Search Results (503)

Background: Contralateral lymph node metastasis (CLNM) in oral squamous cell carcinoma (OSCC) represents a major clinical challenge, in patients with a clinically contralateral node-negative neck. Individualized risk stratification is crucial to guide decisions on elective contralateral neck dissection. This study aimed to synthesize existing evidence and apply Bayesian Monte Carlo Simulation (MCS) to estimate CLNM probability across various clinic-pathological scenarios. Methods: A systematic search of PubMed, PubMed Central, and Embase (2000–2024) identified 26 eligible studies. Effect sizes for seven key risk factors—midline-crossing tumours, extranodal extension (ENE), ≥2 ipsilateral lymph nodes, depth of invasion (DOI) >10 mm, perineural invasion and lymphovascular invasion (PNI-LVI), poor differentiation, and floor of mouth subsite—were computed and incorporated into a Bayesian logistic model. Using the No-U-Turn Sampler (NUTS) in RStan, 100,000 virtual patient profiles were simulated to generate posterior probabilities of CLNM. Results: The baseline CLNM risk for lateralized tumours without additional risk factors was 4.2%. Single risk factors increased probability substantially: midline-crossing tumours (31.7%), ENE (27.4%), and ≥2 ipsilateral nodes (24.9%). Combinations of risk factors amplified the risk non-linearly: the presence of a midline-crossing tumour, ENE, and ≥2 ipsilateral nodes yielded a 76.8% CLNM probability, and the presence of all seven risk factors increased it to 93.7%. Risk tiers were classified from minimal (<20%) to very high (>50%) to guide clinical decision-making. Conclusions: This MCS-based model reveals that CLNM risk increases multiplicatively with the presence of various high-risk features. The simulation supports bilateral neck management in high-risk patients and observation in low-risk cases. Prospective validation is needed to integrate this model into routine clinical practice and to guide patient-specific surgical planning. Full article

The rising prevalence of food allergies, particularly to peanuts and tree nuts, poses significant challenges for pediatric health worldwide. These allergens are among the leading causes of severe allergic reactions, including anaphylaxis, often manifesting in early life. This review synthesizes the current knowledge on the immune mechanisms underlying these allergies, emphasizing the interplay between genetic, immunologic, and environmental factors in shaping allergic sensitization. Advances in prevention strategies, including early allergen introduction, have been critically evaluated. Predictive and diagnostic methodologies, from traditional IgE evaluation to cutting-edge proteomics and metabolomics approaches, have been explored to identify biomarkers that predict allergy onset and severity. By unraveling early immunological and molecular signatures, this study aimed to summarize the early prediction, prevention, diagnosis, and treatment of peanut and tree nut allergies, ultimately contributing to more effective interventions and a better quality of life for affected children. Full article

Enzymatic browning (EB) is a physiological alteration that compromises the sensory and commercial quality of tree nuts, significantly reducing their market value and functional compound content. Due to its complexity and economic impact, this review compiles updated information on mechanisms and factors driving EB in tree nut species, as well as strategies for its prevention. The EB in tree nuts results from the oxidation of phenolic compounds (PCs) to brown pigments. This process is driven by enzymatic activity such as polyphenol oxidase (PPO), peroxidase (POD), and phenylalanine ammonium lyase (PAL) and strongly enhanced by cellular stress and associated regulation of gene expression. The EB has been documented in several tree nut species, including almonds, betel nuts, chestnuts, hazelnuts, macadamias, pecans, pistachios, and walnuts. This alteration developed both pre-harvest and post-harvest and was influenced by agronomic factors (such as cultivar, nutritional status, climatic conditions, and altitude) and handling (including shelling, storage, and processing). Mitigation strategies include the use of synthetic inhibitors, physical treatments, and the use of plant extracts rich in natural antioxidants, the latter perceived as more sustainable and safer alternatives. Full article

With the global population reaching 10 billion in 25 years, food production must increase 70% while addressing sustainability concerns. This review uniquely integrates advanced processing technologies—including precision fermentation, AI-driven optimization, and 3D printing—with comprehensive analysis of nutritional quality and health outcomes of plant-based protein supplements (PBPSs). Common sources include legumes, cereals, and nuts/seeds, each with amino acid profiles requiring strategic protein complementation. Advanced processing technologies including high-pressure processing, ultrasound-assisted extraction, pulsed electric field, precision fermentation, and AI-driven optimization enhance protein digestibility, solubility, and functional properties while reducing antinutritional factors. PBPSs demonstrate comparable muscle protein synthesis to animal proteins while providing superior cardiovascular, metabolic, and gut health benefits due to bioactive compounds, fibers, and antioxidants. Integrating advanced processing with traditional methods presents opportunities to develop high-quality, sustainable protein supplements meeting global demands while promoting human health and environmental sustainability. Full article

Oral squamous cell carcinoma (SCC) is typically found in middle-aged or elderly individuals, is more common in men than women, can occur at any mucosal site, and is associated with a poor prognosis. The primary risk factors for oral SCC include the use of tobacco, betel nut, or areca nut, and excessive alcohol consumption. A comprehensive management plan for oral SCC typically involves a multidisciplinary team approach with surgery being the primary treatment approach, with or without radiotherapy. Radiotherapy is an essential component in the management of oral SCC, with its application guided by both tumour- and patient-related factors. It may be employed as a definitive, adjuvant, or palliative modality, depending on tumour stage, resectability, surgical margins, histopathological characteristics, as well as the patient’s overall health, financial considerations, and personal preferences. Effective radiotherapy for oral SCC inevitably leads to various tissue toxicities, which can vary among patients. These variations are primarily influenced by patient-specific characteristics, tumour-specific factors, and aspects related to the radiotherapy itself. Some of the complications resulting from ionizing radiation (IR) include oral mucositis, facial dermatitis, salivary gland dysfunction, trismus, and osteoradionecrosis, along with their management strategies. Full article

This paper investigates the impact of demographic changes on regional disparities within the European Union. The analysis focuses on key demographic trends—population ageing, low fertility rates, and migration flows—and their long-term implications for labor markets, economic growth, and the sustainability of social systems across EU regions. Using Eurostat data for 169 NUTS2 regions for 2022 and 2023, the study applies descriptive statistics, correlation analysis, and multiple regression models to quantify the effects of life expectancy, fertility rates, and educational attainment on GDP growth and employment in knowledge-intensive and high-tech sectors. Findings indicate that regions with higher shares of highly educated labor and favorable demographic profiles tend to achieve greater economic resilience and competitiveness. In contrast, demographic decline and outmigration continue to deepen structural disparities, particularly in rural and less developed regions. The results underscore the importance of integrated EU policies aimed at addressing demographic challenges while promoting regional cohesion through investment in human capital, innovation, and infrastructure. By highlighting the critical role of demographic factors in shaping regional development, this study contributes to the discourse on designing effective policies to foster sustainable and inclusive growth within the European Union. Full article

Children with Congenital Zika Virus Syndrome (CZVS) experience severe neurological and nutritional impairments. Although immediate clinical consequences are well-documented, long-term anthropometric and nutritional outcomes remain poorly understood. This study assessed longitudinal anthropometric and nutritional outcomes in children affected by CZVS. A cohort of 38 children aged ≥ 5 years diagnosed with CZVS was followed at a reference center in Northeast Brazil. Anthropometric measures (weight, height, BMI, head circumference) were collected using standardized methods, including digital scales and anthropometric tape measures. Growth was analyzed using WHO Anthro and WHO Anthro Plus software (version 3.2.2). Dietary intake was evaluated through two 24 h recalls and analyzed with NutWIN 2.5 software. Nutritional status was classified using WHO growth standards, and associations between dietary intake and BMI were statistically examined. Children showed significant linear growth improvement (p = 0.007) without corresponding weight gain, leading to worsening BMI classifications (p = 0.017). Dietary evaluations revealed limited dietary diversity, frequent intake of ultra-processed foods, inadequate fruit consumption, and widespread insufficiencies in caloric and micronutrient intake (zinc, calcium, iron, vitamin D). Low carbohydrate intake was significantly associated with inadequate BMI (p = 0.030). Multidisciplinary nutritional interventions addressing medical, dietary, educational, and socioeconomic factors are essential for improving health outcomes in children with CZVS. Full article

Micro- and nanoplastics (MNPs) are becoming an increasingly common environmental pollutant. They have been detected in fruit, vegetables, drinking water, seafood, meat, dairy products, and cereals, with particularly high levels often being found in processed foods. The presence of MNPs varies significantly depending on the type of food, geographical region, method of food preparation, and packaging materials used. Of the three main routes of human exposure to MNPs, ingestion is the most important. This article provides a comprehensive review of food contamination by MNPs, including an assessment of the impact of various factors on the MNP abundance. For the first time, it also evaluates the differences in MNP intake among individuals following three typical European dietary patterns: the Mediterranean, Western, and lacto-ovo-vegetarian. The lacto-ovo-vegetarian diet was found to result in the highest MNP intake (69.1 × 10⁶ particles/day), almost doubling that of the other tested patterns. This is mainly due to the very high proportion of fruit, vegetables, legumes, and nuts in daily meals. Taking into account both health concerns and MNP quantity consumed with meals (37.5 × 10⁶ particles/day), the Mediterranean diet is the healthiest. The review also highlights the need to raise awareness of food-related sources of MNPs. Full article

Irritable Bowel Syndrome (IBS) is a functional disorder of the digestive system. Its global prevalence varies widely, estimated at up to 10%, due to differences in diagnostic criteria, cultural factors, and dietary patterns. Dietary interventions have emerged as first-line strategies for symptom management, with the low-FODMAP (fermentable oligo-, di-, and monosaccharide and polyol) diet demonstrating robust efficacy in reducing gastrointestinal symptoms by minimizing poorly absorbed, fermentable carbohydrates. However, concerns regarding the long-term nutritional adequacy, potential alterations in gut microbiota composition, and sustainability of the low-FODMAP diet have prompted the need for more integrative and nutritionally balanced dietary models. In contrast, the Mediterranean Diet (MD), rich in fruits, vegetables, legumes, whole grains, nuts, olive oil, and omega-3 fatty acids from fish, is widely recognized for its anti-inflammatory, cardiometabolic, and potential anticarcinogenic effects. Notably, adherence to the MD has been associated with favorable gut microbial profiles and reduced risk of colorectal and other gastrointestinal cancers. However, the high FODMAP content of many MD components limits its immediate compatibility with IBS dietary protocols. This review explores the evidence supporting the integration of MD principles into a low-FODMAP framework for the dietary management of IBS. Rather than proposing a new model, we synthesize existing literature, including recent clinical findings, and offer practical, evidence-informed guidance for tailoring a Mediterranean-style low-FODMAP diet that supports both symptom management and long-term nutritional health. Integrating MD principles into the low-FODMAP approach offers a promising strategy to enhance the nutritional quality, sustainability, and long-term efficacy of dietary management in IBS. Full article

This study integrates the health impacts of environmental burdens and dietary intake using disability-adjusted life years (DALYs) to inform a healthier, more sustainable Japanese diet. Climate change, air pollution, ozone depletion, photochemical oxidants, and water consumption were quantified with Life cycle Impact assessment Method based on Endpoint modeling (LIME), while eleven dietary risks were converted to DALYs using dietary risk factors. Recipes collected online on a per-serving basis were classified into staple, main, side, and soup dishes and stratified into quartiles based on a nutrient profiling system (NPS) tailored to Japanese well-consumed dishes—the Ajinomoto Group NPS (ANPS) for dishes. ANPS—a culturally adapted NPS emphasizing protein, vegetables, sodium, and saturated fatty acids—was regressed against total DALYs to test whether higher ANPS scores correspond to lower combined health impacts of environment and diet. The analysis identified dish groups and high-scoring quartiles that minimized environmental and nutrition-related DALYs, revealing practical dish combinations that balance reduced sodium and red meat with increased vegetables, seafood, and nuts. These findings demonstrate the utility of coupling nutrient profiling with life cycle assessment (LCA) and provide a scientific basis for dietary guidelines that jointly advance human and planetary health within the emerging nutritional LCA framework. Full article

Background/Objectives: Poor dietary habits remain a significant public health concern, highlighting the need to promote healthy and sustainable eating patterns, especially in childhood and adolescence. This study assessed the eating habits of primary school children in the Tagus Lezíria region, focusing on adherence to the Mediterranean Diet (MD), recognized for its health and environmental benefits. Methods: The KIDMED index (Mediterranean Diet Quality Index for children and adolescents) was applied to 435 children, the vast majority (97.7%) aged 6–10 years. Results: The data showed that 64.6% of participants exhibited high adherence to the MD, 32.0% medium, and 3.5% low adherence. Despite these encouraging levels, several gaps were identified: 80% of the children did not meet the recommendation for regular nut consumption (≥2–3 times/week), 44% consumed legumes less than once a week, and 43% failed to eat vegetables more than once a day. Regarding demographic factors, no significant differences were observed in overall adherence categories; however, differences emerged in specific eating behaviours. For example, girls consumed more vegetables and cereals than boys, and children in rural areas consumed less dairy than those living in urban settings. Conclusions: These findings emphasize the importance of reinforcing targeted school-based educational interventions to promote healthier dietary behaviours, particularly increased consumption of fruits, vegetables, fish, pulses, and nuts. Strengthening children’s adherence to the MD from an early age may contribute to improving their health and fostering sustainable eating practices. Full article

Plant-based beverages are a viable alternative for elderly consumers because of their practicality and sustainable appeal. The use of Brazil nuts for these beverages is relevant because of the added value given to the country’s agrobiodiversity and the nuts’ nutritional quality, including their high selenium content. This study aimed for the understanding and acceptance by elderly people of a vegetable beverage made from Brazil nuts and fruit. The investigation was divided into two parts: (1) development and sensory analysis of Brazil nut beverages, and (2) consumers’ perception, choice, and influencing factors for these beverages. In the first stage, four beverages were formulated with different fruit pulps. A total of 100 elderly individuals (>60 years; 69% female) evaluated the sensory acceptance and purchase intention of the beverages. In the second stage, an online questionnaire was applied to 220 elderly individuals (>60 years-old; 52.7% female), which consisted of a choice test of nut beverage packages, a food neophobia scale, and questions about vegetable beverage consumption. The study showed that the selenium claim was one of the most relevant factors in the choice, demonstrating that using Brazil nuts can boost beverage purchases. Further tests are still needed to improve the attributes, such as sweet taste and appearance. Despite this, the blend of Brazil nuts with fruits positively influenced the choice and acceptance of these products by elderly individuals. Full article

Background/Objectives: While the benefits of almond consumption in reducing levels of TC and LDL-C are well established, the effects on additional lipids that have emerged as important predictors of cardiovascular disease, such as ApoB and the ratio of ApoB:ApoA, are not well characterized. In this systematic review and meta-analysis, the effects of almond consumption on blood lipids were comprehensively assessed. Methods: On 12 May 2025, ProQuest Dialog™ was used to search ten literature databases (AdisInsight: Trials; Allied & Complementary Medicine™; BIOSIS Previews^®; CAB ABSTRACTS; Embase^®; Embase Preprints; Foodline^®: SCIENCE; FSTA^®; MEDLINE^®; National Technical Information Service). Randomized controlled trials at least 4 weeks in duration were included if the investigational product was almonds; the control was void of nuts/tree nuts; the subjects were adults without CVD; and blood lipid levels were assessed. Health Canada’s Quality Appraisal Tool for Intervention Studies was used to assess each study’s risk of bias. The mean difference in the effect for each parameter was pooled across studies in a random effects model, using the inverse of the variance as the weighting factor. Results: 36 publications (48 almond–control datasets) representing 2485 participants were included. Almond consumption significantly reduced LDL-C (−0.132 mmol/L; 95% CI: −0.190, −0.075 mmol/L; p < 0.001), TC (−0.160 mmol/L; 95% CI: −0.218, −0.101 mmol/L; p < 0.001), non-HDL-C (−0.204 mmol/L; 95% CI: −0.281, −0.127 mmol/L; p < 0.001), TC:HDL-C (−0.154; 95% CI: −0.246, −0.063; p = 0.001), LDL-C:HDL-C (−0.112; 95% CI: −0.199, −0.026; p = 0.011), ApoB (−4.552 mg/dL; 95% CI: −6.460, −2.645 mg/dL; p < 0.001), and ApoB:ApoA (−0.027; 95% CI: −0.046, −0.008; p = 0.006), with a borderline significant reduction in TG (−0.037 mmol/L; 95% CI: −0.079, 0.005; p = 0.085) and no effects on HDL-C, ApoA, or Lp[a]. The effects persisted when the analyses were limited to higher quality studies, except for the reduction in TG. Conclusions: Almond consumption improves levels of LDL-C, TC, non-HDL-C, TC:HDL-C, LDL-C:HDL-C, ApoB, and ApoB:ApoA, though dedicated clinical trials are needed to better understand effects on TG levels. Full article

Background/Objectives: Childhood obesity represents a pressing global health challenge, demanding coordinated, long-term strategies. Schools and families are pivotal environments for shaping children’s lifestyle behaviors. The LIVELY project aimed to assess overweight/obesity prevalence and associated factors in primary school children, and to implement a multidimensional educational intervention promoting healthy, sustainable lifestyles. Methods: This single-arm study was conducted from October 2023 to October 2024 in a primary school in Milan. The intervention included age and culturally tailored lessons, games, and activities. Anthropometric measures, dietary adherence, and lifestyle habits were assessed before and after the intervention. Satisfaction surveys were administered to children, families, and teachers. Results: The project involved 227 children across 14 classes (mean age 8.9, SD 1.2 years). The prevalence of overweight/obesity was 23.4%. Adherence to the Mediterranean Diet was moderate, limited by low intake of vegetables, nuts, and dairy. Physical activity was low, screen time excessive, and sleep insufficient. No statistically significant improvements in anthropometrics or diet adherence were observed post-intervention, but positive trends emerged for physical activity, sleep, and hydration. Over half of the children passed the nutritional knowledge test. Despite these challenges, high satisfaction levels have been shared by children, parents, and teachers. Conclusions: The limited duration of the intervention and challenges engaging families in a low socio-economic context may have constrained the impact of the program, and caution is advised in generalizing the findings. The LIVELY project highlights the complexity of tackling childhood obesity in multicultural settings and emphasizes the need for longer, continuous, and culturally tailored programs that actively involve families to promote sustainable healthy behaviors. Full article

The areca nut (AN) is chewed by approximately 600 million people worldwide. Among AN chewers, ~5% develop oral submucosal fibrosis (OSF), a progressive fibrotic disorder of the oral cavity. OSF is characterized by subepithelial fibrosis and mucosal rigidity, leading to restricted mouth opening, difficulty in mastication, deglutition, and speech. These impairments severely compromise oral hygiene and routine dental care, diminishing patients’ quality of life. At least 4% of OSF patients develop oral cancer. The prevalence of OSF correlates with AN chewing, particularly when accompanied by other risk factors such as tobacco use. The International Agency for Research on Cancer has identified chronic chemical and mechanical irritation of the oral mucosa from AN chewing as a major cause of OSF. The active chemical ingredients of AN include alkaloids such as arecoline, flavonoids, and tannins. Of these, arecoline is considered the most potent fibrogenic agent. In vitro, arecoline induces cultured fibroblasts to differentiate into highly contractile α-smooth muscle actin (α-SMA)-expressing myofibroblasts, the effector cells of fibrosis, and to express profibrotic markers and mediators, including transforming growth factor-β 1 (TGF-β1) and cellular communication network factor 2 (CCN2), which is associated with malignant progression of OSF. In vivo, mice exposed to AN extract or arecoline show submucosal collagen accumulation and myofibroblast differentiation, concomitant with upregulated pro-fibrotic gene (TGF-β1, Col1A1, α-SMA) expression. Although myofibroblasts can be seen in OSF patient-derived samples, substantial disease heterogeneity exists, which has thus far hindered the generation of high-quality data necessary to gain insights into underlying mechanisms and disease progression. Consequently, treatment options for OSF are limited and primarily symptomatic. Collectively, evidence from human and animal studies establishes OSF as an AN-induced fibrotic disorder and underscores the urgent need for mechanism-focused research to identify reliable diagnostic markers and therapeutic targets to address its growing global burden. Full article