Search Results (736)

Sum scores are widely used in the social sciences, yet their appropriateness remains a topic of considerable debate in the psychometric literature. A recent article by Raykov and Zhang (2025, Struct. Equ. Model.) has cautioned against employing sum scores as predictor variables in subsequent analyses, as this practice may lead to biased estimates of regression coefficients. As an alternative, structural equation modeling (SEM) based on a unidimensional factor model—where the latent factor replaces the sum score—has been advocated. The present article argues that reliability adjustments can also be implemented without resorting to SEM, using reliability-corrected regression models designed for measurement error correction. Furthermore, it is demonstrated that the SEM approach becomes inferior to measurement error correction methods when the assumption of a unidimensional measurement model is violated or when design-based reliability indices, such as Cronbach’s alpha, are preferred over model-based alternatives like McDonald’s omega. The article concludes that a fully integrated SEM approach, combining both measurement and structural components, is advantageous over measurement error correction approaches with reliability adjustment only under specific and limited conditions. Full article

Background: Large language models (LLMs) are increasingly used in clinical medicine, yet their ability to interpret advanced intraoperative hemodynamic monitoring—particularly in the context of liver transplantation—remains largely unexplored. In this proof-of-concept study, we evaluated ChatGPT’s capacity to interpret multimodal hemodynamic data derived from both standard anesthesia monitoring and the PiCCO system. The study also employed a structured assessment instrument (ARQuAT), adapted through a Delphi-based process to evaluate LLM-generated clinical interpretations. Methods: Ten key surgical–hemodynamic phases of liver transplantation were identified using a modified Delphi approach to capture the major physiological transitions of the procedure. Sequential screenshots representing these phases were obtained from five liver transplant recipients, yielding a total of 50 images. Each screenshot, along with standardized clinical background information, was submitted to ChatGPT. Five expert anesthesiologists independently assessed the model’s responses using the modified ARQuAT tool, which includes six content-quality domains (Accuracy, Up-to-dateness, Contextual Consistency, Clinical Usability, Trustworthiness, Clarity) and a separate catastrophic Risk item. Descriptive statistics were calculated for domain-level performance. Inter-rater reliability (Kendall’s W) and internal consistency (Cronbach’s alpha, McDonald’s omega) were also analyzed. All statistical analyses and visualizations were performed using NumIQO. Results: ChatGPT demonstrated consistently high performance across all content-quality domains, with median scores ranging from 4.6 to 4.8 and more than 90% of all ratings classified as satisfactory. Lower scores appeared only in a small subset of frames associated with abrupt hemodynamic changes and did not indicate a recurring weakness in any specific domain. Catastrophic Risk exhibited a pronounced floor effect, with 86% of ratings scored as 0 and only three isolated high-risk assessments across the dataset. Internal consistency of the six ARQuAT content domains was excellent, while inter-rater agreement was modest, reflecting ceiling effects and tied ratings among evaluators. Conclusions: ChatGPT generated clinically acceptable, contextually aligned interpretations of complex intraoperative hemodynamic data in liver transplant recipients, with minimal evidence of unsafe recommendations. These findings suggest preliminary promise for LLM-assisted interpretation of advanced monitoring, while underscoring the need for future studies involving larger datasets, dynamic physiological inputs, and expanded evaluator groups. The reliability characteristics observed also provide initial support for further refinement and broader validation of the Delphi-derived ARQuAT framework. Full article

As age progresses and the population increases, the prevalence of dementia also increases. Pharmacological interventions are used to treat cognitive decline. Alternative approaches to traditional pharmacology, such as dietary interventions, may help combat cognitive decline in aging populations. This review summarizes existing investigations using complementary and alternative approaches as mitigating interventions. We also briefly note other important modifiable factors to decrease the risk of cognitive decline, and Alzheimer’s disease and related dementias. Such approaches include nutrition and dietary interventions that show promising results for mitigating cognitive decline, as well as additional lifestyle modifying factors that are important to note (e.g., sleep, cardiovascular diseases, environmental factors, physical, social and leisure activities, cognitive stimulation, psychosocial factors, and sensory functioning) for their impact on cognition in aging. Despite the limited findings and support for complementary and alternative approaches in combating existing cognitive decline, findings suggest that such approaches may be most beneficial prior to the onset of cognitive impairment. Specific nutrition components, including flavonoids and omega fatty acids, may mitigate cognitive decline, and emerging evidence suggests that these nutrients may promote a healthy gut microbiota. Of the complementary and alternative approaches, adhering to specific diets, generally, has the most consistent support to combat cognitive decline. It is important to note that other non-nutritional or non-dietary modifiable lifestyle factors also show promising benefits in mitigating further cognitive decline. Future investigations and clinical trials with replication studies are needed to elucidate these complementary and alternative approaches as effective treatment options for clinicians. Full article

Background: Atherosclerosis and its associated chronic inflammation of the arterial wall disrupt fatty acid metabolism, leading to changes in plasma fatty acid composition. These alterations can be used to improve disease diagnosis and risk stratification by the development and application of specific lipidomic indices. Objectives: The objectives of this study are to evaluate the performance of conventional fatty acid indices and enhance diagnostic efficiency in atherosclerosis by introducing novel index based on plasma PUFA n-6 and n-3 content (Omega-6/3 Balance Index, O6/3-BI), as well as the perspective SFA/MUFA ratio (stearic/oleic acid ratio, C18:0/C18:1n-9) and a logit function combining PUFA and SFA/MUFA biomarkers. Methods: Plasma fatty acids were quantified by LC-MS/MS in healthy controls (n = 50) and patients with carotid atherosclerosis (n = 52), stratified by atorvastatin, rosuvastatin, or no statin therapy. The conventional indices (the Omega-3 Status (EPA + DHA), AA/EPA, and the omega-6/omega-3 ratio), and pathway ratios (C18:0/C18:1n-9; and C20:4n-6/C22:4n-6), as well as the newly introduced PUFA index and combined PUFA-SFA/MUFA logit function, were calculated. Their diagnostic performance for distinguishing atherosclerosis was assessed by a receiver operating characteristic (ROC) analysis with the cross-validation and calculation of Cliff’s Δ effect size. Results: The conventional parameters demonstrated a poor to low discrimination ability of the atherosclerosis patients’ groups from healthy controls (area under the ROC curve, AUC 0.548–0.711). In statin-treated patients, these conventional markers lost significance. The newly introduced PUFA index and SFA/MUFA ratio demonstrated improved patients’ discrimination with AUC 0.734–0.780 for the former and strong predictive power with AUC 0.831–0.858 for the latter marker and maintained their diagnostic value under statin therapy. The most significant positive effect size was observed for the SFA/MUFA ratio with Cliff’s Δ = 0.67–0.71. The combined PUFA-SFA/MUFA logit function also demonstrated a strong predictive power with AUC = 0.880 (Cliff’s Δ = −0.76), outperforming any single index. Conclusions: The newly introduced lipidomic index based on the PUFA content, SFA/MUFA ratio, and a logit function combining PUFA-SFA/MUFA biomarkers demonstrated a substantially better discrimination of atherosclerosis-related fatty acid metabolic disturbances than conventional fatty acid biomarkers. Full article

Background/Objectives: Human serum albumin (HSA) is a major endogenous inhibitor of angiotensin-converting enzyme (ACE) and helps fine-tune the activity of the renin–angiotensin–aldosterone system (RAAS), thereby potentially influencing the development of cardiovascular (CV) diseases. As the principal transport protein for free fatty acids (FFAs), HSA may have its ACE-inhibitory capacity modified by its FFA cargo and, through this mechanism, may also affect CV disease risk. We therefore tested the hypothesis that the composition of HSA-bound FFAs determines the magnitude of endogenous ACE inhibition. Methods: We quantified endogenous ACE inhibition and examined the effect of FFA concentration on this inhibition in clinical patients (n = 161 and n = 101, respectively). We measured the effects of HSA treated with saturated, monounsaturated, and polyunsaturated FFAs, as well as FFA-free HSA, on recombinant ACE and on tissue ACE. Results: Endogenous ACE inhibition was stronger in patients with higher serum HSA concentrations (Spearman’s rho = 0.422, 95% CI 0.281–0.544, p < 0.001), whereas total FFA concentration was not associated with endogenous ACE inhibition (Spearman’s rho = 0.088, p = 0.38, n = 101). However, removal of free fatty acids substantially worsened the ACE-inhibitory effect of HSA on recombinant ACE (charcoal-treated HSA: IC₅₀ = 23.24 [19.40–29.78] g/L vs. control HSA: 7.84 [6.58–9.75] g/L, p < 0.001) and on tissue ACE isolated from lung, heart, and lymph node. FFA chain length, degree and position of unsaturation, and cis/trans configuration all differentially modulated endogenous ACE inhibition. Among saturated fatty acids, stearic acid (IC₅₀ = 7.98 [7.04–9.23] g/L), and among omega-3 and omega-6 fatty acids, α-linolenic (IC₅₀ = 5.60 [4.28–6.15] g/L) and γ-linolenic acids (IC₅₀ = 5.09 [4.28–6.15] g/L) produced the greatest enhancement of the ACE-inhibitory capacity of HSA. Conclusions: The present results indicate that HSA concentration relates to endogenous ACE inhibition in serum, and in vitro experiments demonstrate that HSA-bound FFAs can modulate HSA-mediated ACE inhibition, a mechanism that may be relevant to cardiovascular physiology and disease. Full article

Pulsoximeters are widely used in the medical care of preclinical patients to evaluate the cardiorespiratory status and monitor basic vital signs, such as pulse rate (PR) and oxygen saturation (SpO₂). In many preclinical situations, air transport of the patient by helicopter is necessary. Conventional pulse oximeters, mostly used on the patient’s finger, are prone to motion artifacts during transportation. Therefore, this study aims to determine whether simulated helicopter vibration has an impact on the photoplethysmogram (PPG) derived from an in-ear sensor at the external ear canal and whether the vibration influences the calculation of vital signs PR and SpO₂. The in-ear PPG signals of 17 participants were measured at rest and under exposure to vibration generated by a helicopter simulator. Several signal quality indicators (SQI), including perfusion index, skewness, entropy, kurtosis, omega, quality index, and valid pulse detection, were extracted from the in-ear PPG recordings during rest and vibration. An intra-subject comparison was performed to evaluate signal quality changes under exposure to vibration. The analysis revealed no significant difference in any SQI between vibration and rest (all p > 0.05). Furthermore, the vital signs PR and SpO₂ calculated using the in-ear PPG signal were compared to reference measurements by a clinical monitoring system (ECG and SpO₂ finger sensor). The results for the PR showed substantial agreement (${\mathrm{CCC}}_{rest}$ = 0.96; ${\mathrm{CCC}}_{vibration}$ = 0.96) and poor agreement for SpO₂ (${\mathrm{CCC}}_{rest}$ = 0.41; ${\mathrm{CCC}}_{vibration}$ = 0.19). The results of our study indicate that simulated helicopter vibration had no significant impact on the calculation of the SQIs, and the calculation of vital signs PR and SpO₂ did not differ between rest and vibration conditions. Full article

Background: In recent decades, interest has grown in the link between lipid metabolism and mental health. Omega-3 fatty acids (EPA and DHA) play a crucial role in brain function, neuroplasticity, and emotional regulation. Deficiency or an imbalanced omega-6/omega-3 ratio, typical of Western diets, has been associated with an increased risk of mood disorders, such as major depression and bipolar disorder. Objective: This review critically synthesizes neurobiological and clinical evidence on the role of omega-3s in mood disorders, assessing mechanisms, randomized controlled trials, and meta-analyses, with a focus on inflammatory biomarkers and their integration into a personalized psychiatry framework. Methods: A narrative review of epidemiological studies, randomized controlled trials (RCTs), meta-analyses, and experimental research was conducted, evaluating mechanistic pathways (synaptic, inflammatory, neuroplastic, and redox) and clinical moderators (particularly inflammatory markers and dietary lipid profiles). Results: Consistent evidence indicates that EPA-enriched formulations (≥60%) exert antidepressant effects, particularly in patients with elevated inflammatory markers (CRP, IL-6, TNF-α). In contrast, DHA-only preparations show limited efficacy, and outcomes vary depending on dietary omega-6/omega-3 balance. However, the literature remains heterogeneous in design, sample size, and biomarker stratification, which limits generalizability and contributes to conflicting findings across studies. Conclusions: While omega-3 fatty acids represent promising adjunctive interventions for mood disorders, methodological weaknesses and inconsistent formulations hinder definitive conclusions. Future research should prioritize biomarker-guided, precision-based approaches to clarify therapeutic efficacy and optimize clinical use. Full article

Astaxanthin, a potent antioxidant, has attracted growing interest for its applications in the food, pharmaceutical, and cosmetic industries. This study aims to optimize the green extraction of astaxanthin from shrimp (Parapenaeus longirostris) by-products using ultrasound-assisted extraction (UAE) with extra virgin olive oil (EVOO) as a sustainable solvent, and explore its application in trahana fortification, a traditional Greek fermented cereal-based product. Response Surface Methodology (RSM) was applied to optimize astaxanthin extraction conditions (extraction time, liquid-to-solid (L/S) ratio, and ultrasound amplitude). Fatty acid analysis was performed with gas chromatography (GC-FID), and sensory analysis was conducted using a 7-point hedonic scale for sensory attributes. The optimal UAE conditions for astaxanthin, determined by RSM, were 228 min extraction time, a 65:1 liquid-to-solid ratio, and 41% ultrasound amplitude, predicting 83.50 μg astaxanthin/g by-product. At the optimal conditions, the experimentally obtained yield of 76.75 ± 1.17 μg astaxanthin/g by-product fell within the 95% confidence interval of the predicted value. The enriched trahanas retained nutritionally relevant levels after cooking (46.35 ± 0.60 μg astaxanthin per 60 g serving). Accelerated storage testing at 65 °C for six days was used to assess the thermal stability of astaxanthin in enriched trahanas. Based on first-order degradation kinetics and Arrhenius-based extrapolation of literature-derived activation energy values, astaxanthin retention above 80% at 25 °C was estimated to be maintained for approximately 27–51 days. Thereafter, progressive degradation is expected, with the estimated half-life ranging from 85 to 159 days. GC-FID analysis revealed favorable incorporation of bioactive lipids, including omega-3 fatty acids (EPA and DHA). Sensory evaluation demonstrated enhanced consumer acceptability, with enriched samples scoring significantly higher in appearance, aroma, and overall acceptance compared to traditional trahanas. These findings highlight UAE as an efficient and environmentally friendly strategy for recovering astaxanthin from seafood by-products and for developing functional cereal-based foods that align with sustainability. This work demonstrates the effective use of extra virgin olive oil as a green extraction solvent that also serves as a nutritional carrier, enabling the enrichment of trahanas with astaxanthin. The approach ensures both nutritional stability and consumer acceptability, providing a practical pathway for the development of sustainable, functional cereal-based foods. Full article

Background: Mood disturbances, often accompanied by cognitive deficits, represent a major public health challenge. Diet is increasingly recognized as a modifiable factor in mental health, with specific nutrients such as omega-3 polyunsaturated fatty acids (PUFAs) showing therapeutic potential. This study investigated whether dietary omega-3 intake moderates variations in cognitive performance associated with psychological symptoms in non-clinical samples. Method: A total of 313 healthy adults completed a food frequency questionnaire (FFQ) to assess dietary intake. Psychological symptoms were measured using the depression screening questionnaire (PHQ-9) and the stress assessment instrument (PSS-10), while cognitive performance, including short-term and episodic memory, was evaluated using Sternberg and Old/New recognition tests. A subgroup of 52 older adults completed a detailed in-person FFQ to enable the precise quantification of EPA, DHA, and alpha-linolenic acid (ALA) intake. Results: Diets rich in omega 3, particularly nuts, seeds, fish and seafood, were associated with lower depression and stress scores. EPA and DHA, but not ALA, were specifically linked to those mood benefits. However, dietary omega-3 intake was not significantly associated with cognitive performance and did not moderate the relationship between mood and memory. Self-reported omega-3 supplementation was linked to fewer depressive symptoms and better episodic memory. Conclusions: While dietary omega-3 is associated with improved well-being, its role in cognition in healthy adults is not well-established and warrants further investigation. Full article

Inclusive education is currently a central priority within the Basque educational system, where the right to education is understood as a fundamental right that must be guaranteed in inclusive environments fostering social interaction among all members of the school community. Attitudes towards inclusion are a key factor for ensuring the participation of students with disabilities, and empathy has been identified as one of the main capacities supporting inclusive practices. The aim of this study was to translate to Basque, culturally adapt, and validate the Attitudes towards Inclusion of Students with Disabilities in Physical Education Questionnaire (AISDPE) and the Basic Empathy Scale (BES). A validation and reliability study was conducted with 151 students enrolled in compulsory secondary education at a public school in Gipuzkoa. Confirmatory factor analysis was applied to assess construct validity. Reliability was examined using Cronbach’s alpha and omega coefficients for each dimension of both questionnaires. Results demonstrated satisfactory reliability for both instruments (α and ω > 0.75), supporting their applicability in Basque. These findings contribute to the availability of validated tools to assess attitudes towards inclusion and empathy, thereby facilitating future research on inclusive education in the Basque context. Full article

Background/Objectives: The delayed effects of organophosphate poisoning may manifest years after exposure, often masked by age-related diseases. The aim of this retrospective cohort study was to identify the biochemical “trace” that could remain in patients decades after poisoning. We determined a wide range of biochemical parameters, along with the spectrum of esterified and non-esterified fatty acids (EFAs and NEFAs, respectively), in the blood plasma of a cohort of elderly patients diagnosed with occupational pathology (OP) due to (sub)chronic exposure to organophosphates in the 1980s. Methods: Elderly patients with and without a history of exposure to organophosphates were retrospectively divided into two groups: controls (n = 59, aged 73 ± 4, men 29% and women 71%) and those with OP (n = 84, aged 74 ± 4, men 29% and women 71%). The period of neurological examination and blood sampling for subsequent analysis was from mid-2022 to the end of 2023. Determination of the content of biomarkers of metabolic syndrome, NEFAs, and EFAs in blood plasma was performed by HPLC-MS/MS and GC-MS. Results: The medical histories of the examined elderly individuals with OP and the aged control group included common age-related diseases. However, patients with OP more often had hepatitis, gastrointestinal diseases, polyneuropathy, and an increased BMI. Analysis of metabolic biomarkers revealed, in the OP group, a decrease in the concentrations of 3-hydroxybutyrate (p < 0.05), 2-hydroxybutyrate (p < 0.0001), and acetyl-L-carnitine (p < 0.001) and the activity of butyrylcholinesterase (BChE) (p < 0.05), but an increase in the esterase activity of albumin (p < 0.05). Correlation analysis revealed significant relationships between albumin esterase activity and arachidonic acid concentrations in the OP group (0.64, p < 0.0001). A study of a wide range of fatty acids in patients with OP revealed reciprocal relationships between EFAs and NEFAs. A statistically significant decrease in concentration was shown for esters of margaric, stearic, eicosadienoic, eicosatrienoic, arachidonic, eicosapentaenoic, and docosahexaenoic fatty acids. A statistically significant increase in concentration was shown for non-esterified heptadecenoic, eicosapentaenoic, eicosatrienoic, docosahexaenoic, γ-linolenic, myristic, eicosenoic, arachidonic, eicosadienoic, oleic, linoleic, palmitic, linoelaidic, stearic, palmitoleic, pentadecanoic, and margaric acids. Decreases in the ratios of omega-3 to other unsaturated fatty acids were observed only for the esterified forms. Conclusions: The data obtained allow us to consider an increased level of NEFAs as one of the main cytotoxic factors for the vascular endothelium. Modification of albumin properties and decreased bioavailability of docosahexaenoic acid could be molecular links that cause specific manifestations of organophosphate-induced pathology at late stages after exposure. Full article

Background/Objectives: Sleep health impacts numerous domains of human health, and sleep deprivation has emerged as a significant public health concern. Multiple types of dietary nutrient supplementation, dietary intake, and the use of nutritional supplements to enhance sleep quality are recognized as effective methods to improve sleep quality. Methods: We aim to systematically evaluate the efficacy of dietary supplement interventions in sleep quality improvement across populations with sleep disorders and healthy individuals. We conducted a comprehensive literature search across PubMed, Web of Science, CNKI, ScienceDirect, Wiley, and CVIP databases. Sleep evaluation metrics included the Pittsburgh Sleep Quality Index (PSQI), sleep efficiency (SE), sleep latency (SL), total sleep time (TST), wake after sleep onset (WASO), and number of awake after sleep onset (NASO). Meta-analysis procedures were executed in Review Manager 5.3 and Stata 17.0, with heterogeneity quantified via I² statistics. Results: This study, in total, included 28 randomized controlled trials. This meta-analysis’s results suggest dietary interventions significantly improved sleep outcomes: reduced PSQI (MD: −0.70, 95% CI: −1.37 to −0.03, p < 0.05), increased SE (+2.58 min, 95% CI: 2.01–3.16, p < 0.00001), prolonged TST (SMD: +0.23, 95% CI: 0.04–0.43, p < 0.05), and shortened SL (SMD: −0.24, 95% CI: −0.37 to −0.10) and WASO (SMD: −0.30, 95% CI: −0.48 to −0.12) (both p < 0.001). NASO showed a marginal reduction (MD: −1.57, 95% CI: −3.16 to 0.02, p = 0.05). Conclusions: These findings suggest that tryptophan, vitamin D, omega-3, zinc, and antioxidants may enhance sleep quality by decreasing SL, and WASO increases SE and extends TST, respectively. Full article

The global population is aging rapidly and the prevalence of age-related noncommunicable diseases is increasing. Favorable dietary patterns have the power to reduce the risk or progression of various age-related chronic diseases, including obesity, hypertension, cardiovascular disease, type 2 diabetes, several types of cancer, and some neurodegenerative diseases. In contrast, adverse dietary patterns may contribute to the onset or progression of many chronic diseases or their risk factors. A diet rich in wholesome, nutrient-dense, minimally processed foods, such as a Mediterranean-style diet, may promote health and prevent disease through its abundance of antioxidants, fiber, omega-3 fatty acids, and micronutrients. Conversely, a diet high in nutrient-poor and ultra-processed foods may accelerate disease onset and progression by promoting inflammation and affecting metabolic pathways adversely. This narrative review summarizes the literature from clinical trials and large population-based studies on protective dietary patterns and adverse dietary patterns that influence risk of cardiovascular disease and related risk factors, cancer, Alzheimer’s disease and related dementias, type 2 diabetes, frailty, and liver disease. Full article

Chia seed oil, valued for its health-promoting omega-3 and omega-6 fatty acids, is highly susceptible to oxidation. This study employed a multi-technique approach based on electron spin resonance (ESR), low-field nuclear magnetic resonance (LF-NMR), and small-angle X-ray scattering (SAXS) to monitor its oxidative process. ESR identified alkyl (DMPO-•R) and peroxyl (DMPO-•OOR) radicals as primary species derived from unsaturated fatty acids. This was accompanied by a decrease in relaxation time of peak T₂₁, T₂₂, and T₂₃, and the peak area of S₂₁ gradually increased as the heating time increased. The SAXS intensity of chia seed oil at q = 3.4 nm⁻¹ increased markedly after heating for 20 h, and the peak shifted to the low q-region with Δq = 0.6 nm⁻¹, confirming the significant formation of nanoscale aggregates, which correlated with observed increases in oil turbidity. Our findings demonstrate the value of an integrated analytical strategy for a comprehensive understanding of oxidation in chia seed oil. Full article

Introduction: Nutrition plays a fundamental role in sports performance by influencing energy availability, recovery, and training adaptation. In recent years, different dietary strategies have gained popularity among athletes, although the evidence supporting their efficacy is inconsistent. Objective: This consensus document, developed under the auspices of the Spanish Society of Nutrition, aims to provide a critical overview of the most relevant nutritional strategies currently used in sports and to offer evidence-based practical recommendations for both professional and recreational athletes, coaches, and health professionals. Methods: A narrative review was conducted following standardized scientific procedures by a multidisciplinary panel of experts. The analyzed strategies included high-carbohydrate, low-carbohydrate, ketogenic, intermittent fasting, plant-based, Paleolithic, and carbohydrate periodization diets. Each strategy was assessed based on its physiological rationale, evidence of performance in endurance, strength/power, sprint, aesthetic, weight category, and team sports, practical applications, and potential risks. Results: The available evidence shows that no single dietary strategy can be universally recommended for all athletes. High carbohydrate availability remains the most consistent approach for sustaining performance in endurance and high-intensity efforts. Low-carbohydrate and ketogenic diets enhance fat oxidation but often compromise exercise economy at competitive intensity levels. Intermittent fasting may improve body composition and metabolic health; however, it requires careful adaptation. Well-planned plant-based diets can support performance, although attention to certain nutrients (e.g., B12, iron, and omega-3) is essential. Paleolithic diets improve metabolic parameters but show limited direct evidence of athletic performance. Carbohydrate periodization is a promising tool for combining metabolic adaptations with competitive demands. Conclusions: Nutritional strategies should be individualized according to the athlete’s sport, training phase, and personal context. Professional guidance is crucial for minimizing risks and optimizing benefits. Further well-designed, long-term studies on athletes are needed to resolve the current controversies. Full article