Search Results (703)

Background/Objectives: Accurate estimation of nutritional content from food images has important applications in dietary assessment and public health surveillance. While large language models (LLMs) have shown promise for this task, the effects of prompt design and model selection on estimation accuracy remain poorly characterized. Methods: We evaluated three Claude models (Haiku 4.5, Sonnet 4.6, Opus 4.6) for visual estimation of five mandatory nutritional components (energy, protein, fat, carbohydrate, and salt equivalent) across three datasets: NutriImage (691 Japanese meal photographs with dietitian-validated ground truth, after OCR-mask quality filtering), SNAPMe (1463 US meal photographs from a publicly available benchmark), and the Japan Branded Food Database (JBFD; 989–1000 packaged food product images). We systematically compared a default prompt and a visual estimation prompt explicitly instructing the model not to read any text or numbers visible in the image. Results: The visual estimation prompt substantially improved accuracy when paired with a sufficiently capable model (energy R²: 0.23 for Haiku to 0.60 for Sonnet, JBFD). Sonnet and Opus substantially outperformed Haiku across all datasets, while differences between Sonnet and Opus were small (MedAPE difference 1–3 percentage points). Packaged food images (JBFD) yielded higher R² than meal photographs. Salt equivalent showed consistently poor accuracy (MedAPE 34–64%). On SNAPMe, Sonnet achieved lower energy MAE (116.9 vs. 123.0 kcal, −4.9%) and lower MAE for protein (5.9 vs. 7.9 g, −25.7%) and fat (6.6 vs. 8.7 g, −24.5%) compared with a recent ChatGPT-5 study. Conclusions: Claude Sonnet offers the best cost-performance balance for LLM-based nutritional estimation. Prompt design substantially affects accuracy, but only when paired with a sufficiently capable model; model visual recognition capability appears to be a key determinant of performance. These findings highlight the inherent difficulty of this task and provide practical guidance for dietary assessment system development. Full article

The prescription and recommendation of prebiotics and probiotics by healthcare professionals remain an evolving area of research. Despite increasing recognition of their benefits in modulating the gut microbiome, healthcare professionals including dietitians, often lack standardised guidelines and sufficient training to integrate them into practice. Barriers to implementation include insufficient clinical evidence, cost, uncertainty regarding strain-specific efficacy, and a lack of consensus on appropriate therapeutic applications. Studies indicate that while many healthcare professionals acknowledge the potential benefits of these products, their hesitancy arises from insufficient supporting research evidence and associated education. Future efforts should concentrate on enhancing clinical guidelines, improving educational programs for healthcare professionals, and conducting large-scale trails to establish evidence-based recommendations. Additionally, integrating gut microbiome sequencing into clinical decision-making could improve personalised nutrition and optimise the prescription of prebiotics and probiotics. Further research is necessary to address knowledge gaps and promote effective, evidence-based use of these interventions by healthcare professionals. This review explores current prescribing practices, knowledge, and perceptions of healthcare professionals regarding prebiotics and probiotics with a particular focus on the evidence, education, and implementation gaps that may influence their clinical application. Full article

Background/Objectives: Household food insecurity is a modifiable social determinant of health with important implications for diet quality and health outcomes. Dietitians are well positioned to identify and respond to food insecurity; however, little is known about how this is addressed in routine dietetic practice across Europe. This exploratory study examined food insecurity screening and response practices among dietitians practicing in Europe and examined associated correlates using the Capability, Opportunity, and Motivation Model of Behaviour (COM-B). Methods: An online cross-sectional survey informed by the COM-B framework was distributed through the European Federation of Associations of Dietitians’ institutional communication channels between February and June 2024. Participants were recruited using a voluntary, convenience-based sampling strategy through professional networks and social media dissemination. A total of 148 dietitians practicing in European countries responded. The questionnaire assessed routine food insecurity screening practices, COM-B correlates, perceived barriers, actions taken following identification, and learning needs. Quantitative data were analysed descriptively, and open-ended responses were used illustratively to contextualise reported practices. Results: Food insecurity screening was not systematically embedded in routine dietetic practice, with 11.6% of respondents reporting routine screening and 30.2% not asking about food insecurity. Identification of food insecurity did not consistently translate into follow-up action, and responses were predominantly referral-based rather than involving direct material support. While capability and motivation to address food insecurity were generally high, opportunity-related factors—such as time constraints, limited organisational support, and unclear referral pathways—emerged as the main barriers shaping professional behaviour. Substantial heterogeneity was observed across practice settings. Conclusions: In this sample of dietitians practicing in Europe, food insecurity screening and response were variable and often constrained by organisational and contextual factors. These findings highlight the need for system-level support and practice-oriented training to facilitate the integration of food insecurity into routine dietetic care. Full article

Aim: To evaluate the status of the nutritional management of diet-treated IEM in Brazil from the perspectives of healthcare professionals, patients, and families. Methods: Data were collected through two nationwide digital questionnaires administered to healthcare professionals involved in dietary management (n = 37) and to patients and caregivers (n = 278), addressing professional training, workload, access to resources, treatment adherence, and socioeconomic factors. Results: Healthcare professionals from 20 out of the 26 Brazilian states participated, most of them female (81%) and dietitians (81%). Although more than half had over 10 years of experience, 59% considered their training insufficient to work with IEM. Only 19% reported exclusive dedication to the field, and 54% were the sole professional responsible for dietary prescriptions at their center. Weekly workload dedicated to IEM varied widely. Among the patients and families, phenylketonuria (60.4%) and glycogen storage disease (25.9%) were the most frequent conditions. Higher educational level and longer time since diagnosis were associated with a better understanding of dietary management (p < 0.05). Among patients on protein-restricted diets, most reported regular use of protein substitutes, although 92% reported poor palatability and 36% reported supply problems. Access to special low-protein foods was limited, and over half of the families reported some level of food insecurity. Conclusions: Significant systemic, logistical, and socioeconomic barriers to optimal dietary management of IEM persist in Brazil, highlighting the need for strengthened public policies, professional training, and equitable access to dietary resources. Full article

Background: Polyendocrine Metabolic Ovarian Syndrome (PMOS) is recognized as the most prevalent endocrine disorder among women of reproductive age, with an estimated prevalence of approximately 18% according to current Rotterdam diagnostic criteria. Conditions such as dyslipidemia, insulin resistance, hyperandrogenism, central adiposity, and chronic inflammation are frequently observed in women diagnosed with PMOS. These conditions predispose such individuals to an increased risk of developing Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), which is the most prevalent chronic liver disease worldwide, affecting approximately 25% of the global population. PMOS and MASLD represent two interconnected metabolic disorders that share overlapping risk factors. Objective: The purpose of this narrative review is to investigate the underlying pathophysiological connections between PMOS and MASLD and to assess the efficacy of targeted nutritional interventions. Methods: An analysis of nearly 30 articles concerning nutritional strategies for PMOS and MASLD was conducted, including studies on dietary patterns, macronutrient-focused dietary strategies, and dietary supplement interventions. Results and Conclusions: The review concludes that a combined approach—comprising an anti-inflammatory dietary pattern, omega-3 supplementation, and myo-inositol—serves as a good evidence-based initial strategy for clinicians and dietitians managing women with coexisting PMOS and MASLD. It is noteworthy that most of the evidence for these recommendations comes from studies that focus solely on either PMOS or MASLD populations. Studies involving individuals with both conditions are currently lacking. Future research should prioritize long-term randomized controlled trials involving women from diverse backgrounds diagnosed with both PMOS and MASLD. These conditions, whether independently or concurrently, are imposing an increasing burden on women of reproductive age worldwide. As further research is conducted, nutritional interventions may serve as primary rather than supplementary therapeutic strategies for the management of PMOS and MASLD. Full article

Inflammatory bowel disease (IBD; Crohn’s disease and ulcerative colitis) arises from convergent dysfunction of the epithelial barrier, mucosal immunity, and gut microbiome on a background of genetic susceptibility and environmental exposures. Diet is among the most modifiable of these exposures, yet much of the diet–microbiome research in IBD remains descriptive and poorly aligned with the molecular pathways linking food to mucosal effects. This comprehensive review reframes the field around functional dysbiosis, in which altered microbial metabolic capacity (rather than taxonomic shifts alone) drives disease-relevant biology. We trace how dietary substrates and additives are converted by gut microbes into bioactive metabolites (short-chain fatty acids, secondary bile acids, tryptophan-derived indoles, sulfur compounds, and polyphenol-derived molecules) and map these to host receptors and signaling pathways governing barrier function, mucus and antimicrobial peptide production, and Treg/Th17 balance. Defined dietary therapies (exclusive enteral nutrition, the Crohn’s disease exclusion diet plus partial enteral nutrition, and Mediterranean-style patterns) are reinterpreted as interventions that reshape microbial metabolic output, and candidate biomarkers for microbiome-informed precision nutrition are evaluated. Microbiota-derived metabolites provide the molecular interface between diet and mucosal immunity in IBD; personalized dietary algorithms remain a research goal, not a validated clinical tool, and diet is best framed as adjunctive to pharmacotherapy and dietitian care. Full article

Background/Aim: Berberine, an isoquinoline alkaloid widely used in traditional medicine, has attracted considerable interest for its capacity to modulate the gut microbiota and improve cardiometabolic outcomes. Although preclinical evidence is promising, no systematic review has previously synthesised evidence from randomised controlled trials (RCTs) in humans. This review aimed to evaluate the effects of berberine supplementation on gut microbiota and to explore associated cardiometabolic, inflammatory, and immunological changes. Methods: Prospectively registered in PROSPERO (CRD42024524143) and conducted in accordance with PRISMA guidelines, this review searched PubMed, Web of Science, Scopus, and Embase from inception to 10 January 2026. Eligible studies were RCTs in adults reporting gut microbiota outcomes following berberine supplementation. Methodological quality was assessed using the Cochrane Risk of Bias tool. Microbiota assessment methods, including sequencing platforms and bioinformatic pipelines, were systematically characterised across the included studies. Results: Seven RCTs enrolling 34 to 446 participants per intervention arm were included across diverse clinical populations—type two diabetes mellitus (T2DM), hyperlipidaemia, colorectal adenoma, psychiatric disorders, and Parkinson’s disease. Six of seven studies reported significant compositional shifts; the most extensively characterised changes—observed predominantly in T2DM populations—included enrichment of γ-Proteobacteria and depletion of butyrate-producing taxa, with specific taxa and the breadth of compositional changes varying considerably across clinical populations and sequencing methodologies. These shifts co-occurred with improvements in fasting glucose, lipid profiles, and inflammatory markers; however, causal inference cannot be established. Conclusions: Berberine consistently modulated gut microbial composition across heterogeneous clinical populations, with concurrent cardiometabolic and anti-inflammatory improvements. Compositional shifts were not uniformly favourable, and findings should be interpreted as hypothesis-generating. Geographically diverse, mechanistically focused RCTs are required to establish causality. Full article

Obesity prevalence has increased globally, and metabolic bariatric surgery (MBS) is the most effective treatment for severe obesity. However, the impact of postoperative dietary counselling (DC) on clinical outcomes including weight is unclear. This review aims to assess the nature and impact of postoperative DC delivered by dietitians on clinical outcomes in adults undergoing post-MBS, focusing on weight change as the primary outcome, and body composition, nutritional status, biochemical parameters, and complications as secondary outcomes. Five databases (Medline, Embase, Web of Science, CINAHL, and Cochrane Library) were searched for observational studies and randomised controlled trials (RCTs) assessing DC related to weight change. Thirteen studies met the inclusion criteria (five RCTs and eight observational studies), involving 4173 individuals. Eight studies reported no significant difference in weight outcomes between the groups receiving DC and comparison groups. However, secondary outcomes such as nutritional status, complications, and levels of transferrin saturation, vitamin B12, and vitamin D showed improvements with more frequent DC. The components of DC delivered by dietitians varied, including advice on micronutrient supplements, protein intake, physical activity, transition diets, healthy eating, and mindful eating. Evidence supporting the efficacy of postoperative DC in promoting weight loss is limited by short-term assessment and inconsistencies in reporting weight outcomes, highlighting the need for long-term RCTs to ascertain its effectiveness. Full article

Background: Dietary management of phenylketonuria (PKU) focuses on restricting phenylalanine (Phe) intake. The European PKU guidelines and the PKU Dietary Handbook recommend a simplified PKU diet, allowing unrestricted consumption of many low-Phe foods, called free foods. While this approach may reduce the treatment burden for patients, its implementation varies. This study investigated practices of Swedish metabolic dietitians regarding the simplified diet and the use of free foods for classical PKU (cPKU) and compared these with European recommendations. Methods: A survey was distributed to all metabolic dietitians in Sweden. The survey included questions on professional experience, the use of free foods and the classification of 135 low-protein food items as never, sometimes or always counted in cPKU. Data were summarised descriptively. Results: All 13 eligible dietitians participated. The use of free foods was recommended by 8/13 dietitians. Of foods classified as free in the PKU Handbook, about one third were commonly restricted in Swedish PKU practice. For 39% of the foods surveyed, no single response option (never, sometimes or always counted) reached >50%, indicating variation in practice. Classification of individual foods partially aligned with their Phe content, but portion size and concerns about excessive Phe intake also influenced advice. Conclusions: Significant variation exists in the dietary management of PKU in Sweden, and the simplified diet approach is not consistently implemented. Dietitians’ concerns about the safety of increased Phe intake from free foods play a central role in this. These findings highlight challenges in incorporating international guidelines into national practice and underscore the need for further research to address dietitians’ safety concerns related to the simplified diet. Full article

Background: Dietitians play a critical role in preventing food–drug interactions (FDIs) and drug–nutrient interactions (DNIs); however, evidence regarding their knowledge, attitudes, and practices (KAP) in Saudi Arabia remains limited. Objective: The aim of this study was to assess dietitians’ KAP regarding FDIs and DNIs and examine their associations with socio-demographic and professional characteristics. Methods: A national cross-sectional study was conducted among 353 dietitians using a validated and modified questionnaire. Knowledge was assessed via 15 multiple-choice items (score range 0–15) and categorized as poor (0–5), moderate (6–10), or good (11–15). Attitudes were assessed using 8 Likert-scale statements (score range 8–40) and classified as negative (8–19), neutral (20–29), or positive (30–40). Practices were assessed via 6 frequency-scale items (score range 6–30) and categorized as poor (6–14), moderate (15–23), or good (24–30). Associations were analyzed using chi-square tests. Results: In total, 65.2% of participants demonstrated poor knowledge. Knowledge level was significantly associated with nationality (p = 0.011), educational qualification (p = 0.042), attendance at FDI/DNI training courses (p = 0.003), and inclusion of related topics during university education (p = 0.013). Higher knowledge levels were also associated with managing digestive diseases (p = 0.001), cardiovascular diseases (p = 0.020), and cancer (p = 0.031). Positive attitudes were reported by 77.6% of participants and were significantly associated with managing cardiovascular disease (p < 0.001) and obesity (p = 0.008). Good practices were observed in 36.3% of dietitians and were significantly associated with younger age (p = 0.024), more recent graduation (p = 0.006), fewer years of professional experience (p = 0.002), and managing obesity (p = 0.016). Knowledge was positively associated with practice (p < 0.001). Conclusions: Despite generally positive attitudes, substantial gaps in knowledge and practice regarding FDIs and DNIs exist among dietitians in Saudi Arabia. Strengthening academic curricula and continuing professional education is essential to enhance competency and improve patient safety. Full article

Background/Objectives: Phenylketonuria (PKU) is a rare autosomal recessive disorder caused by phenylalanine hydroxylase (PAH) deficiency, impairing the conversion of phenylalanine (Phe) to tyrosine. Although early diagnosis and intervention yield excellent outcomes, dietary adherence often declines in adulthood, potentially leading to poor metabolic control and adverse nutritional consequences. This study aimed to evaluate physical activity levels, nutritional status, metabolic control, and anthropometric outcomes in adults with classic PKU, which have not been sufficiently researched in the current literature. Methods: This cross-sectional study included 100 adults with classical PKU (cPKU; baseline phenylalanine levels ≥ 1200 µmol/L) under regular follow-up at the Division of Metabolism, Hacettepe İhsan Doğramacı Childrens’ Hospital. Sociodemographic traits and dietary behaviors were evaluated through structured interviews carried out by a dietitian. Dietary intake was assessed by using a 24 h dietary recall method, and nutrient analyses were performed with the Bebis 7.2 software program. Using the short version of the International Physical Activity Questionnaire (IPAQ), physical activity levels were specified, and participants were categorized according to established scoring criteria. Results: A hundred adults with classical PKU took part in the study, including 47 males and 53 females, with a mean age of 23.84 ± 5.41 years; 5% of participants were underweight, 40% had normal weight, 39% were overweight, and 16% were listed as obese. The intake of mean daily energy is 2443.8 ± 384.6 kcal for men and 1822.5 ± 312.7 kcal for women. Carbohydrates contributed approximately 61% of total daily energy intake in both genders, whereas protein accounted for 12–13% and fat for approximately 26–27% of total energy intake; 17% of participants were physically inactive, 40% were minimally active, and 43% met criteria for sufficient physical activity according to IPAQ-based classification. Energy intake, the use of Phe-free protein substitutes, and BMI were significantly higher in the sufficiently active group compared to the low-active group in men, while no significant differences were observed between physical activity groups among women. Conclusions: Adults with classical PKU showed a high prevalence of overweight and obesity, together with differences in dietary intake and physical activity patterns. Physical activity levels were associated with several nutritional and metabolic characteristics; however, further long-term research is required to fully understand these connections. Full article

Background: Nutrient-enriched sports foods can support efficient nutrient intake in specific circumstances in athletic nutrition management, such as during competition, when training away from the usual environment, or during periods of weight management. Despite their widespread availability, sports foods are not always used appropriately, necessitating tools to support informed product selection. Objective: This study aimed to characterize sports foods consumed by Japanese athletes and to develop a Japanese sports food exchange list to facilitate product selection based on target nutrient requirements. Methods: Seven sports food categories commonly used in Japanese sports settings were examined: sports drinks, energy jellies, energy bars, energy gels, protein drinks, protein bars, and protein powders. Following the methodology of Spain’s sports food exchange list, development proceeded in two stages. First, suppliers were selected based on INFORMED CHOICE certification or listing on the Japan Anti-Doping Agency’s product information website, with input from experienced sports dietitians. Subsequently, 523 products were classified into subcategories based on nutrient content per unit using established statistical criteria, including the mean, standard deviation, coefficient of variation, and z-values. Results: After excluding products with z-values outside ±2 or compositions deemed unsuitable for carbohydrate or protein supplementation, 498 products from 36 suppliers were classified into 24 subcategories. Japanese sports foods exhibited broad distributions in nutrient composition, variability derived from ingredient differences, and a high proportion of plant-based protein powders. Conclusions: This study developed a Japanese sports food exchange list comprising 498 products across 24 subcategories, enabling evidence-based product selection aligned with the nutrient intake goals of Japanese athletes. Full article

Background: Metastatic renal cell carcinoma (mRCC) remains incurable despite advances with immune checkpoint inhibitors and tyrosine kinase inhibitors. Metabolic interventions, such as the ketogenic diet (KD), may modulate tumor biology and systemic inflammation, yet clinical evidence in mRCC is limited. Objective: To evaluate the feasibility, safety, and tolerability of KD combined with systemic therapy in mRCC patients. Design, Setting, and Participants: CETOREIN was a non-randomized, single-center pilot study enrolling 21 adult mRCC patients initiating systemic therapy. KD was initiated concurrently with treatment for up to 12 months, with follow-up at 1, 3, 6, and 12 months. Intervention: Participants followed a 2:1 KD (≈80% fat, 20% protein + carbohydrates) with dietitian-led counseling, medium-chain triglyceride supplementation, food diaries, and ketonuria monitoring. Outcome Measurements and Statistical Analysis: The primary endpoint was feasibility, defined by diet-related adverse events. Secondary endpoints included adherence, metabolic parameters, and exploratory clinical outcomes (response rate, progression-free survival [PFS], overall survival [OS]). All efficacy-related outcomes were descriptive and exploratory only. Results: Eight patients (40%) completed 12 months on KD, with a mean duration of 7 months. Common diet-related toxicities were diarrhea (55%), weight loss (45%), hypercholesterolemia (40%), and dyspepsia (30%), with no severe events. Early weight loss was modest and transient. Ketonuria correlated with dietary records, confirming adherence. Median PFS was 9.5 months, and median OS was 39 months. Among four patients undergoing cytoreductive nephrectomy, exploratory paired PD-L1 analyses showed decreased expression in three cases; however, these observations are hypothesis-generating only and cannot be attributed to the ketogenic diet. Conclusions: KD is feasible and demonstrated an acceptable tolerability profile in selected mRCC patients, though long-term adherence is challenging. No conclusions regarding antitumor efficacy can be drawn from this small non-randomized pilot study. Future studies should evaluate shorter interventions and optimized dietary protocols in larger randomized trials. Full article

Background: Celiac disease (CeD) requires lifelong adherence to a gluten-free diet (GFD). However, there is evidence that a GFD may lead to an unhealthy cardiometabolic risk profile and potentially increase the risk of cardiovascular disease in some patients. Incorporating plant-based foods (primarily derived from plants) into a GFD may offer a solution to improve cardiometabolic health. Thus, this study aimed to identify the attitudes toward and barriers to adopting a more plant-dominant diet among Danish patients with CeD. Methods: A cross-sectional survey was distributed to 2861 members of the Danish Celiac Society. Data from 959 patients with confirmed CeD were included. Results: Most participants (58.5%) reported adapting their diet after diagnosis by combining gluten-free products with plant-based foods, while 31.2% relied solely on gluten-free replacements. Dietary adaptation was primarily shaped by the limited availability of gluten-free plant-based foods (64%), taste/texture (55%), and cost (51%). More than half of the patients (56.8%) considered ‘eating more plant-based foods’, with ‘health’ being the primary motivator (70%), followed by ‘climate’ (50%) and ‘taste’ (36%). However, several barriers to a more plant-dominant diet were identified. Most notably, ‘taste and texture’ (71%), ‘limited availability of gluten-free plant-based foods’ (68%), ‘nutritional concerns’ (56%), and ‘cost’ (54%) were reported as barriers. Conclusions: Most Danish patients with CeD were generally positive about increasing their intake of plant-based foods; however, barriers to such dietary changes remain. Ongoing follow-up, practical guidance from dietitians, and accessible evidence-based resources may help patients maintain a nutritionally balanced, plant-dominant GFD that supports long-term health. Full article

Background/Objectives: Overweight and obesity are increasing globally. However, structured contemporary data on lifestyle behaviors and adiposity in Romanian young adults remain limited. Therefore, this study aimed to describe dietary and lifestyle habits, BMI, and overweight/obesity prevalence in Romanian adults aged 18–30 years and to examine associations between these variables. Methods: This cross-sectional online questionnaire study included 1202 young Romanian adults. BMI was calculated from self-reported height and weight and analyzed continuously, as well as for overweight/obesity (BMI ≥ 25 kg/m²). Pre-specified exposures were compulsive eating, soft-drink intake, breakfast frequency, physical activity, and sleep duration. Multivariable linear regression with heteroscedasticity-consistent standard errors was used for BMI, and modified Poisson regression with robust variance was used for overweight/obesity. Composite dietary score, sex-interaction, and sensitivity analyses were also performed. Results: Mean age was 23.2 ± 3.3 years, mean BMI was 23.8 ± 4.2 kg/m², and 32.4% of participants had overweight/obesity. Men had higher BMI and a higher prevalence of overweight/obesity than women. Compulsive eating and soft-drink intake showed dose-dependent associations with higher BMI and higher overweight/obesity prevalence. Short sleep duration (≤5 h/night) and daily breakfast consumption were associated with a higher and, respectively, lower prevalence of overweight/obesity. Physical activity showed no independent association after full adjustment, although this finding may be influenced by the use of a single self-reported item. Composite-score analyses supported the main findings. Conclusions: In Romanian young adults, compulsive eating and soft-drink intake were the most consistent behavioral correlates of adiposity, while breakfast regularity and short sleep showed threshold-type associations with overweight/obesity. These findings may inform the design of multicomponent prevention strategies, although longitudinal confirmation is needed. Full article