Search Results (240)

Elevated atmospheric CO₂ is known to alter plant physiology, yet its specific effects on nutrient-rich leafy vegetables remain insufficiently quantified. This study aimed to examine how eCO₂ influences yield and nutritional quality in kale (Brassica oleracea) and spinach (Spinacia oleracea) through the first meta-analysis focused exclusively on these crops. Following the Collaboration for Environmental Evidence (CEE) guidelines, we systematically reviewed eligible studies and conducted a random-effects meta-analysis to evaluate overall and subgroup responses based on CO₂ concentration, crop type and exposure duration. Effect sizes were calculated using Hedges’ g with 95% confidence intervals. The analysis showed that eCO₂ significantly increased biomass in spinach (g = 1.21) and kale (g = 0.97). However, protein content declined in both crops (spinach: g = −0.76; kale: g = −0.61), and mineral concentrations, particularly calcium and magnesium, were reduced, with spinach exhibiting stronger nutrient losses overall. The variability in response across different CO₂ concentrations and exposure times further underscores the complexity of eCO₂ effects. These results highlight a trade-off between productivity and nutritional quality under future CO₂ conditions. Addressing this challenge will require strategies such as targeted breeding programmes, biofortification, precision agriculture and improved sustainable agricultural practices to maintain nutrient density. This research provides critical evidence for policymakers and scientists to design sustainable food systems that safeguard public health in a changing climate. Full article

Despite evidence that exercise improves treatment outcomes, most people living with and beyond cancer (PLWBC) are insufficiently physically active. To address this challenge the Onco-Move Improvement of psychophysical fitness in adult cancer survivors pilot randomized controlled trial aims to investigate the 7-month effects of a 16-week supervised, multicomponent exercise programme on PLWBC adults aged 18–55. The study will include 40 participants currently undergoing cancer treatment or up to 5 years post-treatment with different types of cancer, who will be randomly assigned to the experimental or the control group. The exercise programme will take place three times a week for 16 weeks. We hypothesize that the Onco-Move exercise programme will improve participants’ quality of life, sexual function, and stress-response strategies, as well as their nutrition, physical functions, and body composition. We also expect to observe physiological changes related to the intervention influencing inflammation, metabolism, muscle adaptation, and cellular aging. The Onco-Move exercise programme, once validated, has the potential to be implemented in oncological non-governmental organizations (NGOs) and hospitals in Poland and Spain, among others, as a feasible, effective, and safe non-pharmacological aid for cancer patients and survivors. Full article

Background/Objectives: Patient preoperative cardiorespiratory physical fitness measured by maximal oxygen consumption (VO2max) is highly relevant to postoperative outcomes, with low VO2max associated with a greater symptom burden and a greater prevalence of long-term treatment-related cardiovascular disease risk factors in patients undergoing surgery. A network meta-analysis (NMA) was conducted to determine the effects of different components of prehabilitation, including exercise, nutrition, psychological intervention, and different combinations of the aforementioned interventions, on oxygen consumption in people undergoing major abdominal or cardiothoracic surgery. Methods: A literature search was conducted from inception to December 2025. Randomized controlled trials on the effectiveness of prehabilitation programmes on pre-surgery VO2max were included. The risk of bias was assessed via the Cochrane risk of bias (RoB 2.0) tool, and the quality of evidence was assessed via the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. Pairwise meta-analyses and NMAs were conducted for direct and indirect evidence. Results: Fourteen studies were included in this NMA. The highest effect (ES) for VO2max scores was for the exercise group versus the control group (ES: 0.44; 95% CI: 0.11, 0.78). When exercise was categorized according to intensity, the highest effect was for high-intensity interval training (HIIT) versus the control (ES: 0.51; 95% CI: 0.04, 0.97). Conclusions: Exercise HIIT should be considered the most effective strategy for improving exercise capacity in patients undergoing major abdominal or cardiothoracic surgery. Given the importance of VO2 as a predictor of morbidity, mortality, and the potential occurrence of adverse events after the procedure in surgical patients, it is essential to include its measurement in future studies to estimate both the risk of procedures and the effect of prehabilitation programmes. Full article

Background/Objectives: Breast cancer is the most common malignancy among women globally, with survival rates improving due to earlier detection and better treatment. As a result, cancer survivors now constitute a growing segment of the population, and addressing their long-term health and well-being is a public health priority. Diet and nutrition represent modifiable factors that may influence recurrence, comorbidities, and quality of life (QoL), yet clear evidence-based guidance remains limited. This umbrella review thus synthesized evidence from published reviews on the effects of dietary and nutrition interventions among breast cancer survivors. Methods: Following a prospectively registered protocol in PROSPERO (CRD420251185022), six databases (PubMed, EMBASE, Scopus, Cochrane Library, PsycINFO and CINAHL) were systematically searched for systematic reviews/meta-analyses evaluating dietary or nutrition interventions in adult breast cancer survivors. Eligible reviews reported anthropometric, metabolic, psychosocial, or survival outcomes. Methodological quality was appraised using the AMSTAR-2 tool, and findings were narratively synthesized. Results: Nine systematic reviews encompassing more than 10,000 breast cancer survivors were included. Interventions ranged from general dietary counselling and structured weight-management programmes to Mediterranean-style dietary patterns, dietitian-led primary care, multiple health behaviour change interventions, mobile nutrition apps, and broader lifestyle programmes incorporating diet. Across reviews, interventions consistently improved diet quality and fruit–vegetable intake, produced modest but meaningful reductions in weight, body mass index, and body fat, and enhanced several QoL domains (e.g., fatigue, physical functioning, body image). Higher adherence to Mediterranean-style diets was associated with lower all-cause and non–breast cancer mortality, though certainty was limited by observational designs. However, evidence for long-term maintenance, survival endpoints, and ethnically diverse or low- and middle-income populations remains sparse. Conclusions: Dietary and nutrition interventions, particularly structured, dietitian-supported, and Mediterranean-style approaches, contribute to improved diet quality, sustainable weight control, and enhanced QoL among breast cancer survivors. Integrating nutrition care into survivorship pathways should be the focus of future research. Full article

Background/Objectives: Excessive social media usage in the current times and high rates of food advertising can impact the health status of individuals by increasing food cues related to perceived hunger and, thus, dietary behaviour. This study examined the association between social media usage patterns, food-related advertising, and dietary choices among Gen Z individuals. Methods: A cross-sectional study was carried out amongst 314 young adults between the ages of 18 and 25 in Surat city, Gujarat. Data was collected for social media usage, the most used platforms, preferred content, and eating patterns. Anthropometric measurements (height and weight) were also recorded. Perceived hunger responses to 12 social media-based food images were assessed using a ten-point Visual Analogue Scale (VAS). Statistical analyses were performed using SPSS (version 26.0), with the significance level set at p < 0.05. Results: YouTube and Instagram were the most used social media apps. There were no significant differences observed between the BMI of participants using social media for 2 h a day and those using it 3+ hours a day. However, a significant association between the BMI of those who viewed advertisements for ready-to-eat foods (p = 0.004) and the BMI of those who viewed advertisements for food delivery platforms (p = 0.001) was seen. A significant difference between usage of Pinterest (p = 0.02), Instagram (p = 0.047), and BMI was also found. Conclusions: Social media marketing and food content are shaping the dietary choices of young adults, and more studies need to be conducted in Pan India to understand the reasons. Such evidence will be crucial for guiding nutrition policies, digital marketing regulations, and youth-focused awareness programmes. Full article

This study estimates the prevalence of food insecurity and coping mechanisms among low-income rural households in Sri Lanka, collecting primary data from 400 households in the Ayagama Divisional Secretariat in Rathnapura District. The results uncover that around 38.1% of the households faced food scarcity within a year prior to the survey date, with 77.9% being uncertain about maintaining a nutritious diet in the next 30 days. Notably, household dietary diversity scores reveal that they are either moderately (62%) or severely (22.3%) lacking essential nutrients, irrespective of the gender of the household head. The leading cause is the unaffordability of protein-rich foods and certain fruits. Coping strategies are primarily short-term and consumption-based, such as purchasing food on credit and reducing meal sizes, which propagate future food insecurity. The findings underscore the need for government interventions that combine short-term safety nets with long-term agricultural productivity improvements, alongside nutrition-sensitive practices and market stabilisation to enhance food availability and affordability. Consequently, targeted social protection programmes for vulnerable groups, combined with livelihood support and climate-resilient agriculture, could reduce reliance on harmful coping mechanisms. Lastly, this study proposes integrating food security goals within broader development frameworks and community initiatives as pivotal for long-term stability and resilience. Full article

Background: Transition from paediatric to adult care in congenital heart disease (CHD) represents a pivotal and vulnerable phase that critically influences long-term survival, morbidity, and quality of life. Advances in paediatric cardiology and surgery have generated a rapidly growing population of adults with congenital heart disease who exhibit complex, lifelong, and multidisciplinary needs. However, survival does not equate to cure, and discontinuity of care during adolescence remains a major predictor of adverse outcomes. Despite widespread recognition of their importance, transition programmes are heterogeneous worldwide, and standardised, evidence-based protocols are missing. Objective: This review calls for action acknowledging the urgent need for structured and standardised transition programmes in CHD care, integrating the key elements that should be addressed in any programme to optimise outcomes. Content: Transition should be understood as a multidisciplinary, longitudinal process integrating medical management, patient and family education, psychological preparation, and societal inclusion. Core domains include tailored physical activity, nutritional counselling, cardiovascular risk factor management, infective endocarditis prevention, reproductive health, psychosocial support, and engagement of primary care providers, educators, and employers. Evidence demonstrates that structured transition programmes enhance health literacy, adherence, and self-management, while reducing loss to follow-up. The active involvement of primary care providers, psychologists, educators, and employers is essential to sustain holistic and equitable care. Conclusions: Transition should be reframed as an essential, lifelong component of CHD care. The development and implementation of standardised, multidisciplinary, evidence-based transition protocols are urgently required to ensure continuity, empower patients, and optimise long-term clinical and psychosocial outcomes for adults with CHD. Full article

The gut microbiota plays an essential role in human health through its contributions to immune regulation, metabolism, pathogen defence and disease susceptibility. Despite this significance, most gut microbiome research remains disproportionately focused on high-income countries, resulting in a limited and underrepresented view of global microbial diversity. This bias is evident in Africa, where populations, including those in South Africa, show unique combinations of genetic variation, dietary patterns and environmental exposures that are insufficiently captured in current datasets but offer opportunities to uncover novel insights into microbial evolution and its influences on health across diverse settings. In response to this gap, this review synthesises global patterns in gut microbiota composition and diversity while situating South African findings within this broader context. We examine evidence across microbial domains, including bacteria, fungi, viruses, archaea, protozoa and helminths, and highlight the impact of dietary transitions and environmental exposures on microbial community structure. Although still emerging, research on the gut microbiome of South African populations consistently reports contrasts between rural and urban populations, with rural groups enriched in fibre-fermenting and anti-inflammatory taxa, whereas urban communities often exhibit reduced diversity and features of dysbiosis linked to Westernisation. However, limited sample sizes, heterogeneous methodologies and absence of multi-omic approaches constrain robust interpretation. These lacunae in current knowledge emphasise the urgent need for large-scale, longitudinal studies that reflect South Africa’s demographic and geographic diversity. Strengthening this evidence will not only help identify microbial signatures linked to modifiable lifestyle factors but will also guide nutrition, prevention and screening programmes to improve health in African populations. Full article

Background/Objectives: In Pakistan, 41.7% of women of reproductive age and 53.7% of children aged 6–59 months are anaemic. This study aimed to evaluate the effectiveness of a nutritional supplementation programme, underpinned with behaviour change communication and implemented through Lady Health Workers (LHWs), in reducing anaemia among pregnant and lactating women as well as 6–59-month-old children. Methods: This study used a quasi-experimental design with an intervention and a control group. A total of 2821 and 2410 pregnant and lactating women and 3397 and 3277 children aged 6–59 months participated in the baseline and endline surveys, respectively. The study areas were matched for demographic and economic characteristics, and both had routine public-sector health and nutrition programmes, including iron–folic acid supplementation during pregnancy. The participants in the intervention group received additional nutritional support. Throughout the pregnancy and in the first six months of exclusive breast feeding, women were provided 5 kg (165 g/day) of wheat soya blend (WSB) per month. Children aged 6–23 months received lipid-based nutrient supplements (LNS), and those aged 24–59 months received micronutrient powder. We applied a difference-in-difference (DID) analysis with kernel propensity score matching to assess the impact on anaemia, a secondary outcome of a stunting prevention programme. Results: Maternal anaemia (both pregnant and breastfeeding women) declined substantially in the intervention areas from 80.4% to 62.6% compared with a smaller reduction in the control areas (80.0% to 72.9%). The DID estimate showed a 10.7-percentage-point (pp) greater decline in maternal anaemia (p ≤ 0.001). Both pregnant and lactating women benefited, with DID reductions of 16.7 pp (p ≤ 0.001) and 9.4 pp (p = 0.005), respectively. The largest gains occurred among women in higher-wealth quintiles, with reductions up to 22.6 pp (p ≤ 0.001). In contrast, childhood anaemia showed no overall significant difference between intervention and control areas (DID = −0.7 pp, p = 0.73). However, significant improvements were observed among male children (DID = −10.3 pp, p = 0.001) and those in higher-wealth quintiles (DID = −15.0 pp, p = 0.002). Conclusions: Overall, the findings suggest that LHWs can effectively reduce maternal anaemia when iron–folic acid supplementation is complemented with WSB and targeted behaviour change communication. Full article

Personalized nutrition aims to optimize health by addressing interindividual differences in metabolism, microbiota composition, and dietary responses. Modulating the gut microbiota through probiotics, prebiotics, and synbiotics is promising, yet conventional systems such as capsules or fermented foods offer limited control over dosage, release kinetics, and microbial viability. These formats often cause 2–4 log reductions in viable counts during processing and gastrointestinal transit, underscoring the need for advanced delivery technologies. Three-dimensional (3D) food printing enables digital design of edible matrices with programmable geometry and composition to enhance microbial protection and controlled release. Coaxial and gel-in-gel architectures have retained over 90–96% of probiotic cells after printing and 80–85% after simulated digestion. Synbiotic formulations combining probiotics with fructooligosaccharides or whey protein achieve 98–99% survival and stability for 35 days. This review summarizes advances in formulation, encapsulation, and printing strategies, highlighting how 3D food printing uniquely overcomes challenges of viability, release control, and personalized dosage in microbiota-based nutrition. Full article

Background: Digital transformation is reshaping public organizations worldwide, yet in low-resource contexts, its success is constrained by weak infrastructure and governance. In India, programs such as the Ayushman Bharat Digital Mission and the Aspirational Districts Programme rely on meso-level officers who act as key managerial intermediaries, but their organizational challenges remain understudied. Aim: This study examines sub-district health and nutrition officers’ experiences, organizational barriers, and adaptive strategies in implementing digital reforms. Methods: Eight in-depth interviews were conducted with Medical Officers in Charge (MOICs) and Child Development Project Officers (CDPOs) across urban, semi-urban, rural, and flood-prone blocks of Muzaffarpur, Bihar. Data were transcribed, translated, and thematically analyzed using Braun and Clarke’s approach, informed by organizational and technology adoption theories. Results: Officers valued digital tools for transparency and real-time monitoring but faced systemic barriers, including hardware decay, poor connectivity, fragmented platforms, and limited fiscal autonomy. Despite these, they displayed managerial agency through informal infrastructures such as WhatsApp, peer mentoring, and parallel records. COVID-19 accelerated digital use while widening inequities. Conclusions: Meso-level officers are critical enablers of organizational resilience. Their experiences highlight how leadership, governance, and adaptive management shape digital transformation in resource-constrained settings. Full article

Chronic pancreatitis (CP) precipitates complex malnutrition through synergistic mechanisms: exocrine pancreatic insufficiency–driven maldigestion, duodenal or pancreatobiliary strictures limiting nutrient flow, cholestasis impairing micelle formation, alcohol-related anorexia, pain-induced hypophagia, proteolytic catabolism from type 3c diabetes, and a chronic inflammatory milieu that accelerates sarcopenia and bone demineralisation. Consequent calorie–protein depletion, micronutrient and fat-soluble vitamin deficits, and metabolic derangements markedly amplify morbidity. Pancreatic enzyme replacement therapy (PERT) with targeted micronutrient repletion is foundational; high-protein regimens co-administered with PERT curb muscle loss, and medium-chain triglycerides (MCTs) can augment caloric delivery by bypassing lipase dependence, although their benefit over personalised dietetic counselling is marginal. Optimal dietary fat thresholds and timing of escalation from oral to enteral or parenteral feeding remain unresolved. Comprehensive care also demands alcohol abstinence, effective analgesia and stringent glycaemic control. Serial monitoring—biochemical indices, densitometry, dual-energy X-ray absorptiometry and imaging-based body-composition metrics—permits early detection of high-risk patients and precision tailoring of interventions. Intensified multidisciplinary programmes already improve prognostic endpoints and are unveiling biomarkers of nutritional resilience. A structured, evidence-based strategy integrating PERT, macronutrient engineering, micronutrient repletion and metabolic surveillance is essential to mitigate nutrition-related morbidity, enhance long-term outcomes and optimise quality of life in CP. Full article

Background/Objectives: Undernutrition and intestinal parasitic infections are critical public health problems in low-income countries, with adverse effects on child growth and increasing anaemia. Madagascar, with a high prevalence of these factors, lacks comprehensive studies analysing their interaction. This study aimed to assess the nutritional status, the prevalence of anaemia, and the occurrence of intestinal parasitic infections among children and adolescents in three southern regions of Madagascar. Methods: A cross-sectional, prospective study of 289 children and adolescents (10–18 years) from three schools located in Antsoamadiro, Fianarantsoa, and Toliara was conducted. Sociodemographic, anthropometric, and haemoglobin concentration data, as well as faecal samples, were collected. Nutritional status was assessed by Nutrimetry, combining Height-for-Age and BMI-for-Age indicators. Stool samples were analysed by optical microscopy and molecular methods. Results: Nutricode 1 (short stature/stunting + thinness/wasting) was significantly more frequent in Toliara. Nutricode 1 was also significantly more prevalent in males than females. Anaemia affected 57.8% of participants and was significantly associated with Nutricode 1. The overall parasitism rate was also associated with Nutricode 1. Trichuris trichiura and Ascaris lumbricoides significantly increased the risk of stunting, wasting, and Nutricode 1. Co-infection with Trichuris trichiura + Giardia duodenalis was significantly associated with wasting and Nutricode 1. This co-infection was also related to the presence of anaemia, as was moderate-intensity infection with T. trichiura. Conclusions: There is a high co-burden of undernutrition, anaemia, and parasitic infections in southern Madagascar. These findings highlight the urgency of implementing comprehensive health programmes combining parasite control, nutritional support, and iron supplementation adapted to regional realities. Full article

Background: Adequate nutrition is fundamental to the health and performance of young athletes. However, many fail to meet nutritional recommendations. Nutrition education programmes are promising, cost-effective strategies for improving dietary habits. However, research gaps persist, coupled with notable variability amongst the intervention programmes targeting youth athletes. The aim of this study was to assess the nutritional knowledge of Portuguese youth athletes and to evaluate the effectiveness of a nutrition education programme in improving football players’ understanding of a healthy diet. Methods: Participants were recruited from a local football club through public announcement. Male youth football players aged 13 to 18 years, training at least 3 times per week and competing regularly over the past six months, were eligible. The baseline assessment included anthropometric measurements, an assessment of the adherence to the Mediterranean diet using the KIDMED questionnaire, and an assessment of general and sports nutrition knowledge via a structured questionnaire. Following the intervention—comprising three face-to-face educational sessions and two digital infographics—the KIDMED and nutrition knowledge questionnaires were re-administered. Results: A sample of 38 male footballers were eligible for this study. Most participants exhibited a healthy body weight, with a corresponding adequate body composition. The mean KIDMED score indicated moderate adherence to the Mediterranean diet with no statistically significant difference between the baseline and post-intervention (6.79 ± 1.52 versus 6.97 ± 2.01, p > 0.05). There was a significant enhancement in overall nutrition knowledge, accompanied by notable improvements in the comprehension of macro- and micronutrient sources and sports nutrition principles. Conclusions: This pilot programme proved effective in enhancing young football players’ knowledge of nutrient sources and sports nutrition. Full article

The study examines changes in household food security and identifies their key determinants in Zambia by comparing the pre-pandemic period to the COVID-19 pandemic period. Using nationally representative surveys from 2015 and 2021 and the coarsened exact matching (CEM) approach, 8650 households were matched for comparison. Two complementary food security measures are analysed using multinomial logit regression models: household expenditure share, representing economic vulnerability, and household dietary diversity score (HDDS), representing diet quality. The results show that household food expenditure share significantly increased from 53.8% to 61.4%, indicating increased economic vulnerability. Notably, household dietary diversity improved from 7.1 to 8.2 out of 12, indicating better dietary quality. Consistent determinants of food security—such as household size, education level, marital status, region, and employment—remained significant, but their protective effects weakened during the pandemic. Specifically, the protective effect of education declined, urban households became relatively more vulnerable, and wealthier households experienced minimal changes. The study recommends targeted interventions, including expanding social protection programmes for economically vulnerable households, supporting informal food markets, enhancing rural–urban food supply linkages, and promoting nutrition education to ensure diverse, affordable food access during crises. Full article