Search Results (676)

Time-qualified dietary interventions, including time-restricted eating (TRE), intermittent fasting (IF), and periodic fasting-mimicking diets (FMDs), have emerged as strategies to improve metabolic health. While preclinical studies consistently demonstrate robust effects on energy metabolism, cardiometabolic function, and longevity, translation to humans remains heterogeneous. In free-living settings, most metabolic improvements observed with TRE and IF appear primarily driven by spontaneous caloric restriction rather than meal timing per se, and isocaloric randomized controlled trials generally show no additional benefits compared to standard calorie restriction. Evidence supporting circadian-specific advantages, particularly for early TRE, is promising but inconsistent and often context-dependent. Important uncertainties also persist regarding long-term efficacy, lean mass preservation, safety in specific populations, and the physiological impact of extended fasting windows. Despite these controversies, time-qualified diets represent a paradigm shift in nutritional science by integrating chronobiology with dietary patterns. Future directions include tailoring eating windows to individual chronotypes, combining fasting regimens with high-quality dietary patterns and structured physical activity, and clarifying the molecular mechanisms that may mediate calorie-independent benefits. Large, long-term, mechanistically informed human trials are essential to determine whether aligning eating behaviors with circadian biology can produce durable clinical improvements. Such work will ultimately shape the role of personalized chrononutrition in preventive and therapeutic nutrition. Full article

Background: Picky eating (PE), also termed food selectivity, is one of the most common feeding concerns in childhood. Although often a transient developmental stage, persistent or severe selectivity may lead to nutritional deficiencies, growth impairment, and psychosocial consequences. Methods: This narrative review is based on literature searches conducted in April 2025 across PubMed, Web of Science, Embase, Medline, and Google Scholar. Articles published between 2015 and 2025 were included if they addressed the epidemiology, etiology, assessment, or management of PE in children aged 0–18 years. Additional seminal references predating this period were also considered. Results: Prevalence estimates of PE vary widely (13–50%), with peak incidence between ages two and six. Contributing factors include genetic predisposition, sensory sensitivities, temperament, family feeding practices, environmental influences, and adverse feeding experiences. Distinction from avoidant/restrictive food intake disorder (ARFID) and pediatric feeding disorder (PFD) is essential, as these conditions carry greater risk of nutritional and psychosocial impairment. Assessment relies on caregiver-report instruments, clinical observation, growth monitoring, and targeted nutritional evaluation. Effective management integrates parental education, responsive feeding strategies, repeated exposure to novel foods, and, when indicated, nutritional supplementation or referral to multidisciplinary teams. Sensory-based therapies, behavioral interventions, and psychoeducational programs show particular benefit in persistent cases. Conclusions: While most children outgrow PE without adverse outcomes, a subset remains at risk of long-term nutritional compromise and psychosocial difficulties. Early recognition, family-centered guidance, and evidence-based interventions are essential. Future research should refine diagnostic criteria, develop culturally sensitive assessment tools, and evaluate innovative therapies to improve outcomes. Full article

Background: Eating disorders (EDs) are serious mental health conditions often beginning in adolescence and are associated with significant morbidity and mortality. Although previous research has focused on medical staff, little is known about how EDs are recognised and managed by non-medical mental health professionals within community-based systems. This study examined their awareness, knowledge, and stigmatising beliefs toward EDs in Türkiye, highlighting implications for training and policy development. Methods: A study-specific questionnaire adapted from a validated tool previously used with general practitioners was administered to 42 non-medical professionals (95.2% female; mean age = 33.2 ± 5.6 years) working in community mental health services in Ankara, Türkiye. Participants were randomly assigned to one of six clinical vignettes depicting a young person with anorexia nervosa (AN), bulimia nervosa, binge eating disorder, avoidant/restrictive food intake disorder (ARFID), depression, or type-1 diabetes. The questionnaire assessed illness perception, causal attributions, emotional reactions, professional knowledge, and stigmatising beliefs. Results: Only 28.6% (n = 12) correctly identified the disorder in their assigned vignette. BED had the highest diagnostic accuracy (50%), while AN and ARFID were most frequently misidentified. Participants commonly believed that EDs mainly affected females, had a short duration, and were less responsive to treatment. Stigmatising beliefs—such as personal blame—were also noted. Conclusions: Findings revealed limited awareness and knowledge of EDs—particularly AN and ARFID—among non-medical mental health professionals. Misconceptions that EDs are self-inflicted may delay recognition and referral. The results underscore the need for targeted education, anti-stigma interventions, and integration of ED content into professional training to improve early detection and community-based support. Full article

Background: Children with autism spectrum disorder (ASD) frequently experience eating-related behavioral difficulties; however, the relationships among these difficulties, core ASD deficits, and executive function remain poorly understood. The present study examined how core ASD characteristics—restrictive and repetitive behaviors (RRBs) and social impairments—relate to eating behaviors, including food approach and avoidance tendencies. In addition, the study explored whether executive function serves as a mediating mechanism underlying these associations. Methods: A total of 184 children aged 3–12 years participated in this cross-sectional study. All variables were measured using parent-reported questionnaires, and data were analyzed through path modeling. The Social Responsiveness Scale–Second Edition (SRS-2) and the Repetitive Behavior Scale–Revised (RBS-R) were employed to assess social impairments and RRBs, respectively. Eating behaviors—comprising food approach and food avoidance dimensions—were evaluated with the Children’s Eating Behavior Questionnaire (CEBQ), while executive function was measured using the Child Executive Functioning Inventory (CHEXI). Results: The analysis revealed significant associations between RRBs and both food approach and food avoidance behaviors in children with ASD. Crucially, follow-up regression analyses specifying RRBs subtypes showed that Stereotyped Behavior independently predicted both food approach (β = 0.305, p < 0.001) and avoidance (β = 0.217, p = 0.002), while Compulsive Behavior specifically predicted food avoidance (β = 0.173, p = 0.021). Furthermore, executive function appeared to serve as a potential mediator in these relationships, suggesting that impairments in executive control may partially explain how repetitive behaviors influence eating patterns. Although social impairments showed weaker direct associations with eating behaviors, they indirectly affected both food approach and avoidance behaviors through deficits in executive function, highlighting the complex interplay among behavioral, cognitive, and social domains in ASD. Conclusions: These findings indicate that RRBs—one of the core characteristics of ASD—can predict children’s eating behaviors and are concurrently linked to two seemingly opposite eating patterns. Both social impairments and RRBs appear to influence eating behaviors through executive dysfunction. This study provides new insights into the mechanisms underlying atypical eating behaviors in children with ASD and identifies executive function as a promising target for interventions aimed at improving eating-related outcomes in this population. Full article

Childhood emotional neglect and parental overprotection are two subtle yet influential caregiving patterns that shape emotional, relational, and self-regulatory development. Though they are often examined separately, emerging research suggests that they may act independently and together to increase vulnerability to disordered eating. This narrative review synthesizes contemporary theoretical and empirical contributions to clarify how emotional neglect and overprotection affect pathways related to emotion regulation, attachment processes, and self-concept development. The review introduces the concept of complementarity, explaining how these patterns may co-occur within the same family system or fluctuate among individual caregivers. This creates developmental contexts marked by emotional deprivation and restricted autonomy. Based on this synthesis, the manuscript presents an integrative framework that considers distinct and shared mechanisms connecting caregiving experiences to maladaptive eating patterns. Developmental and clinical implications are discussed, emphasizing the importance of assessing relational histories, supporting emotional clarity, and promoting autonomy in intervention planning. The limitations of the narrative approach and directions for future research are outlined, including the need for longitudinal designs, more precise measurement of caregiving dimensions, and a more systematic investigation of the interactive effects of emotional neglect and overprotection. Full article

Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have transformed treatment for higher weight and diabetes. Because they also influence appetite and reward processes, these medications may shape eating behaviours, emotions, and body image, raising new challenges for eating disorder (ED) research and clinical care. This narrative review synthesises emerging evidence on the psychological and behavioural effects of GLP-1RA use within a biopsychosocial and equity framework. Method: Using a narrative, non-systematic approach, we conducted targeted searches across major databases (2015–September 2025) with combined GLP-1RA and psychological or ED-related terms, supplemented by cross-referencing. Inclusion criteria focused on empirical, theoretical, and clinically meaningful psychological, behavioural, and sociocultural outcomes, enabling a conceptually driven synthesis of the psychological effects of GLP-1RA use. Results: GLP-1RAs reduce hunger and binge-eating frequency, suggesting possible benefits for binge-type EDs. However, evidence for restrictive EDs remains limited, and appetite suppression may reinforce rigid control or perfectionistic traits. Although short-term reductions in emotional eating have been reported, the long-term psychological safety of GLP-1RAs is unknown. Rapid, medication-driven weight loss may disrupt body perception, while social media discourse glamorises thinness and intensifies stigma. These psychosocial effects intersect with inequities in access, disproportionately affecting adolescents and individuals from culturally diverse or socioeconomically marginalised groups. Conclusions: GLP-1RAs sit at the intersection of medical innovation and psychological risk. To ensure safe and inclusive use, research and clinical practice should integrate developmental, cultural, and lived-experience perspectives. Co-designed research and multidisciplinary monitoring will be essential to reduce stigma, address inequities, and support psychologically informed care. Full article

Background: Autism spectrum disorder (ASD) constitutes a heterogeneous neurodevelopmental condition frequently accompanied by considerable disturbances in feeding behavior and nutritional balance. These difficulties arise from complex and multifactorial mechanisms, exerting a significant impact on physical health, metabolic homeostasis, and psychosocial functioning. The present review aims to provide a critical synthesis of current evidence regarding the underlying biological and behavioral mechanisms of feeding difficulties in ASD and to delineate the spectrum of comorbid eating disorders within this population. Methods: A narrative review of the peer-reviewed scientific literature was undertaken, emphasizing studies investigating the interrelationship between ASD and nutritional functioning in pediatric and adolescent populations. Particular focus was placed on research exploring sensory processing abnormalities, gut microbiota alterations, and the clinical manifestation of eating disorders in individuals with ASD. Results: The analysis revealed that sensory hypersensitivity, behavioral inflexibility, and disturbances within the gut–brain axis constitute principal determinants of atypical eating patterns in ASD. Individuals on the autism spectrum frequently exhibit pronounced food selectivity, neophobia, and symptoms consistent with Avoidant/Restrictive Food Intake Disorder (ARFID). Furthermore, an increased prevalence of anorexia nervosa and orthorexia nervosa has been documented, likely reflecting shared cognitive and behavioral features with ASD. “Emotional eating” tendencies and a marked preference for high-caloric, energy-dense foods—often potentiated by psychopharmacological treatment and reduced physical activity—further contribute to an elevated risk of overweight and obesity. Conclusions: Children and adolescents with ASD display a bimodal distribution of body mass, encompassing both undernutrition and obesity, indicative of a multifaceted interplay among sensory, behavioral, cognitive, and metabolic determinants. A comprehensive understanding of this heterogeneity is crucial for the development of individualized, evidence-based interventions integrating nutritional management with behavioral and psychotherapeutic approaches. Full article

Anorexia nervosa is among the most lethal psychiatric conditions. Online pro-anorexia (“pro-ana”) communities may frame starvation and restriction in moral or spiritual terms. This study explored how pro-ana discourse on X (formerly Twitter) encodes values, spirituality, and identity through language, with attention to clinical practice. A dataset of 2396 English-language tweets (2020–2025) was collected using dual criteria (pro-ana hashtags plus eating-disorder keywords). Only U.S.-based English tweets were included to maintain linguistic and cultural coherence with LIWC-22 norms and counseling frameworks developed in U.S. contexts. Tweets were separated into three corpora (full, hashtags, and tweet bodies) and analyzed using Linguistic Inquiry and Word Count 2022 (LIWC-22), supplemented with custom spirituality and pro-ana dictionaries, and keyword/keyness analysis against a 36-billion-token web reference corpus. Religious language appeared consistently higher in hashtags compared with tweets and Twitter norms. Tweets contained more authenticity and self-disclosure, while hashtags functioned as collective markers of identity and practice. Body and food terms were strongly elevated, and affiliation terms appeared comparatively suppressed. Keyness analysis identified distinctive items such as prayer fast, fasting prayer (Luke), OMAD fast, hunger hurt, and I’m punching, illustrating how sacred, cultural, and diet-related slogans were combined within pro-ana discourse. Pro-ana rhetoric may function as a sacralized identity frame that can provide existential meaning to disordered practices. These findings contribute to behavioral science by highlighting how online communities linguistically construct health-related identities and values. They also suggest that effective clinical interventions should address eating disorders not only at behavioral and cognitive levels but also at the level of values and spirituality. Full article

Background/Objectives: Menu calorie labeling policies aim to promote healthier eating habits, yet their effectiveness remains debated. The present study aimed to evaluate the effectiveness of two alternative qualitative labeling strategies—Physical Activity Calorie Equivalent (PACE) labels and Percent Daily Intake (PDI) pie charts—compared to the standard numeric calorie count mandated in several countries, since they have been proposed to enhance consumer comprehension and decision-making. Methods: A nationwide online survey elicited responses from N = 885 individuals living in Italy. Survey participants were randomly assigned to one of three menu conditions: (1) numeric calorie labeling only, (2) numeric calories plus PACE labels, or (3) numeric calories plus a PDI pie chart. Participants selected a three-course meal from their respective menus. Data on sociodemographic factors, dietary habits, BMI, self-assessed nutritional knowledge, and psychological traits—restrained eating (DEBQ-R) and impulsivity (SUPPS-P)—were collected. Ordinal logistic regressions assessed the impact of labeling format, gender, and nutritional knowledge on total calories ordered. Results: Neither PACE labels nor PDI pie charts significantly influenced total calorie selection compared to numeric calorie labels alone. No significant interactions emerged between labeling format and gender or nutritional knowledge. However, age, BMI, and dietary habits were strongly associated with calorie choices: older adults, individuals with restrictive diets, and those with higher restrained eating scores selected lower-calorie meals, while participants with higher BMI or frequent meat intake opted for more calorie-dense options. Conclusions: Alternative calorie labeling formats alone may be insufficient to alter food choices in online settings. Future interventions should integrate motivational and educational strategies tailored to individual traits and dietary habits, rather than relying solely on calorie presentation format. Full article

Background/Objectives: Avoidant/Restrictive Food Intake Disorder (ARFID) frequently co-occurs with Autism Spectrum Disorder (ASD), yet its detection and assessment remain challenging. This study aimed to analyze terminology and professionals’ views on features and indicators related to ARFID among Spanish professionals working with autistic individuals, identifying potential gaps and training needs. Methods: A cross-sectional study was conducted with 194 professionals (62 speech therapists, 62 psychologists, and 70 occupational therapists) from different regions of Spain, who completed a 13-item questionnaire on their familiarity with terminology, definitions, and features they consider indicative to ARFID. Descriptive analyses and chi-square tests were applied to explore interprofessional differences. Results: Significant differences emerged across disciplines (p < 0.001). Psychologists showed greater familiarity with DSM-5 diagnostic criteria (78%), while speech-language therapists (72%) and occupational therapists (69%) more frequently endorsed sensory, oromotor, and behavioral features as relevant. Across all groups, 61% reported uncertainty about ARFID diagnostic criteria, and only 34% reported familiarity with validated assessment tools. Conclusions: Spanish professionals working with ASD populations demonstrate heterogeneous and generally limited understanding of the features they associate with ARFID, with discipline-specific approaches to assessment. These findings provide initial evidence in Spanish-speaking contexts and underscore the need for structured training and validated Spanish-adapted instruments to support early and accurate ARFID identification. Full article

Objectives: Gestational diabetes mellitus (GDM), particularly when combined with overweight or obesity, is associated with adverse neonatal outcomes such as high birth weight and increased adiposity. We determined the effect of a preconception lifestyle intervention initiated before and continued throughout pregnancy on neonatal, birth-related, and body composition outcomes at birth and 6–8 weeks of age in children of participants in the BEFORE THE BEGINNING randomized controlled trial. Methods: People (N = 167) at increased risk of GDM and planning pregnancy were randomly allocated 1:1 to intervention or control. The intervention included time-restricted eating and exercise training. Time-restricted eating involved consuming all energy within ≤10 h/day, ≥5 days per week, and the amount of exercise was set using a heart rate-based physical activity metric (Personal Activity Intelligence, PAI), with the goal of ≥100 weekly PAI points. The main outcome of interest in this report was the proportion of infants with birth weight > 4.0 kg. Results: Among 106 live births, 21% (11/53) of infants in the intervention group and 28% (15/53) in the control group had birth weight > 4 kg (p = 0.367). Mean birth weight did not differ significantly between groups (mean difference −159.3 g, 95% confidence interval −375.7 to 57.2, p = 0.148). No significant between-group differences were found for additional neonatal, birth-related, or early postnatal body composition outcomes. Conclusions: In this secondary analysis, we found no evidence of effects of a preconception lifestyle intervention on the risk of macrosomia or neonatal body composition. Full article

Background/Objectives: Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition characterized by persistent social communication difficulties and restricted, repetitive behaviors, with prevalence estimates continuing to rise worldwide. The gut–brain axis has been proposed as a potential contributor to ASD, yet human studies yield inconsistent findings, partly due to confounding effects of diet and behavior. Methods: Here, we investigated the gut bacteriome and mycobiome of children with ASD (n = 17) compared with their non-ASD siblings (n = 9) and parents without ASD (n = 27), alongside detailed assessment of dietary intake (n = 79) using 7-day food diaries. Results: Multi-kingdom microbiome profiling revealed no significant differences in α- or β- diversity across ASD, sibling, and parental groups, with only minor taxonomic variation observed. Similarly, fungal community composition showed negligible group-level differences. By contrast, dietary patterns strongly differentiated ASD from non-ASD participants: children with ASD consumed higher levels of sweets and sugary foods, lower portions of vegetables, and exhibited reduced overall dietary diversity. Statistical analyses confirmed that dietary factors, rather than microbial composition, explained variation in ASD diagnosis. Conclusions: These findings suggest that selective and repetitive eating behaviors are characteristic of ASD shape dietary intake, which in turn influences gut microbial diversity. Thus, in humans, the directionality may run primarily from behavior to diet to microbiome, rather than from microbiome to behavior. Our results underscore the importance of incorporating dietary variables into microbiome research and highlight the need for targeted nutritional interventions to improve health outcomes in individuals with ASD. Full article

Gestational diabetes mellitus (GDM) is a heterogeneous disorder that compromises maternal and offspring health. Conventional medical nutrition therapy focuses on nutrient composition and caloric targets but largely omits timing and individualized biology. This narrative review synthesizes mechanistic, epidemiologic and interventional evidence linking circadian biology and meal timing (chrononutrition) to maternal glycemic control. Observational cohorts associate late eating and breakfast skipping with worse glycemia, while pilot interventions and CGM-based studies indicate that front-loading carbohydrates, restricting evening carbohydrate, extending overnight fasting (≈10–12 h), and simple within-meal sequencing can reduce postprandial excursions and increase time-in-range. We propose a pragmatic, tiered clinical pathway in which routine second-trimester triage (50 g glucose challenge test and ultrasound abdominal subcutaneous fat thickness) identifies higher-risk women for short-term CGM phenotyping and prioritized chrononutrition counseling. Integrating phenotype-matched timing interventions with dietetic support and digital decision tools allows rapid, individualized adjustments informed by real-time glucose patterns and patient chronotype. In principle, this tiered strategy could improve daily glycemic profiles, reduce the need for pharmacotherapy, and translate into better neonatal outcomes if supported by larger randomized trials. Chrononutrition therefore offers a promising extension of standard care: simple, low-cost adjustments to “when” food is eaten, supported by digital tools, could allow nutrition therapy for GDM to become more precise, more responsive, and ultimately more effective for both mother and child. Key priorities include validating bedside and chrono-omic stratifiers, testing scalable delivery platforms, and ensuring equitable access to personalized chrononutrition in pregnancy. Full article

Background/Objectives: Eating disorders (EDs) often affect fertility, yet many women with ED still become mothers. The pattern of ED symptoms during pregnancy and postpartum, along with their effects on maternal and child health, is not yet fully understood. This longitudinal study aimed to (1) examine the course of ED symptoms from conception to postpartum, (2) evaluate pregnancy outcomes and children’s health and developmental milestones, and (3) assess ED status approximately four years after the initial evaluation. Methods: Thirty women with a prior ED diagnosis (21 with anorexia nervosa, 9 with bulimia nervosa) were evaluated at two time points. Time 1 with the Eating Disorders Examination and the Oxford Risk Factors for Eating Disorders: Interview Schedule; Time 2, approximately four years later, with the Eating Disorders Examination and the Clinical Interview on Reproductive History and Eating Behavior that also included clinical data related to mother’s health and baby’s health and development accessed through the Pregnant Women’s Health Bulletin and the Child and Youth Health Bulletin using the national health records. Results: ED symptoms (dietary restriction, self-induced vomiting, laxative misuse) persisted from conception through postpartum. BN participants reported more severe symptoms and higher rates of pregnancy complications (hyperemesis gravidarum, gestational diabetes, preeclampsia), while premature births occurred only in AN participants. Children of mothers with AN more frequently showed delays in developmental milestones (sitting, walking, speaking, sphincter control) compared to those of BN mothers. Conclusions: A substantial proportion of women with prior ED continued to experience symptoms during and after pregnancy, and nearly half still met diagnostic criteria four years later and are still in treatment. Cognitive features such as body dissatisfaction persisted despite partial symptom remission. These findings highlight the chronicity of ED and underscore the need for systematic screening, psychological support, and interdisciplinary follow-up during pregnancy and early motherhood. Full article

Background: Vitamin D supplementation may influence oxidative stress, but evidence in populations following specific dietary patterns is limited. Methods: In this non-randomized, two-group exploratory study, 50 Orthodox nuns received vitamin D supplementation (2000 IU/day orally) for 16 weeks, whereas 50 age-matched women following time-restricted eating (TRE) served as controls receiving no supplementation. Anthropometric parameters, serum 25-hydroxyvitamin D [25(OH)D], and oxidative stress markers—total antioxidant capacity (TAC), glutathione (GSH), and thiobarbituric acid reactive substances—were measured at baseline and post-intervention. Results: At baseline, both groups were comparable in anthropometric and oxidative stress markers, except for serum 25-hydroxyvitamin D [25(OH)D], which was lower in the intervention group. Following supplementation, serum 25(OH)D increased from 15.77 ± 5.21 to 31.24 ± 7.87 ng/mL (p = 0.031) in Orthodox nuns. No significant changes were observed for TAC (0.93 ± 0.11 to 0.97 ± 0.09, p = 0.081) and GSH (6.01 ± 1.55 to 5.81 ± 1.41, p = 0.069), whereas TBARS decreased significantly (7.32 ± 1.31 to 6.94 ± 1.21, p = 0.041). No significant changes were observed in controls under TRE. Changes (Δ) in all variables represented the post–pre difference over the 16-week period. Pearson correlations showed no significant associations between Δ25(OH)D and ΔTAC (r = −0.244, p = 0.346), ΔGSH (r = 0.110, p = 0.675), or ΔTBARS (r = −0.116, p = 0.657). In multivariable regression adjusted for age, weight, body fat percentage, and baseline 25(OH)D, Δ25(OH)D was not an independent predictor of oxidative stress marker changes; however, weight (β = 0.08, p = 0.011) and body fat percentage (β = −0.13, p = 0.014) were associated with reductions in TBARS. Conclusions: In conclusion, sixteen weeks of vitamin D supplementation in women adhering to Orthodox fasting produced no consistent improvements in oxidative stress markers. While a small reduction in TBARS was observed, this effect was modest and appeared indirect, being more closely associated with decreases in body weight and fat mass than with vitamin D status itself. Taken together, our findings indicate an overall neutral impact of vitamin D on redox balance, suggesting that any antioxidant benefit is likely secondary to metabolic or adiposity-related changes. Full article