world-renowned 53-year-old male tightrope walker and investigated the extent to which his exceptional performance was reflected in our findings. Methods: Comprehensive assessments were conducted, including semicircular canal function tests (caloric irrigation, rotatory-chair testing, video head impulse testing of all six canals, dynamic visual acuity) and otolith function evaluations (subjective visual vertical, fundus photography, ocular/cervical vestibular-evoked myogenic potentials [oVEMPs/cVEMPs]). Additionally, static and dynamic posturography, as well as video-oculography (smooth-pursuit eye movements, saccades, nystagmus testing), were performed. The participant’s results were compared to established normative values. High-resolution diffusion tensor magnetic resonance imaging (DT-MRI) was utilized to assess motor tract integrity. Results: Semicircular canal testing revealed normal results except for a slightly reduced response to right-sided caloric irrigation (26% asymmetry ratio; cut-off = 25%). Otolith testing, however, showed marked asymmetry in oVEMP amplitudes, confirmed with two devices (37% and 53% weaker on the left side; cut-off = 30%). Bone-conducted cVEMP amplitudes were mildly reduced bilaterally. Posturography, video-oculography, and subjective visual vertical testing were all within normal ranges. Diffusion tensor MRI revealed no structural abnormalities correlating with the observed functional asymmetry. Conclusions: This professional tightrope walker’s exceptional balance skills contrast starkly with significant peripheral vestibular (otolithic) deficits, while MR imaging, including diffusion tensor imaging, remained normal. These findings highlight the critical role of central computational mechanisms in optimizing multisensory input signals and fully compensating for vestibular asymmetries in this unique case. Full article

Background/Objectives: Anorexia nervosa (AN) is a severe psychiatric disorder characterized by profound nutritional deficits and significant alterations in body composition, cellular integrity, and hydration. Nutritional rehabilitation is critical not only for weight restoration but also for improving body composition and metabolic functions. However, optimal strategies for integrating caloric and protein intake to achieve balanced recovery remain underexplored. This study aims to evaluate the interactions between caloric/protein intake and time on quantitative (weight and BMI) and qualitative (body composition and cellular health) outcomes, and to identify markers that predict recovery trajectories and guide personalized nutritional interventions. Methods: This retrospective observational study analyzed 79 patients with AN admitted to Villa Miralago for six months of nutritional rehabilitation. Anthropometric and body composition parameters—including body weight (BW), body mass index (BMI), fat mass (FM), fat-free mass (FFM), body cell mass (BCM), phase angle (PA), and hydration markers (TBW and ECW)—were assessed at baseline (T0), 3 months (T1), and 6 months (T2). Generalized Estimating Equations (GEEs) were used to evaluate the effects of caloric and protein intake over time. Results: Significant increases in BW (+6.54 kg, p < 0.0001) and BMI (+2.47 kg/m², p < 0.0001) were observed, alongside improvements in FM, FFM, and BCM. PA increased significantly (+0.47°, p < 0.0001), indicating enhanced cellular health. TBW increased (+1.58 L, p < 0.0001), while ECW% decreased, reflecting improved fluid distribution. Caloric intake predominantly influenced early fat mass recovery, while protein intake was crucial for preserving lean tissues and promoting cellular regeneration. Interaction effects between caloric/protein intake and time revealed dynamic changes in body composition, underscoring the need for adaptive strategies. Conclusions: This study highlights the importance of a dynamic, marker-based approach to nutritional rehabilitation in AN. Integrating caloric and protein intake with advanced body composition and hydration markers enables personalized interventions and balanced recovery, shifting AN treatment toward a focus on qualitative improvements overweight restoration alone. Full article

Background: Amongst children presenting to an interdisciplinary clinic with complaints of picky eating, we aim to identify the proportion who have underlying selective feeding and to describe its implications on growth and nutrition, as well as parental coping responses. Methods: We conducted a retrospective chart review of first-visit consults from January 2020 to July 2022. Caregiver and child mealtime behaviours were assessed using the standardised Caregiver’s Feeding Styles Questionnaire (CFSQ) and by direct observation. Caloric intake and oromotor skills were assessed by dietitians and speech therapists, respectively. Medical concerns were addressed by the doctor. Results: Out of 152 children referred for concerns of “picky eating”, 128 (84.2%) were diagnosed as having selective eating, while the rest were diagnosed with delayed oromotor skills, poor appetite, oral aversion and 4 were deemed to have normal feeding behaviour for their age. Of the 128 selective eaters, 67 (52%) children had comorbidities such as autism spectrum disorder (ASD) (n = 59), attention-deficit/hyperactivity (ADHD) (n = 2) and underlying medical conditions (n = 6). The remaining 61 children were “otherwise well”. Of the “otherwise well” children, 47.5% had inadequate caloric intake and 31% had failure to thrive. The commonest feeding style among caregivers of “otherwise well” picky eaters was authoritarian (36%). The majority (80%) of these caregivers also experienced helplessness. Conclusions: We conclude that picky eating in young children is a symptom with several possible underlying aetiologies. It is associated with nutritional consequences for the child and significant stress on caregivers. Being able to recognise those who need referral for specialist intervention and multidisciplinary management (such as selective feeding and delayed oromotor skills) would be important. Full article

Background: Leptin, an adipokine essential for regulating energy balance, exerts important effects on brain function, notably within the hippocampus, a region integral to learning and memory. Leptin resistance, characterized by diminished responsiveness to elevated leptin levels, disrupts hippocampal function and exacerbates both obesity and cognitive impairments. Scope: This review critically examines how leptin resistance impairs hippocampal synaptic plasticity processes, specifically affecting long-term potentiation (LTP) and long-term depression (LTD), which are crucial for cognitive performance. Findings: Recent research highlights that leptin resistance disrupts N-methyl-D-aspartate (NMDA) receptor dynamics and hippocampal structure, leading to deficits in spatial learning and memory. Additionally, high-fat diets (HFDs), which contribute to leptin resistance, further deteriorate hippocampal function. Potential therapeutic strategies, including leptin sensitizers, show promise in mitigating brain disorders associated with leptin resistance. Complementary interventions such as caloric restriction and physical exercise also enhance leptin sensitivity and offer potential benefits to alleviating cognitive impairments. Aims of the review: This review synthesizes recent findings on the molecular pathways underlying leptin resistance and its impact on synaptic transmission and plasticity in the hippocampus. By identifying potential therapeutic targets, this work aims to provide an integrated approach for addressing cognitive deficits in obesity, ultimately improving the quality of life for affected individuals. Full article

Background: fasting-based strategies (FBS) and continuous caloric restriction (CCR) are popular methods for weight loss and improving metabolic health. FBS alternates between eating and fasting periods, while CCR reduces daily calorie intake consistently. Both aim to create a calorie deficit, but it is still uncertain as to which is more effective for short- and long-term weight and metabolic outcomes. Objectives: this systematic review and meta-analysis aimed to compare the effectiveness of FBS and CCR on these parameters in obese adults. Methods: after screening 342 articles, 10 randomized controlled trials (RCTs) with 623 participants were included. Results: both interventions led to weight loss, with a reduction of 5.5 to 6.5 kg observed at the six-month mark. However, the results showed that FBS led to slightly greater short-term reductions in body weight (−0.94 kg, p = 0.004) and fat mass (−1.08 kg, p = 0.0001) compared to CCR, although these differences are not clinically significant. Both interventions had similar effects on lean mass, waist and hip circumference, blood pressure, lipid profiles, and glucose metabolism. However, FBS improved insulin sensitivity, with significant reductions in fasting insulin (−7.46 pmol/L, p = 0.02) and HOMA-IR (−0.14, p = 0.02). Conclusions: despite these short-term benefits, FBS did not show superior long-term outcomes compared to CCR. Both strategies are effective for weight management, but more research is needed to explore the long-term clinical relevance of FBS in obese populations. Full article

Functional Hypothalamic Amenorrhea (FHA) is a condition characterized by the absence of menstruation, which is increasingly affecting young women. However, specific recommendations for treating and preventing this condition are lacking. Based on a review of the available literature, this article provides practical and feasible dietary management recommendations for healthcare professionals and researchers in women’s health and nutrition. It answers the question of what interventions and nutritional recommendations are necessary to restore menstrual function in women struggling with FHA. Physicians recommend an energy availability threshold of 30 kcal/kg FFM/day to prevent FHA. Also, energy availability below and above this threshold can inhibit LH pulsation and cause menstrual disorders. In addition, the risk of menstrual disorders increases with a decrease in the caloric content of the diet and the duration of the energy deficit, and women with FHA have significantly lower energy availability than healthy women. It is essential to ensure that adequate kilocalories are provided throughout the day (regular meals that are a source of proper glucose) to avoid a negative energy balance, as glucose has been proven to affect LH pulses and T3 and cortisol concentrations in the body. Dietary intervention should focus on increasing the caloric content of the diet, thus increasing energy availability and restoring energy balance in the body. Treatment and diagnosis should also focus on body composition, not just body weight. An increase in body fat percentage above 22% may be required to restore menstrual function. In women with FHA, even an increase in body fat mass of one kilogram (kg) increases the likelihood of menstruation by 8%. It is advisable to reduce the intensity of physical activity or training volume, while it is not advisable to give up physical activity altogether. It is also important to ensure adequate intake of micronutrients, reduce stress, and incorporate cognitive–behavioral therapy. Full article

According to the DSM-5, neurodevelopmental disorders represent a group of heterogeneous conditions, with onset during the developmental period, characterized by an alteration of communication and social skills, learning, adaptive behavior, executive functions, and psychomotor skills. These deficits determine an impairment of personal, social, scholastic, or occupational functioning. Neurodevelopmental disorders are characterized by an increased incidence and a multifactorial etiology, including genetic and environmental components. Data largely explain the role of genetic and environmental factors, also through epigenetic modifications such as DNA methylation and miRNA. Despite genetic factors, nutritional factors also play a significant role in the pathophysiology of these disorders, both in the prenatal and postnatal period, underscoring that the control of modifiable factors could decrease the incidence of neurodevelopmental disorders. The preventive role of nutrition is widely studied as regards many chronic diseases, such as diabetes, hypertension, and cancer, but actually we also know the effects of nutrition on embryonic brain development and the influence of prenatal and preconceptional nutrition in predisposition to various pathologies. These factors are not limited only to a correct caloric intake and a good BMI, but rather to an adequate and balanced intake of macro and micronutrients, the type of diet, and other elements such as exposure to heavy metals. This review represents an analysis of the literature as regards the physiopathological mechanisms by which food influences our state of health, especially in the age of development (from birth to adolescence), through prenatal and preconceptional changes, underlying how controlling these nutritional factors should improve mothers’ nutritional state to significantly reduce the risk of neurodevelopmental disorders in offspring. We searched key words such as “maternal nutrition and neurodevelopmental disorders” on Pubmed and Google Scholar, selecting the main reviews and excluding individual cases. Therefore, nutrigenetics and nutrigenomics teach us the importance of personalized nutrition for good health. So future perspectives may include well-established reference values in order to determine the correct nutritional intake of mothers through food and integration. Full article

Treatment of fatty acid oxidation disorders is based on dietary, pharmacological and metabolic decompensation measures. It is essential to provide the patient with sufficient glucose to prevent lipolysis and to avoid the use of fatty acids as fuel as far as possible. Dietary management consists of preventing periods of fasting and restricting fat intake by increasing carbohydrate intake, while maintaining an adequate and uninterrupted caloric intake. In long-chain deficits, long-chain triglyceride restriction should be 10% of total energy, with linoleic acid and linolenic acid intake of 3–4% and 0.5–1% (5/1–10/1 ratio), with medium-chain triglyceride supplementation at 10–25% of total energy (total MCT+LCT ratio = 20–35%). Trihepatnoin is a new therapeutic option with a good safety and efficacy profile. Patients at risk of rhabdomyolysis should ingest MCT or carbohydrates or a combination of both 20 min before exercise. In medium- and short-chain deficits, dietary modifications are not advised (except during exacerbations), with MCT contraindicated and slow sugars recommended 20 min before any significant physical exertion. Parents should be alerted to the need to increase the amount and frequency of carbohydrate intake in stressful situations. The main measure in emergency hospital treatment is the administration of IV glucose. The use of carnitine remains controversial and new therapeutic options are under investigation. Full article

Lean bodybuilder athletes may encounter challenges in adapting their eating habits during ad libitum refeed, either intuitively or consciously. Aims: This paper investigates whether there is a relationship between adaptive eating and energy intake coping strategies in a refeed model for bodybuilders. Methods: Fourteen male bodybuilders (29.6 ± 3.1 years; 85.6 ± 6.8 kg, ≥6 competitions) completed a 4-week regimen consisting of 5 days of energy restriction followed by 2 days of refeed. Dietary assessment, body composition (ultrasound), recovery stress questionnaire (REST-Q) and Brunel mood scale (BRUMS) were utilized pre- and post-regimen. Coping function questionnaire (CFQ), mindful eating scale version 2 (MES 2) and the intuitive eating scale-2 (IES-2) were evaluated at the 4th week. Results: Compared to the initial values, the refeed day resulted in a daily caloric increase of 44% compared to the average energy intake on the energy restriction days, culminating in a weekly calorie deficit of 27% and a drop in body mass of 3.1 ± 1.4%. Most participants showed reduced body fat and preserved or gained lean mass. The energy consumption during the refeed maintained an inverse relationship with the perception of satiety (r = −0.9; p < 0.01), the IES 2 total scores (r = −0.82; p < 0.01), as well as the confidence in hunger and satiety cues (r = −0.62; p = 0.02) and congruence in food–body choice dimensions (r = −0.56; p = 0.04). Emotional coping maintained an inverse relationship with the IES 2 total scores (r = 0.54; p < 0.05) and an inverse relationship with energy intake during refeed (r = −0.42; p < 0.05). Conclusion: The results suggest that a heightened perception of internal hunger and satiety signals and higher scores in intuitive eating may contribute to adequate energy intake, even when high scores of emotional coping are present. Full article

In recent decades, following the spread of obesity, metabolic dysfunction has come to represent the leading cause of liver disease. The classical clinical presentation of the cirrhotic patient has, therefore, greatly changed, with a dramatic increase in subjects who appear overweight or obese. Due to an obesogenic lifestyle (lack of physical activity and overall malnutrition, with an excess of caloric intake together with a deficit of proteins and micronutrients), these patients frequently develop a complex clinical condition defined as sarcopenic obesity (SO). The interplay between cirrhosis and SO lies in the sharing of multiple pathogenetic mechanisms, including malnutrition/malabsorption, chronic inflammation, hyperammonemia and insulin resistance. The presence of SO worsens the outcome of cirrhotic patients, affecting overall morbidity and mortality. International nutrition and liver diseases societies strongly agree on recommending the use of food as an integral part of the healing process in the comprehensive management of these patients, including a reduction in caloric intake, protein and micronutrient supplementation and sodium restriction. Based on the pathophysiological paths shared by cirrhosis and SO, this narrative review aims to highlight the nutritional interventions currently advocated by international guidelines, as well as to provide hints on the possible role of micronutrients and nutraceuticals in the treatment of this multifaceted clinical condition. Full article