Search Results (88)

Background/Objectives: In many parts of the world, pharmacists hold the primary responsibility for providing safe and effective pharmacotherapy. A key aspect is the availability of appropriate medicines for each individual patient. When industrially manufactured medicines are unsuitable or unavailable, pharmacists can prepare tailor-made medicines. While this principle applies globally, practices vary between countries. In the Netherlands, the preparation of medicines in pharmacies is well-established and integrated into routine healthcare. This narrative review explores the role and significance of extemporaneous compounding, pharmacy preparations and related product care in the Netherlands. Methods: Pharmacists involved in pharmacy preparations across various professional sectors, including community and hospital pharmacies, central compounding facilities, academia, and the professional pharmacists’ organisation, provided detailed and expert insights based on the literature and policy documents while also sharing their critical perspectives. Results: We present arguments supporting the need for pharmacy preparations and examine their position and role in community and hospital pharmacies in the Netherlands. Additional topics are discussed, including the regulatory and legal framework, outsourcing, quality assurance, standardisation, education, and international context. Specific pharmacy preparation topics, often with a research component and a strong focus on product care, are highlighted, including paediatric dosage forms, swallowing difficulties and feeding tubes, hospital-at-home care, reconstitution of oncolytic drugs and biologicals, total parenteral nutrition (TPN), advanced therapy medicinal products (ATMPs), radiopharmaceuticals and optical tracers, clinical trial medication, robotisation in reconstitution, and patient-centric solid oral dosage forms. Conclusions: The widespread acceptance of pharmacy preparations in the Netherlands is the result of a unique combination of strict adherence to tailored regulations that ensure quality and safety, and patient-oriented flexibility in design, formulation, and production. This approach is further reinforced by the standardisation of a broad range of formulations and procedures across primary, secondary and tertiary care, as well as by continuous research-driven innovation to develop new medicines, formulations, and production methods. Full article

Background/Objectives: Patients with stage IV gastric cancer who develop chronic intestinal failure require home parenteral nutrition (HPN). This study aimed to evaluate the prognostic relevance of nutritional and immune–inflammatory biomarkers and to construct an individualised survival prediction model using machine learning techniques. Methods: A secondary analysis was performed on a cohort of 410 patients with TNM stage IV gastric adenocarcinoma who initiated HPN between 2015 and 2023. Nutritional and inflammatory indices, including the Controlling Nutritional Status (CONUT) score and lymphocyte-to-monocyte ratio (LMR), were assessed. Independent prognostic factors were identified using Cox proportional hazards models. A Random Survival Forest (RSF) model was constructed to estimate survival probabilities and quantify variable importance. Results: Both the CONUT score and LMR were independently associated with overall survival. In multivariate analysis, higher CONUT scores were linked to increased mortality risk (HR = 1.656, 95% CI: 1.306–2.101, p < 0.001), whereas higher LMR values were protective (HR = 0.632, 95% CI: 0.514–0.777, p < 0.001). The RSF model demonstrated strong predictive accuracy (C-index: 0.985–0.986) and effectively stratified patients by survival risk. The CONUT score exerted the greatest prognostic influence, with the LMR providing additional discriminatory value. A gradual decline in survival probability was observed with an increasing CONUT score and a decreasing LMR. Conclusions: The application of machine learning to immune–nutritional data offers a robust tool for predicting survival in patients with advanced gastric cancer requiring HPN. This approach may enhance risk stratification, support individualised clinical decision-making regarding nutritional interventions, and inform treatment intensity adjustment. Full article

Food pattern recognition plays a crucial role in modern healthcare by enabling automated dietary monitoring and personalised nutritional interventions, particularly for vulnerable populations with complex dietary needs. Current food recognition systems struggle to balance high accuracy with interpretability and computational efficiency when analysing complex meal compositions in real-world settings. We developed a novel self-explaining neural architecture that integrates specialised attention mechanisms with temporal modules within a streamlined framework. Our methodology employs hierarchical feature extraction through successive convolution operations, multi-head attention mechanisms for pattern classification, and bidirectional LSTM networks for temporal analysis. Architecture incorporates self-explaining components utilising attention-based mechanisms and interpretable concept encoders to maintain transparency. We evaluated our model on the FOOD101 dataset using 5-fold cross-validation, ablation studies, and comprehensive computational efficiency assessments. Training employed multi-objective optimisation with adaptive learning rates and specialised loss functions designed for dietary pattern recognition. Experiments demonstrate our model’s superior performance, achieving 94.1% accuracy with only 29.3 ms inference latency and 3.8 GB memory usage, representing a 63.3% parameter reduction compared to baseline transformers. The system maintains detection rates above 84% in complex multi-item recognition scenarios, whilst feature attribution analysis achieved scores of 0.89 for primary components. Cross-validation confirmed consistent performance with accuracy ranging from 92.8% to 93.5% across all folds. This research advances automated dietary analysis by providing an efficient, interpretable solution for food recognition with direct applications in nutritional monitoring and personalised healthcare, particularly benefiting vulnerable populations who require transparent and trustworthy dietary guidance. Full article

Type 2 diabetes mellitus (T2DM) remains a significant global public health concern, largely driven by poor dietary habits, physical inactivity, and rising obesity rates. In recent years, personalised nutrition (PN) emerged as a promising approach to T2DM prevention and management. This narrative review synthesises current evidence on tailored dietary strategies, including the glycaemic index (GI), glycaemic load (GL), food insulin index (FII), and precision nutrition tools. It further explores their impact on glycaemic control, insulin sensitivity, and adherence to dietary interventions. A structured review of peer-reviewed and grey literature was conducted, taking into account behavioural, cultural, and systemic implementation factors. Although evidence supports the efficacy of PN in improving metabolic outcomes, implementation in low- and middle-income countries (LMICs) remains limited due to infrastructural, financial, and contextual challenges. This review emphasises the need for context-specific, scalable solutions integrated into primary healthcare systems. Full article

The global increase in early-onset cancers among adolescents and young adults has happened at the same time as the rise in the consumption of ultra-processed foods (UPFs). Far beyond their poor nutritional quality, UPFs are increasingly seen as Trojan horses, complex biological agents that interfere with many functions of the human organism. In this review, we utilise the Trojan horse model to explain the quiet and building health risks from UPFs as foods that seem harmless, convenient, and affordable while secretly delivering endocrine-disrupting chemicals (EDCs), causing chronic low-grade inflammation, altering the microbiome, and producing epigenetic alterations. We bring together new proof showing that UPFs mess up hormonal signals, harm the body’s ability to fight off harmful germs, lead to an imbalance of microbes, and cause detrimental changes linked to cancer. Important components, such as bisphenols and phthalates, can migrate from containers into food, while additional ingredients and effects from cooking disrupt the normal balance of cells. These exposures are especially harmful during vulnerable developmental periods and may lay the groundwork for disease many years later. The Trojan horse model illustrates the hidden nature of UPF-related damage, not through a sudden toxin but via chronic dysregulation of metabolic, hormonal, and genetic control. This model changes focus from usual diet worries to a bigger-picture view of UPFs as causes of life-disrupting damage. Ultimately, this review aims to identify gaps in current knowledge and epidemiological approaches and highlight the need for multi-omics, long-term studies and personalised nutrition plans to assess and reduce the cancer risk associated with UPFs. Recognising UPFs as a silent disruptor is crucial in shaping public health policies and cancer prevention programs targeting younger people. Full article

Personalised nutrition education (PNE) can enhance blood glucose control (BGC). We determined whether patients with type 2 diabetes (T2DM) adhered to PNE based on glycemic index (GI), glycemic load (GL), and food insulin index (FII) principles and whether adherence was associated with improved BGC. This retrospective cohort included 67 files for patients who received PNE. The patients completed 3-day food and blood glucose records at three points over 90 days. HbA1c values were compared between time points. An adherence score sheet (ASS) was used to determine their adherence to PNE and the main meal adherence classification (MMAC). A one-way repeated measures ANOVA was used to assess the changes over time. A chi-square test determined the association between the MMAC and blood glucose levels falling within the targeted ranges. Correlations between dietary adherence and BGC indicators were examined using Pearson’s product–moment correlation. Adherence ranged from 88 to 95%. MMAC score was significantly associated with blood glucose being within the targeted ranges (p = 0.028). Mean blood glucose decreased over time, but the correlations with adherence were only significant at time point 1 (p = 0.029). HbA1c levels decreased significantly over time (p = 0.003), but their correlation with adherence was not significant (p > 0.05). In patients with T2DM, high adherence to PNE based on GI, GL, and FII principles was associated with improved BGC. Full article

Tuberculosis is an infectious condition caused by Mycobacterium tuberculosis, primarily targeting the pulmonary system, with the potential to disseminate to various other organs via the haematogenous pathway, ranking among the top ten causes of global mortality. Tuberculosis remains a serious public health problem worldwide. This narrative review aims to emphasise the clinical importance of the inter-relationships between nutrition, pharmacotherapy, and the most common drug–nutrient interactions in the context of tuberculosis and multi-drug-resistant tuberculosis management. Nowadays, pharmacologic approaches utilise polytherapeutic regimens that, although showing increased efficacy, prominently affect the nutritional status of patients and modify multiple metabolic pathways, thus influencing both the effectiveness of therapy and the patient outcomes. There is much evidence that antituberculosis drugs are associated with deficiencies in essential vitamins and various micronutrients, leading to serious adverse consequences. Moreover, poor nutrition exacerbates TB outcomes, and TB further exacerbates nutritional status, a vicious cycle that is particularly prevalent in low-resource environments. Nutritional support is necessary, and clinicians ought to evaluate it on a patient-by-patient basis, as empirical evidence has shown that it can improve immune recovery, decrease tuberculosis-associated morbidity, and increase adherence to therapy. However, drug–food interactions are increasingly prevalent, and patients with tuberculosis require personalised dietary and pharmacological regimens. In this context, antituberculosis treatment requires a holistic approach, based on the collaboration of the prescribing physician, pharmacist, and nutritionist, to assess the patient’s needs from a nutritional and pharmacological perspective, with the ultimate goal of decreasing mortality and improving the prognosis of patients through personalised therapies. Full article

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease characterised by systemic inflammation and the progressive damage of joints, significantly impacting patients’ quality of life. Managing this condition requires a complex approach that integrates pharmacological and non-pharmacological therapies, alongside psychosocial support and patient education. Aim: This study aims to highlight the importance of an interdisciplinary approach in the treatment of rheumatoid arthritis, focusing on the role of pharmacological therapies, monitoring treatment response, and the involvement of a multidisciplinary team in the effective management of the disease. Methods: The analysis was based on a review of the specialised literature concerning the role of disease-modifying antirheumatic drugs (DMARDs, both conventional and biological), the use of inflammatory markers (CRP and ESR), advanced imaging techniques, and the contribution of various medical specialities to the holistic management of rheumatoid arthritis. A total of 595,900 records were identified, of which 53 studies were ultimately included in the detailed analysis. Relevant studies from fields such as rheumatology, nutrition, psychology, and physical therapy were included. Results: The findings underline that DMARDs, in combination with other pharmacological therapies, remain essential for slowing disease progression. Monitoring treatment response through inflammatory markers and imaging techniques allows for the adjustment of therapeutic strategies and the prevention of complications. An interdisciplinary approach, involving the rheumatologist, general practitioner, physiotherapist, nutritionist, and psychologist, provides significant benefits, such as reducing inflammation, improving joint function, and offering psychosocial support. Conclusions: The effective management of rheumatoid arthritis requires a personalised interdisciplinary approach. Integrating various specialities, along with patient education and psychosocial support, contributes to better disease management, the prevention of disabilities, and improved quality of life. This review is not registered. Full article

Gestational diabetes mellitus (GDM) is a complication that affects 20% of pregnancies worldwide. It is associated with adverse short- and long-term cardiometabolic outcomes for both mother and infant. Effective management of GDM involves lifestyle modifications, including medical nutrition therapy (MNT) and physical activity (PA), with the addition of insulin or metformin if glycaemic control remains inadequate. However, substantial gaps persist in the determination of optimal medical nutrition therapy (MNT) for women with GDM. Challenges in MNT include individual variation in glucose tolerance and changing maternal physiology and dietary requirements during pregnancy. Achieving optimal glycaemic control depends on careful macronutrient balance, particularly the distribution and quality of carbohydrate intake and sufficient protein and fat intake. Additionally, micronutrient deficiencies, such as inadequate vitamin D, calcium, and essential minerals, may exacerbate oxidative stress, inflammation, and glycaemic dysregulation, further impacting foetal growth and development. Cultural beliefs and dietary practices among pregnant women can also hinder adherence to recommended nutritional guidelines. Conditions like hyperemesis gravidarum (HG) affect ~1% to 2% of pregnant women can result in unintended energy and nutrient deficits. This special issue explores the current evidence and major barriers to optimising dietary therapy for women with GDM. It also identifies future research priorities to advance clinical practice, improve maternal and foetal outcomes, and address gaps in personalised nutrition interventions. Full article

Background/Objectives: The influence of individual differences in the selection of food portions can have a deep effect on recommendations for personalised nutrition. In addition to typical aspects such us energy density and nutrient composition, portion size is important for dietary recommendations. This study examined the dietary behaviours and portion size selection of 224 subjects in Spain and Germany to use such information to improve dietary adherence to a personalised nutrition app. Methods: An online questionnaire administered to adults in Spain and Germany collected sociodemographic data and dietary habits. The measurement of portion sizes was derived from a classification ranging from XXS to XL across 22 food groups, with assistance from a photographic atlas. Results: Significant differences across dimensions were found. Dietary habits showed that omnivores were the majority in both countries, with significant differences in the consumption of bread, desserts, and beverages. The Mediterranean diet was significantly followed by the Spanish group, reflecting cultural differences. Body mass index (BMI) was slightly higher among Germans, although both populations fell within the normal ranges. Portion size comparisons revealed statistically significant differences in the consumption of various food items between the two countries. Spaniards consumed higher amounts of rice, meat, and legumes, while Germans consumed larger portions of stews, lasagne, and pizza. These variations highlight differing dietary habits influenced by cultural preferences and dietary guidelines. Conclusions: The findings support the development of novel personalised nutrition apps that consider user preferences and enhance dietary adherence, thereby contributing to improved dietary recommendations and health outcomes. Full article

With the spread of enhanced recovery protocols, the management of the perioperative pathway of patients undergoing major orthopaedic surgery has been harmonised to these international standards. A natural evolution of the enhanced recovery framework is to integrate personalised pathways of care for those with unique needs, thus addressing inter-individual differences. Personalised nutrition is the practice of attributing a personal imprint to the perioperative nutritional support and has the potential to ensure more effective and equitable care for those patients who may require more than standard support. The authors of this opinion article review each important element of personalisation with respect to their coverage of what is important in the perioperative care of major orthopaedic procedures such as hip and knee replacement. Full article

This narrative review provides an analysis of the role of nitric oxide (NO) and its precursors, particularly L-arginine, in vascular regulation and health, with an emphasis on findings from our experimental research in animal models. NO serves as a critical mediator of vascular function, contributing to vasodilation, the regulation of blood flow, and the prevention of thrombosis. As a primary precursor of NO, L-arginine is essential for maintaining endothelial integrity, modulating mitochondrial function, and reducing oxidative damage. This review synthesises the data and contextualises these findings within the physiological challenges faced by blood donors, such as repeated blood donation and associated oxidative stress. It examines the effects of L-arginine supplementation on mitochondrial respiration, lipid peroxidation, and microsomal oxidation in different conditions, including differences in age, gender, and dietary interventions. The mechanisms by which L-arginine enhances NO production, improves vascular elasticity, and alleviates endothelial dysfunction caused by reduced NO bioavailability are also investigated. By integrating experimental findings with insights from the existing literature, this review provides a perspective on the potential of L-arginine supplementation to address the specific physiological needs of blood donors. It highlights the importance of personalised nutritional approaches in enhancing donor recovery and vascular resilience. In addition, this review assesses the wider implications of L-arginine supplementation in mitigating oxidative stress and preserving vascular function. The interplay between NO bioavailability, dietary factors, and physiological adaptation in blood donors is highlighted, along with the identification of current knowledge gaps and recommendations for future research. By presenting both original experimental evidence and a critical synthesis of the literature, this article highlights the therapeutic potential of NO precursors, particularly L-arginine, in promoting vascular health in the context of blood donation. Full article

Background: Diet significantly impacts the onset and progression of inflammatory bowel disease (IBD), and diet offers unique opportunities for treatment and preventative purposes. However, despite growing interest, no diet has been conclusively associated with improved long-term clinical and endoscopic outcomes in IBD, and evidence-based dietary guidelines for IBD remain scarce. This narrative review critically examines dietary assessment methods tailored to the unique needs of IBD, highlighting opportunities for precision and inclusivity. Methods: We conducted a comprehensive literature review using search terms related to diet, diet assessment, nutrition, food, sex, gender, equity, and IBD. Results: The identified dietary assessment tools evaluated nutritional quality, dietary patterns, food processing, lifestyle interactions, inflammatory potential, and effects of specific nutrients. Advanced methods, including biomarkers, multi-omics approaches, and digital tools, were highlighted as being complementary to traditional approaches, offering enhanced precision and real-time monitoring. Women remain under-represented in dietary research but face unique nutritional needs due to hormonal cycles, pregnancy, and higher malnutrition risks in IBD. Discussion: Traditional diet assessment methods remain valuable but are often limited by misreporting biases. Advanced approaches may provide greater precision, enabling real-time monitoring and personalised dietary tracking. Incorporating considerations of sex, gender, age, ethnicity, socioeconomic, and sustainability enhances the relevance and applicability of these methods. Addressing these multifaceted aspects of dietary assessment in IBD can facilitate robust interventional trials. Conclusions: Diet assessment tools are essential for developing personalised dietary interventions in IBD, informing evidence-based guidelines, and improving health outcomes and quality of life in IBD. Full article

Background/Objectives: With the rise of artificial intelligence (AI) in nutrition and healthcare, AI-driven chatbots are increasingly recognised as potential tools for generating personalised diet plans. This study aimed to evaluate the capabilities of three popular chatbots—Gemini, Microsoft Copilot, and ChatGPT 4.0—in designing weight-loss diet plans across varying caloric levels and genders. Methods: This comparative study assessed the diet quality of meal plans generated by the chatbots across a calorie range of 1400–1800 kcal, using identical prompts tailored to male and female profiles. The Diet Quality Index-International (DQI-I) was used to evaluate the plans across dimensions of variety, adequacy, moderation, and balance. Caloric accuracy was analysed by calculating percentage deviations from requested targets and categorising discrepancies into defined ranges. Results: All chatbots achieved high total DQI-I scores (DQI-I > 70), demonstrating satisfactory overall diet quality. However, balance sub-scores related to macronutrient and fatty acid distributions were consistently the lowest, showing a critical limitation in AI algorithms. ChatGPT 4.0 exhibited the highest precision in caloric adherence, while Gemini showed greater variability, with over 50% of its diet plans deviating from the target by more than 20%. Conclusions: AI-driven chatbots show significant promise in generating nutritionally adequate and diverse weight-loss diet plans. Nevertheless, gaps in achieving optimal macronutrient and fatty acid distributions emphasise the need for algorithmic refinement. While these tools have the potential to revolutionise personalised nutrition by offering precise and inclusive dietary solutions, they should enhance rather than replace the expertise of dietetic professionals. Full article

Background/Objectives: Lifestyle (in particular, nutrition and exercise) determines present and future youths’ health. The goal of the present study was to identify specific student groups who deserve precise lifestyle improvement interventions, tailored to their characteristics. Methods: An anonymous web-based questionnaire to assess lifestyle was posted on the websites of two main Italian Academic Institutions, and 9423 students voluntarily participated. A personalised immediate report was provided to improve compliance/motivation. We assessed age, sex, affiliation, anthropometrics, lifestyle components (nutrition, exercise, sedentariness, stress perception, smoking, alcohol, sleep), and the desire to be helped with lifestyle improvement. Cluster analysis was performed to identify healthy lifestyle groups among the students. Results: In total, 6976 subjects [age: 21 (20, 23) yrs; 3665 female, 3300 male] completed the questionnaire and were included. Of these students, 73.9% expressed the need for lifestyle improvement help, particularly for becoming physically active (66.7%), managing stress (58.7%), and improving nutrition (52.7%). We unveil three clusters of subjects, each corresponding to a distinct lifestyle pattern. The clusters are differentiated by exercise level and perceptions of stress/fatigue/somatic symptoms (cluster 1: 74.8% meet international exercise guidelines (IEGs), 67.4% have high stress perception, 49.1% drink 1–3 glasses of wine/beer per week, and 63.3% drink 0–1 glass of spirits per week; cluster 2: 75.6% meet IEGs, 75.7% have low/medium levels of stress perception, and 65.8% have low alcohol consumption; cluster 3: 72.5% do not meet IEGs, 77.6% have high stress perception, and 67.5% have low alcohol consumption). More active students present lower stress/somatic symptoms perception. Interestingly, the AHA diet score (nutrition quality) was not in the ideal range in any cluster (nevertheless, obesity was not of concern), being worst in cluster 3, characterized by higher stress perception (59.7% had poor nutrition quality). Those who were physically active but showed a high stress/fatigue perception were used to drinking alcohol. Conclusions: Students desire help to improve their lifestyle, and this approach might help identify specific student groups to whom LIs in Academic Institutions can be tailored to foster well-being and promote health. Full article