Search Results (1,117)

Cardiorenal syndrome (CRS) is a multifactorial clinical condition characterized by the bidirectional deterioration of cardiac and renal function, driven by mechanisms such as renin–angiotensin–aldosterone system (RAAS) overactivation, systemic inflammation, oxidative stress, endothelial dysfunction, and fibrosis. The aim of this narrative review is to explore the key molecular pathways involved in CRS and to highlight emerging therapeutic approaches, with a special emphasis on nutritional interventions. We examined recent evidence on the contribution of mitochondrial dysfunction, uremic toxins, and immune activation to CRS progression and assessed the role of dietary and micronutrient factors. Results indicate that a high dietary intake of sodium, phosphorus additives, and processed foods is associated with volume overload, vascular damage, and inflammation, whereas deficiencies in potassium, magnesium, and vitamin D correlate with worse clinical outcomes. Anti-inflammatory and antioxidant bioactives, such as omega-3 PUFAs, curcumin, and anthocyanins from maqui, demonstrate potential to modulate key CRS mechanisms, including the nuclear factor kappa B (NF-κB) pathway and the NLRP3 inflammasome. Gene therapy approaches targeting endothelial nitric oxide synthase (eNOS) and transforming growth factor-beta (TGF-β) signaling are also discussed. An integrative approach combining pharmacological RAAS modulation with personalized medical nutrition therapy and anti-inflammatory nutrients may offer a promising strategy to prevent or delay CRS progression and improve patient outcomes. Full article

Sarcopenia is a progressive age-related musculoskeletal disorder characterized by loss of muscle mass, strength, and physical performance, contributing to functional decline and increased risk of disability. Emerging evidence suggests that vitamin D (Vit D) plays a pivotal role in skeletal muscle physiology beyond its classical functions in bone metabolism. This review aims to critically analyze the relationship between serum Vit D levels and sarcopenia in older adults, focusing on pathophysiological mechanisms, diagnostic criteria, clinical evidence, and preventive strategies. An integrative narrative review of observational studies, randomized controlled trials, and meta-analyses published in the last decade was conducted. The analysis incorporated international diagnostic criteria for sarcopenia (EWGSOP2, AWGS, FNIH, IWGS), current guidelines for Vit D sufficiency, and molecular mechanisms related to Vit D receptor (VDR) signaling in muscle tissue. Low serum 25-hydroxyvitamin D levels are consistently associated with decreased muscle strength, reduced physical performance, and increased prevalence of sarcopenia. Although interventional trials using Vit D supplementation report variable results, benefits are more evident in individuals with baseline deficiency and when combined with protein intake and resistance training. Mechanistically, Vit D influences muscle health via genomic and non-genomic pathways, regulating calcium homeostasis, mitochondrial function, oxidative stress, and inflammatory signaling. Vit D deficiency represents a modifiable risk factor for sarcopenia and functional impairment in older adults. While current evidence supports its role in muscular health, future high-quality trials are needed to establish optimal serum thresholds and dosing strategies for prevention and treatment. An individualized, multimodal approach involving supplementation, exercise, and nutritional optimization appears most promising. Full article

Introduction: The sodium-to-potassium (Na:K) ratio in the diet is a critical biomarker for cardiovascular and metabolic health, yet global adherence to recommended levels remains poor. Objectives: The objective of this study was to identify dietary determinants of the dietary Na:K ratio and its associations with micronutrient intake and diet quality. Methods: An observational cross-sectional survey was conducted in a representative sample of manufacturing workers through a combined stratified proportional and two-stage probability sampling plan, with strata defined by company size and industrial sector from the state of Rio Grande do Norte, Brazil. Dietary intake was assessed using 24 h recalls via the Multiple Pass Method, with Na:K ratios calculated from quantified food composition data. Diet quality was assessed with the Diet Quality Index-International (DQI-I). Multiple linear regression was used to analyze associations of Na:K ratio with the study variables. Results: The survey was conducted in the state of Rio Grande do Norte, Brazil, in 921 randomly selected manufacturing workers. The sample mean age was 38.2 ± 10.7 years, 55.9% males, mean BMI 27.2 ± 4.80 kg/m². The mean Na:K ratio was 1.97 ± 0.86, with only 0.54% of participants meeting the WHO recommended target (<0.57). Fast food (+3.29 mg/mg per serving, p < 0.001), rice, bread, and red meat significantly increased the ratio, while fruits (−0.16 mg/mg), dairy, white meat, and coffee were protective. Higher Na:K ratios were associated with lower intake of calcium, magnesium, phosphorus, and vitamins C, D, and E, as well as poorer diet quality (DQI-I score: −0.026 per 1 mg/mg increase, p < 0.001). Conclusions: These findings highlight the critical role of processed foods in elevating Na:K ratios and the potential for dietary modifications to improve both electrolyte balance and micronutrient adequacy in industrial workers. The study underscores the need for workplace interventions that simultaneously address sodium reduction, potassium enhancement, and overall diet quality improvement tailored to socioeconomic and cultural contexts, a triple approach not previously tested in intervention studies. Future studies should further investigate nutritional consequences of imbalanced Na:K intake. Full article

Children and adolescents with type 1 diabetes (T1D) often experience abnormalities in bone health. Studies have consistently demonstrated that youth with T1D have lower bone mineral density (BMD) compared to their healthy peers. Additionally, children with T1D show impaired bone microarchitecture and reduced bone turnover. These factors collectively contribute to an increased risk of fractures across the life span of this population. To optimize bone accrual and reduce fracture risk, several strategies can be employed during childhood and adolescence. First, maintaining good glycemic control is critical, as poor glycemic control has been associated with lower BMD and an increased risk of fractures. Second, specific nutritional recommendations can help improve bone health, including a balanced diet, adequate calcium and vitamin D intake, and careful monitoring of both macronutrient and micronutrient intake. Third, regular physical activity plays a vital role. A systematic review and meta-analysis have shown that youth with T1D are generally less physically active, more sedentary, and have lower cardiorespiratory fitness levels than their non-diabetic peers. This review emphasizes targeted strategies aimed at optimizing skeletal health in the pediatric population with T1D, with a particular focus on the critical roles of glycemic control, nutritional adequacy, and regular physical activity. These modifiable factors may contribute to the reduction of fracture risk across the life span in individuals with T1D. Full article

Objectives: This study aimed to investigate both the linear and non-linear associations between serum 25-hydroxyvitamin D [25(OH)D] levels and serum uric acid concentrations in Korean adults, with a particular focus on the vitamin D-insufficient range (<30 ng/mL), and to explore the potential metabolic implications of this relationship. Methods: Using data from the Korea National Health and Nutrition Examination Survey (KNHANES), we analyzed 10,864 adults aged 19 years and older. Serum vitamin D levels were categorized into quartiles (Q1–Q4), and their relationships with uric acid concentrations were examined using Pearson correlation, analysis of variance (ANOVA), and restricted cubic spline regression. Multivariate models were adjusted for potential confounders including age, sex, body mass index (BMI), kidney function, chronic disease status, and macronutrient intake. Results: In unadjusted analysis, a statistically significant but weak negative correlation was observed between serum 25(OH)D and uric acid levels (Pearson’s r = −0.092, p < 0.001). However, in multivariate regression adjusting for confounders, a weak positive association emerged. Restricted cubic spline analysis revealed significant positive associations in the lower quartiles (Q1–Q3), with the strongest association in Q3 (β = 0.769, 95% CI: 0.34–1.19, p < 0.001). No significant association was observed in the highest quartile (Q4). Conclusions: Serum vitamin D and uric acid concentrations show a non-linear relationship, with a significant positive association within the vitamin D-insufficient range (<30 ng/mL). These findings provide new insights into the potential metabolic role of vitamin D and highlight the need for longitudinal and interventional studies to clarify causality and clinical significance. Full article

Recent breakthroughs in cancer immunotherapy have shown remarkable success, yet treatment efficacy varies significantly among individuals. Emerging evidence highlights the gut microbiota as a key modulator of immunotherapy response, while vitamin D (VD), an immunomodulatory hormone, has garnered increasing attention for its potential interactions with gut microbiota and immunotherapy outcomes. However, the precise mechanisms and clinical applications of VD in this context remain controversial. This study systematically analyzed peer-reviewed evidence from PubMed, Scopus, Web of Science, PsycINFO, and MEDLINE (January 2000–May 2025) to investigate the complex interplay among VD, gut microbiota, and cancer immunotherapy. This review demonstrates that VD exerts dual immunomodulatory effects by directly activating immune cells through vitamin D receptor (VDR) signaling while simultaneously reshaping gut microbial composition to enhance antitumor immunity. Clinical data reveal paradoxical outcomes: optimal VD levels correlate with improved immunotherapy responses and reduced toxicity in some studies yet are associated with immunosuppression and poorer survival in others. The bidirectional VD–microbiota interaction further complicates this relationship: VD supplementation enriches beneficial bacteria, which reciprocally regulate VD metabolism and amplify immune responses, whereas excessive VD intake may disrupt this balance, leading to dysbiosis and compromised therapeutic efficacy. These findings underscore the need to elucidate VD’s dose-dependent and microbiota-mediated mechanisms to optimize its clinical application in immunotherapy regimens. Future research should prioritize mechanistic studies of VD’s immunoregulatory pathways, personalized strategies accounting for host–microbiota variability, and large-scale clinical trials to validate VD’s role as an adjuvant in precision immunotherapy. Full article

Background: Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disorder characterized by reproductive and metabolic abnormality disorders. Dietary factors influence the body composition and hydration status, which may exacerbate PCOS symptoms. The aim of this study was to assess the associations between the habitual nutrient intake and bioelectrical impedance analysis parameters in Polish women with PCOS and healthy controls, in order to identify potential nutritional targets for a non-pharmacological intervention. Methods: This study involved 50 women aged 18–45 years (25 with PCOS and 25 healthy). Participants kept 7-day food diaries and their body composition was assessed using the SECA mBCA 515 analyzer. The nutrient intake was compared with EFSA recommendations. Results: Women with PCOS had a higher body weight, waist circumference and body mass index, visceral adipose tissue, and fat mass index, despite no difference in their total energy intake. They consumed more omega-3 fatty acids (EPA + DHA) than the control group. Vitamin D deficiency and irregular supplementation were common in both groups. Body composition parameters such as the phase angle and ECW/TBW ratio correlated with the diet quality—especially with protein; fiber; and vitamin B2, B12, and folate levels. Conclusions: The obtained results showed significant differences in body compositions and the presence of a relationship between the nutrient intake and bioimpedance parameters in women with PCOS. These results emphasize the importance of a comprehensive nutritional and body composition assessment in planning dietary interventions in this group of patients. Full article

Westernization of traditional diets has been implicated in the rising burden of overweight/obesity and type 2 diabetes, especially in developing countries. In recent times, diet therapy is increasingly being recognized as an essential component of diabetes care. This study assessed the effect of diet therapy on body composition, antioxidant nutrient intake, and glycemic status in individuals living with type 2 diabetes (ILWT2D). In this prospective observational cohort study, 45 ILWT2D who were receiving diet therapy (personalized dietary counseling) in addition to standard medical treatment (intervention group) were compared with 45 ILWT2D receiving only standard medical treatment (comparator group). Antioxidant micronutrient intake was assessed using a 24-h dietary recall. Body composition indices, including body mass index (BMI), percentage body fat (%BF), and visceral fat (VF), were assessed. Participants’ fasting blood glucose (FBG), glycated hemoglobin (HbA1C) levels, and blood pressure (BP) were measured. All measurements were performed before and after a three-month period. There were significant improvements in BMI (27.8 ± 6.0 kg/m² vs. 26.9 ± 5.5 kg/m², p = 0.003), %BF (37.8 ± 11.9% vs. 35.5 ± 10.5%, p < 0.001), visceral fat (9.8 ± 3.4 vs. 9.1 ± 3.2, p < 0.001), systolic BP (136.9 ± 19.9 mmHg vs. 124.6 ± 13.0 mmHg, p < 0.001), FBG (8.8 ± 2.8 mmol/L vs. 6.7 ± 1.5 mmol/L, p < 0.001), and HbA1c (7.3 ± 1.0% vs. 6.4 ± 0.8%, p < 0.001) in the intervention group from baseline to endline, but not in the comparator group. In contrast, %BF increased within the comparator group (39.9 ± 7.8 vs. 40.7 ± 7.4; p = 0.029). Vitamin A intake increased significantly (227.5 ± 184.3 µg vs. 318.8 ± 274.7 µg, p = 0.038) within the intervention group but not in the comparator group (174.9 ± 154.3 µg, 193.7 ± 101.4 µg, p = 0.54). There were no significant changes in zinc, copper, selenium, and vitamin C intakes (p > 0.05) in the intervention group from the baseline to endline, unlike those in the comparator group who showed a significant increase in the intake of these nutrients. There was a significant increase in vitamin A intake among the ILWT2D who received dietary counseling as an intervention compared to those who did not. Additionally, the ILWT2D who received dietary counseling had significant improvements in their body composition (BMI, body fat, and visceral fat) and systolic blood pressure, compared to those who did not. The ILWT2D who received the intervention had significantly better glycemic control (FBG and HbA1c) than their counterparts who did not. Thus, this study suggests the potential of diet therapy as a viable non-pharmacological treatment approach for individuals living with type 2 diabetes. Full article

Background/Objectives: This study aims to investigate the relationship between sleep duration, physical activity, and nutritional intake of calories and vitamins to determine the interconnections among sleep, physical activity, and dietary habits. Methods: Overall, 5491 participants (male = 2347, female = 3144) aged ≥ 18 years were recruited from the first survey of the 2023 9th Korea National Health and Nutrition Examination Survey (KNHANES). All participants were assessed for sleep duration, physical activity levels, and intake of vitamin D, carbohydrates, protein, and fat. Results: In both sexes, participants with ≥8 h of sleep per day had significantly higher levels of moderate-intensity physical activity (male: p = 0.026, female: p = 0.011), moderate-to-vigorous-intensity physical activity (male: p = 0.003, female: p = 0.004), vitamin D (male: p = 0.029, female: p = 0.008), protein (male: p < 0.001, female: p = 0.011), and fat (male: p = 0.007, female: p = 0.015) than those with < 8 h of sleep. In the unadjusted model, participants who did not meet the recommended protein intake were less likely to achieve sufficient levels of physical activity (OR = 1.59, 95% CI: 1.39–1.82) and adequate sleep duration (OR = 1.12, 95% CI: 1.10–1.16). Conclusions: Sleep duration, physical activity, and nutrient intake (particularly vitamin D and protein) appear to be interrelated. Therefore, increasing daily physical activity and ensuring adequate intake of protein and vitamin D is recommended to maintain healthy sleep duration. Full article

Vitamin D plays a crucial role in bone health and immune function, with serum 25(OH)D levels influenced by genetic, dietary, and metabolic factors. Background/Objectives: This study investigated the impact of VDR rs731236, CYP2R1 rs10741657, and GC rs2282679 polymorphisms, body mass index (BMI), and dietary vitamin D intake on vitamin D status. Methods: A total of 230 adults were classified into four BMI categories: normal weight (NW), overweight (OW), obesity class I (OB), and obesity class II/III (OP). Participants completed a Food Frequency Questionnaire (FFQ) and a 7-day Food Frequency Diary (FFD). Genotyping was performed using TaqMan assays, and serum 25(OH)D was quantified via spectrophotometry. Statistical analyses included ANOVA and multiple linear regression. Results: The VDR rs731236 CC genotype, CYP2R1 rs10741657 AG/GG, and GC rs2282679 AC/CC were associated with lower serum vitamin D levels. A higher BMI was significantly correlated with reduced serum 25(OH)D (p < 0.001), with BMI emerging as the strongest predictor of vitamin D status. FFQ-based dietary intake showed a modest positive correlation with 25(OH)D (r = 0.47, p < 0.001). Conclusions: BMI and genetic variants in VDR, CYP2R1, and GC significantly influence vitamin D metabolism. Personalized interventions addressing genetic predispositions and weight management may improve vitamin D status. Full article

Background and Objectives: Maternal vitamin D (25-hydroxyvitamin D, 25(OH)D) deficiency during pregnancy is associated with adverse outcomes for both mother and fetus. While vitamin D supplementation is commonly recommended, dietary and lifestyle factors influencing maternal 25(OH)D levels at term remain underexplored, particularly in Southern Europe. Aim: This study aimed to investigate prenatal determinants of maternal 25(OH)D levels at the time of delivery, focusing on dietary intake, supplement use, and seasonal variation. Materials and Methods: We conducted a cross-sectional study on 248 pregnant women admitted for delivery at the General Hospital of Piraeus “Tzaneio” between September 2019 and January 2022. A structured questionnaire was used to assess prenatal intake of vitamin D-rich foods (such as fatty fish, eggs, dairy, and fortified products), supplement use (dose, frequency), sun exposure habits, and lifestyle factors. Maternal serum 25(OH)D concentrations were measured from blood samples collected at the time of admission for delivery. Statistical analysis included descriptive statistics and multivariate linear regression to identify independent dietary and supplemental predictors of maternal vitamin D status. Results: A high prevalence of maternal vitamin D deficiency (VDD) was observed, particularly during the autumn and winter months. Women who reported regular intake of vitamin D supplements (400–800 IU daily) had significantly higher 25(OH)D levels compared to those who did not. Dietary intake of vitamin D-rich foods was positively associated with maternal 25(OH)D status, although the effect size was smaller compared to supplementation. Seasonal variation, BMI, and limited sun exposure were also independent predictors. Conclusions: Both vitamin D supplementation and increased dietary intake were positively associated with maternal 25(OH)D concentrations at delivery. These findings underscore the importance of prenatal nutritional assessment and targeted supplementation strategies to prevent maternal VDD in Mediterranean populations. Full article

Vitamin D deficiency is highly prevalent in individuals with overweight/obesity and this can be largely attributed to the entrapment of VitD in adipose tissue due to impaired lipolytic stimulation. Considering the well-described role of exercise in stimulating lipolysis, the present study investigated the efficacy of multicomponent-type high-intensity interval training (m-HIIT) in increasing 25-hydroxyvitamin D [25(OH)D] levels in males with overweight/obesity. Twenty middle-aged males (43.5 ± 5 years, BMI: 30.7 ± 3.3 kg/m²) participated in three weekly supervised m-HIIT sessions over a 12-week period and underwent assessments at baseline, 6, and 12 weeks. Primary outcomes were total body fat mass, android fat, hepatorenal index, and serum 25(OH)D. Participants’ daily physical activity and dietary intake habits remained unaltered throughout the 12-week training period. The m-HIIT intervention reduced fat mass (by 3% at 12 weeks), android fat (by 3.7% at 6 weeks and 4.4% at 12 weeks), and hepatorenal index (by 8% at 12 weeks). Serum 25(OH)D levels increased by ~14% (+3.21 ng/mL, p = 0.002) and ~31% (+7.24 ng/mL, p < 0.001) at 6 and 12 weeks, respectively. The elevation of 25(OH)D levels at 12 weeks was inversely related to fat mass loss (R = 0.53, p = 0.016). Plasma SGPT, SGOT, ALP, γ-GT, fetuin-A, and calcium levels remained unaltered after the 12-week training period. In conclusion, m-HIIT may be useful as a non-pharmacological intervention to increase circulating VitD levels in adults with overweight/obesity. Full article

Background/Objectives: More children and adolescents are adopting vegetarian diets. A balanced diet is particularly important for growth and bone development in children. It is important to clarify whether a vegetarian diet affects these processes. A systematic literature review was conducted to identify studies investigating differences in anthropometric data, nutrient intake, and biomarkers between vegetarian and omnivorous children. Methods: PUBMED, MEDLINE, and Web of Science Core Collections were searched between the end of 2014 and 2023. We included peer-reviewed randomized controlled trials, intervention, or observational studies that were published in English or German and investigated the differences between healthy children and adolescents from high-income countries who consumed either a vegetarian or an omnivorous diet. The review was conducted in accordance with the PRISMA guidelines. If at least five values with the same unit were available from different studies, a cumulative analysis of selected parameters was conducted. Due to the participants’ varying ages across the studies, limited cumulative analyses were conducted additionally by age category. Results: A total of 1681 studies were screened, of which 20 met the inclusion criteria. Significant differences were found in fiber and energy intake from carbohydrates and proteins. The results were strengthened by the restricted cumulative analysis of the 2–10 age category, which also revealed significant differences when comparing VG and OM. Conclusions: A higher intake of fiber, more energy from carbohydrates, and sufficient energy from proteins and less from fat can be regarded as the benefits of a vegetarian diet, according to this review. There are also the first indications of enhanced vitamin C and E, iron, folate, and magnesium intake. These characteristics can be regarded as potential benefits of a vegetarian diet. A lower vitamin B12 and vitamin D intake has been identified as a potential risk factor. Further longitudinal, prospective, observational studies are needed. Prospero registration date and number: 6 March 2023, CRD42023402301. Full article

Background/Objectives: The EAT-Lancet Commission proposed a healthy and sustainable ‘planetary health diet’ (PHD) based on the nutritional needs of adults, but recommended for all population groups over the age of two years. This study investigated the extent to which UK adolescent diets meet these recommendations, and the association between meeting recommendations and nutritional intake. Methods: Dietary intake data collected from students aged 11–15 years between 2019 and 2022 as part of the Food provision, cUlture and Environment in secondary schooLs (FUEL) study was used. Specifically, 24 h intakes of food groups and key nutrients were summarised for each participant, and micronutrient intake was expressed as a percentage of the reference nutrient intake (RNI). The proportion of participants meeting each PHD recommendation was calculated. A PHD index score was developed to measure the overall adherence to recommendations. Multilevel linear regression models were fitted to explore the association between the PHD score and intake of each nutrient. Results: No participants fully met the recommendations. The mean PHD score was 14.2 (3.3) out of 39. Adherence was low for the emphasised foods, and lowest for nuts (1.3%) and unsaturated oils (0.2%). Higher PHD index scores were associated with lower intakes of all micronutrients, with the largest association for vitamin B12 [regression coefficient: −12.9% (95% CI: −16.3, −9.4) of RNI] and the smallest for vitamin D [regression coefficient: −0.4 (95% CI: −0.7, −0.2) of RNI]. Conclusions: Substantial dietary changes are needed for this population group to meet the PHD guidelines. Further research should focus on why these recommendations may lead to the inadequate intake of some nutrients in this age group. We propose that the PHD guidance needs to be reviewed and potentially adapted for this specific population, with consideration of the typical dietary behaviours of this age group. Full article

Background: Endocrine therapies are accompanied by side effects that significantly impact the quality of life (QoL) of women with breast cancer. Adequate diet is important for fulfilling nutritional requirements, preserving health, and supporting therapy in this vulnerable population. Methods: This preliminary study evaluated the QoL of life and dietary intake in 185 women with breast cancer on two therapies, aromatase inhibitors (AIs) and tamoxifen, using the Functional Assessment of Cancer Therapy—Endocrine Symptoms (FACT-ES), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), and Breast Cancer Specific Questionnaire (QLQ-BR23) and a 24 h dietary recall. A total of 185 women were included in the study and fulfilled the FACT-ES, of whom 73 fulfilled other two questionnaires and a 24 h recall. Results: No significant differences were found in the overall QoL between groups. Joint pain (95.3%) and reduced libido (84.7%) were most common with AIs, while tamoxifen users more frequently reported weight gain and irritability (93.0%, each), and vasomotor and gynecological symptoms. Macronutrient intake was similar, though AIs users consumed more energy-dense (p ≤ 0.001) and sugary foods (p = 0.034), while tamoxifen users had higher omega-6 PUFA intake. Both groups exhibited suboptimal intake of vitamin D, calcium, and selenium, and a higher phosphorus consumption relative to recommended daily values. Conclusions: Preliminary findings showed that QoL and dietary intake were comparable between patients with BC on AIs and tamoxifen treatment. Endocrine-related symptoms were more prevalent among tamoxifen users, whereas joint pain was most common in AIs users. Nutritional interventions may be warranted in both groups to ensure adequate intake of essential micronutrients in accordance with recommended dietary guidelines. Full article