Search Results (1,388)

Background: Food frequency questionnaires (FFQs) are important tools for dietary assessment in large epidemiological studies, playing a crucial role in evaluating the relationship between diet and health. However, adapting the food lists in FFQs to align with specific study objectives or target populations presents a considerable challenge. Methods: The present study develops a framework using mixed-integer linear programming (MILP) to minimize the food list of an FFQ using a vegetarian population in Germany as a proof of concept. Constraints of the optimization ensured that the selected food items have a certain nutrient coverage and variance coverage, as well as an appropriate aggregation level. Nutrient intake for three scenarios for FFQs was compared with 24 h recalls (24HR) using R², calculated through linear regression. The three scenarios were: 1. FFQ reflecting the effect of categorizing portion sizes, 2. FFQ reflecting the effect of selecting food items, 3. FFQ reflecting the effect of categorizing portion sizes and selecting food items. Results: Length of minimized FFQs increased with a higher proportion of nutrient coverage and variance coverage. Including aggregation of food items produced shorter FFQs than FFQs that only contain food items at a lower aggregation level. R² values across the three scenarios showed that the FFQ captured most of the between-person variation in nutrient intake that was observed in the 24HR. Conclusions: MILP offers a reliable and data-driven framework for compiling optimized FFQs. Full article

Background/Objectives: The gut microbiome is a critical regulator of host metabolism, immunity, and the gut–brain axis. Exercise is a promising non-pharmacological modulator of microbial ecology, yet human evidence remains heterogeneous and the translational gap persists. This narrative review synthesizes mechanisms, human and animal evidence, and future directions for the exercise–gut microbiome axis. Methods: PubMed, Scopus, Web of Science, and SID were searched for articles published between January 2000 and February 2025. Keywords included exercise, physical activity, gut microbiome, gut microbiota, short-chain fatty acids, and gut–muscle axis. From 218 initial records, 89 original studies (47 human, 42 animal) met inclusion criteria and were critically appraised. Results: Exercise modulates the gut microbiome via splanchnic hypoperfusion, hyperthermia, altered transit time, and immune-mediated barrier regulation. Moderate-intensity continuous training consistently increases alpha diversity and enriches butyrate-producing taxa (Faecalibacterium prausnitzii, Roseburia hominis) and mucin-degrading Akkermansia muciniphila. High-intensity interval training transiently increases intestinal permeability in untrained individuals but, following adaptation, stimulates butyrate production via lactate cross-feeding metabolism—a recent breakthrough. Effects are transient and reversible upon detraining. Animal models establish causality through fecal microbiota transplantation; human randomized controlled trials demonstrate modest, intensity-dependent, and highly individualistic responses. Emerging evidence supports the gut–muscle axis in sarcopenia and personalized exercise prescription guided by microbiome profiling. Conclusion: Exercise shows promise as a low-cost modulator of the gut microbiome for enriching health-associated taxa and improving metabolic outcomes. Definitive evidence linking exercise-induced microbial shifts to enhanced athletic performance in humans remains lacking. Future research requires diet-controlled randomized controlled trials with ≥12-week interventions, shotgun metagenomics, and mechanistic validation of the gut–muscle axis in humans. Full article

Oxidative stress is an important component of cancer biology and is characterized by an imbalance between the production of reactive oxygen species (ROS) and antioxidant defense systems. Excess ROS can cause molecular damage and genomic instability; at the same time, ROS signaling remains necessary for normal cellular function. Redox homeostasis is of particular importance in this balance. The aim of this structured narrative review was to summarize and critically discuss current evidence on how dietary antioxidants influence redox-sensitive pathways involved in cancer prevention, with particular attention to metabolic inflammation, mitochondrial quality control, and gut microbiota-related mechanisms. We performed a structured literature search of Scopus, Web of Science, and PubMed, focusing on articles published between 2021 and 2026. The evidence covered major redox-sensitive pathways, including Nrf2-Keap1-ARE signaling, AMPK-mTOR regulation, NF-κB-mediated inflammation, mitochondrial quality control (autophagy and mitophagy), and inflammasome activation. These pathways, which are involved in tumor initiation and progression, link oxidative stress to metabolic and inflammatory processes. Current evidence suggests that dietary antioxidants act primarily by supporting endogenous defense systems. This may help explain the “antioxidant paradox”, in which antioxidant-rich dietary patterns are associated with a lower risk of cancer. In some studies, high-dose supplementation with isolated antioxidants has produced inconsistent or sometimes adverse results. These effects depend on dose, chemical form, metabolic context, and baseline redox state. The gut microbiota is also an important mediator of antioxidant bioactivity; by converting dietary polyphenols into bioactive metabolites, it can influence systemic redox balance and metabolic signaling. This microbiota-dependent modulation may partially explain inter-individual variability in responses to dietary interventions. In conclusion, dietary antioxidants should be considered as modulators of redox-sensitive signaling networks, not merely as simple radical scavengers. Personalized modulation of redox homeostasis is a future strategy for cancer prevention, with a greater emphasis on whole-diet and biomarker-guided approaches. Full article

Objectives: This study’s main objective was to examine the association between dietary greenhouse gas emissions (GHGEs) and diet quality among U.S. primary and secondary schoolchildren. Our secondary objectives were to identify demographic characteristics associated with higher-GHGE diets and to assess the relationship between school meal consumption and dietary GHGE. Methods: We conducted a cross-sectional secondary analysis of dietary intake data from 2165 primary and secondary students participating in the nationally representative 2014–2015 US School Nutrition and Meal Cost Study (SNMCS). Dietary GHGEs (kg CO₂-equivalents per 1000 kcal) were estimated by linking reported foods to an environmental impact database. Diet quality was assessed using the Healthy Eating Index-2010 (HEI). Students were categorized into GHGE groups, and differences in total HEI and component scores were examined using appropriate statistical tests. Statistical significance was set at p < 0.05. Results: The average dietary GHGE of the sample was 3.64 kg CO₂-equivalent per person per day. Overall, HEI scores did not differ between the GHGE groups (p = 0.22). However, compared to the high-GHGE group, the low-GHGE group scored significantly higher on some HEI-2010 components, such as fatty acid ratios (p < 0.0001) and sodium (p < 0.0001), and significantly lower on others, such as dairy (p < 0.0001), total protein foods (p < 0.0001), and refined grains (p < 0.0001). Male students and students who ate school meals on the day of recall had higher odds of being in the high-GHGE group compared with their respective reference groups. Conclusions: Lower dietary carbon footprints are achievable without sacrificing overall diet quality, but tradeoffs in specific dietary components indicate the need for additional research and care in recommending diet changes or setting school policies. Full article

Chronic kidney disease (CKD) is characterized by persistent exposure to uremic toxins (UTs), many of which originate from gut microbial metabolism and contribute to renal, cardiovascular, and metabolic complications. Current evidence indicates that CKD is associated with dysbiosis and the enrichment of microbial taxa carrying genes involved in UT precursor production. Diet is a major modulator of the gut microbiota and therefore represents a promising lever to reduce UT generation in synergy with current nephroprotective therapies. Beyond simple protein restriction, more specific dietary approaches, particularly plant-based low-protein diets, appear especially relevant. Additional factors, including amino acid composition, lipid quality, food processing, constipation, transit time, meal timing, and circadian rhythms, may also influence microbial metabolism and UT production. This review examines the role of nutrition in shaping the gut microbiota–UT–kidney axis and discusses how dietary modulation may support precision nutrition in the context of CKD. It also highlights future directions based on multidimensional phenotyping and robust biomarkers to capture interindividual variability, guide personalized interventions, and ultimately improve renal and cardiovascular outcomes in CKD. Full article

The rapid evolution of smart cities demands a transition from reactive healthcare systems to proactive, data-driven health management paradigms that support long-term urban sustainability. Predicting population health status based on lifestyle-related behavioral and physiological factors is critical for enabling early intervention, personalized healthcare, and efficient resource allocation directly contributing to the United Nations Sustainable Development Goals (SDG 3: Good Health and Well-being; SDG 11: Sustainable Cities and Communities). This study proposes an IoT-enabled Explainable Artificial Intelligence (XAI) framework for predictive health scoring as part of sustainable population health management, integrating real-time data acquisition, cloud-based analytics, and interpretable machine learning. To address the limitations of conventional ensemble models particularly the black-box nature and hyperparameter sensitivity of Extreme Gradient Boosting (XGBoost) a Bayesian optimization strategy is employed to automatically fine-tune model parameters, thereby enhancing predictive accuracy and generalization performance. Furthermore, Shapley Additive Explanations (SHAP) are incorporated to provide transparent, interpretable insights into model predictions by quantifying the contribution of individual lifestyle features. Using a publicly available Kaggle dataset (“Health and Lifestyle Data for Regression”), experimental evaluation demonstrates that the proposed Bayesian-Optimized XGBoost model achieves superior performance (Test R² = 0.878, RMSE = 4.983), outperforming ten benchmark models, including standard XGBoost, which exhibits signs of overfitting (Test R² = 0.832). The results further reveal that Body Mass Index (BMI) and diet quality are the most influential factors affecting health scores, providing actionable insights for urban health policymakers. The proposed framework highlights the synergy between IoT, optimization techniques, and explainable AI to develop transparent, reliable, and scalable predictive health systems. This work provides a practical foundation for next-generation smart healthcare applications and decision-support systems, advancing the vision of sustainable, data-driven, and human-centric smart cities. Full article

Introduction: Alterations of the microbiota–gut–brain axis, including increased intestinal permeability (IP), changes in microbial activity, and immune activation, are central to the pathophysiology of irritable bowel syndrome with diarrhea (IBS-D). The low-fermentable oligo-di-monosaccharides and polyols (FODMAP) diet (LFD) is an established therapy for IBS, yet its systemic effects, particularly in patients with elevated depressive symptoms, remain incompletely characterized. Methods: This single-arm pre–post study investigated associations between depressive symptom severity and markers of small IP (s-IP), endotoxin exposure, inflammation, and erythrocyte membrane polyunsaturated fatty acid (PUFA) composition in 43 IBS-D patients undergoing a 12-week personalized LFD. Patients were classified using the Symptom Checklist-90-Revised depression subscale into those with (d+, n = 23) and without (d−, n = 20) clinically elevated depressive symptoms. Results: At baseline, d+ patients exhibited higher s-IP, circulating lipopolysaccharide levels, inflammatory markers, and a more pro-inflammatory PUFA profile. Following LFD, significant improvements in symptoms and several biological parameters were observed in the overall cohort. Greater absolute changes in d+ patients were consistent with their higher baseline values rather than indicating differential responsiveness. Baseline depressive symptoms were not significantly associated with the magnitude of post-intervention changes in IP or inflammatory markers. Conclusions: These findings suggest that elevated depressive symptoms identify an IBS-D subgroup characterized by greater baseline biological burden. Results should be interpreted as associative given the single-arm design, absence of a control group, and the concurrent reduction in body weight, which may have influenced the observed changes. Randomized controlled studies are needed to clarify the role of dietary interventions in modulating gut–brain axis-related pathways in IBS-D. Full article

Health is increasingly recognized as a dynamic state of physiological equilibrium rather than the mere absence of disease. Traditional clinical biomarkers capture only limited aspects of physiology and fail to reflect the multidimensional and dynamic nature of human homeostasis. Metabolomics, by comprehensively profiling small-molecule metabolites downstream of genetic, proteomic, environmental, and lifestyle influences, offers a sensitive and functional readout of an individual’s physiological state. This review catalogues current advances in applying metabolomics to characterize metabolic features of health, focusing on the influence of age, sex, body mass index, physical activity, diet, lifestyle behaviors, microbiome composition, and population heterogeneity. Numerous cohort studies have shown that substantial metabolic variability exists amongst individuals within apparent healthy populations, underscoring the need for stratified and contextual reference frameworks. We further discuss major challenges in defining a standardized metabolic baseline, including analytical platform heterogeneity, biofluid specificity, population diversity, and the predominance of cross-sectional study designs. Finally, we highlight the role of large-scale longitudinal cohorts, biobanks, multi-omics integration, and artificial intelligence–driven tools in overcoming these barriers. Establishing robust, dynamic, and personalized metabolic baselines will be critical for redefining health, enabling early intervention, and supporting predictive and preventive medicine. Full article

Objective: This study aimed to assess quality of life (QoL) and its determinants among Saudi adults diagnosed with type 2 diabetes mellitus (T2DM). Methods: A cross-sectional study was conducted among 200 (45% male and 55% female) Saudi adults with T2DM aged 30–65 years. Data were collected using the Audit of Diabetes–Dependent Quality of Life (ADDQoL) and the Personal Diabetes Questionnaire (PDQ). Anthropometric and clinical measures included weight, height, body mass index (BMI), blood pressure, and glycated hemoglobin (HbA1c). Results: Most participants (73.5%) were ≤50 years of age, and the majority were obese (56.0%) or overweight (28.0%). Nearly half (54.5%) had HbA1c levels ≥ 8.0%, while (50.5%) were hypertensive. Overall, 96% of participants reported a poor to extremely poor QoL. Female sex (p = 0.003), higher BMI (p = 0.034), diet type (p = 0.039), and satisfaction with glucose control (p < 0.001) were significantly associated with the QoL. Conclusions: T2DM substantially impairs the QoL of affected Saudi adults. Psychosocial and lifestyle-related factors, particularly obesity, gender, dietary practices, and perceived glucose control, are more influential than traditional clinical markers. Culturally tailored interventions targeting these determinants may improve patient outcomes. Full article

Micronutrient status is strongly influenced by dietary patterns; however, the extent to which plant-forward dietary patterns versus omnivorous diets shape micronutrient profiles and their associations with blood pressure, body composition, and cardiovascular health remains unclear. This cross-sectional study aimed to comprehensively assess associations between blood micronutrient profiles, blood pressure, and body composition in adults, with analyses stratified by dietary patterns to compare omnivorous and plant-forward dieters. Secondary cross-sectional analyses were conducted using data from an exploratory study of 488 Austrian adults (median age: 38 y [IQR 21]; 48% female, 52% male). Participants were classified as omnivores (n = 260) or plant-forward dieters (including 194 flexitarians, 25 vegetarians, and 9 vegans; n = 228). Blood pressure and anthropometric measurements were obtained alongside fasting venous blood sample analysis to quantify a comprehensive panel of micronutrient, hematological, lipid, and inflammatory biomarkers. Micronutrient concentrations were standardized (scaled −1 to +1, truncated ±3) and evaluated for deficiency or excess according to sex-specific reference ranges. Linear regression was used to analyze the association of micronutrients with BMI, including age and sex as covariates. Vitamin D showed the highest micronutrient deficiency, observed in 96% of omnivores and 93% of plant-forward dieters. Across both dietary subgroups, multiple micronutrients, together with age and sex, were significant correlates of body weight, body mass index, and blood pressure (p < 0.05). Significant differences between omnivores and plant-forward dieters were observed for blood pressure, lipid, hematological, and inflammatory markers, with participants adhering to plant-forward dietary habits exhibiting lower blood pressure and more favorable lipid profiles (p < 0.05). The findings highlight the potential of diet-type-specific strategies for personalized cardiometabolic risk management. Full article

Objective: To evaluate the relationship between legume intake and incident hyperuricemia among Chinese adults using large-scale prospective cohort data. Methods: Baseline and follow-up information from the Shanghai Suburban Adult Cohort and Biobank (SSACB) were used to assess diet and hyperuricemia incidence [serum uric acid (SUA) ≥ 420 μmol/L in males and ≥ 360 μmol/L in females]. A Food Frequency Questionnaire (FFQ) covering 29 food categories quantified food consumption during the previous 12 months. Legume intake was calculated by multiplying the reported consumption of each item by (1 − water content), and participants were classified into tertiles with the lowest third (Q1) as the reference. Cox proportional-hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs), and restricted cubic splines (RCSs) with three knots (10th, 50th, and 90th percentiles) visualized the dose–response relation. Results: Among 43,371 participants, 1456 new cases of hyperuricemia were documented over 225,002.40 person-years (incidence density 6.47/1000 person-years; 95% CI 6.14–6.80). Incidence density decreased with higher legume intake: each 1 g/day increment was associated with a 2% lower risk (HR 0.98; 95% CI 0.97–0.99; p < 0.05). Compared with Q1, the highest tertile (Q3) showed a 26% risk reduction in the fully adjusted model (HR 0.74; 95% CI 0.64–0.86; p < 0.05). RCS revealed a significant nonlinear relationship (p-overall < 0.001, p-nonlinear = 0.0013), with the significant benefit in risk observed at 6–28 g/day. Conclusions: Legume intake is nonlinearly and inversely associated with hyperuricemia risk among Shanghai suburban adults. Given that the current low median intake, comprehensive strategies are needed to rationally adjust the dietary structure, improve legume intake, and provide sustainable development strategies for effective prevention and control of hyperuricemia. Full article

Diet affordability is a critical determinant of food security, health and wellbeing. However, the cost and affordability of diets have not been routinely measured in Queensland (Australia) in over a decade. This study assessed the cost and affordability of healthy (based on national healthy eating guidelines) and habitual (less healthy, based on national reported intake) diets across six Queensland regions. Data were collected in 35 communities, over two years (2023 and 2024), using the evidence-based Healthy Diets Australian Standardised Affordability and Pricing protocol. Data were analyzed relative to a six-person intergenerational Aboriginal and Torres Strait Islander reference household. Results indicate that, across Queensland, healthy diet costs are above the threshold for food stress in Aboriginal and Torres Strait Islander households. On average, healthy diets were 30% cheaper than the habitual diet (which include alcohol and takeaway foods) but cost at least 26% of household income (above the 25% threshold for food stress). In 2023, healthy diets were on average 31% more expensive in remote communities compared to urban and regional centers. In 2024, the cost of a healthy diet in remote communities decreased significantly by 24%, narrowing diet cost differences between remote and non-remote regions. This shift could be associated with the implementation of a freight subsidy in remote Queensland, or other influences on remote food pricing. Findings highlight diet-related cost-of-living challenges for Aboriginal and Torres Strait Islander families, underscore the need for ongoing monitoring and provide insight for policy interventions (such as targeted subsidies) to improve diet affordability and reduce nutrition-related health inequity. Full article

Background: Screening for presymptomatic type 1 diabetes (T1D) reduces the risk of diabetic ketoacidosis (DKA) and allows for early intervention with disease-modifying therapies. Despite the rising incidence of T1D in Bulgaria, screening initiatives remain limited. This pilot study aims to evaluate the feasibility of selective T1D screening in high-risk children and identify potential clinical associations with islet autoimmunity. Methods: The study targeted a recruitment of 250 children aged 0–18 years (200 with a relative with T1D and 50 without). Screening for islet autoantibodies (AABs), including glutamic acid decarboxylase (GADA), insulin (IAA), insulinoma-associated-2 (IA-2A), zinc transporter-8 (ZnT8A), and islet cell cytoplasmic autoantibodies (ICAs), was performed via chemiluminescence immunoassay (CLIA). Participants testing positive for one or more AABs were scheduled for longitudinal immunological and metabolic follow-up to evaluate the persistence of autoimmunity and disease progression. Results: Between October 2024 and February 2026, the pilot study recruited 210 participants (84% of the 250 target), including 160 children with a relative (target 200) and 50 without a family history of T1D (target 50). Within the high-risk group, seven children (4.4%) tested positive for a single autoantibody (3 GADA, 2 ZnT8A, 1 IA-2A, and 1 IAA), while no autoantibodies were detected in the group without a relative. No cases of multiple autoantibody positivity or stage 3 T1D were identified in either group. Furthermore, no statistically significant associations were observed between autoantibody positivity and secondary factors, including breastfeeding, allergic status, a high-glycemic diet, frequent illness, and personal history of autoimmune disease. Conclusions: The findings validate the feasibility of selective T1D screening in Bulgaria, driven by high public interest and successful recruitment across both high-risk and general population cohorts. While this exploratory study found no significant clinical correlations, it establishes a vital roadmap for larger, longitudinal research. Ultimately, this pilot framework provides a scalable model for implementing standardized early detection to reduce the burden of T1D on the national healthcare system. Full article

Background/Objectives: Adequate nutrition in older adults is essential to maintaining health, functionality, and quality of life, particularly in long-term care hospitals (HACLEs). Previous studies suggest that dissatisfaction with hospital food is linked to longer stays, more complications, and negative perceptions of care. Given these concerns, this study aimed to assess patients’ experiences with hospital food over a 15-year period in a HACLE in Spain, identify key influencing factors, and validate an updated PREM (Patient Reported Experience Measure) tool for food services. Methods: A retrospective, observational, repeated cross-sectional study was conducted using annual PREM surveys administered between 2011 and 2025 to patients on oral diets. Psychometric validation of the updated 8-item version (2024) was conducted. Results: Out of 1618 surveys, 1540 were included in the final analysis. The updated PREM showed strong internal consistency (α = 0.85, ω = 0.87), a two-factor structure (food quality and service conditions), and adequate model fit. Perceptions worsened after a catering company change in 2022 but improved following the implementation of new food distribution carts in 2025. The PREM total score showed a strong positive association with the global satisfaction item, providing supportive evidence based on a closely related anchor measure (Spearman’s rho = 0.80, 95% CI 0.77–0.82; p < 0.001). Scores differed significantly by diet type: patients receiving a pureed diet reported the highest average satisfaction score, followed by those on a soft diet and a regular diet. The group on a soft diet excluding foods that pose a choking hazard had the lowest mean score. Conclusions: The validated PREM scale is a reliable tool to monitor patient experience with hospital food. It enables early detection of quality issues and supports targeted improvements. Routine use in long-term care settings may foster personalized, patient-centered nutrition strategies and enhance care quality. Full article

Immune checkpoint inhibitors (ICIs) have revolutionized the therapeutic landscape for hepatocellular carcinoma (HCC); however, a considerable proportion of patients do not achieve durable clinical benefits. This highlights the need for reliable predictive biomarkers, which are currently lacking. The accumulated evidence supports a relevant role of the gut–liver axis in modulating immunotherapy outcomes, and several studies have identified distinct microbial features associated with either responders or non-responders. Responders to immunotherapy frequently present with higher microbial diversity and enrichment of beneficial taxa, whereas the expansion of pro-inflammatory and pathogenic bacteria has been associated with primary resistance and increased treatment-related toxicity in non-responders. However, the available findings remain heterogeneous across cohorts, likely owing to differences in geography, diet, liver disease etiology, treatment regimens, and microbiome analytical methods. Machine-learning models integrating metagenomic and metabolomic data have shown encouraging results in defining microbial signatures associated with treatment outcomes, although variability among cohorts currently limits their clinical applicability and generalizability. Beyond microbial taxonomic composition, microbiota-derived metabolites—such as short-chain fatty acids, bile acids, inosine, and tryptophan catabolites—appear to play a crucial role in shaping the tumor microenvironment and host immune responses, thus representing additional candidate biomarkers, also due to the relative ease of their measurement. Finally, microbiota-targeted interventions are emerging as potential strategies to enhance immunotherapy efficacy. Overall, the gut microbiome and its metabolic activity represent promising tools, albeit still under investigation, for patient stratification and personalized management in HCC treated with ICIs. Therefore, this review aims to summarize and critically discuss the current evidence on gut microbiota-derived biomarkers of response and resistance to ICIs in HCC, with particular focus on microbial composition, microbiota-related metabolites, and emerging microbiome-based therapeutic strategies. This narrative review provides an updated overview of the role of gut microbiota as both a biomarker and a therapeutic target in patients with hepatocellular carcinoma (HCC) receiving immune checkpoint inhibitor (ICI) therapy. Full article