Search Results (696)

Background: According to well-known dietary recommendations, herbs and spices are part of a healthy, balanced diet, and their consumption may contribute to improved health. Globalisation fosters greater exposure to other cultures and cuisines, including the use of spices. This study aimed to assess the awareness and attitudes towards spices among Polish students in a rural area. Methods: A survey study was conducted among 278 Generation Z students (aged 18–28 years old) from a university located in a small town in southeastern Poland. Questions concerning, a.o., preparing meals, awareness of spices’ properties, and the use of seasoning were included. Results: Most of the respondents declared using a lot of spices beyond salt and pepper (61.2%), more often women than men (67.9% vs. 45.1%; p = 0.0004), and more often participants aged ≥23 years than ≤22 years (82.9% vs. 58.0%; p = 0.005). Participants who grew their own spices and often watched TV culinary programs used more seasonings (72.4%; p = 0.001 and 85.2%; p = 0.0002, respectively). Less than half of the respondents (45%) recognised health properties in some of the spices, and 28.1% of them recognised health properties in spices in general, with more older participants (45.7%; p = 0.0402). Respondents with the highest awareness of the health properties of spices used them more often to improve their health (42.3%; p < 0.00). Conclusions: Exposure to cuisines from other cultures and their spices and the willingness to try new flavours among respondents were low. This might be due to sociodemographic factors, including origin from small, rural, traditional communities, where attachment to familiar recipes might be observed. Moreover, awareness of the healing benefits of spice use was low. Therefore, education about the composition and use of local spices might be helpful in increasing their intake for the benefit of health. Full article

Gluten-related diseases (GRDs), affecting approximately 1–6% of the global population, require long-term adherence to a gluten-free (GF) diet for effective disease management. Food label literacy plays a critical role in ensuring dietary safety; however, consumer attitudes, behaviors, and perceptions regarding GF food labeling remain insufficiently characterized. This study systematically reviewed and synthesized evidence on these factors across different GRDs. A comprehensive search of PubMed/MEDLINE, EMBASE, Cochrane Library, Scopus, and Web of Science was conducted for studies published between January 2000 and December 2025. Studies evaluating attitudes, beliefs, and behaviors related to GF food labeling among individuals with GRDs were included. A total of 82 studies involving 61,284 participants from 27 countries were included, with 44 studies contributing to the meta-analysis. Consistent GF label reading was reported by 79.2% of participants, while 60.3% expressed confidence in label accuracy. However, 40.9% reported dietary infractions due to misleading labeling. Label reading behavior varied across disease groups and regulatory settings. Key barriers included ambiguous wording, inconsistent cross-contamination disclosures, and lack of standardized symbols. These findings highlight important gaps in labeling practices and emphasize the need for standardized regulations and targeted educational interventions to improve dietary safety and health outcomes. Full article

Back-ground: In 2022, in Niger, undernutrition was highly prevalent in 6–23-month-old infants and their diet was poorly diversified. Methods: This cluster randomized controlled trial was conducted in the Zinder region of Niger to monitor food and nutritional intakes from two food solutions, fortified infant flours (FIF) and ten nutritionally improved traditional recipes (NITR), in breastfed 6–11-month-old infants divided into four groups: control, responsive feeding (RF) awareness raising, RF + FIF, and RF + NITR. Data were collected at T0 (n = 322 infants) and 3 months later (T3, n = 300 infants). Results: At T0, 29% and 52% of infants had stunting and anemia, respectively, and 24% of them achieved minimum dietary diversity (MDD) in all groups. At T3, the MDD rates significantly increased, particularly in the RF + FIF and RF + NITR groups (71% and 81%, respectively). Food intake remained low in all groups, below the gastric capacity of children. Nevertheless, at T3, food intake was significantly higher in the RF + NITR group than in the other groups (p = 0.0209). Although porridges made with FIF were consumed in smaller quantities, thanks to their high energy density, the mean energy intake was higher in the RF + FIF group than in the control and RF groups. The energy intake of the RF + NITR group was even higher. This can be attributed to the fact that NITR-based meals were more varied, and colorful and offered different tastes and textures, thus appearing more appetizing and stimulating. Conclusions: A strategy that combines FIF and NITR appears relevant for improving nutritional intake in these contexts. Full article

Ultra-processed foods (UPFs) are foods formulated through extensive industrial processing, with little or no natural food constituents, and include ingredients such as artificial colors, flavors, and other food additives to enhance shelf life and palatability. They are typically energy-dense and poor in essential nutrients, including products such as sugar-sweetened beverages, packaged snacks, processed meats, instant noodles and confectioneries. UPF intake has been associated with a wide range of metabolic and inflammatory diseases, especially obesity and adiposity. The transition to independent living and increased dietary autonomy among young adults, particularly university students, are associated with higher reliance on UPF. This narrative review aims to examine the global evidence on the association between UPF consumption and obesity and adiposity outcomes among young adults. Most reviewed studies demonstrated a consistent positive association between UPF consumption and increased obesity and adiposity risks among young adults. UPF consumption within this population is substantial, ranging between 25% and 50% of total energy intake (TEI). The association between UPF consumption and increased risk of obesity and adiposity can be explained through multiple biological and behavioral mechanisms, including high energy density and palatability, disruption of satiety signaling, gut microbiota alterations, and hormonal dysregulation. To reduce the long-term burden of obesity among young adults, public efforts should be directed to important health interventions, such as university awareness nutritional programs, front-of-pack labeling, and policy-level restrictions on UPF marketing. Full article

Background/Objectives: Hypocalcemia is a major transition-cow disorder in dairy cattle, with clinical and subclinical forms differing in detectability, severity, timing, and herd-level consequences. This systematic review integrates evidence on calcium (Ca) homeostasis, classification of clinical hypocalcemia (CHC) and subclinical hypocalcemia (SCH), diagnostic interpretation, risk factors, systemic effects, and preventive and therapeutic strategies in dairy cows. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement, PubMed, ScienceDirect, SpringerLink, and CAB Abstracts were searched in February 2026 for 1994–2025 publications, and 23 reports were included in a qualitative synthesis; meta-analysis was not performed because of methodological and outcome heterogeneity. Results: The evidence indicates that hypocalcemia should be interpreted as a failure of homeorhetic adaptation to abrupt mammary Ca export rather than as a simple mineral deficiency. The parathyroid hormone–vitamin D axis, skeletal Ca mobilization, renal Ca conservation, intestinal Ca absorption, magnesium (Mg) status, dietary cation–anion difference (DCAD), dry matter intake, parity, and acid–base balance jointly determine whether blood Ca is maintained during early lactation. Total calcium (tCa) thresholds are useful decision aids for herd-level monitoring, but their interpretation depends on sampling time, parity, persistence pattern, clinical signs, and the relationship between tCa and ionized calcium (iCa). Subclinical hypocalcemia is most relevant when it is delayed, persistent, or occurs in high-risk cows because reduced Ca availability can impair smooth muscle function, feed intake, immune competence, uterine health, and metabolic resilience. Management should therefore combine prepartum ration control, Mg adequacy, DCAD and urine pH monitoring, selective Ca testing in high-risk cows, targeted oral Ca supplementation for standing cows, and intravenous Ca treatment for recumbent CHC cases. Conclusions: The evidence supports a risk-based, context-aware strategy rather than universal threshold-driven treatment. Full article

Background: Childhood oral hygiene behaviors are crucial to preventing oral diseases and can influence the development and progression of malocclusions. The World Health Organization (WHO) Oral Health Questionnaire is a standardized tool for assessing oral hygiene behaviors, oral health-related behaviors, and preventive dental awareness in children. Aim: This study aimed to assess oral hygiene behaviours and examine associations between WHO Oral Health Questionnaire variables and Angle malocclusion classes among children aged 6–9 years. Materials and Methods: This cross-sectional study included 90 children aged 6–9 years from the Pristina region, Kosovo. Data were collected using the WHO Oral Health Questionnaire for Children, which assessed oral hygiene habits, toothbrushing frequency, fluoride awareness, dental attendance, dietary behaviors, oral symptoms, and oral-health-related quality of life. Malocclusion was classified according to Angle classification into Class I, II, and III malocclusions with 3D intraoral scanners, Aerolscan 3. Descriptive statistical analysis, Chi-square (χ²) test, Spearman correlation analysis, and reliability analysis using Cronbach’s Alpha were performed using SPSS Statistics 23.0 (IBM Corp., Armonk, NY, USA) and Statistica 7.1 (StatSoft Inc., Tusla, OK, USA). Results: Most participants reported regular oral hygiene practices, with 46.7% brushing their teeth two or more times daily. However, limited awareness regarding fluoride-containing toothpaste was observed, as most children answered “don’t know” regarding fluoride use. Occasional toothache or oral discomfort was reported by 33.3% of participants, while 23.3% reported dissatisfaction with dental appearance. Difficulty biting hard foods was present in 34.4% of children. Reliability analysis of the Q10 section demonstrated moderate internal consistency (Cronbach’s Alpha = 0.500). Chi-square analysis demonstrated no statistically significant association between Angle malocclusion classes and WHO questionnaire variables (p > 0.05). The highest χ² value was observed for tooth-cleaning frequency (Q7) (χ² = 11.97; p = 0.152), although the association remained statistically non-significant. Psychosocial impact questions and oral health-related quality of life questions also demonstrated no statistically significant association with malocclusion classes. Conclusions: oral hygiene practices, preventative oral health practices, and oral health-related experiences were comparatively similar among children in different Angle malocclusion classes. Although there were no statistically significant correlations found between malocclusion classes and WHO questionnaire variables, the results show that some children have psychosocial concerns about their dental appearance and insufficient awareness of preventive oral health. The WHO Oral Health Questionnaire is a useful epidemiological tool for evaluating pediatric oral health behaviors and may help build youth orthodontic and preventive oral health policies. Full article

Background: Polyendocrine metabolic ovarian syndrome (PMOS/PCOS) is the most common hormonal disorder in women of reproductive age and is linked to infertility as well as long-term metabolic and psychological problems. In the Gulf Cooperation Council (GCC) region, rising obesity, dietary changes, and sedentary lifestyles may be increasing its burden. However, prevalence estimates remain highly inconsistent due to differences in diagnostic criteria and measurement methods rather than true variation in disease rates. Objective: This study aimed to describe the situation by systematically pooling available evidence on the prevalence of PMOS among women in GCC countries and by summarizing the range of clinical features reported across included studies. Methods: We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. We searched five major bibliographic databases (PubMed, Scopus, Web of Science, Cochrane Library, and Embase) and the Google Scholar search engine for observational studies published up to 1 June 2026. Studies were eligible if they reported PMOS prevalence and related clinical features among women of reproductive age residing in GCC countries. After removing duplicates and screening 570 initially identified records, 25 studies met our inclusion criteria; 24 were included in the quantitative meta-analysis after excluding one high-risk study. Risk of bias was appraised using the Joanna Briggs Institute Checklist for Prevalence Studies. A random-effects meta-analysis using the DerSimonian-Laird method, combined with the Freeman-Tukey double arcsine transformation, was used to estimate the pooled prevalence. Heterogeneity was quantified using the I² statistic and Cochran’s Q test. Subgroup analyses explored differences by country, diagnostic method, study setting, and publication period. Meta-regression was used to identify study-level factors that explained between-study variability. Results: Across 24 studies involving 77,890 women, the pooled prevalence of PMOS was 17.59% (95% CI: 12.98–23.40%). Country-level estimates ranged from 6.56% in Oman to 23.0% in Saudi Arabia. Heterogeneity across all analyses was extremely high (I² = 99.6%), and meta-regression identified the diagnostic tool as the single most important source of variation, explaining 42.7% of between-study variance. Studies using structured clinical criteria (Rotterdam or NIH) yielded prevalence estimates around 13–14%, while those relying on self-report or physician diagnosis without standardized criteria reported considerably higher figures (20–37%). Common clinical features included menstrual irregularity (up to 100% of PMOS cases in clinical cohorts), hirsutism (5–100%), acne and oily skin (17–74%), and obesity (17–73%). Awareness of PMOS among women in the region was highly variable, ranging from under 3% to nearly 100%. Conclusions: PMOS is a significant public health concern across the GCC region. The markedly higher pooled prevalence combined with high rates of obesity and metabolic risk in this population calls for urgent, coordinated action. Standardizing diagnostic practices, investing in population-level screening, and developing culturally tailored awareness programs are essential steps toward reducing the clinical and social burden of PMOS. Full article

Over the last years, incretin receptor agonists—including glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1 RA) and the dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonist tirzepatide—have dramatically improved the management of type 2 diabetes, overweight and obesity. However, as the use of incretin receptor agonists continues to increase worldwide, micronutrient deficiencies—including iron deficiency—have emerged as newly recognized adverse effects of these drugs. The present article aims to discuss recent preliminary observational evidence on the potential relationship between incretin receptor agonist-based therapies and the development of iron deficiency and iron deficiency anemia (IDA), as well as the potential mechanisms by which incretin receptor agonists may affect iron homeostasis. Potential mechanisms and factors underlying the development of iron deficiency and IDA in patients treated with incretin receptor agonist-based therapies include inadequate dietary iron intake (due to incretin receptor agonist-mediated reduction in food intake and/or gastrointestinal adverse effects of incretin receptor agonists), low dietary variety, monotonous diets, and changes in food preferences, as well as impairment of intestinal iron absorption (due to delayed gastric emptying, reduced small intestinal motility and/or decreased gastric acid secretion caused by incretin receptor agonists). Moreover, vitamin B2 (riboflavin) deficiency and changes in gut microbiota composition are hypothetical mechanisms that may partly explain iron deficiency in patients treated with incretin receptor agonists, although these hypotheses require confirmation through mechanistic studies. Even though iron deficiency and IDA currently appear to be uncommon adverse effects of incretin receptor agonist-based therapies, clinicians should be aware of the possibility of their occurrence to ensure appropriate prevention and management of these nutritional complications. Nevertheless, future prospective studies are certainly needed to better establish the causal relationship between the initiation of incretin receptor agonist-based therapies and the development of iron deficiency/IDA, as well as the exact mechanisms underlying the potential development of these nutritional complications in patients treated with incretin receptor agonists. Meanwhile, the prescription of incretin receptor agonists should not be unjustifiably restricted by the possible and modest risk of iron deficiency and IDA in patients with one or more approved indications for therapeutic use of these agents. Since no established guidelines currently exist for the prevention and management of iron deficiency and IDA in patients treated with incretin receptor agonists, we herein propose practical strategies to address these possible nutritional complications of incretin receptor agonist-based therapies. These proposed strategies should only be regarded as practical clinical approaches deriving from the existing recommendations for the prevention and management of iron deficiency and IDA, although their cost-effectiveness for the prevention and management of incretin receptor agonist-associated iron deficiency/IDA should be appropriately assessed in future clinical trials. Full article

Autophagy-associated readouts in localized prostate cancer cannot be interpreted based on LC3, p62/SQSTM1, or LC3 puncta alone. In line with the concept of autophagy as a stress-response system, this review proposes a flux-aware, organelle-centered framework for assigning biological meaning to autophagy-related changes under disease-relevant stress. The framework integrates oxidative burden, lysosomal competence, selective autophagy, mitophagy, ferritinophagy, p62/SQSTM1-NRF2 signaling, ferroptosis-aware controls, and disease-stage context to distinguish four interpretive states: homeostatic quality control, adaptive tumor survival, blocked clearance, and stress-overload vulnerability. Flavonoid-associated responses are used as stress-test examples because they expose recurrent limitations in the field, including supraphysiologic exposures, limited metabolite realism, static-marker inflation, and insufficient assessment of lysosomal function. However, the framework is not restricted to dietary compounds; it applies to metabolic, pharmacological, inflammatory, androgen-related, radiation-associated, or therapy-induced perturbations in which autophagy-associated markers are altered without resolution of flux or organelle function. By linking autophagosome formation, cargo turnover, lysosomal acidification, redox buffering, and phenotype-level endpoints, this review defines a practical evidence hierarchy for interpreting autophagy in localized prostate cancer and for prioritizing translational vulnerabilities arising from organelle crosstalk. This contribution is primarily conceptual and is operationalized methodologically through flux-based evaluation criteria and translationally through disease-window-specific study-design recommendations. Full article

Background/Objectives: Gastric cancer is a major cause of morbidity and mortality in Saudi Arabia, where late-stage presentation is common. Public awareness of risk factors and warning symptoms is essential for early detection. This study assessed gastric cancer knowledge and its demographic correlates among adults in Jeddah. Methods: A cross-sectional survey of 1400 adults was conducted between August and October 2025 using a structured 45-item questionnaire covering 37 knowledge items across four domains. Analyses used independent t-tests, one-way ANOVA, chi-squared tests, and multivariable linear regression. Results: The mean age was 31.34 ± 10.18 years; 53.8% were women. The mean total knowledge score was 18.94 ± 7.34/37 (51.2%). Domain scores were risk factors 4.95 ± 2.04/11 (45.0%), symptoms 4.54 ± 2.87/10 (45.4%), prevention 4.91 ± 2.09/10 (49.1%), and management 2.99 ± 1.95/6 (49.8%). Knowledge was associated with occupation (p < 0.001), with healthcare workers scoring highest (25.97 ± 5.56). Higher knowledge was also associated with education (p < 0.001), age (p = 0.003), and family or friend history of gastric cancer (p = 0.003), but not sex (p = 0.39). In multivariable analysis, educational attainment (β = 0.30) and healthcare-provider occupation (β = 0.23) were the strongest independent correlates of knowledge (both p < 0.001). Only 34% of respondents identified Helicobacter pylori as a risk factor. Conclusions: Awareness of gastric cancer in Jeddah is suboptimal, particularly for risk factors and symptom recognition. Targeted interventions addressing risk factors, alarm symptoms, and dietary risks—delivered through primary care and community channels—may improve awareness and support earlier detection. Full article

Food allergies impose strict constraints on dietary decision-making, necessitating recommender systems that guarantee safety without compromising nutritional quality or user satisfaction. Existing systems often treat safety as a preference, failing to meet rigorous safety-critical standards or account for complex interactions between allergens, nutrition, and visual appeal. To address this issue, we propose a structured, multi-objective recipe recommendation framework. In this framework, rather than being modeled as an additive objective, allergen safety is prioritized through a safety-aware penalty-based ranking mechanism. The framework integrates three core modules: an allergen safety score accounting for cross-reactivity and cooking conditions; a nutritional balance score aligned with Dietary Reference Intakes (DRIs); and a neural-derived visual appeal score. In evaluation, we conducted a controlled user study ($N=20$) to evaluate the framework against single-factor baselines. Our integrated strategy consistently outperforms all single-factor baselines across evaluated metrics. Sensitivity analysis further confirms that safety-aware ranking ensures stable recommendation behavior across diverse preference profiles. Notably, behavioral analysis revealed a decision–action discrepancy, wherein users exhibited more risk-averse behavior during actual interactions than their explicitly stated preferences suggested. These findings suggest that prioritizing safety through safety-aware ranking mechanisms, together with multi-objective optimization, provides a robust foundation for personalized health-aware dietary support. Full article

Sustainable dietary transitions are increasingly recognised as essential for addressing the interconnected challenges of public health, environmental degradation and food system sustainability. Although the Mediterranean Diet (MD) is widely acknowledged as a healthy and sustainable dietary model, adherence has progressively declined across diverse populations. This study develops an integrated conceptual framework to explain the sustainable adoption of the Mediterranean Diet, with particular emphasis on the conceptual mediating role of plant-based foods. A structured conceptual narrative review was conducted using interdisciplinary evidence from nutrition science, sustainability research, behavioural sciences and food policy. The proposed framework integrates individual capacities, socio-cultural contexts, structural environments and ecological awareness within a systems-oriented perspective. The findings suggest that dietary behaviour is shaped by dynamic and context-dependent interactions influenced by feedback mechanisms, life-course transitions and structural constraints. Within this framework, plant-based foods function as integrative leverage points linking health, environmental and cultural dimensions. The study highlights the limitations of individual-centred approaches and emphasises the importance of coordinated multi-level strategies to support sustainable dietary transitions. Overall, the framework provides a theoretically grounded basis for future research, policy development and integrated interventions aimed at promoting resilient and sustainable food systems. Full article

Highlighting its pivotal role in modern pharmacology, the gut microbiome is emerging as a key determinant of drug efficacy, toxicity, and bioavailability. This review proposes the Gut Microbiome Dependency Continuum, a four-layer framework describing progressively deeper levels of microbiome involvement in drug discovery and therapeutic function. The first layer, intact functional microbiome-dependent therapeutics and includes interventions such as faecal microbiota transplantation and defined microbial consortia. The second layer, microbiome-modulated approved drugs include widely used therapeutics whose pharmacokinetics or pharmacodynamics are strongly influenced by microbial metabolism. Examples include metformin, irinotecan, levodopa, and digoxin, where gut microbial interactions influence efficacy, toxicity, and inter-individual variability in treatment outcomes. The third layer, microbiota-transformable natural products, encompasses dietary and plant-derived compounds such as polyphenols, ginsenosides, alkaloids, fibres, isoflavones, lignans, and glucosinolates. Their biological activity depends on microbial biotransformation into bioactive metabolites. The fourth layer, engineered microbiome therapeutics, includes synthetic biology approaches such as programmable microbial systems, engineered probiotics, CRISPR-based microbiome editing, and microbiome-responsive drug delivery systems. It also includes synthetic microbial consortia, enabling targeted sensing, therapeutic delivery, and ecological reprogramming of gut microbial communities. Altogether, these layers define a continuum in which the gut microbiome evolves from a passive modulator to an essential metabolic organ and ultimately a programmable therapeutic platform. The article provides an integrated framework for microbiome-informed drug discovery. It also supports the development of precision, ecology-aware, and engineered microbial therapeutics. Full article

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

Diabetes mellitus is a complex metabolic disorder whose management has moved from glycemic control to the control of risk factors through the use of new antihyperglycemic drugs with pleiotropic effects. Despite the multiple cardio–renal benefits of sodium-glucose co-transporter 2 (SGLT2) inhibitors, their prescription is often avoided due to concerns regarding side effects. This review aims to discuss the multiple benefits of SGLT2 inhibitors in balance with one of the most concerning side effects, the risk of euglycemic diabetic ketoacidosis (EDKA). A literature search was performed to identify and select articles relevant to this topic. We accessed several databases, including PubMed, Web of Science and Scopus, using appropriate keywords. We selected and evaluated randomized controlled trials, retrospective studies, systematic reviews and meta-analysis published between 2014 and 2024 supporting the multifaceted benefits of SGLT2 inhibitors and the limitations of their recommendations and focusing on the risk of EDKA. Initially designed as antidiabetic agents, SGLT2 inhibitors have demonstrated important cardio–renal benefits, these drugs being the first-line medication in patients with established cardiovascular disease, heart failure and chronic kidney disease. SGLT2 inhibitors are associated with some potential side effects, but with contradictory data concerning their prevalence and clinical relevance. From the possible side effects, EDKA is a life-threatening metabolic emergency whose incidence and recognition has increased, in particular with the use of SGLT2 inhibitors. These drugs can cause this disorder through several mechanisms, including reduced insulin secretion and increased glucagon levels, leading to free fatty acid production, which generally occurs in the presence of some risk factors such as reduced dietary carbohydrates, intercurrent illnesses, surgical stress and alcohol consumption. Through awareness of these risk factors as well as of the clinical symptoms, this condition could be promptly avoided or managed and SGLT2 inhibitors could be safely used. Full article