Search Results (2,387)

Background/Objectives: Curcumin has been proposed as a nutritional strategy to support exercise recovery through antioxidant and anti-inflammatory actions. However, trials differ in sport context, training status, supplementation timing, dose, formulation, and methodological control. This systematic review evaluated its effects on recovery outcomes in active individuals and athletes, with particular attention to the applicability of the evidence to real-world sport settings. Methods: PubMed, Scopus, Web of Science, SPORTDiscus, and Cochrane Library/CENTRAL were searched from 2012 to June 2026. Randomized double-blind placebo-controlled trials were eligible when they evaluated oral curcumin, curcuminoids, Curcuma-derived preparations with a specified curcumin dose, or curcumin combined only with bioavailability enhancers. Studies using artificial muscle-damage protocols, clinical populations, non-randomized designs, or combined bioactive interventions were excluded. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale, supplemented by a Cochrane Risk of Bias 2 (RoB 2) assessment and a Grading of Recommendations Assessment, Development and Evaluation (GRADE) certainty-of-evidence evaluation. Owing to heterogeneity, findings were synthesized narratively by outcome domain, supplementation timing, formulation type, exercise context, and training status. Results: Fifteen trials were included. Favorable effects were reported in 6/7 studies assessing oxidative stress, 4/6 assessing muscle damage, 3/8 assessing inflammation, 3/7 assessing subjective recovery, soreness, or fatigue, and 4/8 assessing physical or athletic performance. However, effects varied substantially according to population, exercise context, biomarker selection, timing of assessment, and formulation type. The certainty of evidence was low for oxidative stress and very low for muscle damage, inflammation, subjective recovery/soreness/fatigue, and performance. Conclusions: Curcumin supplementation may support selected aspects of exercise recovery, particularly oxidative stress responses. However, these findings should be interpreted cautiously because the evidence derives mostly from small trials with heterogeneous populations, exercise protocols, supplementation regimens, formulations, biomarkers, and assessment time points. Evidence for muscle damage, inflammation, subjective recovery, fatigue, and performance remains inconsistent, and further well-controlled trials in trained and high-performance athletes are needed before practical recommendations can be established. Full article

Background/Objectives: Linear growth in children reflects cumulative influences of nutrition, health, and skeletal development. Vitamin K₂, particularly menaquinone-7 (MK-7), plays an important role in bone mineralization, yet evidence regarding its potential relationship with height growth in children remains limited. This study evaluated the association between continuous MK-7 supplementation and longitudinal height growth in children. Methods: A longitudinal observational study was conducted among 1150 apparently healthy children aged 6–14 years in Hanoi, Vietnam (2022–2025), including 613 controls and 537 children receiving MK-7 supplementation. MK-7 was administered orally at 360 µg/day from baseline throughout follow-up. A total of 3491 repeated height measurements were collected. Analyses were stratified according to pubertal stage (no-puberty and pre-puberty). Height gain was summarized according to follow-up duration, and initial mixed-effects models were used to explore longitudinal growth trajectories. Because substantial follow-up imbalance was observed after the first follow-up assessment, the primary regression analyses were subsequently restricted to baseline and first follow-up observations. Multivariable linear regression models evaluated the interaction between MK-7 supplementation and follow-up duration after adjustment for age, sex, baseline body mass index-for-age Z-score, early sleep, and physical activity. Results: Height gain increased significantly with follow-up duration across all analyses (β range: 0.49–0.58 cm/month; all p < 0.001). MK-7 supplementation alone was not independently associated with height gain; however, positive interactions between MK-7 supplementation and follow-up duration were observed in several subgroup analyses. In the overall cohort, the interaction estimate was β = 0.05 cm/month (95% CI: 0.02–0.09). Positive interactions were observed in no-puberty children (β = 0.05; 95% CI: 0.01–0.09) and pre-puberty children (β = 0.06; 95% CI: 0.03–0.09). The largest interaction estimate was observed among pre-puberty boys (β = 0.10; 95% CI: 0.07–0.13), whereas no statistically significant interaction was observed among girls in the pre-puberty subgroup. Conclusions: The findings suggest that continuous MK-7 supplementation may be associated with progressively greater height gain over time rather than an immediate increase in height. The observed associations appeared more evident with longer follow-up duration, particularly among pre-pubertal boys. However, given the observational design and substantial follow-up imbalance between groups, the findings should be interpreted cautiously. Further prospective studies with balanced longitudinal follow-up are needed to clarify the potential relationship between MK-7 supplementation and pediatric linear growth. Full article

Intravenous (IV) iron is used to replenish iron stores in patients with iron-deficiency anemia (IDA) who do not benefit from oral iron supplementation. Hypophosphatemia is an increasingly recognized adverse event associated with certain IV iron formulations. Mild/moderate hypophosphatemia may be asymptomatic or present with symptoms similar to those seen in patients with IDA, including fatigue, malaise, and muscle weakness. Persistent hypophosphatemia can cause osteomalacia due to reduced bone mineralization, leading to bone pain and pseudofractures. Ferric carboxymaltose (FCM) can impact phosphate homeostasis through an increase in fibroblast growth factor 23, leading to increased urinary phosphate excretion and hypophosphatemia. In clinical trials, rates of hypophosphatemia were significantly higher in patients receiving FCM compared with other IV iron formulations, such as ferric derisomaltose and ferumoxytol. Treatment guidelines recommend monitoring serum phosphate levels in patients receiving FCM who are at risk for low phosphate or who require repeat infusions, and alternative iron formulations should be considered in at-risk patients. This narrative review summarizes current evidence regarding IV iron-induced hypophosphatemia in individuals with IDA and examines the underlying pathophysiology and clinical evidence for IV iron-induced hypophosphatemia, particularly with FCM, the populations most at risk, and the clinical consequences of persistent hypophosphatemia. Full article

Individuals with Duchenne muscular dystrophy (DMD) are prone to nutritional imbalances, and zinc deficiency may contribute to impaired bone health. This study evaluated serum zinc status and the effects of oral supplementation on bone parameters in DMD. In this quasi-experimental before-and-after study, 34 patients were assessed at three time points over eight months. Eligible participants who met the inclusion criteria and agreed to participate received the proposed interventions during routine follow-up at the Neurology outpatient clinic. Anthropometry, dietary intake, bone mineral density (BMD), bone mineral content (BMC), and serum zinc were measured; supplementation (5–15 mg/day) was provided for four months. Baseline zinc deficiency was observed in 36.7% of participants. No significant overall changes were detected. Stratified analyses revealed a modest increase in total body BMD among individuals with adequate baseline BMD (p = 0.02). As this finding emerged from a subgroup analysis, it should be interpreted cautiously, and the potential contribution of physiological growth to the observed change cannot be excluded. In addition, zinc-deficient participants showed a significant rise in serum zinc levels (p = 0.008). These findings suggest that the response to zinc supplementation may vary according to baseline nutritional and skeletal status and underscore the relevance of micronutrient monitoring in individuals with DMD. Trial registration: The trial was also registered in the Brazilian Registry of Clinical Trials under the code RBR-7cfdxm, approved on 14 June 2018. Full article

Background/Objectives: Although vitamin K has been implicated in osteoarthritis pathophysiology, the specific effects of vitamin K2 (menaquinone) on cartilage degeneration remain poorly characterized. This study aimed to investigate the effect of oral vitamin K2 supplementation in a monosodium iodoacetate-induced osteoarthritis model. Methods: Twenty-four male Sprague Dawley rats were included in the study and divided into 3 equal groups: sham group, control (osteoarthritis) group, and treatment group. Saline was applied to the right knee of the sham group, and MIA was applied intra-articularly to the right knee of the control and treatment groups to create an osteoarthritis model. Rats in the treatment group were given 8 micrograms (μg)/day of vitamin K2 orally in addition to the standard diet. After 28 days of follow-up, all rats were euthanized. The right knee articular cartilage was examined histologically with Hematoxylin–Eosin and Safranin O and immunohistochemically with type II collagen alpha 1 and Matrix Metalloproteinase-13. Results: Histological evaluation demonstrated significantly lower Mankin scores in the treatment group (4.25 ± 0.83) compared with the control group (11.10 ± 0.83). Immunohistochemical analysis showed more intense type II collagen staining and reduced matrix metalloproteinase-13 staining in the treatment group relative to the control group. Conclusions: Oral vitamin K2 administration was associated with reduced cartilage degeneration and improved matrix preservation at the 28-day endpoint in an induced MIA osteoarthritis rat model. Full article

Micronutrients are essential for optimal muscle metabolic function. We previously showed that heat-induced skeletal muscle injury is associated with depletion of nicotinamide adenine dinucleotide (NAD⁺) and magnesium (Mg²⁺), and boosting NAD⁺ abundance with the precursor nicotinamide riboside (NR) improves skeletal muscle integrity against heat stress in male mice. In this study, we hypothesized that NR supplementation would prevent heat-induced skeletal muscle injury in female mice. Female 6-week-old C57BL/6J mice were orally administered vehicle or NR (185 mg/kg body weight) daily for 10 days. Subsequently, they underwent a single sham or heat exposure experiment. No significant differences in muscle NAD⁺ content were observed between vehicle and NR groups or between sham and heat groups. Heat groups showed significantly lower muscle Mg²⁺ levels compared to sham groups. In vehicle groups, heat exposure caused significant inflammation, oxidative stress, mitochondrial impairment, and apoptosis in skeletal muscle compared to the sham condition. NR treatment significantly reduced these alterations. While neither heat exposure nor NR affected muscle NAD⁺ homeostasis, the protective effects of NR on skeletal muscle against heat stress were similar to those observed in male mice. Together, our results demonstrate the preventive effect of NR on muscle heat injury in female mice. This effect is associated with anti-inflammatory and antioxidative activities, mitochondrial protection, and anti-apoptosis without NAD⁺ homeostatic alterations. Full article

The immune response is essential in the protection of our body against pathogens; however, the inflammatory response caused by the immune system can become a disease itself. In fact, anti-inflammatory and immune-suppressive drugs are applied to limit the immune response to treat inflammatory diseases. Flavonoids are plant-derived polyphenols extensively investigated for their anti-inflammatory and antioxidant properties in inflammatory diseases. Studies applying isolated compounds as well as using supplements as nutraceuticals based on flavonoids have been conducted. Our review systematically analyzed the top five studied flavonoids between 2020 and 2025: quercetin (1742 articles), kaempferol (642), luteolin (589), apigenin (419), and epicatechin (354), highlighting their major therapeutic applications in diseases affecting the liver (12%), nervous system (11%), and lungs (10%). Mechanistically, these compounds act as multi-target agents mainly by inhibiting NF-κB and inducing Nrf2-dependent antioxidant programs. Application of advanced delivery systems, which increase oral bioavailability by up to 20-fold, overcomes pharmacokinetic bottlenecks. Clinical highlights demonstrated promising therapeutic effects, including reduced intrahepatic lipid accumulation in non-alcoholic fatty liver disease patients following quercetin supplementation (11.5% to 9.6%) and accelerated SARS-CoV-2 clearance after quercetin phytosome administration. The translation of flavonoids into standardized clinical therapies remains limited by the lack of large-scale, well-controlled clinical trials. Full article

Diabetic neuropathy (DN) is a multifactorial complication of diabetes mellitus driven by chronic hyperglycemia, insulin resistance, and disturbed metabolic homeostasis, leading to progressive injury of both the peripheral and central nervous systems. This study investigated whether L-serine supplementation could attenuate DN through dose-dependent metabolic and neuroprotective mechanisms in a high-fat diet (HFD) plus streptozotocin (STZ)-induced diabetic rat model. Male Wistar rats (n = 8 per group) were allocated to five groups: normal control (NC), diabetic control (DC), pioglitazone (PIO; 1.5 mg/kg/day), low-dose L-serine (S1; 200 mg/kg/day), and high-dose L-serine (S2; 400 mg/kg/day). After 60 days of oral gavage, behavioural testing, glucose and insulin profiling, HOMA-IR calculation, brain histopathology, nerve growth factor (NGF) immunohistochemistry, and LC–MS/MS-based proteomic analysis of cerebral tissue were performed. Diabetic rats exhibited marked hyperglycaemia (355.33 ± 4.72 mg/dL), hyperinsulinaemia, severe insulin resistance (HOMA-IR 16.8 ± 3.2; a 14-fold increase), impaired thermal nociception, motor dysfunction, and pronounced neuronal degeneration. L-serine supplementation significantly improved metabolic status: S1 reduced HOMA-IR by 77.4% and S2 by 87.5% relative to diabetic controls (p < 0.001). High-dose L-serine produced greater improvements in thermal sensitivity, motor coordination (rotarod latency 26.67 ± 1.52 s vs. 16.1 ± 0.85 s in DC; p < 0.05), and NGF expression (8.6-fold increase vs. DC). Histopathology confirmed attenuation of neuronal injury and gliosis in both treatment groups. Exploratory, group-level proteomic profiling identified dose-specific molecular signatures: S1 was predominantly associated with carbohydrate, lipid, and biosynthetic pathways, whereas S2 was associated with synaptic, neurotransmission-related, and proteostasis pathways. Within the constraints of an exploratory design—group-level pooled proteomics, analysis of cerebral rather than peripheral-nerve tissue, and only two doses—these findings indicate that L-serine attenuates the metabolic and behavioural features of experimental diabetic neuropathy and generates the testable hypothesis of dose-dependent neuro-metabolic remodelling. The proteomic signatures are hypothesis-generating and require orthogonal validation before any mechanistic or translational inference can be drawn. Full article

Background/Objectives: Perioperative fasting combined with procedure-related trauma increases the risk of malnutrition and determines the treatment outcomes of surgical patients. The aim of this study was to assess the range of metabolic deficiencies and the effectiveness of oral nutritional supplements (ONSs) after surgical intervention. Methods: 84 patients undergoing elective abdominal surgery were included in this study. Patients were divided into three groups: receiving a low-osmotic ONS (Group I), high-osmotic ONS (Group II), and Group III, who did not receive any oral supplementation. The clinical assessment involved body weight measurements and metabolic blood tests preoperatively and on the 4th, 7th, 14th, and 28th postoperative days. Results: The mean blood levels of total protein, albumin, cholesterol, and blood lymphocyte count decreased in the first 4 days after surgery and returned to baseline between 7 and 14 days. Similarly, BMI dropped during the first two weeks and then stabilized or returned to pre-surgery values. Triglycerides initially increased and, after 14 days, started to normalize. Patients receiving an ONS compensated quicker than the control group and more efficiently with low-osmotic supplements. Conclusions: Surgical trauma is associated with metabolic deficiency. The early administration of ONSs provides significant benefits to patients undergoing abdominal surgery. Low-osmotic supplements are especially recommended due to better tolerance. Full article

Background/Objectives: Evidence for herbal ergogenic aids remains uncertain, and ashwagandha trials span heterogeneous performance domains. This review evaluated oral Withania somnifera supplementation on exercise performance and explored participant-, outcome-, formulation-, and supplementation-related moderators. Methods: PubMed, Web of Science, Cochrane Library, Embase, and SPORTDiscus-EBSCO were searched from inception to 1 April 2026. Eligible randomized controlled trials compared oral ashwagandha with placebo or control conditions and reported objective exercise-performance outcomes. Dependent effects were synthesized using restricted-maximum-likelihood three-level random-effects models; 95% prediction intervals, GRADE certainty ratings, subgroup analyses, and dose/duration meta-regressions were reported. Results: Thirteen trials involving 599 participants contributed 79 effect sizes. Samples were mainly young adults or athletes; reported ages included one 18–40-year trial and one late-adolescent athlete cohort aged 17.4 ± 1.7 years. Trial-level sex composition was four male-only, one female-only, three mixed-sex, and five incompletely reported cohorts. Ashwagandha improved overall exercise performance on average (Hedges’ g = 0.47, 95% CI [0.25, 0.69], p < 0.001; I² = 60%; 95% prediction interval [−0.40, 1.33]), but the prediction interval crossed zero. Exercise type was the clearest moderator (P_between = 0.006): evidence was most consistent for aerobic endurance (g = 0.54, 95% CI [0.22, 0.85], p = 0.002), whereas strength effects were positive but uncertain and power or muscular endurance evidence remained sparse. Dose analyses were hypothesis-generating; 500–600 mg/day was the most evidence-supported extract-dose range. Conclusions: Oral ashwagandha may improve selected exercise-performance outcomes, particularly aerobic endurance, but benefits are not uniform across contexts. Future trials should be preregistered, adequately powered, double-blind, formulation-standardized, sex-stratified, and include rigorous blinding checks, mechanistic endpoints, adverse-event monitoring, and sport-specific performance tests. Full article

Background/Objectives: Metabolic syndrome (MetS) is a pressing global health challenge comprising obesity, hyperglycemia, hypertension, and hyperlipidemia. Conventional polypharmacy often presents long-term compliance issues and side effects. Eucommia ulmoides Oliv., a traditional medicinal and edible plant rich in iridoids, lignans, flavonoids, and polysaccharides, has emerged as a promising natural intervention. This review aims to systematically summarize the bioavailability and multifaceted pharmacological mechanisms of E. ulmoides and its bioactive components in alleviating MetS. Methods: We comprehensively reviewed the recent in vitro and in vivo literature to map the functional evidence, specific signaling pathways, and gut microbiota–host interactions associated with E. ulmoides extracts and its key phytochemicals (e.g., asperuloside) against various metabolic dysfunctions. Results: Current evidence indicates that E. ulmoides operates through a “multi-component, multi-target, and multi-pathway” paradigm. For hyperlipidemia and obesity, it activates hepatic lipid metabolism (PPARα/CPT1A, FXR/CYP7A1) and mitigates oxidative stress (Nrf2/ARE). Furthermore, it dose-dependently reshapes the gut microbiota by enriching beneficial bacteria like Akkermansia and increasing butyrate production, exerting profound gut–liver axis regulation. It also ameliorates hypertension by activating the ACE2-Ang-(1–7)-Mas axis, improves insulin resistance via the AMPK/PI3K/Akt cascade, and manages hyperuricemia by modulating XOD and renal transporters. Notably, the low oral bioavailability of its glycosides highlights the crucial role of gut microbial hydrolysis in its efficacy. Conclusions: E. ulmoides holds substantial therapeutic potential as a multi-target natural supplement for MetS. However, future translational applications necessitate large-scale randomized clinical trials, multi-omics studies to further clarify host–microbiome interactions, and the development of standardized formulations to ensure clinical efficacy. Full article

Background: N-Acetylneuraminic acid (Neu5Ac), the predominant form of sialic acid, exhibits potent antioxidant, anti-inflammatory, and anti-glycation properties in preclinical studies, suggesting potential dermatological benefits. However, robust clinical evidence supporting the efficacy of oral Neu5Ac supplementation on human skin conditions remains lacking. Methods: A randomized, double-blind, placebo-controlled trial was conducted with 55 Chinese women (40–65 years) who received 120 mg/day Neu5Ac (n = 27) or a matching placebo (n = 28) for 84 days. Skin pigmentation, hydration, biomechanical properties, and dermis echogenicity were evaluated at baseline, D28, D56, and D84 using standardized clinical and instrumental assessments. Results: Both clinical (Pantone color card) and instrumental (photographic) assessments showed that oral Neu5Ac supplementation significantly improved skin lightness on both pigmentary spots and surrounding normal skin compared with placebo at day 84. In addition, stratum corneum hydration and skin biologic extensibility were significantly increased in the Neu5Ac group. Dermal echogenicity showed numerical improvement but did not reach statistical significance. Self-assessment indicated that 100% of the Neu5Ac participants reported improvements in skin whiteness, radiance, elasticity, firmness, and hydration, with mean satisfaction scores of 9.1/10 versus 7.9/10 for placebo. Conclusions: Daily oral supplementation with 120 mg Neu5Ac for 84 days significantly promoted localized spot brightening, enhanced skin hydration, and improved skin elasticity, providing the first clinical evidence supporting Neu5Ac as a safe and effective oral cosmetic ingredient for skin anti-aging. Full article

Background/Objectives: Disease-related malnutrition affects millions of patients worldwide. Nutrition support therapy (NST), namely oral nutritional supplements (ONSs), serve as a cornerstone therapeutic intervention. However, treatment effectiveness depends not only on an appropriate prescription but also on patient acceptance and adherence. This study evaluates the provision pathway of ONSs within a co-payment healthcare system, focusing on patient acceptance patterns, barriers to adherence, and the critical yet underexplored role of pharmacist–patient interactions in determining treatment outcomes. Methods: A cross-sectional observational study was conducted across 100 Croatian community pharmacies during September–October 2025. Pharmacists prospectively documented 973 patient encounters involving ONS prescriptions requiring co-payment using real-time patient record forms. Data captured patient demographics, diagnoses, prescription patterns, prior knowledge of co-payment requirements, acceptance responses, and pharmacist-assessed reasons for refusal. Results: While 65% of all patients knew about co-payment requirements in advance, 51% of first-time users arrived uninformed, leading to dramatically different acceptance patterns (93% immediate acceptance when informed versus 33% when uninformed, p < 0.05). Overall, 8–12% of patients refused or reduced prescribed ONSs. Among refusals, 59% cited the financial burden, but, critically, 23% appeared not to understand why an ONS was prescribed or what benefits to expect, revealing significant communication gaps in the care pathway. Overall, fifteen percent of patients required an explanation from the pharmacist before accepting their prescription, demonstrating pharmacists’ decisive role as gatekeepers of nutritional therapy. Conclusions: These findings suggest that the pharmacy dispensing encounter is an important decision point in the ONS care pathway, where insufficient preparation and coordination may be associated with suboptimal treatment outcomes among vulnerable patient populations. Improved prescriber–patient communication about co-payment and clinical rationale, pharmacist education in disease-specific nutrition and ONS counseling, and structured communication protocols between prescribers and pharmacists represent areas that may warrant further attention and evaluation. Full article

Background: Oral nutritional supplementation (ONS) is commonly prescribed in malnourished older adults after hip fracture, but formulations are heterogeneous, and their comparative association with mortality remains unclear. We aimed to evaluate whether HMB-containing ONS was associated with lower mortality than non-HMB ONS and to explore whether supplement formulation combined with treatment persistence was associated with differential mortality patterns. Methods: This was a formulation-specific subanalysis of a previously described prospective cohort of older adults with hip fracture and malnutrition or significant nutritional risk. Only patients with known ONS formulation were included (n = 107): 59 received HMB-containing ONS, and 48 received non-HMB ONS, including standard, diabetes-specific, and renal-oriented formulations. Mortality at 3, 6, and 12 months was analyzed using crude comparisons and multivariable logistic regression adjusted for sex, age, and Charlson comorbidity index. A 6-month adjusted Cox model was used as the main time-to-event analysis. Exploratory analyses assessed mortality according to supplement formulation and treatment persistence. Results: Overall mortality was 14.0% at 3 months, 23.4% at 6 months, and 29.9% at 12 months. At 6 months, mortality was lower among patients receiving HMB-containing ONS than among those receiving non-HMB ONS (13.6% vs. 35.4%; p = 0.011), and the association remained significant after adjustment (OR 0.267; 95% CI 0.091–0.784; p = 0.016). Associations at 3 and 12 months were directionally consistent but not statistically significant. In the adjusted Cox model, prescription of HMB-containing ONS was associated with a lower hazard of death within 6 months (HR 0.358; 95% CI 0.145–0.885; p = 0.026). Exploratory analyses showed a 6-month mortality gradient according to formulation and persistence, ranging from 0.0% in patients receiving HMB-ONS for ≥3 months to 41.2% in those receiving non-HMB ONS for <3 months. Conclusions: In this formulation-specific subanalysis of malnourished older adults with hip fracture, an association between HMB-containing ONS and lower 6-month mortality was observed compared with non-HMB ONS. Exploratory findings suggested a clinically relevant mortality gradient according to both supplement formulation and treatment persistence, although these results should be interpreted cautiously. Larger prospective studies are warranted to confirm these findings. Full article

Oropharyngeal dysphagia is prevalent in hospitalized geriatric and neurological populations and constitutes a major driver of disease-related malnutrition. Conventional texture-modified diets frequently rely on diluting solid foods with liquid agents to achieve safe swallowing consistency, a process that reduces caloric and protein density per gram and creates a so-called volume paradox, whereby large meal volumes deliver inadequate nutrients. This retrospective observational study, conducted at the Fondazione Policlinico Gemelli IRCCS in Rome, compared nutritional intake in 208 hospitalized dysphagic adults receiving either a traditional homogenized standard diet (THSD; n = 58) or a density-enriched dysphagia-prepared diet (DPD; n = 150). Following propensity-score matching, total daily energy intake was significantly higher with the DPD compared to the THSD (1024 ± 307 kcal vs. 523 ± 161 kcal; p < 0.0001), as was total protein intake (37.3 ± 12.9 g vs. 26.2 ± 12.7 g; p < 0.0001). Clinically meaningful differences were observed across all meal components, including a more than twofold advantage in breakfast protein content (6.6 ± 1.7 g vs. 3.0 ± 1.5 g). Despite these improvements, total energy and protein intake remained below estimated daily requirements in both groups, highlighting the need for systematic nutritional monitoring alongside catering optimization. These findings support density-enrichment as a practical and safe strategy for improving nutritional adequacy in dysphagic inpatients, with implications for reducing reliance on oral nutritional supplements and mitigating disease-related malnutrition in clinical settings. Full article