Search Results (153)

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

Autism spectrum disorder (ASD) is frequently associated with gastrointestinal symptoms, immune dysregulation, and altered microbiota-related signaling, supporting interest in microbiota-targeted interventions. This study evaluated adaptive functioning for over 180 days in children with ASD in a previously randomized controlled trial (RCT). After the initial 90-day blinded phase, the study continued as an open-label extension (OLE) in which all participants received K11 TMAX, a kefir-derived probiotic consortium combined with a microencapsulated micronutrient blend. The study included 130 children (3–11 years of age) who continued from the RCT were followed-up in three different trajectories: (1) placebo → K11-TMAX; (2) K11 → K11-TMAX; and (3) continued K11-TMAX supplementation. Children’s adaptive functioning was assessed by the Vineland Adaptive Behavior Scales, Third Edition (Vineland-3), Adaptive Behavior Composite (ABC) as well as by four core domains: (1) communication; (2) daily living skills; (3) socialization; and (4) motor skills. All three groups of children improved significantly on all of the parameters that were assessed with the effect sizes ranging from 0.13 to 0.43. The greatest improvement in the communication domain was seen in the transition group (1) and the greatest decrease in the externalizing behavior scores were seen in the continuous group (3) of children. Children’s adaptive functioning improved in clinically meaningful ways. Children’s improvement, however, was within the disability range and did not reach the level of typical development of children of the same age. These findings suggest supplementary therapeutic use of K11-TMAX, modulating the gut–brain axis, in children with autism spectrum disorder (ASD). Full article

Background: Emerging evidence suggests that metabolic, nutritional, and lifestyle-related factors may be associated with tinnitus occurrence and symptom burden. Nutritional status, obesity, and sedentary behavior have been hypothesized to be linked with auditory function, neural excitability, and tinnitus-related outcomes. This scoping review aimed to map and summarize the available evidence on associations between dietary factors, nutrient intake, body mass index (BMI), obesity, physical activity, and tinnitus occurrence, severity, and related clinical outcomes. Methods: A scoping review was conducted in accordance with the PRISMA-ScR reporting guidelines. A comprehensive search of PubMed, Web of Science, and Cochrane Library databases was performed. Eligible designs included randomized controlled trials, cohort studies, case–control studies, and cross-sectional studies. Data were extracted and synthesized narratively due to methodological heterogeneity. Results: Twenty-four studies met the inclusion criteria. Several observational studies reported associations between protein intake, lipid profile, micronutrient status, BMI, obesity, physical activity, and tinnitus-related outcomes. Evidence on antioxidant supplementation was heterogeneous, with some trials reporting favorable changes in tinnitus-related measures and others showing no significant benefit compared with placebo. Elevated BMI, obesity, and altered body composition were generally associated with tinnitus occurrence or greater symptom severity. Randomized trials suggested that structured lifestyle programs involving dietary modification, weight reduction, and physical activity may be associated with improvements in tinnitus severity and quality of life in selected patient groups. Conclusions: The available literature suggests potential associations between nutritional, metabolic, and lifestyle-related factors and tinnitus occurrence or symptom severity. However, the evidence is heterogeneous and largely observational, with inconsistent adjustment for hearing loss, psychological distress, and general health status. Further well-designed prospective studies and randomized controlled trials are needed before causal or clinical recommendations can be formulated. Full article

Background/Objectives: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have transformed type 2 diabetes mellitus (T2DM) and obesity care, with clinical trials demonstrating weight loss exceeding 15%. However, real-world effectiveness lags trial efficacy, largely owing to high discontinuation rates. We characterize the global persistence gap and propose a framework integrating Medical Nutrition Therapy (MNT) to improve adherence. Methods: We conducted a narrative review of real-world evidence from North America, Europe, Asia, and Latin America, synthesized with physiological, nutritional, and behavioral data to distinguish established contributors to discontinuation from strategies that remain partly extrapolated from related populations. Results: Global persistence varies widely: from approximately 75–80% at 12 months in reimbursed T2DM cohorts (Sweden, Denmark) to below 10% in obesity-focused or high out-of-pocket-cost settings (Poland, Colombia), with intermediate rates in the United States and United Kingdom; in several cohorts, persistence falls below 15% by 24 months. The primary drivers are gastrointestinal intolerance and economic barriers. Meal size, dietary composition, and gastric-emptying effects influence gastrointestinal tolerability; inadequate protein intake during rapid weight loss raises concern for lean mass loss. Conclusions: Pharmacotherapy alone is unlikely to sustain long-term obesity management. Narrowing the persistence gap will require an integrated care model in which structured nutritional support—targeting protein intake, micronutrient density, and gastric-sparing feeding—is systematically offered rather than treated as an optional adjunct, while recognizing that most supporting evidence is extrapolated from primary trials in obesity and cardiometabolic disease rather than derived from GLP-1–specific randomized trials. Full article

Background/Objectives: GLP-1-based obesity pharmacotherapy has shifted clinical attention from the magnitude of weight loss to the quality of weight loss. This review evaluates whether body composition changes during treatment with GLP-1-based agents represent clinically meaningful muscle loss and identifies nutrition, supplementation, exercise, and monitoring strategies that may help preserve lean mass, function, bone health, and nutritional adequacy. Methods: A comprehensive narrative review was performed using focused searches of PubMed, publisher-hosted journal platforms, and reference lists of key primary studies and recent evidence syntheses through March and May 2026. Evidence was organized around body composition, muscle quality and function, dietary protein and micronutrient adequacy, exercise, supplementation, bioelectrical impedance analysis, imaging, and emerging biomarkers. Results: Semaglutide and tirzepatide preferentially reduce fat mass, including visceral and ectopic adiposity, while producing smaller but consistent reductions in lean mass or lean soft tissue. However, DXA-derived lean mass and BIA-derived fat-free mass are not equivalent to skeletal muscle, and lean tissue loss does not necessarily indicate impaired strength or physical performance. The most defensible supportive care model combines food-first nutritional counseling, adequate protein intake, structured resistance exercise, management of gastrointestinal adverse effects, and risk-based monitoring of micronutrient inadequacy. Protein supplementation and nutritionally complete meal replacements may be useful when intake is insufficient, whereas creatine, essential amino acids or leucine, beta-hydroxy-beta-methylbutyrate, fiber, probiotics, omega-3 fatty acids, and multi-ingredient products remain adjunctive options supported mainly by indirect or phenotype-specific evidence. Conclusions: Future GLP-1 trials and clinical care should move beyond body weight and total lean mass toward integrated assessment of muscle quantity, muscle quality, function, bone, and nutritional adequacy, and standardized BIA-based clinical monitoring where advanced imaging is not feasible. Full article

Survival rates in pediatric cancer have increased substantially over recent decades. However, children and survivors frequently experience treatment-related alterations in physical function, body composition, bone health, and metabolic regulation. Chemotherapy, glucocorticoid exposure, physical inactivity, nutritional imbalance, and inflammatory and neuroendocrine disturbances may contribute to reduced lean mass, decreased bone mineral density, sarcopenic obesity, and long-term cardiometabolic risk. This narrative review critically summarizes current evidence on multimodal exercise and nutritional interventions in pediatric oncology, with particular attention to their effects on physical function, body composition, nutritional status, and metabolic health. Literature searches were conducted in PubMed, Scopus, and Web of Science up to April 2026, combining contextual evidence with studies evaluating combined exercise and nutritional strategies. Current evidence suggests that structured and supervised exercise, particularly resistance and combined aerobic–resistance training, is feasible and safe, and may improve cardiorespiratory fitness, muscle strength, functional capacity, and body composition. Nutritional care should be individualized, prioritizing adequate protein intake, micronutrient status, periodic reassessment of energy requirements, and body composition rather than relying on BMI alone. Nevertheless, available findings remain limited by small sample sizes, heterogeneous protocols, variable supervision, inconsistent outcome assessment, and limited long-term follow-up. Integrating exercise, nutrition, and regular monitoring into pediatric oncology care may help mitigate treatment-related functional and metabolic complications. Future studies should prioritize adequately powered randomized trials, standardized intervention protocols, objective monitoring of exercise intensity, harmonized body composition and functional outcomes, and longer follow-up to define clinically applicable multimodal care models. Full article

Sarcopenia is increasingly recognized as a key extracardiac manifestation of heart failure (HF), contributing to functional impairment, reduced quality of life, and adverse clinical outcomes. Characterized by progressive loss of skeletal muscle mass, strength, and physical performance, it affects more than half of hospitalized HF patients. It is independently associated with increased mortality and reduced exercise capacity. The pathophysiology of sarcopenia in HF is multifactorial and closely linked to metabolic and nutritional disturbances. Chronic inflammation, neurohormonal activation, oxidative stress, endothelial dysfunction, and anabolic resistance contribute to muscle catabolism and impaired protein synthesis. These alterations are further exacerbated by inadequate dietary protein intake and micronutrient deficiencies, promoting progressive muscle wasting and functional decline. Sarcopenia may also represent an early and potentially modifiable stage in the continuum toward cardiac cachexia. This narrative review provides a comprehensive synthesis of current evidence on the epidemiology, pathophysiological mechanisms, and management of sarcopenia in HF, with particular emphasis on nutritional and metabolic determinants. Emerging data support a multimodal therapeutic approach integrating exercise training with targeted nutritional strategies, including adequate protein intake, essential amino acid supplementation, and correction of micronutrient deficiencies. However, evidence from large, well-designed trials remains limited. In summary, improved recognition and integrated management of sarcopenia in HF are essential. Future research should focus on the development of effective, nutrition-centered therapeutic strategies. Full article

Type 2 diabetes mellitus (T2DM) affects approximately 10–25% of patients undergoing orthopedic procedures and is associated with impaired tissue healing, increased complication rates, and reduced responsiveness to orthobiologic therapies, including platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and mesenchymal stem cell (MSC) preparations. The underlying mechanisms include advanced glycation end-product accumulation, NF-κB-driven chronic inflammation, Nrf2 pathway impairment, mitochondrial dysfunction, and epigenetic diabetic memory, collectively compromising both orthobiologic product quality and the tissue microenvironment. Emerging, predominantly mechanistic evidence suggests that targeted nutritional interventions, including bioactive compounds targeting mitochondrial biogenesis pathways, anti-inflammatory dietary patterns, and specific micronutrients, may modulate these pathological processes and potentially improve orthobiologic outcomes. This narrative review synthesizes evidence from diabetic pathophysiology, orthobiologic outcomes research, and nutritional science to propose a conceptual clinical framework for regenerative medicine optimization in T2DM patients. Critical knowledge gaps are identified, and a research agenda is proposed. The proposed framework, based primarily on mechanistic and preclinical evidence, should be interpreted as a foundation for research prioritization and hypothesis generation rather than as a clinical protocol. Rigorous randomized trials directly evaluating nutritional optimization in orthobiologic therapy for diabetic patients are required before evidence-based recommendations can be established. Full article

Background: Nutritional psychiatry increasingly links diet quality and specific bioactive nutrients to depression and anxiety outcomes. Mechanistic evidence implicates neuroimmune activation, inflammation, altered neurotransmitter synthesis, and microbiota-derived metabolites. Objective: The objective of this study is to synthesize evidence on omega-3 polyunsaturated fatty acids (n-3 PUFAs), the microbiota–gut–brain axis, and vitamins and minerals that influence neurotransmitter synthesis, inflammation, and brain function and to translate these findings into food-based strategies. Methods: This study consisted of a focused synthesis of randomized controlled trials (RCTs), meta-analyses, and systematic reviews indexed in PubMed, Scopus and Web of Science, selected for relevance to omega-3s, probiotics/prebiotics, dietary patterns, and micronutrients (folate/B-vitamins, vitamin D, magnesium, zinc, and vitamin C/copper pathways). Results: RCT and meta-analytic evidence suggest modest benefits of omega-3 supplementation for anxiety severity and depressive symptoms, with heterogeneity by dose, EPA: DHA composition, and baseline inflammatory status. The gut–brain axis literature supports bidirectional effects of stress and microbiota, and meta-analyses of probiotics/prebiotics show small improvements in depressive and anxiety symptoms, likely dependent on strain and host phenotype. Micronutrients serve as enzymatic cofactors for monoamine and GABA synthesis and modulate immune signaling; clinical effects are the most consistent when correcting insufficiency or in biomarker-defined subgroups. A whole-diet RCT demonstrates that structured dietary improvement can reduce depressive symptoms as adjunctive therapy. Conclusions: A food-first approach emphasizing Mediterranean-style dietary patterns, omega-3-rich seafood, a diverse array of fiber, and micronutrient density is the most defensible. Supplementation may be considered selectively, guided by clinical context and nutritional status. Full article

Background/Objectives: Previous studies have compared nutritional deficiency parameters in patients with venous leg ulcers (VLUs) to healthy individuals or those with unrelated conditions. This single-center study assessed blood levels of factors involved in ulcer healing and compared patients with VLUs to those with chronic venous insufficiency without ulcers. Methods: A total of 24 patients were included: 17 with VLUs formed the study group, and 7 with lower-limb venous insufficiency without ulcers served as controls. Disease severity was assessed using the CEAP classification, and all participants underwent ankle–brachial index (ABI) measurement. Venous blood samples were analyzed for selected vitamins, proteins, ions, protein electrophoresis, and amino acid profiles. Results: Strong correlations were identified (r > 0.5 or r < −0.5), some of which were statistically significant. Positive associations in the study group included BMI with waist circumference (r = 0.85, p < 0.05), tyrosine with proline (r = 0.84, p < 0.05), and valine with leucine (r = 0.82, p < 0.05). Negative correlations included albumin with folic acid (r = −0.73, p < 0.05), albumin with vitamin B6 (r = −0.71, p < 0.05), and folic acid with waist circumference (r = −0.65, p < 0.05). No significant differences in blood concentrations were observed between groups. Conclusions: Statistically significant correlations were observed between selected biochemical parameters, including albumin and alpha-1 globulins, as well as amino acid and vitamin concentrations, in both patients with VLUs and controls with chronic venous insufficiency without ulcers. Larger studies are needed to confirm these findings and clarify their relevance to venous leg ulcers. Full article

Aging is closely linked to oxidative stress and inflammation. This review provides a critical overview of the antioxidant compounds present in apple pomace and explores how they may mitigate age-related oxidative damage and inflammatory responses. We focus on the nutritional profile of apple pomace including its macro- and micronutrients, with particular focus on polyphenols, such as procyanidin tannins, quercetin glycosides (rutin, quercetin-3-glucoside), phloridzin, dietary fiber, vitamins, and lipids alongside current techniques for isolating its bioactive components. Special attention is given to biological pathways through which these compounds influence aging: redox regulation via Nrf2, inflammatory modulation via NF-κB, and metabolic regulation via AMPK, SIRT1 and PI3K/Akt/mTOR. Evidence from in vitro cellular models (HepG2, CCD-986Sk fibroblasts), in vivo rodent studies and limited human pilot trials is summarized, as well as existing and emerging applications of apple pomace in functional foods, cosmeceuticals, and other sectors. Finally, we discuss the challenges and future opportunities in harnessing this by-product of the food industry. Although clinical data remain limited, preclinical findings support the repurposing of apple pomace as a sustainable functional ingredient contributing to healthier aging and circular economy goals. Future long-term randomized controlled trials are necessary to confirm efficacy in humans. Full article

Age-related macular degeneration (AMD) is a leading cause of irreversible vision loss worldwide and is driven by complex pathophysiological processes, including oxidative stress, chronic inflammation, complement dysregulation, and vascular endothelial growth factor (VEGF)-mediated neovascularization. Nutritional interventions—particularly supplementation with carotenoids, omega-3 fatty acids, polyphenols, and essential micronutrients—have demonstrated clinical benefits in slowing disease progression, as evidenced by landmark trials such as AREDS and AREDS2. However, many AMD-relevant bioactives exhibit poor aqueous solubility, low chemical stability, and limited gastrointestinal bioavailability, which significantly constrain their therapeutic efficacy. Food-grade microgels have emerged as versatile colloidal delivery platforms capable of addressing these limitations through rational structural and physicochemical design. This review provides a systematic roadmap for developing food-grade microgels, organized into: (1) the molecular design of protein- and polysaccharide-based networks; (2) advanced fabrication strategies such as microfluidics and atomization; (3) spatiotemporal release programming within the gastrointestinal tract; and (4) multi-nutrient synergy for retinal protection. This approach highlights how controlled crosslinking, interfacial assembly, and tunable network architectures enhance nutrient stabilization. Particular emphasis is placed on spatiotemporal release programming within the gastrointestinal tract, including diffusion-limited gastric retention, pH- and bile-responsive swelling in the small intestine, and microbiota-triggered degradation in the colon. These mechanisms collectively enable region-specific release, improved micellar incorporation, enhanced systemic absorption, and more consistent retinal delivery. Furthermore, we discuss co-encapsulation strategies that accommodate both hydrophilic and lipophilic bioactives, thereby minimizing antagonistic interactions and enabling synergistic nutritional modulation of oxidative and inflammatory pathways implicated in AMD. A central novelty of this review is the integration of the gut–eye axis, framing microgel-based oral delivery as a systemic pathway to modulate retinal health via the intestinal environment. By bridging retinal disease biology with food colloid science, this review proposes food-grade microgels as a translational platform for next-generation nutraceutical interventions. The integration of programmable release behavior with clinically validated nutrient regimens offers a promising pathway toward more effective and mechanistically informed dietary management of AMD. Full article

Background: Obesity is characterized by chronic low-grade systemic inflammation that contributes to metabolic dysfunction. Diet is a modifiable factor that can help reduce this inflammation. Nuts such as almonds are rich in unsaturated fats, and antioxidant and anti-inflammatory micronutrients, which may work synergistically to attenuate obesity-related inflammation. Hence, the objective of this study was to investigate whether daily almond consumption improves systemic inflammatory and immune markers in adults with obesity. Methods: In this randomized controlled parallel-arm trial (ClinicalTrials.gov ID NCT05530499), 69 adults (age 30–45 years) with obesity (BMI 30–45 kg/m²) were assigned to consume either 57 g/day of almonds (n = 38) or an isocaloric snack (cookie; n = 31) for six weeks. Fasting serum inflammatory cytokines, innate immune cell counts, body weight, serum glucose, insulin, lipid profile, and alpha-tocopherol were measured at baseline and week six. Dietary intake, compliance, palatability, acceptance, and appetite ratings were also assessed. Primary outcomes were analyzed using linear mixed models and baseline-adjusted linear models. Results: Subjective compliance was high in both groups, with greater acceptance of almonds (p < 0.05); however, serum alpha-tocopherol did not change. Almond consumption significantly decreased serum IL-6, TNF-α, and IFN-γ over 6 weeks compared with the cookie group (p < 0.05). No significant group differences were observed for innate immune cell counts, body weight, appetite ratings, blood pressure, or serum fasting glucose, insulin, total cholesterol (C), LDL-C, and triglycerides over six weeks. The almond group also increased intakes of monounsaturated fat, fiber, alpha-tocopherol, magnesium, zinc, and manganese, and improved diet quality indices relative to the cookie group (p < 0.05). Conclusions: Daily almond consumption for six weeks improved inflammatory cytokine profiles in adults with obesity, without changes in body weight under free-living conditions. These findings support recommending almonds as part of healthy dietary patterns to help attenuate obesity-related inflammation. Full article

Inflammatory bowel diseases, comprising Crohn’s disease and ulcerative colitis, represent chronic inflammatory disorders with rising global incidence, underscoring the pivotal role of modifiable environmental factors in disease pathogenesis. Diet and intestinal microbiota have emerged as critical bidirectional therapeutic targets through complex interactions with host immune responses. Epidemiological evidence demonstrates that healthy and high fiber diets reduce disease risk, while ultra-processed foods and inflammatory dietary patterns increase susceptibility. Therapeutic nutritional interventions, including exclusive enteral nutrition, the Crohn’s Disease Exclusion Diet combined with partial enteral nutrition, and the Mediterranean diet can induce and maintain clinical remission while promoting favorable microbiome modifications characterized by the enrichment of butyrate-producing taxa such as Faecalibacterium prausnitzii and Roseburia species, alongside a reduction in pathogenic Proteobacteria. Micronutrient deficiencies affect up to 78% of patients through malabsorption, chronic blood losses, dietary restrictions, and drug–nutrient interactions. Nutritional status significantly impacts surgical outcomes, with preoperative malnutrition and sarcopenia associated with increased postoperative complications, and it reciprocally influences biologic therapy response. Integration of personalized, microbiome-informed dietary strategies as complementary components of comprehensive treatment plans represents a promising therapeutic frontier, requiring multidisciplinary collaboration, rigorous clinical trials with standardized microbiome analyses, and precision nutrition algorithms accounting for disease phenotype, baseline microbial composition, and individual patient characteristics to optimize outcomes and improve quality of life. Full article

The importance of micronutrient status in human food choice remains a fundamental issue needing further investigation. The objectives of the present paper are to present and discuss historic and current research together with a general model incorporating this interaction and to suggest future research to address the questions this poses. By definition, essential nutrients must be consumed in sufficient amounts to meet an individual’s requirements. While data indicate that complex neuroendocrine mechanisms provide negative-feedback control of energy and protein intake to support homeostasis, corresponding mechanisms controlling micronutrient intake are less well studied. In some contexts, they are explicitly assumed to be absent, specifically for models evaluating safety and risks of deficiencies. However, it may be hypothesized that for at least some micronutrients, mechanisms exist that aid attainment of requirements by altering preference for micronutrient-rich foods so as to increase ingestion of foods containing them, similar to how being thirsty increases the appeal of watermelon compared with dry food. If this hypothesis is correct, it may hold important implications for understanding the types and quantities of foods ingested. Greater appeal in foods richer in essential nutrients may reduce the risk of malnutrition. However, by extension, it may be posited that the use of supplements could confound the most healthful food choices. For example, obtaining vitamin C from supplements or fortified foods could then causally reduce the dietary intake of vegetables and fruits by reducing the appeal of these foods. The unintended consequence may be a lower intake of fiber, nitrate, and phytochemicals, food constituents that may contribute to health without being essential nutrients themselves. This hypothesis can and should be tested empirically, for example, through randomized placebo-controlled supplementation trials. If clear causal effects are documented, clinical and public health guidance will require critical evaluation and possible modification. Full article