Search Results (124)

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of global chronic liver disease, with a prevalence of approximately 30%. This review outlines the diagnostic transition from the exclusionary non-alcoholic fatty liver disease (NAFLD) framework to the affirmative MASLD nomenclature, which mandates the presence of at least one of five specific cardiometabolic risk factors (CMRFs) to prioritize active pathophysiology. Beyond hepatic complications, MASLD drives systemic metabolic failure, significantly elevating risks for type 2 diabetes, hepatocellular carcinoma, and cardiovascular disease, the primary cause of mortality in this cohort. Clinical management relies on a standardized, two-tier risk-stratification pathway for advanced fibrosis. Primary care triage utilizes the Fibrosis–4 (FIB–4) index; a score < 1.3 excludes advanced disease via a high negative predictive value, whereas indeterminate or high scores require secondary validation via vibration-controlled transient elastography (VCTE) or the enhanced liver fibrosis (ELF) test to guide specialist referral. Although lifestyle modifications, principally a 7–10% weight reduction and Mediterranean diet adherence, remain foundational, management has transitioned toward disease-modifying pharmacotherapies. A pivotal breakthrough occurred with the 2024 FDA approval of resmetirom, a selective thyroid hormone receptor-beta (THR-β) agonist, for non-cirrhotic metabolic dysfunction-associated steatohepatitis (MASH) with moderate-to-advanced fibrosis. Concurrently, the emergence of GLP-1 receptor agonists and multi-incretin mimetics offers a personalized, multi-target approach simultaneously addressing hepatic inflammation, glycemic control, and adiposity. Full article

Spent mushroom substrate (SMS), the main by-product of mushroom production, is rich in valuable compounds that could be recovered by ultrasound-assisted extraction (UAE) and exploited as fat-mimetic functional ingredients in food formulations. In this study, low-fat cookie prototypes were developed by incorporating a dietary fiber extract obtained from SMS using UAE. The extraction process was optimized following a Box–Behnken experimental design, identifying optimal conditions at a specific energy input of 200 J/mL, a particle size of 2 mm, and a solvent-to-solute ratio of 27%, yielding a dietary fiber recovery of 30.82%. The optimized SMS extract exhibited high oil-holding capacity (OHC) (1.39 g/g), emulsion stability (ES) (80%), and foaming capacity (FC) (83.55%). Four cookie formulations were evaluated, among which G1 (50% fat replacement) showed the best balance between consumer acceptability and an improved nutritional profile, characterized by higher protein (8.4 g/100 g), total dietary fiber (TDF) (7.10 g/100 g), and mineral contents. Notably, G1 cookies displayed a significant reduction in predicted glycemic index (pGI), decreasing from 83.84 in the control to 69.65. Overall, these results demonstrate that optimized SMS-derived dietary fiber is an effective functional ingredient for the development of low-fat, high-fiber, and reduced-glycemic cookies, contributing to the valorization of agro-industrial by-products within a circular economy framework. Full article

This study investigated the reformulation of traditional Anatolian flatbread (bazlama), a staple food of the Mediterranean diet, into a functional product with enhanced nutritional quality. High-amylose refined (white) flour obtained from high-amylose Svevo (Svevo-HA) wheat and resistant starch produced via repeated autoclaving–cooling cycles were incorporated to increase resistant starch content and antioxidant capacity, reduce the predicted glycemic response, and evaluate the resulting changes in textural attributes. Six bazlama formulations were produced using white flours of normal Svevo, Svevo-HA, and recombined Svevo-HA flour containing resistant starch and gluten, with and without vital gluten supplementation. Color, texture profile, phenolic content, antioxidant capacity (DPPH, ABTS, FRAP), resistant starch content, and in vitro glycemic index (GI) were evaluated. Bazlama samples enriched with resistant starch exhibited significantly higher total antioxidant activity (113.7–174.7 mg Trolox equivalent/100 g dw) and resistant starch (9.1–10.3%) levels, along with reduced GI values (53.8–54 < 55), classifying them as low-GI foods. The results demonstrate that incorporating high-amylose wheat–derived resistant starch can successfully convert bazlama into a functional flatbread with improved health-promoting properties. Full article

Pigmented wheat varieties represent a promising source of bioactive compounds, particularly anthocyanins, with potential applications in the development of functional cereal-based foods. This study investigated the combined effect of pigmented wheat genetics and innovative milling technologies on the nutritional and technological properties of wheat-derived products. Two pigmented bread wheat genotypes, the blue-grained cultivar Purendo and the purple-grained line Vanilnoir, were compared with the non-pigmented cultivar Peralba. Grains were processed using conventional milling or through micronization followed by air-classification to obtain enriched fractions (F250 and G250). The resulting flours and fractions were evaluated for compositional traits, rheological properties, antioxidant activity, and pasta-making performance. Air-classification significantly increased ash, protein, and lipid contents while reducing total starch, confirming the enrichment of outer kernel components. Bran-enriched fractions exhibited enhanced antioxidant capacity, with the highest FRAP and TEAC values observed in pigmented genotypes. Pasta produced from enriched fractions showed improved nutritional profiles and, in most cases, a reduced predicted glycemic index compared with conventional flour-based pasta. Technological responses were genotype-dependent: while bran enrichment negatively affected dough rheology, the purple genotype maintained more balanced technological and sensory properties in pasta compared with the blue genotype. These results demonstrate that integrating pigmented wheat genetics with targeted milling strategies can support the development of functional cereal-based foods with enhanced antioxidant potential and improved nutritional quality. Full article

Background/Objectives: Both adiposity and nutritional–inflammatory status influence glucose metabolism; however, their longitudinal associations with glycemic changes in non-diabetic populations remain unclear. We examined the independent, interactive, and joint associations of body mass index (BMI) and prognostic nutritional index (PNI) with the 3-year change in HbA1c (ΔHbA1c). PNI, a composite marker of serum albumin and peripheral lymphocyte count, reflects both protein nutritional status and systemic immune competence. We hypothesized that BMI and PNI would each independently predict ΔHbA1c and that their joint profiling would identify higher-risk subgroups. Methods: A total of 9414 non-diabetic adults from the Shanghai Suburban Adult Cohort were included. Participants with diabetes at baseline (defined as fasting plasma glucose ≥ 7.0 mmol/L, 2-h post-load glucose ≥ 11.1 mmol/L, HbA1c ≥ 6.5%, or self-reported physician diagnosis of diabetes or use of glucose-lowering medications) were excluded. BMI was measured, and PNI was calculated as serum albumin + 5 × lymphocyte count. ΔHbA1c was assessed over a 3-year period. Multivariable linear regression, interaction testing, and joint stratification were performed. Covariate selection was guided by prior biological plausibility, and model adequacy was evaluated using the Akaike Information Criterion (AIC). Results: Both BMI (β = 0.013% per kg/m², 95% CI: 0.011–0.016, p < 0.001) and PNI (β = 0.002% per unit, 95% CI: 0.000–0.004, p = 0.019) were independently and positively associated with ΔHbA1c. No significant interaction was observed (p = 0.431). High BMI (≥24 kg/m²) was associated with glycemic worsening irrespective of PNI level (β ≈ 0.075%, p < 0.001). Among normal-weight individuals, higher PNI was associated with a modest increase in ΔHbA1c (β = 0.031%, p = 0.007). Conclusions: Although the absolute effect sizes were modest at the individual level, BMI was consistently and independently associated with glycemic deterioration therefore, even small per-unit increases may translate into meaningful risk at the population level given the high prevalence of overweight and obesity. PNI showed a small positive association, suggesting that in relatively healthy populations a higher PNI may partly capture subtle pro-glycemic factors—such as low-grade inflammation or higher protein intake—rather than representing unambiguous nutritional benefit. The absence of interaction suggests that BMI and PNI act through largely independent pathways. These findings extend prior evidence by demonstrating that PNI provides modest additional glycemic information beyond BMI in non-diabetic community-dwelling adults, particularly among those of normal weight. Full article

Starch–polyphenol complexes have attracted increasing attention as functional ingredients for improving the structural stability and reducing the glycemic potential of starch-based foods, yet their application in extruded fresh noodles remains insufficiently understood. In this study, chestnut starch–resveratrol complexes prepared by heat-moisture synergistic recrystallization treatment (CS-HMRT-Res) were incorporated into extruded fresh noodles, and their quality, structural characteristics, digestibility, and glycemic response were systematically evaluated. Compared with commercial wheat-based Regan noodles, CS-HMRT-Res noodles exhibited enhanced cooking stability (lower swelling and leaching) and improved texture (hardness, chewiness, tensile strength), with a markedly lower total color difference after cooking (ΔE = 1.8 vs. 6.5). SEM, FTIR and XRD indicated a more compact and ordered network; the relative crystallinity of cooked noodles increased to approximately 30.8%. In in vitro digestion, CS-HMRT-Res showed the lowest starch hydrolysis extent at 180 min (45.92%) and yielded a low predicted glycemic index of 53.35, compared with 70.65 for Regan noodles. Consistently, gavage studies in mice confirmed that HMRT-Res-chestnut starch produced the lowest postprandial blood glucose increment response (4.31 mmol/L). Molecular dynamics simulations further suggested that resveratrol could competitively occupy the α-amylase binding cavity and reduce starch accessibility to the enzyme. Overall, CS-HMRT-Res improved processing quality, structural integrity, and reduced glycemic potential, offering a structure-function framework for designing low-GI products. Full article

The integration of rooted plant flour into traditional noodle matrices, such as rice noodles and qingke noodles, represents a novel approach to enhancing the nutritional and sensory profiles of staple foods. This study investigates the volatile flavor components and functional compounds derived from rooted plant flours, including Gongmi “tribute rice”, qingke “highland barley” flour, kudzu vine flour, Gastrodia elata blume flour, dried ginger flour, and fishwort root flour, when incorporated into rice and qingke noodles. The novelty of this research lies in its comprehensive analysis of how these flours influence not only the nutritional and textural properties but also the volatile organic compounds (VOCs) that define sensory acceptance and health benefits. Using advanced gas chromatography mass spectrometry (GC-MS), we identified key VOCs, such as esters, aldehydes, and terpenes, which contribute to unique flavor profiles like umami, sweetness, and earthy notes in fortified noodles. Additionally, the study highlights the best functional compounds for health, including polyphenols, resistant starch, and polysaccharides, which demonstrate significant antioxidants, anti-inflammatory, and cholesterol-lowering properties. For instance, highland barley enriched flour exhibited high levels of phenolic compounds and carotenoids, which correlated with improved antioxidant activity and a reduced glycemic index. Similarly, Gongmi flour contributed elevated levels of γ-aminobutyric acid (GABA) and rutin, enhancing the rice noodles’ potential to manage metabolic diseases and support cardiovascular health. Molecular docking analyses predicted strong interactions between key volatile compounds (e.g., 3-dihydro-1, 3-trimethyl-33-phenyl-1H-indene) and metabolic targets like ACE and SGLT1, suggesting mechanisms for their cardioprotective and anti-diabetic effects. This research provides a groundbreaking framework for developing next generation functional foods by leveraging rooted plant flours to bridge the gap between sensory appeal and health efficacy, offering strategic insights for personalized nutrition and sustainable food production. Full article

Background: This study evaluated the independent predictive value of preoperative Systemic Immune–Inflammation Index (SII) for postoperative wound infection (WI) in diabetic patients undergoing isolated Coronary Artery Bypass Grafting (CABG). Methods: A retrospective cohort of 300 diabetic patients (2024–2025) was analyzed. The primary outcome was 30-day postoperative WI. Preoperative SII was calculated from blood counts within 24 h before surgery. Multivariable logistic regression was performed using both a primary model (adjusting for age, BMI, and comorbidities) and an extended model including glycemic control (HbA1c), smoking status, operative duration, and transfusion requirements. Model discrimination was evaluated via Area Under the ROC Curve (AUC). Statistical power and sensitivity analyses were conducted to ensure the robustness of the findings. Results: WI occurred in 7% (n = 21). Preoperative SII was significantly lower in the WI group (958.48 ± 493.49 vs. 1293.56 ± 758.15, p = 0.047). SII remained an independent predictor in the adjusted model (Adjusted OR per 100-unit increase: 0.93; 95% CI: 0.86–1.00; p = 0.048). ROC analysis confirmed an inverse predictive pattern (AUC: 0.374, 95% CI: 0.312–0.436). Comparative analysis showed that SII provided superior additional insight compared to NLR and PLR in this population. Conclusions: Preoperative SII is an independent predictor for WI in diabetic CABG patients. However, given the modest discriminative performance (AUC: 0.374), it should be integrated into a broader clinical risk assessment. Contrary to conventional expectations, lower SII values indicated increased susceptibility, suggesting that immune exhaustion rather than hyperinflammation may drive infectious risk in diabetic patients. Full article

Commercially produced gluten-free bread has gained popularity over the past decade. However, it often struggles to match its gluten-containing counterparts in terms of nutritional aspects, appearance, texture, and consumer acceptability. In this study, we aimed to optimize a novel gluten-free formulation based on tapioca starch and red lentil flour using a D-optimal mixture design. According to our findings, the swelling power and oil-holding capacity of the blended flour increased with the proportion of red lentil flour. The volume of bread loaves with 15% red lentil flour and 15% or 30% tapioca starch was close to that of the control bread. The addition of lentil flour tended to reduce the springiness of the experimental bread crumb, while the hardness was lower for the experimental sample with 15% lentil and 30% tapioca starch. The predicted glycemic index of the bread samples ranged from 70 to 87, and the sample containing 30% tapioca and 30% red lentil flour achieved the lowest score. Finally, the optimized gluten-free bread formulation showed lower hardness, pore density, and predicted glycemic index, and higher volume compared to the control bread sample, demonstrating that it is possible to improve gluten-free baked goods without compromises. Full article

Enriching bakery products with highly nutritious ingredients, such as microalgae and insect powder, is a promising strategy for developing functional foods. This study aimed to evaluate the effects of spirulina, chlorella, and cricket powder on the quality of sponge cakes. The assessed parameters included color, nutritional value, mineral composition, antioxidant activity, predicted glycemic index (pGI), and sensory properties. The addition of microalgae significantly reduced the L* value and altered the color shade of the sponge cakes, while the insect powder caused milder color changes. The enriched samples contained higher levels of protein (by up to 14%) and minerals, including calcium, magnesium, iron, and zinc. Antioxidant activity was enhanced across all variations, particularly in sponge cakes with insect powder, which showed the highest TPC (47.96 mg GAE), DPPH· (0.107 mM TE), and ABTS·⁺ (0.208 mM TE) levels. Cakes containing spirulina exhibited the highest total flavonoid content (63.95 mg EPI). Additionally, the enriched samples demonstrated a statistically significant reduction in the pGI. Among all the supplemented samples, the sponge cake with cricket powder received the highest consumer acceptance. Overall, enriching sponge cakes with microalgae and cricket powder improved their nutritional value and antioxidant properties, with insect powder offering the best balance between sensory quality and functionality. Full article

Background: Acute coronary syndrome (ACS) remains a leading cause of morbidity and mortality worldwide, and improved risk stratification beyond conventional biomarkers is needed. Novel laboratory-derived indices reflecting systemic inflammation and immunonutritional status including the inflammatory prognostic index (IPI), prognostic nutritional index (PNI), and aggregate index of systemic inflammation (AISI) may provide integrated prognostic information in ACS. Methods: In this cohort study, 2400 participants were included: 800 controls, 800 patients with non-ST-elevation myocardial infarction (NSTEMI), and 800 with ST-elevation myocardial infarction (STEMI). Results: Compared with controls, NSTEMI and STEMI patients were younger and exhibited higher body mass index, blood pressure, heart rate, and progressively worse glycemic indices (fasting glucose and HbA1c; all p < 0.001). Lipid parameters were significantly higher in ACS groups versus controls (p < 0.001). Cardiac biomarkers were markedly elevated in ACS, with significantly higher troponin I and CK-MB levels in STEMI than NSTEMI and controls (both p < 0.001). Inflammatory and renal parameters (CRP, fibrinogen, urea, creatinine) were increased in ACS, most prominently in STEMI. Composite indices demonstrated strong inter-correlations, including a strong positive correlation between AISI and IPI (r ≈ 0.91, p < 0.001), while PNI correlated inversely with CONUT score (r ≈ −0.70, p < 0.001). The Gensini score differed significantly among groups and was highest in NSTEMI (p < 0.001). Survival was significantly lower in STEMI than NSTEMI (log-rank p = 0.005), with RMST of 315.5 days in NSTEMI versus 299.4 days in STEMI. In multivariable Cox regression, STEMI presentation independently predicted higher mortality risk (HR 1.26, 95% CI 1.04–1.53; p = 0.018), and higher Gensini score was also independently associated with mortality (HR 1.01 per point; 95% CI 1.00–1.02; p = 0.036). Higher PNI was independently protective (HR 0.997; 95% CI 0.993–1.000; p = 0.045), whereas age and CONUT score were not significant in the adjusted model. Conclusions: Novel laboratory-derived systemic inflammatory and nutrition-related indices particularly IPI and AISI as markers of inflammatory burden and PNI as a marker of immunonutritional balance provide clinically relevant prognostic information in ACS. STEMI presentation is associated with shorter survival, and all-cause mortality is independently related to STEMI status, greater angiographic severity (higher Gensini score), and lower PNI. These readily available indices may offer incremental value for risk stratification in NSTEMI and STEMI when integrated with conventional clinical and angiographic assessment. Full article

Monofloral honeys are widely recognized for their distinct chemical characteristics which are largely influenced by botanical origin. This study aimed to compare the physicochemical and functional properties of monofloral honeys produced in South Korea. Five monofloral honey types, Castanea crenata, Robinia pseudoacacia, Toxicodendron spp., Hovenia dulcis, and Styrax japonicus, were analyzed, and their floral origins were confirmed through melissopalynological analysis. Physicochemical parameters (moisture content, total soluble solids, hydroxymethylfurfural content, stable carbon isotope ratio, free acidity, pH, color, and sugar composition), along with amino acid profiles, predicted glycemic index (GI), and antioxidant activity, were determined. Most physicochemical parameters showed statistically significant differences among honey types. Amino acid composition differed markedly among honey types, with Castanea honey exhibiting higher levels of proline, phenylalanine, and leucine compared to Robinia and Styrax honeys. Predicted GI values were predominantly within the low-GI range, with no statistically significant differences observed among floral origins. Antioxidant activity showed a similar trend to amino acid content, with Castanea honey displaying the highest antioxidant values. These findings demonstrate that botanical origin is a key determinant of the physicochemical and in vitro functional attributes of honey, including antioxidant activity and predicted GI, and provide a scientific basis for the characterization of South Korean monofloral honeys. Full article

Background/Objectives: This study aimed to investigate the relationship between serum endocan and total testosterone levels in male patients with prediabetes. Materials and Methods: This cross-sectional observational study included 37 men with prediabetes and 37 healthy male controls. In addition to routine laboratory tests, blood samples were collected to measure serum endocan levels using the enzyme-linked immunosorbent assay (ELISA), and total testosterone levels were analyzed using a chemiluminescence method. Results: Age did not differ significantly between the groups (p > 0.05). Body mass index (BMI), fasting plasma glucose (FPG), postprandial plasma glucose (PPG), insulin, HbA1c, and serum endocan levels were significantly higher in the prediabetes group (BMI: p = 0.003; FPG: p < 0.001; PPG: p = 0.019; insulin: p = 0.007; HbA1c: p < 0.001; endocan: p = 0.012). No significant difference was observed in testosterone levels between the groups (p = 0.228). Conclusions: Elevated serum endocan levels in individuals with prediabetes may reflect early endothelial dysfunction associated with glycemic dysregulation. These findings suggest that endocan may serve as an exploratory biomarker of early vascular alterations in prediabetes. However, further large-scale and prospective studies are warranted to clarify its clinical relevance and potential role in risk stratification and the prediction of microvascular complications. Full article

The interaction between chrono-nutrition (dinner intake), glycemic index (GI), and the C358A variant of the endocannabinoid-degrading enzyme fatty acid amide hydrolase (FAAH), along with its impact on morning fasting insulin and glycemia, has not been previously explored. This study provides new insights into chronometabolic and nutrigenetic interactions. This study aims to analyze the association between the dinner GI and the C385A variant in the FAAH gene with respect to fasting glucose, insulin levels, and HOMA-IR in adults with obesity. It was hypothesized that the dinner GI, probably influenced by the FAAH variant, could be associated with glycemic homeostasis in adults with obesity. This is a secondary analysis of a cross-sectional study focused on 189 adults with obesity (129 women; mean age, 41 ± 12 years; mean BMI, 38.0 ± 5.2 kg/m²). Dietary intake was assessed through two 24 h food records, enabling the calculation of GI and macronutrient composition at each meal, especially dinner. Fasting-parameter setting and genotyping were done during the study. The lineal regression analyses were adjusted by age, sex, BMI, energy intake and dinner protein. Participants with lower fasting glucose levels had higher total GI and dinner GI values than those with higher fasting glucose levels, whereas no differences in dinner GI were observed across groups stratified by insulin or HOMA-IR levels. In fully adjusted regression models, dinner GI values remained inversely associated with fasting glucose levels (β = −0.172, 95%CI −0.298 to −0.045; p = 0.008). The FAAH C385A variant independently predicted lower insulin (β = −2.674, 95%CI −5.185 to −0.164; p = 0.037) and lower HOMA-IR (β = −0.731, 95%CI −1.364 to −0.099; p = 0.024) levels. No statistically significant interaction between dinner GI and the FAAH genotype was detected with respect to glycemia, insulin, and HOMA-IR. Overall, these findings indicate that the dinner GI influences fasting glucose levels in adults with obesity; the FAAH variant predicted lower insulin and HOMA-IR levels, supporting a plausible chrono-nutrigenetic interaction between carbohydrate quality, mealtime intake, and FAAH variation in metabolic regulation, which must be further studied. Full article

Background/Objectives: Our objective was to assess the role of clinical and continuous glucose monitoring (CGM) parameters in predicting the risk of hypoglycemia in pediatric patients with type 1 diabetes. Methods: Pediatric patients with type 1 diabetes (n = 71) at the Oradea County Clinical Emergency Hospital, Romania, who underwent CGM during their initial visit and were followed for at least 6 months with in-clinic visits every 3 months were enrolled in this study. Age, body mass index, time in range, the mean daily glucose (MDG) concentration, and the coefficient of variation (%CV) were considered as potential predictors of the risk of hypoglycemia, which was defined as the percentage of time spent below two glycemic thresholds of 3.9 and 3.0 mmol/L, corresponding to mild and clinically significant hypoglycemia, respectively. Results: Among a total of 142 glycemic profiles, the MDG concentration was significantly lower in those with hypoglycemia compared to those without, whereas %CV was significantly higher (p < 0.0001). Regression tree models identified %CV as the dominant variable for both thresholds, whereas classification tree models identified %CV as the dominant variable for clinically significant hypoglycemia and MDG for mild hypoglycemia. In profiles with a %CV of less than 36.15% and an MDG concentration greater than 7.16 mmol/L, the mean percentage of time spent below the 3.9 mmol/L threshold was 4.8%, which is close to that recommended by the American Diabetes Association guidelines. Patients younger than 7 years presented the highest frequency for both mild and clinically significant hypoglycemic episodes. Conclusions: Our study supports %CV and the MDG concentration as key factors in predicting hypoglycemia risk. Minimizing the risk of hypoglycemia in pediatric patients requires a %CV of less than 36%. Full article