Search Results (7,581)

Background/Objectives: Accurate assessment of dietary behaviors is essential for understanding their impact on health and guiding nutritional policies. Given the escalating prevalence of noncommunicable diseases in the MENA region, the availability of culturally adapted and psychometrically validated Arabic-language instruments is essential for accurate health assessment. This systematic review aims to identify and evaluate studies that have translated, adapted, or validated dietary behavior measurement instruments into Arabic. Methods: Following the PRISMA guidelines and registered in PROSPERO (CRD420251157552), a search was conducted in PubMed, Scopus, and Web of Science. Studies including the validation, translation, or adaptation of instruments into Arabic among Arabic-speaking populations were included. Methodological quality was assessed using the COSMIN checklist. Results: Thirty-two studies were included, published between 2006 and 2025, primarily in Lebanon (n = 14) and Saudi Arabia (n = 6). The instruments measured various concepts: dietary intake, diet quality, eating disorders, etc. While internal consistency and structural validity were frequently assessed with adequate methodological quality, content validity, measurement error, and responsiveness were either under-reported or failed to meet COSMIN standards. Conclusions: Despite an increasing volume of publications, the methodological quality of Arabic instrument validation remains heterogeneous, with significant gaps in the assessment of longitudinal properties. Efforts are needed to improve the rigor of adaptation processes and to evaluate key properties such as responsiveness in order to ensure reliable tools for research and clinical practice in the MENA region. Full article

Pain and stress are frequent and clinically relevant challenges in neonatal intensive care, particularly among preterm and critically ill newborns exposed to repeated invasive procedures, mechanical ventilation, surgery, and advanced life-support interventions. Effective analgosedation is essential to reduce discomfort, attenuate physiological instability, improve tolerance of intensive care procedures, and potentially limit adverse neurodevelopmental consequences. However, neonatal pain and analgosedation management remain complex because of developmental immaturity, pharmacokinetic and pharmacodynamic variability, and the need to balance adequate analgosedation against treatment-related complications. This narrative review summarizes current evidence on analgosedation in the Neonatal Intensive Care Unit, focusing on clinical indications, pharmacological agents, non-pharmacological strategies, monitoring tools, adverse effects, and future perspectives. Opioids, benzodiazepines, dexmedetomidine, and ketamine each have specific potential benefits and limitations, requiring individualized selection, careful titration, and continuous reassessment. Non-pharmacological interventions, including oral sucrose, non-nutritive sucking, facilitated tucking, breastfeeding, skin-to-skin care, and environmental modulation, should be integrated into multimodal pain-management protocols. Validated instruments such as COMFORTneo, N-PASS, and PIPP-R support standardized assessment and guide therapeutic decisions. Future advances may derive from objective monitoring technologies, artificial intelligence, developmental pharmacology, and precision-medicine approaches. A multidisciplinary, protocol-driven, and family-centered strategy is essential to optimize neonatal comfort while minimizing avoidable drug exposure. Full article

Background: Adolescent obesity is an escalating public health concern globally and in Greece, associated with significant physical and psychological consequences. Pediatricians serve as frontline clinicians in the early identification, counseling, and management of adolescents with excess weight; however, their practices, perceived competence, and the barriers they face remain insufficiently explored in certain Greek regions. Methods: A cross-sectional observational study was conducted using a structured, anonymous questionnaire distributed to all pediatricians working in Western Macedonia (n = 60). Fifty-one pediatricians participated (response rate 85%). The questionnaire assessed demographic characteristics, training, knowledge, clinical practices, attitudes, self-assessed competence, and perceived barriers. Results: Most participants (88.2%) reported no specialized training in adolescent obesity. Nearly half of respondents were unfamiliar with current diagnostic criteria for adolescent obesity. Although pediatricians expressed confidence in providing nutritional and lifestyle counseling, they reported limited competence in pharmacotherapy and bariatric surgery discussions. The most prominent barriers included insufficient family cooperation, lack of referral pathways, and difficulty engaging adolescents. Older and more experienced pediatricians reported higher levels of perceived competence and stronger interdisciplinary collaboration. Conclusions: Significant gaps in training and clinical support hinder the effective management of adolescent obesity in Western Macedonia. Strengthening continuous professional education, establishing multidisciplinary obesity care networks, and improving family engagement strategies appear crucial to enhancing clinical practice and improving health outcomes for adolescents. Full article

Background/Objectives: Malnutrition is prevalent among patients in the pediatric intensive care unit (PICU) and has been shown to worsen in some patients during the PICU stay. In critically ill children, malnutrition is associated with longer PICU length of stay and increased mortality. Several tools have been developed and validated to screen for nutritional status in children, but none were specifically designed for critically ill children. Our study aims to fill this gap. The goal of this study was to refine and validate a novel PICU nutrition screening tool in a diverse population of critically ill children from six PICUs across the United States. Methods: Subjects underwent the nutrition screen and a Subjective Global Nutritional Assessment (SGNA). We used chi-square tests and Mann–Whitney tests to compare elements of the nutrition screen to the SGNA to identify those elements most associated with malnutrition. We used stepwise logistic regression to determine the best fitting model for a malnutrition screening tool. We proposed a scoring system using the factors identified in the best fitting model to define a positive screen. Results: We enrolled 732 subjects at six PICUs. Of these, 131 subjects (17.9%) were malnourished per the SGNA. Children with and without malnutrition did not differ with respect to age, sex, or race. The likelihood of malnutrition increased as weight-for-age percentile decreased (p < 0.001). We found that the best fitting model of a malnutrition screening tool for critically ill children included weight-for-age percentile, cancer, feeding less, parent perception of growth as poor, and being significantly underweight. We defined a positive screen that should prompt referral to a dietitian. Conclusions: We have developed a nutrition screening tool for critically ill children. Full article

Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) has become increasingly common, a trend driven by obesity, excess nutritional intake, and dysfunctional adipose tissue. While continuous dietary stress triggers adipose-tissue-derived lipotoxicity and disrupts hepatic metabolic homeostasis and provokes inflammation, the transcriptional scaffolds that mitigate this lipotoxicity remain incompletely understood. We investigated the role of zinc finger protein 90 (ZFP90) in defending against diet-induced metabolic stress and MASLD pathogenesis. Methods: Wild-type and ZFP90-knockout mice were subjected to a high-fat diet (HFD) to model nutrient-overload-induced MASLD. Hepatic phenotypes were characterized using metabolic profiling and RNA sequencing. Mechanistic dynamics were evaluated through protein interaction assays, and clinical relevance was validated using human MASLD liver biopsies. Results: ZFP90 deficiency significantly accelerated HFD-induced steatosis, systemic insulin resistance, and inflammatory infiltration. Crucially, ZFP90 depletion drove severe white adipose tissue (WAT) dysfunction, characterized by impaired lipogenic capacity, exacerbated lipolysis, and diminished local insulin signaling. This was accompanied by a pro-inflammatory secretory shift in WAT, evident from decreased Adipoq and increased Cd68/Ccl3 expression. In the liver, transcriptomic analysis revealed a profound induction of pathways related to fatty acid uptake and cytokine signaling. Mechanistically, ZFP90 forms a repressive complex with TRIM28, acting as a crucial molecular brake on NF-kB signaling. Loss of ZFP90 unleashes p65-mediated hyper-inflammation. Clinically, hepatic ZFP90 expression is significantly upregulated in patients with MASLD. Conclusions: ZFP90 is a novel regulator of immunometabolic homeostasis under dietary stress. By forming of complex with Trim28 to inhibit the nuclear translocation of NF-κB, ZFP90 suppresses pro-inflammatory responses and protects the liver from obesity-associated systemic lipotoxicity. These findings provide critical insights into the adipo-hepatic axis and highlight ZFP90 as a promising therapeutic target to mitigate the progression to metabolic dysfunction-associated steatohepatitis (MASH). Full article

Background/Objectives: Tendon and ligament injuries are challenging conditions because of limited vascularization, slow collagen turnover, and prolonged rehabilitation timelines. This narrative review aimed to synthesize current evidence on nutritional strategies that may support connective tissue rehabilitation and return-to-activity or return-to-sport progression. Methods: This narrative review synthesized the relevant clinical, mechanistic, and applied sports nutrition literature identified through targeted database searches and manual reference screening. Results: Adequate energy availability and protein intake emerged as foundational priorities for tissue repair, endocrine and immune function, and tolerance to progressive loading. Collagen or gelatin supplementation with vitamin C before tendon- or ligament-loading exercise may provide targeted substrate and cofactor support for collagen remodeling. Creatine may assist muscle preservation during reduced loading, while micronutrient adequacy and omega-3 fatty acids may support musculoskeletal health and inflammation resolution. Conclusions: Nutrition should be viewed as an adjunct to, rather than a replacement for, structured rehabilitation loading. Phase-specific and individualized nutritional strategies may support rehabilitation when integrated with structured loading; however, additional well-designed clinical trials are needed to determine their effects on clinically meaningful outcomes, including return-to-sport time, reinjury risk, and long-term tissue outcomes. Full article

Background: Gestational anemia represents a major public health challenge in Peru, with a national prevalence ranging from 20% to 27.9%; however, the northern regions remain insufficiently studied. This study aimed to explore the multidimensional structure of clinical and sociodemographic characteristics among pregnant women with gestational anemia treated in northern Peru. Methods: A cross-sectional study was conducted among 70 pregnant women diagnosed with gestational anemia and treated at the Chicama micro-network in the La Libertad region during 2024. Sociodemographic, territorial, reproductive, and nutritional variables were obtained from medical records. Principal Component Analysis for Categorical Data (CATPCA) was applied to identify multidimensional patterns associated with anemia severity. Results: The CATPCA identified a two-dimensional structure explaining 38.47% of the total variance. Dimension 1 (sociodemographic–territorial profile; 22.55%) included health facility (−0.925), educational level (0.887), maternal age (0.878), and district of origin (−0.871). Dimension 2 (reproductive–biological profile; 15.91%) included number of previous pregnancies (0.909), interpregnancy interval (0.909), and body mass index classification (0.589). Multivariate profiles showed that mild anemia (n = 49) was predominantly associated with pregnant women younger than 20 years, lower educational attainment, and rural settings. In contrast, moderate/severe anemia (n = 21) was more frequently associated with women aged 20–35 years, secondary or higher educational attainment, and urban healthcare settings, contrary to the conventional expectation that higher educational attainment acts as a protective factor against anemia. Additionally, mild anemia was associated with multiparity and overweight/obesity, whereas moderate/severe anemia was linked to primiparity and normal BMI. Conclusions: Gestational anemia in northern Peru follows a two-dimensional pattern in which sociodemographic and territorial characteristics showed greater explanatory contribution than reproductive–biological factors. Distinct anemia severity profiles were identified, highlighting the need for context-specific prenatal care strategies and targeted public health interventions. Full article

Aim: Asprosin, a white adipose tissue-derived glucogenic adipokine, and spexin, a satiety-promoting neuropeptide, are dysregulated in obesity, yet their collective modulation by structured exercise and nutritional supplementation remains poorly characterized. This trial investigated the effects of 12 weeks of combined aerobic–resistance training, with and without taurine supplementation, on plasma asprosin, spexin, and body composition in obese men. Methods: Forty-four obese men (BMI ≥ 30 kg/m²) were allocated in a randomized, placebo-controlled, supplement-blinded design to control plus placebo (CON), taurine supplementation alone (SUP; 3 g/day), exercise plus placebo (EX), or exercise plus taurine (EX + SUP; n = 11 per group). The 12-week protocol combined aerobic training at 60% heart rate reserve (Karvonen formula) with progressive resistance training at 60% of one-repetition maximum, with load re-estimated every four weeks. Plasma asprosin and spexin were quantified by ELISA; body fat percentage (BFP) was assessed by bioelectrical impedance analysis. Two-way repeated-measures ANOVA with Bonferroni post hoc correction and Cohen’s d effect size estimation were applied throughout. Results: Significant Group × Time interactions were detected for all five outcomes (all p < 0.05). EX + SUP generated the greatest reductions in plasma asprosin (Δ = −11.20 ng/mL, p < 0.001), body mass (Δ = −5.50 kg, p = 0.003), BMI (Δ = −1.80 kg/m², p = 0.002), and BFP (Δ = −4.90%, p < 0.001), together with the greatest elevation in plasma spexin (Δ = +0.29 ng/mL, p < 0.001); effect sizes were large across all EX + SUP outcomes (Cohen’s d = 1.17 to ≥1.87). CON showed no significant change in any variable (all p > 0.05). Conclusions: Combined aerobic–resistance training with taurine supplementation produced statistically superior, large-magnitude improvements in adipokine regulation and body composition relative to either modality in isolation, demonstrating greater improvements in the combined intervention group compared with either modality applied independently. Given the per-group sample of n = 11, these findings should be considered preliminary and exploratory; independent replication in larger, adequately powered trials is required before any clinical translation can be considered. Full article

Iron supplementation in patients with tuberculosis remains a controversial issue due to the complex role of iron in the host immune response and in the pathogenesis of Mycobacterium tuberculosis infection. Although supplementation may be beneficial for some patients with persistent iron deficiency, the available evidence does not support its routine use. The efficacy and safety of such an intervention appear to depend, among other factors, on the activity of the inflammatory process, the severity of iron metabolism disturbances, and the timing of supplementation initiation. Current evidence highlights the need for an individualized assessment of iron status and for further research to establish clear clinical recommendations. At the same time, growing interest has been directed toward the role of long-chain omega-3 polyunsaturated fatty acids, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), as potential modulators of immune and inflammatory responses in tuberculosis. EPA and DHA may influence immune cell function, cytokine production, and the formation of lipid mediators involved in the resolution of inflammation. Experimental evidence suggests that omega-3 fatty acids may reduce the severity of inflammation and infection-associated anemia; however, their effectiveness may depend on baseline fatty acid status, the stage of disease, and interactions with other nutrients, including iron. Human clinical evidence remains very limited and is currently based mainly on one small intervention study, therefore, clinical claims regarding omega-3 fatty acids supplementation should be interpreted cautiously and should not be understood as a recommendation for routine use. The aim of this review is to discuss the significance of iron metabolism and omega-3 fatty acids in tuberculosis, with particular emphasis on their roles in the regulation of inflammation, immune responses, anemia, and potential nutritional support. Current evidence underscores the need for individualized nutritional interventions and further clinical research to determine the safety, efficacy, and optimal timing of iron and omega-3 fatty acids supplementation in patients with tuberculosis. Full article

Background and Objectives: Physical inactivity is a major modifiable lifestyle factor associated with type 2 diabetes mellitus (T2DM). However, real-world primary care datasets often rely on pragmatic clinical estimates of physical activity (PA) and may lack HbA1c, fasting glucose, dietary data, diabetes duration, and detailed medication information. Therefore, PA–T2DM associations in routine care must be interpreted within the limitations of cross-sectional observational data. Materials and Methods: This cross-sectional observational study analyzed 863 adult patients from a real-world primary care cohort. Participants were categorized into low, moderate, and high PA groups according to self-reported habitual weekly activity levels estimated during routine physician interviews. PA categories were based on clinically meaningful weekly activity thresholds consistent with public health recommendations. The primary outcome was documented T2DM. Secondary variables included lipid profile, blood pressure, body mass index, waist circumference, smoking status, and statin therapy. Multivariable logistic regression models were used to assess associations between PA category and T2DM, with high PA as the reference group. Results: T2DM prevalence showed a graded inverse cross-sectional association across PA categories, being highest in the low PA group (29.7%), intermediate in the moderate PA group (16.7%), and lowest in the high PA group (8.9%) (p < 0.001). In the fully adjusted model, low PA was strongly associated with higher odds of T2DM compared with high PA (odds ratio [OR] 4.32, 95% confidence interval [CI] 2.61–7.15, p < 0.001). Moderate PA was also associated with higher odds of T2DM compared with high PA (OR 2.07, 95% CI 1.23–3.48, p = 0.006). LDL-C differed significantly across PA groups, with the lowest values observed in the high PA group, whereas most other cardiometabolic parameters were comparable. Conclusions: Lower self-reported PA was strongly associated with higher T2DM prevalence after multivariable adjustment in this real-world primary care cohort. These findings support routine PA assessment as part of lifestyle-based cardiometabolic risk stratification. Because dietary intake, HbA1c, diabetes duration, glucose-lowering medication details, and regulatory biomarkers were not available, causal and mechanistic conclusions cannot be drawn. Future studies should integrate PA, nutritional assessment, glycemic markers, medication data, and physiological regulatory measures to better characterize lifestyle-related diabetes risk. Full article

Vitamin C (L-ascorbic acid) is an essential micronutrient involved in collagen biosynthesis, redox regulation, immune function, endothelial biology, carnitine synthesis, neurotransmitter metabolism, and non-heme iron absorption. Dietary reference values are designed primarily to prevent deficiency in general populations, but vulnerability to low-vitamin C status may increase during trauma, surgery, chronic inflammation, malignancy, metabolic disease, smoking, poor intake, environmental exposure, and tissue repair. This narrative review synthesizes mechanistic, pharmacokinetic, clinical, and safety evidence on vitamin C as a stress-responsive micronutrient. Evidence is reviewed across tissue repair and wound healing, orthopedic recovery and selected complex regional pain syndrome risk contexts, fatigue, neuropsychiatric vulnerability, cancer-supportive care, vascular homeostasis, dermatologic biology, and preliminary microbiota–gut–brain axis hypotheses. The strength of evidence differs substantially across domains: biochemical functions and deficiency correction are well established, whereas benefits of supraphysiologic oral supplementation in vitamin C-replete patients remain uncertain. Oral nutritional supplementation is distinguished from intravenous pharmacologic ascorbate, with attention to route, formulation, dose division, gastrointestinal tolerance-limited adjustment, and safety monitoring. Because evidence for high-dose oral supplementation remains limited and condition-specific, such use should be individualized, time-limited, and clinician-monitored rather than presented as a population-level recommendation or evidence-defined therapeutic target. Taken together, the clinical value of vitamin C depends on baseline status, patient vulnerability, route, formulation, dosing interval, clinical endpoint, and safety review. Full article

Inflammatory bowel disease (IBD) represents a growing public health challenge worldwide, and its prevalence is increasing year by year. A growing body of evidence suggests that diet plays a key role in shaping the gut microbiota, whose dysbiosis is a significant component of IBD pathogenesis. In response to the limitations of traditional, one-size-fits-all dietary recommendations, the concept of precision nutrition is emerging, which involves tailoring nutrition to a patient’s clinical, biological, and genetic characteristics. Of particular importance in this context is nutrigenomics, the science that studies the impact of dietary components on gene expression and the modulation of immune processes. Dietary components, such as polyphenols and certain vitamins, may influence gene expression and immune pathways. However, direct evidence that specific nutrients directly regulate genes associated with inflammatory bowel disease in humans remains limited. Nutrigenomic mechanisms reveal complex relationships between diet, gut microbiota, and genetic predispositions in IBD, encompassing transcriptome regulation, metabolomic changes, and epigenetic processes. A personalized nutritional approach, based on regular assessment of clinical and biological parameters and the close integration of dietary therapy with comprehensive treatment, appears to be a promising direction for the further development of IBD therapy. Full article

Background: Maternal influenza during the peripartum period poses a clinically significant risk to newborns, particularly for infants younger than 6 months. This group is especially vulnerable because of immune immaturity and the absence of an approved influenza vaccine for this age group. In light of emerging influenza virus mutations with pandemic potential, current protocols require evaluation with respect to infection prevention. Objective: To map and synthesize the available evidence and recommendations on the management of neonates born to mothers with suspected or confirmed influenza, with particular focus on delivery, skin-to-skin contact, breastfeeding, mother–infant separation, and neonatal antiviral therapy. Sources of Evidence: We performed a scoping review of the literature and professional guidance documents addressing the perinatal and postnatal management of newborns exposed to maternal influenza, using PubMed, Google Scholar, Web of Science, Embase, WHO, and CDC publications. The available evidence was synthesized narratively across the principal domains of clinical care. Conclusions: Current evidence does not support changing the mode of delivery solely because of maternal influenza. When the mother’s clinical condition permits, rooming-in, skin-to-skin contact, and breastfeeding can generally be supported with strict droplet precautions and hand hygiene. These practices provide substantial benefits for bonding, nutrition, and passive immune protection. Temporary separation may be considered in selected cases of severe maternal illness, although consistent evidence of benefit is limited. In neonates with suspected or confirmed influenza, early antiviral treatment should be considered in accordance with current pediatric guidance, whereas routine chemoprophylaxis in infants younger than 3 months remains insufficiently supported by evidence. Overall, recommendations remain heterogeneous, highlighting the need for higher-quality studies and clearer neonatal care pathways. Full article

Dietary fiber is an under-consumed nutritional substrate that supports gut microbial metabolism, intestinal barrier integrity, enteroendocrine signaling, and cardiometabolic regulation. Among dietary fibers, psyllium and glucomannan are clinically accessible viscous, gel-forming soluble fibers with distinct but complementary physicochemical profiles. This narrative review examines how these fibers act through luminal viscosity, nutrient diffusion, bile acid and cholesterol handling, short-chain fatty acid production, epithelial barrier support, enteroendocrine L-cell signaling, and low-grade metabolic inflammation. Psyllium has the strongest clinical support for stool normalization, glycemic modulation, and LDL cholesterol reduction, whereas glucomannan provides marked viscosity and water-holding capacity that may support satiety, lipid modulation, and weight-management strategies when appropriately hydrated and tolerated. We also discuss the emerging nutritional context of glucagon-like peptide-1 receptor agonist therapy, in which appetite suppression, reduced meal volume, delayed gastrointestinal transit, and constipation may reduce dietary fiber intake and fermentable substrate delivery to the colon. The pain- and mood-related implications are framed as hypothesis-generating extensions, because direct clinical evidence that psyllium or glucomannan improves these outcomes remains limited. A psyllium-centered, selectively glucomannan-supported strategy may help close the fiber gap and support bowel function, microbial metabolite signaling, and cardiometabolic stability during modern metabolic and weight-loss therapies. Full article

Background/Objectives: The aim of this systematic review was to analyze the impact of dietary modifications on unsaturated fatty acids (UFAs) intake on the course of three oral autoimmune conditions: oral lichen planus (OLP), recurrent aphthous stomatitis (RAS), and pemphigus. These acids serve a structural function as key components of cell membrane phospholipids, influencing their fluidity and membrane receptor activity. The proper ratio of these acids in the diet may be crucial for maintaining normal functioning of the human immune system. Methods: The following bases were searched with no time restrictions: PUMS Library, Embase/Elsevier, PubMed/MEDLINE, Scopus, and Web of Science. Of the 247 results identified in pre-screening, 6 studies that met all search criteria were included in the final systematic review. The risk of bias was assessed using the Revised Cochrane Risk of Bias Tool for randomized trials and the Newcastle–Ottawa Scale for non-randomized studies. Results: The outcome measures included: proportions of LA-derived oxylipins (9-HODE, 13-HODE), ulcer size (mm), monthly number of ulcers, average pain (VAS), duration of episodes, and quality of life (OHIP-14), healing time, and fatty acid analysis of total plasma phospholipid fraction, Pemphigus Disease Area Index (PDAI) for disease severity (mild ≤ 15, severe > 15); AHEI-2010 score (9–90 points) for diet quality. In all studies, improvements in clinical parameters and subjective complaints were observed after implementing a dietary intervention. Conclusions: Dietary modification may be a valuable component of adjunctive therapy. Nutritional optimization offers a genuine opportunity to reduce reliance on conventional pharmaceuticals, thereby limiting the risk of systemic adverse effects associated with long-term pharmacotherapy. Full article